Come for the politics, stay for the snark.

… riddled with inexplicable and elementary errors of law and fact

Let’s delete this post and never speak of this again.

You are either for trump or for democracy. Pick one.

The revolution will be supervised.

Let me eat cake. The rest of you could stand to lose some weight, frankly.

Perhaps you mistook them for somebody who gives a damn – Nancy Pelosi

Is it irresponsible to speculate? It is irresponsible not to.

Consistently wrong since 2002

JFC, are there no editors left at that goddamn rag?

Wow, I can’t imagine what it was like to comment in morse code.

Just a few bad apples.

Balloon Juice has never been a refuge for the linguistically delicate.

… makes me wish i had hoarded more linguine

Fuck these fucking interesting times.

Usually wrong but never in doubt

Impressively dumb. Congratulations.

Accused of treason; bitches about the ratings. I am in awe.

Almost as fun as hiking the Appalachian Trail

Gastritis broke my calculator.

Reality always wins in the end.

Tick tock motherfuckers! Tick fucking tock!

Historically it is a little unusual for the president to be an incoherent babbling moron.

We need fewer warriors in public service and more gardeners.

An almost top 10,000 blog!

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Fuck The Poor

Idaho, Partial Medicaid Expansion and the 400% FPLers

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Medicaid is primarily health insurance for poor people or very sick people.

Idaho’s legislature is monkeying around with the voter approved straight-up Medicaid expansion to 138% of the Federal Poverty Level (FPL).

 

This will harm middle class Idaho families who need community rated, guaranteed issue insurance from the individual market.

How does that work if Medicaid is health insurance for poor people?

Cost Sharing Reduction (CSR) work-arounds of Silverloading and differential morbidity matter.

Adrianna MacIntyre and I argued in a Health Affairs blog that full expansion has two paths to decreasing premiums for people earning over 400% FPL that are not available if a state elects and receives a waiver for a partial expansion to only 100% FPL.

 evidence found that Medicaid expansion improved the risk pool of state individual markets, suggesting that the population between 100 and 138 percent FPL is sicker and more expensive, on average, than other exchange enrollees. Insuring this cohort through Medicaid is associated with a seven to eleven percentage point decrease in individual market premiums. …

household incomes between 100 percent and 150 percent FPL, those that would be eligible for 94 percent AV silver plans.  This income bracket overlaps the Medicaid expansion income group significantly.  States that fully expand Medicaid end up with far fewer people in the most generous CSR bucket, as they have moved the 100-138 percent population to Medicaid

CSR 94 Enrollment by all APTC receiving enrollees 2018 Healthcare.gov

Keeping a cohort that is more expensive than the rest of the ACA individual market risk pool in the risk pool raises premiums. Pulling the 100-138% population out of the ACA risk pool lowers market premiums as long as this group is more expensive than average. Furthermore while Idaho has engaged in the Silver Switcheroo, Silverloading increases premiums for folks who want a Silver plan and buy it on Exchange either because they don’t know if they will be just over or just under the subsidy cut-off point of 400% FPL or they can’t access an off-Exchange plan that meets their requirements.

Full Medicaid expansion reduces the premium pain of the middle class. Partial expansion continues the pricing pain for the middle class.

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The Forever Bullshit War on Abortion

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The article John posted yesterday from Jezebel about the New York Reproductive Health Act (RHA) is worth a read. It addresses the cloud of bullshit around abortion after 24 weeks of pregnancy which, as anyone who cares about women’s health instead of policing uteri knows, is a rare procedure only used in cases of severe, unsurvivable fetal abnormality or risk to the mother’s life:

The RHA now ensures that people in New York will have their constitutional right to an abortion; that includes the right to abortion after the 24th week in pregnancy if the pregnant person’s life or health is threatened by the pregnancy, or if the fetus has a condition incompatible with life. Prior to this legislation, I have had patients find out about a fetal anomaly who then had to travel long distances to other states to get the care they needed. Abortion later in pregnancy is not what patients anticipate for themselves; it’s not how they see their pregnancies unfolding. I had one patient who couldn’t afford to travel outside of the state and so she continued the pregnancy and the baby died shortly after birth due to a brain malformation. Years later, she is unable to tell her story without tears.

Before Ralph Northam’s blackface revelations, he was part of a faux controversy over a similar law in Virginia.  Northam is a pediatric neurosurgeon, and here’s the answer he gave to a radio station on the issue of abortion after 24 weeks:

“[Third trimester abortions are] done in cases where there may be severe deformities. There may be a fetus that’s nonviable. So in this particular example, if a mother is in labor, I can tell you exactly what would happen,” […] “The infant would be delivered. The infant would be kept comfortable. The infant would be resuscitated if that’s what the mother and the family desired. And then a discussion would ensue between the physicians and the mother.”

I’m sure it could have been phrased better, but he basically spoke the truth.  Babies who are severely deformed may live for a few minutes, hours or days, but they’re not going to live long. It’s a sad fact of life, but just speaking it summons a screeching hoard of anti-abortion dementors who pick apart the wording of whoever spoke the awful truth.

These zealots are winning – soon the Supremes will effectively do away with affordable abortions, if not all abortions, in red states.  They’ve have been enabled by people like Trump, who know that their children or mistresses will be able to get a safe, legal abortion because they can pay for it.  It’s only the poor who suffer, as always.

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Pay Or Die

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It turns out that some of the Sackler family were pressing hard to get more people addicted to the opioids Purdue Pharma was selling, even as they were trying to avoid media coverage for their drug connections and donating to museums, which should now be removing the Sackler name from their halls.

But that’s only secondarily what this post is about. It turns out that manufacturers of insulin, which many people need to stay alive, have been gaming the system to make things more profitable for them and much more inconvenient for patients and doctors. But what’s human suffering compared to profit, hey Ray Sackler?

The exorbitant prices confound patients and doctors alike since insulin is nearly a century old now. The pricing is all the more infuriating when one considers that the discoverers of insulin sold the patent for $1 each to ensure that the medication would be affordable. Today the three main manufacturers of insulin are facing a lawsuit accusing them of deceptive pricing schemes, but it could be years before this yields any changes.

There are several reasons that insulin is so expensive. It is a biologic drug, meaning that it’s produced in living cells, which is a difficult manufacturing process. The bigger issue, however, is that companies tweak their formulations so they can get new patents, instead of working to create cheaper generic versions. This keeps insulin firmly in brand-name territory, with prices to match.

This is why we need a different healthcare system. I’m not well enough informed to know whether it’s single payer or Medicare for All, or something else. But this profiting off human suffering has to end.

Open thread.

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Texas vs Azar : stay calm

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The district Court decision in the trolling lawsuit Texas vs HHS is out. The district Court judge just decided to toss several centuries of precedent.

This decision will be slapped around on appeal.

Keep on signing up. This will get quickly stayed and the judge will get bench-slapped.

update 1one of the conservative legal minds behind King v Burwell<\i> has this comment

update 2

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Jesus Wept…While The GOP Laughed

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I hope I never have enough snark in me to snark at this:

A 7-year-old girl from Guatemala died of dehydration and shock after she was taken into Border Patrol custody last week for crossing from Mexico into the United States illegally with her father and a large group of migrants along a remote span of New Mexico desert, U.S. Customs and Border Protection said Thursday.

This child was in CBP custody for more than eight hours before she started seizing.  When someone finally checked her out, they found that

she “reportedly had not eaten or consumed water for several days.”…

…An initial diagnosis by physicians at El Paso’s Providence Hospital listed the cause of death as septic shock, fever and dehydration, CBP said.

The quoted official response centers on a lie:

“Border Patrol agents took every possible step to save the child’s life under the most trying of circumstances…”

If they had done so, of course, she and all the refugees in her group would have received water in less than one third of a day.

The warehousing and brutalization of refugees is being done in our name, by people and an infrastructure at the border that is at best ill-equipped and insufficient for the task, and at worse, deliberately engaged in a campaign of exemplary mistreatment designed to décourager les autres.

So children die. In the care and under the “protection” of the US government; our government.  As a result of a policy that uses neglect as a tool of border enforcement.

This policy, this explicit choice is Donald Trump’s. But it is far from his alone. The GOP controls Congress. It could have chosen not to be party to the misery and sorrows unto death.  It did not.

Every Republican in national office is complicit.  All of them share in this tragedy, and the others we’ve heard about and the (likely) many more we haven’t.  The moral stain on America as a whole ain’t fading anytime soon, and the reckoning won’t even be able to begin until the GOP as it is now constituted goes the way of the Confederate States of America.

Last thought: I note we are in the midst of the holiday season, the culmination of which, as conservatives hasten to remind us, is the day on which Christians remember the birth of the Prince of Peace. What Babies Would Jesus Starve?

Image: Albrecht Dürer, Christ as the Man of Sorrows, c. 1493.

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Just a reminder of the stakes

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Go vote early if your state allows you to do so.

Open thread

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Work requirements working as intended

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Arkansas has instituted Medicaid work requirements.  A subset of Medicaid beneficiaries have to report monthly online their work or work-search or community engagement activities.

September 5th was the end of the third reporting period.

They are working as their advocates have intended.

 

The work requirements are paper work and administrative hassle requirements.  They are roadblocks to coverage which is leading to a 50% attrition rate in a good, high employment economy.

 

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