• Tips gratefully accepted here. Thanks!:

  • Recent Comments

    Ivory Bill Woodpecke… on Redlining is evil
    Ga6thDem on Redlining is evil
    Ga6thDem on Harris
    Ivory Bill Woodpecke… on Redlining is evil
    eurobrat on Harris
    lililam on VEEP Stakes.
    William on VEEP Stakes.
    riverdaughter on Redlining is evil
    Ga6thDem on Redlining is evil
    Ga6thDem on VEEP Stakes.
    Ga6thDem on VEEP Stakes.
    William on Harris
    riverdaughter on VEEP Stakes.
    riverdaughter on Harris
    Kathleen A Wynne on VEEP Stakes.
  • Categories


  • Tags

    abortion Add new tag Afghanistan Al Franken Anglachel Atrios bankers Barack Obama Bernie Sanders big pharma Bill Clinton cocktails Conflucians Say Dailykos Democratic Party Democrats Digby DNC Donald Trump Donna Brazile Economy Elizabeth Warren feminism Florida Fox News General Glenn Beck Glenn Greenwald Goldman Sachs health care Health Care Reform Hillary Clinton Howard Dean John Edwards John McCain Jon Corzine Karl Rove Matt Taibbi Media medicare Michelle Obama Michigan misogyny Mitt Romney Morning Edition Morning News Links Nancy Pelosi New Jersey news NO WE WON'T Obama Obamacare OccupyWallStreet occupy wall street Open thread Paul Krugman Politics Presidential Election 2008 PUMA racism Republicans research Sarah Palin sexism Single Payer snark Social Security Supreme Court Terry Gross Texas Tim Geithner unemployment Wall Street WikiLeaks women
  • Archives

  • History

    June 2013
    S M T W T F S
     1
    2345678
    9101112131415
    16171819202122
    23242526272829
    30  
  • RSS Paul Krugman: Conscience of a Liberal

  • The Confluence

    The Confluence

  • RSS Suburban Guerrilla

    • Here we go again
      This is one more reason why Biden will need to expand the federal bench and add a couple hundred new judges: @fedjudges reports the White House is nominating Kathryn Kimball Mizelle, an associate at Jones Day, and former clerk to Justice Thomas, to a lifetime-tenured judgeship in Florida. She graduated college in 2009, earned her … Continue reading Here we g […]
  • RSS Ian Welsh

    • Biden Picks Kamala Harris As VP
      The two most important consequences of this decision come from the fact that Biden is old and almost certainly senile. This means that Harris stands a good chance of becoming President if Biden dies or his incapacity becomes un-concealeable even with the best drug cocktails. If that doesn’t happen, Kamala is odds on to be […]
  • Top Posts

Pockets of sanity in Texas

I recently discovered Hilah Cooking on YouTube.  If you love Tex Mex, you’ll love her channel.  She’s got a new gig on Tastemade called Hilah’s Texas Kitchen.  Check out the recipe for the Grapefruit Sorbet, which looks just about perfect for a hot summer day.  She also does a Hilah Talking thing where she answers cooking questions and talks about stuff.

This Hilah Talking episode from last year is hilah-rious and gives me hope that all is not lost in Texas.

I’m going to borrow a theme from Lambert.  I’m looking for a Household Remedy for an particularly aggressive honeybee.  Every time I try to clean out my flower bed and plant the

Twist and Shout hydrangea

gorgeous Twist and Shout Hydrangea I bought last week, I get strafed by this fricking bee.  Yesterday, it chased me around the yard until I ran screaming into my house.  I thought it had landed on my shirt and in my frenzy to get away from it, ripped off my shirt and slapped my neck with poison ivy tainted gardening gloves.

Ok, you guys can stop laughing now at that mental picture of RD standing half nekkid in her gardening gloves shrieking and spastic over a bee.

The topical steroids are helping with the poison ivy blotches on my neck.

One other amusing little story.  I live across the street from another Tolkien fanatic.  Yes, yes, it doesn’t get any better.  Except last night, the neighbors were having a family party.  They were pretty good at keeping the noise down and I fell asleep with the happy chatter of people having a good time in their hot-tub across the street, only to be woken up about an hour later to someone screaming “GANDALF!!,  GANDALF!!” at the top of his lungs. For a minute there, in my semi-sleepy state, I thought I was in Moria or something.  It was very confusing.

Turns out the dog had gotten loose – and his name is Gandalf.

Pro-choice hysteria

I saw Wendy Davis’s filibuster the other night and was ecstatic to see someone from the left, besides Hillary, actually forcefully defending a woman’s right to choose.  And then I witnessed all of the hysterical, emotional responses from the left blogosphere about just how incredibly awful it would be if we can’t get abortions at any point in time during a pregnancy, and despaired.

Both the right and the left seem to be hung up on something and it took me awhile to pin it down.  Here it is:

Pregnancy is a temporary condition. Motherhood is FOREVER.  

Neither side can get past the first part.  Pregnancy is temporary.  It has a finite duration.  There is definitely an endpoint and you pretty much know when that endpoint is coming so you can prepare for it in advance.

The right would like to extend that period indefinitely and insists that women become instant mothers from the moment of conception.  Women are supposed to love and feel nurturing feelings towards a temporary visitor.  Of course, that works for the right politically and economically on several levels.  Mostly, abortion is a political football and a defining issue for the right.  If the other side is for it, they’re agin it.  But they are agin it for economic reasons as well.  More women staying at home being mothers frees up more of the shrinking pie for the menfolk.  Amiright?  You know I am.  So all this romanticization of the fetus is designed to make mothers stay out of the workforce.  Let’s just be honest about that up front, OK?

The left seems to believe that pregnancy is forever.  It is not. It’s also not punitive or a death sentence.  It is what it is- a temporary condition, like many other temporary physical conditions. And no one can make you be a mother if you don’t want to be.  It is true that labor and delivery is painful, somewhat dangerous, time consuming and recovery can take awhile.  But putting your body through that pain and inconvenience does not make you a mother.  Sure, there are a lot of conservative assholes who would like to shame women for getting pregnant and if women are forced to endure shame for getting pregnant but not wanting to be mothers, that’s something we can definitely work on.  Think of it as a Gay Straight Alliance type activity.  If the state insists that women carry a pregnancy past the 20th week, it really should pick up the tab for that and forcefully prohibit employers from terminating employment of pregnant employees.  Where is that legislation?  Why aren’t women insisting on it?  Where is Wendy Davis when we need that kind of bill?

Don’t get me wrong.  I am strongly pro-choice.  I don’t think the state has an interest in what you do with your womb.  But I do kinda draw the line when the fetus is viable.  I’m not talking about when the fetus is compromised or has a genetic abnormality or when the woman’s health or life is in danger or in cases of rape or incest or when the person carrying the fetus is only a little girl or in cases where a previous legal abortion was unsuccessful. (let me see, have I covered all exceptions?  I think I have)  In those cases, I don’t have a problem with abortions extending beyond the 20th week.  And as for fetuses experiencing pain, I’d be very surprised if TEXAS can’t figure out a way of lethally injecting a human being without pain prior to removal from a uterus.  Please.  Governor Perry has done it 261 times.

BUT…

What one person may consider an unacceptable infringement of their time and persons may be a premature infant worth lifesaving measures to another.  At the point of viability, I have to apply my Good Samaritan test.  If I found a premature infant at 21 weeks gasping for breath at the side of the road, what would I do?  I think most of us would pick up that infant and rush it to the nearest neonatal intensive care unit.  I think I would have the same concern for the fetus who can survive on its own but is not yet gasping for breath.  The difference between an aborted fetus and a premature infant mandating special care is extremely thin at the age of viability.

For every infant, the dividing line between viability and non-viability is different and the call should probably go to a group of physicians.  The danger in that is that you might get a group of rightwing crackpots with an agenda.  But oddly enough, this is how they do it in some of the world’s most progressive countries and I’m assuming they’ve managed to avoid that scenario.  Sweden, for example, allows abortions only until the 18th week.  After that, you need to appeal to a panel of doctors who will make the call and they usually only do it in cases when the fetus or the woman carrying the fetus have some kind of health complication or abnormality.  Otherwise, I suppose, you’re denied an abortion and are back on that train until you reach your destination a few months later.

I don’t hear Swedish women or Norwegian women or Danish women screaming bloody murder or telling sob stories about how hard it is to carry a baby to term or whining that the state is not treating them as fully human simply because it makes them wait out a temporary condition and make some hard choices afterwards. Yes, adoption is a hard choice.  I’m not sure that it is a harder choice than aborting a fetus after 20 weeks though. Yes, they have a lot of social safety net options that we don’t, including socialized medicine.  Maybe we should focus on that instead.  Women who are forced to endure a temporary condition should be given all the support and medical services that women in Scandinavian countries get.  If they don’t want to continue on with motherhood, right wingers should be forced to stuff a sock in it.

But I don’t think there is any really good excuse for someone to wait until the 20th week to get an elective abortion.  Yep, I’ve heard that some ditzy women don’t know they’re pregnant until then.  For some reason, American women seem particularly prone to not knowing they’re pregnant until the fifth month.  The rest of the world seems to have gotten the memo but we haven’t.  I don’t hear any bloggers on the left attempting to explain that disparity.  There MUST be a good reason for why American women wait so fricking long to take a pregnancy test but no one has come forward to tell us why that is.

That’s not to say it doesn’t happen. It’s unfortunate but probably a lot more rare than we would like to admit.  I don’t know how those unfortunate who miss the deadline would react to a Good Samaritan test.  Probably not well.  But it is a temporary condition and if other countries have limits, especially countries with higher gender equality cultures, then imposing a 20 week viability test is probably not going to kill what little gender equality we have here in the US.

What WILL kill gender equality here is all the proscriptions and obstacles women face before that 20 week limit.  And I stand with Wendy on fighting that.  There’s no good reason why we are still living with bronze age tribal morality in the twentieth century.  That’s what is preventing women from being fully human and getting on with their lives after a temporary physical condition.

Lame article but at least we’re getting somewhere

Check out this article at the NYTimes about the impact of the H1B visa increase on tech workers.  A Bill Allowing More Foreign Workers Stirs a Tech Debate gives me mixed feelings about the state of journalism.  It feels like the author is starting to ask the right questions and is no longer simply accepting the business community’s excuse that it can’t find good help anymore but he/she isn’t going quite far enough.  I only regret that journalism majors aren’t required to take a bunch of science courses so they could figure this one out.

Here’s the thing the author is missing: if a business brings in cheap foreign labor to do its heavy lifting in science and math and tech, that business still has to train those workers.  Oh, yeah. You don’t think they come off the boat knowing how to create the perfect data tables or design drugs do you?  F^&* no.  That takes practice.  Ask anyone who’s actually done the work.  In fact, for the pharma industry, it takes at least one good, long lasting project before you get the hang of what the hell’s going on and one project could easily stretch on for several years before it’s killed in some bloody MBA massacre.

As for older tech workers who have not been able to keep their skills fresh, that’s certainly true if you don’t have a job.  Just getting our hands on papers is a logistical and economical nightmare.  The ACS charges $35.00 for 48 hours of access to a single paper and when you are not affiliated with a lab or college, that kind of money is just nuts.  As a result, the unemployed can’t keep up with changes that are happening rapidly in their fields. That’s why so many of us will take part time work, or adjunct work or no pay at all.  But it *IS* possible to teach old dogs new tricks.  I learned structural biology and molecular biology lab techniques in my last year of work.  Was I perfect?  No, but I was able to do my job and correct my mistakes, and since I really enjoyed my work, I was looking forward to getting better at it.  I was about on par with a H1B visa worker with one year of experience in structural bio when the layoff happened.  Plus, I was able to translate what I learned in the lab to my drug design work, which was the real bonus in my move back to the lab.  Frankly, I don’t know why more labs don’t try retraining but they don’t.   Since it’s not the ability to learn new things that prevents older tech workers from being retained, it must be something else, right?

And relocating.  The author says that the H1B visa workers add to the higher salaries in the economy where they are employed.  But the reason why businesses are bringing them in is because they are cheaper than the people they are displacing.  So, I don’t think I buy this, or anyway, it’s relative to what the local economy was before the massive layoffs.  But if high tech/biotech companies really want to save money, they could abandon the coasts for the midwest from whence many of them came.  It’s cheaper to live here and there is this thing called the internet.  I guarantee, your researchers won’t miss a thing.  They won’t miss out on seminars and new information as long as there is wifi.  They won’t miss the outrageous cost of housing and, believe it or not, they have Starbucks, Thai food and all the Broadway touring shows you can eat.  There is culture and music and all kinds of things to keep you entertained.  There are colleges and universities that are not called Harvard or Stanford out here.  It’s true.  They even teach real educational stuff and have research facilities.  So, verily I say unto the huddled masses yearning to breathe free in Cambridge, MA, go west!

There is no good reason for the biotechs to be spending money holed up in Massachusetts and South San Francisco, forcing their workers into more and more precarious existences and stressing them when they should be thinking about science.  Since the trend is to keep following the herd to these outrageously expensive places to live in search of get rich quick schemes, then I can only conclude that good science is not the goal with the H1B visa quota.  Cheap, exploitable labor is.  In other words, the MBA class will do whatever it’s allowed to do until someone tells them it’s not allowable anymore.

So, kudos to the NYTimes for looking into the problem but you need to keep digging.

PPACA: Resource Library

PPACA: Resource Library. Links will be added regularly.

Contents
Federal Government Resources
State Resources
Academic Resources
Private Organization Resources
News, Blog Posts and Stories of interest

Federal Government Resources

HealthCare.Gov :: “The creation of the Web site was a requirement of the Patient Protection and Affordable Care Act that President Obama signed into law in March 2010, and the site is designed to provide comprehensive, easy-to-understand information on health insurance options. (Lacking an obvious “About” page on the site, this description was borrowed from HowStufWorks.com

— IRS
— — 26 CFR Part 1 :: Minimum Value of Eligible Employer – Sponsored Plans and Other Rules Regarding the Health Insurance Premium Tax Credit (http://www.gpo.gov/fdsys/pkg/FR-2013-05-03/pdf/2013-10463.pdf) TAGS:: MV, Minimum Value, EHB, Essential Health Benefits, Employer Sponsored Plans

— Health and Human Services


State Resources
— California

— Oregon

— Washington, D.C.


Academic Resources
— University of California
— — Berkeley
— — — Labor Center: Health Care Policy
— — — — National Calculator
— — — Law School: Health Care Reform Policy Briefs, Research & Other Materials
— — — Publications:
— — — — How the Affordable Care Act Will Create Perverse Incentives Harming Low and Moderate Income Workers, by David Gamage


Private Organizations (NOTE: Lambert or Katiebird have browsed these sites and they found evidence of credibility and interest but, they can’t guarantee the validity or relevance of the information on the sites listed here)

Henry J. Kaiser Foundation (http://kff.org) TAGS: General Health Care Information, Medicare,
— — Subsidy Calculator (http://kff.org/interactive/subsidy-calculator/) TAGS: Calculators, Subsidy Calculator, Exchange Calculator NOTE: This is a widely used calculator but, browse through the Notes and Frequently Asked Questions and you’ll see this disclaimer, “Premiums in the calculator are illustrative examples in 2014 dollars derived from estimates of average premiums for 2016 from the Congressional Budget Office” also there are no links to the Federal Rules and Regulations that lie under their calculations.

PPACA Links: 2013-06-24

[Contributed and cross-posted by Lambert Strether of Corrente]

Readers: Here’s the next of a series of Monday posts that will collect what I hope are the most interesting stories of the week on the PPACA (ObamaCare). This is a huge subject to cover, so if you have additional links, please add them in comments! –lambert

Obamacare starts in 99 days. These 99 things need to happen before then Washington Post 06-24-2013. “60. All those call center agents will need to undergo training on the Affordable Care Act. This is important: When Part D launched, about one-third of seniors got an inaccurate or incomplete answer from the new call center.”

10 to watch on ObamaCare rollout The Hill 2013-06-23. Debbie Curtis (Deputy Policy Director, District of Columbia Health Benefit Exchange); Andy Allison (Arkansas Medicaid Director); Anne Filipic (Enroll America President); Anton Gunn (Director of External Services, Health and Human Services Department); Timothy Jost (Professor of Law, Washington and Lee University School of Law); Denis McDonough (White House Chief of Staff); Peter Lee (Executive Director, California Health Benefit Exchange); Sandy Praeger (Kansas Insurance Commissioner); Jon Kingsdale (Executive Director, Wakely Consulting Group); Teresa Miller (Acting Director, Insurance Programs Group, Center for Consumer Information and Insurance Oversight).

NFL’s help sought in promoting Obama health plan as outreach begins Reuters 2013-06-24. “The Obama administration is seeking the help of major U.S. sports organizations, including the National Football League, to persuade young and healthy Americans to sign up for medical insurance coverage later this year, officials said on Monday. …. The campaign is expected to target 2.7 million younger consumers between the ages of 18 to 35, mostly male and non-white, whose participation in new online health insurance exchanges is vital to the success of President Barack Obama’s 2010 healthcare reform law.”

Time Is Running Short for Big ‘Obamacare’ Push National Journal 2013-06-23. “Making the sell for Obamacare will be a particularly tough challenge for the national organizations. States are all approaching the exchanges differently; some are working in partnership with the federal government, some are going it alone, and others are letting the federal government run the show. Not all states are expanding their Medicaid programs, which will leave certain low-income adults without any affordable health insurance options. Different groups have different concerns about the law, and different insurance needs. The Obama administration may be well-positioned to find and target these groups—micro-targeting is something it was renowned for during the latest presidential campaign—but getting people to sign up for insurance could prove much more complicated than getting out the vote.”

Health group launches major ObamaCare enrollment drive The Hill 2013-06-18. “A group with ties to the White House is beginning a massive grassroots effort this week to promote enrollment under President Obama’s healthcare law. … [Enroll America President Anne Filipic said] the enrollment drive will aim to “create almost an echo chamber” of information about enrollment. … Many of the young, healthy people the administration most wants to enroll live in a small handful of states, and the outreach effort aims to appeal to them through targeting reminiscent of Obama’s 2012 reelection campaign.”

Insight – It takes an army: Tens of thousands of workers roll out Obamacare Reuters 2013-06-21. “From the chief actuary at the California health insurance exchange that President Barack Obama’s healthcare reform law established to the legions of call center staffers who will help people trying to buy insurance through such state exchanges, the number of people working to implement “Obamacare” has reached the tens of thousands, a Reuters analysis has found. The number of such workers, obtained through documents and interviews with officials, consultants and contractors, could be significant enough to produce a modest, if temporary, boost to employment across several industries. What is clear is that relatively few of the Obamacare-related jobs are in healthcare, at least so far. The sector added an average of 24,000 jobs per month over the last year, the Bureau of Labor Statistics reported this month. Helping the uninsured buy coverage is expected to bring millions more paying patients to doctors, clinics and hospitals starting in 2014, but most providers have adopted a wait-and-see attitude on staffing.”

Government begins education blitz for uninsured USA Today 2013-06-24. “Starting Monday, visitors to healthcare.gov [1-800-318-2596, 24/7] will be asked questions about their age, sex, disability status and income. How they answer could provide them with detailed information, such as: “• Whether a participant is eligible for help paying for insurance. • What would be covered if a woman becomes pregnant. • What plans are available with benefits that fit a person’s needs.  • Whether insurance would come through a federal or state exchange. • How small businesses can use the exchanges for insurance for their employees. The site also contains features that allow visitors to sign up for Internet updates or instant chats with a call-center operator to answer questions.”

Who’s preparing state for ‘Obamacare’?: Lots of groups, businesses, and the gov’t The Montana Standard 2013-06-23. “[Tom Jacobson, executive director of Rural Dynamics Inc of Rural Dynamics says] Montana stands to benefit from the marketplaces because it has a lot of lower-wage workers who should be eligible for substantial subsidies to buy health coverage. “I really think we need to get the public talking about this,” he says. “But people don’t want to talk about things that they don’t understand. We have to get them to understand the ins, the outs, the options. We need to have neighbors talking across the fence about what type of policy they bought on the (marketplace), rather than debating whether Obamacare is good for the country.”

An Obamacare PR Launch Gets a Correction The Atlantic 2013-06-24. “The Social Security Administration set one recipient’s teeth on edge when it emailed him the wrong link to learn about the new insurance marketplace. According to the source code, someone made a very basic error in processing the original link, probably just cutting and pasting the wrong thing in the wrong place. This is a common form of error. But with expectations and nerves about joining the new exchanges running as high as they are right now, every little thing counts. And is being counted.”

Implementing Health Reform: A GAO Progress Report On The Exchanges Health Affairs Blog 2013-06-20. “Third, although the [GAO] reports do not directly discuss this, the Obama administration damaged its own cause by suspending rulemaking activity in the months leading up to the 2012 election.  Apparently the administration concluded that it could not risk alienating voters by pushing ahead with ACA implementation during the heart of a reelection campaign, but several months of valuable time were lost as rulemaking languished in the fall of 2012.” Excellent overview. (Here isan excellent article on rationing and market failure, also from Health Affairs Blog.)

New ‘Obamacare’ exchanges could miss enrollment deadline – GAO Reuters 2013-06-19. “The report by the nonpartisan Government Accountability Office (GAO) said U.S. officials have missed deadlines and remain behind schedule on key parts including those that involve consumer eligibility for federal subsidies, the certification of health plans to be sold on the exchanges and the hiring and training of special “navigators” to guide people through the enrollment process. GAO found that states have also failed to complete many of the tasks assigned for implementation and that the administration has conducted only initial testing of the computerized system that will link the exchanges with states and federal agencies including the Internal Revenue Service. A separate GAO report found that the exchanges for small businesses that are also being created under the Patient Protection and Affordable Care Act are behind schedule, with about 44 percent of the key activities targeted for completion by March 31.”

Will the Affordable Care Act’s (“ObamaCare”) Federal Health Insurance Exchanges Be Ready On Time? Finally the Facts! Health Care Policy and Marketplace Review 2013-06-19. CMS has been outwardly optimistic but is clearly struggling to make the deadlines. While the GAO report gives us a clear sense of where CMS was as of about May, we are now essentially in the dark again. As the GAO report says, whether the exchanges will be ready or not now depends upon key dates between May and October. Why can’t the administration build upon this report and keep us informed?”

Blue Cross-Blue Shield Bets Big On Obamacare Exchanges Kaiser Health News 2013-06-21. “[UnitedHealth Group and Aetna [and most other non-Blue insurers “seem to be proceeding cautiously” in the online marketplaces expected to cover to millions, said David Windley, who follows the industry for Jefferies & Co., an investment firm. Five Blues executives attended the meeting with Obama on April 12 to coordinate exchange implementation: Scott Serota, CEO of the Blue Cross and Blue Shield Association; Florida Blue CEO Patrick Geraghty; Chet Burrell, CEO of CareFirst BlueCross BlueShield, with plans in Maryland and D.C.; Patricia Hemingway Hall, CEO of Health Care Service Corp., with Blues plans in four states; and WellPoint CEO Joseph Swedish. WellPoint is the No. 2 health insurer and operates Blues plans in 14 states.  [F]or health coverage sold directly to consumers — the kind that will be offered on the exchanges — Blues have the most members in a large majority of states. Protecting that business is why Blues have little choice but to offer plans in the online marketplaces, analysts said. If they abstain, they risk losing those members. Once in the game, they need to recruit as many customers as possible to avoid signing a disproportionate share of the sick.”

Contractor that handles public’s Medicare queries will do same for Affordable Care Act WaPo 2013-06-20. “The Department of Health and Human Services estimates that Vangent’s call centers will receive 42 million calls about the federal marketplaces this year, a daily average of up to 200,000; plus answer 2,400 letters and 740 e-mails, and host 500 Web chats daily. … Neither Vangent nor HHS would provide specific requirements of the contract or a copy. Employment ads for the call centers’ “temporary customer service representatives” seek applicants who have a high school diploma or equivalent and six months of telemarketing or secretarial experience. An HHS spokeswoman said that customer service representatives will answer questions by reading from HHS-approved scripts and provide state-specific information. However, she would not provide examples of the scripts or say whether they were tested with consumers.”

ObamaCare premiums lower than expected 2013-06-19 The Hill. “A new analysis from Avalere Health says the lower-than-expected prices show that the central piece of the healthcare law — new insurance exchanges in each state — is working as intended. “In the nine states that have publicized their 2014 rates, every benchmark plan came in cheaper than estimated by the Congressional Budget Office. The CBO has said it expects the benchmark policies to cost an average of $433 per month. The actual rates filed so far range from $205 to $413 per month — even the most expensive policy is still below the budget office’s estimates. Although the rates are lower than expected, they’re still higher than what young, healthy people are paying now for comparable coverage. Avalere’s analysis also comes with a catch: the consulting firm compared rate filings for 2014 to CBO estimates for 2016. The CBO has not publicly released an estimate for 2014, Avalere said. So, lower-than-expected premiums next year could still rise to the level the CBO predicted — or even higher — in the next two years.  That’s especially likely if insurers are intentionally setting their prices low in the beginning, to attract initial business, and plan to raise them once the new system is more fully engrained.”

Subsidy Calculations Not As Simple As They Seem Colorado Health Insurance Insider 2013-06-17. “If you’re confused about the subsidies for health insurance starting in the exchanges in 2014, you’re probably not alone.  Although the basic math is quite simple in terms of the maximum amount a family or individual will have to pay based on their income if they earn less than 400% of federal poverty level, it’s still tough to pin down specifics in terms of who will end up getting subsidies, especially for people who are right on the border of the income cut-off. For now, it appears that most subsidy calculators are using generalized national average data, estimated by the CBO.  But the numbers turn out differently depending on what calculator you use. For people who are right on the brink of qualifying for a subsidy based on income, it might be worth crunching the numbers and possibly discussing your situation with a qualified financial adviser or tax planner.”

The ACA’s Obamacare Problem The American Prospect 2013-06-24. “But over time—and, my guess is, rather quickly—the exchanges will just be something that’s always been there. It won’t seem very government-y, after all: It’s just going to look like a web site hosting a bunch of private health-insurance plans. Most consumers will remember the name of their insurance company; far fewer will remember the trying-to-be-catchy name of the web site, and of those, only a small minority will associate it with all that fuss that people in Washington were talking about. Now, under the hood, there is all sorts of government intervention going on—all sorts of new regulations about what insurance companies can do, how they must spend their money, what products they are allowed to offer through the exchanges. But that’s all going to become invisible to consumers over time.”

When insurance is too expensive no matter what PNHP 2013-06-21. “The whole point of the Affordable Care Act is to expand health insurance. But here’s the thing, even after the law has taken effect, about 30 million people — almost all of them U.S. citizens — still won’t be covered. Dr. Steffie Woolhandler, who co-authored a recent report about the uninsured under the new health care law in the journal Health Affairs, explains who will be out of luck….[W]ith salaries averaging $22,000 for most of them… ‘Even if you are subsidized, you still have to pay thousands of dollars out of pocket and lots of low- and middle-income people won’t be able to do that,’ she says. Woolhandler says many of these people work in industries that don’t offer insurance, such as agriculture, forestry, and the service sector. She says between premiums, co-pays and deductibles, health costs will easily run into the thousands.”

“So, You’re Thinking About Running the 29er Strategy” Affordable Care Act Review 2013-06-17. “In response to the Affordable Care Act, many employers are considering cutting some of their employees’ hours to something less than 30 per week. …  But the 29-hour strategy might not be a cure-all: it could expose the employer to claims under Section 510 of the Employee Retirement Income Security Act of 1974. … The prototypical Section 510 case is one in which the employer fires an employee right before the employee’s rights in a pension plan become “vested.” … Nobody knows whether or how courts will apply Section 510 to an employer who reduces employees’ hours to avoid the § 4980H penalty.  Our view from here is that Section 510 lawsuits challenging the 29-hour strategy are not likely to succeed on their merits, but the theory may be plausible enough to require some hard legal work to get to a final ruling.”

Tenet To Buy Vanguard Health Amid ‘Obamacare’ M&A Frenzy Forbes 2013-06-24. “Tenet Healthcare (THC) is buying Vanguard Health Systems (VHS) in a deal that further consolidates the U.S. healthcare industry in the wake of the passage of the Affordable Care Act (ACA) …. Health Management Associates (HMA) had been considered a target of Tenet, however, some analysts have speculated the company’s largest shareholder Glenview Capital Management could push for a merger with Community Health Systems (CYH). Glenview, which has staked billions on investments in healthcare providers and hospitals, is a top shareholder in Tenet Healthcare with a near 10% stake, according to May 31 SEC filings. Bottom Line: Tenet’s deal for Vanguard indicates a continued sellers’ market as major healthcare industry players position for ‘Obamacare.’ Expect continued consolidation among healthcare providers and hospitals.”

Weiner Wants City to Test Single-Payer Health Care New York Times 2013-06-21. “Vowing to “make New York City the single-payer laboratory in the country” if he is elected mayor, Anthony D. Weiner on Thursday presented an ambitious plan to create a Medicare-like system for the coverage of municipal workers, retirees and uninsured immigrant residents left out of the Affordable Care Act.  Of insurance companies, he said, ‘Their job is to take in as much money as they can and pay out as little as they can.’ The complexity and delays of private insurance processing are no accident, he added: “’They make money on the float.'”

Lambert here: Even today, I still find it astonishing is that no priority is given to getting coverage to people who actually need care, either in the marketing or the program itself. No priority whatever. Nothing could more clearly indicate that ObamaCare is not a health care program at all, but a health insurance program.

Here is the blogroll we have at Corrente for health care blogs. We check these regularly. Please add health care blogs we should read in comments, and we’ll check them out.

More Obama Privacy Creepiness

Hooliganism moves online at The Cave in Chicago, sucking up your private information and harassing your friends

There’s nothing surprising (at least to Clintonistas) that the Obama campaign has been using peer pressure and psychological manipulation to herd Democrats.  But in light of Snowden’s revelations about the extent to the NSA’s reach into our private lives, the Obama campaign’s tactics are deeply disturbing.  If you got an email from a suspicious sender asking you to surrender your address book and a lot of private information so he can harass your friends, you’d quickly change all your passwords and turn on two-step verification.  But when it’s some 20 something Obama fan boy in a cave in Chicago doing it, we’re supposed to trust them?

I don’t think so.  

Anyway, listen to the Terry Gross  interview with Jonathan Alter and think to yourself how different this sounds now than it would have a month ago.  Who believes that the information gathering, retention and mining stopped after the election?  I have bridge in Brooklyn…

PPACA FAQ: Affordability and Subsidies (Part 2)

(This would be so much more fun if I was writing about a plan for universal health care for everyone. Medicare for Everyone or whatever.  Put us all in one bucket and let us all wait in the same lines.)

(Cross-posted to Corrente)

My plan was to continue the discussion of Affordability and Subsidies with an answer to a remaining after discussion in the comments on The Corrente site regarding this piece of the story:

I’ll list the essentials:

  1. Employee earns $35,000/yr
  2. Employee-only coverage = $275/mo (This is just under 9.5% of her salary)
  3. Employee +children = $500/mo or 17% of Employee Income (The IRS ruling says that only the cost of Employee-Only coverage is considered for affordability. But, PPACA does require an option for dependent coverage on parent’s policies)
  4. There is no spousal coverage option (there is no PPACA requirement for spousal coverage)
  5. Spouse may purchase insurance through an Exchange and would be eligible for a subsidy (because family income is under 400% of poverty)
  6. Employee & Children do not qualify for Subsidies because the Employee’s share of the insurance is affordable.

The question I’ve been hammering on all week (6 hours when I stopped counting) Relates to points 4 & 5 above. He may purchase insurance through the Exchange — but what will he be expected to pay? His wife is already paying 9.5% of the household income (using MAGI which will not be explained here) for her affordable employee-only coverage. Will he be expected to pay another 9.5% of their income before his subsidy kicks in?

Sadly, those 6+ hours didn’t reveal a definitive answer (to me). If I was going to make a guess, I would go to the California Calculator and enter the family’s information and take that for my answer. Their calculator happens to have one of my favorite explainations — the one labeled, “A married couple earning $40,000 per year if one spouse in on Medicare” (You might be able to tell just how frustrating my week has been that I am collecting favorite explanations.) It seems possible that this family’s situation might be comparable to that One Spouse on Medicare situation. But, I’m not at all sure.

For now at least, file this one under Questions Without Answers.

Update:

Commenter t, quoted below gave me an Ah, HA! moment:

No, he won’t be required to fork over 9.5%. Search Mandate exceptions. One of the exceptions of the ACA is that if individual insurance premiums with subsidy cost more than 8% of the MAGI, then the individual is exempt from the mandate. He will not be required to carry insurance at all. If he does carry insurance in your scenario, because he is part of a family of 4, he will qualify for a subsidy that will take his costs quite a bit below 9.5%. Exactly how much below, it’s hard to say. I’m guessing via looking at calculators that it will be in the range of 6.5%, which is still exorbitant.

But yes, this is a sticking point for sure. MAGI in his case should exclude the cost of the other family premiums. But because this law is a complete mess, it doesn’t.

I am predicting pitch forks, tar and feathers by 2014.5

T clarified something I didn’t understand:

1) Mom’s insurance could cost as much as 9.5% of her salary because that is how affordability is defined for employer-offered insurance.

2) But the subsidies for Exchange policies are calculated by which Bucket group your family falls into … see this Table from Wikipedia

Which explains why entering this family’s into the California Calculator, the cost to the family is so far below 9.5%

Still not a firm answer – The mom’s purchase of insurance through her employer (at 9.5% of family income) is within the scope of the PPACA requirements.  And, Medicare (referring to the California Calculator explanation) is NOT within the scope of PPACA requirements.

But, we can be pretty sure that Dad’s premiums will be something under another 9.5% of their household income.

As t says, “still exorbitant.”


What DID I find during that 6+ hours of research? …. Lots and lots and lots of interesting stuff.  And an idea for keeping track of it all. Now I can say that as part of the PPACA FAQ we’ll have an organized resource library to be unveiled as soon as it actually exists!

One of the most interesting essays I found is, “How the Affordable Care Act Will Create Perverse Incentives Harming Low and Moderate Income Workers“. I’m still reading through it (and the over 150 footnotes!) but I can already tell that it will be a very important reference throughout the course of this project.

It cannot be said often enough: Things do not have to be this complicated. We could be talking about the changes coming with Medicare for Everyone. Struggling to understand how the PPACA affects us is not what I expected from the 2008 election.

The case against increasing H1B Visas: the Wyeth-Pfizer massacre

I’m on a roll this morning.  I’ll have another post later today on the “Academia discovers everything that pharma goes on to exploit” myth and explain why, counterintuitively, this is a self-fulfilling prophecy.  But for the moment, I want to go over the reasons why business leaders are lying through their teeth about needing more highly skilled workers from other countries because the US simply does not produce enough {{rolling eyes}}.

First, I want to say that I worked with a lot of Chinese, Indian and European scientists and back in the 90’s, the US benefitted from an influx of foreign scientists and students, particularly Chinese and Russian emigres.  Most of them have since become American citizens so whatever provision is made in the immigration bills to displace them with cheap foreign labor is going to affect them as well.  I’m also aware of some Chinese students who had a hard time getting their PhDs because their advisors saw them as indentured servants who could be kept working indefinitely because the only alternative for them was to go home.  And then there were the Chinese scientists who only had work visas who were promptly sent home as soon as their companies laid-off, closed their facilities, etc, because the company itself had sat on their green card applications while the MBAs decided how they were going to restructure their R&D facilities for the 450th time.  There are a lot of sad and tragic stories from foreign researchers that I knew personally whose lives and families were not at all important to the companies they worked for and lost their ability to live in the country they called home, where they BOUGHT homes and had children and friends.  Some of these people had no choice but to leave all of that behind when they lost their jobs.  This country can be cruel to the best and the brightest, especially those from foreign countries but this country doesn’t spare it’s own citizens either.

Secondly, I have to bust the myth about the superlative skills of the foreign scientist. Not all foreign researchers are geniuses.  They’re a lot like other researchers.  Some are brilliant, some are hard-working, some of them didn’t realize what they were getting into before they had invested a good chunk of their lives in science.

So, that out of the way.

In 2008, Pfizer bought Wyeth.  Pfizer is a behemoth of a pharma company that has spent the last 10 years gobbling up companies, extracting their pipelines and spitting out the people who, you know, actually did the discovery.

After Pfizer bought Wyeth, it laid off all of the Wyeth research staff.  Yep, all of them.  Oh sure, a handful of the 19,000 people were retained and sent to Groton where Pfizer had a few holes to fill in their own ranks.  But there were thousands and thousands of scientists, Americans, Chinese, Russians, Israeli, you name it, who were laid off en masse for no reason at all.

It didn’t matter how good they were and I knew quite a few who were excellent and extremely hard working scientists. It didn’t matter what their performance evaluations were like. The lay off was indiscriminate and didn’t separate the wheat from the chaff. It didn’t matter how cheap they were.  They didn’t choose to live on the East Coast where the cost of living is extremely high.  A lot of them had been displaced by previous mergers and acquisitions from more affordable midwest facilities.  And it’s not like Pfizer was particularly choosey when they laid off.  It didn’t look at both companies and pick the best people to save.  No, it just picked the losing company and laid off all of those researchers without any consideration at all whether they were laying off the next blockbuster discoverer or not.   You’d think the board of directors and shareholders would have preferred Pfizer to be more selective but that didn’t seem to be very important and no one seems to have asked why that was.

All that mattered was THERE. WERE. TOO. MANY. OF. THEM. FOR. PFIZER.

Researchers cost money and research costs money and that was getting in the way of the people who were trying to make money off the acquisition so the researchers had to go.  Other labs might have been able to absorb all this excess talent but other labs were also shedding American and foreign researchers like there was no tomorrow so most of my friends ended up contracting, consulting, working for much less money in academia or small start up companies or getting out of science altogether.

So, verily I say unto you congresspersons who are about to flood an already flooded market with cheap indentured servants from other countries, you really need to stick an amendment into this bill that prevents companies that laid off thousands and thousands of experienced, well educated, highly skilled researchers from getting away with ruining the lives of those researchers, some of them foreign who they swear they need, and contributing to the collapse of the economy and housing markets in places like New Jersey.  It is time that companies who work here in the US who claim to be corporate “persons” to start acting like good citizens.

One last thing: there is simply no good excuse for Congresspersons and Senators to not check out the claims of the businesses who whine that they “can’t find good help anymore”.  All you have to do is get one of your congressional staffers to contact the departments of labor in New Jersey, Pennsylvania, Connecticut, California (San Diego area) and New York to verify that the unemployment rolls have been chock full of math and science majors who were laid off since 2008.  It shouldn’t take longer than a few hours in one afternoon to expose the truth.

Anything else is craven laziness that helps to depress the economy and further erode research in this country.  Researchers are not swappable, just-in-time, labor parts.  They’re individuals with specific knowledge bases who need continuity and support for their expertise to thrive.  Anyone who tells you differently is lying through their teeth.

I’m not an economist but…

…I read Krugman’s latest post on Conscience of a Liberal this morning about the recent actions of the Fed to raise interest rates.  I’m scratching my head over this one as well because the economy, as I see it, is still in the dumps and I’m still meeting plenty of people who think the economy sucks and unemployment is too high and self-employed people are hurting and it’s just pretty fricking awful all over the damn place.  So, I’m going to guess that the actions of the Fed are in response to something Wall Street is doing as they take advantage of The Market and everyone else in the world.  Are we experiencing another housing bubble? Are the hedge funds still accumulating foreclosed properties like there’s no tomorrow, driving up the cost of housing for everyone else?  I was lucky to get my house but I knew there were a lot of other offers on it and the only thing that gave me an edge is that I had cash and was an owner who was actually going to, you know, live there.

Anyway, I’m going to guess that there’s something afoot that I haven’t paid attention to that is on the Fed’s radar and since bankers, brokers, hedgies and the bonus class are the only people we bail out and go out of our way to not inconvenience, the rest of the world’s billions will just have to suck it up.  If our lives become even more difficult and strained, well, tough titties for us. We must not make it hard for the yacht owners to pay their kids private school tuitions or wives go without the underpaid au pairs for even one summer.  And since the vast majority of us do not occupy the ranks of the “not to be inconvenienced” group, it should come as no surprise that the consequences of the Fed’s actions on OUR lives is of no concern to it.  Of course, impoverishing the real market is eventually self-limiting and self-correcting, as Jefferson once wrote, but people will put up with a lot of shit before they throw the bastards out.

Or is there a political element to this strategy?  Is it still the plan to inflict as much suffering on average Americans as possible so that they will snap and take any measly short term relief in exchange for giving up whatever is left of the tattered social safety net?  If I were going to gut social security, this is not the way I would do it.  No, I’d wait until the economy was growing like Topsy and everyone was fat and happy and only then spring it on us that we’d have to give up social security.  But maybe these guys think Fear, Uncertainty and Dread will be more effective.  If we plunge back into recession because of it, will the Democrats catch the blame, along with all the bad stuff headed their way over Obamacare?  Time will tell.  But one thing is for sure.  The rest of us must still pay for the outrageously reckless behavior of a handful of selfish, greedy sociopaths.

PPACA Links: 2013-06-17

[This one is by Lambert of Corrente and cross-posted from that site]

Readers: Here’s the first of a series of Monday posts that will collect what I hope are the most interesting stories of the week on the PPACA (ObamaCare). This is a huge subject to cover, so if you have additional links, please add them in comments! Oh, and since I’ve turned into a night owl, this is a nominal Monday. We’ll see if I do better next week. –lambert

Obamacare’s big question: What’s it going to cost me? McClatchy 2013-06-17. “Earl Pomeroy, a former North Dakota Democratic congressman and state insurance commissioner, said insurance companies were facing “the most complicated rating challenge” that he’d ever seen. It involves the great unknown,” Pomeroy said. “New systems, new market structures and behavior responses from the population that will be impossible to predict.”

Obamacare Rollout Seen Slowed by Confusion Over Benefits Bloomberg 2013-06-17. “Judith Mayer Lynn, uninsured and battling breast cancer, should be a fan of the Affordable Care Act. Instead, she barely knows about it. Told of the benefits, Lynn remained unconvinced, skeptical of insurers and government alike. ‘It’s a joke,’ she said. ‘There’s going to be loopholes in all of these provisions.'”

Report: 1 in 5 Will Buy Coverage via Private Exchanges by 2017 California Health Line 2013-06-10. “Accenture noted that relatively few U.S. residents understand that private exchanges ‘shift considerable financial responsibility to employees.'”

Exchange Watch: The ongoing game of Spin the Rates Columbia Journalism Review 2013-06-14. “In the end, it’s the price of the insurance policy to a consumer that matters (along with what is in that policy) and the [Ohio] insurance department was not ready to tell the press what those prices will be. At least the Dispatch got the headline right: ‘Insurance prices still unclear.’ They are unclear in most states at the moment, and may be up until close to October 1, when the state exchanges open for business.”

Will the Affordable Care Act’s Health Insurance Exchanges Be Ready On Time? The Obama Administration’s Top Secret Enterprise Health Care Policy and Marketplace Review 2013-06-10. “I continue to be puzzled by the way the Obama administration is developing the federally run exchanges in the 35 states in which they will have to run them. We don’t know any details on just where they are and if they are on track. But why all of the secrecy?”

States running out of time on health insurance exchanges WaPo 2013-06-16. “Integration is a critical component. All states, whether or not they’ll be running their own exchanges, will depend on the federal hub to decide whether consumers qualify for subsidies.”

Impact of National Health Reform and State-Based Exchanges on the Level of Competition in the Nongroup Market Robert Wood Johnson Foundation June 2013 [PDF]. “Across the 10 states, the total number of carriers increased substantially, from 52 to 70, or by 35 percent. Six of the 10 states experienced an increase in the number of issuers applying to be on the nongroup exchange versus the number of significant competitors in the pre-reform, base year; and four states report no change. Among the six states reporting an increase of one or more in the number of competitors, the largest increase is for Massachusetts, which has seen an increase of seven health plans. California, Oregon and Washington each reported increases of three issuers.”

Competition in Medicare programs: Boon or boondoggle? The Union 2013-06-15. “In her research study published in the International Journal of Health Services, [Dr. Ida Hellander, policy director for Physicians for a National Health Program] found that competing insurance programs, called Medicare Advantage plans, did not save money. In fact, since their introduction, the private (mostly for-profit) insurance programs have cost taxpayers an extra $282.6 billion.”

Implementing Health Reform: Program Integrity And Other Exchange And Market-Reform IssuesHealth Affairs 2013-06-13. Review of big HHS NPRM (Notice of Proposed Rule Making) “[R]esolves a host of outstanding issues that must be tied up before the exchanges, premium stabilization programs, and market reforms become fully operational in 2014.”

Enrolling uninsured in Obamacare will be a challenge Journal-Sentinel 2013-06-15. “The Wisconsin Primary Health Care Association’s proposal calls for hiring six full-time navigators statewide as well as two staffers to oversee coordination. It estimates that the six navigators will be able to sign up a total of only 6,000 of those hundreds of thousands of people statewide who may need help. That’s based on each application taking an hour — an estimate that the association admits is optimistic.”

Choice of Health Plans to Vary Sharply From State to State Times 2013-06-13. “People in certain parts of the country may not have the robust choice of insurers that the law sought as a way to keep premiums lower and customer responsiveness high. These people are likely to have few brand-name options to choose from, and they will be gambling on plans offered by insurers new to the individual market as well as brand-new carriers.”

Underinsured in the Age of Obamacare In These Times 2013-06-15. “A 2012 report by the state’s Division of Health Care Finance and Policy found that Massachusetts employers increasingly choose insurance plans with fewer benefits, higher cost-sharing and lesser value. Between the years 2008 and 2010, the percentage of small group enrollees in the most risky, highest cost-sharing and seemingly least attractive plans (the bronze plans) increased from 2 percent to 27 percent, while those in the most comprehensive plans with less cost-sharing declined from 34 percent to 11 percent.”

A SEC for Health Care? The Health Care Blog 2013-06-04. “Even when methodologies are transparent, clinicians, insurers, government agencies and others frequently disagree on whether a measure accurately indicates the quality of care.”

Study finds jump in hospital ER-related admissions Crains Detroit 2013-05-22. “A RAND Health study found that hospital emergency rooms are now the point of access for nearly half of all hospital admissions in the U.S. and account for almost all of the growth in admissions between 2003 and 2009. During that time, hospital admissions grew only 4 percent — not even keeping pace with population growth. But ER-related admissions jumped 17 percent.”

Panel Tells Congress Medicare Is Unfairly Penalizing Hospitals Serving The Poor  Kaiser Health News 2013-06-14. “Changing the program, however, might not be easy. Medicare officials have said that many details were spelled out in the 2010 law, making them difficult to change in light of deep partisan divisions in Congress.”

Should Physician Pay Be Tied to Performance? PNHP 2013-06-13. “An exhaustive analysis of pay-for-performance research by the Cochrane Collaborative, an international group that reviews medical evidence, unearthed ‘no evidence that financial incentives can improve patient outcomes.'”

The Higher Health Insurers’ Claim Denial Rate, the Higher the CEO Pay NNU 2013-04-23. “Blue Cross Blue Shield of Vermont is by far the biggest and the only one based in the Green Mountain State. MVP is headquartered in New York, and Cigna, the for-profit company among the three, is based in Connecticut. Which of the trio do you think denied the most claims on a percentage basis in 2012? If you guessed the for-profit company, as I did, you would be right. …  Of all the claims submitted to it last year by health care providers and policyholders, Blue Cross denied 7.6 percent. Cigna denied 21 percent. MVP was in the middle at 15.5 percent

Affordable Care Act spurs hiring blitz Los Angeles Times 2013-06-06. “The nation’s complicated healthcare overhaul is proving to be a surprising source of work: People are needed to explain the law’s provisions to consumers. … [T]he federal Affordable Care Act is feeding a cottage industry in call centers.”

Could This Little-Watched Court Case Sink Obamacare? California Health Line 2013-06-12. “[Halbig et al v. Sebelius] threatens a key element in the Affordable Care Act: Whether the tax subsidies slated to help many Americans purchase coverage through many insurance exchanges are even legal under the ACA’s language.

Issa subpoenas ObamaCare files The Hill 2013-06-17. “House Oversight Committee Chairman Darrell Issa (R-Calif.) subpoenaed documents from a controversial ObamaCare program on Friday after charging that the Obama administration had denied his request several times. Issa is seeking information on a federal attempt to boost nonprofit health plans, known as CO-OPs (consumer oriented and operated plans), which compete with traditional health insurance.”

Here is the blogroll we have at Corrente for health care blogs. We check these regularly. Please add health care blogs we should read in comments, and we’ll check them out.