• NRA Declares War on Half of America

    Here’s the latest from the NRA:

    I’m not sure this video is even unusual for the NRA, which, these days, is more a purveyor of wholesale culture war zealotry than it is just a gun rights group. But it’s still a pretty spectacular appeal to the seemingly bottomless resentment of liberal sophisticates that eternally haunts conservatives despite controlling virtually the entire political apparatus of the United States. If there were a secret version of this video that ended with a call to march on Hollywood and raze it to the ground, I wouldn’t be surprised.

    This raises a question for “both sides” apostles: Can you think of a recent video anywhere near as vicious as this one from a left-wing group? I don’t mean some dude on Twitter. I mean some significant organization associated with mainstream liberalism. It’s an honest question. I don’t watch a lot of propaganda videos, so I could easily have missed something. Any takers?

  • Canada Says It Has Authority to Censor Internet in United States

    This seems like a bad thing:

    The Supreme Court of Canada ruled against Google on Wednesday in a closely-watched intellectual property case over whether judges can apply their own country’s laws to all of the Internet. In a 7-2 decision, the court agreed a British Columbia judge had the power to issue an injunction forcing Google to scrub search results about pirated products not just in Canada, but everywhere else in the world too.

    ….“This is not an order to remove speech that, on its face, engages freedom of expression values, it is an order to de-index websites that are in violation of several court orders. We have not, to date, accepted that freedom of expression requires the facilitation of the unlawful sale of goods,” wrote Judge Rosalie Abella.

    Hmmm. It is not an order that restrains speech, it is merely an order to de-index websites. I’m pretty sure I tried out similar kinds of sophistry in high school, and it did me no good. Apparently I just wasn’t aiming high enough.

    But it doesn’t really matter. This issue has been burbling along at barely radar level for years, and eventually it’s going to explode. In the print era it was never a big deal. Occasionally issues of a magazine or newspaper would be banned from a country, or China would demand that the Economist delete a chart from copies sold in their country. But this kind of thing was infrequent, and it didn’t affect anyone else. Likewise, autocratic regimes could ban publications entirely. But again, it didn’t affect anyone else.

    It’s not entirely clear to me why the internet is viewed differently, but it is. I don’t think, for example, that the Canadian Supreme Court would dream of ruling that a printed index of corporate profiles had to delete the entry of a company that had violated the law. And they definitely wouldn’t try to demand that it be deleted in every copy sold around the world. But if it’s a Google search result? Sure.

    Partly, of course, this a response to the loss of sovereign control that the internet has spawned. If a printed book were banned in Canada, the ban would be pretty effective. There would still be some underground copies circulating, but that’s small beer. A digital listing, however, is a whole different thing. Ban it on google.ca and it takes only a few seconds to search google.com instead. The ban is all but useless.

    So how will this play out? At some level, the world will either come to a consensus that censorship is hopeless, or else every country will have its own little internet. Today’s Canadian decision is hardly a big deal, but what happens when China or Russia or Vietnam demands that Amazon stop selling something everywhere in the world, not just in their country? Or that Facebook change its news feed for the whole planet? Or that Google globally delist sites insulting to Dear Leader?

    Will it still be no big deal then?

  • Let’s Cut the Crap: Trumpcare Cuts Medicaid Spending a Ton

    Every tedious old argument in the world is being regurgitated lately in service of the final, desperate defense of the Republican health care bill. The latest hotness is the old “we’re not cutting, we’re just slowing the rate of growth” argument for Medicaid. So let’s make this easy. Here’s the basic chart of federal Medicaid spending since 2000:

    Sure enough, spending continues to rise under BCRA. But even a high school freshman knows that you have to adjust for inflation in any time series like this. Here’s the chart for real spending:

    There’s a reason this is called real spending. As you can see, Medicaid spending isn’t “slowing down,” it’s being cut. Spending in 2026 is 18 percent lower than spending in 2017. And here’s the result:

    The CBO estimates that the reduced spending will result in 15 million fewer people receiving Medicaid. Unsurprisingly, that’s a reduction of about 18 percent. It’s pretty simple.

    NOTE: Historical Medicaid spending from CMS here (NHE Table 3). CBO spending projection here (page 13). CPI-M here. I used a conservative 3 percent as the CPI-M over the next decade—a bit lower than the average over the past decade. CBO Medicaid enrollment projection here (page 17).

  • Where Are All the TVs on TV?

    This is not my usual beat, but I’m curious about something. Like millions of others, I sometimes watch the home renovation shows on HGTV. Or I catch bits and pieces while Marian is watching. And I’ve noticed that almost universally, the finished homes have no place for a TV in the shared living spaces (family room, living room, etc.). And if they do, it’s mounted above the fireplace about eight feet off the ground, which is a terrible viewing position.

    If this were a photo spread in Architectural Digest, then sure. They’re pretending to be so posh that they don’t watch TV. But this is a TV show! And yet they never have TVs in their houses.

    What’s up with this?

  • Lunchtime Photo

    What are Orange County’s most famous attractions? At a guess, I’d rank them something like this:

    1. Disneyland
    2. Knott’s Berry Farm
    3. Christ Cathedral (aka the Crystal Cathedral)
    4. Mission San Juan Capistrano
    5. Huntington Beach pier
    6. Richard Nixon library
    7. Balboa Island
    8. Little Saigon
    9. South Coast Plaza, a famous shopping mecca
    10. Other
    11. stuff
    12. The Great Park balloon

    I don’t have pictures of any of the other things, but I do have a picture of the balloon. If you’re ever in Orange County, come on out and take a ride. It’s a tethered balloon that goes up 400 feet, that being the length of its steel cable, and the view at the top is…OK, I guess. Be sure to check the weather first, since they halt balloon “flights” at the merest hint of wind. Tickets are ten bucks.

  • Trump Blather Notches Another Foreign Policy Win!

    On Monday, the White House warned that Syria would “pay a heavy price” if they launched another chemical attack. So how did that go? It’s yet another victory for Donald Trump!

    Secretary of Defense Jim Mattis claimed Wednesday that the Syrian government backed down after the White House said that Syrian President Bashar al-Assad’s forces were preparing for another possible chemical attack. “They didn’t do it,” Mattis said.

    I would like to formally announce that if Russia kills my mother in a nuclear attack, there will be grave consequences. If my mother is still alive tomorrow, that will show that they’ve backed down. I’ll let you know.

  • Conservatives Sure Are Touchy

    Conservatives sure are touchy. Here is Alexandra DeSanctis over at National Review:

    In a piece yesterday, Cosmopolitan senior writer Rebecca Nelson highlighted seven women who are supposedly “generating 2020 buzz,” and every single woman on her list is either a Democratic politician or a public figure committed to the left-wing cause.

    The list doesn’t mention Republican Susan Collins, who has been a GOP senator from Maine for over two decades. It also disregards the GOP’s remaining four female senators, several of whom have been in office longer than the Democratic senators Nelson names.

    Likewise ignored are female Republican governors across the country who outnumber their Democratic counterparts four to two. Nelson snubs U.N. ambassador Nikki Haley, who served a successful six years as governor of South Carolina and who is widely considered one of the GOP’s rising stars.

    I dunno. The article is specifically about people who “could be our first female president,” and I guess Cosmo is assuming that Donald Trump will run for reelection in 2020. This means that no one, male or female, is generating “2020 buzz” on the Republican side of the aisle. Am I missing something here?

  • Assisted Suicide Is a White Thing

    California’s assisted suicide act went into effect last year, and today the Department of Public Health released statistics for 2016. A total of 191 people requested prescriptions for aid-in-dying drugs, and 111 used them. However, because the program is very new, and only covered half the year, these numbers are certain to go up significantly in future years.

    Unsurprisingly, the initial statistics confirm what we know from other states that have similar laws: assisted suicide is barely used at all among non-whites.

    The reasons for this are not entirely clear. Among Hispanics, it’s probably partly related to religion, since the majority of Hispanics are Catholics and the church forbids suicide. More generally, it’s probably also related to a distrust of doctors among minority groups. Beyond that, I’m not sure anyone really has a persuasive explanation.

    Generally speaking, though, the main demographic for assisted suicide is professional, college-educated white folks who are used to being in charge and dislike the idea of losing control over their lives. This was true in the 90s and aughts, when it was illegal and done under the table, and I believe it’s true in every state that’s legalized assisted suicide since then.

    UPDATE: Via Twitter, Forrest Sholars points out that assisted suicide is mostly an option for the elderly, and the demographics of those over 60 is different from California’s overall demographics. That’s true, especially for Hispanics, and I intended to mention this in the original post. It just slipped my mind before I published it. So here it is:

    There’s still a considerable racial disparity, but it’s somewhat less dramatic than it is when comparing to all age groups.

  • Some Notes on California’s Single-Payer Health Care Plan

    Last night a reader emailed to ask what I thought about the death of California’s single-payer health care bill. Is Assembly Speaker Anthony Rendon a progressive traitor because he tabled the bill for this legislative year? For you non-Californians out there, here are a few things to know:

    History. Don’t make the mistake of thinking that SB562 was some brand new, Bernie-esque health care reform. California Democrats have been introducing universal health care bills of one sort or another for decades. This is California’s seventh attempt, following the introduction of single-payer bills and ballot initiatives in 1992, 1994, 1998, 2003, 2005, and 2009.

    Funding. Single-payer would cost something like $200 billion, give or take a few billions. This is nearly double the entire state budget, but SB562 blithely ignored it. It included no funding mechanism at all, and simply passed that reponsibility to the state Assembly. It’s not surprising that Rendon was reluctant to shoulder this on his own over the course of the next few months.

    Prop 98. Like it or not, California has a school funding law put in place years ago by Proposition 98. It’s insanely complicated, but basically requires that 40 percent of the state budget go to K-12 schools. Using round numbers, if the state budget is $100 billion, school spending has to be at least $40 billion. If state spending goes up to $300 billion, school spending has to be at least $120 billion. Aside from being ridiculous, it also leaves only $120 billion for the health care bill. Oops.

    As far as I know, there is no tricky way to get around this. It would have to be dealt with by a ballot initiative. That’s obviously not going to happen in this legislative session.

    Waivers. This is the issue nobody pays attention to, but is probably the most important of all. To implement single-payer, California would need $200 billion in new funding plus $200 billion in federal money that currently goes to Medicare, Medicaid, veterans health care, and so forth. Without federal waivers to give California access to that money, the plan can’t go anywhere. As Duke University researcher David Anderson puts it, “If there aren’t waivers, this plan is vaporware.” What do you think are the odds that the Trump administration will grant all those waivers? Zero is a pretty good guess.

    Along the same lines, Michael Hiltzik points out that self-funded health care plans are governed exclusively by federal law. That means California would need an exemption from the law. What do you think are the odds that a Republican Congress will grant that exemption? Zero again?

    Two-thirds. This bill requires a two-thirds vote to pass. Democrats control exactly two-thirds of both houses of the legislature. They can afford to lose one vote in the Assembly and no votes in the Senate. This means the bill needs to be very, very carefully crafted.

    State plans. This is not about California in particular, but it’s worth remembering Ezra Klein’s Washington Monthly piece in 2007 about the history of state attempts to set up universal health care plans. As he concluded, “the results are pretty clear: states are no good at delivering universal health care.” Who knows? Maybe a better plan could succeed where others have failed. But it better be a pretty good plan.

    Single-payer at the state level is enormously complicated, extremely expensive, difficult to set up properly, and politically fraught. Developing a workable policy will not take months, it will take years. Bottom line: Rendon could have kept the bill alive, but it would have been a charade. It was going nowhere this legislative session and he knew it. At a policy level, this needs a lot more work before it’s ready for prime time.

  • Inquiring Minds Want to Know: How Stupid Is Donald Trump?

    Ha ha ha ha:

    Here’s the New York Times piece that Trump is griping about:

    A senator who supports the bill left the meeting at the White House with a sense that the president did not have a grasp of some basic elements of the Senate plan — and seemed especially confused when a moderate Republican complained that opponents of the bill would cast it as a massive tax break for the wealthy, according to an aide who received a detailed readout of the exchange.

    Mr. Trump said he planned to tackle tax reform later, ignoring the repeal’s tax implications, the staff member added.

    The eternal question is: evil or stupid? Does Trump really not know that the health care bill is a huge tax cut for the rich? Or does he just not want anyone to mention it in his presence? The problem here is that Trump would have to be really, really stupid not to understand that the central provision of both the House and Senate bills is a huge tax cut for the rich. I mean, nobody is that stupid. Right?

  • McConnell: Trump Attacks Are “Beyond Stupid”

    Mitch McConnell may have a dark and twisted soul, but he’s a pretty good legislative tactician. That’s why he’s basically told Donald Trump to stay out of health care negotiations in the Senate, since he’d probably just screw things up. But Trump couldn’t help himself. After Sen. Dean Heller of Nevada announced that he would vote against the bill, Trump gave the OK to a Super PAC to run ads against Heller. According to the New York Times, McConnell was pissed:

    Over the weekend, Mr. McConnell made clear his unhappiness to the White House after a “super PAC” aligned with Mr. Trump started an ad campaign against Senator Dean Heller, Republican of Nevada, after he said last week that he opposed the health care bill.

    The majority leader — already rankled by Mr. Trump’s tweets goading him to change Senate rules to scuttle Democratic filibusters — called the White House chief of staff, Reince Priebus, to complain that the attacks were “beyond stupid,” according to two Republicans with knowledge of the tense exchange.

    ….The move against Mr. Heller had the blessing of the White House, according to an official with America First, because Mr. Trump’s allies were furious that the senator would side with Nevada’s governor, Brian Sandoval, a Republican who accepted the Medicaid expansion under the health law and opposes the Republican overhaul, in criticizing the bill.

    As near as I can tell, the biggest tailwind Democrats have going for them right now is that Trump is such a cretin. I don’t know how likely it is that Republicans can pass a health care bill anyway, but there’s not much question that Trump is making it harder thanks to his bottomless ignorance of both policy and politics. Trump’s only tool is a wrecking ball, and that means he views every problem as a building to be razed. This is very definitely not how US senators like to be viewed, but Trump is too stupid to understand this.

    And who knows? In the end, that might be the thing that saves Obamacare.

  • Somebody Needs to Defend John McEnroe. Why Not Me?

    John Walton/PA Wire via ZUMA

    I’ve been waiting to see if anyone will defend John McEnroe against the dumb attacks he’s getting right now, and so far I haven’t seen anyone willing to risk the backlash. So what the hell. I guess I’ll do it. Here’s the NPR interview that has everyone up in arms:

    GARCIA-NAVARRO: We’re talking about male players, but there [are] of course wonderful female players. Let’s talk about Serena Williams. You say she is the best female player in the world in the book.

    MCENROE: Best female player ever — no question.

    GARCIA-NAVARRO: Some wouldn’t qualify it; some would say she’s the best player in the world. Why qualify it?

    MCENROE: Oh! Uh, she’s not, you mean, the best player in the world, period?

    GARCIA-NAVARRO: Yeah, the best tennis player in the world. You know, why say female player?

    MCENROE: Well, because if she was in, if she played the men’s circuit, she’d be, like, 700 in the world.

    McEnroe is getting slagged for insulting Serena Williams by saying she’d rank #700 on the men’s circuit. Also for the sin of thinking that female athletes have to be compared to men. And for being an idiot. Etc.

    This is ridiculous. McEnroe can run his mouth with the best of them, but in this case he’s completely innocent. Just read the interview:

    • McEnroe says Serena William is the best female tennis player in history, full stop. This is something he’s said many times before.
    • The interviewer then sloppily changes the subject to whether Williams is the best player in the world. Not the best woman in history, but the best in the world right now among all tennis players. This is laughably ignorant.
    • McEnroe is obviously taken aback, but then answers accurately: If we’re talking about the quality of all tennis players on the planet right now, Williams isn’t even close. This is completely noncontroversial, and it’s something Williams herself has said herself.

    McEnroe didn’t bring this up out of nowhere. He wasn’t trying to say anything about Serena Williams or women’s tennis in general. He wasn’t trying to generate controversy. He was responding to a dumb question from an interviewer. I suppose he could have told the interviewer he didn’t understand what she was saying, and then asked for a clarification, but instead he just answered and moved on—or would have, anyway, except that the interviewer just wouldn’t let it go.

    Since then, half the sports writers in America have proved they have too much free time on their hands by going after McEnroe. And everyone else is now chiming in too.

    This piece at Vox is what finally sent me over the edge. Alex Abad-Santos obviously understands that this whole thing is baseless. He acknowledges that Serena Williams has said the same thing McEnroe did. He acknowledges that McEnroe’s past history clearly demonstrates his appreciation of both Williams and women’s tennis in general. He acknowledges that McEnroe is innocent of racism and sexism. He acknowledges that the interview was sloppy, but then turns this into a weird kind of praise: “Garcia-Navarro does a good job of getting McEnroe to talk himself into a bit of trouble.” But even after acknowledging all this, he claims the whole thing is McEnroe’s fault: he’s just “courting controversy” and is being stubborn and bullheaded for declining to apologize.

    This is so, so tedious. Everyone knows how dominant Serena Williams has been. Everyone knows that men play a stronger game than women. It’s a matter of opinion whether Serena is the most dominant tennis player of all time. And McEnroe only mentioned this because an interviewer asked a stupid question.

    Why do we have to pretend to be outraged over trivia like this? Just give it a rest, folks. There’s nothing here.

    POSTSCRIPT: If you’re not mad enough at me already, here’s one more thing. In addition to everything else, Abad-Santos tweaks McEnroe for “the 700 number he seems to have pulled out of nowhere.” No he didn’t. In fact, he was probably being nice. I’d guess that the real number is more like 2000. I’d offer to argue about this with anyone who’s interested, but honestly, who cares? This is one of the dumbest “controversies” ever. If you really need an excuse to show how woke you are, pick something else.

  • Lunchtime Photo

    This is a western tiger swallowtail butterfly. They’re pretty common around here, but I didn’t take this in our garden. This is the last of my pictures from my trek to Silverado Canyon a couple of months ago. I should probably go out again. This particular spot, with its shady, distant background, was really great for taking pictures of various flying critters.

  • Senate Health Care Bill Postponed


    Facing resistance from their own party, Senate Republican leaders said Tuesday they would postpone a vote on their healthcare bill until after the July 4th recess, according to two sources familiar with their thinking….Senate Majority Leader Mitch McConnell wants to provide more time to try to convince reluctant GOP senators to vote for the measure.

    Conventional wisdom says that time is not McConnell’s friend. In fact, it turns out that even a week was too much time. I’d like to say that the Senate bill was just too appalling even for Republicans to take, but I’m not sure that’s quite right. After all, a lot of the pushback has been from tea-party types who think the bill isn’t brutal enough.

    In any case, the summer recess will now be an opportunity for Republican senators to find out just how dangerous a Yes vote really is. The progressive community needs to make sure they find out. And don’t forget to recruit your moderate conservative friends too. They probably have more influence with your local GOP senator than you do.

  • Say It With Me: Democrats Want to Fix Obamacare

    Jonah Goldberg suggests today that no one can say what they really believe about health care. Republicans refuse to admit that they don’t really want to repeal Obamacare after all. As for Democrats:

    Meanwhile, the Democrats know that Obamacare has been a huge albatross for their party and understand that the best thing that could happen for them is if the Republicans agreed to keep Obamacare in name (i.e., abandon the rhetoric of “repeal”) but do whatever is necessary to make the thing work. But the GOP is doing the opposite. It’s largely keeping Obamacare in terms of policy (at least the really popular parts) but rhetorically it’s claiming to destroy Obamacare utterly. So, both the Democrats and the Republicans end up claiming this is a repeal of Obamacare when it’s not. It’s all a war for the best spin, not the best policy.

    Wait a second. “Keep Obamacare but fix it” is practically the Democratic rallying cry these days. There’s hardly a Democrat alive who doesn’t loudly and publicly support this position. A couple of months ago all 48 Democratic senators signed a letter promising, “If repeal is abandoned, we stand ready to work with you to help all Americans get the affordable health care they need.” Every liberal rally and march includes people carrying “Don’t repeal it, fix it!” signs. I’ve personally written multiple times about this, most recently two days ago: “Obamacare’s modest problems could be fixed with nothing more than a few minor changes and additional funding of $5-10 billion or so.” Those minor changes include, possibly, a higher mandate penalty and continuing to fund the CSR subsidies. Nothing all that hard.

    Would Democrats be willing to support some conservative priorities—tort reform, HSAs, block granting Medicaid—in return for this? Beats me. But Democrats have sure made it clear that keeping Obamacare and fixing it is what they want. If Republicans truly have any interest in this, they shouldn’t have any trouble finding willing listeners.

  • Why Oh Why Did Susan Rice Become a Republican Punching Bag?

    Andrew Harrer/DPA via ZUMA

    Susan Rice, the right’s favorite new¹ punching bag over the past few years, talks about her experience of continuing to be a punching bag even after she left government service:

    I ask Rice why she thinks she became a target. She laughs, sort of. “I’ve spent a lot of time thinking about this. What do you think?”

    I mention Benghazi, the moment when much of the right’s base became aware of Rice’s existence. “Does it start there?” she asks. She is not a person given to agitation, but here, Rice’s focus sharpens — she looks at me more directly, with heightened intensity. “And why me? Why not Jay Carney, for example, who was then our press secretary, who stood up more?”

    Carney isn’t an African-American woman, of course….I point out that she has a reputation for being tough, and a strong-willed woman who seems sure of herself makes a certain kind of man nervous.

    “Let me just put it this way,” she says. “I do not leap to the simple explanation that it’s only about race and gender. I’m trying to keep my theories to myself until I’m ready to come out with them. It’s not because I don’t have any.”

    Well, I for one will be eager to hear her theories once Rice decides she’s ready. Rice is certainly the most unfairly maligned public servant of the past few years, all because she went on TV and told the truth about Benghazi. That was her real sin, of course.³

    And as long as we’re on the subject, I’ll just take this opportunity to add that progressives didn’t exactly cover themselves in glory while Rice was being endlessly slandered by conservatives over Benghazi. For weeks they mostly held their tongues or damned her with faint praise (“she probably shouldn’t have mentioned the video….”). But Rice literally did nothing wrong. Zero. On her infamous Sunday show appearances, she told the absolute truth as it was then understood by the intelligence community. This was, unfortunately, a precursor to progressives also failing to aggressively defend Hillary Clinton over her emails. Why? I suppose because lots of progressives were afraid there might be a smoking gun somewhere and didn’t want to risk coming strongly to her defense and then looking foolish. Cowards. In the end, of course, we eventually learned that Clinton had also done literally nothing wrong and the FBI never had even a weak case against her.

    ¹As opposed to favorite longtime punching bags Hillary Clinton and Nancy Pelosi.²

    ²Both of whom are also women. Kinda makes you think, doesn’t it?

    ³Aside from being female and black, that is.

  • Support for Gay Marriage Just Keeps Going Up

    Let’s start the day off with some good news. You never know: it might be the last we get today. Here’s the latest on same-sex marriage from Pew Research:

    Everyone is getting more comfortable with gay marriage: all ages, all races, all religions, and all parties. On the other hand, I guess we still have to sort out whether a Christian bakery can refuse to make a wedding cake for a same-sex couple. That’s going to seem pretty quaint a few years from now.

  • Here’s the tl;dr Version of the Republican Health Care Bill

    Need a quick couple of quickie graphics to summarize the Senate health care bill? I’m here to help. First, the basics:

    Next, a comparison of premiums. It’s true that the Republican bill generates lower premiums than Obamacare, but that’s only because its coverage is so skimpy and its deductibles and copays are so high. It’s like bragging that a gas-guzzling old jalopy is cheaper than a new Prius. However, Kaiser has crunched the numbers to come up with average premiums under BCRA and Obamacare for similar policies. Here they are. These estimates are for a current average silver plan after all tax credits have been applied:

  • CBO: Trumpcare Would Cut Taxes on the Rich, Slash Health Coverage for the Poor

    The CBO’s score of the Senate heath care bill is out. There are no surprises: it contains big tax cuts for the rich and big health care cuts for the poor. But let’s go through the dreary details anyway:

    • By 2026, spending on Medicaid will be slashed $772 billion. (Page 5)
    • As a result, there will be 15 million fewer people on Medicaid. (Page 16)
    • By 2026, spending on subsidies for private insurance will be slashed $408 billion. (Page 5)
    • As a result, there will be 7 million fewer people with private insurance. (Page 17)
    • This sums to a total of 22 million more uninsured people by 2026, compared to 23 million under the House version of the bill.
    • Revenue would be reduced about $750 billion, mostly via tax cuts on corporations and the wealthy. (Tables 2 and 3)
    • Obamacare is not in a death spiral: “The subsidies to purchase coverage, combined with the effects of the individual mandate…are anticipated to cause sufficient demand for the market to be stable in most areas.” (Page 6)
    • BCRA would also be stable. However: “A small fraction of the population resides in areas in which—because of this legislation, at least for some of the years after 2019—no insurers would participate in the nongroup market or insurance would be offered only with very high premiums. Some sparsely populated areas might have no nongroup insurance offered….In addition, the agencies anticipate that all insurance in the nongroup market would become very expensive for at least a short period of time for a small fraction of the population residing in areas in which states’ implementation of waivers with major changes caused market disruption.” (Page 7)
    • Deductibles for silver plans will increase from about $3,600 to about $6,000. (Page 8)
    • The actuarial value of health care plans will be reduced to 58 percent. This means that even after buying insurance, consumers are responsible for 42 percent of their total health care expenses. “As a result, despite being eligible for premium tax credits, few low-income people would purchase any plan.” (Page 8)
    • “Because nongroup insurance would pay for a smaller average share of benefits under this legislation, most people purchasing it would have higher out-of-pocket spending on health care than under current law.” (Page 9)
    • Because of the reduced value of health care policies under BCRA, premiums will go down. (Page 9) However, net premiums after accounting for subsidies will go up for most people. Among those with modest incomes, net premiums for silver plans would go up $500 for 21-year-olds; $1,300 for 40-year-olds; and $4,800 for 64-year-olds. Among those with higher incomes, net premiums would go down except for 64-year-olds, who would face increases as high as $13,000. (Table 5)
    • The share of uninsured older folks with low incomes would skyrocket from about 11 percent to 26 percent. (Page 16)
    • Caps on Medicaid spending will likely cause some states to reduce already low reimbursement rates for doctors. If this happens, “fewer providers might be willing to accept Medicaid patients….If states reduced payments to Medicaid’s managed care plans, some plans might shrink their provider networks, curtail quality assurance, or drop out of the managed care program altogether.” (Page 30)

    Reading the CBO report in its entirety, it’s hard to see that BCRA offers any improvements over Obamacare aside from cutting taxes for the rich. Net premiums go up for most people—quite massively in the case of older consumers; deductibles go up; out-of-pocket expenses go up; the working poor are virtually shut out of the insurance market; the quality of coverage gets worse; and 22 million people lose insurance.

    The only plausible path for any improvement is the increased flexibility states would have to run their own health care progams. Historically, this has accomplished little except to allow conservative states to cut back on health services to the poor, so you’d need to be mighty starry-eyed to think that it will produce amazing innovations this time around. But that’s about it: believing in the power of states to innovate because they have less money is the only path for defenders of BCRA.

  • Lunchtime Photo

    Last week I put up a picture of a guy cycling and texting at Santa Monica beach. That’s kid stuff. Here’s a guy cycling, texting, and holding a beer¹ in his teeth. That’s how we roll in Huntington Beach, my friends.

    ¹Or something.