Tag Archives: current

Friday Is D-Day For the Republican Health Care Bill

Mother Jones

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From Politico:

President Donald Trump is demanding a vote Friday in the House on the Republican plan to repeal and replace Obamacare, White House Budget Director Mick Mulvaney said. If the bill fails, Trump is prepared to move on and leave Obamacare in place, Mulvaney said.

This makes sense on a whole bunch of levels:

As a threat against conservatives: Vote for the bill or else Obamacare stays around forever and it’s your fault.

As a boredom minimizer: I doubt very much Trump himself cares one way or the other about health care, and he’s probably tired of all boring technical talk that surrounds it (EHBs, continuous coverage, age bands, etc. etc.). He also instinctively understands that the whole thing is a shit show that’s making him more and more unpopular.

As politics: The current debacle has shown that there’s just no sweet spot acceptable to both moderate and conservative Republicans. Why keep beating yourself up over it?

As revenge against liberals: Trump has said that 2017 is the year Obamacare unravels. He will now do everything he can to make that come true, and there’s a fair amount he can do.

As substance: It frees up time for taxes and trade, things Trump is more interested in.

Besides, I don’t think Trump wants to stay in Washington over the weekend. The Mar-a-Lago golf course beckons. So let’s just put this baby to bed one way or the other, OK?

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Friday Is D-Day For the Republican Health Care Bill

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Republicans Now Considering How to Make a Bad Health Care Plan Into a Complete Wreck

Mother Jones

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Our acronym for the day is EHB, which stands for Essential Health Benefits. These are things which every health care plan is required to cover, and Obamacare spells out ten of them:

  1. Doctor visits
  2. Emergency room visits
  3. Hospital visits
  4. Prescription drugs
  5. Pediatric care
  6. Lab services
  7. Preventive care
  8. Maternity care
  9. Mental health care
  10. Rehabilitation services

The Republican health care bill is still having trouble getting enough votes to pass, so Paul Ryan is thinking about placating conservatives by repealing all of these EHBs. This means that a health insurer could literally sell you a policy that didn’t cover doctor visits, hospital visits, ER visits, your children’s health care, or prescription drugs—and still be perfectly legal. Here’s a rough estimate of how much we spend nationally on each of these categories of EHB:

There are many problems with repealing Obamacare’s minimum required benefits, but I’d like to list just three:

Oh come on. This is ridiculous.

Even if the current version of AHCA doesn’t cause a death spiral, it sure would if EHBs got repealed. Insurers would assume that anyone who asks for a policy that covers one of these (former) EHBs is pretty sure they’re going to need it. Naturally they’d price their policies accordingly: Worthless policies would get really cheap, but comprehensive policies would get astronomically expensive. Virtually no one would be able to afford them.

There’s a good chance that repealing the EHBs would not only produce crappier insurance policies, but would also cost the government more money. Think about it. Every year AHCA provides you a tax credit for health insurance. You might as well use it, right? So insurers would all compete to offer policies that cover almost nothing but cost exactly $2,000 or $3,000 or $4,000. Everybody would sign up for one, because it’s free so they might as well. So instead of, say, 10 million people using the tax credits, 30 million would. These policies wouldn’t do squat, but Uncle Sam has to pay for them anyway—and now he’s got to pay for three times as many of them.

This is all pretty straightforward stuff, and it’s hard to believe that Ryan would go down this catastrophic road. Enough’s enough. If I had to guess—and we might well know the answer before I wake up on Thursday—I’d say that Ryan tries to buy off the conservatives by taking maternity benefits off the EHB list and leaving everything else alone. After all, it’s maternity care that really seems to be a burr in the ass of the Freedom Caucus folks.

Why? Because they’re knuckle-draggers. It’s hard to put it any other way. They figure that being pregnant is solely a woman’s responsibility and there’s no reason men should have to help pay for it. Really. I’m not joking. What can you even say to people so terminally dimwitted?

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Republicans Now Considering How to Make a Bad Health Care Plan Into a Complete Wreck

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GOP Health Care Bill Is Worse Than Just Repealing Obamacare Completely

Mother Jones

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Over at The Upshot, Margot Sanger-Katz catches something that any of us might have noticed if we’d had keen enough eyes. The CBO famously projected that the Republican health care bill would result in 24 million people losing health insurance:

But one piece of context has gone little noticed: The Republican bill would actually result in more people being uninsured than if Obamacare were simply repealed. Getting rid of the major coverage provisions and regulations of Obamacare would cost 23 million Americans their health insurance, according to another recent C.B.O. report. In other words, 1 million more Americans would have health insurance with a clean repeal than with the Republican replacement plan, according to C.B.O. estimates.

Here’s what the CBO said in its January report. If only the individual mandate, the subsidies, and the Medicaid expansion are repealed, 32 million people will lose insurance by 2026. If, in addition, community rating, minimum coverage requirements, and the preexisting conditions ban are repealed—in other words, if essentially all of Obamacare is repealed and nothing put in its place—23 million people will lose insurance by 2026.

As it happens, the current Republican bill is similar to Option 1, which means the GOP is making progress. Under their old bill 32 million people would be kicked off the insurance rolls, while the new bill only kicks off 24 million. However, they could do even better by just repealing everything, full stop.

Now, it so happens that they can’t do that. Democrats can filibuster all the additional stuff in Option 2. Nevertheless, Sanger-Katz is right: it’s pretty remarkable that the Republican bill actually does more damage than repealing Obamacare and simply doing nothing at all. Not just any party can pull off something like that.

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GOP Health Care Bill Is Worse Than Just Repealing Obamacare Completely

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Here’s Why CBO Projects 10% Lower Premiums Under the Republican Health Care Bill

Mother Jones

One of the surprising things about the CBO score of AHCA, the Republican health care bill, is their conclusion that premiums will fall starting in 2020. By 2026, average premiums will be 10 percent lower than they would be under Obamacare. But why? Here’s CBO:

First, the mix of people enrolled in coverage obtained in the nongroup market is anticipated to be younger, on average, than the mix under current law. Second, premiums, on average, are estimated to fall because of the elimination of actuarial value requirements, which would result in plans that cover a lower share of health care costs, on average.

….By 2026, CBO and JCT project, premiums in the nongroup market would be 20 percent to 25 percent lower for a 21-year-old and 8 percent to 10 percent lower for a 40-year-old—but 20 percent to 25 percent higher for a 64-year-old.

Hmmm. Let’s translate this into English. First, CBO assumes that premiums will go up for old people, forcing many of them to drop out of the market. Since old people have expensive premiums, fewer old people means the average for the remaining pool will be lower.1 Second, AHCA policies will cover far less of your medical expenses, so naturally they’ll be cheaper.

The chart below shows how this “reduces” average premiums. If you use CBO’s projections and do a little arithmetic assuming a modestly younger pool, you get the average premium estimate for the overall pool shown on the left. AHCA is cheaper than Obamacare.

But the current age breakdown in the Obamacare insurance pool is 28 percent young, 38 percent middle-aged, and 26 percent old. What if you assume that stays the same? You get the premium estimates in the middle.

Finally, what if you assume that AHCA paid for 87 percent of your medical bills, just like Obamacare? Then you get the premium estimate on the right.

In other words, if you compare apples to apples, AHCA produces far higher overall premiums than Obamacare.2

Note that CBO didn’t do anything wrong here. They simply did their projections based on a (correct) assumption that AHCA would be too expensive for many old people and would produce crappier policies that had higher deductibles and paid far less of your medical bills. The “average” premium is lower, but obviously not in a way that helps anybody in real life.3

1Think about it this way. If a high school sends all its A students to a magnet school across town, the school’s average GPA will go down. This is despite the fact that nobody’s grades have actually changed.

2This is a fairly extreme example because the actuarial value changes a lot (87 percent vs. 65 percent) for the cheaper policies preferred by low-income folks. CBO has a second example that uses a middle-class worker, and it produces similar but less dramatic results.

3Hardly anybody, that is. If you’re young and don’t get any medical care, then the lower premiums really do help you.

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Here’s Why CBO Projects 10% Lower Premiums Under the Republican Health Care Bill

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Trump Plans to Slash the Most Effective Social Program in History

Mother Jones

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Reuters tells us what to expect from President Trump’s budget:

Under the proposal, which was sent to the EPA this week, grants to states for lead cleanup would be cut 30 percent to $9.8 million, according to the source, who read the document to Reuters.

What an idiot. This is hardly the biggest issue in his budget, and I’ll grant that the current allocation for lead cleanup is so pitiful that a 30 percent cut hardly matters. On principle, though, it’s obvious that Mick Mulvaney’s crew just saw a line item in their spreadsheet and slashed it without knowing anything about it. Nice work, folks. You get a gold star.

By coincidence, the Washington Post ran a piece yesterday that’s all about lead—though the reporter didn’t realize it:

In dozens of one-on-one meetings every week, a lawyer retained by the city of Philadelphia summons parents whose children have just been jailed, pulls out his calculator and hands them more bad news: a bill for their kids’ incarceration….He is one agent of a deeply entrenched social policy that took root across the country in the 1970s and ’80s. The guiding principle was simple: States, counties and cities believed that parents were shedding responsibility for their delinquent children and expecting the government to pick up the tab.

.…”It was a very different time, when too many parents frequently wanted to essentially ‘dump’ their adolescent children on juvenile courts when they found them unruly, ungovernable, uncontrollable,” Linda O’Neal, executive director of the Tennessee Commission on Children and Youth, said of the era decades ago when the laws were implemented.

Regardless of what you think about this policy, there’s a reason it “took root” in the ’70s and ’80s: Kids of that era spent their early childhoods surrounded by lead fumes from automobiles, so they contracted lead poisoning in massive numbers. By the time they were teenagers they really were “unruly, ungovernable, uncontrollable,” and parents didn’t know what to do.

As it turns out, there was nothing they could do. The damage was done. But nobody knew that, so we put in place pointless laws based on the premise that if only they worked harder, parents could keep their kids under control. In reality, the only policy that ended up working came from Trump’s hated Environmental Protection Agency, which banned leaded gasoline and put an end to our national epidemic of lead poisoning.

But the old laws are still around, even though they don’t work, while the EPA’s lead cleanup program is being slashed, even though it does work. Welcome to America.

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Trump Plans to Slash the Most Effective Social Program in History

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