Sweet jeebus, David Brooks.
Archives for July 2015
Alaska: Home to oil, polar bears and Medicaid Expansion
Via Think Progress:
Alaska will become the 30th state to accept Obamacare’s optional Medicaid expansion, after Gov. Bill Walker (I) announced on Thursday that he will use his executive power to bypass the GOP-controlled legislature and implement the policy on his own.
Walker — a former Republican who has since become an Independent — has been advocating for Medicaid expansion for over a year. Implementing this particular Obamacare provision, which was ruled optional by the Supreme Court in 2012, would extend health coverage to an estimated 40,000 low-income residents in his state.
Decent chance there will be a court fight on the expansion, but establishing facts on the ground that this is what a civilized state does (especially when someone else is paying either the entire bill or the vast majority of it), and more importantly getting the hospital groups on board and used to the revenue will start entrenching the program.
And here is the Republican response to Medicaid expansion in Alaska:
“I think in this time, in these lean years, it’s time for communities to pull together, it’s time for churches to step up, it’s time to help give a hand to each other as individuals. We can be kind as people. It’s not government’s place to be kind,” State Rep. Shelley Hughes (R) said in reference to uninsured Alaskans when the House voted down Medicaid expansion in March.
Counting on churches, private charity, bake sales and magical unicorns flying out of a yeti’s ass has been the working poor health insurance plan for years. That has not worked, but let’s try it again and clap louder. Asshole.
Alaska: Home to oil, polar bears and Medicaid ExpansionPost + Comments (170)
Rate increases
There have been a ton of stories about massive rate increases in the Obamacare market. This article from Pennsylvania is actually a really good article about the national state of play:
Pennsylvania’s largest health insurer has requested a 36 percent premium hike for a plan sold on the Obamacare exchange, and another has requested a hike of up to 58 percent.
Big scary lede. Some insurers are asking for the moon.
Yet a closer look at premium requests in Pennsylvania shows the situation isn’t clearcut, and it’s not certain people will have to pay dramatically more in 2016.
Many insurers selling plans in Pennsylvania are requesting only modest increases, and some are requesting decreases.
And now for some context in the third sentence. We are only seeing the high increase outliers as the name and shame element of the PPACA rate regulation mechanism only comes into play when the increase request is more than 10%. There are plenty of insurers offering plans whose rates aren’t increasing at an astronomical rate.
As a result of receiving that “risk adjustment” information, Geisinger (the 58% requester) is submitting revised requests for lesser amounts, said Bowen, who couldn’t immediately provide revised figures.
As expected, the initial ask by insurers is being revised down. It is easier for insurers to get state regulators to agree to a lower number from the initial than to get the regulators to agree to a higher number than the initial ask. That allows regulators and their champions to point to a clear example of their effectiveness at protecting the public. This is a bit of a kabuki. In my state, when Mayhew Insurance and our competitors submit rates, there is a de facto implicit fudge factor built into the rates (usually as excess reserve accumulation) that everyone expects to be cut by the third round of review.
Substantial increases in Highmark plans could have a big impact, since the insurer sold exchange-based plans to 219,000 people — nearly half the Pennsylvania residents who bought such plans, and more than any other insurer in the state. …. In western Pennsylvania, a Highmark silver plan had some of the lowest premiums in the country. There’s little doubt that’s the result of the intense western Pennsylvania competition between Highmark and UPMC Health Plan, which also charged some of the lowest lowest premiums. That means the sharpest Highmark increases could be confined to western Pennsylvania.
UPMC, for its part, requested a 9.75 percent increase for one of its plan for individuals, and no increase for the other, according to the insurance department’s website.
Competition matters.
Looking at HealthSherpa, UPMC already had the lowest rates in Pittsburgh for a 40 year old non-smoker, and it looks like the gap between their rates will increase. The 2015 rates were kept low by competition between the two regional giants, and it looks like UPMC’s lowest price plans will increase by less than 10% while Highmark’s lowest price plan in Pittsburgh will increase by 25%. The gap between the 2nd Silver from UPMC and the lowest Highmark Silver will be larger in 2016 than 2015.
This means shopping matters. The Federal government takes on all of the excess cost growth risk for the subsidized on-Exchange population by the subsidy formula. People whose incomes don’t change at a rate greater than inflation from 2015 to 2016 will see their monthly premium obligation remain the same plus inflation. Anything above that, the Feds eat the cost. Highmark buyers in 2015 will have a choice of switching to a UPMC or other, lower cost Silver plan in 2016 to reduce their monthly premium payment, or sticking with Highmark. We saw in 2015 that people were willing to switch for a better deal. I think in Pennsylvania, there will be a lot of switching.
Keystone Health Plan Central requested a two percent decrease for a plan covering small groups, and Capital requested a 2.4 percent decrease for a small group plan. Keystone is owned by Capital, which is based in Dauphin County.
Some prices are going down as plans either get more information about their costs or they are trying to compete for more business based on pricing.
Kaiser looked at costs of the lowest and second-lowest silver plans in 11 major cities around the country and found an average increase of 4.4 percent from 2015. In Portland, Ore., the requested premium is 16.2 percent higher than in 2015. But in Seattle, Wash, the requested premium is 10.1 percent less than in 2015.
If people are willing to switch, the effective rate increases are very low and below historical norms. People who are determined to stick with their high cost insurer will get pounded on pricing.
All in all, this is one of the best articles on laying out the mechanics of pricing interactions for Exchange products that I’ve read in a while. The reporter should be commended.
Friday Morning Open Thread: Do Not Leave The Boat
Let me save you all time on this morning’s Bobo piece on Ta-Nehisi Coates’s book: he actually restrains himself all the way until the fifth paragraph to start the “Well, actually…” whitesplaining nonsense that puts a complete lie to the article’s title, “Listening to Ta-Nehisi Coates While White”.
Brooks doesn’t even listen to how insipid his own tripe is. Stay in the boat on this one.
Open thread otherwise.
Friday Morning Open Thread: Do Not Leave The BoatPost + Comments (113)
Friday Morning Open Thread: Eid Mubarak!
Universally popular commentor Amir Khalid, Thursday morning:
Tomorrow is Eid al-Fitri. Tomorrow is my birthday…
From Wikipedia:
Eid al-Fitr (Arabic: عيد الفطر ʻĪd al-Fiṭr, IPA: [ʕiːd al fitˤr], “festival of breaking of the fast”), also called Feast of Breaking the Fast, the Sugar Feast, Bayram (Bajram), the Sweet Festival or Hari Raya Puasa and the Lesser Eid, is an important religious holiday celebrated by Muslims worldwide that marks the end of Ramadan, the Islamic holy month of fasting (sawm). The religious Eid is a single day during which Muslims are not permitted to fast. The holiday celebrates the conclusion of the 29 or 30 days of dawn-to-sunset fasting during the entire month of Ramadan…
A (somewhat belated) Selamat Hari Raya, and many happy birthday returns, Amir! May you have as much fun as this guy celebrating:
Friday Morning Open Thread: Eid Mubarak!Post + Comments (85)
Late Night Open Thread: Tragedy of the Reddit Commons
I have been told, many times over the past fifty years, that it is uniquely frustrating to be a young(ish) white man in modern America. “Everybody knows” that white American men have all the power, and yet, from the perspective of the vast majority of young white men, they spend their best hours (if they’re lucky) performing crappy jobs requiring abject subservience to older more fortunate individuals, and getting laid (if they’re lucky) requires abject subservience to people who are not even young(ish) white men. This strikes young(ish) white men as brutally unfair.
Also, testosterone (however organically sourced) is one hell of a drug.
This is the lens through which I try to understand Reddit, because I’m too old and ADD to immerse myself in the full Reddit experience. I accept that most of Reddit is people sharing their interests, however quirky — people who neither need nor want my approval. Many of my own hobbies are perennial targets of normals-scorn, so it’s not like I don’t understand the defensiveness when a small atypical fringe of ‘my’ community is attacked. But then again, I could not appreciate the importance of self-identifying as a Trekker instead of a Trekkie (which was the friendship-destroying, marriage-threatening debate among my interest-group peers in the mid-1970s), so maybe I’m just not serious enough to understand the very strong feelings evoked by the ongoing Crisis in Reddit-Space.
That being said, I appreciated Margaret Hartmann’s explainer in NYMag:
… Reddit is a site founded in 2005 that bills itself as the “front page of the internet.” It’s the tenth most popular site in the U.S. and the 33rd most visited worldwide, according to Alexa.com. The basic concept is that users can post anything — observations, images, TV show analysis, questions about weird medical ailments, etc. — and others can reply. Every comment can get “upvoted” or “downvoted,” making it more or less prominent on the page.
Users can customize which subreddits they subscribe to, so when a particular user logs on to the site she may only see respectful discourse on Game of Thrones, makeup tips, photos of abandoned buildings, and facetious praise for Nicolas Cage. But as the Daily Beast notes, 74 percent of Reddit users are male and nearly 60 percent are under age 34. If someone is complaining about a Redditor online, they’re probably talking about the stereotypical young male user who sees the site as a bastion of free speech and will vigorously defend the existence of gross subreddits such as /r/creepshots and /r/fatpeoplehate. In recent years Reddit administrators have sporadically removed some particularly offensive subreddits (though some just reemerged under different names).
What started the current uproar?
Reddit has about 60 paid employees, and they’ve traditionally been fairly hands off. One exception was Victoria Taylor, who played a key role in developing and coordinating Reddit’s popular “Ask Me Anything” posts… Taylor seemed to get Reddit in a way the other administrators didn’t, and the site’s powerful moderators — the unpaid top users who actually run the various communities — came to rely on her. In a post revealing that Taylor had been suddenly let go, AMA moderator karmanaut said the administrators gave them no warning, though she was in the midst of helping them set up several projects…/r/IAmA and several other subreddits said they had to go private because they needed to figure out how to function without Taylor. Soon hundreds of subreddits joined in, temporarily shutting down to protest her dismissal, and what they said was increasingly poor communication and disrespect from the administrators…
Which is a lead-in to notorious Reddit-denouncer Sam Biddle’s epic Gawker rant, “No One Wants to Admit It, but Reddit Can’t Be Saved“:
It’s looking more and more like Ellen Pao was, in some sense, set up to fail by her male board of directors. Her predecessor Yishan Wong says it. A top Reddit engineer said it right after quitting. It might sound conspiratorial if it weren’t about this particular site.
But this is Reddit. To the site’s super-dedicated core, an overwhelmingly male group of very vocal power-users whose understanding of progressive politics is limited to the idea that their pirated ecchi torrents have just as much a right to bandwidth as Netflix, few things are more offensive than being told what to do by a woman. And when harassment was banned and their fat-hating subreddit was shut down, they plugged their ears and screamed and stomped and spammed swastikas until they got their way. (It obviously didn’t hurt that their way also happened to align with the interests of the site’s founders.)
Late Night Open Thread: Tragedy of the Reddit CommonsPost + Comments (100)
A New Low for Gawker Media
I’m not going to go into it in detail and I am certainly not going to provide a link, but some asshole named Jordan Sargent just ruined a private citizen’s life for nothing more than revenge and clicks. Basically, a married man (who is wealthy and connected) was attempting to arrange a tryst with a male escort in Chicago. The escort found out who the man was, and then attempted to blackmail the man to apply political pressure on a HUD appeal he was working on regarding his housing situation. The man said he couldn’t help him, backed out of the tryst, paid the escort anyway. The escort then went to Jordan Sargent at Gawker with copies of their text messages, and basically Sargent decided “HELL YEAH I WILL HELP YOU BLACKMAIL HIM.” So now a man has been outed for not acting unethically, his marriage might be ruined (who knows, she may know he is bi and is ok with him doing this when he is out of town), and his kids are going to have this crap thrown at them.
It’s the most disgusting thing I have ever seen on the internet and I read the Daily Caller and have read Chuck Johnson’s GOTNews.
I am now actively rooting for Hulk Hogan to win his lawsuit against Gawker and Nick Denton. Just despicable.