What does last night mean for PPACA?
These are initial, pre-coffee thoughts and not all of the data is in. I’m also venturing away from technical comments and towards general political punditry which is not my strength, so please apply an appropriate discount to everything.
- Medicaid expansion is dead for at least the next two years. Utah and Wyoming will probably get waivers and that will be it. (90% confidence)
Not expanding Medicaid inflicted absolutely no cost on the veto players in any state that I can see. Larger Teabagging majorities are opposed to Medicaid expansion for Those People. The invisible portion of the Republican primary process is coming to an end sometime in the next hour or two, so no one who thinks they have a shot in 2016 can thread a needle for expansion.
- Arkansas may stop the private option expansion (60% confidence)
From my understanding, Arkansas needs 75% reauthorization and the governor’s signature every year for the private option. I don’t think either condition is in place for next year. This will destroy the financial stability of hundreds of thousands of people AND destroy the financial base of the Arkansas rural hospital system as those hospitals were replacing charity care and uncompensated care DSH payments with Exchange payments.
- At least 1 week of government shutdown will happen by next October (85% confidence)
- Employer mandate will go down (80% confidence) as well as medical device tax (97% confidence)
From a policy point of view, the Employer mandate is probably the least important pound of flesh for Republicans to claim. It does not do much for coverage, and it produces bad business level incentives as well as locking people into really crappy insurance that their job provides when they would be better off on the Exchange. This is a probably a good piece of policy. The Medical device tax has bipartisan opposition because medical device makers sit in too many districts and are raising a big stink. The only question is whether the revenue losses are offset. I would hope that as part of the negoatitations, the rest of PPACA is Halbig proofed. If it is, then Don Taylor would be right in that there is a window to talk health policy on both sides of the aisle. I don’t think that will be the case.
- PPACA will work in states where the states want it to work. It will be a clusterfuck in Republican base states.
- At least one Republican base state will start preparing Wyden Waivers for 1/1/17 which makes everything on Exchange an HSA style system with no EHBs. (60% confidence)
- Risk adjustments are at risk as they need appropriations
PPACA has three risk transfer mechanisms. Reinsurance and Risk Corridors are temporary stabilizers, and risk adjustment is a permanent program. The goal is to help insurers figure out what a stable market risk pool looks like by transferring money from low risk/healthier than average plans to high risk/high disease burden plans. The problem is that the way PPACA is written, money can come into the Federal government, and it can go out for 2014 payments, but it is questionable if it can go out in 2015 and 2016 without an appropriation.
- My hangover will subside by late afternoon (98% confidence, 100% hope)
Valdivia
thank you for writing this. It is the one thing I have been very concerned about. Also the case pending for review at the Supreme Court (not Halbig, but the similar one which they kicked for further review this friday)
JPL
The republicans don’t pay for anything so the medical device tax will not be offset. The republicans will then say that ACA is causing the deficit to increase.
Botsplainer
PPACA is dead. Cruz and his fascists are going to hold the global economy hostage, and I guaranfuckingtee that any extraordinary measure brings serious and dangerous secession talk.
McConnell isn’t going to be able to control that.
Valdivia
Richard, any thoughts on this?
http://www.newrepublic.com/article/120125/republican-plans-obamacare-device-tax-mandates-risk-corridors
Matt McIrvin
Here’s the thing I keep coming back to: That map that, I think, the NYT published a little while ago showed the number of insured increasing substantially even in the Republican base states. Even Mississippi, where we were told almost simultaneously that the ACA can accomplish nothing because of state-level sabotage. It wasn’t anything like the gains in Kentucky or WV, but you could see the number of uninsured getting cut in half in the poorest counties.
What was going on there?
NotMax
Which will McConnell first allow to be brought to the floor? Christening it the Ronald Reagan Memorial Senate Chamber or jettisoning the filibuster entirely?
Decisions, decisions…
MomSense
They are the party of Deatheaters.
Anyone seen Villago?
JPL
@NotMax: Tax cuts in order to pay off the deficit.
skerry
@Matt McIrvin: No expert, but I think the increase is from the number of people able to get insurance without prejudice from pre-existing conditions as well as subsidies that are not state-based. Think Silver plan, not Medicaid expansion. Also, young adults can stay on parent’s policies.
Botsplainer
@MomSense:
He’s probably in an alcohol coma on a floor in a puddle of his own vomit.
Loviatar
.
Wait a minute, according to the practical, pragmatic Democrats PPACA is the first step towards Universal Healthcare. I mean all those people got healthcare because of PPACA and we know that they will keep their healthcare because of PPACA. Ohhh, you mean they won’t keep their healthcare because PPACA is a Rube Goldberg solution which will collapse from the Republicans many attacks.
———
I wonder which will be better for those who got healthcare under PPACA and the country in the long run:
A: a half-assed solution that perpetually pisses off a 1/4 to a 1/3 of the population, which will then quickly damage and ultimately destroy it.
or
B: a solution that perpetually pisses off a 1/4 to a 1/3 of the population, which will then try anything to repeal it, but will ultimately fail.
———-
The practical, pragmatic Democrats chose A, hows that working out for you guys?
tbone
Fuck ’em. They don’t want health insurance? Fine by me. Poorer and sicker red states. They get what they deserve.
Richard Mayhew
@Loviatar: go fuck yourself please with a rusty trowel…. can you please explain to me how to get a non-half-assed solution that does not piss off 27% of the country at any point since 1940?
Additionally, the pieces that I listed (employer mandate and medical device tax) are not too important to the basic functioning of the law. The Medicaid portions are due to John Roberts et al being douchecanoes and was not in the original law.
So yes, please tell yourself that Single Payer for All would do the following:
1) Pass the 2009-2010 Congress as it was in this universe
2) Pass the Supreme Court
3) Be implemented without problems
4) Shit unicorns and produce massive political benefits instead of a gray power backlash who feared for their Medicare.
You’re making a lot of very conditional statements in your counterfactual that I don’t think can be supported, so please tell me how your universe makes things better
FlipYrWhig
@Loviatar: Those weren’t the choices. It was either something like your A (being charitable) or… nothing. There’s no B. I don’t even know what you imagine B to be.
vhh
Richard— you are great but please define acronyms. What is an EHB?
Loviatar
@Richard Mayhew:
Not today. I’m trolling too hard today to be able to respond coherently. I’m just enjoying the Schadenfreude.
Richard Mayhew
@vhh: Essential Health Benefits — no co-pays on preventative care, vaccines, contraception etc.
MomSense
@Botsplainer:
That sounds better than what I’m feeling today.
vhh
@tbone: totally agree. The deep red states are nearly all net takers from the Feds. Let em shut their rural hospitals and watch their young emigrate a la WV via education or the Army. Let them pay for their own roads and flood control as climate issues worsen. Reduce them to cheap vacation locations and national parks for the smarter and richer blue staters to visit. Sharpen natural selection to improve the gene and voter pools.
MomSense
@MomSense:
I’m feeling like I don’t like my fucking neighbors at all. The people that I smile and exchange pleasantries with at the grocery store. Yeah those nice fuckers don’t care if people die because of lack of health care. Seriously, I looked at the precinct reports and 47% of my fucking nice town are assholes who voted for a bully who doesn’t fucking care if people die.
I pack food packs every week for school children who have lost their access to dental care, food assistance, and medical care. Should we start packing inhalers and teaching parents how to do DIY dental cleanings?
Matt McIrvin
@vhh: The people getting screwed in the deep-red states are, by and large, black people, and Hispanics, and American Indians. The people screwing them are white people. Those states are fucked up because of white resentment and racism, and the whites in power are getting exactly what they want.
This is not any kind of karma.
Matt McIrvin
…meanwhile, the states that had the worst pockets of white poverty? Have already expanded Medicaid, and are doing great things with the PPACA, thank you very much! And electing Republicans to Congress, but they got theirs already, so screw you.
MomSense
@Matt McIrvin:
And children. This is not karma. This is cruelty.
PAULA
@Loviatar:
So let me get this straight …
You’re interpreting last night like it was some kind of subtextual demand for the public option or single payer or some shit?
You really are dumber than a sack of hammers.
Loviatar
@PAULA:
Actually No, right now I’m just pointing a finger and laughing and enjoying the butt hurt from the pragmatics.
———
P.S.
My interpretation of last nights results are very simple; a bunch of racist old people voted, while the more representative reflection of the population stayed home. And as far as the US is concerned, whenever I want to interpret a political situation I look to race and how it impacts the situation. I consider what will be the most negative results for minorities and usually that’s what will occur. Very rarely am I wrong.
Racism is out original and eternal sin. Everything goes from there.
JMV Pyro
@MomSense:
Seriously. I see a lot of “Let’em burn” attitudes without any acknowledgement of who we’re burning.
PeorgieTirebiter
6 months ago my back pain was diagnosed as being moderate arthritis.given the level of pain and other assorted problems I was experiencing it seemed ridiculous. The diagnosis was based on a series of x-rays that I had to pay for out of my own pocket. On October 1st the insurance policy I was able to purchase thru the federal marketplace went into effect. My new doctor listen to my complaints and promptly ordered an MRI, as it turns out I have two fractured vertebra and spinal stenosis.believe it or not that’s a good news I know it’s wrong and it can be treated,the total cost was 250 bucks and half my deductible for the year has been taken care of. As a real world Democrat, my universe has improved and I am grateful for that.
karen
I’m in MD, where we now have a GOP governor. Does that mean no Obamacare now and right now my state has Medicaid expansion, which is why I’ve been able to not pay for any of my cancer hospitalization and chemo and such? Medicaid is also paying for my personal care aide that I will get this month? Should I just pack my bags and go to NY where my parents are? And I’m in a HUD subsidized independent living facility, is that gone too?
d58826
@Richard Mayhew: Question. Ill. uder Quinn went for the medicaid expansion. Tthe Gooper who defeated Quinn has said he is oposedto the expansion. Can he opt out of the expansion?. For that matter can any state opt out after having opted in?
Gene108
I look for Republicans to gut the hell out of the PPACA, if they get the White House in 2017 and maintain control of Congress.
In the end they will make sure there is no legacy the current Negroe in their White House will leave behind for future generations, and thus rendering his two terms a footnote in American history.
Richard Mayhew
@karen: Medicaid expansion in Maryland was accepted. The state legistlature is still Democratic, so I think you are safe.
Morbo
So we’re getting a two-tier healthcare system after all.
JoyfulA
And Pennsylvania will have full Medicaid expansion, so there’s that.
d58826
Even Brownbeck won last night.
rip democratic party 11/5/14
Alicia
@Matt McIrvin:
They’re also hoping to make it bad enough that the black, Hispanic, & American Indian residents pick up and move to a blue state so that they (the red state) don’t have to take care of them, while still getting all the money from the blue states that pay their way.
karen
@Richard Mayhew:
Thanks. Larry Hogan was only able to win because:
In the beginning of election ads, Larry Hogan never mentioned his party, just MD high taxes (which why it was a progressive state).
Lt Governor Anthony Brown DID NOT ADVERTISE until late October. In the meantime, Larry Hogan ran a campaign where he basically won because of taxes and Anthony Brown did not run ANY ads until late October. Hogan had an ad where an African American women said that she’d voted for Obama but said that it cost too much to live in MD. A white women did the same thing. They both said that it wasn’t about party it was about taxes and how high they were and how expensive 6 years of O’Mally made it to live in MD. Larry Hogan didn’t win. Anthony Brown LOST. The Dems took it for granted and we’ve just lost a blue governor.
I want to vomit.
Sister Rail Gun of Warm Humanitarianism
@Alicia: Except that a lot of that blue state money will leave with the minorities, since it’s dependent on population levels.
Not that these people have ever been good on thinking things through to their logical conclusion.
Crouchback
@Sister Rail Gun of Warm Humanitarianism: There’s also the question of who does all the cheap labor. Not to mention what happens to white rural populations when the rural hospitals shut down due to lack of money.
Tbone
@Matt McIrvin:
Then maybe those minorities need to get off their ass and vote. I hear you loud and clear, but sorry. Fuck ’em. They don’t vote, they get what’s coming. Good and hard.
BubbaDave
@Tbone:
What does minority mean? It means they are outnumbered by the majority — and if that majority has enough fucking cracker-ass bigots, they can vote all they’re legally allowed to. Doesn’t help.
Fuck, you want to blame Texas Black and Latino citizens for the reason Wendy and Leticia lost? You might be stupid enough to be a Texas voter.
brantl
Dead wrong. What they did was allow the Republicans to cast Obama as an over-government incompetent. What the Dems should have done is ticker-taped his accomplishments and who they worked for, and said, “You’re damn right I stand by Obama, because he has stood by you And, oddly all of these POLICIES ARE STILL POPULAR. LOOK ON THE BALLOT MEASURES THAT PASSED
brantl
Don’t use acronyms without explanation.