Come for the politics, stay for the snark.

Republicans seem to think life begins at the candlelight dinner the night before.

Our job is not to persuade republicans but to defeat them.

… riddled with inexplicable and elementary errors of law and fact

Let me file that under fuck it.

I’m sure you banged some questionable people yourself. We’re allowed to grow past that.

They are lying in pursuit of an agenda.

A thin legal pretext to veneer over their personal religious and political desires.

Many life forms that would benefit from greater intelligence, sadly, do not have it.

Shut up, hissy kitty!

Democrats have delivered the Square Deal, the New Deal, the Fair Deal, and now… the Big Joe Biden Deal.

Republicans got rid of McCarthy. Democrats chose not to save him.

“And when the Committee says to “report your income,” that could mean anything!

Donald Trump, welcome to your everything, everywhere, all at once.

The truth is, these are not very bright guys, and things got out of hand.

This really is a full service blog.

Be a traveling stable for those who can’t find room at the inn.

He really is that stupid.

Tide comes in. Tide goes out. You can’t explain that.

Following reporting rules is only for the little people, apparently.

We still have time to mess this up!

Anyone who bans teaching American history has no right to shape America’s future.

So cool that a Black prosecutor nailed his ass.

They were going to turn on one another at some point. It was inevitable.

Jack be nimble, jack be quick, hurry up and indict this prick.

You are here: Home / 2021 / Archives for February 2021

Archives for February 2021

Respite Open Thread: Good News Out of Texas

by | 54 Comments

This post is in: ,

The ‘sea turtles stunned by cold water’ situation is common enough here in New England that the Boston-based New England Aquarium has a hotline:

… Our response area ranges from Boston north to the New Hampshire-Maine border. If you encounter a sea turtle in distress on the beach within this territory, please call our Sea Turtle Rescue Hotline at 617-973-5247.

Our rescuers rehabilitate endangered sea turtles. In the past decade alone, our rescuers have treated and released hundreds of Kemp’s ridley sea turtles as well as many green and loggerhead sea turtles. These numbers are especially significant considering the Kemp’s ridley is the most endangered sea turtle in the world.

Each fall, staff and volunteer walkers from the Massachusetts Audubon Wellfleet Bay Wildlife Sanctuary comb dozens of miles of beach trying to find stranded sea turtles. The turtles are transported to the rescuers and veterinarians at the New England Aquarium with extreme hypothermia, severe dehydration, pneumonia, and often shell or bone fractures. While 2014 was a record-smashing year when 733 turtles were treated at the Animal Care Center in Quincy, on average we treat about 300 turtles each year. Their treatment can last between two and eight months, sometimes longer. Most of the sea turtles that arrive alive at the Aquarium recover and are released back into the ocean…

Respite Open Thread: Good News Out of TexasPost + Comments (54)

Tuesday Afternoon Open Thread

by | 222 Comments

This post is in: ,

I’m not watching the Senate hearings on January 6th Capitol security (or lack thereof) live, but the clips I’ve seen are infuriating because suspects are directly questioning witnesses:

Senator Ron Johnson (he came from Wisconsin!) used his question time to lie about the insurrection being an antifa false-flag operation. Come retrieve your village idiot, Mankato!

One of my two horrid US senators, Rick Scott, used his time to grouse about the National Guard presence in D.C., implying it’s unnecessary. I have no idea, but the Q-MAGA cult allegedly believes the real presidential inauguration is coming up early next month and that their orange calf will be reinstalled, so maybe it makes sense for the National Guard to stick around.

Anyhoo, open thread.

PS: Thanks for the birthday greetings last night! I did not see the thread until this morning because, as birthday princess with absolute control over home media for the day, I was making my husband binge-watch Twin Peaks with me. On his birthday, we had to watch Gladiator again.

Tuesday Afternoon Open ThreadPost + Comments (222)

On Unfucking

by | 181 Comments

This post is in: 

My old business partner and friend has a great saying:  “unfucking is much harder than fucking.”  For the past 30+ years, Repulicans fuck up, and Democrats unfuck.  Clinton unfucked the “Reagan Revolution”, Obama unfucked the terrible Bush years, and Biden will be unfucking the giant mess left by Trump.

I think we’ll all agree that we haven’t gotten the credit we deserve for our unfucks.  Part of that is just because it’s hard to frame and message unfucks.  Part of it is because some of those unfucks will create small inequties as part of solving bigger ones.  And a big part of it is that we’re never in office long enough to well and truly unfuck situations.

A case in point is the absolute god damned mess that unfettered access to student loans has created in this country.  Whether it’s $10K, $50K or some other amount of loan that’s forgiven, somebody’s going to be getting money that someone else thinks is undeserved.  Yet far too little attention will be paid to the forty or so years during which our higher ed system gradually fucked the poor and middle class.

I worked in a small rural state college financial aid office in the late 80’s/early 90’s, so I was there just when loans were getting out of control.  Here are some of the things that we could see happening that just have gotten much, much worse:

  • The Pell Grant program, which was supposed to let poor kids go to school for basically free, was starting to be outstripped by inflation and tuition that rose faster than inflation.  So, kids who had no idea about the kind of commitment they were making were getting thousands of dollars of debt as part of their financial aid package.  Yet, from the point of view of the school, it didn’t matter because loan money and grant money paid tuition.
  • The Perkins Loan program, which was essentially a federal loan fund administered by the school, was grossly underfunded after the Guaranteed Student Loan (Stafford Loan) program, administered by banks and passed by Congress after heavy bank lobbying.  But the Perkins Loan program was so much more healthy for the school, because if the school had good collections, they could loan more money.  With Perkins loans, the school had an positive incentive to make good loans.  GSLs (and their follow-ons) had no such positive incentive – the school just had to keep its default rate down.
  • Single moms from rural towns would use financial aid as an adjunct to all the other programs they were receiving, making barely OK progress towards some kind of degree, but incurring (for them) staggering debt as they did.
  • Kids from little towns would come down for a semester or a year, unprepared for college, flunk out, and go home a few thousand dollars poorer.  The debt wasn’t crippling, as it is now, but it sure didn’t help them start out in life.
  • Programs of questionable academic merit with fairly large bureaucracies were started routinely, with the goal of snagging enrollment.  We had more-or-less open admission, and the incremental cost of adding students to the university as a whole was fairly low, the institution  worked to get more marginal students in the door, and many of them were attracted by these new, marginal academic programs.
  • The Community College feeder system, while in general a good thing, was always trying to create four year degree granting programs, again because students with financial aid packages brought in money to the community.  These programs were tiny, and I don’t think the graduates were of as high quality as the graduates from a comparable program at our college.
  • We were starting to see a few transfers from private for-profit schools and it was clear those kids were absolutely worked over by those schools.

The government has an obvious interest in a higher ed system that is somewhat efficient, that allows students to fail without ruining them, and where four-year and community colleges stay in their lanes.  The rocket fuel of financial aid, from what I saw, fucks with each of those goals.  Colleges had “free money” that made them less efficient. Student failure led to burden, and there was duplication of effort between two-year and four-year schools.  Private for-profit schools probably shouldn’t be allowed access to federal financial aid — it’s just too much of an incentive for them to screw kids.

So, this whole fucking mess needs to be unfucked.  The first step is to try to address the inequity of giving kids massive loans.  It is fundamentally unjust to allow kids who can’t even drink legally to commit themselves to a lifetime of debt.  Free community college is a good next step.  But the real answer is affordable public higher education, just like the least-great generation, the boomers, had.  Unfortunately, around the mid-90s, we just decided that couldn’t happen.  Now, Democrats are stuck with yet another unfuck that will make a lot of people unhappy.

On UnfuckingPost + Comments (181)

Medicaid or ACA when you’re on the boundary?

by | 6 Comments

This post is in: 

Kent raised a great question/scenario yesterday in comments:

I started the process of trying to get my 55 year old brother onto his first ACA plan.  Some questions and confusion and I welcome any advice.

First he lives in Alaska and which is a medicaid expansion state that uses the federal exchange.  I went on the exchange on his behalf and it turns out he is right at the borderline of 138% of poverty level so can go either way, an ACA plan or Medicaid.  His 2020 income put him below the 138% but he is also a tile and stone contractor with an aggressive accountant and so they managed to take probably $45,000 of income and push it down to about $18,000 with aggressive business deductions.  He could easily be slightly less aggressive in 2021 to qualify for an ACA plan.  So…questions.

First, given a choice between ACA and Medicaid, is it the obvious choice to go with a Blue Cross ACA plan?  I’m not really sure which way to advise him here.  He has the ability to manipulate his income to go either way.

Really good question — if someone is near the boundary for either Medicaid Expansion OR ACA Silver CSR-94 plans what should one choose?

First, it is quite plausible for someone to qualify for both Medicaid and ACA subsidies at the same time. Medicaid uses monthly income to determine eligibility. The ACA uses estimated annual income with reconciliation on the back-end to determine subsidy eligibility and level of subsidy. If someone works in a seasonal industry, they could have a low cash month to qualify for Medicaid even if their annual income has them earning over 138% FPL. This has been the case since 2014. Since 2020 with the CARES Act, Medicaid enrollment is stickier as states can not redetermine income to remove people from Medicaid coverage. And all of this happens without needing an aggressive accountant. An aggressive but legal accountant can help.

There was a recent paper in JAMA Open Network by Heidi Allen et al** that looked at what services did people right on the boundary between Medicaid and ACA plans use, what were the cost-sharing obligations and what was the quality of care between the two programs. They used Colorado data.

So what did they find?

This cross-sectional study of 8182 participants used a propensity score–matched sample narrowed to 5 percentage points above and below the federal poverty level threshold that separates Medicaid and Marketplace eligibility (138%). Marketplace coverage was associated with fewer emergency department visits and more office visits than Medicaid, total costs were 83% higher in Marketplace coverage owing to much higher prices, and out-of-pocket spending was 10 times higher in Marketplace coverage; results for quality of care were mixed.

Cost-sharing for ACA plans is way higher. Doctors and hospitals made more money on ACA plans due to higher reimbursements, less emergency department use for ACA plans (probably due to high cost-sharing) and quality was leaned to advantage ACA plans.

So what is the take-away for someone who is on the border?

Under current law, they are likely paying a monthly premium for ACA plans and are exposed to significantly more cost-sharing as most CSR-94 plans will have out of pocket maximums ranging from $450 to $2,850.

There may be value in an ACA plan in that it may have a better to you network, although the least expensive plans tend to be narrower networks. Even if the networks between Medicaid and the lowest cost silver plan on the ACA are nominally the same, there could be an argument that appointments are more likely/convienent under the ACA plan than Medicaid. But that network value does come at significant cost-sharing exposure and likely higher monthly premiums.

If someone is looking for insurance to provide protection against meteors, heart attacks and buzz saws slicing off a finger or three, then both Medicaid Expansion and ACA plans provide that protection. Medicaid Expansion will provide that protection at lower cost to the individual than ACA plans.

** Allen H, Gordon SH, Lee D, Bhanja A, Sommers BD. Comparison of Utilization, Costs, and Quality of Medicaid vs Subsidized Private Health Insurance for Low-Income Adults. JAMA Netw Open. 2021;4(1):e2032669. doi:10.1001/jamanetworkopen.2020.32669

Medicaid or ACA when you’re on the boundary?Post + Comments (6)

Tuesday Morning Open Thread: Our President

by | 153 Comments

This post is in: , , ,

show full post on front page

Tuesday Morning Open Thread: Our PresidentPost + Comments (153)