Late Night Open Thread: Pauli Boy (Weak & Nasty, But So Cleverly Marketed)

What I wanna know — when did “wonk” become a synonym for “soulless ideologue”? Or is that just one of those IOKIYAR exemptions?
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Whats going to happen today?

The short answer is mass chaos.

The longer answer is we will seeing some non-controversial bills come up under suspension rules this morning.  Around 10:00 AM, the Rules Committee will vote on the most recent set of changes that were placed in the bill overnight.     Those changes (stripping or punting EHB mainly) are probably going to cost a quarter of a trillion dollars and could lead to millions more not getting coverage but they are not waiting for a CBO score.  Once a special accelerated rule is voted on, the actual voting starts.

My opinion is that we are in good shape if there is an immediate blocking coalition of 23 Republican No votes in the first six or seven minutes.  At that point, the internal logic of the Republican caucus makes voting Yes and seeing the bill Fail become a no reward position so we could see a cascade towards No.  If we don’t see that, I would not be optimistic.

My gut feeling is that AHCA either passes by less than three votes or fails by more than fifteen. I can’t see the incentive structure for a narrow failure as the House leadership will hold the vote open for hours to arm twist a couple of hold-outs.

So call the House one last time.

Update 1:

 

He is from New Jersey, part of leadership and as of this morning he was in the New York Times Undecided/Unclear column. So him moving to a clear No is intriguing.



Bronze is a great age

I want to look at one element of the CBO score. It is the offered actuarial value of plans. Under the House Bill, out of pocket maximums would be fixed but there would be no age banding. The CBO sees this having an interestingly low effect.

Beginning in 2020, the legislation would repeal those requirements, potentially allowing plans to have an actuarial value below 60 percent. However, plans would still be required to cover 10 categories of health benefits that are defined as “essential” under current law, and the total annual out-of-pocket costs for an enrollee would remain capped. In CBO and JCT’s estimation, complying with those two requirements would significantly limit the ability of insurers to design plans with an actuarial value much below 60 percent.

Mechanically, under the House bill without a follow-on phase 2 or phase 3 bill, insurers can probably design plans that have at least 55% actuarial value (AV) coverage as the minimum level of coverage. Bronze right now is 60% +/-2 points of AV.

It will be very hard for people to buy a non-Bronze plan because insurers won’t offer them except at exorbirant prices. Let’s work through my logic.

Insurers are currently required to offer at least one Silver and one Gold plan if they want to sell on Exchange. Those plans are age rated at 3:1 with subsidies absorbing almost all of the local price increase risk for the Silver plan. Under the AHCA, those requirements are not in place and the subsidy is not tied to local pricing. Young buyers who are healthy will either opt out or buy the lowest actuarial value coverage possible because it will cost them very little.

Insurers then have to look at the people who actually need coverage and cost money to cover. They’ll offer a Bronze plan to get the young people in. But if they see a 58 year old asking for a Silver or Gold plan, they know that this person is going to be hyper expensive to cover as they have just self-identified as being high risk and high expense. Insurers won’t offer actuarial value levels above the minimum requirements because they will lose money on those policies.

So we will quickly see a proliferation of $6,000 to $9,000 deductible plans and very little else. That means the 64 year old who is seeing a $10,000 a year premium increase will also see their deductibles increase by $4,000 to $7,000 a year.



Friday Evening Open Thread: Ryancare — It’s Terrible for Everybody


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Even — it is devoutly to be hoped — the Zombie-Eyed Granny Starver’s reputation?

That would be a lovely coda to trashing the GOP’s whole misbegotten “AHCA” (Always Helping Cronies Accumulate) no-health, no-hope plan.

What else is on the agenda as we start the weekend?



It Begins, Again: Paul Ryan Drops His ‘Replacement ACA’ in the Punchbowl

No matter how cynical you try to be…


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Evidence based care in Medicaid

We want to do evidence based care.  We want to do things that work and avoid things that don’t work.  This sounds simple.  Let’s look at two very good natural experiments on unintended pregnancy rates:

Colorado:

    Since 2008, Colorado has successfully increased access to family planning services throughout the state, particularly for the most effective contraceptive methods, such as intrauterine devices (IUDs) and implants.

  • The Colorado Family Planning Initiative has increased health care provider education and training and reduced costs for more expensive contraceptive options, enabling more than 30,000 women in the state to choose long-acting reversible contraception….
  • When contraception, particularly the long-acting methods, became more readily available in Colorado between 2009 and 2013, the abortion rate fell 42 percent among all women ages 15 to 19 and 18 percent among women ages 20 to 24.
  • Colorado is a national leader in the use of long-acting reversible contraception, and reducing teen pregnancy and repeat pregnancies.

    • Teen birth rates in our state have declined more rapidly than in any other state or the nation as a whole.
  • The birth rate for Medicaid-eligible women ages 15 to 24 dropped sharply from 2010 to 2012, resulting in an estimated $49 million to $111 million avoided expenses in Medicaid birth-related costs alone.

More reliable and effective contraception was made available to Colorado women who had the choice to elect Long Acting Reverisble Contraception (LARC) or do something else.  A significant number of women elected to use LARC and the increased autonomy and reliability produced amazingly good results.

Texas

 

Reducing contraceptive availability led to higher abortion rates and higher unplanned pregnancies. Earlier live births have massively negative multi-generational repercussions for both the parents and kids.

The evidence strong suggests that significant improvements in quality of life can be made and significant expenditures reduced if contraception is made readily available.

And guess what Congress will consider to be a high priority:

House Speaker Paul Ryan announced Thursday that Republicans will move to strip all federal funding for Planned Parenthood as part of the process they are using early this year to dismantle Obamacare.

Wahoo… the evidence will strongly support the hypothesis that this policy will lead to more unintended pregnancies, more abortions and far worse outcomes for far more Americans.

Evidence based policy making — Hoo Yaa



Open Thread: Could Not Happen to A More Deserving Zombie-Eyed Granny Starver

ETA:


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