I’m trying not to swear as much in public writing anymore as I like my communications director too much.
But WHAT….
Avik Roy on how he sees the Senate bill in a Vox interview:
There’s been a lot of commentary on the left about how this bill allegedly erodes the safety net. It does no such thing. It replaces the Medicaid expansion under Obamacare with tax credits to buy individually purchased insurance.
His point is that people who make under 133% FPL can buy a 58% Actuarial Value (AV) plan for between 2.0% and 2.5% of income. Voila, it is the same.
REALLY!
Currently, people who make under 100%-138% FPL are either eligible for Cost Sharing Reduction Silver plans at 94% AV or qualify for Medicaid expansion. In Expansion states, people making under 100% of FPL qualify for Medicaid expansion at 98% to 100% AV. People in non-expansion states who earn under 100% FPL are better off as they currently get nothing and they could get something.
He is arguing that a 58% AV plan will be the same thing. A 58% AV plan has a $7,000 or more deductible in 2018. 94% CSR plans are $300 deductibles. Even being charitable and saying that the state stability and innovation funds can be used in place of CSR funding for these populations, the money is insufficient to bring the AV up to anything remotely close to what they are currently receiving through Medicaid or CSR Silvers.
Under the most favorable reading to Roy, he is advocating $2,000 or more individual deductibles for people currently on Medicaid expansion. We know from the Rand Health Insurance Experiment that there is a significant population who has worse health outcomes when their care is subject to light cost sharing (hint, $2,000 or 12% or more of single individual income is heavy cost sharing). And that population is people with low incomes**.
Importantly it did find that one population saw detrimental health outcomes as a result of paying more for health services- low-income folks
— Emma Sandoe (@emma_sandoe) June 25, 2017
So there is not just a difference in degree but in kind between Medicaid and Silver CSR cost sharing and his preferred cost sharing levels for people with low incomes. That difference is sufficient to say that Medicaid as we know it is destroyed in concept and execution under the Senate bill for the Expansion population.
** Ware JE Jr, Brook RH, Rogers WH, Keeler EB, Davies AR, Sherbourne CD, et al. Comparison of health outcomes at a health maintenance organisation with those of fee-for-service care. Lancet 1986;1(8488):1017-22.
Marcopolo
Hello & good morning. Have you seen this tweet commentary on how the state waiver provision in the AHCA is written & do you have any thoughts on it?
https://mobile.twitter.com/nicholas_bagley/status/879319280160047105
westyny
Is there a way to reach Roy to disabuse him of his misunderstanding?
MobiusKlein
So Avik Roy is actually a hack, not a Very Serious Person, engaged in Very Serious Debate?
Well knock me over with a feather!
Chris
How the fuck do you buy a plan with tax credits? A person with zero income isn’t going to magically become able to buy a plan just because he’s not being taxed on that zero income.
Dr. Ronnie James, D.O.
Mr. “Medicaid makes people sicker” Roy is, was, and always will be a hack. One underexposed downside of tax credits is that they are a terrible way to help people with unstable incomes pay for care. Care to guess who has the most volatile/unstable income?
D58826
@MobiusKlein: Yep he was supposed to be one of the serious/sane ones. I guess it is a requirement that before you can become a republican VSP you must under go a lobotomy.
schrodingers_cat
Is Avik short for something?
p.a.
Q: if Cali has 5th/6th largest economy vis actual nation-states why can’t they seem to design a single payer system that works, as Euro nations have? I mean works on paper even, not necessarily politically.
Chris
@D58826:
I’ve been saying for years that the formulation “not all conservatives are stupid, but most stupid people are conservative” is exactly backwards. Conservatives have no monopoly on stupidity – there are idiots everywhere. What’s remarkable about modern conservatism isn’t that it includes stupid people, but the extent to which is consists of nothing but stupid people, or people who have to go along with the stupid or face excommunication.
p.a.
@D58826:
He’s not stupid. He’s compensated to play stupid. His audience requires it.
D58826
The McConnell seat steel is about to bear fruit. SCOTUS will hear a case of the baker who won’t sell a wedding cake to a gay couple and they will hear the Muslim ban.
Now maybe the cake decision will go 5-4 to the couple if Kennedy remains on the court but the Muslim ban? But I suspect SCOTUS would have voted differently with Garland on the court.
D58826
@p.a.:
well less painful than a lobotomy I guess. But I’m sure if the lobotomy is required at some point HIS medical plan will cover it.
rikyrah
Roy is a piece of shyt, and you need not be polite Mayhew.
rikyrah
BOMBSHELL from @sarahkliff. Insurance industry: Senate bill will “cause most small employers’ premiums to go up.” https://t.co/kWDudxJzqN
— Topher Spiro (@TopherSpiro) June 26, 2017
rikyrah
Why are Mitch & @GOP actively trying to crash the economy w/Genocide4TaxCutBill? US – so goes the globe? Are they stupid? #GOPMathFail 1/
— bardgal (@bardgal) June 26, 2017
Or is this coming health industry collapse = economy crash their long-term Reichstag Fire so they can takeover/hold power with forever? #SOS
— bardgal (@bardgal) June 26, 2017
sam
@Chris: a tax “credit” can actually go to someone with an income but no income taxes – that’s exactly how the Earned Income Tax Credit works for most people. You’re thinking of a tax deduction.
That being said, the rest of what Roy says is complete argle-bargle.
D58826
@p.a.: My totally not expert guess would be a couple of things:
1. CA isn’t a sovereign nation so things happen in the other 49 and at federal level that bleed into CA
2. even in liberal CA the tax burden for single payer is more than the electorate is willing to pay
3. providers can flee the state if the required cost/service controls are to great (this may be a variation of 1).
smintheus
@westyny: No, you can’t reach Roy. He’s not advancing a genuine argument, he’s trolling.
D58826
@sam:
To many details and not enough brain cells. But I think the issue is whatever the credit might be a for low income person, that person will not be able to afford the premium even with the tax credit.
But her emails!!!
@p.a.:
Because they’re part of an integrated nation state. They don’t have the control over their borders, laws, tax, fiscal and monetary policy that even a small nation does.
1. How do they get the Feds to sign off on the use of Medicare and Medicaid funds to support single payer
2. California send a lot of money to the Feds that gets converted to roads in Mississippi and tax cuts in Wyoming. That’s money not available for Health Care spending in the state
3. How do they keep companies from relocating to Nevada or Texas in response to taxes/requirements needed to create a single payer system?
4. There’s no barrier to travel. A sick person from anywhere in the US can travel/relocate to California for treatment. California’s got to deal with that.
5. Like most states, California requires itself to have a balanced budget. How do you reconcile this with the need to continue spending on gealthcare during a downturn?
Chris
@sam:
But in that case, the money doesn’t come to you until next year, right? My earned income tax credit for 2016 doesn’t come until 2017. So how would that help me get health insurance in 2016?
Chris
@D58826:
And this, of course.
?BillinGlendaleCA
@sam: There are different kinds of tax credits, a non-refundable tax credit only takes your tax owed down to zero, a refundable tax credit will pay even if it exceed your tax payment. The EITC is a refundable credit.
Villago Delenda Est
Avik Roy is a fucktard. There. I said it.
D58826
SCOTUS on travel ban:
https://twitter.com/gsiskind/status/879349868376010753
OR
https://twitter.com/JuddLegum/status/879347048654483456
HELP
Bobby Thomson
Hey, Politifact would score your correction as lie of the year. Which is why Politifact jumped the shark.
Villago Delenda Est
@D58826: It’s all in the spin. Broderism rulz!
D58826
@?BillinGlendaleCA: I sometimes wonder if we could make a sizable dent in the cost of medical coverage just by enrolling every one in Medicare. No more paper work, no more profit margins, no more ins. company. TV ads.
schrodingers_cat
@D58826: I trust Siskind on immigration related matters. He is an immigration attorney. I have followed his blog and now his Twitter feed since 2007.
I have no idea what Legum’s credentials are on immigration related matters apart from being a Pundit.
Carlito Brigante
@sam:
Yes. These are refundable tax credits which are like EIC which you noted.
hitless
@D58826:
The critical details are:
1) Is the tax credit refundable? If not, then people who pay little or no income tax see little or no benefit. The EITC is one of the few refundable tax credits..
2) Even if the credit is refundable, is the money enough to buy quality insurance?
All of this is really an exercise in sophistry though…you can work backwards from the goal of the legislation…fundamentally the goal is to reduce government spending (primarily in medicaid) enough to allow a large tax cut to be passed (if the cut is not paid for, it would require more than 50 votes in the Senate to pass I believe).
It’s not about providing better care or anything like – it’s simply enacting the political and philosophical position that “my” tax dollars should not be used for “other” people’s healthcare. If Avik Roy wants to honestly argue a position, that’s the one to defend.
trollhattan
O/T The Roberts court has been busy, with predictable results.
Balls and strikes, people.
David Anderson
@p.a.: Money and federal laws are the problem for California. When things slow down, I have a couple of half written posts on the issues with state level single payer from a mechanical point of view.
zhena gogolia
@D58826:
I don’t know, but the Trumpanzees in the WaPo comments section are exulting, so I assume it’s bad.
gene108
@D58826:
The real fruit they want is to make sure none of the Voter ID challenges making their way through the courts change existing law, once the SCOTUS gets done with it.
Republicans know their continued success in elections relies heavily on Citizen’s United allowing unlimited money to flood down ballot races and voter suppression tactics to disenfranchise non-white voters.
gvg
People don’t understand insurance. It’s always your money is being used for someone else’s care or fire damage or accident. Everyone pays so everyone has more security because almost no one can afford the big hits. If you don’t have a concept of insurance, every one has to be extremely risk adverse which means everyone saves most of their money and can’t risk trying anything new, or expanding their business, or just investing. This means all the money is hidden in mattresses and no one has any money to spend including at your own business which leads to lay offs and starvation or close or a medieval economy, definitely not capitalism. Basically there is nothing wrong with your money saving other people, it’s really making your whole lifestyle possible.
Also no insurance leads to a lot more panics, sort of like bank run panics, only it’s for every kind of business. Economic ignorance is going to be the death of us all. a lot of it is really counter intuitive, like how unlike a family budget the National Debt is. We have been going backwards on education the last few decades, mostly by being too cheap so I am afraid to propose economics being a required subject like math or English. I am sure in the current time it would be implemented in a harmful way. However in general I think it should be required, especially macroeconomics.
D58826
@schrodingers_cat: Here is the WAPO take –
All smoke and mirrors and following the little bright ball. Der Fuhrer has figured out a way to turn most of the country into the cat chasing the laser beam. While he and his crooked cronies are stealing everything that isn’t nailed down and as they look for a hammer and saws to get what is nailed down as well.
gene108
@rikyrah:
This doesn’t get enough attention, but sucking $880 million dollars in direct government payments for services out of the economy is going to leave a mark and cause a lot of folks to lose their jobs and create a downward spiral of contracting the economy.
But hey, Betsy DeVos can buy another $3 million vacation home with the tax money she saves, so it all balances out the thousands of healthcare related workers, who will lose their jobs.
Your a home healthcare nurse? What do you do for a living, when all your at-home patients get shipped to be warehoused at nursing homes, because Medicaid no longer has money to pay you?
I’m guessing apply to be domestic help at the new DeVos vacation home.
gene108
@gvg:
Doesn’t help matters that the billionaire Republican sugar-daddies are paying for people to produce crap papers, like Roy’s noted above, in order to keep people confused.
D58826
@gvg: W/o a concept of insurance would the age of exploration ever happened? Someone had to spread the risk on the shipping that opened the new world. Heck as vile as it may be even slavers insured their ships and slave owners insured their slaves against economic loss. The title of my INS 101 text book from 1966 – ‘RISK AND INSURANCE’ back in the day when insurance wasn’t a 4 letter word. But I’ll bet the Koch brothers have every last thing near and dear to them insured.
But making sure kids have insurance coverage for health issues. NO never. work of the devil.
D58826
@gene108:
We kicked this around a bit on a thread yesterday, For most of the 1% the actual dollars they will get in tax breaks doesn’t even amount to a rounding error. Given her fortune or the 80 billion dollars that the Kochs are worth, would they even notice an extra 3 million dollars a year in terms of life style. I guess Der Fuhrer could apply a few more layers of gold foil to his penthouse but…
Chris
@gvg:
Yep. We’ve basically reached a latter-days-Soviet-Union level of madness, sacrificing everything on the altar of an ideology that we cling to like a religion.
Enhanced Voting Techniques
@Chris: I rather seriously blame creationism for – by turning the idea that the Flintstons is a documentry in to a matter of faith they conditioned a huge chunk of the Right to be willfully stupid.
Cermet
@D58826: There will be NO ruling on the ban; by the time the court will hear the case, the Ban will be long over and they state that if such, the court will not hear the case. So, once again, the court ceded power to any crazy POTUS (but never to sane or better known any democratic POTUS.)
Chris
@Enhanced Voting Techniques:
Yeah. I’ve said for years that the single scariest statistic in the United States is that fully half the population refuses to “believe in” evolution. (That’s evolution of any kind, including the “well, evolution and all that happened, but we think there was a God directing it from behind the scenes/we think that’s just how God made the universe” type dodges). That’s a terrifying statistic. The kind that you normally expect to find in pre-industrial societies and failed states with no education to speak of and superstition running rampant. That level of willful ignorance was always going to need to be reckoned with somehow, either that or wreck the country altogether.
Ryan
@westyny: On the last edition of The Weeds, Ezra mentioned he was wanting to get Roy on the Ezra Klein show this week. Ezra will expose his mendacity.
wenchacha
CNN, for some reason, is sharing some statistics, comparison of various patient outcomes, all about Medicaid. It is like there are differences in states that expanded Medicaid and states that did not. Two women in Texarkana, similar health problems, but one on the Arkansa side of town, one on the Texan. Same hospital, but entirely different coverage story for the pair.
This story was always here. It was always here, for YEARS, even. CNN is actually telling us why it is so hard for Republicans to make decisions about this, because of how much it will hurt the people who voted for them. This story was Always HERE.
jake the antisoshul soshulist
@Enhanced Voting Techniques:
This a hundred times. Opened the door to disbelief of anything the doesn’t fit their ideology.
goblue72
Oh, so you mean, contra Democratic technocrats, Avik Roy is NOT an honest interlocutor but is actually just another right-wing propagandist? You mean, “academics” who can’t get actual academic appointments at real universities and who instead start “think tanks” are really propagandists for whomever is cutting their checks, and not objective analysts?
Quelle surprise.
Jim, Foolish Literalist
@goblue72: what the fuck are you babbling about, Dwight, you ridiculous little poseur? (sticking with your French theme, petit con)
EthylEster
@D58826:
FYI: CMS generates tons of paper.
Maybe you meant that about patient.
Ruckus
@Chris:
That’s exactly how you can buy a plan with tax credits rather than subsidies.
You fucking can’t. Which of course is their point exactly.
Wealth determines your value as a human. You have less wealth, you are less worthy of living. Ergo if you don’t have enough wealth to use tax credits you don’t deserve to live.
This is the entire course in Conservatism 101-101,000,000. It covers all years, from 0-2017.
Everything else is fluff to get people without wealth to vote for them.
Ruckus
@D58826:
It isn’t the absolute amount of wealth, it’s the pecking order of who has more. Once you are comfortable, well fed, have your own planes, houses in multiple states/countries, servants, etc it’s all a pissing contest. Which of course is where the term Tinkle Down Economics™ originates.
goblue72
@Jim, Foolish Literalist: I’ve long since stopped taking you seriously bub.
Jim, Foolish Literalist
@goblue72: OH GOD NO!
You make me laugh, Dwight.
Uncle Ebeneezer
@David Anderson: Awesome! I was just going to ask if we might get a CA Single Payer post. My collective FB Lefty friends are all in pitchfork/DemsAreTheREALEnemy mode and I’d like to have some better understanding about how feasible the plan was and how much Democratic Sell-Out was really involved in pulling the bill.
Chet Murthy
@Jim, Foolish Literalist: What the shitbird (Dwight) doesn’t realize, is we haz pie filter. Only time I see anything of his, is when somebody else comments on it, and I have the curiosity to go back and see what the inciding inanity was.
sam
@D58826: @Chris: Yes. These things are true – even a refundable tax credit is in NO WAY sufficient to (a) pay for comparable health coverage to what poor people on medicaid have now and/or (b) pay for it now, as compared to down the line when this theoretical credit actually shows up.
I was just noting that a tax credit could technically exceed ones tax liability. That does not mean I think this is in any way a good idea.