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You are here: Home / Anderson On Health Insurance / Who needs coverage when taxes can be cut

Who needs coverage when taxes can be cut

by David Anderson|  February 27, 20177:19 am| 107 Comments

This post is in: Anderson On Health Insurance, World's Best Healthcare (If You Can Afford It)

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First Axios has a briefing to the National Governors Association on what the GOP Medicaid plan would look like:

For a hypothetical Medicaid expansion states:

  • The state would lose $635 million in federal funding, a 65 percent decrease.
    • Net of 200,000 people would lose insurance coverage

For a hypothetical non-Medicaid expansion states

  • The state would lose $885 million in federal funding, an 80 percent decrease.

    • A net of 30,000 people would lose coverage in addition to the people who are in the Medicaid gap

Secondly, Loren Adler passes along a useful comparison made by Jed Graham, a conservative health wonk and reporter who does good work.  Jed examines what a 64 year old couple making 150% of federal poverty level would see under PPACA and under the Price Plan.

A low-income, near-senior couple would go from paying 8-12% of their income on h’care to ~80% under Price’s plan https://t.co/JKt40M4NEk pic.twitter.com/bldBcR63NX

— Loren Adler (@LorenAdler) February 25, 2017

Finally, I whipped up some charts of what counties on Healthcare.gov in 2017 would have a 40 year pay at least $200 per month for the least expensive plan available.  This is after the flat age based subsidy for the best person in the subsidy class and it is for a plan with a $7,000 out of pocket maximum.

This is the chart of which Senators need to be pressured.  Alaska was excluded purely for presentation purposes but it is brilliant fire engine red.

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Reader Interactions

107Comments

  1. 1.

    SFAW

    February 27, 2017 at 7:27 am

    In the Kaiser chart Adler presented, there was a phrase “before rates spiked due to adverse selection.” What does that mean in terms morons (i.e., yours truly) can understand?

    ETA: Corrected “hiked” to “spiked,” because apparently I can’t even transcribe things correctly.

  2. 2.

    rikyrah

    February 27, 2017 at 7:27 am

    Thanks for the info Mayhew. It is as heinous as we could imagine it to be.

  3. 3.

    SFAW

    February 27, 2017 at 7:34 am

    @rikyrah:

    Oh, come on! I’m sure the poor and nearly-poor will come out ahead, when their capital gains taxes are cut.

  4. 4.

    Lapassionara

    February 27, 2017 at 7:44 am

    But, didn’t Twitler promise something way better than the ACA? More coverage, less cost, and lots of freedom?

  5. 5.

    aimai

    February 27, 2017 at 7:45 am

    I know I am very, very, bad with visuals, graphs, and numbers but I really think that you can show both those maps and graphs to a true believing Trump voter and they will simply not have the slightest idea what they are being shown. The cost comparison graph in that tweet, for instance, is very badly labeled for people who are graph averse or naive. They look at relative positions and color choice more than they look at the information in the graph. By that information the GOP “plan” offers “more” than Obama because there’s more dark blue. I think the same about the map–I have no idea what it is showing.

  6. 6.

    OzarkHillbilly

    February 27, 2017 at 7:48 am

    @Lapassionara: Well it costs a lot less if you just can’t afford it and you are more free to die at any time. As for coverage, don’t you already have a blanket?

  7. 7.

    Kay

    February 27, 2017 at 7:50 am

    Watching Kasich panic at Trump and the GOP gutting Medicaid is amusing. He’s all over Ohio media insisting he’s protecting Medicaid.

    The truth is the Medicaid expansion was good for everyone- patients, providers and GOP governors who cut taxes and blew a giant hole in their budget, like Kasich :)

    Wait until they go after Medicaid payments to nursing homes. I think 90% of the people in this county who are in a nursing home are Medicaid beneficiaries. Obviously, that benefits their grown children – middle aged people.

  8. 8.

    Kay

    February 27, 2017 at 7:57 am

    If I had to pick a group of white people who will be most harmed by Donald Trump is would be “near old” white working class. They have no assets. They often have debt. They had no health insurance prior to Obama. None. Some of them have never had health insurance in their lives.

    And they do manual labor so they are falling apart physically.

    Boy, I hope sticking it to the black guy was worth it. They signed their own goddamned death warrant. I don’t know- I try to be sympathetic but my grandmother used to say “you can’t cure stupid” and that is, in fact, true.

  9. 9.

    SFAW

    February 27, 2017 at 8:03 am

    @Kay:

    but my grandmother used to say “you can’t cure stupid” and that is, in fact, true.

    Not to disrespect your grandmother, but the AnythingButThatBlackGuy’sCare plan will cure it pretty damn well. In a very Darwinian manner, of course.

    I think the next Darwin Award should be given en masse to the Shitgibbon voters who thought they’d end up with better insurance/healthcare.

  10. 10.

    OzarkHillbilly

    February 27, 2017 at 8:05 am

    @Kay: After the election I gave one such person a tub of vase!ine and he said “I don’t need this, I voted for him.” I can’t remember exactly what I said in reply, probably something like, “Than he doesn’t need you anymore.” or “You think he cares?”

  11. 11.

    amk

    February 27, 2017 at 8:08 am

    @Kay: suicide by stupidity.

  12. 12.

    Kay

    February 27, 2017 at 8:09 am

    I know this is water under the bridge and it’s not a new idea by any means, but Democrats really missed the boat on telling health care/ Medicaid expansion STORIES. Not graphs. Stories.

    I see these people and it is amazing. It is life-changing. There are white working class in their late middle aged who never had access to health care in their lives before Medicaid expansion. Never. I meet people who hadn’t seen a doctor since their public school sports physical in high school and they didn’t even see a doctor then- it was a county health nurse.

    The place to look is the local drugstore. Look at what I think of as the “home remedies” aisle. The poorer the area the more stuff there is- splints, remedies, potions- all kinds of things. They do their own healthcare. There’s an over the counter product to fill your own teeth. I don’t know if it works! Not an endorsement. I am acquainted with a man who set his own broken hand. It’s like a claw, which is a problem because he lays carpet. It was 10,000 to fix and he has never in his life had anything approaching that. He probably MAKES 10,000 in a year. Less now with the useless hand.

  13. 13.

    aimai

    February 27, 2017 at 8:14 am

    @Kay: Further to my point the comments below the Cleveland Newspaper’s editorial supporting the Medicaid expansion are full of uninformed but firm trolls arguing that “11 million” undeserving, jobless, teens are using the medicaid expansion to pay for their std checks and abortions and that this is un-American and unchristian.

  14. 14.

    Baud

    February 27, 2017 at 8:24 am

    @Kay:

    I try to be sympathetic

    I don’t anymore.

    @Kay:

    Democrats really missed the boat on telling health care/ Medicaid expansion STORIES. Not graphs. Stories.

    I’m all for self-improvement, but to my mind, the people who needed to hear the message just stopped listening to anything the Dems had to say.

    ETA: They are listening now.

  15. 15.

    aimai

    February 27, 2017 at 8:31 am

    @Baud: Right–if these stories were everywhere then the people who needed to hear them already knew them. But, in fact, they failed to “connect”–in a Howard’s End kind of way. They failed to grasp that the democrats were trying to help them because they didn’t want to know that because it didn’t line up with other fantasies and angers they had about the democrats and black people, or the democrats and women, or the democrats and jews. They wanted to believe trump’s stories and republican stories and they refused to believe their own stories about their own lives because it didn’t fit their narrative of calvinism/money/elect/racism. White people are ashamed of their poverty, and resentful of it, because they no longer have a moral story which lets them imagine a world in which their poverty is unjust and something that they have a right to ask the government to help them with. This leaves them nothing but anger, spite, resentment, or resignation as modes of political action. And that is just what Trump offered them–wanger, spite, resentment and a new white nationalist promise that goodies would be showered on them because they were deserving (because white) and their previous poverty was not their fault (because black people.) You can’t combat that with stories that don’t give them that thrill.

  16. 16.

    Peale

    February 27, 2017 at 8:34 am

    @aimai: fine, old people. Our birth control for a year is about 1000 times less than one back surgery for you. Enjoy your Christianity, if you can stand for it.

  17. 17.

    OzarkHillbilly

    February 27, 2017 at 8:35 am

    @Baud: Elections have consequences.

  18. 18.

    FlipYrWhig

    February 27, 2017 at 8:41 am

    @aimai:

    This leaves them nothing but anger, spite, resentment, or resignation as modes of political action. And that is just what Trump offered them

    This. And don’t forget how much he promised to inflict pain on Others. Which dipshits on the civil-libertarian “left” somehow understood as an antiwar streak rather than as a promise for more, bigger, and faster indiscriminate slaughter and pillage.

  19. 19.

    Dr. Ronnie James, D.O.

    February 27, 2017 at 8:45 am

    @Kay: Back when I worked for a local public health department (about 2011), we were getting emails from the White House asking people for Affordable Care Act success stories. The effort has been made. I’m not sure why more messaging didn’t get out there; The Obama White House generally seemed pretty reluctant to play heavy retail politics, for whatever reason. Senators and Congresspeople are usually much better / more shameless about retail politics. They are surely making a similar effort now and will probably publicize it much more than Obama ever did.

  20. 20.

    delosgatos

    February 27, 2017 at 8:49 am

    @aimai: I’m very good with charts, graphs and such, and I can’t figure out the point of the map either. These are… counties where even with the ACA things are still expensive? Ok, so… pressure their congresspeople? To… fix the ACA? Not repeal the status quo? Make the replacement at least as good as this target? What?

    David, if I can’t look at this map and read your commentary on it and understand why you’re saying they’re significant and what action you’re trying to focus on, they’re not communicating.

    I would also agree about the bar chart. I had to read the legend twice, going back and forth between it and the bars. Would help if its author had said “out of pocket cost” instead of “premium” and had labeled the lower bar “Republican proposal” or something. But that’s quoted from another source.

  21. 21.

    NobodySpecial

    February 27, 2017 at 8:53 am

    @Kay: I remember a lot of stories being told. I was looking for them. Unfortunately, those stories were not as sexy to the mainstream press as emails.

    Messaging only works when they have to share the message. When they suppress it, it doesn’t help. The media is complicit, and Villago’s name again applies.

  22. 22.

    OzarkHillbilly

    February 27, 2017 at 8:56 am

    @delosgatos: Well if you guys are gonna bash David over the bar chart I guess I’ll have to stand up for him: I knew exactly what it said within 5 seconds.

    As to the map however, I am clueless.

  23. 23.

    amk

    February 27, 2017 at 8:56 am

    @Dr. Ronnie James, D.O.:

    Senators and Congresspeople are usually much better / more shameless about retail politics.

    Really? I didn’t see any evidence of these cowardly dipshits doing that.

  24. 24.

    WereBear

    February 27, 2017 at 8:57 am

    @Kay: I know this is water under the bridge and it’s not a new idea by any means, but Democrats really missed the boat on telling health care/ Medicaid expansion STORIES. Not graphs. Stories.

    This is a clear Democratic problem: we have such a high wonk ratio that we lose track of the emotional power in stories.

    We see emotion being used for bad purposes by Republicans and we are repelled by it, but in fact we do our best politically the same way everyone else does: by harnessing the power of charisma in our spokespeople.

    We shouldn’t discount it, or ignore it, or act like we can win elections with the Power of our Powerpoint. It’s the difference between winning (Barack Obama) and losing (Hillary Clinton.)

    Because the policies were the same. Not that I do not find HRC appealing: it’s that she is a wonk, and not a “star.” We ignore that at everyone’s peril.

    Because it can be worked around. But not if we ignore it’s power.

  25. 25.

    SFAW

    February 27, 2017 at 8:59 am

    One thing regarding the Graham/Adler bar chart: the Rethugs are calling it the “Empowering Patients First Act”? Yet another lie, of course, but it also occurred to me that EVERY TIME the Rethugs have used the word “Empower” in that type of context/situation, it has meant that they’re fucking over everyone who’s not a one-percenter.

    Perhaps the Dems should point that out? As in, every fucking day? “Any time I hear a Republican legislator say they’re going to ’empower’ me, I check my wallet to see if they’ve left me anything.”

    ETA: And, as with Ozark, I “got” the bar chart, mainly because I read the text above. But it also could have been tweaked. And the map was … “interesting” (Sorry for piling on, David.)

  26. 26.

    amk

    February 27, 2017 at 8:59 am

    steve beshear championed the ACA and the moron voters of KY replaced him with a rethug who promptly repealed it.

  27. 27.

    WereBear

    February 27, 2017 at 9:00 am

    @aimai: I have come up with an analogy for explaining:

    Trump voters are sinking into a swamp. On one side of the swamp are the Democrats, throwing in ropes. On the other side, the Republicans are yelling, “Throw us your wallets, and we’ll throw you a big rope!”

    And the voters in the swamp are saying, “Did a gay man touch this rope? This rope looks kind of dark to me. I don’t like a woman telling me what to do.”

    And they wait for the Republicans to throw the rope that never comes.

  28. 28.

    aimai

    February 27, 2017 at 9:01 am

    @OzarkHillbilly: Our point isn’t to bash David–its not even his tweet/bar chart. But just to point out that the claims the bar chart and map are making are non-obvious.

  29. 29.

    aimai

    February 27, 2017 at 9:02 am

    @WereBear: Love it.

  30. 30.

    SFAW

    February 27, 2017 at 9:04 am

    @WereBear:

    Wow.

  31. 31.

    the idler

    February 27, 2017 at 9:04 am

    Only the nutter Freedumb Caucus would vote for this plan…goes nowhere in the Senate.

  32. 32.

    aimai

    February 27, 2017 at 9:06 am

    @Dr. Ronnie James, D.O.: We forget that the press wasn’t willing to cover these human interest stories. Fox news sure wasn’t. The country is segmented by tribal affiliation–the voters who needed to understand what was happening to them, like the Kentucky voters who signed up for kinect but didn’t know it was obamacare, were both misinformed and also willfully ignorant. The very people signing them up were reluctant to disabuse them of their stupid ignorance because of fear that they would refuse to sign up. I wish people would stop assuming that there is some one to one correlation between telling people the truth/stories about their lives and getting them to realize that you are on their side. They are very well defended against learning anything that disturbs their overall world view. The right side has spent millions of dollars manipulating them and keeping them in the dark, and spent millions more on manipulating their face book interactions with other people int heir social circles. You can’t combat that with an earnest government propaganda program. That is not where information gets shared and believed.

  33. 33.

    Baud

    February 27, 2017 at 9:07 am

    @aimai: I agree.

  34. 34.

    SFAW

    February 27, 2017 at 9:07 am

    @aimai:

    Our point isn’t to bash David

    David’s probably the least-bashable FP-er. (How’s THAT for sucking up?) But that Mayhew guy, that’s another story. Where’d he go, anyway?

    Cole, on the other hand …. (Just kidding, John)

  35. 35.

    rikyrah

    February 27, 2017 at 9:08 am

    @Kay:

    Wait until they go after Medicaid payments to nursing homes. I think 90% of the people in this county who are in a nursing home are Medicaid beneficiaries. Obviously, that benefits their grown children – middle aged people.

    This.

    The poster child for who takes the most Medicaid $$$$$$

    Is June and Bobby’s Grandma and Grandpa.

    NOT Shaniqua and Rosa Maria.

  36. 36.

    rikyrah

    February 27, 2017 at 9:09 am

    @Kay:

    Boy, I hope sticking it to the black guy was worth it. They signed their own goddamned death warrant. I don’t know- I try to be sympathetic but my grandmother used to say “you can’t cure stupid” and that is, in fact, true.

    Tell it.

  37. 37.

    zach

    February 27, 2017 at 9:11 am

    Medicaid and, to a lesser extent, other anti-poverty funding is the only sizable pot of money that the GOP is allowed to touch. If they want permanent tax cuts without breaking the Byrd rule, Medicaid cuts are inevitable.

  38. 38.

    laura

    February 27, 2017 at 9:14 am

    @Kay: Yep, that’s me. Despite having pensions and social security, my parents would not have been able to direct pay when my mother’s dementia required more care than we could provide. Thank FSM that a decent and kind doctor admitted her for a three day hospital stay, triggering Medicare coverage, and then getting her medi-cal eligible to cover almost all her costs for placement in a memory care facility. Probate court allowed for transfer of her income to dad so we kept her spent down below the medi-cal eligibility limits.
    My worst fear was dad dying first -and he came so, very close, as it would then be impossible to keep her spent down. Then she’d be asked to leave the care facility and without any suitable alternative.

    When dad dies, medi-cal will make a claim for reimbursement and that will take every penny they worked for and saved. Me and my brothers are fine and have no need for, or expectation of any kind of inheritance other than our memories of being well parented, loved and wanted children.

    The GOP plan is so incredibly heartless and cruel. And likely the blame will be placed on president Obama. And too many people would likely fall for it.

  39. 39.

    Mike R

    February 27, 2017 at 9:15 am

    @rikyrah: Exactly, have tried pointing this out to some Trump voters and was told their parents would never need government assistance. Low and behold one of them had his father in a nursing home being paid for by the V. A. and medicaid, his mother currently in a nursing home being paid for by medicaid. I could go on but willful ignorance abounds, and seems in a never ending supply.

  40. 40.

    OzarkHillbilly

    February 27, 2017 at 9:15 am

    @aimai: I know you aren’t ;-) but the bar chart was all but immediately obvious to me. I think the map is a copy/paste fail where something didn’t carry over and David didn’t notice (bad David, BAD David). Just giving you guys a little shit with my wording.

  41. 41.

    WereBear

    February 27, 2017 at 9:16 am

    @rikyrah: The poster child for who takes the most Medicaid $$$$$$

    Is June and Bobby’s Grandma and Grandpa.

    NOT Shaniqua and Rosa Maria.

    Preach it.

    However, they have been trained for decades now to only believe what they want to believe. It will take massive nursing home closures and Grandma rooming with June for them to be hit in the face with reality, because they absolutely refuse to be convinced any other way.

    I adore Driftglass, and he has been on fire lately, pointing out that everything liberals said the right wing was going to do is being done right now.

  42. 42.

    WereBear

    February 27, 2017 at 9:18 am

    “Any sentence that begins ‘But Republicans have to understand…’ is semantically null and fundamentally ridiculous.” — driftglass

  43. 43.

    Mike R

    February 27, 2017 at 9:18 am

    @WereBear: Republicans rarely lie about making people suffer, almost like they enjoy writhing and gnashing of teeth.

  44. 44.

    rikyrah

    February 27, 2017 at 9:20 am

    @amk:

    steve beshear championed the ACA and the moron voters of KY replaced him with a rethug who promptly repealed it.

    Was Beshear defeated, or was it the case that he couldn’t run again?

    I understand your sentiment, but I blame Kentucky Democrats, because they let those folks live with the delusion that Kynect WAS NOT OBAMACARE.

    So, you wanna be a smartypants about it….

    Then, that muthaphucka could tell the truth – I’m gonna take away Obamacare, and the rubes who had been sold Kynect does not equal Obamacare, thought he was talking about THOSE PEOPLE.

  45. 45.

    Baud

    February 27, 2017 at 9:22 am

    @rikyrah: Term limited, I believe. Beshear didn’t lose directly.

  46. 46.

    rikyrah

    February 27, 2017 at 9:23 am

    @WereBear:

    I adore Driftglass, and he has been on fire lately, pointing out that everything liberals said the right wing was going to do is being done right now.

    IT WAS OBVIOUS WHAT THEY WOULD DO.

    which adds to me having no patience or tolerance for trying to ‘ understand’ Dolt45 voters.

  47. 47.

    Baud

    February 27, 2017 at 9:25 am

    @rikyrah: Agree. Trump is a watershed moment because, unlike past Republicans, he didn’t hide behind mushy talking points designed to make the GOP look more moderate. The excuses are gone.

  48. 48.

    Ohio Mom

    February 27, 2017 at 9:32 am

    @rikyrah: I know I am a broken record on this, but just in case someone, somewhere, has missed this:

    Medicaid also supports adults with disabilities. In my area, a year of living in a group home costs about $30-40,000 a year.

    If you have a loved one whose best quality of life would require a supervised living situation, you could come up with that money yourself, or you could make sure your loved one applies for, and maintains, a Medicaid Waiver (I say “maintain” because you have to periodically demonstrate you are still eligible). The Waiver covers the cost of the group home as well as providing medical coverage.

    Each state gets to make up its own rules for who qualifies. So for example, right now people with autism who are not also intellectually disabled (the disability formerly known as “mentally retarded”), are not eligible for a Waiver in Massachusetts, but they are in my state, Ohio, if they can show that their autism does in fact significantly limit their ability to function.

    What all this means is, if Medicaid is block granted or otherwise reduced, states that aren’t willing/able to make up that funding on their own are going to change the Medicaid Waiver rules to make them a lot more stringent. Which in turn, will cause many people with disabilities to lose their Waivers.

    And after that…? I guess more homeless old people, after the now Waiverless disabled outlive their parents.

    Sorry to go on so long but I think this is an important part of Medicaid that isn’t widely known about.

  49. 49.

    WereBear

    February 27, 2017 at 9:36 am

    @Ohio Mom: You are right, it is important, and there is nowhere for so many people to go if Republicans decide they have the same right to die in the street that the rich have.

  50. 50.

    amk

    February 27, 2017 at 9:38 am

    @rikyrah: yeah, beshear was term limited but the ky voters had a perfectly good dem replacement and they went and voted for that rethug anyway.

  51. 51.

    laura

    February 27, 2017 at 9:40 am

    @rikyrah: Rikyrah Preach! FYI, it was Shaniqua, Rosa Marie, Tatiana and Ruben that provided the tender care for my mother in her memory care facility. Truly warm and tender care, that still shames and haunts me that I could not provide. Everyday Saints working among us and under paid.

  52. 52.

    FlipYrWhig

    February 27, 2017 at 9:42 am

    @Dr. Ronnie James, D.O.:

    I’m not sure why more messaging didn’t get out there

    Maybe it had something to do with the left constantly pissing and moaning about how terrible it was.

  53. 53.

    Ohio Mom

    February 27, 2017 at 9:44 am

    @laura: Yes, this is what’s in it for the states. They put up funding for Medicaid, and the Feds match it.

    Eventually, decades later, the states claim their reimbursements and get to keep whatever they can collect. If it is more than they put in originally, that’s gravy.

    My kid is disabled and on a very low-level Medicaid Waiver, which among other things, pays for whatever our family’s health coverage doesn’t (co-pays, etc.). Somewhere in Columbus, every penny that they are paying for is being tallied.

    Of course I have no way of monitoring if any mistakes are being made. Which you can only assume is inevitable, given the huge amount of data being maintained.

  54. 54.

    gene108

    February 27, 2017 at 9:46 am

    @aimai:

    Most graphs / charts are poorly done. I understood the bar graph, but it is not intuitive, by just looking at it as to what is the better deal.

  55. 55.

    ThresherK

    February 27, 2017 at 9:50 am

    @Ohio Mom: You had me at “block grants”, which my brain autotranslates to “watch Texas fuck this up”.

    Texas used to have a Secretariat-style lead in this race, but they are getting competition.

  56. 56.

    schrodingers_cat

    February 27, 2017 at 9:54 am

    @Kay: Please include leftier-than-thou, JS voting purity ponies in your too stupid to live column, too.

  57. 57.

    Barbara

    February 27, 2017 at 9:56 am

    @Kay: This is exactly the case for my brother, 55 years old, struggling with health problems and working a fairly physical job. He went for a long time without any insurance, until 2014. Except that he never votes at all. (Or at least, he won’t admit to voting, but I very much doubt he would vote for Trump.)

  58. 58.

    Shalimar

    February 27, 2017 at 9:59 am

    @OzarkHillbilly: Same here. On the bar chart, it is clear they can probably afford coverage under Obamacare depending on their other fixed expenses but have no way in hell of ever affording what Price’s plan offers them. No clue on the map.

  59. 59.

    Shalimar

    February 27, 2017 at 10:02 am

    @ThresherK: In this case, I think “block grants” means money to struggling hospitals while making them treat as few poor people as possible.

    ETA: With Republicans, the goal is always to give government money to people who already have money.

  60. 60.

    Major Major Major Major

    February 27, 2017 at 10:02 am

    @aimai: the national review today is arguing that Obamacare doesn’t save lives and Medicaid kills people, so at least the trolls are making slightly more sense.

  61. 61.

    Barbara

    February 27, 2017 at 10:06 am

    @amk: Most of them ran away from ACA as fast as they could. Adding spineless and cowardly to the list of adjectives that Republicans were able to throw at them. However, one of the problems with the ACA was that its true, life changing benefits were not sufficiently front loaded, and it is always harder to defend something in the abstract. Nonetheless, a lot of these guys didn’t even try.

  62. 62.

    Tripod

    February 27, 2017 at 10:06 am

    There is no option that will bring back the “good old days”. Your kindly small PCP can’t meet the capital requirements of today’s healthcare industry.

    The likeliest target for screwing are industrial unions and the rural middle class. Because they stepped up to the window and bet on Donald J. Trump.

  63. 63.

    Baud

    February 27, 2017 at 10:07 am

    @Tripod:

    Trump did well with union members, but were there any unions that officially endorsed Trump over Hillary?

  64. 64.

    Ohio Mom

    February 27, 2017 at 10:08 am

    @ThresherK: Everyone screws up block grants. That’s their purpose!

    You just must happen to have more information on what goes on in the Lone Star State than what goes on in other places.

    The current matching funding system allows for increases, block granting is the opposite: it creates caps.

    All this stuff about how block granting will give states more autonomy, I mean “freedom,” is nonsense. They already can shape their Medicaid programs.

  65. 65.

    schrodingers_cat

    February 27, 2017 at 10:11 am

    Yesterday I was out grocery shopping, saw a man in overalls, unshaven and looked tired and his eyes were red. I flinched when our gaze met. I remembered the the shooting in Kansas. He smiled sheepishly and continued his shopping. I smiled too. I felt bad for racially profiling him in my head.
    I have worked in labs where I was the only woman but never have I been so keenly aware of how different I am.

  66. 66.

    amk

    February 27, 2017 at 10:14 am

    @Baud: police union. I think the ice nutz.

  67. 67.

    Barbara

    February 27, 2017 at 10:15 am

    @aimai: There is a particular streak of human idiocy that elevates small risks and problems while ignoring gaping dangers and horrifying events. Thus, we worry about airplane crashes even as we text while driving. In this case, we mourn the loss of people’s ability to buy mini-med plans that are all but worthless, while greatly discounting the experience of people who are going bankrupt for lack of coverage.

    Republican Voter: “My exchange plan doesn’t have my preferred doctor!”
    Republican Politician: “That’s outrageous! The obvious solution is for you to go without any care at all or to be driven into bankruptcy.”
    Republican Voter: “Wow, I knew you guys would understand.”

    The truth is, the Republican voter in this scenario thinks someone else is going to go without care or go bankrupt. I read about a guy in South Carolina who is mostly self-employed and who refused to sign up for an exchange plan on principle only to find out after open enrollment that he had an eye ailment that required surgery, and soon, or else he would go blind. They don’t think they are in this together with the rest of us. Until they do, they won’t change.

  68. 68.

    dr. bloor

    February 27, 2017 at 10:15 am

    @Tripod:

    Funny you should mention those folks…

    The cognitive dissonance and mental gymnastics are dizzying.

  69. 69.

    Baud

    February 27, 2017 at 10:16 am

    @amk: Right. I should have specified industrial unions, since that’s what was mentioned in the comment I was responding to.

    @schrodingers_cat: I’m very sorry to hear about what you are going through. I know you’ve said you live in a very blue area, so I hope you have some like-minded people in your life that you can talk to.

  70. 70.

    Barbara

    February 27, 2017 at 10:18 am

    @rikyrah: When I visited my mother before Christmas she told me to stop worrying about stupid old people and whether their Medicare benefits would be protected. As she said, if they don’t want to take care of themselves it’s not my job to do it for them. There is just so much you can do, and her advice was to look out for my own generation and my children’s.

  71. 71.

    amk

    February 27, 2017 at 10:18 am

    @Baud: do they even have large industrial unions now? right to work and all that bs.

  72. 72.

    PK

    February 27, 2017 at 10:19 am

    @Kay:

    If I had to pick a group of white people who will be most harmed by Donald Trump is would be “near old” white working class. They have no assets. They often have debt. They had no health insurance prior to Obama. None. Some of them have never had health insurance in their lives.

    Well at least they”ll have the comfort of knowing that they’ll not be shot by a fellow white man while sitting in a restaurant watching basketball, or not be deported.

  73. 73.

    OzarkHillbilly

    February 27, 2017 at 10:23 am

    @schrodingers_cat: You can’t help it.

  74. 74.

    Major Major Major Major

    February 27, 2017 at 10:23 am

    @Barbara:

    I read about a guy in South Carolina who is mostly self-employed and who refused to sign up for an exchange plan on principle only to find out after open enrollment that he had an eye ailment that required surgery, and soon, or else he would go blind. They don’t think they are in this together with the rest of us. Until they do, they won’t change.

    Natural selection at work. I’m one of those horrible equality-of-opportunity liberals, and if he wants to go blind out of spite then it’s his right.

    They will never think this way because they’re authoritarians. Collectivism is anathema, unless there’s a common enemy.

  75. 75.

    Woodrowfan

    February 27, 2017 at 10:25 am

    @schrodingers_cat:

    @Kay: Please include leftier-than-thou, JS voting purity ponies in your too stupid to live column, too.

    Yes!! PLEASE!

  76. 76.

    ArchTeryx

    February 27, 2017 at 10:26 am

    Man, I was starting to actually get used to the idea that I was, you know, not going to die simply because Trump got elected. This article just brings the horror right back, full steam ahead.

    I did submit my story to my Senators and my Congressman (all Dems, since I live in Albany, NY) but I don’t know if it ever got used. Sounds like not. About the only good news in this is that the Republican governors are starting to get very, very antsy about virtually every health care dollar they get from the feds withdrawn. Take a good look at Kansas for what’s going to be all their futures if the Medicaid expansion is blown up and ACA dollars withdrawn.

  77. 77.

    schrodingers_cat

    February 27, 2017 at 10:29 am

    @OzarkHillbilly: Yes, but I don’t like prejudging people just based on what they look like.

  78. 78.

    delosgatos

    February 27, 2017 at 10:30 am

    @OzarkHillbilly: The bar chart’s not bad, it just would benefit from some labeling tweaking. Five seconds is a fair estimate for how long the back-and-forth took me.

  79. 79.

    SFAW

    February 27, 2017 at 10:30 am

    @dr. bloor:

    Funny you should mention those folks…

    The 23-year-old “progressive Republican” in that article is too fucking stupid to live. Or, would be, if a just God existed.

  80. 80.

    Major Major Major Major

    February 27, 2017 at 10:32 am

    @SFAW: I wouldn’t mind him if he were a democrat. He sounds like one.

  81. 81.

    ArchTeryx

    February 27, 2017 at 10:35 am

    @Ohio Mom: And shape Medicaid they did – to exclude as many entire demographic groups as they could, and impose income caps that make SNAP’s look like Scrooge McDuck’s vault. The #1 goal of Obama in creating the ACA was to plug these giant holes that excluded about 90% of the poor from health care of any kind. Reforming the individual insurance market was #2.

    A huge number (David probably would have the specifics) of the newly insured came from Expanded Medicaid. That number would have been made much higher, too, had not John Roberts allowed refusenik states. He has the blood of thousands on his hands for that.

  82. 82.

    laura

    February 27, 2017 at 10:42 am

    @Ohio Mom: Ohio Mom (((hug)))!
    The tender mercy of the states, which we all know, must balance a budget, will cut medicaid to do so. Cuts that never seem to get restored, so we can all expect to endure the worst and witness avoidable death and needless suffering.

    Anyone care to wager who’s going to be the first Aldo Moro in these united state as we are forced to go Bader-Meinhoff?

  83. 83.

    OzarkHillbilly

    February 27, 2017 at 10:42 am

    @schrodingers_cat: None of us do, but in your case you have to be extra wary for a reason. I am unsure of where you live, but out here there are probably exceedingly few people who might come to somebodies aid should they need it. I wish it was otherwise but vigilance is the price of life for all too many now.

    I don’t have to worry about it like you do but I all too well remember the feeling from living in some of the STL neighborhoods I lived in back in the late 70s, 80s, and 90s.

  84. 84.

    WereBear

    February 27, 2017 at 10:57 am

    In other healthcare news, I am moving into the eighth fabulous month of trying to make my health insurance make sense.

    Woke up the morning with the realization that they probably screwed up yet again: the latest turn down was contradictory. (This is like the fifth reversal. Or so I have been told on the phone. I have requested, pleaded, and demanded a letter that says all the things they have been telling me, to no avail.)

  85. 85.

    schrodingers_cat

    February 27, 2017 at 11:01 am

    @OzarkHillbilly: I live in a blue area of a blue state. I have lived in ME before which is like 99% white, I have ventured alone to places, where one would have stood out if they were from Boston. But this generalized anxiety is new to me.

  86. 86.

    Weaselone

    February 27, 2017 at 11:09 am

    @dr. bloor:

    I’m also getting a little sick of this “Hillary was a bad candidate” crap. Why was she a bad candidate? Which of her policies do you disagree with? She’s been in politics for decades, so what has she actually done that is so horrible? Shadows and fog don’t count. If you think there’s pay to play going on, give me an actual example. Just don’t feed me the BS Russians and uranium or Saudis and weapons sales tripe.

  87. 87.

    Baud

    February 27, 2017 at 11:10 am

    @Weaselone:

    Why was she a bad candidate?

    She had too many of the right enemies.

  88. 88.

    chris

    February 27, 2017 at 11:12 am

    @schrodingers_cat: I think Adam would tell you that situational awareness is a good thing. At the same time, I’m sorry you should ever have to worry.

  89. 89.

    dr. bloor

    February 27, 2017 at 11:12 am

    @SFAW: Yep. A high school grad with a well-paying union job is going to do really well in the Right to Work States of America.

  90. 90.

    Weaselone

    February 27, 2017 at 11:15 am

    @Baud:

    She had too many of the right enemies.

    Honestly, that’s just another reason people should have voted for her. Vote Hillary. She has the right enemies.

  91. 91.

    Barbara

    February 27, 2017 at 11:20 am

    @ArchTeryx: In retrospect, and perhaps for future efforts, I wonder if we could not have fashioned a more targeted incentive at these states. One potential penalty would be to withhold and/or refuse to renew any Medicaid waivers for any state that did not expand. This sounds like a small penalty, but most states rely on waivers in order to shape Medicaid managed care coverage. The justification would be that federal efforts need to be targeted at states doing their best to expand coverage. States would still receive money, just have less flexibility. The other potential penalty would be to reduce the match for the existing populations to the lowest available for any state. So Mississippi would have to suck it up and come up with California’s level of spending, which I am here to tell you it can’t do. At any rate, more targeted and less draconian measures would likely be just as effective.

  92. 92.

    SFAW

    February 27, 2017 at 11:35 am

    @Major Major Major Major:

    I wouldn’t mind him if he were a democrat. He sounds like one.

    Oh, bullshit. If he were a Dem, he would have voted for Jill Stein, and you know it. Because e-mails, Or purity. Or DWS rigged all the primaries.

    Go back to Red State, you Commie.

  93. 93.

    Gretchen

    February 27, 2017 at 11:36 am

    Sara Clift went to Kentucky to talk to those Republican voters. They knew the Republican said he’d get rid of Kynect, but they didn’t believe him. He couldn’t do that, they really needed it! Same with Trump – he told them what he planned to do, and they didn’t want to believe him. I don’t know how you get past that.
    Rick Santorum was on tv yesterday saying Obamacare is a disaster because people sign up for a year, only pay for nine months, then sign up for a new plan the next year. They don’t even try not to talk nonsense.

  94. 94.

    SFAW

    February 27, 2017 at 11:39 am

    @schrodingers_cat:

    But this generalized anxiety is new to me.

    Considering that MA has a large streak of redneck in it, that’s not unexpected — even without Fascist/Racist-In-Chief (and his lackey, Shitgibbon) in the White House.

    MA ain’t like any of the Deep Red states, but for a place as blue as it is, there are a lot of haters here.

  95. 95.

    schrodingers_cat

    February 27, 2017 at 11:42 am

    @SFAW: As a not too tall and not too dark person of female persuasion it has never been directed at me personally. Even now its not, but I still worry. That’s what’s new.

  96. 96.

    SFAW

    February 27, 2017 at 11:42 am

    @Gretchen:

    They knew the Republican said he’d get rid of Kynect, but they didn’t believe him. He couldn’t do that, they really needed it! Same with Trump – he told them what he planned to do, and they didn’t want to believe him.

    It’ll take a nipponized bit of the old sixth avenue el to get him to believe it, apparently.

  97. 97.

    Major Major Major Major

    February 27, 2017 at 11:43 am

    @SFAW: huh?

  98. 98.

    SFAW

    February 27, 2017 at 11:44 am

    @schrodingers_cat:

    Understood.

  99. 99.

    Starfish

    February 27, 2017 at 11:54 am

    @ArchTeryx: Have you written a letter to the editor or written an editorial for a paper near you? This is what is being encouraged by a lot of organizations who are trying to show that the ACA really did help people.

    I saw one story that someone local was trying to submit, and it was really weak. He was a man in his 40s whose medication, mostly mental health related, was about $1,000 a month that he could not afford without ACA. To me, that story is more about how outrageous the costs of prescription drugs have gotten.

  100. 100.

    SFAW

    February 27, 2017 at 12:01 pm

    @Major Major Major Major:

    Just a not-very-good attempt at a joke. I thought you might have been joking, because I’m not sure I could envision a Dem being such a clueless asshole — except for those BS-bots or JS-bots. But maybe I need to get out more.

  101. 101.

    Mark Regan

    February 27, 2017 at 1:09 pm

    Sorry about the sideways presentation, but the most meaningful bar charts on this subject are the enrollment slides McKinsey presented to the NGA at the end of last week:

  102. 102.

    Villago Delenda Est

    February 27, 2017 at 1:10 pm

    @Weaselone: Why was Hillary a bad candidate? Vagina.

  103. 103.

    EthylEster

    February 27, 2017 at 2:07 pm

    @aimai: Me, too. Where is the legend for color? “Mr. Mayhew” is a gem but WTF? And it doesn’t seem to matter to the commenters here.

    Makes me wonder….

  104. 104.

    Mingobat f/k/a Karen in GA

    February 27, 2017 at 2:26 pm

    @WereBear: Perfect.

  105. 105.

    Steeplejack (phone)

    February 27, 2017 at 4:22 pm

    Huh, Leicester City is putting a beatdown on Liverpool. Roughly equivalent to the Cleveland Browns blanking the Steelers.

  106. 106.

    Steeplejack (phone)

    February 27, 2017 at 4:24 pm

    @Steeplejack (phone):

    Oops, wrong thread. Won’t let me delete.

  107. 107.

    Monala

    February 27, 2017 at 4:53 pm

    @Kay: I was at a recent panel discussion for my US Senator on how the ACA had made a difference in people’s lives. Stories included a man who lost his job and had pre-existing conditions, a father whose soon-to-be-18 teenage son was diagnosed with a life-threatening condition, and a doctor who shared about how she had long treated children with Medicaid whose parents couldn’t help them much because of their own untreated health issues. Now with the ACA, she can over health care to the parents, too.

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