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You are here: Home / Archives for 2020

Archives for 2020

Medicaid block grants and shocks

by David Anderson|  January 27, 20208:52 am| 19 Comments

This post is in: Anderson On Health Insurance

Later this week, the Trump Administration will be rolling out their guidance to states on how to apply for Medicaid block grants:

 

NEW: Trump admin will announce its Medicaid block grants on Thursday at event billed “Transforming Medicaid: A New Opportunity for Better Health.”https://t.co/FYv5SpvZ2V pic.twitter.com/9v3WXkFffg

— Dan Diamond (@ddiamond) January 25, 2020

 

The first guarantee is that any state that files for a block grant will be generating an amazing number of billable hours for lawyers. Nick Bagley explains:

Setting aside the dubious policy merits of block grants, however, I don’t think the proposal is legal. I don’t even think it’s close.

Under section 1903 of the Medicaid statute, the federal government must pay a fixed “match rate” (known in the statutory lingo as “the Federal medical assistance percentage”) to every state that participates in Medicaid. In Tennessee, the match rate is 65.21%. That means that, for every $1 that Tennessee spends on its Medicaid program, the federal government kicks in about $2….

As Tennessee recognizes, it’ll need a waiver from HHS to make these changes. And section 1115 of the Medicaid statute does allow HHS to waive lots of the law’s restrictions in connection with experimental projects that are likely to assist in promoting Medicaid’s objectives.

Now, I’ve written before that I’m not at all sure that block granting Medicaid counts as an experiment that serves Medicaid’s purposes. But there’s a more fundamental problem with Tennessee’s proposal. You can’t use section 1115 to waive section 1903. To the contrary, section 1903 is pointedly omitted from the list of statutory provisions that HHS is empowered to waive.

But let’s put aside the legal gymnastics of storming that castle for a moment. Let’s think about what happens to a state that chooses to block grant when faced with a shock?

  • Major hurricane that destroys a lot of public health infrastructure and creates a lot of sudden, unanticipated morbidity and mortality?
  • New virus that is readily transmittable with significant symptoms and care needs?
  • New drugs/treatments that have high first year costs but are massive net present value savers under any reasonable discount rate after five or ten years?
  • A family of clutzy triplets who all have  inhibitor resistant hemophilia moving across the state line ?

All of these are shocks to the payment system.  All of them could readily increase first year costs significantly.  Under the current system, the cost of a shock is split between the federal government and the state government.  The cost of the shock is split 3:1 in Mississippi and 1:1 in Massachusetts for legacy Medicaid and 9:1 federal/state for expansion.  The ratios differ as the federal government,which has the best capacity to eat risk and bad luck in the world, bears a good chunk of the risk.

Under a pure block grant, the federal government bears no risk of a shock. Instead that risk is shifted entirely to a state government whose risk bearing capacity is orders of magnitude less than the federal risk bearing capacity.

That is what a block grant will do when a state is faced with a shock.

 

Medicaid block grants and shocksPost + Comments (19)

Monday Morning Open Thread: Gonna Be Another Long Week

by Anne Laurie|  January 27, 20206:17 am| 188 Comments

This post is in: Election 2020, Foreign Affairs, Impeachment Inquiry, Open Threads, Republican Venality, Trumpery

Two rescued baby bats
(Photo: Jurgen Freund Photography) pic.twitter.com/DOsR672tkk

— 41 Strange (@41Strange) January 24, 2020

Something about those faces… the bright-eyed curiosity on the left, the blissful superiority on the right…

You left off “to convict” https://t.co/d7Wgu7wjCT

— Michelle Goldberg (@michelleinbklyn) January 27, 2020

press still buying GOP narrative that half the country wanting a sitting president removed from office for first time in US history is a ho-hum story https://t.co/C9qBJGCKWW

— Eric Boehlert (@EricBoehlert) January 27, 2020

Elsewhere…

Iowa caucus-goers want a candidate who is both:

1. “more moderate than most Democrats”

and

2. “Promises fundamental systematic change to American society”https://t.co/tw6xgmDb3j pic.twitter.com/rjUIFZ0TRX

— Kevin Robillard (@Robillard) January 25, 2020


Iowa caucus-goers want a candidate who’ll offer them a bag of magic beans. But they must be artisanal, free-range, responsibly-sourced magic beans!

On Feb. 3, Dems will caucus in Iowa, obsessed over who can beat Trump. On Feb. 4, the response to Trump's State of the Union will be from a suburban white moderate woman who won Michigan (@GovWhitmer) and a Latina who won Beto O'Rourke's old House seat on the border (@RepEscobar)

— Edward-Isaac Dovere (@IsaacDovere) January 24, 2020

Think positively:

Republicans won the House popular vote by 1.1% in 2016. Democrats won it by 8.6% in 2018. The underlying fundamentals in 2020 are going to be different than they were in 2016. That's a 9.7% swing. Democratic primary voters should vote out of optimism, not out of fear.

— Dean Steitz (@theminorchords) January 26, 2020

Mandatory Bolton content:

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Monday Morning Open Thread: Gonna Be Another Long WeekPost + Comments (188)

On The Road – Auntie Anne – More from southern England – Oxford and Glastonbury

by Alain Chamot (1971-2020)|  January 27, 20205:00 am| 10 Comments

This post is in: On The Road, Photo Blogging

Good morning everyone,

Today we rejoin a trip, already in progress!

 

 

From Blenheim, we went on to Oxford. We only had about three hours there, so we did not visit any of the colleges, choosing instead to have a leisurely lunch at the Turl Street Kitchen and wander around the town a bit.

The day after we visited Blenheim and Oxford, we went to Glastonbury, which was amazing.  The size of the monastery must have been incredible!

 

On The Road – Auntie Anne – More from southern England – Oxford and GlastonburyPost + Comments (10)

On The Road - Auntie Anne - More from southern England - Oxford and Glastonbury 7
Oxford, EnglandAugust 26, 2019

The front of the Ashmolean Museum.  It was a terrific place to visit, and the Pompeii exhibit was excellent.

Sunday / Monday Coronavirus Update: Don’t Panic

by Anne Laurie|  January 27, 20204:30 am| 16 Comments

This post is in: Foreign Affairs, Healthcare

The armchair quarterbacking on Twitter of the #2019nCoV response is … a lot.
Outbreaks are chaotic, exhausting & frightening. Fog of war conditions. Good to keep that in mind.

— Helen Branswell (@HelenBranswell) January 26, 2020

On last night’s thread, commentor Starfish recommended Dr. Tara C. Smith’s twitter feed. Dr. Smith has some very helpful information:

/4 If you feel you need to "do something," 1) make sure you're vaccinated for influenza so if a case comes to your area, you're one fewer febrile person to be tested and potentially isolated.

— Dr. Tara C. Smith (@aetiology) January 25, 2020

/6 3) you'll see some disagreement among scientists. That's ok; were still working it out. Again, there will be lots of uncertainty from limited data in the early weeks.

4) lots of good people to follow from suggestions in this thread. https://t.co/okW6Wnpf3y /fin

— Dr. Tara C. Smith (@aetiology) January 25, 2020

IMO, at this particular moment, the situation appears to be pretty good. There’s no widespread panic, the news media seems to have acquired some immunity to the OMG WE’RE ALL GONNA DIE conspiracies that flared around SARS and the last global Ebola outbreak, and the governments involved appear to be reacting, if not flawlessly, at least reasonably. Murphy the Trickster God willing, we’ll be watching similar reports for the next few weeks / months…

This medic in China was infected while treating patients with the new coronavirus.

The death toll has jumped to 81, with Chinese authorities saying there are now more than 2,700 confirmed cases. pic.twitter.com/p63MMZsfEy

— Al Jazeera English (@AJEnglish) January 27, 2020

Within a month of the discovery of the Wuhan coronavirus, the @CDCgov has generated an assay for the virus and made the protocol publicly available to the world. This is an outstanding example of the importance of publicly funded scientific infrastructure! https://t.co/W6krZbVfaS

— Russ Poldrack (@russpoldrack) January 26, 2020

The additional genomes released in the last two days provide further evidence for a single animal-human spill-over event 7-10 weeks ago. Here is our updated report. https://t.co/bbp9CfMJez

— Richard Neher (@richardneher) January 26, 2020

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Sunday / Monday Coronavirus Update: Don’t PanicPost + Comments (16)

Late Night Open Thread: When Fashion & Politics Intersect

by Anne Laurie|  January 26, 202011:09 pm| 43 Comments

This post is in: Open Threads, Popular Culture, Readership Capture

YESSSSSS BILLY ???? #Grammys pic.twitter.com/heagugaE2S

— MEFeater Magazine (@mefeater) January 27, 2020

Wearing @bajaeast
Custom Hat by Sarah Sokol Millinery

— MEFeater Magazine (@mefeater) January 27, 2020


I totally want this hat, although given my color preferences, red grosgrain would be more practical (for very specific values of practical). It would certainly improve IRL political discourse.

Lots of elegance at the Grammys tonight. Here is a lady who does justice to a strapless bodice — or, as a dear friend used to call it, ‘the dessert tray’…

Lizzo at the 2020 #Grammys ?? pic.twitter.com/8wBWBclhmf

— MEFeater Magazine (@mefeater) January 26, 2020

Congrats to Lizzo on winning ‘Best Pop Solo Performance’ for ‘Truth Hurts’ at the 2020 #Grammys ?? pic.twitter.com/pDHFA8uYgq

— MEFeater Magazine (@mefeater) January 27, 2020

For a tiny little chick, this is unexpectly effective. (And when her feet get tired, no need to look for a chair):

Ariana Grande at the 2020 #GRAMMYs ?? pic.twitter.com/e34fYWpVy1

— MEFeater Magazine (@mefeater) January 26, 2020

Edwardian era re-imagined — Fortuny pleating, massive chiffon poufs & a silver silk frock coat!

Chrissy Teigen & John Legend at the 2020 #Grammys ?? pic.twitter.com/NTNhTaFr1M

— MEFeater Magazine (@mefeater) January 27, 2020

And, back to the Political Twitter angle:

Congrats to Michelle Obama on winning a Grammy for ‘Best Spoken Word Album’ ?? #Grammys pic.twitter.com/uMlUF9T9Sl

— MEFeater Magazine (@mefeater) January 26, 2020

Late Night Open Thread: When Fashion & Politics IntersectPost + Comments (43)

Ambassador John Bolton is a Coward, Has No Professional Ethics, Could Care Less About the Security of the United States, and Cares Only for His Personal Profit

by Adam L Silverman|  January 26, 20208:42 pm| 139 Comments

This post is in: America, Domestic Politics, Election 2020, Foreign Affairs, Impeachment, Impeachment Inquiry, Information Warfare, Media, Open Threads, Politics, Russia, Silverman on Security

Ambassador Bolton, the Frank Burns of American national security, has allowed his unpublished manuscript to be selectively leaked to Maggie Haberman and Michael Schmidt at The New York Times. Bolton’s book deal reportedly came with a $2 million advance! Haberman and Schmidt have excerpted the material that is pertinent to the President’s impeachment and which Bolton would not share with the House Permanent Select Committee on Intelligence or the House Judiciary Committee because there isn’t any profit in doing so.

President Trump told his national security adviser in August that he wanted to continue freezing $391 million in security assistance to Ukraine until officials there helped with investigations into Democrats including the Bidens, according to an unpublished manuscript by the former adviser, John R. Bolton.

The president’s statement as described by Mr. Bolton could undercut a key element of his impeachment defense: that the holdup in aid was separate from Mr. Trump’s requests that Ukraine announce investigations into his perceived enemies, including former Vice President Joseph R. Biden Jr. and his son Hunter Biden, who had worked for a Ukrainian energy firm while his father was in office.

Mr. Bolton’s explosive account of the matter at the center of Mr. Trump’s impeachment trial, the third in American history, was included in drafts of a manuscript he has circulated in recent weeks to close associates. He also sent a draft to the White House for a standard review process for some current and former administration officials who write books.

Multiple people described Mr. Bolton’s account of the Ukraine affair.

The book presents an outline of what Mr. Bolton might testify to if he is called as a witness in the Senate impeachment trial, the people said. The White House could use the pre-publication review process, which has no set time frame, to delay or even kill the book’s publication or omit key passages.

Over dozens of pages, Mr. Bolton described how the Ukraine affair unfolded over several months until he departed the White House in September. He described not only the president’s private disparagement of Ukraine but also new details about senior cabinet officials who have publicly tried to sidestep involvement.

For example, Secretary of State Mike Pompeo acknowledged privately that there was no basis to claims by the president’s lawyer Rudolph W. Giuliani that the ambassador to Ukraine was corrupt and believed Mr. Giuliani may have been acting on behalf of other clients, Mr. Bolton wrote.

Mr. Bolton also said that after the president’s July phone call with the president of Ukraine, he raised with Attorney General William P. Barr his concerns about Mr. Giuliani, who was pursuing a shadow Ukraine policy encouraged by the president, and told Mr. Barr that the president had mentioned him on the call. A spokeswoman for Mr. Barr denied that he learned of the call from Mr. Bolton; the Justice Department has said he learned about it only in mid-August.

And the acting White House chief of staff, Mick Mulvaney, was present for at least one phone call where the president and Mr. Giuliani discussed the ambassador, Mr. Bolton wrote. Mr. Mulvaney has told associates he would always step away when the president spoke with his lawyer to protect their attorney-client privilege.

During a previously reported May 23 meeting where top advisers and Senator Ron Johnson, Republican of Wisconsin, briefed him about their trip to Kyiv for the inauguration of President Volodymyr Zelensky, Mr. Trump railed about Ukraine trying to damage him and mentioned a conspiracy theory about a hacked Democratic server, according to Mr. Bolton.

Charles J. Cooper, a lawyer for Mr. Bolton, declined to comment. The White House did not provide responses to questions about Mr. Bolton’s assertions, and representatives for Mr. Johnson, Mr. Pompeo and Mr. Mulvaney did not respond to emails and calls seeking comment on Sunday afternoon.

Mr. Bolton’s submission of the book to the White House may have given the White House lawyers direct insight into what Mr. Bolton would say if he were called to testify at Mr. Trump’s impeachment trial. It also intensified concerns among some of his advisers that they needed to block Mr. Bolton from testifying, according to two people familiar with their concerns.

Bolton’s real concern, according to Haberman’s and Schmidt’s reporting is that if he doesn’t get to testify in the President’s impeachment trial in the Senate, that people will think he’s only interested in his personal profit.

Mr. Bolton would like to testify for several reasons, according to associates. He believes he has relevant information, and he has also expressed concern that if his account of the Ukraine affair emerges only after the trial, he will be accused of holding back to increase his book sales.

Ya think?!?!?!?!

Ambassador Bolton has long been known as a professionally toxic leader. But for some bizarre reason a portion of America’s very serious people have perceived him as being a legitimate, if somewhat extreme, national security professional who cares deeply about the national security of the United States. Those people need to have their heads examined! Bolton couldn’t care less about the national security of the United States. What Bolton cares about is using the national power of the United States, specifically its intelligence and military power, to prosecute his petty grievances with the rest of the world. And making money. Lots and lots and lots of money. Ambassador Bolton doesn’t have to worry about whether people will think he’s only in it for the money. That ship has sailed, got caught in a storm after leaving port, and has sunk. I’d call Ambassador Bolton a selfish, egomaniacal, megalomaniacal whore, but that would be insulting to selfish people, egomaniacs, megalomaniacs, and whores!

Also, and as something that needs to be called out: WTF is wrong with Haberman, Schmidt, their editor,  and The New York Times that allowed this view from nowhere paragraph to make it into the article (emphasis mine):

He, Mr. Pompeo and Defense Secretary Mark T. Esper had collectively pressed the president about releasing the aid nearly a dozen times in the preceding weeks after lower-level officials who worked on Ukraine issues began complaining about the holdup, Mr. Bolton wrote. Mr. Trump had effectively rebuffed them, airing his longstanding grievances about Ukraine, which mixed legitimate efforts by some Ukrainians to back his Democratic 2016 opponent, Hillary Clinton, with unsupported accusations and outright conspiracy theories about the country, a key American ally.

If you cannot and will not bring yourselves as reporters at the paper of record in the US to unequivocally report this for what it is, a Russian created lie intended to get the President to lift sanctions on Russia, direct the power of the US against Ukraine, and achieve one of Putin’s strategic objectives, then you need to get out of the way and let reporters with professionalism and courage do the reporting. Haberman and Schmidt have failed here as journalism professionals as clearly as Ambassador Bolton has as a national security professional.

Open thread!

Ambassador John Bolton is a Coward, Has No Professional Ethics, Could Care Less About the Security of the United States, and Cares Only for His Personal ProfitPost + Comments (139)

Previewing John Bolton’s Book

by Cheryl Rofer|  January 26, 20208:19 pm| 32 Comments

This post is in: Impeachment, Republican Venality, Trump Crime Cartel

The New York Times, Maggie Haberman and Michael Schmidt in particular, have gotten hold of a copy of John Bolton’s book. I am seeing reports on Twitter to expect a Washington Post story in which Bolton and his publisher deny making that book available. What. Ever.

As far as the overall story goes, there is nothing new. Trump was extorting Ukrainian president Volodymyr Zelinsky to manufacture dirt on Biden and perhaps other candidates. What is new is that he said exactly that to Bolton. And Mike Pompeo knew about the campaign to remove Marie Yovanovich, and so did Mick Mulvaney. I am not surprised about any of this.

Bolton has been holding all this back to make a buck on his book. Great patriot there.

This is absolutely my preferred outcome. The Senate subpoenas Bolton's manuscript; it becomes a part of the public record in the impeachment trial; and then no one has any need to actually buy Bolton's book and he ends up making like $50 off of it.https://t.co/giOXc8AKy7

— Susan Simpson (@TheViewFromLL2) January 26, 2020

JUST IN: Schiff and House managers weigh in on Bolton. pic.twitter.com/w0UKr3xUKQ

— Kyle Cheney (@kyledcheney) January 27, 2020

The reaction on Twitter is that now the Senate will have to call witnesses, this changes everything, yatta yatta. Seems to me the story has been clear all along, and the Republicans have managed to stick together in crime. This is just words. There’s something much worse they’re hiding, and the longer they hide it, the more essential it is to continue. Not a single one has any sense of country.

Previewing John Bolton’s BookPost + Comments (32)

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