Trump retweeted this at 7 am, then deleted it 30 minutes later.
IOKIYAR
by DougJ| 52 Comments
This post is in: Assholes
This post is in: Anderson On Health Insurance
Adrianna Macintryre, Allen Joseph and Nicholas Bagley had a recent perspective in the New England Journal of Medicine regarding the possibility of a partial Medicaid expansion model. I want to explore some of the distributional and macro-economic implications of this possibility. (Disclaimer, I helped Adrianna with some of the data). But first, let’s see the argument and the potential policy:
another decision of arguably greater long-term significance has been overlooked: whether to allow “partial expansions” pursuant to a state Medicaid waiver. Arkansas has already submitted a waiver request for a partial expansion, and other states may well follow its lead… waivers became more consequential in 2012, when the U.S. Supreme Court gave states a choice about whether to expand their Medicaid programs to cover everyone with an income of up to 138% of the federal poverty level.
In general, Obama-era expansion waivers permitted adoption of rules congenial to Republican policymakers….
These waivers, however, did not grant red states everything they requested. The Obama administration refused to approve waivers that would have conditioned Medicaid eligibility for some beneficiaries on their ability to find work. It denied waivers that would have terminated coverage for beneficiaries with incomes below the poverty level if they failed to make out-of-pocket payments for medical care. And it declined states’ requests to partially expand their Medicaid programs to enroll beneficiaries with incomes up to 100% of the poverty level, but not those between 100% and 138%.Why were states interested in these partial expansions? Starting in 2020, states are responsible for covering 10% of the costs associated with the Medicaid expansion. Because of a drafting mistake, however, the ACA says that the 100-to-138 population can receive subsidies to purchase a private health plan on the exchanges — but only if they are ineligible for Medicaid. For those people, the federal government bears the entire cost of subsidizing private coverage, with no contribution from the states. As a result, the states save money for every beneficiary whom they can move from Medicaid into their exchanges.
The waivers that have been approved for non-standard expansions to 138% FPL have had premiums and cost sharing. Premiums have been limited to 2% of income and cost sharing is limited to 5% of income. That roughly translates to $20 per month in premiums and a $600 deductible. This is the level of a 94% Actuarial Value Silver plan with Cost Sharing Reduction (CSR) subsidies.
The distributional consequences are important. For people who earn between 100-138% FPL in states that have not expanded Medicaid, nothing will change for them. They are no worse off. People who live on less than 100% FPL in these states will be dramatically better off as they will have Medicaid for their coverage. People who earn between 100-138% FPL in waiver states won’t be significantly worse off. A few benefits (vision and non-emergency transportation for instance) may no longer be available but these are marginal changes. People earning under 100% in waiver states won’t see a change.
The major area of change would be individuals who earn between 100-138% FPL and live in states that made a straight forward Medicaid expansion. These individuals will have higher premiums and higher cost sharing. They would be worse off if Pennsylvania or Louisiana or Oregon or anywhere else with a simple expansion reduced the expansion eligibility to only 100% FPL and shifted them onto the Exchanges.
If this is primarily a tool used by states that have not expanded Medicaid or have current cost sharing and premium requirements through Obama era waivers, then the distributional consequences have minimal harms and significant improvements.
I want to geek out a bit below the fold on secondary points.
A minor argument in favor of moving people onto the Exchanges instead of Medicaid is a macro-economic stabilization argument. State governments face balance budget constraints that the Federal government does not have. That means during recessions, state revenue drops even as eligibility and need for Medicaid enrollment spikes. States retrench on their spending at the absolute worse times. Shifting a small proportion of the population to an automatic counter-cyclical stabilizing program is cheap and insufficient but helpful macro-economic insurance if one is ever worried about 2008-2009 striking again.
The authors are also worried about Exchange risk pool composition if this policy was adapted. States without expansion had sicker Exchange risk pools than states with expansion.
Partial expansion could also degrade the quality of states’ individual insurance markets. One analysis found that exchange premiums were 7% higher in nonexpansion states — where the population with incomes between 100% and 138% of the poverty level already qualifies for subsidized coverage — than in expansion states, after adjustment for state differences. Though other factors may contribute to this finding, one possible explanation is that the 100-to-138 population is sicker than the rest of the individual-market risk pool. If so, adding them to the exchanges will drive premiums up for everyone.
If partial expansion was adapted to 100% FPL, a little bit less financial engineering will be going on. This would improve the risk pool as the sickest people making just under 100% FPL in non-expansion states would have been the most motivated to find some way to show that they earned 100.0001% FPL to qualify for subsidies for a Silver CSR. There might even be incentives for the sickest people to stay under 100% FPL and off the Exchanges to avoid maxing out their cost sharing. I think the financial incentives are very messy with no clear direction in this scenario.
Medicaid partial expansion’s consequencesPost + Comments (4)
by Alain Chamot (1971-2020)| 17 Comments
This post is in: On The Road, Open Threads, Readership Capture
Good Morning All,
This weekday feature is for Juicers who are are on the road, traveling, or just want to share a little bit of their world via stories and pictures. So many of us rise each morning, eager for something beautiful, inspiring, amazing, subtle, of note, and our community delivers – a view into their world, whether they’re far away or close to home – pictures with a story, with context, with meaning, sometimes just beauty. By concentrating travel updates and tips here, it’s easier for all of us to keep up or find them later.
So please, speak up and share some of your adventures and travel news here, and submit your pictures using our speedy, secure form. You can submit up to 7 pictures at a time, with an overall description and one for each picture.
You can, of course, send an email with pictures if the form gives you trouble, or if you are trying to submit something special, like a zipped archive or a movie. If your pictures are already hosted online, then please email the links with your descriptions.
For each picture, it’s best to provide your commenter screenname, description, where it was taken, and date. It’s tough to keep everyone’s email address and screenname straight, so don’t assume that I remember it “from last time”. More and more, the first photo before the fold will be from a commenter, so making it easy to locate the screenname when I’ve found a compelling photo is crucial.
Have a wonderful day, and enjoy the pictures!
First up, pictures from valued commenter No One You Know.
July is for Stargazers and cattails.
Taken on 2017-07-30
Stargazer lilies burst into fragrance as well as color in the front yard.
Stargazer lilies and cattails.
Today, pictures from valued commenter Le Comte de Monte Cristo, fka Edmund Dantes.
After Work Hike
Late Summer Afternoon
Taken on 2017-08-09
Mitchell Hill Lake, from the earthen dam.
The Jefferson Memorial Forest is the largest municipal forest in the United States, and is operated by Louisville Metro Parks. It is located in the southwest fringe of Jefferson County, and consists of 6500 acres of woods, trails, campgrounds and limited conference facilities, as well as a zipline attraction. It is pretty easy to get to after work or on weekends. We decided to take an end of day hike, about a 4.5 mile loop.
Ducks!
Taken on 2017-08-09
Mitchell Hill Lake
There were about 15 ducks patrolling the lake when we were there. I liked them, but only had a phone, so there is no good zoom.
Thank you so much Le Comte de Monte Cristo, fka Edmund Dantes, do send us more when you can.
Travel safely everybody, and do share some stories in the comments, even if you’re joining the conversation late. Many folks confide that they go back and read old threads, one reason these are available on the Quick Links menu.
One again, to submit pictures: Use the Form or Send an Email
This post is in: domestic terrorists, Don't Agonize - Organize, Open Threads, Proud to Be A Democrat, Republican Venality, I Can't Believe We're Still Talking About Fucking Nazis
Someone was murdered at a Neo-Nazi rally today. That happened. In America. In 2017. It's time to make clear where we stand – all of us.
— Elizabeth Warren (@SenWarren) August 13, 2017
It’s easy to tweet hate has no place here. But no legislator should be horrified on Saturday & then vote to drag America backward on Monday.
— Kamala Harris (@KamalaHarris) August 14, 2017
.
From Politico, “Democrats press GOP to scrutinize rise in white supremacy”:
… Democrats on the House Homeland Security Committee are asking panel Chairman Michael McCaul (R-Texas) to examine racist fringe groups, including those that organized Saturday’s violent protest against the removal of a statue of Confederate Gen. Robert E. Lee on the University of Virginia campus…
California Rep. Lou Correa, who sits on the Homeland panel, was the first Democrat to call for hearings.
“Yesterday’s horrific acts against innocent Americans were clear acts of terrorism,” he said. “Our country has a homegrown terrorism problem we refuse to address. That ends now. We must hold hearings and finally address that terrorism inflicted by white supremacy extremists is destroying our country.”
A spokesman for Homeland ranking member Bennie Thompson (D-Miss.) confirmed to POLITICO that committee Democrats were organizing to increase pressure on the panel to schedule hearings on white supremacist terrorism.
Homeland Democrats have already called for such hearings twice this year to no avail. A spokesperson for McCaul did not respond to request for comment.
The issue is going beyond the committee. Top House Democrats will discuss the matter during a leadership call and Democratic caucus conference call scheduled for Tuesday, according to a senior Democratic source. House Judiciary Democrats likewise held a call and are coordinating efforts to ramp up pressure on Republicans to address the growing threat…
The Clinton voters knew it would be this bad. The Trump voters still thinks this is good.
— Schooley (@Rschooley) August 13, 2017
Rs and their staff have become adept at figuring out exactly what "condemnation" language will let them off the hook with the press. 3/
— Adam Jentleson (@AJentleson) August 13, 2017
If all the press demands are words, Republican leaders will eventually find satisfactory ones. It's time to stop letting words be enough. 5/
— Adam Jentleson (@AJentleson) August 13, 2017
Tuesday Morning Open Thread: Proud to Be A DemocratPost + Comments (306)
This post is in: Dolt 45, domestic terrorists, Hail to the Hairpiece, Open Threads, Republican Venality, Bitter Despair is the New Black, I Can't Believe We're Still Talking About Fucking Nazis
By all means, compare these shitheads to Nazis. Again and again. I'm with you.
— Mike Godwin (@sfmnemonic) August 14, 2017
Everything happening now is a dumber version of an event preceding it:
Stupid Watergate
Dumb Cuban Missile Crisis
Dipshit Third Reich— Maggie Serota ?? (@maggieserota) August 12, 2017
20-year old Ohio jihadist riots w/ 1000 fellow militants with medieval weapons then runs over 15 people & we'd be talking drone strikes rn.
— Local Milk Steak (@ZeddRebel) August 13, 2017
He so wants to say, "The Nazis have said very, very nice things about me." pic.twitter.com/ZoW3Y29lK0
— Schooley (@Rschooley) August 15, 2017
Not a novel point, but may be the best single-sentence summary of "Trumpism" I've seen. https://t.co/Br0ZYLffVa pic.twitter.com/AE8FH9qf8t
— Eric Levitz (@EricLevitz) August 14, 2017
"I condemn White Supremacy, but vote for Trump's agenda" is the new "I send thoughts and prayers to the victim, but vote against gun safety"
— Dan Pfeiffer (@danpfeiffer) August 13, 2017
A question from a senior Republican aide just now: "What idiot in [Trump's] admin is telling him to worry about the white supremacist vote?"
— Haley Byrd (@byrdinator) August 13, 2017
Counterpoint: maybe his political instincts about how crucial they are to his coalition are correct. https://t.co/Hml6Zx0vAC
— Christopher Hayes (@chrislhayes) August 13, 2017
Late Night Open Thread: Godwin’s Other LawPost + Comments (33)
This post is in: domestic terrorists, Excellent Links, Open Threads, Republican Venality, I Can't Believe We're Still Talking About Fucking Nazis
December 1, 2016 pic.twitter.com/RIn0FA6cbo
— ???? (@marv_vien) August 12, 2017
Mr. Charles P. Pierce, at Esquire, is a wise man:
… [W]hen anybody, especially the president*, talks about what happened in Charlottesville, Virginia, over the weekend, from the Citronella Putsch on Friday night, to the violence on Saturday morning, to the graphic fulfillment of the philosophy behind these lunatic laws on Saturday afternoon, tells you that what happened in Virginia has anything to do with “polarization,” or that it is a problem equally shared by Both Sides, that person is trying preemptively to pick history’s pockets.
Every Republican who ever played footsie with the militias out west owns this bloodshed.
Every Republican who ever spoke to, or was honored by, the Council of Conservative Citizens and/or the League of the South owns this bloodshed.
Every Republican administration that ever went out of its way to hire Pat Buchanan, and every TV executive who ever cut him a check, and every Republican who voted for him in 1992, and everyone who ever has pretended his views differed substantially from the ones in the streets this weekend, owns this bloodshed…
Anyone who followed the presidential campaign saw this coming. Frankly, I’m surprised there wasn’t more of it. Every Trump rally came with an implied promise of some kind of violence. Sometimes, the promise was fulfilled. Sometimes it wasn’t. But it was the dark energy behind that whole campaign. For all the relentless chin-stroking about the economically anxious and forgotten white working class, and for all the prayerful coverage of Donald Trump’s “populist” appeal, there was no question what was driving events on the Republican side.
If they merely wanted change, they had 16 other Republican candidates to choose from. But that wasn’t what got them out to the rallies, to bathe in that dark energy and chant their imprecations. That wasn’t what got them to the polls in droves. The inside voice, carefully honed by four decades of practice, had gone silent in favor of saying out loud all the spells and incantations that had worked their magic ever since Harry Dent had written the original book of spells and handed it to Richard Nixon…
We now know what the reaction will be if the institutions of government, and the people in them, get so sickened by this administration that they act to rid the country of it. Is there any doubt that a president* who, after the events of this weekend, can’t even see fit to rid himself of the fascists around him, including the ludicrous Dr. Sebastian Gorka, Ph.D., wouldn’t balk at encouraging paranoid violence as a means of self-preservation? Is there any doubt that a president* who could not even muster the gumption or the outrage to criticize Nazis for what they are wouldn’t blink at bringing the temple down on his own head either out of pure childish pique, or because he doesn’t know any other way?
Except for himself and (possibly) his family, there is nothing this president* cares enough about to keep from destroying it if he thinks he has to do so. And, if he thinks he has to do it, he will use whatever tools are at hand, because why wouldn’t he? Nobody in the party he purportedly leads has shown any willingness to do anything more than moan about how Troubled they are at what he’s doing. And a lot of what his administration is doing comes from the same place in our history out of which James Fields, Jr. and his automobile came barreling in the summer sunshine of a Saturday afternoon. The administration still employs Kris Kobach for the purpose of suppressing minority voters. The administration is still in court defending the rights of oppressed white college applicants. Jefferson Beauregard Sessions III is still the attorney general, and a lot of people are trying to get the inside voice to speak again. Somebody never stopped whistling Dixie…
Today:
.
Made additional remarks on Charlottesville and realize once again that the #Fake News Media will never be satisfied…truly bad people!
— Donald J. Trump (@realDonaldTrump) August 14, 2017
“what was even the point of saying nazis are bad if you’re not going to praise me" https://t.co/Pic2iJy7vU
— Ashley Feinberg (@ashleyfeinberg) August 14, 2017
There is absolutely no question Trump holds the media in more contempt than he holds the Nazis that marched in Charlottesville this weekend https://t.co/5aSE6ZYnTB
— Dan Pfeiffer (@danpfeiffer) August 14, 2017
Think about the implications here. Essentiallly: "I condemned Nazis against my will to appease the media and they're still not happy." https://t.co/cSUyKCam1P
— Ryan Lizza (@RyanLizza) August 14, 2017
And I guarantee you that's part of it. He sees racists wearing MAGA hats instead of white hoods and thinks Cha Ching Cha Ching.
— Local Milk Steak (@ZeddRebel) August 14, 2017
Richard Spencer doesn't think President Trump condemned his movement today. He called it "kumbaya" nonsense, & said Trump didn't mean it.
— Olivia Nuzzi (@Olivianuzzi) August 14, 2017
Spencer took Trump's words seriously but not literally. https://t.co/PJpVOGSx6G
— Daniel W. Drezner (@dandrezner) August 14, 2017
This post is in: Domestic Politics, Open Threads, Assholes, General Stupidity
My daughter has a temporary job at an apartment complex, cleaning shit up for incoming university students. Today was move-in day. It didn’t go universally well:
Exactly. It’s DEAD, lady. FFS. That’s the sign of a full-service student housing unit. ?
Open thread!