Come for the politics, stay for the snark.

“More of this”, i said to the dog.

Republicans are the party of chaos and catastrophe.

We cannot abandon the truth and remain a free nation.

“But what about the lurkers?”

fuckem (in honor of the late great efgoldman)

If you’re pissed about Biden’s speech, he was talking about you.

Give the craziest people you know everything they want and hope they don’t ask for more? Great plan.

They fucked up the fucking up of the fuckup!

No offense, but this thread hasn’t been about you for quite a while.

Is it irresponsible to speculate? It is irresponsible not to.

Why did Dr. Oz lose? well, according to the exit polls, it’s because Fetterman won.

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

And we’re all out of bubblegum.

A dilettante blog from the great progressive state of West Virginia.

Despite his magical powers, I don’t think Trump is thinking this through, to be honest.

If you are still in the GOP, you are an extremist.

I know this must be bad for Joe Biden, I just don’t know how.

Being the leader of the world means to be the leader of peace.

I’d hate to be the candidate who lost to this guy.

I’d try pessimism, but it probably wouldn’t work.

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

Incompetence, fear, or corruption? why not all three?

After roe, women are no longer free.

Optimism opens the door to great things.

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Elective Policing

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If the NYPD’s work slowdown is causing them not to make arrests “unless absolutely necessary”, then it means fewer arrests for public urination, selling loosies, walking while black, and the rest of the stuff that poor minority neighborhoods experience every day. Is that a bad thing? Matt Taibbi:

It’s incredibly ironic that the police have chosen to abandon quality-of-life actions like public urination tickets and open-container violations, because it’s precisely these types of interactions that are at the heart of the Broken Windows polices that so infuriate residents of so-called “hot spot” neighborhoods.

In an alternate universe where this pseudo-strike wasn’t the latest sortie in a standard-issue right-versus left political showdown, one could imagine this protest as a progressive or even a libertarian strike, in which police refused to work as backdoor tax-collectors and/or implement Minority Report-style pre-emptive policing policies, which is what a lot of these Broken Windows-type arrests amount to.

[…]

It would be amazing if this NYPD protest somehow brought parties on all sides to a place where we could all agree that policing should just go back to a policy of officers arresting people “when they have to.”

Because it’s wrong to put law enforcement in the position of having to make up for budget shortfalls with parking tickets, and it’s even more wrong to ask its officers to soak already cash-strapped residents of hot spot neighborhoods with mountains of summonses as part of a some stats-based crime-reduction strategy.

Taibbi’s take on the Garner case is worth a read, too, as is his book The Divide. Matt Ford covers the same territory.

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PPACA and the Continuing Resolution

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The continuing resolution that needs to be passed sometime soon to keep the government open will deal with PPACA.  There are currently two big things not included in the resolution.  One may prompt a veto threat (I assess that at 10% probability) and the other has been baked into the cake for over a year now.

The big new thing that is not in the continuing resolution at this time is an appropriation to fund the risk corridors.  The Hill explains:

The language, buried deep in the 1,603-page bill, is a victory for conservative opponents of the healthcare law. It would prevent new government funds from flowing to ObamaCare’s so-called risk corridors, a three-year program established to subsidize insurer losses in order to keep premiums stable.

A commonly used tool in public policy, risk corridors have become a political football since Sen. Marco Rubio (R-Fla.) highlighted the ObamaCare provision as a “bailout” in November of last year. Since then, activists with Heritage Action and other groups have repeatedly sought to kill the payments in major fiscal negotiations.

The “cromnibus” spending bill would allow the government to continue collecting payments from insurers that post better-than-expected results under ObamaCare and passing them to companies that do worse. But it would not permit the Centers for Medicare and Medicaid Services to make additional funds available for insurers that are struggling.

Risk corridors are used to create incentives for insurers to participate in fuzzily defined markets.  Insurers that price in a way that attracts only healthy populations send money to insurers who have to cover the sicker parts of the population.  Medicare Part D has permanant two-way risk corridors.  PPACA had temporary three year risk corridors authorized but the money was not appropriated to pay for them past the FY2014.  The Congressional Research Service issued an opinion that the PPACA language  was too fuzzy and did not explicitly appropriate  money to go back out.

What are the work-arounds?

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Convergence

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The important thing to remember is that 2014 was a beta test year for Obamacare.  Some insurers went into the market with loss leader membership build strategies, others went in with a reasonable price sustainability model, others went in with a hyper cautious approach.  Some insurers had optimistic pricing models, others projected a much sicker enrolled population than they actually got. 

2015 is the first significant readjustment and the market is acting pretty much as we should expect markets for minimally differentiated products.  Plans that were underpriced are seeing their pricing go up, plans that are overpriced are seeing cost reductions.  It is almost like the market structure could work.

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Fundamental divergence; oddity or realignment

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There have been two interesting news stories on elections in the past week as well as an interesting inside baseball geek out concerning how to model and predict Senate elections that could be either interesting outliers, or harbingers of change.

The two interesting stories are the Democratic Parties of Kansas and Alaska happily seeing their preferred candidates for Senate and Governor respectively drop out of the race. There were no mysterious revelations of hookers, blow, green balloons, or toe tapping in the restroom. There were no plane crashes, there were no children of the candiddates being diagnosed with cancer.

Instead, the candidates dropped out in Kansas and formed a fusion/unity ticket to allow independent candidates who are polling well to be the primary opposition to Republican incumbents in deep red states. The basic thrust is that Senator Roberts and Governor Parnell are reasonably unpopular with the general electorate but could very easily cobble together a coalition of 43% of the voters. 43% is usually more than enough to win a plurality in a three way race, while 43% is a big loss in a two way race. The bet is that the independent candidates have a much higher probability of putting together a plurality or even better a clear majority coalition against the incumbent.

The basis of the bet is that both independents are former Republicans who look at the deep-red strains of the Republican Party and think they are sufficiently bat-shit insane that it was worth running against Republican incumbents. In Kansas, this has been a long tradition where the electorate has been split into nearly even chunks of Teabaggers/extreme conservatives, moderate Republicans and then a wide array of Democrats of various flavors. Democrats could win state wide office with good candidates who could pick up a good chunk of the moderate Republicans who were momentarily disgusted at the Teabaggers. It is a long and successful strategy. Democratic success in Alaska in the past generation has either counted on a felony conviction (later overturned) or a split Republican Party for any state wide wins.

If Democrats can successfully engage in a strategy of being the party of the sane and continue to pick up former Republicans (such as John Cole) without losing significant elements of the current Democratic base, is that the start of a realignment?

The other big, and geeky debate that I’ve been paying attention to has been the poll aggregating and prediction site differentials.

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Hard to make plans when it’s impossible to see past your next shift

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I’m really pleased this is getting attention:

As more workers find their lives upended and their paychecks reduced by ever-changing, on-call schedules, government officials are trying to put limits on the harshest of those scheduling practices.
The actions reflect a growing national movement — fueled by women’s and labor groups — to curb practices that affect millions of families, like assigning just one or two days of work a week or requiring employees to work unpredictable hours that wreak havoc with everyday routines like college and child care.
The recent, rapid spread of on-call employment to retail and other sectors has prompted proposals that would require companies to pay employees extra for on-call work and to give two weeks’ notice of a work schedule.
Vermont and San Francisco have adopted laws giving workers the right to request flexible or predictable schedules to make it easier to take care of children or aging parents. Scott M. Stringer, the New York City comptroller, is pressing the City Council to take up such legislation. And last month, President Obama ordered federal agencies to give the “right to request” to two million federal workers.

Chaos in families is part of it and that chaos ripples, because the people caring for the children of employees with “on call” schedules also become subject to the needs of the employer. It’s not just people with children, either, and they don’t need to be attending classes or doing something considered productive and industrious to ask for predictability and order. Maybe they just want to have certain planned blocks of time where the demands of their low wage employer are not put above their own needs or desires.

It’s pretty amazing what they were getting away with:

Fatimah Muhammad said that at the Joe Fresh clothing store where she works in Manhattan, some weeks she was scheduled to work just one day but was on call for four days — meaning she had to call the store each morning to see whether it needed her to work that day.
“I felt kind of stuck. I couldn’t make plans,” said Ms. Muhammad, who said she was now assigned 25 hours a week.

They were paying her for one day but they kept her tied up for five.

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Small Company ISO ASO for a cheap date and a good time

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Earlier this year, I described why there will be significant and true rate shock stories this fall as community underwriting will go into effect for almost all fully insured small group plans:

PPACA is changing the means of how groups are underwritten for non-grandfathered policies that went into effect on or after January 1, 2014. The new policies are underwritten based on a modified community rating system that allows for consideration of the age of people in the underwritten group, their locations (which can still tie a lot of statistical probabilities of cost and health status) and smoking status.  The community that they are rated against is the entire pool of small groups that an insurance company insures….

Right now under experience and/or statistical underwriting, there are significant premium differentials between groups with members who are the same age, location and smoking status.  This system has its own set of entrenched winners and losers…  Statistical and experience underwriting gives better rates to groups that historically have lower health care costs.  Those groups tend to have more men then women, and fewer than typical number and severity of pre-exisiting conditions for each age cohort.  Conversely, groups that have more women than men and have greater than expected number of people with expensive conditions, tend to get much higher rates than average and median….

On average, the total cost of premiums to insure the same people in the same groups with experience or statistical underwriting versus community underwriting will be the same.  However the distribution of those costs will be wildly different.  Groups that are more male and/or healthier in general will see significant rate increases due to underwriting changes.  Groups that are more female or statistically likely to be sicker than average will see flat rates or decreases. 

The change in underwriting assumptions for the small group market only applies to companies that are “fully insured.”  Fully insured is a term of art.  It means the insurance company collects a premium and takes on all of the risk of claim expenses being higher than projected.  If a group of three people have two of the three covered lives go to the trauma center in a benefit year, the insurance company eats a massive loss on the group.  That loss should be covered by the thousands of other covered lives in other small groups.  If that same group has a total of seven claims for the entire year totalling $800 and that $800 is entirely deductible dollars, the company will have given the insurance company a massive check for peace of mind only.  There would be no refund. 

There is a loophole for companies that think they want to take on additional risk to reduce their premiums. 

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He’s going the distance, he’s going for speed

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The skinniest Exchange narrow networks from 2014 won’t be as skinny for the 2015 open enrollment period.  There are three major drivers.

The first is a federal regulatory driver.  The 2014 regulation required the minimally acceptable network to contract with 20% of the Essential Community Providers in a service area.  An ECP is a center that serves underserved populations.  Federal primary care clinics, family planning, AIDS care clinics are the most common ECPs.  The 2015 regulation is 30% of the ECPS in a service area must be in network.  For most networks, this is a fairly minor tweak, but the skinniest networks will need to add facilities and docs to meet requirements. 

The second is that providers are starting to see that the Exchanges are here to stay and that it is better to get Medicare +8% from an Exchange product than who the hell knows what from the spare cash flow of an uninsured individual.  Mayhew Insurance has seen a steady stream of inquiries of providers who want into the Exchange networks.  They are coming in either to help one or two current patients who switched their insurance, or they are seeing that the Exchanges will improve their bottom lines.  The narrowest and usually the lowest paying networks will probably see the highest percentage increase in provider participation in 2015 as the base level of participation for the super-skinnies would be very low regionally.

The final reason why networks are getting larger is amazingly technical and geeky.  The speed assumption in one of the major geo-access/GIS software packages changed.  

Now what is this and why is it important?

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