The Senate revised draft of their tax bill paid for by Medicaid cuts is due to drop sometime this afternoon. So I want to talk about a possible future path where the bill fails. Doing nothing is a plausible option that will not make things significantly worse or more expensive. Sabotage and neglect have been priced into premiums for the individual market and Medicaid will be at risk due to regulatory rule making and active localized monkey wrenching but that is a plausible baseline in a future where the BCRA is defeated.
There's a sentence for the ages… via @MEPFuller https://t.co/uql3zJUCVb pic.twitter.com/PuELgeI1TJ
— ☪️ Charles Gaba ✡️ (@charles_gaba) July 13, 2017
I think Matt Fuller is reading this wrong.
CSR ceases to be a leverage point on 12/31/17. After that almost every insurer that is on the Exchange will have priced their products as if CSR was not to be paid. If CSR is paid, they’ll pocket large profits. If it is not paid, it is business as usual. The threat of yanking CSR funding has an even more limited life span than the end of the year:
More subtly, let’s imagine that CSR has been paid through November 30th. If they were not paid in December, the carriers would have to use their reserves to cover the expenses but insurers would not flee the market before the end of the policy year. They might be able to reprice their 2018 policies based on the lack of the regular, early notification of accounts payable that they get before the CSR money is actually transferred in mid-December. They would take a hit, but it would not be a show stopper.
Moving to payment through Halloween but no payment for November and December, most insurers would have sufficient reserves to eat the loss and re-adjust their prices for 2018 while their lawyers get warmed up. Moving back another month, thinly capitalized insurers will start being in trouble as they may be hitting a Premium Deficiency Reserve (PDR) event that threatens their Risk Based Capital (RBC). At that point, some state regulators would be forced to either shut down insurers or allow insurers to terminate the CSR policies immediately. Well capitalized insurers could survive longer and jack up their rates for 2018 with state support.
CSR threats are valid through the end of August and then weaken quickly by Thanksgiving.
More importantly, chaos and sabotage is old information. Many insurers have pulled out of the ACA individual markets because of the cost of uncertainty due to sabotage that has been ongoing since 1/20/17. But that is old news.
Only new and unexpected monkeywrenching would increase the level of chaos in the individual market.
randy khan
The loss of leverage over CSR really does shorten the horizon for efforts to force Dems to capitulate to a lousy compromise. (I don’t think they’d cave anyway, but it’s nice to know the threat has a time limit.)
rikyrah
Thank you for the accurate description, Mayhew.
NotMax
Expect the unexpected.
satby
@NotMax: especially since they aren’t tinkering to achieve any desired healthcare outcomes, just the tax repeal. They don’t understand the policy ramifications at all really, just that they need to get x billion $$ for their bosses out of whatever turd they produce.
Betty Cracker
The best way to undermine Trump right now is to defeat this massive transfer of wealth from working people to fat cats disguised as a healthcare reform bill.
rikyrah
@Betty Cracker:
Agreed
Yarrow
@Betty Cracker:
QFT. I don’t know if the Russia stuff might be getting so much attention that people are kind of caught up in it and aren’t calling as much. Is there any word from those that know about how the call volume to Congress is?
Brachiator
The GOP leadership is also trying to get out from under the burden of having to replace Obamacare with something better. They keep trying to distract their constituents with lectures about the free market and individual choice when it comes to health insurance coverage.
Betty Cracker
@Yarrow: I haven’t heard anything about call volume, but even when it was considered high, it was pathetically small, IMO. A few hundred calls a day is apparently considered an inundation.
Yarrow
@Betty Cracker: Yeah, that’s just sad. Although when the House was getting close to passing their version you could hardly get through to some Reps, so I guess they do occasionally get overwhelmed with calls. Since only a few hundred calls is a tsunami of calls, then every call carries more weight. Speaking of that, I need to go call.
rikyrah
@Betty Cracker:
I honestly believe it’s because they fix the phones.
Yarrow
@rikyrah: I’m sure some of them do. There were anecdotal reports, even from people who comment here, of people visiting their Reps’ offices and hearing the phones ringing off the hook, so I’m not sure all of it is.
Sab
@rikyrah: I call from Ohio, and I get an answering machine. Portman’s voice asks for my name, address, phone number and e-mail. I always give the info and my message. I never hear back from them. It’s very disheartening, which is undoubtedly the point. I see why calls are so low. I feel like what’s the point. I still keep calling.
Yarrow
@Sab: No one ever picks up the phone at my Senators’ offices. It’s a recording. I first get the option to leave a message (voicemail), but if I wait then there’s an option to talk to someone. I don’t always get someone–sometimes it goes through to a busy signal and I get disconnected. But the last few times I’ve reached a real live person.
Have you tried calling local offices? The Senators may have a few in the state, and ones in less populous locations may not get as many calls. I called one and completely flustered the woman who answered the phone. She sounded like she’d never spoken with a constituent before. She learned because I had lots to say. Heh.
Sab
@Yarrow: Yeah., I have done that a few times. I try not to tie up the local lines because those are for constituents with real problems that need addressing. In retrospect that is stupid, because Portman’s office has no interest in addressing the problems of anyone who isn’t a major donor.
Sherrod Brown’s office, on the other hand, has returned my call every single time I have called. I have Republican relatives, and his office has returned their calls every single time they have called.
Constituent service is a big part of their job. Republicans don’t do it any more. Democrats still do.
Yarrow
@Sab:
Me losing healthcare is a real problem they need to address. I don’t feel bad calling any one of their offices.
Ben Vernia
Re: CSR being paid despite insurance co. assumptions it won’t be: Aren’t profits capped under ACA?
rikyrah
MAYHEW…
Are you going to do a post about this?
4: The bill will still slash Medicaid by more than $700 billion. This will explode to more than $2 trillion after this decade. pic.twitter.com/Gc4kUIDo6m
— Topher Spiro (@TopherSpiro) July 13, 2017
Keeping taxes on investment income in the Senate bill means this bill is basically just about destroying Medicaid. https://t.co/CwPPJ04KJX
— Matt Stoller (@matthewstoller) July 13, 2017
rikyrah
Xu Ji et al.: Disruptions in #Medicaid coverage can have costly consequences. #churn https://t.co/zbTD88rJrf
— Adam Wilk (@AdamSWilk) July 13, 2017
rikyrah
This is disastrous. A refresher on why: https://t.co/zMeYWclDEJ https://t.co/mDipesc5Wc
— Indivisible Guide (@IndivisibleTeam) July 13, 2017
rikyrah
? Check https://t.co/b3Nmy33xpR for the LOCAL offices of your senators and call those. Today and each day.
— Ben Wikler (@benwikler) July 13, 2017
Sab
@Yarrow: I am calling now. My stepdaughter and her autistic child agree with you.
David Anderson
@rikyrah: tomorrow that post is already scheduled
Mike J
Talking about Russia:
Talking about health care:
Sab
If Kay is reading these, I am drafting a letter to the editor for my local paper for the Senate race, probably Sherrod Brown v Josh Mandel. My focus is constituent service. I know you have stories of constituent service from Brown’s office to red Ohio. Can you save those for us to include to letters of the editor before the election. I live on a blue county so we assume Brown will help us. Ohioans need to realize how much he helps red parts that didn’t vote for him. He has been everyone’s Senator.
Sab
If Kay is reading these, I am drafting a letter to the editor for my local paper for the Senate race, probably Sherrod Brown v Josh Mandel. My focus is constituent service. I know you have stories of constituent service from Brown’s office to red Ohio. Can you save those for us to include to letters of the editor before the election. I live on a blue county so we assume Brown will help us. Ohioans need to realize how much he helps red parts that didn’t vote for him. He has been everyone’s Senator.
Also debbie and Ohio Mom who live in reddish districts.
Kay
@Sab:
I will. He really is a good Senator, just in terms of serving the whole state. I know the CEO of the hospital here contacts him personally on Medicaid/rural hospitals because Brown joked about it once. The CEO gave nasty quotes on O-Care and Brown was laughing because the same guy lobbies him constantly for more Medicaid money.
Brown understands trade (which is fairly unusual) and I know he has worked on sugar subsidies issues for the candy company here. The US was subsidizing sugar producers (because agriculture is really politically powerful) which brought prices up for the candy company. They want to use US sugar and they can if the government stops propping up prices at the behest of US sugar producers.
TenguPhule
Oh come on, now you’re just asking for it.
Trump: Hold my beer, bitches!
Sab
@Kay: Thanks Kay. You are a treasure for this state.