Whither Obamacare?

[Oexmelin]

Trump's streaks are the best streaks.

[Jacob]

Trump's streaks are the best streaks.

He prefers them well done, I hear.

[DGuller]

Trump's streaks are the best streaks.

He prefers them well done, I hear.

That's just fucked up.

[Monoriu]

That's odd but frankly, that's like the least concerning aspect of Trump's personality.  If he is a good president, I'd forgive him for wearing bunny ears to review the military honour guard. 

[Syt]

https://www.nytimes.com/2018/07/07/us/politics/trump-risk-adjustment-payments-obamacare.html?smid=tw-nytimes&smtyp=cur

Health Insurers Warn of Market Turmoil as Trump Suspends Billions in Payments

WASHINGTON — The Trump administration said Saturday that it was suspending a program that pays billions of dollars to insurers to stabilize health insurance markets under the Affordable Care Act, a freeze that could increase uncertainty in the markets and drive up premiums this fall.

Many insurers that enroll large numbers of unhealthy people depend on the "risk adjustment" payments, which are intended to reduce the incentives for insurers to seek out healthy consumers and shun those with chronic illnesses and other pre-existing conditions.

"Any action to stop disbursements under the risk adjustment program will significantly increase 2019 premiums for millions of individuals and small-business owners, and could result in far fewer health plan choices," said Justine G. Handelman, a senior vice president of the Blue Cross and Blue Shield Association. "It will undermine Americans' access to affordable care, particularly for those who need medical care the most."

Trump administration officials said they decided to suspend payments under the program because of a ruling in February in Federal District Court in New Mexico. The judge tossed out the formula used to calculate payments, finding that it was flawed.

"We were disappointed by the court's recent ruling," said Seema Verma, the administrator of the Centers for Medicare and Medicaid Services. "As a result of this litigation, billions of dollars in risk adjustment payments and collections are now on hold."

Ms. Verma said her agency had asked the court to reconsider its ruling and was hoping for a prompt resolution of the issue, to "prevent more adverse impacts on Americans who receive their insurance in the individual and small group markets."

But supporters of the Affordable Care Act said the move was the latest example of the Trump White House's efforts to undermine the health law.

"The Trump administration just keeps pushing their destructive repeal-and-sabotage agenda, no matter the cost to the American people," said Brad Woodhouse, the director of Protect Our Care, an advocacy group that supports the health law. "Following through with this latest act of sabotage could raise rates for all consumers even more."

Some insurers expressed alarm at the administration's decision, which comes just as insurance companies are developing premiums for 2019 and states are reviewing proposed rates.

"We are very discouraged by the new market disruption brought about by the decision to freeze risk adjustment payments," said Matt Eyles, the president and chief executive of America's Health Insurance Plans, a trade group for insurers.

He predicted that costs to taxpayers would rise because the government provides subsidies that increase along with premiums. Those premium subsidies, for low- and moderate-income people, will continue.

The decision in February, by Judge James O. Browning, voided the formula used by the federal government to calculate risk adjustment payments each year from 2014 to 2018. The amount at stake just for 2017 is $10.4 billion. The payments shuffle money among insurers, from those with healthier customers to those with less healthy members who have a higher risk of using costly medical care.

Trump administration officials said they were caught between two conflicting court rulings. The New Mexico ruling prevents the government from making further collections or payments under the risk adjustment program using the current formula, they said. But, they added, in January a federal district judge in Massachusetts upheld the method used by the government to calculate risk adjustment payments.

While insurers warned of market turmoil if the payments were withheld, Dr. Martin E. Hickey, the founder of New Mexico Health Connections, the company that filed the lawsuit in that state, said the court ruling there would benefit consumers.

"The risk adjustment formula was extremely biased in favor of large, established insurers and discriminated against new and small insurers, including co-ops like ours," Dr. Hickey said in an interview on Saturday.

"People spin the administration's decision as Trump trying to do harm, but it's exactly the opposite," Dr. Hickey said. "It will allow more companies to get into the insurance market. That will increase competition, and competition will help keep prices down."

Risk adjustment payments are based, in part, on the health status of consumers. When the risk adjustment program began in 2014, some large insurers had a potential advantage: They knew the medical and claims history of many consumers because they had insured them in the past.

Judge Browning said the payment formula was flawed because federal officials "assumed erroneously" that collections and payments under the risk adjustment program had to offset each other so there would be no new cost to the federal government.

That might have been a rational policy choice, he said, but the government never articulated its reasons.

The Trump administration blamed President Barack Obama on Saturday, saying, "This aspect of the risk adjustment methodology was promulgated as part of a regulation first issued by the Obama administration in 2013."

[The Minsky Moment]

" . . . he shall take care that the laws be faithfully executed  . . ."

[Zanza]

" . . . he shall take care that the laws be faithfully executed  . . ."

It's scary, but also interesting to see, if your venerable constitution can survive an enemy of the constitution in the highest office of the country. I sure hope so.

[Zanza]

As far as I can tell, a lot of economists believe that strong redistribution of wealth, e.g. in the form of welfare states that include universal healthcare, is just about the only viable answer that nation states have in the face of the sheer power of globalization to take care of the losers of globalization. America has decided to do the exact opposite, namely to raze its social state institutions such as healthcare, welfare etc. and at the same time to torpedo globalization by errecting new tariff barriers. If it wasn't real people involved in it, that would be an interesting social experiment to see which way forward is better at mellowing globalization for the common people in Western countries.

[OttoVonBismarck]

American politicians broadly aren't making decisions about maximizing the welfare of common people in the way that you suggest, so that probably isn't even part of the calculus.

The Republicans want to promote the ultra-rich and large corporations. Democrats want to promote black people/other dark skinned minorities who represent the poorest groups, while focusing on "social justice" issues for women and homosexuals. There's broadly no political ideology that's really intentionally trying to help out the people in the 20%-80% income range who are most likely to actually be losers of globalization.

[Syt]

As far as I can tell, a lot of economists believe that strong redistribution of wealth, e.g. in the form of welfare states that include universal healthcare, is just about the only viable answer that nation states have in the face of the sheer power of globalization to take care of the losers of globalization. America has decided to do the exact opposite, namely to raze its social state institutions such as healthcare, welfare etc. and at the same time to torpedo globalization by errecting new tariff barriers. If it wasn't real people involved in it, that would be an interesting social experiment to see which way forward is better at mellowing globalization for the common people in Western countries.

That's ok if you try to disenfranchise people who generally don't vote for you (gerrymandering, erecting hurdles for voting, etc.) while keeping them busy with max hours min wages jobs so they don't have time to become activists. Though only a cynic would claim that the anti-contraception/anti-abortion stance combined with cutting support/opportunities for disadvantaged families is a means to keep the poor poor.

[Zanza]

American politicians broadly aren't making decisions about maximizing the welfare of common people in the way that you suggest, so that probably isn't even part of the calculus.

The Republicans want to promote the ultra-rich and large corporations. Democrats want to promote black people/other dark skinned minorities who represent the poorest groups, while focusing on "social justice" issues for women and homosexuals. There's broadly no political ideology that's really intentionally trying to help out the people in the 20%-80% income range who are most likely to actually be losers of globalization.

Maybe you are right. One would think that there must be room for a party that "insures domestic Tranquility" and "promotes the general Welfare" of the United States, but maybe in your hyper-polarized partisan politics, there is no room for such a political position anymore. 

[OttoVonBismarck]

Correct, America ran off the rails in the mid-2000s and a lot of people are only fully realizing it now. There's no sane party any longer. The Democrats are closer to sane than the Republicans, but there's no equivalent to the moderate center-rightists that you have in Germany. Even parties like the Tories in Britain which have bought in to a lot of dangerous ideas of late are like sedate Rockefeller Republicans compared to today's GOP.

[Iormlund]

American politicians broadly aren't making decisions about maximizing the welfare of common people in the way that you suggest, so that probably isn't even part of the calculus.

The Republicans want to promote the ultra-rich and large corporations. Democrats want to promote black people/other dark skinned minorities who represent the poorest groups, while focusing on "social justice" issues for women and homosexuals. There's broadly no political ideology that's really intentionally trying to help out the people in the 20%-80% income range who are most likely to actually be losers of globalization.

I have a hard time imagining the Democrats as a party representing the poorest individuals. If so they are rather terrible at it. The US political landscape has drifted right so brutally that any mainstream conservative party in Western Europe is now left of America's "liberals". Even the Tories can only dream of abolishing the NHS.

The Democratic Party strikes me as simply one without clear purpose of what it represents, nevermind the guts to sell it to the American voter. The GOP, OTOH, has a perfectly clear message of hate, Bible-thumping and tax cuts. It's no wonder they trump over Democrats time and time again.

[OttoVonBismarck]

Something I've said for a long time is our basic government structure is causing a lot of this, and that same structure also is almost impossible to change.

Other Western democracies may reside in much older countries, but their governments are far more modern. If you look at Western Europe about the only one that hasn't essentially rebuilt its government from ground up in the last 100 years is Britain, but in Britain with the absolute of Parliamentary supremacy it's very issue to reform big parts of government with a simple Parliamentary majority.

I think America's system, for when it was implemented in 1789 was very good for the time/place. It kept 13 colonies together when it wasn't certain they would remain so, and it provided a level of stability more "experimental" democracies of the 18th and 19th century never attained. It survived the rigors of civil war. But as we moved into the modern era it simply needed updating to reflect what America is today versus generations ago, and unfortunately there's no easy way to do that. More unfortunately there's a band of extreme libertarian thought that disproportionately (relative to their numbers) affects one of our major parties and much of local government, and they control the levers that would make it all but impossible to ever structurally reform our government.

[Jacob]

Democrats want to promote black people/other dark skinned minorities who represent the poorest groups, while focusing on "social justice" issues for women and homosexuals.

Is the problem with the Democrats that they want to do this to the exclusion of everything else (i.e. they're too caught up in social justice to do anything useful)? Or is the problem that they want to do this at all, while also doing other things (i.e. they may want to useful things, but their pursuit of social justice makes their other intentions irrelevant)?