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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All You Need To Know About Paul Ryan

This:

…the speaker is torn between his personal feelings about the tape showing Donald Trump discussing grabbing women by the genitals and his desire to preserve the historic GOP majority in the House of Representatives.

My reaction:

A) Profile in Courage.

edouard_manet_-_the_rabbit_1866

B) Put his picture in the dictionary next to “Party Before Country”

I have many dreams about this election. One that is very unlikely — but less so than a week ago — is that the GOP loses the House, and Ryan loses his seat.

A boy can dream, can’t he?

Image:Éduoard Manet, The Rabbit 1866.

ETA:  I’ll confess. This post was motivated in part by a desire to use that picture in association with today’s GOP.



Of Course It Is, You Fucking Asshole

These sanctimonious pricks:

Paul Ryan called the Democratic lawmakers’ sit-in Wednesday to protest inaction on gun laws a “publicity stunt,” saying that House liberals were more interested in headlines than solving the problem.

The speaker of the House also told CNN’s Wolf Blitzer on “The Situation Room” that he was not planning on actively fundraising for Donald Trump’s cash-strapped campaign, and that he saw possible agreement between his pro-trade message and Trump’s protectionist sympathies.

But the sit-in that began earlier in Ryan’s chamber earned his scorn.

“This is nothing more than a publicity stunt,” Ryan said, saying House Democrats would infringe on Second Amendment rights and do nothing to prevent terrorist attacks. “This is not about a solution to a problem. This is about trying to get attention.”

Of course it’s a fucking publicity stunt. They are trying to publicize the fact that the house won’t even vote on stuff that 85% of the god damned country wants to happen. They’re trying, in vain, most likely, to shame you shameless sociopathic motherfuckers into doing something.

Not to mention, the Republicans have been sitting on their asses in the house for how many years now? Where’s that fucking jobs bill?