Skip to main content

On April 16, 2015, President Obama signed into law the Medicare Access and CHIP Reauthorization Act of 2015 (“MACRA”). This new law raises Medicare premiums for higher-income retirees, who will be paying more for their Part B and Part D coverage in the future. I may have missed the outcries from the left and the right about this, and believe it warrants further discussion. Silence may be a collective sigh of relief in order to digest the compromise permanent elimination of the annual SGR can-kicking rodeo.

Increased beneficiary cost sharing could be considered a political “third rail".  Are the increased Part B premiums for high-income beneficiaries in effect since 2007 a progressive tax, or are they the slippery slope of a means-tested welfare program? Is MACRA  a "Third Way" law?

Section 402 of MACRA addresses income-related premium adjustments for Parts B and D.
In 2015 individuals with modified adjusted gross income (MAGI) of $85,000 or less and couples with $170,000 or less pay only the base Part B premium of $104.90. Several income brackets had been created in 2007, with enrollees in higher brackets paying a greater percentage of program costs. Higher income beneficiaries likewise pay higher premiums for their Part D coverage. Currently, individual Medicare beneficiaries with incomes between $107,000 and $160,000 pay 50% of average annual per capita program expenditures, those with incomes $160,000- $214,000 pay 65%, and those with incomes > $214,000 pay 80%. MACRA lowers the thresholds at which beneficiaries must pay higher applicable percentages of program costs. Beginning in 2018, the income levels and ranges change as follows:
•    Income $107,000-$133,500 will pay 50% of average annual per capita program expenditures
•    Income $133,500-$160,000 will pay 65%
•    Income > $160,000 will pay 80%
These levels would remain constant for 2018 and 2019. Beginning in 2020, these thresholds would be updated annually based on inflation, yet in such a fashion as to reduce future inflation adjustments to the brackets. The prior law froze the income thresholds through 2019, at which point they were to be indexed to inflation as if they had not been frozen. In MACRA, any prior inflation will be disregarded, and the threshold for inflation will be based on the brackets as they are in 2019. Reducing the inflation adjustment in this manner is expected to increase the number of beneficiaries who will be subject to higher Medicare premiums.  

More follows the labyrinthine squiggle.

Continue Reading

I shall discuss the recent votes on HR 37 Promoting Job Creation and Reducing Small Business Burdens Act.

HR 37 would gut the Volcker Rule and other key parts of the Dodd-Frank Wall Street reform law. The vote failed, and was covered in this DKos diary

I reviewed the Tea Party Caucus log from Wikipedia as listed 2 years ago. I reviewed the roll call for HR 37 and find 45 Yea votes from the 50 Tea Party members in that list. Several of the 5 "missing" members have moved on from the House.

The Tea party caucus may be in disarray, and has lost some traction over the past 2 years, yet remains a real and dangerous faction.

My recollection of the Tea Party is that it rose to power in 2009 after the bailouts of banks by the Obama administration. I also understand that the Tea Party considers bailout and stimulus plans to be illegal.

The current Yea votes of House Tea Party members is strongly at odds with the irresponsible behavior and actions of banks and financial institutions that led to the financial meltdown in 2008, requiring bailouts, and then stoking "grassroots" anger resulting in the birth of the current Tea Party. The Tea Party was rapidly "astroturfed" by multiple well-funded right wing organizations. The current Tea Party is just another subset of Republicans beholden to Wall Street. They have turned their backs on the original grassroots anger over bailouts, and care not about Main Street.

I am aware that House Democrats are not without guilt on HR 37, but that is not the theme of this diary, and has been covered in this DKos diary

I understand that this diary is yet another anti-Tea Party rant. I read the recent diary IMHO, the Tea Party is one of the most destructive elements in American politics in my lifetime.

Physician working on a laptop with stethescope on desk.
The Health Information Technology for Economic and Clinical Health (HITECH) Act was included in the American Recovery and Reinvestment Act (ARRA) and was signed by President Obama on Feb.17, 2009 during the depths of the recession. HITECH was intended to promote the adoption and meaningful use of health information technology, and included requirements for implementation and expansion of Electronic Health Records (EHR's) in medical practices. The HITECH Act set meaningful use of interoperable EHR adoption in the health care system as a critical national goal. The goal was meaningful use of EHRs — that is, their use by providers to achieve significant improvements in care. A variety of timelines were outlined, with incentives for various levels of meaningful use from 2011-2014 (the Carrot), to be followed by penalties for non-compliance (the Stick), in 2015 and thereafter, for Medicare. Meaningful Use is a complex topic and is beyond the scope of the current diary.

There are many who will blame EHR's on the ACA, but the progressive adoption of EHR's has predated the ACA by many years.

More follows the orange digital Caduceus

Continue Reading

Just watched Rachel Maddow outlining the collapsing Iraq army and the unfolding dangerous complexity in Mesopotamia. ISIS is a frightening foe.

Consider that Hillary Clinton has by far the depth and breadth of knowledge and experience about these complex issues.

I love Elizabeth Warren's economic populism. Does she have the foreign policy and gravitas of former Sec. Clinton?

The Republicans can field only neocons and fools (That's you Senator Cruz).


From Colorado 6th District Congressman Mike Coffman's website.

Coffman Introduces Bill to Prevent Insurance Industry Bailout
Jan 7, 2014  Press Release
Repeals Provisions in Obamacare to Cover Insurance Industry Losses
(Washington, D.C.) U.S. Representative Mike Coffman (R-CO) announced today that he has introduced legislation that will amend the Affordable Care Act, better known as Obamacare, to prohibit a potential bailout for the insurance industry that is currently authorized under Section 1341 and Section 1342 of the Affordable Care Act.

“The American people have had enough of big bailouts for big business and it’s time for this culture of corporate cronyism that has become a dominant part of Washington, D.C. to stop,” said Coffman.

Coffman’s legislation, the No Bailouts for Insurance Industry Act of 2014, would amend the Affordable Care Act to repeal Section 1341, the “reinsurance” fund, and Section 1342, the “risk corridor” provision.  Together, both could provide for a massive taxpayer bailout to cover the losses of a large insurance company.  Coffman is concerned that Obamacare is based on signing up a sufficient number of younger, healthier people for insurance through the exchanges - at a much higher premium cost - in order to shift the cost away from an older population that is expected to sign up for health insurance through the exchanges.  If the young don’t sign up in sufficient number, and Coffman doesn’t think they will, then he sees the cost of Obamacare spiraling out of control and the insurance industry suffering significant losses.

“The taxpayers should not be on the hook for the failures of Obamacare.  Any reasonable person can see that this scheme isn’t going to work and Americans should not be forced to bail it out once it fails,” said Coffman.

I would note that Coffman is in one of the top ten most vulnerable races for 2014, will likely face formidable candidate Andrew Romanoff, that the 6th CD is now much more competetive, and that House leadership has very likely allowed Coffman to be the standard-bearer of this bill to strengthen his candidacy.

This follows the January 2, 2014 Charles Krauthammer Washington Post editorial entitled Stop the Bailout Now.

Consider that the health insurance companies are probably less popular than the big banks, and that all Democratic Representatives and Senators will be faced with a difficult choice over this "bailout" decision. This one could pass the Senate if Harry Reid allows a vote. I would predict an Obama veto if it passes.

This issue could paint the for-profit health insurance companies an even darker shade of black.

The ACA is concurrently adding millions of newly insureds while the above legislation grinds through the process. The only reasonable alternative to any ensuing "death spiral" of hugely increased premiums without a "bailout" fallback would be a public option, then hopefully leading eventually to single-payer.


Nary a day passes that we don't experience Chuck Todd or one of his media-mates lamenting the latest Obamacare "fail".

None of them interview those with pre-existing conditions who are newly covered, often after many years uninsured. Pre-ACA policies for this large group were typically never even issued, or if so then only with exorbitant premiums.

I am optimistic that the ACA will survive the current Republican-driven feces-storm.

I would have preferred a single-payer system, and believe am preaching to the Kossack choir about this topic. The current ACA is such a complicated compromise.

A public option was originally considered but unfortunately never implemented.

Should (shudder) the ACA eventually be so weakened by future political misdeeds that many of the newly-insured would lose coverage, what would be the fate of these newly-insured enrollees with pre-existing conditions? I don't have any data about this, but believe they could number in the millions of enrollees.

The political pressure from the left and center could result in a public option solution for this group, in lieu of abandoning them.

Am curious whether the extreme right has worked through their hatred of the ACA to realize that demand for a public option would only be strengthened by further opposition to and weakening of the ACA.

I've no doubt overlooked some important facets of this issue and would appreciate your thoughts.


When people are referring to an "emperor with no clothes" scenario, they mean that other people are being suck-up toadies and are collectively denying the truth of the situation. So it takes one person with the guts (or naivete) to speak the truth and blast through the BULLSHIT.

Senator Cruz represents the (insane) Tea Party faction of the fading Republican party that has no realistic alternative to the ACA.

At one time the Republicans championed Repeal & Replace. Recently their sole obsession has been Repeal.

Some fundamentals of  the ACA derive from the well-known Heritage Foundation ideas. In October 1989, Heritage published the Stuart Butler Study Assuring Affordable Healthcare for All Americans "[N]either the federal government nor any state requires all households to protect themselves from the potentially catastrophic costs of a serious accident or illness. Under the Heritage plan, there would be such a requirement...Society does feel a moral obligation to insure that its citizens do not suffer from the unavailability of health care. But on the other hand, each household has the obligation, to the extent it is able, to avoid placing demands on society by protecting itself...A mandate on households certainly would force those with adequate means to obtain insurance protection." In March 1992 Heritage published Butler's The Heritage Consumer Choice Health Plan."Step #2: Require all households to purchase at least a basic package of insurance, unless they are covered by Medicaid, Medicare, or other government health programs. All Heads of households would be required by law to obtain at least a basic health plan specified by Congress...The private insurance market would be reformed to make a standard basic package available to all at an acceptable price...Employers would be required to make a payroll deduction each pay period, at the direction of the employee, and send the amount to the plan of the employee's choice."

Please refer to this excellent link for History of the Individual Health Insurance Mandate.

The House Republican Study Committee released a weak alternative plan in September 2013. Nothing new here, just the same tired talking points. Of course it begins by repealing the ACA. It expands tax deductions for the privileged and wealthy. Income and payroll tax deductions would be available to individuals ($7,500) and families ($20,000) for health coverage. No tax credits here, just deductions that only really benefit the upper middle class and above. No premium assistance or Medicaid assistance for anybody, especially the lower income groups helped by the ACA premium supports. Insurance plans could be sold across state lines. Medical malpractice laws would be reformed to reduce doctors' risk of litigation, and of course that will barely make a dent in medical expenses. The federal government would pump $25 billion over 10 years into state high-risk pools for people with preexisting conditions. Nothing said about prohibiting carriers from such practices, so it's back to the same old shit.

No surprise that the Repugs have not attempted to publicize this cynical and morbid alternative to the ACA. Unless the Republicans can provide a realistic alternative to the ACA, they will be increasingly talking to their Echo chamber.

The ACA will provide for: Elimination of pre-existing conditions, kids allowed to be on their parents' insurance until age 26, coverage without cost for preventative healthcare, expansion of Medicaid for states willing to accept billions of dollars from the federal government, and the insurance exchanges.

The ACA rollout issues will be worked out in time. I disagree with Ezra Klein and others who are making this so negative.

Americans deserve health care as right and not a privilege. It must be universal. It must not exclude pre-existing conditions. All citizens must accept the individual responsibility of health care coverage as a duty of citizenship in exchange for guaranteed coverage.

How about a genuine Replacement for the ACA, before you Repeal it and send us back to the pre-ACA healthcare hell, Emperor Cruz?

How about a jobs stimulus plan, Emperor Cruz?


Wed Oct 16, 2013 at 09:17 PM PDT

Time to bill the extremists

by skepticalcitizen

Preliminary draft invoice. Have no doubt neglected to list many other responsible parties as well as multiple other damages.

Sat Oct 05, 2013 at 12:22 PM PDT

Red October meets the Shutdown

by skepticalcitizen

Respects to Tom Clancy, who passed on October 1, 2013, day one of the self-inflicted Republican shutdown. Wikipedia describes him as a Reagan conservative. I don't know whether he supported the Tea Party, but will forgive him if so. I am ex-Air Force and enjoyed his complex novels and resulting movies.

I enjoy metaphorical snark, so here goes.

In the 1990 movie, The Hunt for Red October, the Soviet fast attack Alfa sub Konovalov is ordered to attack and destroy the Soviet stealth missile sub Red October. The American fast attack sub Dallas is also engaged in the underwater battle.  In true Hollywood style, three subs are flitting around underwater like hummingbirds, and shooting torpedoes AK-47 style.

Captain Tupolev of the Soviet fast attack boat orders torpedo safety ranges set to zero and fires another torpedo.

Visualize the Konovalov's (think Tea Party) own torpedo (think Obamacare-defunding CR) about to strike the Konovalov (yep, Tea Party):

Konovalov officer Andrei Bonovia (think most Americans, the Senate, the President, House Democrats, some House Republicans) shouts to Captain Tupolev (think Ted Cruz) You arrogant ass. You've killed us! (think devastating and multiple effects of shutdown, much further loss of Teapublican credibility, loss of US credibility worldwide)

It's not hard to visualize Bonovia looking for the cowardly torpedo officer Boehner before Tupolev unwisely zero-fuses the torpedoes while reading Green Eggs and Ham.


The ACA will proceed, as it is mandatory spending. I understand that the shutdown only impacts discretionary spending. The Tea Party first demanded that the ACA be defunded, and as I understand then demanded that implementation be rolled back one year. Of course, if it were rolled back one year, the extremists would continue infinite exortion, and the ACA would never be implemented.

Let's hypothesize that the ACA is defunded or delayed.

What is then to prevent the Tea Party extremists to go on a power rampage with a series of short term CR's in which they systematically proceed to defund portions of other critical mandatory spending programs, including Medicare, Medicaid, and Social Security?


First, what did President Obama say one year ago?

David Jackson, USA TODAY 8:21 a.m. EDT May 6, 2013
On Aug. 20 of last year, President Obama popped into the White House press room to take some questions -- and uttered a term that may well hang over the rest of his second term.
"Red line."
Asked in August about reports that Syria may be prepared to use chemical weapons against rebels, Obama said:

"We have been very clear to the (Bashar Assad) regime, but also to other players on the ground, that a red line for us is we start seeing a whole bunch of chemical weapons moving around or being utilized. That would change my calculus. That would change my equation."

There appears to be ample wiggle room to be very cautious based on his change comments.  I am unclear whether Obama's recent comments amount to a more forcible position.

Second, how incredibly complex is Syria? Credit to ivorybill's excellent diary.

Third, how certain is the current evidence? Are we 100% certain that Assad's troops used the chemical weapons? Did Assad actually give that order or were renegade troops involved? Are we certain that the weapons weren't used by rebels?
President Obama stated in his PBS interview Aug 27, 2013 “Nobody disputes --

or hardly anybody disputes
-- that chemical weapons were used on a large scale in Syria against civilian populations,” the president said. “We have looked at all the evidence, and we do not believe the opposition possessed … chemical weapons of that sort.”
There must be NO doubt. This has far too much similarity to the Iraq WMD fiasco.

Fourth, as Kos has outlined, Death is Death.

Fifth, as speculated by many far wiser than me, what would be the reaction to US military action? Would Russia attack our warships in the Mediterranean? Would Hezbollah go all hell-out against Israel? Would Iran unleash terror on our homeland, go crazy with their nuke program, or close the straits of Hormuz? Would Iraq further destabilize?

Humility and great caution must prevail in these troubled times.


The immigration debate and review of this recent WSJ editorial led me back to one of my favorite political charts ever, A Guide to the Conservative Movement in One Handy Chart, posted by Kos on 3/7/13. Thank you again, Markos. How do the various Con-servative factions view this debate?

The Border Security Ruse (for many Republicans, the border will never be secure enough) was the lead editorial in the WSJ June 19, 2013. The article points out that the border is currently more secure than it has been in decades, and that illegal entries are at a 40-year low. It actually states "The value of all of this additional border spending is probably marginal, and at some point it becomes offensive to U.S. values of freedom and human dignity."  It questions whether Americans would support the extreme measures that would be required to reduce illegal immigration as drastically as the far-right wants, as the price of reform. It goes on to conclude that the "Border Surge" is intended to kill the bill.  The editorial snidely comments that Republicans could then campaign in 2014 on self-deportation, a strategy that worked well for Mitt. I would conclude that the corporate con-servatives appear to have spoken in favor of the cheap labor provided by passage of this legislation, and oppose their farther-right fellow Republicans.

The Senate may pass the Gang-of-Eight bill with the Border Surge. The various conflicting conservative factions in the House will condemn but never concede,  will contradict but never consent, and will only contest the consequences of this controversial conundrum. Their contemptuous conduct and inability to compromise will probably prevent passage of any meaningful legislation.  OK, enough of the con-jobs.

As I review Kos' chart, it appears that the Teabaggers, Neocons, and Paleocons will oppose any path to citizenship. Will the Theocons really want to recruit immigrants? Will "libertarian" Rand Paul truly wish to bring them in? Do the corporate conservatives actually care?

You can add a private note to this diary when hotlisting it:
Are you sure you want to remove this diary from your hotlist?
Are you sure you want to remove your recommendation? You can only recommend a diary once, so you will not be able to re-recommend it afterwards.


Subscribe or Donate to support Daily Kos.

Click here for the mobile view of the site