CSR funding and the next best option

Andrew Sprung at Xpostfactoid has pushed back on my argument that Democrats have the advantage of inertia on the CSR funding argument. He raises an excellent point.

1. Cost. CBO projects premium increases of 20% right off the bat in 2018 and 25% by 2020. Higher premiums mean more people qualify for subsidies, and those subsidies are bigger. CBO projects a 10-year cost of $194 billion — to increase coverage by 1 million. In 2026, that 1-million coverage boost would cost a cool $37 billion. CBO’s 2016 projection for spending on marketplace subsidies in 2026 is $106 billion. Imagine the effects of increasing that spending by 36% in more rational ways. Compare, for example, the comprehensive set of subsidy sweeteners proposed by Urban’s Blumberg and John Holahan in 2015 — which included raising the AV of benchmark plans to 80%, reducing the percentage of income paid at every level and capping premiums for all buyers at 8.5% of income. The authors estimated the ten-year price tag at $221 billion over ten years.

This is a very good point. The coverage gains bought by loading all CSR costs onto Silver only are an extraordinarily inefficient way to expand coverage and improve the law. I am not disputing that at all. There are better ways to spend the money to increase coverage. The same coverage increase can be bought far more cheaply by tweaking Medicaid matching rates or encouraging some creative 1332 waivers.

In Health Affairs, Steven Chen has a good blog post on how states could use the CSR windfall to improve coverage via a 1332 waiver. He uses California and 2016 numbers for his example:

Using California as an example, Covered California showed that the termination of CSR payments by the Federal government would cause insurance premiums for silver plans in the individual market to increase by 16.6 percent in 2018. The study also showed an inverse relationship between CSR and APTC: The Federal government paid $750 million in CSR payments in 2016, but if it were to defund CSR payments, not only would it not receive any savings, it would incur an additional $976 million in APTC spending. Using these figures as illustration, if the Federal government had terminated CSR payments in 2016 and if California had provided CSR payments through a 1332 Waiver, under this scenario California would have to pay $750 million in CSR payments, but it would receive $976 million from the Federal government in lost APTC payments—payments California would have otherwise received without waiver—ending up with a total net profit of $226 million!

The ACA needs a technical corrections bill. It needs a “it’s been live for four to eight years and some things work and some things didn’t, let’s push the things that work and fix or drop the duds… bill”

Not funding CSR sets a plausible outcome absent of an agreement. It is a boundary condition. Deals get made when all sides of a deal believe that they have an outcome that is better through an agreement than the outcome which would occur without an agreement. I can easily and readily see deals.

There could be a trade where CSR is funded and $75 billion dollars are allocated to reinsurance and $30 billion dollars are allocated to increasing subsidies for people who make between 200% and 500% FPL. There could be a trade where $100 billion dollars are spent to up CSR 73 to CSR 80 and then adding a new tier of CSR for people making between 250% and 325% FPL so their Silver is now has an actuarial value of 75%. There could be a trade where Medicaid 1115 waivers can be integrated with 1331 (Basic Health Plan) and 1332 (State Innovation) ACA waivers as well as additional funding for safety net hospitals and community health centers. There could be dozens of deals that spend less money, cover more people and fix known problems. But all of these deals are premised that the outcome due to no agreement is a significant albeit inefficient Democratic policy victory.








Tripling Down

Twitler’s on a tear this morning. He began by attacking two fellow Republicans (Senators Flake and Graham) and urging their constituents to boot them out of office. Then he moved on to decrying the removal of monuments to white supremacists and again compared founding fathers to the traitors who attempted to destroy the country:

You know Kelly & Co. are itching to Gorilla Glue oven mitts onto Trump’s teeny-tiny hands. But I’m glad he’s letting his freak flag fly for another news cycle.

This is the unstable, vindictive, racist goon the Republican Party rallied around as their standard bearer. They should marinate in his indefensible awfulness.

He’s right about one thing — you can’t change history, but you can learn from it. I hope the lesson of the Trump Error is clear: Electing an unhinged demagogue is a catastrophic mistake, even if his opponent once used a private email server and was seen as too friendly with Wall Street types.



The All American Division: The 82nd Airborne Jumps in to Provide Support

Several days ago these two sergeants, SGT Allen L. Stigler and SGT Roshain E. Brooks, were killed in the line of duty in northern Iraq.

On Saturday this lovely fellow showed up to the Unite the Right rally in Charlottesville wearing an 82nd Airborne ball cap:

The 82nd Airborne’s Public Affairs Office decided to jump in with both feet and make it very clear who are part of the All American Division, like SGTs Stigler and Brooks, and unlike the guy in the picture above giving the NAZI salute with the wrong arm.

The 82nd Airborne Division is 100 years old this week:

All the way!

And open thread.

 

 



Vice News’ Interview with the Racists

Vice News has made their interviews with some of the leaders and participants from Saturday’s Unite the Right rally in Charlottesville online so everyone can see it, not just HBO subscribers. They describe their reporting as:

On Saturday hundreds of white nationalists, alt-righters, and neo-Nazis traveled to Charlottesville, Virginia, to participate in the “Unite the Right” rally. By Saturday evening three people were dead – one protester and two police officers – and many more injured.

“VICE News Tonight” correspondent Elle Reeve went behind the scenes with white nationalist leaders, including Christopher Cantwell, Robert Ray, David Duke, and Matthew Heimbach — as well as counterprotesters. VICE News Tonight also spoke with residents of Charlottesville, members of the Black Lives Matter movement, and the Charlottesville Police.

From the neo-Nazi protests at Emancipation Park to Cantwell’s hideaway outside Virginia, “VICE News Tonight” provides viewers with exclusive, up-close and personal access inside the unrest.

Here’s the video:



Transcript of the President’s Remarks this Afternoon

Politico has published the transcript of the President’s remarks this afternoon from his impromptu question and answer with the press. I’d like to highlight this part before we get to the whole thing (emphasis mine):

REPORTER: Senator McCain defined them as the same group.

TRUMP: Okay, what about the alt-left that came charging at us – excuse me – what about the alt-left that came charging at the, as you say, the alt right? Do they have any semblance of guilt?

(Update at 6:2o PM EDT):

Politico has now updated their transcript, without further comment, notation, or explanation so that the section above now reads as:

REPORTER: Senator McCain defined them as the same group.

TRUMP: Okay, what about the alt-left that came charging at ’em – excuse me – what about the alt-left that came charging at the, as you say, the alt right? Do they have any semblance of guilt?

If they post an explanation, and I’m around, I’ll post it.

ETA at 6:10 PM EDT

Literally the easiest thing to do for an American politician or leader is to denounce NAZIs. The whole justification for American leadership in the global system is that we finally got our butts in gear in 1941 and defeated the purest, most unadulterated evil movement, NAZIism, during World War II. This us such a gimme it isn’t even the equivalent of a 3 inch put. The President’s inability to do this simple thing, while standing next to two two Jewish Americans (Gary Cohen and Stephen Mnuchin) and an Asian American (Elaine Chao) speaks volumes about him. The fact that none of those three didn’t resign immediately, even if they waited till they were all off camera so as not to make a scene, also speaks volumes about them.

The whole transcript after the jump updated at 6:20 PM EDT to reflect the revisions that Politico made to their transcript:

Read more



#NotAllNazis* (Updated)

I must say, Team Trump has really tightened up their messaging strategy now that John Kelly is running the show:

He not only both-sides NAZIS, he equates removal of Confederate monuments to taking down statues of George Washington.

Good lord, what a staggeringly destructive buffoon.

ETA: Here’s the whole thing:

I just don’t know what to say.

*H/T to valued commenter Major Major Major Major



Doubling Down (Open Thread)

This fucking guy:

I suspect Trump’s handlers are trying desperately to convince him to do today what he couldn’t bring himself to do this weekend: unequivocally denounce Nazis, klansmen and white supremacists. I hope he ignores them.

The fact is, we have a white supremacist president. Millions of us figured that shit out long before the election — including the white supremacists. The sooner the rest of America figures that shit out, the better.