Monday, November 28, 2022

At Don't play ACA tennis on an unmarked court

I have a post up at that's a focused subset of my strategic guide to applying for coverage in the ACA marketplace. It's focused on the importance of knowing key "break points" in the income scale that determines ACA benefits:

Robert Frost said that writing poetry without rhyming was like playing tennis without a net. Applying for ACA coverage without knowing the income levels at which benefits change is like playing tennis without any lines. And when you don’t see the lines, it’s easy to hit the ball out.

This piece is largely though not exclusively concerned with the plight of working people in nonexpansion states at risk of being denied subsidized coverage because they forecast a next-year income below the Federal Poverty Level.  The logical and moral travesty of denying people affordable coverage because they earn too little is exacerbated by the fact that many in this situation could avoid being stiffed if they knew the income threshold they must reach. 

Of all the ACA's various gaps and friction points, none burn me as much as the coverage gap -- and the fact that many fall into through sheer ignorance of its existence. I have a more detailed guide to avoiding it here.

Thursday, November 24, 2022

Against gratitude

Repost from 2011

Okay, not really. But I am personally uncomfortable with overt expressions of gratitude, and while I think this is mainly an emotional limitation on my part, there may be at least the ghost of a reasonable caveat in it.

As a teenager, I took a slightly unsavory pleasure in the science fiction of Robert Heinlein.  He not only entertained but also influenced and repelled me. He once wrote (through a character) that there was something sick at the heart of German civilization, and whether that's true or not, I think that the sickness he condemned clings to him, in a kind of gleeful authoritarianism. At the same time, some fragments of his cracker barrel wisdom stayed with me. One of his quirks, voiced by various favored characters, is an aversion to gratitude. As I recall at this distance, he cast it as a power play of the weak, a form of toadying, or guilt masquerading as love.  I think he's wrong to reduce gratitude to those impulses, though gratitude is certainly alloyed with them.  In a similar vein, though, he ridiculed worship, asking why an omniscient, omnibenevolent  God would require the saccharine praise of human beings. That was the question that really stuck with me. It gets at the heart of gratitude, since worship is mainly an expression of gratitude to God.

Such gratitude is -- should be -- a spontaneous expression of love. That's how those who voice it understand it.  But why does it express itself in "saccharine" praise?  In a Thanksgiving post, Andrew Sullivan's Dish suggested an answer:

Sunday, November 20, 2022

The case for Medicaid-like coverage at high-middle incomes: Alex Sheff of Health Care For All Massachusetts

Line up those ducks for ConnectorCare expansion

My last post focused on a plan in Massachusetts to extend eligibility for ConnectorCare, the state's unique low-cost health insurance program for marketplace enrollees with income up to 300% of the Federal Poverty Level, to residents with income up to 500% FPL. This past July, the state legislature passed a budget provision funding the eligibility extension for a two-year pilot period, but  Republican Governor Charlie Baker vetoed it.

Yesterday I spoke to Alex Sheff, policy director at nonprofit Health Care Access for All Massachusetts, a prime mover of the proposal, about the rationale for focusing new state spending on a relatively affluent income segment -- those with household income ranging from $40,770 to $67,950 for an individual and from $83,5250 to $138,750 for a family of four. HCFA commissioned an actuarial study, conducted by Gorman Actuarial Associates, that sketched out the proposal's parameters. HCFA provides phone help to Massachusetts resident who need help enrolling in health coverage and stresses that its policy proposals derive from trends gleaned from the call line.

To keep background as short as possible here (see the last post for more): ConnectorCare features a standardized benefit design (varying somewhat by income bracket) with zero deductibles, low copays, and annual maximum out-of-pocket (MOOP) cost limits lower than those generally available in a conventional state ACA marketplace. Those costs are modestly lower than in the ACA marketplace at the lowest incomes, but much lower at the 200-300% FPL level.* ConnectorCare premiums range from $0 at incomes up to 150% FPL** to $130 per month for a solo enrollee with income in the 250-300% FPL range.

Friday, November 18, 2022

A valediction: The Twitter School of Public Health

As Twitter may well be on the brink of imploding, I want to preserve for the record -- for my own benefit, if no one else's -- my on-site eulogy thread for its central role in my education about healthcare. The like list for each of the four tweets below is a repository of public health and healthcare policy professionals and journalists willing to engage, with much to give. Look for them on Mastodon, or whatever new Twitterish site gains traction. Or of course on Twitter, if it somehow emerges intact. I'm at and now posting at as well as here.

As I inevitably missed a number of tweeps, I'll add a tweet or two today to make the list as complete as possible. 

I love Twitter. My feed is a thing of beauty. I was never bombarded by trolls and missed the hate. Whatever I know about healthcare was basically via Twitter University & the people and documents it led me to. To exaggerate just a little, my social life is one long DM thread.
Co-Founder Get America Covered, Former CMO, and Amateur Sumo
Sr VP, Kaiser Family Foundation (), Director, Program on Medicare Policy and Sr Advisor to the President
Health care business reporter for  and its Health Care Inc. newsletter. Contact: or DM.
HSR PhD candidate . Doggy dad. Former health policy at Harvard SPH. Former think tanker. Wannabe economist. Opinions my own.
Goal-driven fighter for health and social justice. VP . Former . DC πŸ‘, Michigan πŸ’™πŸ‡±πŸ‡Ή-American, stands with πŸ‡ΊπŸ‡¦
United We Stand M4All For-Profit Health Care is morally abhorrent
Data, Analytics, & Strategy - currently  - alum  - proud kentuckian - πŸ³️‍🌈 (he/him) -
Dad; Haverford, LBJ School, UT Law alum; active health care lobbyist
Husband, dad, wonk with  & runner, preferably on trails. Trying to bring Shalom to the commonwealth. The plural of anecdote is not data.