Fuck yeah.
Archives for June 2016
Euro 2016 Italy v Sweden Open Thread
Can the Swedes bounce back? Will my wife continue to swoon over Gianluigi Buffon?
Reworking HSA rules
Last December, I argued that deductibles are the preferred means of cost sharing for a given actuarial value if we are seeking to minimize the total amount spent by a chronically ill individual:
Deductible plans favor the sickest people as the low utilizers pay for almost all of their care via deductible cash. That means the proportion of the pool’s individual responsibility amount is borne by healthy people.
Co-pay only plans favor people who use highly concentrated cost services. A co-pay does not differentiate between a specialist visit with a contract expense of $200 and a specialist visit with a contract expense of $600. It is the same fee. So people who use very costly services but only rarely are best off. People who use a lot of fairly low costs services on a regular basis pay more proportionally.
Co-insurance only plans favor low cost utilizers. They are not paying full price via their deductible, and unlike co-pays, the individual cost per unit matters.
There are a pair of points about cost sharing on the Exchange that need to be tweaked.
First Louise Norris notes that the maximum cost sharing amount allowed on Exchange has increased over the allowable cost share amount for the HSA tax benefit:
In 2014, the out-of-pocket maximums for individual health plans under the ACA were the same as the limits on HDHPs: $6,350 for individuals and $12,700 for families.
But in 2015, the ACA began to allow maximum out-of-pocket limits even higher than those allowed for HSA-qualified plans. Under ACA guidelines, the maximum out-of-pocket for all plans in 2015 was $6,600 for an individual and $13,200 for a family. But HSA guidelines limited the maximum out-of-pocket on HSA-qualified plans in 2015 to $6,450 for individuals and $12,900 for families.
The gap increased in 2016. The maximum out-of-pocket for all plans under the ACA is $6,850 for an individual, and $13,700 for a family. But for HSA-qualified plans, the maximum out-of-pocket in 2016 is $6,550 for an individual, and $13,100 for a family.
And for 2017, the gap will widen even more. The maximum out-of-pocket limit on all plans will be $7,150 for individuals and $14,300 for families. But for HSA-qualified plans, the out-of-pocket limits will remain unchanged from 2016, at $6,550 for individuals, and $13,100 for families.
This means people who are buying Bronze plans probably can not benefit from the tax benefit of the HSA so their effective costs are higher than people who can afford to buy Silver or Gold HSA compliant plans if they both use significant services over the course of the plan year. The policy tweak would be to have Congress mandate that the HSA deductible limit be synchronized with the QHP out of pocket maximum limit.
The other issue that needs to be addressed with HSA’s and HDHP is that these plans key on deductibles. As I have shown before, there are lots of ways to get the same actuarial value with several different types of cost sharing:
Creating a deductible only plan was fairly simple. The insurance would pay nothing out until the person spends $3,725 on cost-sharing eligible services.
The co-insurance routine was a bit harder to build. There are a wide ranges of co-insurance rates that could be chosen. For simplicity sake’s I chose a $0 deductible and a 40% co-insurance rate to start with. That failed. I could not design a Silver plan using only co-insurance at 40% before I hit the maximum out of pocket constraint of $6,850.
A 50% co-insurance rate creates a 72% Silver plan while a co-insurance rate of 53% creates a 70% Silver plan. The out of pocket maximum for these plans are $6,850.
Those three benefit design choices all produce plans that have roughly the same actuarial value. However the deductible only plan design is HSA/HDHP eligible. The other two plan designs are not HSA eligible.
That is stupid.
That is fixable.
The fix is to tie HSA/HDHP tax benefits to the plan’s actuarial value independent of the cost sharing arrangements that produced the calculated actuarial value. The entire goal of the HDHP movement was to lower the actuarial value of coverage so that people could have more “skin in the game”. The tax benefit of an HSA would act as a bit of a cushion to the increased individual level risk. However as plan designs have gotten a bit crazier and esoteric, the HDHP goal of lower actuarial values is being achieved but the tax benefits are idiosyncratically applied.
Friday Morning Open Thread: Could Be Worse, We Could Be Republicans
"My campaign has been one of honesty and substance." — Donald J. Trump, man without irony.
— Jon Ralston (@RalstonReports) June 16, 2016
Can’t find the link now, but somebodyHat tip to commentor Luthe, who recently posted tweeted “God must’ve been in a REALLY good mood when Hillary prayed that her enemies be made ridiculous.”
What’s on the agenda, as we wrap up another week few will be sorry to see the back of?
Heh, the RNC Chair’s job has devolved to being a chaperon to keep the nominee out of trouble https://t.co/eVJFv4pdWY
— Dana Houle (@DanaHoule) June 16, 2016
Flying to Dallas now with @realDonaldTrump…Reports of discord are pure fiction. Great events lined up all over Texas. Rs will win in Nov!
— Reince Priebus (@Reince) June 16, 2016
so Trump clearly stole Reince's phone https://t.co/kEv8klMPta
— Simon Maloy (@SimonMaloy) June 16, 2016
.@Reince Blink twice if you need helphttps://t.co/IkL3MYkI8B
— Gary Legum (@GaryLegum) June 16, 2016
Donald Trump is the kindest, bravest, warmest, most wonderful human being I've ever known in my life. https://t.co/V8uPJ01BOc
— Jeet Heer (@HeerJeet) June 16, 2016
Most common answers to Trump ?s from GOPers:
1. "I will support the nominee."
2. "Hillary's terrible."
3. "I forgot I have somewhere to be."— Jon Ralston (@RalstonReports) June 16, 2016
Major #RNC scoop from @zachmider: Wells Fargo, JPMorgan, Ford, UPS, Walgreens all pulling out of RNC convention https://t.co/FFD0xOhqd3
— Rashad Robinson (@rashadrobinson) June 16, 2016
The full headline: More Companies Opt to Sit Out Trump’s Coronation in Cleveland
Looking forward to the "Sad!" splash headlines when Trump loses.
— Josh Barro (@jbarro) June 16, 2016
Friday Morning Open Thread: Could Be Worse, We Could Be RepublicansPost + Comments (213)
Late Night Bern-Off Open Thread: Go AWAY, Bernie
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Few things show the their difference in understanding politics than comparing Bernie's livestream and Clinton's glass ceiling speech.
— Mike Caulfield (@holden) June 17, 2016
Unlike the Blogmaster, I was not impressed by Senator Sanders’ “My dream will never die, screw the rest of you” non-concession speech this evening. Of course, I am a Hillbot, and more important, have been a Democrat all my life, good times (and candidates) and bad. So, yes, I am biased against the old crank who shows up at the block party without an invite, doesn’t bring so much as a bag of store-brand chips to share, harangues everyone he can corner, pisses off the people who’ve been doing the grunt work for years and encourages the malcontents and youngbloods to pull stupid stunts. If I wanted to listen to a cranky old alte kacker yarp on about how he was the only pure operative in the entire world, I could’ve stayed in the Bronx — and he could’ve stayed in Brooklyn. Okay, he’s “excited a new generation” and “moved the discussion leftward” (for some tightly defined values of excitement and leftward). At this point, he’s just leaching attention away from our real enemies, who happen to be in charge of the Republican party.
Why you didn’t see Bernie during the marathon Democratic gun filibuster https://t.co/YIvG7LYO5w
— daveweigel (@daveweigel) June 16, 2016
Before Sen. Chris Murphy (D-Conn.) headed to the floor yesterday to begin a marathon gun safety speech, his office reached out to members of the 46-member Democratic caucus. By the end of it, early Thursday morning, Murphy announced that the Democrats would get votes on Sen. Dianne Feinstein’s legislation to prevent people on the terror watch list from buying guns, and his own legislation to expand background checks. Thirty-eight of his fellow senators joined the filibuster, allowing Murphy to rest, reading comments from the Internet or describing mass shootings in their own states.
Not among them: Sen. Bernie Sanders of Vermont. The runner-up in the Democratic presidential primaries was in Burlington, Vt., ahead of a simulcast speech to supporters today. (He is not expected to concede.) He’d been in Washington the night before the filibuster began, for the Democratic luncheon and a meeting with Hillary Clinton, but he was not able to return to the city…
Sanders, who opposed the Brady Bill that expanded background checks and waiting periods, has since come into sync with the Democratic caucus… On Wednesday, he tweeted in support of the filibuster…
He sent a tweet — what more do you expect? One thing Bernie does have in common with Donald Trump, apart from their mutual unwillingness to release tax returns: He can’t be arsed to do anything that doesn’t immediately redound to the greater glory of His Own Magnificent Personage.
@DemFromCT @daveweigel He was ready and willing to stand on the same stage with Trump, yet he couldn't stand with his fellow senators.
— Ryan Jackson (@RTJackson77) June 16, 2016
Besides not being in the #filbuster, Sanders tried to drop CT Gov Malloy from convention leadership bc Malloy criticized him on gun policy.
— Amy Fried (@ASFried) June 16, 2016
In the meantime, Dem-leaning voters have already started consolidating behind Clinton. pic.twitter.com/dos4LHejYU
— Greg Greene (@ggreeneva) June 17, 2016
Late Night Bern-Off Open Thread: Go <em>AWAY</em>, BerniePost + Comments (195)
Actually, This Was a Pretty Solid Speech
I didn’t watch the Sanders speech, but I did read it, and I gotta say there is a lot in there that I like a great deal. Some minor quibbles, but this is some pretty solid stuff:
It means that we can no longer ignore the fact that, sadly, the current Democratic Party leadership has turned its back on dozens of states in this country and has allowed right-wing politicians to win elections in some states with virtually no opposition – including some of the poorest states in America. The Democratic Party needs a 50-state strategy. We may not win in every state tomorrow but we will never win unless we recruit good candidates and develop organizations that can compete effectively in the future. We must provide resources to those states which have so long been ignored.
Most importantly, the Democratic Party needs leadership which is prepared to open its doors and welcome into its ranks working people and young people. That is the energy that we need to transform the Democratic Party, take on the special interests and transform our country.
Here is a cold, hard fact that must be addressed. Since 2009, some 900 legislative seats have been lost to Republicans in state after state throughout this country. In fact, the Republican Party now controls 31 state legislatures and controls both the governors’ mansions and statehouses in 23 states. That is unacceptable.
We need to start engaging at the local and state level in an unprecedented way. Hundreds of thousands of volunteers helped us make political history during the last year. These are people deeply concerned about the future of our country and their own communities. Now we need many of them to start running for school boards, city councils, county commissions, state legislatures and governorships. State and local governments make enormously important decisions and we cannot allow right-wing Republicans to increasingly control them.
I hope very much that many of you listening tonight are prepared to engage at that level. Pease go to my website at berniesanders.com/win to learn more about how you can effectively run for office or get involved in politics at the local or state level. I have no doubt that with the energy and enthusiasm our campaign has shown that we can win significant numbers of local and state elections if people are prepared to become involved. I also hope people will give serious thought to running for statewide offices and the U.S. Congress.
That’s an ambitious and extremely important goal and message, and I can’t for one second imagine why any Democrat would reject this or not feel a little bit excited about it. This is Howard Dean’s vision of the DNC with a twelve million man mandate. If this is the legacy of Bernie Sanders, and not the hurt feelings and rest of the nonsense that went with this primary, count me as ecstatic.
Actually, This Was a Pretty Solid SpeechPost + Comments (175)
Stop Me If You Have Heard This Before
It never ends:
The man being held in connection with the death of MP Jo Cox has been named as Thomas Mair, who was described as a “loner” with a history of mental health problems who had previously subscribed to a far-right magazine.
Mair, 52, who was arrested by armed officers shortly after the attack, had spoken about receiving “psychotherapy and medication”, and was described by his younger brother as having “a history of mental illness”.
Despite being born in Kilmarnock, Scotland, a decade-old website posting identified Mair as a subscriber to S. A. Patriot, a South African magazine that was published by the pro-apartheid group, the White Rhino Club.
Police on the sceneThe club describes the magazine’s editorial stance as being against “multi-cultural societies” and “expansionist Islam”. A blog post attributed to the group, dated January 2006, described Mair as “one of the earliest subscribers and supporters of S. A. Patriot.”
I suppose we are just lucky this was in the UK, and not the US, or the guy would probably have been armed with a helluva lot more firepower.