Here’s the Trump/Republican agenda

Today we get an idea of what Trump and Republicans want to do:

The revised order is narrower and specifies that a 90-day ban on people from the six countries does not apply to those who already have valid visas or people with U.S. green cards.

According to the fact sheet, the Department of Homeland Security will conduct a country-by-country review of the information the six targeted nations provide to the U.S. for visa and immigration decisions. Those countries will then have 50 days to comply with U.S. government requests to update or improve that information.

Additionally, Trump’s order suspends the entire U.S. refugee program for 120 days, though refugees already formally scheduled for travel by the State Department will be allowed entry. When the suspension is lifted, the number of refugees allowed into the U.S. will be capped at 50,000 for fiscal year 2017.

This will probably cut the number of visitors to the US, cut the number of students who want to go to college in the US, and cut the number of people who want to work in the US. This will cost millions of jobs and redirect some of the best and brightest to Europe and Canada.

House Republicans on Monday released their long-awaited plan for unraveling former President Barack Obama’s health care law, a package that would scale back the government’s role in health care and likely leave more Americans uninsured.

House committees planned to begin voting on the 123-page legislation Wednesday, launching what could be the year’s defining battle in Congress.

GOP success is by no means a slam dunk. In perhaps their riskiest political gamble, the plan is expected to cover fewer than the 20 million people insured under Obama’s overhaul, including many residents of states carried by President Donald Trump in November’s election.

The proposal would continue the expansion of Medicaid to additional low-earning Americans until 2020. After that, states adding Medicaid recipients would no longer receive the additional federal funds Obama’s law has provided.

More significantly, Republicans would overhaul the federal-state Medicaid program, changing its open-ended federal financing to a limit based on enrollment and costs in each state.

The changes also might crash the individual market to make it impossible for tens of millions of Americans to get health insurance. That would be a plus for Republicans.

However, it was the next phrase Carson uttered that landed him in hot water.

“There were other immigrants who came here in the bottom of slave ships, worked even longer, even harder for less,” Carson said. “But they too had a dream that one day, their sons, daughters, grandsons, granddaughters. . . might pursue prosperity and happiness in this land. And do you know of all the nations in the world, this one, the United States of America, is the only one big enough and great enough to allow all those people to realize their dream.”

Ok, that seems a little unfair. Well:

The original nine plaintiffs claim that detainees are forced to work without pay and that those who refuse to do so are threatened with solitary confinement.

Specifically, the lawsuit claims, six detainees are selected at random every day and forced to clean the facility’s housing units. The lawsuit claims the practice violates the federal Trafficking Victims Protection Act, which prohibits modern-day slavery.

‘‘Forced labor is a particular violation of the statute that we’ve alleged,’’ Free said. ‘‘Whether you’re calling it forced labor or slavery, the practical reality for the plaintiffs is much the same. You’re being compelled to work against your will under the threat of force or use of force.’’

This has been going on for a while so it’s not just the new administration, except that President Obama tried to cut back on private prisons for this type of reason and the Trump administration wants to expand them:

Notably, the stocks of the two biggest private prison operators, Geo Group and CoreCivic (formerly known as Corrections Corporation of America), have surged since Trump’s election. The companies donated a total of $500,000 to Trump’s inaugural festivities, USA Today reported.

Since Trump took office, his administration has reversed the Obama administration’s policy to end the country’s reliance on private prisons.

And if a little slavery slips in, well all for the better. Just ask Ben Carson–immigration and slavery are basically the same thing.

3=3.49

Via here, we get this:

Insurers would have more leeway to vary prices by age, so that premiums for the oldest customers could be 3.49 times as large as those for younger customers. Today, premiums for the old can be only three times as high as premiums for the young, which is what the Affordable Care Act stipulates. According to sources privy to HHS discussions with insurers, officials would argue that since 3.49 “rounds down” to three, the change would still comply with the statute.

At some level, this is politically stupid since it explicitly raises the rates of older people while reducing it for the young–the opposite of the voting pattern for Trump. For me, the problem is the math–at most 3 times as large means at most 3 times as large, even 3.01 is out, never mind 3.1 or 3.49.

This will be similar to the “Pi Bill” from Indiana which indirectly says that pi is 3.2 (the bill tried to prove a method of squaring the circle, which is impossible, by making it a law).

This is the type of thing which shows why there needs to be a March for Science (it will be on April 22 with satellite marches all over the country).

Trumpcare=No Care

Via Kevin Drum, we see how well Donald Trump and Republicans have prepared for the elimination of Obamacare:

Congressional Republicans, despite pledging to quickly repeal the Affordable Care Act, are struggling with what parts of the law to roll back and how to lock up the votes they will need, particularly in the Senate, to push their ambitious plans.

Thirty-one states, including many with Republican governors, have expanded Medicaid through Obamacare and could lose billions of dollars if the law is cut back.

In Washington, Republicans are also struggling to figure out what to do with Obamacare insurance marketplaces that Republicans worked for years to dismantle. In a reversal, GOP leaders now are trying to figure out how to prevent their collapse, which would jeopardize coverage for millions more Americans.

Insurance experts, including leading industry officials, have repeatedly warned Republicans over the past several months that repealing the health law without a replacement risks destabilizing insurance markets and will push many insurers to simply stop selling health plans.

So, not only will the repeal likely lead to tens of millions of people losing their health insurance it might actually wreck the entire individual health insurance market. Things would be even worse than before the ACA was passed:

But when the time came to pay up for risk reduction in the Obamacare exchanges, Congress reneged and paid only 12% of what was owed to the insurers. So, on top of the fact that the companies had to bear the risk of unknown costs and utilization in the startup years, which turned out to be higher than they expected, insurers had to absorb legislative uncertainty of whether the rules would be rewritten.

And now comes the reality of the “repeal and replace” initiatives from the Republicans. If the uncertainty of this market was large before with the ACA, it is almost unknowable under whatever comes next. Thus the initial exit of some latecomers, including United Healthcare, and undercapitalized minor entrants, such as nonprofit co-ops, is almost certain to become a flood of firms leaving the exchanges. They have little choice since the risks are too large and the actuarially appropriate rates are still not obvious given the political turmoil and changing rules.

Some in Congress seem to think that passing the “repeal” part immediately but delaying its implementation for two or three years will somehow leave everything as it is now. But this naive notion misses the fact that the riskiness of the Obamacare individual insurance exchange markets will have been ramped up to such a level that continuing makes no sense.

How does the Trump administration plan to deal with this?

The budget legislation gives congressional committees until Jan. 27 — a blink of an eye for lawmakers — to write legislation repealing major parts of the health care law. Likely targets include the law’s tax penalties for people who don’t obtain insurance, its requirement that many companies cover workers and tax increases on higher-earning individuals and many health care firms.

Aware they have no chance of quickly agreeing on replacement legislation, Republicans plan to delay when their repeal would actually take effect. A range of 18 months to three years — perhaps longer — has been under discussion.

Trump has provided few specifics about how he would revamp the nation’s $3 trillion-a-year health care system. Steps he and congressional Republicans have mentioned include greater reliance on tax credits to help people afford coverage.

Republicans don’t want to abruptly end health care coverage for millions of voters who live in GOP-represented districts and states, or cause chaos in health care markets and prompt insurance companies to stop selling policies. So they are considering including provisions in their repeal bill to protect consumers and insurers during the transition period.

Sen. John Thune, R-S.D., a member of the GOP Senate leadership, said that could include money to temporarily continue helping people afford to buy coverage and language letting the Department of Health and Human Services help stabilize insurance markets.

A few things:

  • Republicans have been talking about repealing the ACA since it was passed and they have no plan to replace it yet? Obviously they have never really planned a real replacement.
  • Given the above discussion, it’s very possible that the repeal of the ACA will crash the individual insurance market so it won’t matter if there are subsidies since there will be no companies willing to participate in the market. Why would a company participate in a market they know will be gone in a few years and which depends on Congress supporting them to break even–knowing that Congress reneged the last time such a promise was made?
  • Given all the complexities, they are going to write the repeal legislation very quickly. I’m sure they will be very well written and carefully vetted.

Donald Trump, being Donald Trump, is trying to get out the lie that any failure will be the fault of Democrats:

massive increases of ObamaCare will take place this year and Dems are to blame for the mess. It will fall of its own weight – be careful!

Sorry Donald, this will all be on you and the Republicans. You will be responsible for tens of millions of Americans losing health insurance.

Trump will screw Trump states

Kevin Drum put this up:

Once Obamacare’s subsidies are repealed, it’s likely that 3 million people with expensive pre-existing conditions will be instantly tossed out of the health care system, unable to get insurance and unable to afford proper care.

He’s using the numbers from here. If you look at the chart in Kevin Drum’s post you notice that the states with the highest percent of people with pre-existing conditions voted for Trump. In fact, there are 23 states that are at or above the US average of 27% with pre-existing conditions–of these 4 voted for Clinton including Maine which split electoral votes (3 for Clinton, 1 for Trump). And all 11 with 30% or higher voted strongly for Trump (Clinton got less than 40% of the vote in all those states).

Hey, here’s a scatterplot (DC is the one in the upper left):

pre-exist

Donald Trump has said he wants to keep the ban on people being denied health insurance if the have pre-existing conditions but the health insurance companies will go bankrupt unless they’re allowed to charge them much more and/or force almost everyone to have insurance. Since the mandate to have insurance is not one of the things Trump wants to keep, health insurance will become unaffordable to a good chunk of these people which is why Kevin Drum says that 3 million of these people will be instantly tossed out of the health care system.

Trump voters really know how to stick it to themselves.

Republicans want to cut, Medicare, ACA, Medicaid, and Social Security

Let’s see what Republicans plan now that they hold the three parts of government:

Amid all the hand-wringing over Republican plans to eviscerate Medicare and Medicaid and repeal the Affordable Care Act, it shouldn’t be overlooked that the GOP has the knives out for Social Security too.

Johnson’s “Social Security Reform Act” changes the program’s benefit formula to provide modest benefit increases for the lowest-earning workers in the system— those who earned up to an annual average of about $22,105 over their lifetimes in inflation-indexed pay — with cuts for everyone else ranging from 17% to as much as 43%, compared with currently scheduled benefits, by 2080.

The act would cut way back on cost-of-living increases for retirees. It would do this by cutting out cost-of-living raises entirely for retirees earning adjusted gross income of more than $85,000 ($170,000 for couples) starting in December 2018, and using the chained consumer price index to calculate the COLA for all others. (The income threshold would be adjusted for inflation.)

Finally, the measure also raises the full retirement age, which is now pegged to reach 67 by 2022, to 69 by 2030. this means that workers taking early retirement, which is permitted as soon as age 62, would face a steeper cut in annual benefits for starting early.

Hey, that’s great news for all the working-class people that were so upset that they voted for Trump … if they wanted to make their lives worse.

Anyway, let’s move on to Russia:

Trump’s team lashed out at the agencies after The Washington Post reported that the CIA believed that Russia had intervened to undercut Clinton and lift Trump, and The New York Times reported that Russia had broken into Republican National Committee computer networks just as they had broken into Democratic ones, but had released documents only on the Democrats.

There are even some Republicans who say this is a bad thing:

The Republicans who lead the congressional committees overseeing intelligence, the Pentagon and the Department of Homeland Security take the opposite view. They say that Russia was behind the election meddling, but that the scope and intent of the operation need deep investigation, hearings and public reports.

“We cannot allow foreign governments to interfere in our democracy,” Rep. Michael McCaul, R-Texas, who is the chairman of the Homeland Security Committee and was considered by Trump for secretary of Homeland Security, said at the conservative Heritage Foundation. “When they do, we must respond forcefully, publicly and decisively.”

Of course Trump hasn’t been going to many of the intelligence briefings so he knows more about what’s going on than those that actually go. I assume that’s his argument.

Fun time to be an American and Trump isn’t even President yet.

Government works, part two

Republicans keep saying that Obamacare has been a disaster. Let’s see what a recent study says:

A study published Monday in JAMA Internal Medicine offers another way of looking at the issue. Low-income people in Arkansas and Kentucky, which expanded Medicaid insurance to everyone below a certain income threshold, appear to be healthier than their peers in Texas, which did not expand.

Their survey found people in Arkansas and Kentucky were nearly 5 percent more likely than their peers in Texas to say they were in excellent health in 2015. And that difference was bigger than it had been the year before.

The survey also asked about other subjects. It found that people in the expansion states were more likely to have a doctor and to have a place to go for care. They said they were more likely to have their chronic disease treated, and that they were more likely to have received screening for high cholesterol or high blood sugar, markers for heart disease and diabetes.

On financial measures, the study was in line with some previous studies, finding that people in Kentucky and Arkansas were less likely to postpone care or avoid taking prescribed drugs because of the cost, and that they were less likely to be struggling with a medical bill.

Gee, a government program has made people healthier. That’s going to end civilization as we know it.

Obamacare works

The Census Bureau has a report out on the number of uninsured in the US in 2013 and 2014. Let’s see the conclusions:

The percentage of people without health insurance coverage decreased sharply between 2013 and 2014 by just under 3.0 percentage points, specifically, by 2.9 percentage points as measured by the CPS ASEC. The ACS measured a comparable decline. The CPS ASEC uninsured rate, which represents the percentage of the population who had no health insurance coverage during the entire year, changed from 13.3 percent in 2013 to 10.4 percent in 2014.

After several years of a relatively stable uninsured rate between 2008 and 2013, as measured by the ACS, the percentage of the population who were uninsured dropped between
2013 and 2014, marking the largest percentage-point decline in the uninsured rate during this period

Let’s put that in context:

In 2014, 10.4 percent of people (or 33.0 million) were uninsured for the entire calendar year. This was a decrease of 2.9 percentage points from 2013, when 13.3 percent (or 41.8 million) were uninsured for the entire calendar year.

Hmm, I wonder how widespread it was?

Between 2013 and 2014, every state and the District of Columbia experienced a decrease in their uninsured rate

People of all education levels experienced an increase in the rate of health insurance coverage between 2013 and 2014.

Between 2013 and 2014, health insurance coverage rates increased for each income category.

Between 2013 and 2014, the population living at every income-to-poverty ratio level experienced a decrease in their uninsured rate.

Between 2013 and 2014, all of the family status groups experienced an increase in health insurance coverage rates.

Between 2013 and 2014, health insurance coverage rates increased for all nativity groups.

Between 2013 and 2014, the overall rate of health insurance coverage increased for all race and Hispanic-origin groups.

The percentage of people without health insurance coverage dropped for every single age under 65 between 2013 and 2014

It sure does seem that it helped pretty much all groups of people. I wonder how the states that resisted it did:

Variation in both the uninsured rate and change in the uninsured rate by state may be related to whether the state expanded Medicaid eligibility in 2014 as part of the Affordable Care Act. In general, in 2014, the uninsured rate in states that expanded Medicaid eligibility was lower than in states that did not expand eligibility. In states that expanded Medicaid eligibility (“expansion states”), the uninsured rate in 2014 was 9.8 percent, compared with 13.5 percent in states that did not expand Medicaid eligibility (“nonexpansion states”).

The decrease in the uninsured rate was 3.4 percentage points in expansion states, compared with 2.3 percentage points in non-expansion states.

That’s good work there by the Republican governors–their states, on average, had a higher percent of residents without health insurance before the expansion AND their states decreased the rate of those without insurance less. If the non-expansion states had reduced the uninsured rate as much as the expansion states (and their reduction should have been larger since they started with a higher rated of uninsured) then that would mean the rate would have decreased by 3.4% overall which means about 1.5 million more Americans would have insurance.

Hey, that’s a great slogan for the Republicans–“we kept 1.5 million Americans from getting health insurance”.

On the other hand, maybe Republicans don’t want to trumpet this which may be why Obamacare has barely been mentioned in the first two Republican debates.

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