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LM's avatar

Thank you for this thorough and easily understood breakdown! Much appreciated.

Norm Spier's avatar

1) On the tariff Supreme Court decision, I noted in the NY Times coverage of

https://www.nytimes.com/2025/02/20/us/politics/supreme-court-trump-tariffs.html

I noted that one of the three dissenters, Justice Kavanaugh, warned:

' that any refund process [though unclear if it will happen] could be a substantial “mess.” '

I found this amusing, because making a mess of things hasn't stopped the Supreme Court, or possibly any U.S. court, before.

(One such case from the Supreme Court was giving states the option not to expand Medicaid, which certainly made a pretty good mess of the ACA, and made our byzantinely-complex mess of a healthcare system a little more of a byzantinely-complex mess.

As well as, over the last 12+ years, letting umpteen million people go without any health insurance that they could possibly afford, which certainly made a mess of, or kept as a mess, the lives of many of our citizens.)

2) Separately, since you mention health care spending and effect on affordability, I bring up (perhaps repeating content from a prior comment) that the recent lapsing of the ACA expanded subsidies caused some hundreds of thousands of people (primarily older people over-the-returned 400% of Federal Poverty Level “subsidy cliff”) to have humongo increases (of 25%-50%) in their cost of living by any reasonable definition, and as well, the 24 million people on the exchanges have average increases in that same reasonable cost of living going up maybe 3%.

This is all missed by the CPI, because it excludes means-tested government transfers. (Real wages, of course, will miss any effect, as well.)

Now, diluted over all people in the country, the cost of living increase due to the lapsed expanded subsidies might be just 0.2%, though it won’t be caught at all by either CPI or real wage measure.

The meaningful analysis of the effect of the lapsed expanded subsidies can’t be an average, and has to divide into cases, showing the people with it going up like 50%, 30%, 15%, 10%, 5%, 3%, 1%, etc. (A “distribution” of changes in cost of living, rather than an average.)

(With other things, perhaps say housing, the cost of living increases vary much by individual situations, and so distribution, not average, is really the only way to go in such cases, as well.)

APPENDIX: references:

A) That BLS CPI misses any effect from the lapsed expanded subsidies

(From

https://www.bls.gov/opub/hom/cpi/concepts.htm

where it says:

“Government-provided and government-subsidized items

The CPI treats any changes to fees that the government charges for items, such as admission to a nation­al park, as in-scope changes in price. The CPI also counts the price of subsidized items that is available to the general public. For example, govern­ments may subsidize local transit operations. If the subsidy is cut and the fare is raised, the CPI will reflect this as a price in­crease. On the other hand, the CPI does not reflect changes to means-tested subsidies (dependent on the recipient’s income), such as the SNAP or Section 8 Housing Program. Changes in such subsidies are treated as changes to the recipient’s income and are out of scope.”

B)For the 25%-50% cost of living rises in the bad over the cliff I am using my knowledge around over-the-cliff cases like:

Laramie County, Wyoming. Zip 82001. Married couple. Both 62 years old. Non smokers both.

Total income $88,000 a year. U.S. citizens both.

If expanded subsidies were extended

An option: BlueSelect Gold Standard without Kid’s Dental ($4000 deductible, $16,400 oop max)

Premium after subsidy: 4748.64/yr =5% of income

Now, without the extension:

Lowest-cost plan: BlueSelect Bronze (skimpy truly catastrophic-only—deductible and out-of-pocket max both: $21,200/year (=24% of income)

Premium (no subsidy available) : $39,904.80/yr (=45% of income))

And, though Wyoming is a bit higher than average in premium, in virtually all states, older people (maybe 55-65) just a bit over the cliff have big problems of typically premiums of at least $25,000 a year in the same case (rising from perhaps $5,000 to $6000 a year for a lower o.o.p. max with the expanded subsidies in place).

(I am then taking a guess of usual total expenditures for such people of maybe $65,000 a year.)

C) For my very rough average of 3% for the 24 million people on the exchanges, I am using an average of about $1000 a year (source: https://www.kff.org/affordable-care-act/aca-marketplace-premium-payments-would-more-than-double-on-average-next-year-if-enhanced-premium-tax-credits-expire/

(Guessing on maybe $30,000 a year per individual in the full on-exchange group of 24 million.)

D)There’s nothing worse than a comment without supporting references!

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