• Menu
  • Skip to primary navigation
  • Skip to main content
  • Skip to primary sidebar

Before Header

  • About Us
  • Lexicon
  • Contact Us
  • Our Store
  • ↑
  • ↓

Balloon Juice

Come for the politics, stay for the snark.

The math demands it!

Shelter in place is one thing. Shelter in pants is quite another.

I see no possible difficulties whatsoever with this fool-proof plan.

A snarling mass of vitriolic jackals

Nevertheless, she persisted.

Everybody saw this coming.

Fuck if i know. i just get yelled at when i try it.

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

This is a big f—–g deal.

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

They traffic in fear. it is their only currency. if we are fearful, they are winning.

Impressively dumb. Congratulations.

If you tweet it in all caps, that makes it true!

Consistently wrong since 2002

The cruelty is the point; the law be damned.

The revolution will be supervised.

So it was an October Surprise A Day, like an Advent calendar but for crime.

Deploy the moving finger of emphasisity!

Republican obstruction dressed up as bipartisanship. Again.

Proof that we need a blogger ethics panel.

We have all the best words.

Hot air and ill-informed banter

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

Sitting here in limbo waiting for the dice to roll

Mobile Menu

  • Look Forward & Back
  • Balloon Juice 2021 Pet Calendar
  • Site Feedback
  • All 2020 Fundraising
  • I Voted!
  • Take Action: Things We Can Do
  • Team Claire, and Family
  • Submit Photos to On the Road
  • BJ PayPal Donations
  • Politics
  • On The Road
  • Open Threads
  • Topics
  • Nature & Respite
  • Information As Power
  • COVID-19 Coronavirus
  • Authors
  • About Us
  • Contact Us
  • Lexicon
  • Our Store
  • Politics
  • Open Threads
  • On The Road
  • Garden Chats
  • Nature & Respite
  • Look Forward & Back

They Have A Book to Sell Open Thread: “Luck Favors Only the Prepared Mind”

by Anne Laurie|  March 1, 20218:49 pm| 96 Comments

This post is in: Books, President Biden, Media Mudlarks

"Sometimes a book is so eager to take readers behind the scenes that it neglects to spend enough time on the scenes themselves" https://t.co/ZIRQeHNXqT

— Scott Lemieux (@LemieuxLGM) February 28, 2021

Louis Pasteur, as per the quip in the title, knew a thing or two about succeeding against the odds. Jonathan Allen and Amie Parnes are media mudlarks; they make a living rooting through the sewage outflow of politics, looking for nuggets they can resell. Hey, it’s a living!

Lemieux quotes at length from Washington Post book critic Carlos Lozada’s review, “Joe Biden won the presidency by making the most of his lucky breaks”:

… Four years ago, Allen and Parnes co-authored the best-selling “Shattered,” an examination of Hillary Clinton’s failed 2016 campaign, in which they placed the blame largely on the ineptitude of the losing side. In this sequel, they are only slightly more generous with the Democratic nominee. Joe Biden won, of course, but mainly because he “caught every imaginable break.” He was the “process-of-elimination candidate,” emerging from a crowded set of more exciting Democratic contenders. He was “lousy in debates and lackluster on the trail,” prevailing despite “a bland message and a blank agenda.” Biden, they argue, got lucky.

The fiasco of the Iowa caucuses, where the app designed to report the results failed miserably, temporarily obscured Biden’s fourth-place showing. “This was a gift,” a campaign aide later explained. Luck returned when rival Democrats such as Pete Buttigieg (who ended up winning Iowa) and Mike Bloomberg (who won American Samoa) suffered debate night takedowns by Amy Klobuchar and Elizabeth Warren — and when Biden survived his own hit from Kamala Harris over his past positions on school busing and desegregation. (That almost cost Harris the subsequent veep nod, Allen and Parnes report.) Fortune smiled again when the entire Democratic Party establishment rushed to Biden’s side after his victory in the South Carolina primary, even if it was less about devotion to him than panic that Bernie Sanders might secure the nomination. “On Super Tuesday, you got very lucky,” President Donald Trump told Biden at their first debate. The Democrat did not disagree…

A simplistic focus on identity is evident throughout the Democratic field, with new aides often hired to make staffs look young and more diverse — only to complicate things by, you know, having ideas of their own that diverged from those of entrenched advisers. Allen and Parnes portray a Biden campaign split along “deep fault lines mostly based on generation, race, ideology, and time in Bidenworld.” Biden was in the middle of it, in every sense, hewing to centrist positions on health care, racial justice and law enforcement, no matter the pressures from his campaign team and his party. He may not have been “Sleepy Joe,” but he remained “Unwoke Joe,” Allen and Parnes quip. “That was the ugly truth many Democrats had to face in the aftermath of the 2020 election: To beat Trump, they had to swallow their progressive values and push forward an old white man who simply promised to restore calm.”

show full post on front page

That “simply” is a little deceptive. The 2020 race transpired against the backdrop of a deadly pandemic, widespread racial-justice protests and threats to American democracy emanating from the presidency itself. In “Lucky,” such context matters largely to the extent that it affects the candidates’ rhetoric and fundraising. (George Floyd’s death, for instance, required some “nimble positioning” by Biden, Allen and Parnes write, trying to keep both moderate White voters and party activists happy.) As a result, the moments of high drama in “Lucky” can feel small-bore. Should Biden leave New Hampshire and head to South Carolina before the Granite State’s full primary results are announced, thus potentially alienating supporters there for the general election? (Spoiler: He did leave early. It was fine.) And how do longtime Biden campaign staffers react when the interloping new campaign boss, Jennifer O’Malley Dillon, receives a glowing write-up in The Washington Post’s opinion section, complete with a portrait-type photo? “The profile landed like the mother of all bombs in the civil war between the Obama veterans and Biden’s primary crew,” Allen and Parnes overwrite…

“Lucky” provides useful detail to understand Biden’s victory, even if the framing is not particularly novel. What candidate has not experienced some luck or misfortune during a long presidential bid? One time it might be a major health crisis, another time, a self-righteous FBI director. Stuff happens, and the best candidates figure out how to react. “Knowing who he was, and where he wanted to be politically, allowed Biden’s campaign to capitalize when luck ran his way,” Allen and Parnes write in their final pages.

In other words, Biden was more than lucky. And for political reporters as for political candidates, spending too much time on optics is just not a good look.

Basically, the strategy of 99% of all of these horse race access books is to emphasize structural and contingent factors when they help a candidate, and to ignore or downplay them when they don’t, which allows you to create any narrative you want https://t.co/mfG1dWc4Os

— Scott Lemieux (@LemieuxLGM) February 28, 2021

I plead guilty to thinking that Biden wouldn't win the nomination, and nor would I have voted for him, but when a candidate goes 46-11 at some point you have to consider that maybe what makes an effective campaign and what access journalists consider exciting are not the same

— Scott Lemieux (@LemieuxLGM) February 28, 2021

Acid test of the Allen/Parnas theory, in what passes for the real world:

It was an throughline of campaign messaging — Biden just didn’t rile up conservatives and so he was painted as a Trojan horse for figures who did. Now it has carried into his presidency, both at political rallies and in his opposition’s messaging in Congress.

— Sahil Kapur (@sahilkapur) February 28, 2021

<em>They Have A Book to Sell</em> Open Thread: “Luck Favors Only the Prepared Mind”Post + Comments (96)

Respite Open Thread: Last Night’s Golden Globes

by Anne Laurie|  March 1, 20214:45 pm| 183 Comments

This post is in: C.R.E.A.M., Movies, Open Threads

Since it’s very difficult to tell, these days: Yes, satire:

This is the crap Hollywood is throwing at us now. I can’t fucking believe this. pic.twitter.com/t7ws9EL9dW

— Tim Dillon (@TimJDillon) February 25, 2021

I’m kinda hoping, by this time next year — politics willing and the pandemic numbers don’t rise — we’ll have the mental bandwidth to spend a Sunday evening discussing dopey drunken movie award shows again.

Also, frankly, that preview parody makes more sense to me than ‘See, it’s the INTANGIBLES’ stories than this one…

How a 10-second video clip sold for $6.6 million https://t.co/x29fcsr9rb @e_howcroft @ritvikcarvalho

— Guy Faulconbridge (@GuyReuters) March 1, 2021

Respite Open Thread: Last Night’s Golden GlobesPost + Comments (183)

What to Defend and What to Let Go

by Four Seasons Total Landscaping mistermix|  March 1, 20213:48 pm| 119 Comments

This post is in: Open Threads

Mario’s kid is in even more trouble now that a second accuser has come forward.  He’s in such deep shit that he issued his third apology yesterday — and this is a guy who never apologizes for anything.  New York’s formidable Attorney General, Tish James, told him to pound sand when he submitted the name of a sympathetic judge to run an investigation, and Cuomo quickly backed down.  I sincerely doubt he’ll resign, but for the first time I wonder if he’ll stand for re-election.

This raises the question of how Democrats should respond to the charges against Cuomo.  Fuck him, is one legitimate way of looking at it, and I don’t want to downplay it because, well, fuck him.  That said, the Whatabout Party (QOP) is going to use Cuomo to try to excuse their rapist-in-chief and their shit response to the pandemic, so maybe we should care.

Paul Campos’ piece in LGM this morning is pretty good at pointing out the hypocrisy of using minor charges of harassment that probably wasn’t harassment to bring down Democrats, but I’m a bit tougher than him on the harassment score.  As a guy just a few years younger than Cuomo who’s had leadership positions in the recent past, there’s no fucking way you’d catch me saying anything like the things he said to those women, whether or not it met the technical definition of harassment.   The reasons go beyond the obvious ones (you’ll make the women uncomfortable and you’ll get in trouble with HR) — it’s more of a having an understanding of your place in the world and, frankly, a little bit of pride.  Twenty-something women, on the whole, have basically zero sexual or romantic interest in late 50s/early 60s men.  If you delude yourself to think that flirting and other little comments are going to get you anywhere, you lack the insight and understanding that should be part of a leadership position.  Plus, you look the fool.

Cuomo’s treatment of these women are of a piece of his being out of touch with where the world has moved.  His stupid intransigence and delay of the legalization of marijuana (which this scandal may, yet again, delay) is just one example.  Watching his reaction to the NYPD’s treatment of BLM protesters,  it was surprising to me that he maintained a faux naivete about what police have become in this society.  He seemed to really believe that most cops are good guys, and he believed that because they were (at least in the white parts of Queens) when he was growing up.  The world has passed Cuomo by, and he just doesn’t get it.

That said, I really disagree with this part of Campos’ post:

I think Cuomo should resign because he botched New York’s response to the pandemic and unnecessarily killed a lot of people in the process […]

Cuomo’s response to the pandemic was far from perfect, but we do ourselves a giant disservice to put it in the same category as Ron DeSantis or Kristi Noem.   Yeah, he hammed it up in his press conferences and his book, but he also put together a world-class testing program, pushed unpopular but effective restrictions that kept our hospitals from filling up, and did a decent job with vaccine preparation.  None of the Republican “own the libs” shitposting all-stars did any of those things.

When we’re all vaccinated and the economy comes roaring back, the Republicans are going to do everything they can to downplay the Democrats’ leadership in fighting the pandemic.  Letting that happen would be politically stupid.  Better to have Cuomo resign because he was a creep than to have him quit because of some mistakes with the pandemic.

The party line should be that Cuomo was far better than any Republican governor on the pandemic, but Democrats don’t tolerate office holders who treat women poorly, so he has to go.

What to Defend and What to Let GoPost + Comments (119)

Odds and Ends (Open Thread)

by Betty Cracker|  March 1, 202111:35 am| 184 Comments

This post is in: Media, Open Threads, Politics

I’ve avoided looking at media coverage of QPAC because fuck those ridiculous a-holes and their goddamned cult leader. But I clicked through a CNN push alert earlier today and was pleasantly surprised at the tone of this piece by Stephen Collinson.

Collinson framed the story correctly, i.e., the ongoing threat the Persimmon Pustule poses to democracy. He called lies “lies.” And he pointed out that outlets like Fox News and other con media that carried the lie-fest live were irresponsibly helping the Pumpkin-Head ImPotentate further radicalize cultists who have already demonstrated a propensity for violence.

We’re awfully critical of the Beltway press around here, and they often deserve it. But CNN did evolve during the stump error. Not as quickly as the crisis demanded and not always in the most helpful ways, IMO. But here’s some credit where it’s due.

In other news, WaPo is reporting that senior Dems are abandoning the Plan B for a $15 minimum wage that was floated last week, i.e., to use tax penalties to force big companies to raise the current starvation wages:

Senior Democrats are abandoning a backup plan to increase the minimum wage through a corporate tax penalty, after encountering numerous practical and political challenges in drafting their proposal over the weekend, according to two people familiar with the internal deliberations…

Democrats have said they will seek to include the $15 minimum-wage proposal in a separate legislative package to be advanced later in Biden’s administration. It remained unclear how they would do so or how they would overcome the obstacles that prevented them from securing the provision in the current stimulus plan.

It sounds like it’s mostly a timing issue — the rescue package needs to be passed quickly before unemployment benefits run out this month. In a TV appearance over the weekend, Press Sec Psaki said Biden remains committed to raising the minimum wage, and they’ll be working on it in the coming days and weeks. Good.

In other other news, valued commenter Ksmiami recently reached out with an idea for body-slamming Republicans in upcoming elections. It revolves around a little-remarked-on (that I heard of, anyway) provision in the Turnip tax cuts of 2017, in which home office deductions for most W-2 employees were eliminated. Via FedWeek:

The IRS has issued a statement on an issue that has been raised by many federal employees who—like many others in the private sector—have been teleworking full-time for months: whether they can claim a home office deduction when they file their taxes next year for 2020 income.

In sum, the answer was no, regarding work related to a salaried federal position—but maybe, related to side income such as self-employment income. It says:

“The home office deduction is available to qualifying self-employed taxpayers, independent contractors and those working in the gig economy. However, the Tax Cuts and Jobs Act suspended the business use of home deduction from 2018 through 2025 for employees. Employees who receive a paycheck or a W-2 exclusively from an employer are not eligible for the deduction, even if they are currently working from home.”

This might come as a nasty surprise to millions of office workers who’ve incurred business expenses while telecommuting due to the pandemic. Ksmiami speculates that Democrats could use the anti-worker change the Turnip admin embedded in the tax code against Republicans. Sounds like a good idea to me.

Open thread.

Odds and Ends (Open Thread)Post + Comments (184)

OSCAR’S billion dollar bet

by David Anderson|  March 1, 20219:35 am| 27 Comments

This post is in: Anderson On Health Insurance

This week, Oscar Health is going to IPO.  It will attempt to raise about a billion dollars from the public markets after raising over $1.5 billion from non-public sources.

This is a big bet.  I don’t get what Oscar is doing.  That is not a new sentiment (July 2019, March 2017, June 2016 among other comments).

Oscar has had massive losses (from their S-1 p.23)

We have not been profitable since our inception in 2012 and had an accumulated deficit of $1,012.9 million and $1,427.1 million as of December 31, 2019 and 2020, respectively. We incurred net losses of $261.2 million and $406.8 million in the years ended December 31, 2019 and 2020, respectively. We expect to make significant investments to further market, develop, and expand our business, including by continuing to develop our full stack technology platform and member engagement engine, acquiring more members, maintaining existing members and investing in partnerships, collaborations and acquisitions. In addition, we expect to continue to increase our headcount in the coming years. As a public company, we will also incur significant legal, accounting, compliance, and other expenses that we did not incur as a private company. The commissions we offer to brokers could also increase significantly as we compete to attract new members. We will continue to make such investments to grow our business. Despite these investments, we may not succeed in increasing our revenue on the timeline that we expect or in an amount sufficient to lower our net loss and ultimately become profitable. Moreover, if our revenue declines, we may not be able to reduce costs in a timely manner because many of our costs are fixed, at least in the short-term. If we are unable to manage our costs effectively, this may limit our ability to optimize our business model, acquire new members, and grow our revenues. Accordingly, despite our best efforts to do so, we may not achieve or maintain profitability, and we may continue to incur significant losses in the future.

I will try to give Oscar’s argument about why they are a multi-billion dollar company and then I want to work through what I see as my sources of doubt.

Oscar has identified a real problem: Health insurance is not a consumer friendly business.

Oscar’s solution is to throw a ton of technology and front-end user interface development at consumer facing applications to make the consumer experience way nicer and smoother. Oscar then thinks that it can apply machine learning to its ever growing stack of data consisting of  both claims data and user reported data to more effectively direct their covered lives to highly effective providers or to direct earlier upstream interventions to save long term money.

The back-end secret sauce relies on a high level of engagement (p.118 of the S-1 ~44% of members are “engaged” monthly.) Over time, the data gets better and the recommendations improve as members are engaged and active and they stick to OSCAR longer which allows for capture of the downstream gains from the back-end secret sauce even as the consumer experience is pleasant and not-painful which is a second source of value.

They are overwhelmingly doing this on the ACA individual health insurance markets.

I think this is a fair description of their pitch.

I have significant doubts about the probability that OSCAR can be a good enough insurance company as it is currently configured to make long term sustained profits.  I have several concerns:

  1.  ACA Individual Market is a tough market for the back-end value proposition
  2. Increased competition
  3. Ability to execute in 2 parts
  4. Policy, price shocks and attention

TLDR: OSCAR is making a lot of big bets that highly engaged membership because of an easy to use and user friendly experience can lead to better data that leads to better interventions and a source of private and social value over time.  They have spent at least $1.5 billion dollars to learn how to be an insurance company and buying membership.  They want to spend a lot more to keep on buying membership and building out their back-end.  I have a hard time seeing how this strategy works well on highly competitive ACA individual marketplaces where the marginal buyer is buying almost entirely on cost.  If they succeed, that is great, but I still don’t understand what their operations looks like when they are profitable.

More below the fold.

show full post on front page

1 — ACA Individual Market is a tough market for the back-end value proposition

The ACA individual market from 2014-2021 is a bifurcated market.  Individuals who earn between 100 to 400% Federal Poverty Level receive price linked subsidies that fill the gap between a household’s expected contribution and the local benchmark plan’s gross premium.  Many insured individuals will over the course of their contracts never have a claim.  Most costs are at the extreme end of the distribution. The marginal new buyer in the market is extremely price sensitive.  Many buyers are on the market for a year or two at the most.  Some buyers are long term individual market buyers, but the market as a whole is a churning maelstrom of price chasers.

From this perspective, membership chases premium more than it chases other features.  Vastly superior networks are not highly valued (~$25 per month willingess to pay) and adversely selected.  Customer experience is likely a positively valued attribute  but given that most people are barely touching the medical system over the course of the year, it is not going to make up a large pricing gap.  Most of the value proposition from the buyer’s point of view is pricing, and more specifically whether or not the plan is either the cheapest silver plan if the buyer earns under 200% FPL or the cheapest plan in each metal tier for everyone else.

OSCAR’s pricing is widely variant.  In 2021, they are selling in 128 counties served by Healthcare.gov.  In 24 counties they offer the least expensive Silver plan.  In another 10 counties, they offer the benchmark silver plan.  Slightly less than 20% of their potential market by population on Healthcare.gov will a consumer who is subsidy eligible see OSCAR as either the best or 2nd best option for the most commonly bought plan type (silver).  Assuming the House reconciliation bill passes, this will be even more important as both the least expensive and the benchmark silver plans will be effectively zero premium plans.  Looking at Bronze plans (the lowest premium, highest cost-sharing plans) OSCAR only has the least expensive plan offering in 16 counties.  They have low risk membership attractive pricing in Arizona including Maricopa County and then bits and pieces here and there.  In Texas, they are operating at a significant pricing disadvantage to Medicaid managed care like entities such as Molina and Centene.

2 — Increased competition 

Risk corridors and accruing MLR liabilitiesFrom 2018 to 2020, the structural conditions of the ACA market were set up to allow insurers to make a whole lot of money.  Policy and political uncertainty in 2017 created a massive number of monopolies in 2018.  Silverloading led to premiums to be massively overpriced in 2018 and overpriced in 2019.  Industry wide Medical Loss Ratios (MLR) were really low.  By 2020, Silverloading probably had mostly worked its way through the system after two years of nearly flat industry wide premiums.  And then COVID hit which meant a massive decrease in claims.  These years are structurally set up for insurers in the ACA individual market to be making serious money through low MLR.  OSCAR did not do this.  They got their 2020 MLR down to 84.7% from their 2019 MLR of 87.6%.  Their MLR is well above industry leaders.

There are two ways to get MLR down; increase premiums or lower claims costs.

And the possibility that they can increase premiums quickly without losing a lot of membership will be constrained by increased competition.  Insurers, by 2021, had mostly returned to the marketplaces after running like hell in 2018.  More insurers are projected to come back in 2022.  Holding premiums constant (average $505 PMPM) and bringing MLR down to 80% only reduces the $1000 Per Member Per Year loss by about $300 PMPY.  OSCAR needs to at least increase premium while still compressing claims and then get a handle on their admin costs.  Given new entrants to the marketplace, the premium portion is going to be a significant challenge.  And this challenge of increasing competition, assuming the Supreme Court does not remove more than 1 or 2 pages of the law in Texas v California,  will be persistent.

OSCAR’s pricing is not amazing in most regions to compete solely on price.  And these are prices that are generating significant operational losses, so OSCAR is trying to buy membership and scale right now so that they have more leverage against hospitals to get lower per unit costs (some areas they get good for commercial plan pricing, and other areas, they are paying for the privilege of having almost no utilizing membership in a region where the local hospitals can laugh at the concept of pricing concessions).  If OSCAR has to price at a level where they break even, they have an even harder time getting to scale.

3 — Ability to execute in 2 parts

Strategy and Covered Population

I have repeatedly said that I have a hard time seeing what OSCAR does besides get good press, deploy a nice app and lose a lot of money that my former co-workers do not do.  This specifically applies to their ability to run the basics of pricing risk and running the back-end of an insurance company in a regulated market.

OSCAR currently insures a population that on net is much healthier than the general ACA individual market.  OSCAR is currently insuring a population is coded to be very healthy relative to the rest of the ACA universe.     We know this because OSCAR is a significant net payer into risk adjustment.  In 2020, each member, on average had about a  $1700 transfer into risk adjustment (some markets OSCAR was a risk adjustment receiver) which is notably larger than the 2019 net outflow of  just under $1,200 per member per year.  About a quarter of premium goes out the door for risk adjustment.

THERE IS NOTHING WRONG WITH A STRATEGY THAT INVOLVES PAYING INTO RISK ADJUSTMENT! 

Centene and other Medicaid-esque insurers routinely pay a significant portion of premium in net risk adjustment payables.  Other insurers are profitable with significant risk adjustment receivables.  Both of those courses are fine as long as pricing and strategy are aligned with the population being insured.

I don’t think there is alignment.

OSCAR’S membership is currently heavy on 18 to 34 year olds and light on 55 to 64 year olds (P. 117).  Premiums are heavily concentrated in 55-64 year olds.

Profitable insurers with large risk adjustment payables are mainly competing on price because their membership is barely using services.

More importantly, OSCAR’S adjustment profile is saying that their covered population should be healthy and use few services but their MLR is telling me that they either have horrendous per unit costs or a lot of utilization.  I am curious if their highly engaged members and OSCAR’s no cost-sharing virtual platforms generate a lot of low dollar, low acuity claims that are not generating risk-adjustable diagnoses for things that if there was either cost sharing or an expectation of in-person visits with the corresponding transaction and hassle costs would never have generated a visit.  I know that if my son is feeling mostly fine but a little warm and had green boogers coming out of his nose and he wants to go to bed by 7:00, the diagnosis is likely a viral infection with a treatment course of sleep, hydration and a day of cartoons.  If there are either cash or transaction costs to go to a doctor, we’re not going to the doctor unless it does not clear up in a week.  If there is a no cost to the visit and we can do it in between conference calls, sure, I’ll get him checked out.

OSCAR has demonstrated that they can sell an experience at a loss.  The population that is mostly buying this experience is young and comparatively healthy.  They have not demonstrated that they can price their products competitively at a break-even point.  There is little space left at current pricing to drive down MLR.  Their 2020 membership gains were from a population that was even healthier relative to the rest of the market than their 2019 population which was still an extremely healthy population relative to the rest of the market.

OSCAR contends that its analytical engine’s special sauce driven by integrating both claims (which every insurer can do, and many can do so from far deeper and broader data sets) and member reported data which is somewhat unique to OSCAR will lead to better choices for lower cost bundles of care and better health.  This sounds plausible if there are large populations with robust medical needs that may be amenable to management and intervention.  But given OSCAR is insuring a population that is heavy on young people and light on old people and has a risk score that is well below market averages, where is the squeeze?  OSCAR’s special sauce to better manage diabetes could be fantastic but OSCAR is unlikely to be covering a lot of people with Type 2 diabetes. Where is the squeeze with the current covered population?

Scale

OSCAR is bragging that they are rapidly growing. They are buying membership with large losses.  Some of their markets have decent scale within the context of the ACA (California, Texas, Florida).  Some of their markets are tiny with fewer covered lives than my high school had students.  They have half a million total covered lives in 18 states.  Their ability to leverage their membership to get good pricing locally is limited.  Their administrative costs have been high and are not shrinking on either an absolute or percentage of premium basis.  When I worked at UPMC Health Plan, the Medicaid line of business for a single state (Pennsylvania) had 400,000 covered lives and was profitable.  We had scale in parts of the state and were an after-thought in other portions of the state.  We had scale challenges in a single state with the same ballpark of covered lives as OSCAR has in a good chunk of the national footprint.

 

4 — POLICY 

As I mentioned earlier, OSCAR has been operating in an environment from 2018-2020 that is conducive to pricing high and low MLRs.  That is changing.

More importantly, operating with the assumption that the Biden Administration is able to pass the COVID-related American Rescue Plan with significantly enhanced subsidies for more people, large chunks of the current covered population will be receiving significant positive price shocks.  Inertia has been the friend of any insurer that can gain membership by pricing low in their first year and then raise premiums modestly over time.  Price shocks, even positive price shocks, will make people who are currently not paying attention and automatically renewing their policies in plans that are no longer the best priced options, pay attention.  OSCAR’s pricing in 2021 for Healthcare.gov is the best for the under 150% FPL group that will see $0 premium Silver CSR plans.  This will be helpful to OSCAR in 2022.  However, its pricing in other markets will not be as good as other on-exchange carriers which people will pay attention to and plausibly switch to in 2022.

 

 

OSCAR’S billion dollar betPost + Comments (27)

Monday Morning Open Thread: The President Flexes

by Anne Laurie|  March 1, 20217:30 am| 209 Comments

This post is in: C.R.E.A.M., Open Threads, President Biden

Holy shit! He did it! Just to be clear: FDR never said this about any particular labor struggle, nor did he say workers generally should join a union (as the CIO cleverly attributed to him). So…this is, um, better than expected. And yes—the Bernie/Warren/AOC faction *matters.* https://t.co/UwO7lUlCz6

— Richard Yeselson (@yeselson) March 1, 2021

… Biden didn’t mention Amazon, but specifically referenced “workers in Alabama” in the video and a tweet introducing it. He said every worker should have a free and fair choice to join a union, and no employer could take that away. “It’s your right…So make your voice heard,” he said.

“Unions lift up workers, both union and non-union, but especially Black and Brown workers,” Biden said in the video. “There should be no intimidation, no coercion, no threats, no anti-union propaganda. No supervisor should confront employees about their union preferences.”

Amazon, America’s second-biggest private employer, has no unionized labor in the United States, and workers at its fulfillment center in Bessemer, Alabama, would be the first if they vote in favor. Such a decision could encourage workers attempting to organize at other Amazon facilities…

Biden has vowed to increase union membership in the United States after years of steady declines.

The Bureau of Labor Statistics reported the union membership rate in the private sector was around 6.2% in 2019, compared to around 20% in 1983.

show full post on front page

The Washington Post adds:

… “We haven’t had this aggressive and positive of a statement from a president of the United States on behalf of workers in decades,” said Faiz Shakir, a former senior aide to Sen. Bernie Sanders (I-Vt.) and the founder of More Perfect Union, which has released a series of videos on the Amazon unionization drive. “It is monumental that you have a president sending a message to workers across the country that if you take the courageous step to start to unionize you will have allies in the administration, the NLRB, and the Labor Department. It means a lot.”…

“It’s almost unprecedented in American history,” said Erik Loomis, a labor historian at the University of Rhode Island. “We have the sense that previous presidents in the mid-20th century were overtly pro-union, but that really wasn’t the case. Even FDR never really came out and told workers directly to support a union.”

Loomis said the video was a sign of the ways the Democratic Party has moved to the left on issues of economic justice in the past decade…

Biden has taken a number of other steps that have pleased labor advocates and liberals on issues around worker power in his first few weeks in office.

He fired Peter Robb, a Trump appointee at the National Labor Relations Board, the agency that oversees union elections, who was seen as a major antagonist of union campaigns, within a day of taking office in January. His incoming labor secretary, Boston Mayor Marty Walsh, has a strong union background, having risen to prominence in the city through a local union chapter. Other high-profile appointees such as Jennifer Abruzzo, Biden’s pick to replace Robb, have also come from the world of organized labor…

And the Vice-President:

Putting in the work. Ready to take on the week ahead. pic.twitter.com/xKoVZ3Sfbe

— Vice President Kamala Harris (@VP) February 28, 2021

Also, even though I haven’t always met these standards, I LOL’d:

Biden Voters?? vs Trump Cult??#MICDrop ?? pic.twitter.com/Qx9rLeOZxI

— ??????TraitorWarrior?????? (@Traitor_Warrior) February 28, 2021

Monday Morning Open Thread: The President FlexesPost + Comments (209)

Vaccine questions

by David Anderson|  March 1, 20217:00 am| 48 Comments

This post is in: Anderson On Health Insurance, COVID-19 Coronavirus

Over the weekend, the Food and Drug Administration approved an Emergency Use Authorization (EUA) for the Johnson and Johnson COVID vaccine.  The big thing is that this is a single dose vaccine with very easy to meet storage requirements:

 

Good to chat with ⁦@thsaey⁩ ⁦@ScienceNews⁩ about implications of EUA for J&J #covidvaccine. Having an effective single-dose vaccine could be a global game changer. @dukeghic ⁦@DukeGHI⁩ ⁦@DukeMargolis⁩ https://t.co/y0whFoVxqm

— Krishna Udayakumar (@krishna_u) February 28, 2021


This generates a few questions:

 

Which vaccine should I get?

Get vaccinated by whichever vaccine is locally available as soon as possible. All of the vaccines that have an EUA are equally effective in protection against death and severe disease. From a risk assessment point of view, all of the vaccines definitely reduce the consequences of infection. We are generating evidence on transmission effects at this time, but there are hints that the vaccines reduce transmission risk as well.

When should I get vaccinated?

As soon as possible. Pay attention to your state/local prioritization orders but once your group can vaccinated, go get vaccinated.

Where should I get vaccinated?

The federal government is setting up mass-vaccination sites. Primary care providers are likely to be able to get access to the one-shot vaccines and distribute through those channels. Get a vaccine from whatever source is easiest for you to schedule.

What should I do after I get vaccinated?

Go get ice cream. After that, still remember that you don’t get protection from infection for several days. Continue to mask-up and maintain outside social engagement whenever possible.   After a week or two hugs are way lower risk.  As more people get vaccinated, the odds that July 2021 look way more like July 2019 than July 2020 increase. We can get through this. We just need to ride out another couple of months as restrictions ease but we stay smart with behavioral modifications as well as built environment modifications. For instance I have a hard time seeing myself sitting and drinking in a bar while bullshitting with friends for a long time; however I’m more than willing to grab a beer and go out to the patio to geek out about price-linked subsidies in a month or two.

Vaccine questionsPost + Comments (48)

  • « Go to Previous Page
  • Go to page 1
  • Go to page 2
  • Go to page 3
  • Go to page 4
  • Go to page 5
  • Interim pages omitted …
  • Go to page 9383
  • Go to Next Page »

Primary Sidebar

Do Something!

Call Your Senators & Representatives
Directory of US Senators
Directory of US Representatives

I Got the Shot!  (Month 2)
I Got the Shot!

 

🎈Ways to Support Our Site

Become a Balloon Juice Patreon
Donate with Venmo, Zelle or PayPal
Shop Amazon via this link to support Balloon Juice ⬇  

Recent Comments

  • Richard on A Bit of Historical Perspective On the Responses By Republicans In Congress To FBI Director Wray’s Testimony On the 6th January Insurrection (Mar 3, 2021 @ 4:08am)
  • Keith P. on Late Night Horrorshow Open Thread: Another Reason to Scotch the Iowa Caucuses (Mar 3, 2021 @ 4:00am)
  • Odie Hugh Manatee on Late Night Horrorshow Open Thread: Another Reason to Scotch the Iowa Caucuses (Mar 3, 2021 @ 3:52am)
  • opiejeanne on Late Night Horrorshow Open Thread: Another Reason to Scotch the Iowa Caucuses (Mar 3, 2021 @ 3:34am)
  • Winston on Late Night Horrorshow Open Thread: Another Reason to Scotch the Iowa Caucuses (Mar 3, 2021 @ 3:30am)

Team Claire, and Family

Claire Updates
Claire is Home!

Balloon Juice Posts

View by Topic
View by Author
View by Month & Year

Featuring

John Cole
Silverman on Security
COVID-19 Coronavirus
Medium Cool with BGinCHI
Furry Friends

Calling All Jackals

Site Feedback
Submit Photos to On the Road
Nominate a Rotating Tag
Meetups: Proof of Life
2021 Pets of Balloon Juice Calendar

Culture: Books, Film, TV, Music, Games, Podcasts

Noir: Favorites in Film, Books, TV
Book Recommendations & Indy Recs
Mystery Recommendations
Netflix Favorites
Amazon Prime Favorites
Netflix Suggestions in July
Longmire & Netflix Suggestions

Twitter

John Cole’s Twitter

[custom-twitter-feeds]

Site Footer

Come for the politics, stay for the snark.

  • Facebook
  • RSS
  • Twitter
  • Comment Policy
  • Our Authors
  • Blogroll
  • Our Artists
  • Privacy Policy

Copyright © 2021 Dev Balloon Juice · All Rights Reserved · Powered by BizBudding Inc