Earlier this week, the Supreme Court ruled that the federal government owed ACA insurers $12+ billion dollars in risk corridor payments. The non-payment of risk corridor obligations in a timely manner led to a dozen or more small insurers including the co-op start-ups to go bust before the start of the 2017 plan year. Quite a few of the co-ops had low premium levels in 2014 and 2015. Monopoly markets proliferated. Monopoly markets have higher gross premiums all else being equal.
Yesterday, Coleman Drake and I wrote in the Conversation about the effects of silver-loading and zero premium plans in the ACA market:
Did President Trump’s effort to sabotage the Affordable Care Act backfire? … We discovered that more than 200,000 people, using the Healthcare.gov platform in 2019, gained insurance in 37 states due to the Trump administration’s actions. This finding may even be more important now as massive unemployment from the coronavirus pandemic leads to huge losses of employer-based insurance coverage – and ultimately more people enrolling in the marketplaces.
Without those zero-premium plans, our analysis showed more than 200,000 lower-income marketplace enrollees would have gone uninsured.
Another 60,000 would have gained insurance had California and New Jersey eliminated regulations that prohibited zero premium plans — and if Indiana, Mississippi and West Virginia had adopted silver loading. Many more likely got coverage in states not included in our study.
All this is clearly not what the Trump administration had in mind when it cut subsidy payments. Other changes to the marketplaces probably masked some coverage gains that occurred. Notably, cuts in the public outreach for Healthcare.gov, along with the elimination of the individual mandate, decreased enrollment. But the popularity of zero premium plans resulting from silver loading likely stopped much of the damage – and Trump’s attempt to destabilize the marketplaces.
Sabotage may have been the intent of these policy actions. It produced chaos and it produced disruption that lowers enrollment as administrative burden to switch increased or renewal options became more complex.
But the oddities of the ACA subsidy structure mitigate or at least redirect the damage. Perfectly competitive markets with multiple insurers offering near substitutes that are tightly clustered around a common price point lowers subsidized enrollment. Dysfunctional markets with large monopoly pricing and no Medicaid Expansion makes subsidized plans significantly cheaper than markets that are competitive with significant state support and investment for the ACA in the form of Medicaid Expansion and/or Basic Health Plans.
The effective policy implications of the Trump Administration and Republicans in Congress has been to hammer non-subsidized buyers with higher premiums while the higher premiums have increased plan affordability for the subsidized population. So it may have been intended as sabotage or monkey wrenching for some desired political effect, but has it really been sabotage? I’m stuck on this and I have been stuck on this for a while now.
Cheryl Rofer
The constant question about Trump and the Republicans: Do they deliberately want to kill people and tank the economy, or are they blinded by their ideology?
I have to admit that I haven’t figured this out, but either way, they should be removed from any power, down to dogcatcher, and shunned by all. Yes, I am for bringing back shunning.
OzarkHillbilly
@Cheryl Rofer: Porque no los dos?
Baud
@Cheryl Rofer:
Agree with @OzarkHillbilly. It’s also important to keep in mind that we have a broken political culture in which a number of people in the media and elsewhere will blame Democrats for not stopping Republicans from hurting people. It’s a rotten feedback loop that helps maintain and even worsen the current system.
Sab
So they tried to blow it up and failed, but they did blow up little insurers that tried to enter the market?
Cheryl Rofer
@OzarkHillbilly: @Baud: Can’t disagree.
jeffreyw
@Cheryl Rofer:
Cheryl Rofer
@Baud: Good luck with getting through the ‘rona!
Barbara
Trump wants poor and dark people to die. The flaw in his plan is that he can’t figure out how to do it without jeopardizing old white people in nursing homes.
Jado
@Cheryl Rofer:
The ideology requires the death and destruction of large swaths of people and the economy must be restructured to benefit the fewest number of “winners”. The little people must be made to suffer so the chosen can prosper.
Ruckus
@Jado:
Not prosper, excel at greed and theft. They will then have enough money to afford to pay people subsistence wages for their bidding and then still have a significant bank account, which proves they are superior.
Nicole
John Rogers did a good Tweet thread today about the mindset of the right-wingers in power now:
https://twitter.com/jonrog1/status/1255416699752415234?s=20
(Thread breaks twice, but he has links so you can keep reading. It’s 15 tweets total, I think. Bonus Columbo reference included!)
Subsole
@Cheryl Rofer:
You’re too nice. I am thinking the pillory.
Immanentize
@Nicole: This is a great well written line from #13 in that thread:
That is some clear, concise — and true! +- writing.
Subsole
He’s a little far left for me, but a man named A.R. Moxon summed conservatism very well on twitter (of all places):
‘The animating force of conservatism is the liquidation of the isufficiently profitable, for a profit.’
laura
These guys say yes, it is indeed sabotage https://youtu.be/z5rRZdiu1UE
Immanentize
@OzarkHillbilly: Are you still here? OT. What wood treatment can I use to strengthen wood for outdoor use?
Your usual go to is Watcos…. Anything else? Cedar chair replacement leg at issue.
Subsole
Personally, I think conservatism is very poorly-instituted feudalism. It has always been feudalism. Every century or so they throw a new coat of paint over it to make it look current. But yeah. Feudalism. And I feel I am insulting feudal lords by the comparison…
oldster
“So it may have been intended as sabotage or monkey wrenching for some desired political effect, but has it really been sabotage?”
I’m not sure I understand the question. Isn’t sabotage determined by the intention rather than by the success?
So maybe your question was, “has it really done any damage?” or “has the sabotage been effective?”
Subsole
@Baud:
This is a good point. You see it when conservatives get interviewed in foreign countries – they are utterly helpless when someone actually holds them to a standard.
Nicole
@Immanentize: So true. Remember GWB (it was GWB, I believe) hearing from that voter working what, 2 or 3 jobs to make ends meet and raving about how amazing it was? No, it was not amazing, GW, you dumb bucket of hair; it was terrible.
schrodingers_cat
@Baud: Especially the Journobros on Twitter. Now we have the BS wing who continuously shit on the elected Ds.
WereBear
Since these people are evil, they have what is known in literary terms as “sowing the seeds of their own destruction.”
Kristine
@Nicole: Thanks for the link–really good thread.
Ohio Mom
I’m filing this example of a failed effort to weaken the ACA under “We’ll have to pass it to see what’s in it.”
At the time I thought Pelosi was referring to health and social effects that would only be seen far in the future — say, a permanently reduced number of dialysis patients ten years hence, or high school graduation rates going up because families were enjoying better health — but now I see it can also refer to how sturdily the ACA was constructed.
Ruckus
@Cheryl Rofer:
They do not want to sabotage the economy. Well not in the manner of wrecking it. In the manner of stealing it, yes, yes it is sabotage. They want a working economy, one where everyone works for them and they get all the profit, every damn penny of it. They don’t want government because government spends their money in ways they don’t profit from. They want all the people they don’t like – which means they are not profiting from – to die. Unless they can work for free and can be owned. They want to own all the means of production and that means people – slavery. They want corporations to be free of all liability. Not having a government helps with that. trump is not the ultimate capitalist, he is just a horrible inarticulate, lying, ignorant, moldable enabler. They do not want a government of the people, by the people and for the people. That takes away everything they want.
Another Scott
@Nicole: +1 Excellent.
Thanks for the pointer.
Cheers,
Scott.
Bruce K
From the webcomic “Freefall” (relevant link here):
“I was struck by the unfairness that others should have their money and I don’t.”
(Don’t worry: his plan fails, and he ends up cleaning toilets in a Cricket Burger restaurant.)
L85NJGT
You can’t go home again. They believed some market driven, pre-Obama status quo would return. With employer provided non-profit insurance, and a GP in every small town. That that system was in a state of collapse, and that was a large part of the impetus to the ACA, is lost on them.
patrick II
@Barbara:
He doesn’t care about old white people in nursing homes. Most of them aren’t rich and many don’t vote. Rich people , and if they happen to be white even better, who vote and who can buy even more votes are who he cares about.
It’s a mistake average white people make — that Trump is on their side. He’s not, like the rest of the Republican party, he uses them by appealing to their worst instincts for his advantage. If you are a working white man in a meat cutting plant he will send you to your death just as quickly as a black or hispanic. But for many, as long as they ain’t takin gubm’t welfare, it’s O.K.
schrodingers_cat
@Cheryl Rofer: They think they are special, that the havoc they wreak won’t affect them.
LuciaMia
“The Gang That Couldnt Shoot Straight.” Sometimes thats a good thing.
Amir Khalid
@Subsole:
That’s actually a good way to look at it: conservatism as an effort to revive feudalism.
Enhanced Voting Techniques
I think we can’t also rule out “stupid and lazy”; my bet was they were using the money to pay for Trump’s stupid wall.
Zelma
Thanks for the Rogers thread. I wish I knew how to send it to my best friend because I keep trying to get the point across to her that we have a “ruling” class that has no sense of responsibility to anything beyond their own wealth and power. “Ruling” classes are almost always chiefly interested in maintaining their own position, but a capitalist ruling class takes selfishness to a new level. There once was the concept of noblesse oblige, that having wealth meant that you “took care” of those for whom you were responsible. Now we can complain that this was paternalism and it was as often ignored as it was adopted, but the concept did exist. It is completely foreign to the current crop of Republican politicians and their masters. Sad.
Mike in NC
Nobody could have predicted that having Fat Bastard in the White House would cause chaos and disruption, said all the people who’d spent the past 40 years living in a cave.
Enhanced Voting Techniques
As far as “What are the Republicans really up to” I think there is no strategy on their side, they lazy, lazy and incurious people. Look at Florida; the solution to unemployment, break the state UI system because that’s easier than fixing the economy, Georgia; they open barbers, hair salons and masseuses because the senior Republicans want their hair done and an excuse to their family to go get a session with a sex worker The meat packing industry, ignore every directive sent to them until the disease trashes their work force(in a business so tightly on the edge they won’t let a worker go to the bathroom, 22% of the work force too ill work and another 1-5% dead in a week is a disaster) . Trump/ Jared’s reopening plan – copy the West Coast governor’s alliance plan and pretend it’s their idea. It’s all what meets the conservative most immediate animal need and what is the easiest way to do it.
EthylEster
@Cheryl Rofer: HI. I missed the thread where you answered questions about the virus. I have one that I have been asking for over a week now and nobody answers. My questions below.
From Tom Friedmans’ latest quoting the Swedes: A recent survey from one of our hospitals in Stockholm found that 27 percent of staff there are immune.
But from WHO website: There is currently no evidence that people who have recovered from COVID-19 and have antibodies are protected from a second infection.
So…the WHO comment implies that antibodies are necessary but not sufficient. I guess I was thinking that maybe it was the case that as long as you still have anti-bodies you have immunity. But that clearly cannot be the case because antibodies are being found yet the WHO comment directly states that protection is not guaranteed.
So…how does one verify immunity? Can this be done in vitro? Can you take a blood sample from a recovered person and then add “something”, maybe live virus, and see if the virus then replicates?
I have not seen anybody explain this or even address it. Somebody has to know the theoretical answer. Maybe it’s: there is no way to establish immunity except by observing that previously infected people never get another infection. OK. But somebody (who is qualified) needs to say that.
Help!
Enhanced Voting Techniques
And part #2 to my point about them being lazy; were is their any incentive for a Republican to do anything. They are basically funded to stop a Democrat from getting elected to the seat they hold. As long as they say the right message time to time no one of the Rights cares what they accomplish (who on the Right is holding Trump and Turtle to account for not overturning Obamacare when they had the chance?) and when they lose an election, it’s off to Wingnut Welfare for them. This is opposite what a professional or political career should be.
Mary G
I’m voting for evil AND stupid.
Amir Khalid
@EthylEster:
What WHO is saying is that it’s too soon to be confident that having coronavirus antibodies post-recovery confers immunity on individual patients, let alone herd immunity. It might, it might not. The data simply isn’t in yet.
Nicole
@EthylEster: What @Amir Khalid: said. When the WHO says “there is no evidence people; are immune from a second infection” they aren’t saying “there is evidence they aren’t immune”; they’re just saying that there’s no evidence either way, and that’s simply because the virus is so new. We won’t know, really, for years, whether immunity is conferred and for how long, because it’ll take time for people to get sick, recover, and then be in circumstances where they could conceivably get the virus a second time.
I found out last spring I needed a measles booster because it’s fairly recent that we’ve observed not all measles vaccinations conferred lifelong protection. Who knows how long I’d been wandering around no longer immune? Some things only come clear with time.
(Thinking about that vaccination I’m now annoyed my doctor wouldn’t give me the tetanus booster at the same time, as I was at 9 years since my last shot and she said wait one more year. Now I’m a bit past ten years, but who knows when I’ll be able to get back in to see her… sigh.)
Nicole
…. or maybe it’ll turn out I don’t need that booster shot after all…
https://www.statnews.com/2020/02/25/adults-dont-need-booster-vaccinations-for-tetanus-diphtheria-study/
Time and observation, man…
Ruckus
@Subsole:
Conservatism is feudalism that people it screws right along with everything/everyone else can vote for.
IOW you are absolutely correct. It’s feudalism disguised as a system that helps people, all the while royally fucking them.
EthylEster
@Amir Khalid: What WHO is saying is that it’s too soon to be confident that having coronavirus antibodies post-recovery confers immunity on individual patients, let alone herd immunity. It might, it might not. The data simply isn’t in yet.
So what data would they need? How is the existence of herd immunity detected? Is there an “immunity” test? If so, what would be measured? Everybody keeps mentioning antibodies but that’s the immune system’s response to a new challenge. It’s my understanding that memory T cells are an integral part of immunity from past infections.
Ruckus
@patrick II:
Not that you necessarily are, but we have to be careful not to make the mistake of giving shit for brains any credit whatsoever. He’s earned none, he deserves none, and he only uses it to screw up more.
Sab
@Cheryl Rofer: They don’t actually care if they kill people. My brother is one of them and he never has cared about killing if he is entertained. He used to launch frogs in baskets with helium balloons. They died up in the air too high to jump to safety. He thought it was hilarious. I believe the word is sociopath. They can mimic normal people but they are not normal.
Elizabelle
@Sab: Is he a captain of industry now? What a creep. My sympathies to you and the poor frogs.
James E Powell
@Mike in NC:
Chaos and destruction are awesome, said 100% of the press/media.
Sab
@Elizabelle: I cannot believe that it took me 60 years to notice this but it did. I just thought he was male, so I didn’t like them. My husband has spent 20 years convincing me that not all men are like that
ETA : Also he thinks everything wrong in the world is due to Hillary or Obama. Also too this pandemic was started by Fauci whom Obama should have fired. I kid you not.
Sab
@Elizabelle: Kind of. He is treasurer of a mutual fund.
Amir Khalid
I mentioned in another thread an AFP story posted in The Guardian‘s liveblog, which reported on a Chinese study that found no clinical benefit from Remdesivir. That liveblog has now posted a story about another study, conducted in the US, that found something quite different:
Amir Khalid
@EthylEster:
If a recovered patient is re-exposed to the coronavirus, do they get sick again? If they don’t, they’re immune. If a community with many recovered patients is exposed, does the infection spread, or does it die out? If it dies out, then herd immunity has been established. That’s the data that health authorities must wait for.
Subsole
@James E Powell: Yep. Pisses me off more than Trump. For all their eye rolling and loud protestations of exhaustion, always always always remember:
They thought this shit was going to be amusing.
SWMBO
@Amir Khalid: @EthylEster:
Think chicken pox and shingles. Having chicken pox confers something like immunity. Until it erupts in shingles. Not everyone who gets chicken pox gets shingles. But it does happen. And, according to my doc, when you have an outbreak of shingles, you are shedding the virus and are contagious again. If you can have mild COVID19, you might have something after that looks/feels like a cold and be shedding virus. Nobody knows what’s going to happen with this. Yet.