Koch brothers network aims to raise $300M to $400M for conservative causes
by Fredrika Schouten - USA Today
INDIAN WELLS, Calif. — The leaders of the powerful network aligned with billionaires Charles and David Koch aim to raise and spend between $300 million and $400 million over the next two years to advance their free-market policy and political agenda, officials said Saturday.
The target, announced at the opening of the network’s annual winter gathering for donors, marks a substantial increase from the $250 million the network spent to influence political battles in the 2016 election and help Republicans retain their grip on the Senate.
Although Charles Koch refused to throw his political might behind President Trump’s candidacy, his top political operatives on Saturday signaled support for some of Trump’s actions during the first week of his presidency and a willingness to collaborate with his administration on other top Koch priorities, such as repealing the 2010 Affordable Care Act
“There’s been some good things, for sure,” top Koch official Mark Holden said of Trump’s early actions, singling out the new president’s move to cut federal regulation and revive the stalled Keystone XL Pipeline , designed to take oil from Canada to the Gulf Coast.
“A focus on less government ... is the way to go,” Holden said. “So, hopefully, the regulatory environment will improve.”
The early signs of optimism from the Koch camp about Trump’s presidency are a sharp departure from the tone that Charles Koch struck during the early days of the presidential campaign. Koch, an industrialist who is one of the world’s richest men, sharply criticized some of Trump’s rhetoric and policies during the election. At one point, he described Trump’s proposed Muslim registry as “reminiscent of Nazi Germany .”
On Saturday, Koch aides reserved early judgment about Trump’s move Friday to temporarily bar entry to visitors from several predominantly Muslim countries.
In a statement, Brian Hooks , who oversees the network's seminar with Holden, said the "rhetoric is extremely troubling," but said it would take some to evaluate Trump's executive order to deliver a "thoughtful response."
Koch officials also pointed to an area of potential contention: Trump’s apparent embrace this week of a 20% tax on imported goods. Trump aides said he was considering the border tax, first proposed by House Republicans, as one of several options to finance his pledge to build wall along the southern border with Mexico.
Americans for Prosperity officials slammed the border tax Friday in a letter to the leaders of the House tax-writing committee, saying it would drive up the cost of consumer goods.
The Kochs' fundraising announcement came as the Koch brothers and more than 550 ultra-wealthy donors in their network gathered for their first summit since the election to hash through their priorities. The network is one of the most powerful forces in conservative politics with an annual budget and staff that rivals the Republican Party's — and has its own for-profit data and marketing branches to identify voters and spread the Kochs’ libertarian-influenced brand of free-market conservatism.
Although the Kochs did not engage in the presidential campaign, the network spent heavily to help the Republican Party retain its control of the Senate and to shape state and local races across the country. Seven of the eight Senate candidates the Kochs backed won.
"We've had, by far, the most productive year in the history of this network," Koch told the donors early Saturday evening, as they sipped cocktails in a palm-fringed courtyard at the Renaissance Resort and Spa. He urged them to do more to achieve the network's vision of "advancing the country toward a brighter future now, while the opportunity is available."
"We may not have an opportunity again like we have today," he added.
Organizers say the gathering is the largest since the network began holding seminars in 2003. Seminar attendees must commit to giving at least $100,000 annually to the network to support the array of groups that promote their agenda
Network spokesman James Davis said 200 of those assembled were first-time attendees. The three-day gathering, organized under the theme “A Time to Lead” will emphasize some of the network’s top priorities, including promoting what officials call “free-speech” on college campuses and projects aimed at supporting anti-poverty, up-by-the-bootstraps programs.
Several top officials also attended, including Republicans Sens. Pat Toomey of Pennysylvania, James Lankford of Oklahoma and Mike Lee of Utah, who made remarks Saturday night.
In recent years, the publicity-averse Koch has sought to remake his image, giving more media interviews and opening the parts of the twice-annual donor seminars to journalists. Organizers, however, impose restrictions on coverage, barring journalists from identifying donors at the event without contributors’ permission and imposing restrictions on photographs.
Although the network did not focus on the presidential race, Trump’s campaign likely benefited from the Koch network’s big spending in Senate races. The network’s main grassroots arms, Americans for Prosperity, mobilized voters to turn out in key states, including Wisconsin, Pennsylvania, Florida and North Carolina – all states won by Trump.
The network’s ties to Trump's new administration run deep. Vice President Mike Pence, a former congressman and Indiana governor, has attended Koch seminars. Marc Short, the new White House director of legislative affairs, until recently was a top Koch operative.
Republicans lay out plans for Obamacare repeal
By Susan Cornwell and David Morgan, Reuters
PHILADELPHIA — Republican leaders on Wednesday laid out plans for repealing Obamacare by spring, followed by funding the building of a border wall and reforming the tax code by late summer, as lawmakers launched an effort to unify behind a legislative strategy.
But Republicans gathered in Philadelphia for a three-day retreat showed little fervor for President Donald Trump’s calls to investigate what he believes was large-scale voter fraud in the Nov. 8 election.
Trump on Wednesday said he would seek such a probe, although there is overwhelming consensus among state officials, election experts and politicians that such fraud is rare in the United States.
At the closed-door retreat, House Speaker Paul Ryan laid out a plan of legislative action including repeal of the Affordable Care Act, former President Barack Obama’s signature health law known as Obamacare, by March or April, followed by appropriations for a border wall with Mexico and overhauling the tax code by August, one Republican source said.
Republicans have majorities in both the House and Senate.
A senior House Republican, U.S. Rep. Diane Black, said key House committees will take votes within the next two weeks on draft legislation to repeal the Affordable Care Act.
“Then we expect that probably toward the latter part of February, or the first part of March, that we should be ready to go with the final reconciliation bill” to repeal Obamacare, she told reporters.
U.S. Rep. Chris Collins, a New York Republican who was an early Trump backer, said on MSNBC that lawmakers were told at the retreat that they will write legislation “in the next two months” to help pay for the border wall that Trump signed directives to build.
On the issue of tax reform, Ryan, speaking to MSNBC, said, “Our goal is to get this done by the end of summer, which is for Congress quite fast.”
While there is Republican enthusiasm about the idea of swift action against Obamacare and on taxes, the challenge for Trump and congressional Republicans will be getting lawmakers to coalesce around specific plans.
Trump won in November because he secured the most votes in the state-by-state Electoral College system, but he lost the popular vote to Democrat Hillary Clinton by nearly 3 million ballots. Irked by that large figure, he has blamed voter fraud, without citing evidence, and called for an investigation.
U.S. Sen. John Thune of South Dakota, chair of the Senate Republican Conference, saw little need for a probe.
“I’ve not seen any evidence to that effect, but if they want to take that issue up, that’s a decision obviously that he can make,” Thune told reporters.
“All I can say is what I’ve said before, and that is that we’ve moved on, the election’s over with, we had a decisive winner in our constitutional system, and we’re ready to go to work,” he said.
U.S. Rep. Cathy McMorris Rodgers of Washington state, chair of the Republican conference in the House, took a wait-and-see attitude toward Trump’s demand for a probe.
“It’s very important that people have confidence in the elections and the outcome of those elections. And I’ll wait until I see more of what he’s proposing before I comment on what his action is going to be,” she said.
Trump and Vice President Mike Pence are expected to meet with the lawmakers on Thursday. British Prime Minister Theresa May will also join lawmakers in Philadelphia on Thursday and is expected to discuss plans for a possible U.S.-U.K. trade deal.
Congress is under pressure from Trump to act quickly. But some congressional Republicans have expressed concern about starting a repeal without clarity about how to replace a law that has expanded health insurance coverage to millions.
The retreat will provide an opportunity for Trump and his staff to build a rapport with lawmakers, many of whom have had little contact with the president.
http://bangordailynews.com/2017/01/26/politics/republicans-lay-out-plans-for-obamacare-repeal/print/
In Private, Republican Lawmakers Agonize Over Health Law Repeal
by Robert Pear and Thomas Kaplan - NYT
WASHINGTON — Congressional Republicans, meeting behind closed doors this week in Philadelphia, expressed grave concerns about dismantling the Affordable Care Act on the urgent timetable demanded by President Trump, fretting that, among other things, they could wreck insurance markets and be saddled with a politically disastrous “Trumpcare.”
An audio recording of a session at their annual retreat, obtained by The New York Times, shows Republicans in disarray, far from agreement on health policy, and still searching for something to replace former President Barack Obama’s health care law. While their leaders called for swift action to rescue consumers from the Affordable Care Act, some backbench Republicans worried about potential pitfalls.
“We had better be sure that we are prepared to live with the market being created,” said Representative Tom McClintock of California, because “that’s going to be called Trumpcare.”
He added, “Republicans will own it lock, stock and barrel, and we’ll be judged on that.”
When Democrats were writing the Affordable Care Act seven years ago, their primary goal was to provide health insurance to more people, an ambition that the Obama administration went to great lengths to fulfill as it enrolled millions of people in Medicaid or private health plans.
Now, as Republicans try to devise a replacement for the law, they have set a nearly impossible standard for themselves: They have promised that none of the 20 million people who gained coverage through the Affordable Care Act will lose it if the law is repealed, even as they lift its mandates and penalties, pull back the tax increases that pay for it and pledge to enact a new program that will be cheaper for taxpayers and consumers.
In their private session, the recording of which was first reported on by The Washington Post, Republicans revealed that they understood the predicament they had largely created for themselves.
“I recognize that we can’t keep Obama’s promises,” Representative Tom MacArthur of New Jersey said. “They were wrong to begin with, and the system can’t be sustained.” He worried aloud about the possibility that some people could lose insurance as the law is unwound.
“We’re telling those people that we’re not going to pull the rug out from under them, and if we do this too fast, we are, in fact, going to pull the rug out from under them,” Mr. MacArthur said. After giving states the choice to expand Medicaid under the law, he said, reversing that expansion too quickly would run the risk of pulling a “bait and switch with the states.”
The lawmakers’ concerns contrasted with the confidence that Republican leaders and President Trump have expressed as they rush to replace Mr. Obama’s signature domestic achievement, also known as Obamacare. Congress this month approved a budget blueprint that clears the way for quick action to repeal major provisions of the law, and Mr. Trump has said Congress should repeal and replace the law at the same time, putting pressure on lawmakers to agree on an alternative.
That budget measure created an aspirational deadline to draft repeal legislation by Jan. 27, a day that came and went.
Privately, Republicans made clear they understand the risks they are running. At their session this week, they voiced concern that their efforts to undo the law could have harmful consequences, such as inadvertently destabilizing insurance markets — a concern shared by Democrats and insurers.
Under Senate rules, the Senate could vote to repeal major provisions of the Affordable Care Act using fast-track procedures that neutralize the threat of a Democratic filibuster. “We can repeal parts of it,” Mr. McClintock said, “and the parts that remain, I’m concerned, could make the market even more dysfunctional.”
Republican leaders tried to reassure anxious backbenchers, making the same points in private as they have in public.
“We don’t own Obamacare,” said Senator John Barrasso of Wyoming, the chairman of the Senate Republican Policy Committee, adding: “We are the rescue party. We campaigned to provide relief and help repair the damage.”
Republican leaders have predicted that Democrats will come to the table to help draft a replacement once it becomes clear that the health law will be repealed. But some rank-and-file members were not so sure.
Representative John Katko of New York wondered what Republicans would do “if we can’t get anything out of the Democrats.”
Another New York Republican, Representative John J. Faso, warned colleagues they were playing with fire if they cut off funds for Planned Parenthood clinics, as Speaker Paul D. Ryan has said Republicans intend to do.
“Health insurance is going to be tough enough for us to deal with, without allowing millions of people on social media to come to Planned Parenthood’s defense,” Mr. Faso said. He wanted to know from the administration that “we’re not going to have a tweet from the president” saying “we should protect Planned Parenthood.”
”We’re making a grave mistake including this Planned Parenthood provision in a health care bill,” he said.
For many Republicans, coverage and cost are still the most important issues. Estimates of the number of people who will gain or lose coverage will affect the outlook for any proposal to dismantle and replace the 2010 law. If the Congressional Budget Office, the nonpartisan scorekeeper on Capitol Hill, concludes that a significant number of people could lose coverage under a Republican plan, opposition from lawmakers — including Republicans — could jeopardize passage.
Before Mr. Trump stepped into the debate with his call for “insurance for everybody,” Republicans were choosing their words with utmost caution: Their goal in replacing the health law was to guarantee “universal access,” they said, not necessarily universal coverage.
“We will give everyone access to affordable health care coverage,” Mr. Ryan said in early December when asked if Republicans had a plan to cover everyone.
But that discipline has broken down as lawmakers hear from constituents terrified of losing insurance and as Mr. Trump weighs in.
“No one who has coverage because of Obamacare today will lose that coverage,” Representative Cathy McMorris Rodgers of Washington, the chairwoman of the House Republican Conference, said on Jan. 10.A spokeswoman for Ms. McMorris Rodgers later tried to clarify what she had said. The congresswoman “didn’t deliver her remarks exactly as prepared,” the spokeswoman said. In the prepared remarks, Ms. McMorris Rodgers included an important qualification: “No one who has coverage because of Obamacare today will lose that coverage the day it’s repealed” — in the transition to a new market-oriented health care system.
But Senator John Cornyn of Texas, the No. 2 Senate Republican, has made a sweeping commitment just like the one by Ms. McMorris Rodgers. After meeting with governors on Jan. 19, Mr. Cornyn was asked about concerns that people who benefited from the expansion of Medicaid might lose that coverage with a repeal.
“We’re all concerned, but it ain’t going to happen,” Mr. Cornyn said. He amplified the point, adding: “Nobody’s going to lose coverage. Obviously, people covered today will continue to be covered. And the hope is we’ll expand access. Right now 30 million people are not covered under Obamacare.”
A spokesman for Mr. Cornyn said he “meant no one will lose access to coverage.”
Chris Jacobs, a health policy analyst who used to work for Republicans in Congress, said Republicans and Mr. Trump were at risk of overpromising, just as Mr. Obama did.
“Conservatives should not remain fixated on the number of people with health insurance when designing an Obamacare alternative,” Mr. Jacobs said. “We will never win the battle with liberals if you measure success in terms of how many people have health insurance cards. We don’t want to spend as much as liberals, and we don’t believe in coercing people to buy insurance.”
Democrats remember how Republicans hounded Mr. Obama for breaking his promise that “if you like your health care plan, you can keep your health care plan.” Democrats say they will hold congressional Republicans and the Trump administration accountable in the same way.
Increasing the number of people with insurance was a lodestar for the Obama administration. It spent tens of millions of dollars advertising the benefits of the law. It extended deadlines to give people more time to sign up. It allowed many people to sign up outside the regular annual enrollment period and played down the significance of big premium increases, saying consumers could get subsidies to defray the costs.
Republicans say they can get the same results for less money and without a statutory mandate that most Americans have insurance. But without that requirement, budget analysts say, it will be difficult for Republicans to achieve coverage gains as large as those achieved under the Affordable Care Act.
“It’s easier for the Congressional Budget Office to estimate significant coverage effects if there is a federal requirement” for people to have insurance, said Douglas W. Elmendorf, who was the budget office director from 2009 to 2015. “It would be very hard to maintain the levels of insurance coverage we have now without the penalties and subsidies.”
Option #1:
Let states keep A.C.A. as is
Option #2:
Alternative plan with federal funding
Option #3:
Alternative plan with no federal funding
Individual mandate
Repeal
Repeal
The Affordable Care Act (A.C.A.) requires people who can afford it to obtain health insurance or face tax penalties. This is a critical part of the law that keeps insurance affordable for those who are older or sick.
This option repeals the individual mandate and instead allows states to auto-enroll uninsured individuals in basic coverage. This would bring more healthy people into the market to keep insurance affordable for those who are older or sick.
The individual mandate would be repealed, and states choosing this option would not auto-enroll the uninsured.
Employer mandate
Repeal
Repeal
Under the A.C.A., larger companies must provide affordable insurance to their employees or face financial penalties.
Subsidies
Change
Repeal
Under the A.C.A., the federal government provides tax credits to some individuals, generally those making under 400 percent of the federal poverty level, to help offset the cost of premiums and deductibles. States choosing this option would get 95 percent of the funding they would have received under the A.C.A.
The federal government would pay states 95 percent of the funding they would have received for subsidies under the A.C.A. States would receive the money as grants or tax credits, and the money would be deposited into patients' health savings accounts to pay for health insurance.
The federal government would provide no funding.
Medicaid expansion
Keep
Repeal
Under the A.C.A., more than 30 states expanded Medicaid coverage by raising the eligibility cutoff to 138 percent of the poverty level.
States that expanded Medicaid eligiblity would continue to receive federal funding and could also use the money as subsidies to help individuals buy private insurance.
The federal government would provide no funding.
Pre-existing conditions policy
Change
Change
The A.C.A. requires insurance companies to cover people, regardless of pre-existing medical conditions, and bars them from charging more based on a person's health history.
States would be required to keep this provision for people who stay insured. But customers who let their insurance coverage lapse could be charged higher prices, as well late enrollment penalties, if they have a history of medical conditions.
Even states not receiving any federal funding would be required to keep this provision for people who maintain insurance coverage. But customers who let their insurance coverage lapse could be charged higher prices if they have a history of medical conditions.
Restrictions on charging more for older Americans
Repeal
Repeal
Under the A.C.A., plans can only charge their oldest customers three times the prices charged to the youngest ones.
Essential health benefits
Keep just one.
Keep just one.
Under the A.C.A., all insurers must offer 10 essential health benefits, including maternity care and preventive services.
States would be required to keep coverage only for mental health and substance use disorder.
States would be required to keep coverage only for mental health and substance use disorder.
Prohibitions on annual and lifetime limits
Keep
Keep
The A.C.A. bars insurers from setting any limit on how much they have to pay to cover someone.
States would be required to keep this provision.
Even states not receiving any federal funding would be required to keep this provision.
Dependent coverage until 26
Keep
Keep
Under the A.C.A., children can stay on their parents' insurance policies until age 26.
The New York Times
Behind closed doors, Republican lawmakers fret about how to repeal Obamacare
by Mike Debones - Washington PostRepublican lawmakers aired sharp concerns about their party’s quick push to repeal the Affordable Care Act at a closed-door meeting Thursday, according to a recording of the session obtained by The Washington Post.
The recording reveals a GOP that appears to be filled with doubts about how to make good on a long-standing promise to get rid of Obamacare without explicit guidance from President Trump or his administration. The thorny issues with which lawmakers grapple on the tape — including who may end up either losing coverage or paying more under a revamped system — highlight the financial and political challenges that flow from upending the current law.
Senators and House members expressed a range of concerns about the task ahead: how to prepare a replacement plan that can be ready to launch at the time of repeal; how to avoid deep damage to the health insurance market; how to keep premiums affordable for middle-class families; even how to avoid the political consequences of defunding Planned Parenthood, the women’s health-care organization, as many Republicans hope to do with the repeal of the ACA.
“We’d better be sure that we’re prepared to live with the market we’ve created” with repeal, said Rep. Tom McClintock (R-Calif.). “That’s going to be called Trumpcare. Republicans will own that lock, stock and barrel, and we’ll be judged in the election less than two years away.”
Even at GOP retreat, Trump sets the agenda
Play Video2:34
At the Republican retreat for members of Congress in Philadelphia, President Trump's tweets, speeches and executive orders derailed the GOP's plan to agree upon a replacement for Obamacare and set other policy initiatives. (Video: Jayne Orenstein/Photo: Getty Images/The Washington Post)
Recordings of closed sessions at the Republican policy retreat in Philadelphia this week were sent late Thursday to The Post and several other news outlets from an anonymous email address. The remarks of all lawmakers quoted in this article were confirmed by their offices or by the lawmakers themselves.
“Our goal, in my opinion, should be not a quick fix. We can do it rapidly — but not a quick fix,” said Sen. Lamar Alexander (R-Tenn.). “We want a long-term solution that lowers costs.”
Sen. Rob Portman (R-Ohio) warned his colleagues that the estimated budget savings from repealing Obamacare — which Republicans say could approach a half-trillion dollars — would be needed to fund the costs of setting up a replacement. “This is going to be what we’ll need to be able to move to that transition,” he said.
Rep. Pete Sessions (R-Tex.) worried that one idea floated by Republicans — a refundable tax credit — would not work for middle-class families that cannot afford to prepay their premiums and wait for a tax refund.
Republicans have also discussed the idea of generating revenue for their plan by taking aim at deductions that allow most Americans to get health insurance through their employers without paying extra taxes on it. Sen. Bill Cassidy (R-La.), who has drafted his own bill to reform the Affordable Care Act, said in response, “It sounds like we are going to be raising taxes on the middle class in order to pay for these new credits.”
Rep. Kevin Brady (R-Tex.), who chairs a key tax-writing subcommittee, countered, “I don’t see it that way,” adding that there is “a tax break on employer-sponsored health care and nowhere else” equal to $3.6 trillion over 10 years.
“Could you unlock just a small portion at the top to be able to give that freedom [to self-employed Americans]? That is the question,” Brady said.
Rep. John Faso (R-N.Y.), a freshman congressman from the Hudson Valley, warned strongly against using the repeal of the ACA to also defund Planned Parenthood. “We are just walking into a gigantic political trap if we go down this path of sticking Planned Parenthood in the health insurance bill,” he said. “If you want to do it somewhere else, I have no problem, but I think we are creating a political minefield for ourselves — House and Senate.”
The concerns of rank-and-file lawmakers appeared to be at odds with key congressional leaders and Andrew Bremberg, a top domestic policy adviser to Trump, who have laid out plans to repeal the ACA using a fast-track legislative process and executive actions from the administration. However, these leaders acknowledged in Thursday’s meeting, as they have before, that Obamacare cannot be fully undone — or replaced — without Democratic cooperation.
That and other aspects of the unfinished GOP plan prompted several wary lawmakers to urge their leaders to move more deliberately — even as the Trump administration appears to be moving ahead with repeal. Thursday, the White House ordered federal health officials to immediately halt all advertising and other outreach activities for the critical final days in which Americans can sign up for 2017 health coverage through Affordable Care Act marketplaces. The administration partly retracted that directive on Friday, allowing the Department of Health and Human Services to continue to contact people eligible for ACA coverage by email, text and automated phone calls, and reviving use of a HealthCare.gov Twitter account.The new directive also allows airing of some ads if the government would otherwise lose the money it paid for them upfront.
House Speaker Paul D. Ryan (R-Wis.) dismissed the concerns aired in the meeting during an interview at a Politico event Friday.
“We have a responsibility to work for the people that put us in office,” he said. “That’s the oath we take: to defend the Constitution, to fight for the people we represent, and this is a fiasco that needs to be fixed.”
Of particular concern to some Republican lawmakers was a plan to use the budget reconciliation process — which requires only a simple majority vote — to repeal the existing law, while still needing a filibuster-proof vote of 60 in the Senate to enact a replacement.
“The fact is, we cannot repeal Obamacare through reconciliation,” McClintock said. “We need to understand exactly: What does that reconciliation market look like? And I haven’t heard the answer yet.”
Several important policy areas appeared unsettled. While the chairmen of key committees sketched out various proposals, they did not have a clear plan for how to keep markets viable while requiring insurers to cover everyone who seeks insurance.
At one point Cassidy, a physician who co-founded a community health clinic in Baton Rouge to serve the uninsured, asked the panelists a “simple question”: Will states have the ability to maintain the expanded Medicaid rolls provided for under the ACA, which now provide coverage for more than 10 million Americans, and can other states do similar expansions?
“These are decisions we haven’t made yet,” said House Energy and Commerce Committee Chairman Greg Walden (R-Ore.).
Rep. Tom MacArthur (R-N.J.) worried that the plans under GOP consideration could eviscerate coverage for the roughly 20 million Americans now covered through state and federal marketplaces and the law’s Medicaid expansion: “We’re telling those people that we’re not going to pull the rug out from under them, and if we do this too fast, we are in fact going to pull the rug out from under them.”
Republicans are also still wrestling with whether Obamacare’s taxes can be immediately repealed, a priority for many conservatives, or whether that revenue will be needed to fund a transition period.
And there seems to be little consensus on whether to pursue a major overhaul of Medicaid — converting it from an open-ended entitlement that costs federal and state governments $500 billion a year to a fixed block grant. Trump and his top aides, including counselor Kellyanne Conway, have publicly endorsed that idea. But doing so would mean that some low-income Americans would not be automatically covered by a program that currently covers 70 million Americans.
Many of the concerns aired Thursday were more political than policy-oriented. Faso’s remarks about Planned Parenthood generated tepid applause. Ryan said this month that he expects the House to pursue the organization’s defunding in the reconciliation bill.
Those expressing qualms included some of the top congressional leaders who are in line to draft the health-care legislation. Alexander, for one, is chairman of the Senate Health, Education, Labor and Pensions Committee.
Ryan and other leaders have said they intend to pursue a piecemeal approach, following the reconciliation bill with smaller ones that address discrete aspects of reform.
Bremberg, chairman of Trump’s domestic policy council, offered little detail in the session about particular executive actions the Trump administration intends to take or what legislative proposals the new president favors.
Instead, he pointed to the executive order Trump signed last week, his first, as proof of his commitment to undoing Obamacare’s mandates and said his choice of Rep. Tom Price (R-Ga.) to be his health and human services secretary “should speak volumes to people trying to understand what he’s hoping to achieve.”
“This is not a technocrat,” Bremberg said. “This is an experienced, compassionate doctor who has experienced the health-care system firsthand and who has been a leader here in Washington trying to address the policy reforms that need to take place. Having both of those in a secretary is going to be very important and very powerful.”
Even as Bremberg offered few details about what the president plans to do, he emphasized that last week’s executive order “repeatedly” used phrases “such as ‘to the maximum extent permitted by law’ ” to enable his political appointees to start dismantling the ACA by executive authority.
“I’m sure many of us have been very concerned about the interpretation of that phrase in the last six or so years,” Bremberg quipped, referring to the previous administration. “The president has now officially given direction [not only] to HHS, but to all of these agencies that have responsibility . . . to exercise all available discretion to begin helping the American people and to begin fixing our health-care system.”
The White House did not immediately respond to a request for comment on Bremberg’s remarks.
Faso warned that by defunding Planned Parenthood in the reconciliation bill, “we are arming our enemy in this debate.”
“To me, us taking retribution on Planned Parenthood is kind of morally akin to what Lois Lerner and Obama and the IRS did against tea party groups,” he said, a reference to accusations that the Internal Revenue Service improperly targeted conservative political groups for audits.
Faso continued: “Health insurance is going to be tough enough for us to deal with without having millions of people on social media come to Planned Parenthood’s defense and sending hundreds of thousands of new donors to the Democratic Senate and Democratic congressional campaign committees. So I would just urge us to rethink this.”
Robert Costa, Juliet Eilperin and Paul Kane contributed to this report.
Republicans Trying To Replace Obamacare Still Don’t Have Any Idea What They’re In For
They’re just figuring out this is going to be hard.
by Matt Fuller - Huffington Post
PHILADELPHIA ― Senate and House Republicans came to their GOP retreat here to get on the same page on Obamacare, to figure out the broad strokes of a health care alternative and to emerge with a unified message.
Republicans left town Friday with still more questions than answers on an Obamacare alternative, and the only thing lawmakers truly seem to agree on is that the Affordable Care Act needs to go.
On Wednesday, House Speaker Paul Ryan (R-Wis.) and Senate Majority Leader Mitch McConnell (R-Ky.) laid out a timeline for repealing major parts of the 2010 health care law through a reconciliation process before April. At that point, the secretary of health and human services would begin issuing new guidance on Obamacare, which the lawmakers seem ready to consider part of a “replacement.”
And then ... they’ve offered little idea what happens next, how long it will take or what it will end up.
Republicans talk broadly about incorporating some elements they’ve already agreed to in the past, like expanding health savings accounts, creating high-risk pools and lifting barriers to the purchase of insurance plans across state lines. But those ideas alone assume that some crippled version of Obamacare remains in place and that Republicans in both chambers go along with gutting the health care system without a real replacement plan. The closer Republicans get to the sticking point, though, the more some lawmakers will want policy particulars, which their leaders simply don’t have.
When HuffPost asked House Majority Whip Steve Scalise (R-La.) on Friday for the proposed details of the replacement plan, he focused on the repeal.
“What we’ve looked at is as many things as we can put in a reconciliation bill that not just deal with a repeal but also a replace,” Scalise said. He then explained that the measure ripping apart the law will contain only small portions of an Obamacare alternative because of Senate rules barring new policies in a reconciliation bill. After they pass that repeal, he said, Republicans would “start moving some other things through the legislative process.”
“One of the flaws with Obamacare ― there were many ― was that [then-Speaker] Nancy Pelosi literally wrote the bill in a room with maybe two or three other people the night before the vote and nobody read the bill before they voted on it,” Scalise said.
While it’s true the law enacted in 2010 included its fair share of backroom deals, the substance of the Affordable Care Act was the subject of a lengthy, open debate that started during the 2008 presidential campaign and continued in Congress for about a year ― with some 130 public hearings across five committees.
President Donald Trump has vowed to pass a replacement in the same week or on the same day ― “could be the same hour” ― as the repeal. Although Ryan said earlier this month that he and Trump were “in complete sync” on that timeline, it appears it might be more spin than reality.
Republicans now look ready to have an actual debate on Obamacare, with hearings and multiple bills. This process would take time and could generate significant backlash. If Republicans are able to repeal Obamacare with, say, a three-year delay on the effective date, they could use those years to develop and pass multiple individual components of a health care alternative.
But those bills would likely all need 60 votes in the Senate, and there’s little incentive for Democrats to go along with gutting the law, especially if GOP lawmakers are shaky about what they’re doing.
Some Republicans think this is where Trump might come in handy. “I like the idea that we have a president who’s going to be using the bully pulpit, flying around on Air Force One to those states where Democrats might want to be standing in the way of their own voters,” Scalise said.
Again, that assumes Republicans themselves can agree on the broad strokes of a plan.
On Thursday, Republicans held a two-and-a-half hour session on Obamacare that many lawmakers thought could produce those general agreements on a replacement. Instead, in the words of one member, “it was a farce.” Two other members characterized it as “pathetic.”
A secret recording obtained by The Washington Post reveals the extent of lawmakers’ confusion and their wariness of barreling toward a repeal without a clear replacement plan. The general uneasiness is captured in one exchange when a lawmaker asked panelists a “simple question”: Will states be able to maintain the expanded Medicaid rolls provided for under the Affordable Care Act?
“These are decisions we have to make,” replied another, according to The Washington Post. “That’s why we are here today.”
“The only person in the room talking specifics was Dr. Cassidy,” one member told HuffPost, referring to Sen. Bill Cassidy (R-La.). “You might not like his plan, but at least he is talking about a real solution.”
Cassidy’s plan, which is also supported by Sen. Susan Collins (R-Maine), is to essentially allow states where Obamacare is working well, like California and Michigan, to keep that structure, while other states where it’s not working so well, like Arizona and Tennessee, could adopt a new system. It’s easily pitched to voters and relies on the key Republican principle of bringing government closer to the people. Naturally, the plan looked dead on arrival.
Republicans at that Thursday session reported to HuffPost that there were plenty of ideas tossed around, just no real consensus.
“Lots of different perspectives on how to best fix the Obamacare fiasco,” Rep. Mo Brooks (R-Ala.) said. “No coalition on any one form of repeal or fix.”
Brooks himself is not necessarily against just repealing Obamacare and doing nothing more. “As a matter of law, if there is a repeal, then we revert back to the best health care system the world has ever known, and that’s the health care system America had in 2008,” Brooks has said previously.
But other lawmakers argue that premiums and deductibles need to be reduced and coverage for the sick must be maintained ― all while repealing the taxes that help pay for Obamacare and removing insurance mandates.
That was the position of Rep. Brian Babin (R-Texas), who thinks Republicans can achieve all those things. Told that his insurance plan sounded like magic, Babin went on to praise the free enterprise system and decry the fact that some Americans had to change doctors under Obamacare.
“Nothing’s magic,” he said.
It’s not realistic, either. If you take away the mechanisms that pay for Obamacare ― as Republicans want to do ― insurance coverage will not miraculously get better or cheaper simply because there’s more competition across state lines. The net result will be fewer Americans insured, larger medical bills to be paid out of pocket, or a combination of the two. Real people will suffer real consequences.
If you want to pass a health care alternative in the open, through regular order, with multiple bills, over many months ― to give full public consideration to a major decision ― you also have to deal with public opposition. Votes on measures that already look like they can’t win 60 senators will be even tougher. And the competing viewpoints ― from conservatives who want to see less government interference and support, from moderates and liberals who want to see more ― will duke it out in a very messy battle that could overwhelm an already jammed congressional schedule.
Which is all to say: A Republican alternative to Obamacare faces real trouble, and that isn’t something you can resolve over a couple of days in a hotel ballroom.
Laura Barron-Lopez and Jonathan Cohn contributed to this report.
A Republican Plan for
Medicare Gets a Revival
by Aaron Carroll and Austin Frakt - NYT
A number of Republican health care policy proposals that seemed out of favor in the Obama era are now being given new life. One of these involves Medicare, the government health insurance program primarily for older Americans, and is known as premium support.
Right now, the federal government subsidizes Medicare premiums — those of the traditional program, as well as private plan alternatives that participate in Medicare Advantage. The subsidies are established so that they grow at the rate of overall per enrollee Medicare spending. No matter what Medicare costs, older Americans can be sure that the government will cover a certain percentage of it. That’s the main thing that panics fiscal conservatives, because that costs the government more each year.
Premium support could quiet that fear. Subsidies would be calculated so they don’t grow as quickly, thus protecting the federal government (that is, taxpayers) from runaway spending. There are lots of variants, but there are really two principal ideas.
The first is to set the subsidy to a level established by the market, as opposed to one established by the government, as it is now.
One way to do that is to tie the subsidy to the average premium of all Medicare plans, including that of traditional Medicare. This is how the Medicare drug program, Part D, already works. For Part D, Medicare collects bids from all plans that reflect their costs of providing the required, minimum level of drug coverage. Then it sets the subsidy at 74.5 percent of the average bid.
Beneficiaries pay the difference, which will be higher for more costly plans that may offer more generous benefits, and lower for cheaper plans. The system also includes additional subsidies for low-income beneficiaries.
The thinking is that the market drives the subsidy. Because insurance companies want to attract more enrollees, they are motivated to drive their bids downward, driving subsidies downward as well and saving taxpayers money.
If this sounds somewhat similar to how the subsidies for the Affordable Care Act marketplace plans work, it’s because it is similar. Obamacare ties the premium subsidy to the second-lowest premium instead of the average. If an enrollee wants a plan with more benefits but at a higher premium, he or she would pay the difference, not the government.
But even though the approach is similar to Part D — which was passed by a Republican Congress and signed into law by a Republican president — and the A.C.A. marketplaces — established with only Democratic support — it does not have bipartisan endorsement.
That’s just one more example of how congressional actions and attitudes on health care reform are inconsistent. Republicans think subsidies based on bids is an excellent way to reform Medicare, but they don’t laud the Affordable Care Act for adopting the same approach. When it comes to the A.C.A., of course, Democrats supported this mechanism, but they’ve opposed it when it comes to Medicare reform.
Obamacare’s creation of the insurance exchanges and subsidies to expand coverage was a move leftward, supported by Democrats and opposed by Republicans. Anything that relies more heavily on private Medicare options would be a move rightward, and it would probably be opposed by Democrats and supported by Republicans. Such is Washington.
It’s worth noting that progressives are also concerned that this plan might erode traditional Medicare. It could do that because, for a variety of reasons, private plans are likely to bid lower than traditional Medicare. If people have to pay more for traditional Medicare, relative to private plans, they’re likely to leave it, weakening that arm of the program.
The second main idea included in some premium support plans is to further protect the government from rapidly growing expenditures by explicitly capping the growth in subsidies. This could be layered on top of the bidding approach. It would work like this: Plans bid, and the government picks the average or second lowest. Then the government makes sure it doesn’t pay a predetermined amount more than last year — a growth cap.
This kind of cap on subsidy growth is an even more contentious issue. As anyone who follows health care spending knows, it has grown significantly faster than inflation for the past several decades. Putting a more restrictive cap on growth will make budget projections look better. The problem is that such action assumes that there are ways we haven’t previously figured out to reduce Medicare spending without reducing benefits, reducing reimbursement or increasing cost-sharing.
Progressives fear that, given our inability to control health care spending in other ways, this would most likely wind up transferring more and more of the cost of health care onto older Americans themselves. Many would be unable to afford care. The same problems we’re seeing with underinsurance and cost-related access barriers in the private insurance market could become more prevalent.
The entire point of premium support is to rely on the market to innovate and come up with more efficient ways of providing health care and health insurance for it. As such, one cannot say in advance how it would keep costs below a growth cap.
Some people deride this as “market magic,” and it’s easy to see where they’re coming from. It’s not crazy, however, to think that care could be better managed to produce good outcomes more efficiently, at least to some extent. This, in fact, is the theory underlying some of the Affordable Care Act’s reforms, like accountable care organizations.
But the bottom line is this: With premium support, no one can be certain how things will work out. As we consider any premium support approach, we will need to acknowledge that one of the easiest ways to cut premiums is to shift more health care costs to older Americans.
Trump’s Obamacare Executive Order: Much Ado About Very Little
n Inauguration Day, newly sworn-in President Donald Trump signed an Affordable Care Act (ACA) executive order that the new Administration heralded as a major development. In a Washington Post page 1 story, the headline read “Signed Order Might Start the Gutting of ACA Mandate.” The story’s headline in The New York Times said “Trump Issues Executive Order to Scale Back Part of Health Care Law,” and a jump-site for the story indicated “A President’s One-Page Directive Could Have a Wide-Ranging Impact.”
Despite the Administration’s hype and the headline hullabaloo about the executive order, that order constitutes much ado about very little. Indeed, the executive order is vacuous. Thankfully, the seasoned, thoughtful Post and Times reporters who wrote the stories offered a much more nuanced and contextualized description about the President’s order than the headlines suggest. And, as Vox’s Sarah Kliff aptly characterized it in a tweet, the executive order is “akin to a political scream, but a policy whisper.”
Reading The Executive Order Closely
Certainly Trump’s first-day ACA-related “action” confirms that the historic law remains a top-priority bulls-eye for the President. More significantly, however, the executive order’s lack of meaningful content confirms that the White House and congressional Republicans remain totally confused and unclear about their proposed directions for America’s health care system.
As the order’s heading states, its intended purpose is to “minimiz[e] the economic burden” of the ACA “pending repeal.” It tells the Secretary of Health and Human Services (HHS) and other federal officials that, to “the maximum extent permitted by law,” they should “waive, defer, grant exemptions from, or delay” implementation of the law so it doesn’t “burden” individuals, families, states, health care providers, and insurers.
The key operative term, of course, is the portion italicized above. Moreover, the order goes on to say that “heads of agencies shall comply with the Administrative Procedure Act and other applicable statutes in considering or promulgating” ACA-related revisions. In other words, the executive order neither countermands any portions of the historic statute nor vitiates any of the regulations duly promulgated by the Obama Administration’s HHS and other departments.
The Order Changes Very Little
So what substantive effect should be ascribed to the executive order other than its political restatement that the new Administration will “seek the prompt repeal” of the ACA? First, contrary to the Post’s headline, the order does not, in any way, modify the historic statute’s individual mandate. This can only be changed by an act of Congress. Since the Supreme Court in National Federation of Independent Business v. Sebelius (the first major legal challenge to the ACA) made clear that the individual mandate is central to the operation of the ACA, it would be a tall order for the Trump Administration to eliminate or water it down without explicit congressional approval. It is possible that Administration officials will seek to grant individualized hardship exemptions from the mandate, but this is rather insignificant.
Second, the executive order does not eliminate or modify the tax-credit premium subsidies that are crucial to making premiums affordable in the private marketplace. The order also does not authorize the new Administration to eliminate the Medicaid expansion now helping many millions of people in 31 states, including numerous states with Republican governors. Modification of either of these crucial provisions will require new legislation.
Third, the executive order does not change key rules imposed on insurers. They will still be prohibited from discriminating against people with pre-existing health conditions. They will not be able to impose annual or lifetime caps on how much they pay out to people experiencing major illnesses or accidents. They remain unable to charge higher premiums to women and will be restricted in how much extra they can charge older people. And young adults under 26 years of age will still be able to obtain insurance through their parents.
Fourth, and perhaps most importantly, the executive order does appear to function as an exhortation that Administration officials should grant (so-called “1332” and “1115”) waivers to states seeking to modify the operation of their marketplaces and Medicaid. However, the granting of such waivers is circumscribed by key provisions in the statute, and the exhortation doesn’t add anything to HHS Secretary-designate Price’s existing inclination to issue numerous state waivers.
The net result, therefore, is that the new executive order is unlikely to change anything significant about the ACA. But, since it is devoid of meaningful substance, it underscores how irresponsible Republicans continue to be by maintaining their ongoing commitment to repeal the ACA even though they do not have a clear vision about what should replace it.
Advocates submit signatures to put Medicaid expansion on Maine ballot
by The Kennebec Journal
The initiative is a response to Gov. LePage's refusal to authorize the state to accept federal Medicaid funds.
A group that hopes to expand Medicaid in Maine turned in more than 67,000 signatures to the secretary of state Wednesday in hopes of getting a question on the November ballot.
Mainers for Health Care wants to ask voters to require the state to accept federal funds to expand MaineCare, the state’s Medicaid program. Similar bills have passed in the Legislature in recent years, but Gov. Paul LePage has vetoed them.
LePage’s newest proposed budget would tighten eligibility requirements further, reducing the number of people who get health insurance through the program.
The Maine Republican Party issued a statement Wednesday saying that the ballot question may well be “a moot point and waste of state resources” because of anticipated federal changes to the Affordable Care Act, under which state Medicaid programs can be expanded.
“We are likely witnessing the introduction of a referendum that would have no effect other than misguided demands that Maine taxpayers would be saddled with, and potentially, even more welfare costs,” said Nina McLaughlin, the Republican Party’s communications direction, in a news release.
Democratic House Speaker Sara Gideon, D-Freeport, released a statement saying the ballot measure would boost the state’s economy and help more people get access to health care.
“Too many Mainers are struggling to pay their doctor’s bills or not going to a doctor at all because it’s too expensive,” she said in the statement. “(The ballot measure) would make available over $500 million in new funds to the state annually that will go towards quality health care.”
After a State House news conference, volunteers delivered boxes of signatures to the state. For the proposal to appear on the ballot, at least 61,123 valid signatures must be confirmed.
Maine DHHS wants to charge some MaineCare recipients premiums, fees
Health and Human Services Commissioner Mary Mayhew says the state is seeking flexibility under President Trump to 'tailor' programs.
by Scott Thistle - Portland Press Herald
AUGUSTA — Gov. Paul LePage’s administration is again seeking to reform Maine’s Medicaid system, MaineCare, and sees a new opportunity under the Trump administration.
Among the changes is a request by LePage and Health and Human Services Commissioner Mary Mayhew to charge MaineCare recipients monthly premiums and co-pays for services if it is determined they have an ability to earn an income.
Mayhew said the governor believes Trump will look more favorably on waivers Maine has previously sought but were rejected under former President Obama.
“We believe that President Trump and the incoming executive leadership in Washington present Maine and other reform-minded states with a unique opportunity to reshape the Medicaid program to best fit the needs of their citizens,” Mayhew said in a statement. “That means expecting able-bodied adults to work, contribute to the cost of their coverage, and pay a small fee if they miss an appointment in exchange for taxpayer-funded health insurance. Like our other welfare programs, Medicaid should be a temporary hand up, not a lifetime benefit for an able-bodied adult.”
Other changes being sought by Maine under the waivers include work requirements, a time limit on benefits and asset tests.
Mayhew’s renewed request lines up with what Trump’s nominee to lead the federal Department of Health and Human Services says he would like to see done nationwide. Dr. Tom Price, a member of Congress from Georgia, supports providing block grants to states and said he believes the state of Indiana, which requires co-pays and premiums for Medicaid recipients, has the right model.
Indiana, under then-Republican Gov. Mike Pence, held off expanding Medicaid under the Affordable Care Act until it could enact a state law requiring some financial participation by recipients.
In general, states led by Republican governors or states where Republicans hold majorities in the Legislature have begun to renew their prior requests for waivers on their Medicaid programs.
Last week, Gov. Robert Bentley of Alabama, a Republican, said he hoped the Trump administration will allow states to charge Medicaid premiums and set new enrollment requirements, The Associated Press reported. Alabama requested a waiver to be able to charge premiums to Medicaid recipients in January.
The requested changes also line up with what House Speaker Paul Ryan has proposed as reforms to state and federally funded Medicaid programs.
LePage’s administration has been relatively successful in changing components of the state’s welfare system in recent years, including putting in place work requirements for those accepting food benefits under the Supplemental Nutrition Assistance Program, previously known as food stamps, as well as changing eligibility requirements for Medicaid. About 270,000 Mainers are on MaineCare. Roughly 350,000 were on the program when LePage took office in 2011, Mayhew said in her letter to Price.
LePage’s current budget also looks to further restrict welfare benefits in Maine by reducing the maximum time a family could receive state and federally funded Temporary Assistance to Needy Families cash benefits, from 60 months to 36. About 12,000 Maine families could be affected by that change, while another 20,000 Mainers could lose their health care coverage under a proposal by LePage to tighten eligibility requirements for MaineCare by lowering the amount parents with children can earn and still qualify.
Democratic lawmakers, including Dr. Patricia Hymanson, a state representative from York and co-chair of the Legislature’s Health and Human Services committee, have said that cutting off Medicaid for low-income parents is “cruel” and helps keep families trapped in poverty.
In her release Thursday, Mayhew touted the administration’s reductions in welfare costs, noting the state’s overall budget has benefited by a new stability in the DHHS budget, which makes up about one-third of all state spending.
“Our programs are on firm financial footing, so instead of dealing with a crisis, we can carefully evaluate how to best use taxpayer money,” Mayhew said. “We are able to ensure Maine’s programs prioritize their intended beneficiaries – our poor children, our elderly and our disabled. This focus will help build a better future for our communities and our state.”
Mayhew said Maine will be requesting the changes via a section 1115b Medicaid waiver in the coming days.
“In planning for Maine’s future, our focus needs to remain fixed on the disabled and elderly in our state,” she said. “To make serving them properly a reality, we need a commitment from the federal government that we can tailor our program to best serve our state.”
These so-called “skin-in-the-game” provisions also have been floated in the Maine Legislature, including as recently as last year, when a pair of Senate Republicans teamed with Democrats to advance a bill, with a one-vote margin, that would expand Medicaid in Maine under the ACA but would have required some limited co-pays. The bill eventually died between the House and Senate when the Legislature adjourned in 2016, But the bill faced a likely veto from LePage, who had five times successfully vetoed bills to expand Medicaid in Maine.
According to a January report from the Kaiser Family Foundation, a national nonprofit that studies health care policy, 39 states charge parents of children in the Childrens Health Insurance Program some fees, and 23 of the 32 states that have expanded Medicaid charge cost-sharing for adults in the expansion. Six states have received waivers to charge premiums or monthly contributions for adults on Medicaid.
Mayhew’s announcement comes just one day after a group of advocates for Medicaid expansion in Maine turned in more than 67,000 signatures to the Secretary of Statein hopes of getting a question on the November ballot.
Previous support for Medicaid expansion in the Legislature has included some Republicans, including Sens. Roger Katz of Augusta and Tom Saviello of Wilton.
Thursday, during his weekly appearance on WGAN’s radio talk show in Portland, LePage said his goal was to preserve government health care programs for the most needy Mainers and not for those who can work and pay part of their own health care costs.
“We are not, we are not trying to get people off Medicaid,” LePage told show hosts Matt Gagnon and Spencer Thibodeau. “In fact, if you are disabled, you are mentally ill or you’re elderly, I’m the first one in line to get you on. The people that we are trying to target are the people who are 19 to 50, that are able-bodied, that have no disabilities, that refuse to go to work. I say, ‘You go to work.'”
LePage then repeated a message he has stated previously that even those working full-time for the minimum wage, now at $9 an hour, would be eligible to purchase health insurance from the federal exchange set up under the ACA. “So there should be no more uninsured in the state of Maine,” he said.
LePage did not mention that he has opposed both the ACA and increasing Maine’s minimum wage, which voters in November supported.
Rep. Drew Gattine, D-Westbrook, the former House chairman of the Legislature’s Health and Human Services Committee, disagreed. He said other states that received federal waivers to add co-payments or premiums were granted them because they were expanding their programs to cover more individuals, not so they could limit access further.
LePage’s administration is asking for waivers as a way to remove more people from the system, Gattine said.
“This department continues to be obsessed with finding ways to take access to health care away from low-income people,” Gattine said. He said LePage has vetoed bills to expand Medicaid in Maine that included many of the provisions LePage is now seeking with the federal waivers, except the administration is asking for the waivers without expanded coverage for additional low-income Mainers.
“We’ve already got tens of thousands fewer people on our MaineCare program than we did when this governor took office,” Gattine said. “At what point is enough enough?”
Troops Who Cleaned Up Radioactive Islands Can’t Get Medical Care
RICHLAND, Wash. — When Tim Snider arrived on Enewetak Atoll in the middle of the Pacific Ocean to clean up the fallout from dozens of nuclear tests on the ring of coral islands, Army officers immediately ordered him to put on a respirator and a bright yellow suit designed to guard against plutonium poisoning.
A military film crew snapped photos and shot movies of Mr. Snider, a 20-year-old Air Force radiation technician, in the crisp new safety gear. Then he was ordered to give all the gear back. He spent the rest of his four-month stint on the islands wearing only cutoff shorts and a floppy sun hat.
“I never saw one of those suits again,” Mr. Snider, now 58, said in an interview in his kitchen here as he thumbed a yellowing photo he still has from the 1979 shoot. “It was just propaganda.”
Today Mr. Snider has tumors on his ribs, spine and skull — which he thinks resulted from his work on the crew, in the largest nuclear cleanup ever undertaken by the United States military.
Roughly 4,000 troops helped clean up the atoll between 1977 and 1980. Like Mr. Snider, most did not even wear shirts, let alone respirators. Hundreds say they are now plagued by health problems, including brittle bones, cancer and birth defects in their children. Many are already dead. Others are too sick to work.
The military says there is no connection between these illnesses and the cleanup. Radiation exposure during the work fell well below recommended thresholds, it says, and safety precautions were top notch. So the government refuses to pay for the veterans’ medical care.
Congress long ago recognized that troops were harmed by radiation on Enewetak during the original atomic tests, which occurred in the 1950s, and should be cared for and compensated. Still, it has failed to do the same for the men who cleaned up the toxic debris 20 years later. The disconnect continues a longstanding pattern in which the government has shrugged off responsibility for its nuclear mistakes.
On one cleanup after another, veterans have been denied care because shoddy or intentionally false radiation monitoring was later used as proof that there was no radiation exposure.
A report by The New York Times last spring found that veterans were exposed to plutonium during the cleanup of a 1966 accident involving American hydrogen bombs in Palomares, Spain. Declassified documents and a recent study by the Air Force said the men might have been poisoned, and needed new testing.
But in the months since the report, nothing has been done to help them.
For two years, the Enewetak veterans have been trying, without success, to win medical benefits from Congress through a proposed Atomic Veterans Healthcare Parity Act. Some lawmakers hope to introduce a bill this year, but its fate is uncertain. Now, as new cases of cancer emerge nearly every month, many of the men wonder how much longer they can wait.
Plutonium Problems’
The cleanup of Enewetak has long been portrayed as a triumph. During the operation, officials told reporters that they were setting a new standard in safety. One report from the end of the cleanup said safety was so strict that “it would be difficult to identify additional radsafe precautions that could have been taken.”
Documents from the time and interviews with dozens of veterans tell a different story.
Most of the documents were declassified and made publicly available in the 1990s, along with millions of pages of other files relating to nuclear testing, and sat unnoticed for years. They show that the government used troops instead of professional nuclear workers to save money. Then it saved even more money by skimping on safety precautions.
Records show that protective equipment was missing or unusable. Troops requesting respirators couldn’t get them. Cut-rate safety monitoring systems failed. Officials assured concerned members of Congress by listing safeguards that didn’t exist.
And though leaders of the cleanup told troops that the islands emitted no more radiation than a dental X-ray, documents show they privately worried about “plutonium problems” and areas that were “highly radiologically contaminated.”
Tying any disease to radiation exposure years earlier is nearly impossible; there has never been a formal study of the health of the Enewetak cleanup crews. The military collected nasal swabs and urine samples during the cleanup to measure how much plutonium troops were absorbing, but in response to a Freedom of Information Act request, it said it could not find the records.
Hundreds of the troops, though, almost all now in their late 50s, have found one another on Facebook and discovered remarkably similar problems involving deteriorating bones and an incidence of cancer that appears to be far above the norm.
A tally of 431 of the veterans by a member of the group shows that of those who stayed on the southernmost island, where radiation was low, only 2 percent reported having cancer. Of those who worked on the most contaminated islands in the north, 20 percent reported cancer. An additional 34 percent from the contaminated islands reported other health problems that could be related to radiation, like failing bones, infertility and thyroid problems.
Budget Cuts and the Cleanup
Between 1948 and 1958, 43 atomic blasts rocked the tiny atoll — part of the Marshall Islands, which sit between Hawaii and the Philippines — obliterating the native groves of breadfruit trees and coconut palms, and leaving an apocalyptic wreckage of twisted test towers, radioactive bunkers and rusting military equipment.
Four islands were entirely vaporized; only deep blue radioactive craters in the ocean remained. The residents had been evacuated. No one thought they would ever return.
In the early 1970s, the Enewetak islanders threatened legal action if they didn’t get their home back. In 1972, the United States government agreed to return the atoll and vowed to clean it up first, a project shared by the Atomic Energy Commission, now called the Department of Energy, and the Department of Defense.
The biggest problem, according to Energy Department reports, was Runit Island, a 75-acre spit of sand blitzed by 11 nuclear tests in 1958. The north end was gouged by a 300-foot-wide crater that documents from the time describe as “a special problem” because of “high subsurface contamination.”
The island was littered with a fine dust of pulverized plutonium, which if inhaled or otherwise absorbed can cause cancer years or even decades later. A millionth of a gram is potentially harmful, and because the isotopes have a half-life of 24,000 years, the danger effectively never goes away.
The military initially quarantined Runit. Government scientists agreed that other islands might be made habitable, but Runit would most likely forever be too toxic, memos show.
So federal officials decided to collect radioactive debris from the other islands and dump it into the Runit crater, then cap it with a thick concrete dome.
The government intended to use private contractors and estimated the cleanup would cost $40 million, documents show. But Congress balked at the price and approved only half the money. It ordered that “all reasonable economies should be realized” by using troops to do the work.
Safety planners intended to use protective suits, respirators and sprinklers to keep down dust. But without adequate funding, simple precautions were scrapped.
Paul Laird was one of the first service members to arrive for the atoll’s cleanup, in 1977. Then a 20-year-old bulldozer driver, he began scraping topsoil that records show contained plutonium. He was given no safety equipment.
“That dust was like baby powder. We were covered in it,” said Mr. Laird, now 60, during an interview in rural Maine, where he owns a small auto repair shop. “But we couldn’t even get a paper dust mask. I begged for one daily. My lieutenant said the masks were on back order so use a T-shirt.”
By the time Mr. Laird left the islands, he was throwing up and had a blisterlike rash. He got out of the Army in 1978 and moved home to Maine. When he turned 52, he found a lump that turned out to be kidney cancer. A scan at the hospital showed he also had bladder cancer. A few years later he developed a different form of bladder cancer.
His private health insurance covered the treatment, but co-payments left him deep in debt. He applied repeatedly for free veterans’ health care for radiation but was denied. His medical records from the military all said he had not been exposed.
“When the job was done, they threw my bulldozer in the ocean because it was so hot,” Mr. Laird said. “If it got that much radiation, how the hell did it miss me?”
Scant Avenues for Help
As the cleanup continued, federal officials tried to institute safety measures. A shipment of yellow radiation suits arrived on the islands in 1978, but in interviews veterans said that they were too hot to wear in the tropical sun and that the military told them that it was safe to go without them.
The military tried to monitor plutonium inhalation using air samplers. But they soon broke. According to an Energy Department memo, in 1978, only a third of the samplers were working.
All troops were issued a small film badge to measure radiation exposure, but government memos note that humid conditions destroyed the film. Failure rates often reached 100 percent.
Every evening, Air Force technicians scanned workers for plutonium particles before they left Runit. Men said dozens of workers each day had screened positive for dangerous levels of radiation.
“Sometimes we’d get readings that were all the way to the red,” said one technician, David Roach, 57, who now lives in Rockland, Me.
None of the high readings were recorded, said Mr. Roach, who has since had several strokes.
Two members of Congress wrote to the secretary of defense in 1978 with concerns, but his office told them not to worry: Suits and respirators ensured the cleanup was conducted in “a manner as to assure that radiation exposure to individuals is limited to the lowest levels practicable.”
Even after the cleanup, many of the islands were still too radioactive to inhabit.
In 1988, Congress passed a law providing automatic medical care to any troops involved in the original atomic testing. But the act covers veterans only up to 1958, when atomic testing stopped, excluding the Enewetak cleanup crews.
If civilian contractors had done the cleanup and later discovered declassified documents that show the government failed to follow its own safety plan, they could sue for negligence. Veterans don’t have that right. A 1950 Supreme Court ruling bars troops and their families from suing for injuries arising from military service.
The veterans’ only avenue for help is to apply individually to the Department of Veterans Affairs for free medical care and disability payments. But the department bases decisions on old military records — including defective air sampling and radiation badge data — that show no one was harmed. It nearly always denies coverage.
“A lot of guys can’t survive anymore, financially,” said Jeff Dean, 60, who piloted boats loaded with contaminated soil.
Mr. Dean developed cancer at 43, then again two years later. He had to give up his job as a carpenter as the bones in his spine deteriorated. Unpaid medical bills left him $100,000 in debt.
“No one seems to want to admit anything,” Mr. Dean said. “I don’t know how much longer we can wait, we have guys dying all the time.”
Why Succeeding Against the Odds Can Make You Sick
by James Hamblin - NYT
In 1997, a few hundred people who responded to a job posting in a Pittsburgh newspaper agreed to let researchers spray their nostrils with a rhinovirus known to cause the common cold. The people would then be quarantined in hotel rooms for five days and monitored for symptoms. In return they’d get $800.
“Hey, it’s a job,” some presumably said.
Compensation may also have come from the knowledge that, as they sat alone piling up tissues, they were contributing to scientific understanding of our social-microbial ecosystem. The researchers wanted to investigate a seemingly basic question: Why do some people get more colds than others?
To Gene Brody, a professor at the University of Georgia, the answer was “absolutely wild.” (Dr. Brody is a public-health researcher, so “wild” must be taken in that context.) He and colleagues recently analyzed the socio-economic backgrounds and personalities of the people in the Pittsburgh study and found that those who were “more diligent and tended to strive for success” were more likely than the others to get sick. To Dr. Brody, the implication was that something suffers in the immune systems of people who persevere in the face of adversity.
Over the past two years, Dr. Brody and colleagues have amassed more evidence supporting this theory. In 2015, they found that white blood cells among strivers were prematurely aged relative to those of their peers. Ominous correlations have also been found in cardiovascular and metabolic health. In December, Dr. Brody and colleagues published a study in the journal Pediatrics that said that among black adolescents from disadvantaged backgrounds, “unrelenting determination to succeed” predicted an elevated risk of developing diabetes.
The focus on black adolescents is significant. In much of this research, white Americans appeared somehow to be immune to the negative health effects that accompany relentless striving. As Dr. Brody put it when telling me about the Pittsburgh study, “We found this for black persons from disadvantaged backgrounds, but not white persons.”
Dr. Brody, who does much of his work in African-American communities in rural Georgia, focuses on people who overcome the odds to prosper, academically, professionally and financially. The personality trait that predicts this kind of success against the odds is known in psychology as resilience. Many consider it desirable. Dr. Brody’s summary of the classical tenets of resilient strivers sounds like something from a motivational poster: “They cultivate persistence, set goals and work diligently toward them, navigate setbacks, focus on the long term, and resist temptations that might knock them off course.”
In the United States, gaps in health and longevity between the wealthy and the poor are some of the greatest in the world. It seems natural to assume that jumping from one stratum to the next — being upwardly mobile — would come with gains in health. And conceivably it could work that way — like if a person won the lottery or achieved overnight fortune from writing a truly insightful tweet. But decades of research show that when resilient people work hard within a system that has not afforded them the same opportunities as others, their physical health deteriorates.
The effect has become known as John Henryism. The term was coined by a young researcher named Sherman James in the 1980s, after he met a man named John Henry Martin. Mr. Martin didn’t have any known relation to the John Henry of folk legend who beat a mechanical steam drill in a steel-driving contest, only to collapse dead from exhaustion. (It’s debated whether the original John Henry was himself an actual person with an actual nine-pound hammer that he used to drive metal stakes into Big Bend Mountain in West Virginia in the 1870s so that dynamite could be embedded in the rock and a tunnel could be built for the C.&O. Railroad, or possibly an amalgam of many former slaves who transitioned into freedom.)
Mr. Martin was born into a family of North Carolina sharecroppers in 1907. He worked tirelessly to escape the system and, by the time he was 40, owned 75 acres of farmland. But in his next decade he began to suffer from hypertension, arthritis and a severe case of peptic ulcer disease that required the removal of nearly half his stomach. As Dr. James saw it, John Henry Martin both won and lost his battle with the machine.
Dr. James went on to develop what he called the John Henryism scale, meant to identify people who use “high-effort coping” to manage challenges. The scale is based on how strongly people identify with statements like “When things don’t go the way I want them to, that just makes me work even harder” and “I’ve always felt that I could make of my life pretty much what I wanted to make of it.” He found that high scores correlated with worse health among poor and working-class blacks. Notably, like Dr. Brody, Dr. James found that working-class white Americans seemed unaffected by this phenomenon.
If striving against odds does cause physical harm, that could happen in multiple ways. Our environments affect how our DNA expresses itself. Dr. Brody and colleagues have found variations in DNA methylation patterns — indicators of how genes are translated — that seem to be the product of socioeconomic statuses. His team has also found elevated levels of cortisol, a stress hormone, and adrenaline circulating in the blood of strivers from a young age.
“Constantly bathing cells in stress hormones, the science would suggest, could sponsor more inflammatory responses,” Dr. Brody offered, potentially leading to autoimmune disorders like diabetes.
Of course, nothing about adrenaline or DNA expression should be unique to people with high levels of melanin in their skin. Why would white people appear to be immune?
There’s now a website where you can enter your address and find out how long you’re going to live.
At least it gives you an average. As a physician and a betting man, if I could know only one thing about a person to predict their longevity, it would probably be their address.
The site works only for people in California, unfortunately, because it’s run by the California Endowment, a charitable organization whose modest mission is to “ensure health and justice for all.” The group is among many now championing the new mantra in public health: Your ZIP code matters more than your genetic code. In the San Francisco Bay Area, discrepancies in average life span from one neighborhood to the next can exceed 10 years.
At the University of California, Berkeley, the public-health researcher Mahasin Mujahid works to understand the mechanisms behind these differences. There are the obvious elements: unsafe neighborhoods, food deserts, a dearth of yoga studios, etc. But it’s not always so straightforward.
Last month, Dr. Mujahid published findings from a study of a (needless to say, pale) population in Finland. Lower socioeconomic status correlated with more heart attacks (as expected) — but this effect was strongest among people who scored highest on the John Henryism scale.
“This is a significant step forward in understanding the generalizability of the John Henryism hypothesis,” said Dr. James, who collaborated with Dr. Mujahid on the new study. “Because we called it John Henryism, it carried a strong connotation of being unique to black men. But that wasn’t our original expectation.”
When Dr. James was first coming to appreciate the John Henryism effect in the mid-1980s in eastern North Carolina, he reminded me, “the economic resources and social standing of blacks and whites in that community were very different.” Very few African-Americans had even high-level blue-collar jobs, and virtually none had white-collar jobs. Almost all white people had one or the other.
“The items that speak to John Henryism don’t speak to gender or race or socioeconomic status,” said Dr. Mujahid. The scales are designed to measure repetitive, high-effort coping. Her conclusion is that because African-Americans encounter more overt and systemic discrimination, “the combination of adversity and high-effort coping is what’s having health consequences.”
Globally, there is no association between skin color and the length of one’s life. This is an American phenomenon. In medical school we are taught that black men are much more likely than other patients to have hypertension, as if this were simple biology.
But some data suggests that people in West African and Caribbean countries have much lower rates of hypertension than do people in the United States.
“There’s very little genetic basis for hypertension,” said Dr. Mujahid. “It’s much more about social context and lifestyle.”
And that social context is now changing in the United States.
“Because African-Americans experience so much more exclusion and degradation — something that working-class whites didn’t experience at the time — that probably created conditions that were ripe for us to only see the effects in blacks,” Dr. James said about his research in the ’80s. “But now white Americans are experiencing a great deal of economic — and, dare I say, psychological — pain because of their dislocation as a result of powerful macroeconomic forces.”
Dr. James expects John Henryism can now be seen across Western democracies, wherever people are inculcated with a Protestant sense of personal responsibility and belief in self-reliance. “When people act on that — really trying to make ends meet going up against very powerful forces of dislocation — their biological systems are going to pay a price,” he said.
“That’s the situation African-Americans have been in since the beginning,” he added. “Now we’re seeing other groups begin to be exposed to these same forces.”
In the spirit of the original John Henry, among those forces is technologically induced unemployment. The mechanization of labor once pushed rural Southern blacks into the factories of the North. Now mechanization is giving way to automation, affecting less-educated white Americans, especially men.
The Trump administration could do much more to damage Americans’ health than just repeal the Affordable Care Act and leave people without access to hospitals and medications. “The consequences around the divisiveness, and increased instability and uncertainty for families and children, combined with increased racial tension and overt acts of discrimination,” Dr. Mujahid noted, all stand to heighten the John Henryism effect.
“What we want is for people who overcome so much to achieve the American dream to have the health to enjoy the fruits of their efforts,” said Dr. Brody. “Right now that doesn’t seem to be happening.”
Or maybe people should simply have to overcome less in the first place — to have something close to equal opportunity to succeed. But as the middle class contracts and wealth gaps expand, the promise of equal opportunity seems to be receding.
“This is going to be a very difficult time,” said Dr. Mujahid. She added, not hopefully, “There will probably be some interesting natural experiments that emerge.”
Headaches Persist As Covered California Enrollment Nears End
Covered California’s fourth annual open enrollment period, set to end Tuesday, has been rocky for many consumers.
During this period, two Covered California errors have affected roughly 50,000 policy holders, leading to higher-than-expected premiums or the potential loss of their tax credits:
- Covered California discovered late last year that about 24,000 policy holders hadn’t provided consent for the agency to verify their income, even though the agency thought they had. Without that consent, thousands of consumers lost their 2017 tax credits, at least temporarily.
- Covered California gave insurers the wrong tax credit information for about 25,000 policy holders, resulting in inaccurate bills. In most cases the recalculated premiums are higher than consumers had initially anticipated.
Those mistakes are in addition to ongoing challenges, including Covered California website glitches, complicated password resets and the often-fraught interaction between Covered California and Medi-Cal, the state’s health coverage program for low-income residents.
Covered California Executive Director Peter Lee said the agency is contacting enrollees to fix the problems. “No one’s perfect. Anything of the scale we’re doing is going to have some problems along the way,” he said at the agency’s most recent board meeting.
“But what we do is turn on a dime and make sure we make things right. We reach out to consumers, do it aggressively and have done that exactly here.”
Those affected by the error involving wrong tax credit amounts will qualify for a special enrollment period that lasts 60 days, beginning the day they received notice of the discrepancy, said Covered California spokeswoman Lizelda Lopez.
For instance, if enrollees received an email on Jan. 4 from Covered California explaining the mistake, that’s their start date, she said.
Emily Bazar, California Healthline columnist and senior correspondent, recently appeared on the “McIntyre in the Morning” show on KABC AM 790 in Los Angeles to discuss these problems and their effect on consumers.
Editor's Note -
Please click on the hot-link above, and listen to the full interview with Emily Bazar. It will be well worth your time. The "consumers" she mentions at the very end of the interview as being overlooked by the Congress are otherwise known as voters.
-SPC
by Joan McCarter - The Daily Kos
Popular vote loser Donald Trump made a lot of promises during the campaign, touting his superior powers as a negotiator. He was going to make all the deals. He was going to bring big pharma to its knees, forcing it to negotiate Medicare drug prices. Then he met big pharma, and folded like his ill-fitting suit.
Today, after a meeting with pharmaceutical industry lobbyists and executives, he abandoned that pledge, referring to an idea he supported as recently as three weeks ago as a form of “price fixing” that would hurt “smaller, younger companies.” Instead of getting tough, Trump’s new plan is that he’s “going to be lowering taxes” and “getting rid of regulations.” […]As recently as January 11, President-elect Trump was promising to revisit this policy."Pharma has a lot of lobbies, a lot of lobbyists and a lot of power. And there's very little bidding on drugs," he said at a press conference at Trump Tower in Manhattan. "We're the largest buyer of drugs in the world, and yet we don't bid properly."Today he apparently changed his mind. According to Herb Jackson, the designated pool reporter for the day, Trump's new policy on prescription drugs is that drug companies should get tax cuts and deregulation.
Here's what he said: "I'll oppose anything that makes it harder for smaller, younger companies to take the risk of bringing their product to a vibrantly competitive market. That includes price-fixing by the biggest dog in the market, Medicare, which is what's happening. But we can increase competition and bidding wars, big time." That makes no sense, compared to what he’s previously said about Medicare—either Medicare is “price-fixing” (?) or it’s not bidding “properly.” Those things aren’t the same. Further, here's what he said about how he’s going to fix pharma now, apparently to save money for the government (?): "We're going to be lowering taxes, we're going to be getting rid of regulations that are unnecessary."
Competition through corporate tax cuts and deregulation, at the cost of people on Medicare, which is pretty much Paul Ryan's wet dream. As for Medicare price-fixing, who knows what he means, but it's probably this: "someone, somewhere, probably tried to explain formularies to him. (I suspect it didn't take.)" Trump doesn't have to worry about things like what prescription drugs his plan will cover (chances are, his doctor just has a stash he dispenses directly from and there's no need for dealing with pesky pharmacies or insurance).
Republicans talk more of repairing Obamacare, with unity elusive
Congressional leaders are moderating their language as polls show Americans want to keep the ACA in some form.
BY ALAN FRAM AND RICARDO ALONSO-ZALDIVARASSOCIATED PRESS
WASHINGTON — Republicans are increasingly talking about repairing President Barack Obama’s health care overhaul, a softening of tone that comes as their drive to fulfill a keystone campaign promise encounters disunity, drooping momentum and uneasy voters.
GOP lawmakers insist they’ve not abandoned their goal of repeal, though they face lingering disputes about whether that vote should come before, after or simultaneously with a replacement effort.
Republicans triumphantly shoved a budget through Congress three weeks ago that gave committees until Jan. 27 to write bills dismantling the law and substituting a Republican plan. Everyone knew that deadline meant little, but now leaders are talking about moving initial legislation by early spring.
And as the party struggles to translate its long-time political mantra into legislation that can pass Congress, some Republicans have started using gentler language.
“It’s repairing the damage Obamacare has caused. It’s more accurate” than repeal and replace, said Sen. Lamar Alexander, R-Tenn., who chairs the Senate health committee. He notes that President Donald Trump and many Republicans want to keep popular pieces of the overhaul like requiring family policies to cover children up to age 26.
Rep. Greg Walden, R-Ore., who chairs the House Energy and Commerce Committee, said Republicans are “laying the foundation to rebuild America’s health care markets as we dismantle Obamacare.”
The refined phraseology has been endorsed by Frank Luntz, the long-time GOP rhetoric guru. He credited Sen. Ron Johnson, R-Wis., with the idea, saying by email, “He was right. Americans want the ACA repealed and repaired,” using the Affordable Care Act’s acronym.
The shifting language comes with much of Washington focused on battles over Trump’s Supreme Court and Cabinet nominees. That and controversies surrounding his temporary refugee ban have sapped energy from the health care drive.
It also comes with polls spotlighting GOP risks. A recent Associated Press-NORC Center for Public Affairs Research poll found 53 percent want to keep Obama’s law in some form, and 56 percent very concerned that repeal means many will lose insurance.
House Speaker Paul Ryan, R-Wis., says Republicans want to “rescue” the health system and Thursday embraced all of the competing phraseology.
“The best way to repair a health care system is to repeal and replace Obamacare,” he said.
Talk of repair dismays other Republicans, including hard-line conservatives. They say their message since Democrats enacted the 2010 law was that the GOP would repeal it, later amended to “repeal and replace.”
“You’ve got to repeal the law that’s the problem. That’s what we told the voters we were going to do,” said Rep. Jim Jordan, R-Ohio, a leader of the conservative House Freedom Caucus.
Jordan cites problems that have accompanied the statute, including rising premiums and deductibles and diminished choices in the individual insurance market in some communities. He says health care would improve if Obama’s law vanishes.
“If you start from that premise, repair shouldn’t be your mindset,” Jordan said.
Democrats say the GOP’s evolving language signals retreat. They say Republicans will threaten health care’s availability and raise rates, angering the 20 million people who gained insurance under the law and tens of millions of others who benefit from the statute’s coverage requirements.
“It puts the burden on them to come up with the so-called repairs,” said No. 2 Senate Democratic leader Richard Durbin of Illinois. “What a departure from repeal it, walk away from it and America will be a better place.”
Meanwhile, Republicans continue shaping proposals to void Obama’s statute. Potential targets include the law’s requirement that people who don’t get coverage at work buy policies, the subsidies many of them receive and the tax increases imposed on higher-income people and the health industry.
Some Republicans want to reshape and cut Medicaid, which provides health coverage to lower-earning people, while others are from states that expanded it under Obama’s statute. Most want to include language blocking federal payments to Planned Parenthood but some don’t, and some would let states choose to keep Obama’s law intact.
There are also disputes over how to provide money so people don’t abruptly lose coverage and insurance companies fearing losses don’t stop selling policies.
With insurers crafting their 2018 rate structures over the coming two months, the insurance industry’s leading trade group made its jitters clear to Congress this week. Marilyn Tavenner, president of America’s Health Insurance Plans, told Alexander’s committee that insurers must know soon whether lawmakers will continue federal payments that let companies reduce out-of-pocket costs for many lower-earning customers.
Losing those subsidies “would further deteriorate an already unstable market and hurt the millions of consumers who depend on these programs for their coverage,” she warned.
At a hearing Thursday before a House health subcommittee, Republicans revealed four drafts of potential bills. One would let insurers charge older customers higher rates. Another would replace the law’s unpopular individual mandate with a requirement that people maintain “continuous” coverage if they want to avoid paying more for policies.
Two top Republicans open to repairing Obamacare ahead of repeal
by Kelsey Snell and Mike Debones - Washington Post
Two top Republicans long expected to lead the Senate’s role in repealing the Affordable Care Act said publicly this week that they are open to repairing former president Barack Obama’s landmark health-care law ahead of a wholesale repeal, which has been a GOP target for eight years.
Coming one week after a closed-door strategy session in which Republicans expressed frank concerns about the political ramifications of repealing the law and the practical difficulties of doing so, statements this week by Sen. Orrin G. Hatch (R-Utah) and Sen. Lamar Alexander (R-Tenn.) brought into public view the political and policy challenges the GOP is facing.
Alexander, chairman of the Senate Committee on Health, Education, Labor and Pensions, said at a hearing Wednesday: “I think of it as a collapsing bridge. . . . You send in a rescue team and you go to work to repair it so that nobody else is hurt by it and you start to build a new bridge, and only when that new bridge is complete, people can drive safely across it, do you close the old bridge. When it’s complete, we can close the old bridge, but in the meantime, we repair it. No one is talking about repealing anything until there is a concrete practical alternative to offer Americans in its place.”
And Hatch, chairman of the Senate Finance Committee — another panel with a crucial role in the effort to repeal the ACA — said Thursday that he “could stand either” repealing or repairing the law. “I’m saying I’m open to anything. Anything that will improve the system, I’m for,” he said.
The comments come one month after Republicans in Congress first set out to immediately repeal and replace the Affordable Care Act. While an increasing number of them have expressed concern about how feasible it is, many others, including House Speaker Paul D. Ryan (R-Wis.), remain committed to a wholesale repeal and replacement.
On Thursday, Ryan tried to right the party’s message on health care by insisting that repair is the same thing as replace.
“There’s a miscommunication going on,” he said Thursday morning on “Fox & Friends.” “If we’re going to repair the U.S. health-care system . . . you must repeal and replace Obamacare.”
Although Alexander has advocated a go-slow approach for weeks, Hatch has aggressively pushed to repeal the ACA, including the tax provisions that help most people with health plans under the law afford their premiums.
His comments Thursday seemed to contradict a statement the day before, when he told an audience at the U.S. Chamber of Commerce that he wanted to quickly repeal as much of the law as possible.
“I believe that we need to repeal Obamacare immediately, and provide for a stable transition period,” Hatch said. “In my view, we need to advance replacement policies in tandem with the repeal process. And then we can keep working on the other parts of the system.”
Yet Hatch has also consistently warned conservatives that there are limitations to what Congress can do to unwind the law. The Senate has chosen to use a special budget process to walk back as many provisions as possible, but they will be limited to tackling the parts of the ACA that deal with spending, taxes and the deficit.
Concerns over those limitations have created frustration and consternation within the GOP, as was clear on a recording obtained last week by The Washington Post and other news outlets.
Audio: GOP lawmakers discuss health care at retreat
Play Video93:02
During a retreat in Philadelphia, Republican lawmakers discussed national security, defense and foreign policy. Contributors included Sens. John Barasso (Wyo.), Lamar Alexander (Tenn.), Reps. Greg Walden (Ore.), Kevin Brady (Tex.), Virginia Foxx (N.C.) and Andrew Bremberg, a top domestic policy adviser to President Trump.(Obtained by The Washington Post)
On the recording, made last week at a GOP retreat in Philadelphia, a number of Republicans worried that they would be blamed if the health-care system implodes in the wake of their repeal plans.
Among those most concerned was Alexander, who said: “The word ‘repair’ is a lot better than the word ‘repeal.’ . . . Saying we’re going to repair the damage is more accurate.”
Other Republicans in the House and Senate besides Ryan have tried to regain control of the message in recent days by saying that repair is just another way to explain their replacement plans. What’s less clear is whether concrete plans are underway to dismantle the law.
Sen. John Cornyn (R-Tex.), the No. 2 Republican leader, said Thursday that the procedural process in the Senate and the words used to describe it can be complicated but goal is still the same: getting rid as much of the Affordable Care Act as they can.
“It gets a little confusing,” Cornyn said. “I don’t think even if we wanted to repair Obamacare we could do it. That’s why I believe we’re going to do repeal and replace.”
In the House, the messaging has been no less complicated. While the word “repair” has held appeal for moderates who are wary of repealing Obamacare root and branch, it has raised alarms among fervent conservatives who see in it a potential betrayal of their campaign promises.
“If you’re talking about repairing the Affordable Care Act, it’s unrepairable,” said Rep. Mark Meadows (R-N.C.), chairman of the hard-right House Freedom Caucus. “We need to repeal it. We need to replace it. If you want to call that a repair, so be it, but I don’t know that that makes it any more palatable to the folks back home.”
Ryan later told reporters on Capitol Hill, “Our job is to repair the American health-care system and rescue it from the collapse that it’s in. And the best way to repair a health-care system is to repeal and replace Obamacare. It’s not an either/or.”
Rep. Greg Walden (R-Ore.), chairman of the House Energy and Commerce Committee and a key architect of GOP health-care plans, has favored yet another R-word in recent days: “rebuild.”
“Working with the Trump administration, we’ll take a multi-step, multi-pronged approach to deliver relief and rebuild our health care system so it works for patients,” he wrote with fellow committee member Rep. Michael C. Burgess (R-Tex.) in an op-ed published by Morning Consult on Tuesday.
Meanwhile, the Trump administration is working on its initial changes in federal rules under an executive order the president signed his first night in office to ease the ACA’s regulatory impact on consumers and segments of the health-care industry.
The possible rule changes, under review by the Office of Management and Budget, would be aimed at helping health insurers keep the law’s marketplaces functioning while Congress and the White House try to design new health policies.
According to Edmund Haislmaier, a senior fellow at the Heritage Foundation and member of the Trump transition team for the Department of Health and Human Services, the proposed rules being considered could further restrict Americans’ ability to sign up for ACA health plans outside of the annual open-enrollment season.
They also could require more extensive checks of applicants’ eligibility for marketplace coverage and prohibit consumers from enrolling in health plans for another year if they are behind on their premium payments.
Amy Goldstein contributed to this report.
Another View: Republicans fail to earn trust on how to revamp Obamacare
A harmful health care replacement is likely unless they work in good faith to do what's right for the country.
BY CLIFF WHITE
In response to Maine Republican Party Executive Director Jason Savage’s Jan. 27 op-ed (“Commentary: Obamacare editorial ignored the ‘repeal and replace’ scenario”), which continued to spin the oft-heard “alternative fact” that the Affordable Care Act is a “failed program,” I have to call poppycock.
The United States, the richest country in world history, has the ability and the obligation to pay for quality health care for all its residents, which is the aspiration of the ACA. While it has not yet achieved that goal, it has improved the lives of tens of millions of people, not harmed them, as Savage claims.
For him to argue that “we owe it” to a Republican-controlled Congress to give them the freedom to gut the ACA, after the Republican Party led a politically tactical eight-year campaign to obstruct and undermine Obamacare and every other legislative effort put forth by Democrats, led by then-President Barack Obama, is extremely hubristic. President Trump’s early days in office, which have been full of divisive executive orders, have further proved that Republicans want it their way or not at all.
Until Trump and the Republicans show evidence they’re willing to work in good faith to find bipartisan solutions to our country’s problems, the only path forward is to distrust the motives of Savage, Trump and the rest of the Republican Party. I, for one, will be taking a page out of their playbook and resisting – by any political means necessary – their imposition of an extremist ideology I believe is disturbingly harmful to our country.
There’s a sad reason behind this emerging consensus in Augusta
Editorial Board - Bangor Daily News
Maine has stood out on a key health indicator over the past two decades — and for all the wrong reasons.
While the nation’s infant mortality rate has generally been on a downward trend, the trend in Maine has gone in the opposite direction.
Maine, in fact, has been the only state to see a long-term increase in its infant mortality rate over the past two decades. It was the sole state with a higher infant mortality rate on average between 2005 and 2014 than in the previous decade, from 1995 to 2004.
It’s a sad statement about the health of our state: A high infant mortality rate could indicate that there’s a critical lapse, or multiple lapses, in the structures and resources set up to support infants, pregnant women and new mothers — whether during pregnancy, during delivery or once the family has returned home.
Fortunately, Maine finally looks poised to do something about it.
For about a decade, a state panel has been in place with the mission of investigating the deaths of fetuses, infants and mothers during pregnancy or within six weeks of giving birth. The work is crucial to understanding what is going wrong in Maine so policymakers, health care providers and social service agencies can focus on correcting it.
But the panel has been hobbled by the 2006 law that created it, which severely limits the group’s access to the information it needs to research infant deaths in detail. In order to review relevant medical records — which could reveal information about where a whole system of medical and support services failed — the panel’s coordinator must first seek the family’s permission. But the coordinator can’t reach out until four months after an infant or new mother has died. The outreach can only happen by letter with state agency letterhead.
There’s a good chance many letters don’t reach their intended recipients; many families move after losing an infant, searching for a fresh start. The letters that do reach the intended recipients go unanswered. What family wants to relive the pain of losing an infant four months after it happened?
Indeed, no infant death case that the Maternal, Fetal and Infant Mortality Review Panel has looked into has come to the panel through the letter request process. That means Maine could be missing out on crucial information or trends that could help it prevent future infant deaths.
It’s understandable for families who have lost infants to seek privacy, but there are other provisions to protect privacy written into the law: Review panel members never review personally identifiable information about infant deaths. There are exceptions written into federal medical privacy rules specifically for public health reasons — to identify threats that could affect the health of many others. And no other state panel across the country that looks into infant deaths is subject to the same restrictions as Maine’s panel.
We’re heartened to see a legislative consensus emerging this year that could lead to the Maternal, Fetal and Infant Mortality Review Panel gaining access to the information it needs in order to thoroughly look into the reasons behind infant deaths in Maine.
The Department of Health and Human Services has submitted legislation to remove the need for the panel to obtain the family’s consent in order to review medical records. The agency also plans to restart the panel at the end of March after a hiatus of nearly three years.
A Republican senator from Dixfield is proposing legislation that goes even further than the DHHS bill: In addition to removing the barriers to information, Sen. Lisa Keim’s bill would require that the infant death review panel meet at least twice per year — an important provision for a panel that simply stopped sending letters and meeting in 2014 — and that it specifically look into why Maine’s infant death rate has risen over the past two decades. Democratic Rep. Scott Hamann of South Portland will sign on as a co-sponsor
When it comes to a priority so basic as preventing the deaths of Maine’s youngest, we’re happy to see seeds of consensus in Augusta rather than conflict.
Bernie Sanders asks: Will Trump have the guts to stand up to Big Pharma?
With 1,400 lobbyists and $58 million in political donations, drug companies will battle to keep consumers in their grip.
by Bernie Sanders - The Wasington Post
President Donald Trump and other Republicans have talked about the greed of the pharmaceutical industry. Recently, Trump said (rightly) that Big Pharma is “getting away with murder.” But talk is cheap. The question is: Will Republicans really have the guts to join me and many of my colleagues in standing up to the drug companies to fight for American consumers and end the disgrace of having our country pay by far the highest prescription drug prices in the world? Here’s why.
The five largest drug manufacturers made more than $50 billion in profits in 2015. Meanwhile, nearly 1 out of 5 Americans could not afford the medicine they were prescribed. The result: Millions of Americans became sicker, and some ended up in emergency rooms at great cost. Others unnecessarily lost their lives.
It is beyond comprehension that while Americans are suffering and dying because they cannot afford the medications they need, the 10 highest-paid chief executives in the pharmaceutical industry collectively made $327 million in 2015. These executives get richer while Americans die. That’s not acceptable.
The root of this problem is that we are the only major country not to negotiate drug prices with the pharmaceutical industry. There are no legal barriers in place to stop these arbitrary increases. Pharmaceutical corporations can raise prices as high as the market allows. I
If people die, it is not their concern. If people get sicker, it is not a problem for them.
Yet, 50 miles from my home in Vermont, the same medications manufactured by the same companies in the same factories are available for a fraction of the price. A 90-day supply of Januvia, which treats diabetes, is $505 in the United States but $204 across the northern border. A 90-day supply of Advair, used in asthma inhalers, costs about $222 in Canada and approximately $464 in the United States. A year’s supply of one of the most important treatments for advanced prostate cancer, Xtandi, is sold for $30,000 in Canada. Patients here pay about $130,000.
Outrageously, our government, and therefore U.S. taxpayers, paid for research that led to Xtandi’s discovery.
This state of affairs is unacceptable. Until recently, Trump agreed. Yet after one meeting with pharmaceutical lobbyists, the president started reversing course. Instead of negotiating drug prices down, he talked about cutting taxes for drug companies that already make billions on the backs of American consumers.
Again, this cannot continue. That is why I am introducing legislation to end this insanity, allowing Americans to buy the same drugs they receive now, but from Canada, at far lower prices.
The drug companies, with nearly 1,400 D.C. lobbyists and enormous amounts for campaign contributions, will fight back. Recipients of their contributions in Congress will tell us that allowing the importation of prescription drugs would compromise the safety of Americans.
This is absurd: We can eat fish and vegetables from all over the world but somehow cannot import brand-name prescription drugs, manufactured by some of the largest companies in the world, from an advanced country such as Canada? It’s nonsense.
Furthermore, the United States already imports roughly 80 percent of the key ingredients in its medicines from other countries, including developing countries such as India and China. According to Kaiser Health, 19 million Americans have bought cheaper prescription drugs from other countries. To afford their vital medications, they shop online, sometimes from pharmacies that haven’t been properly regulated. Our bill will in fact improve safety by ensuring that only prescription drugs sold by Food and Drug Administration-certified foreign sellers, such as pharmacies regulated by Canada’s health system, will be permitted to be imported, protecting Americans from the snake oil some are buying right now.
The bill will also deal with the most critical safety issue: Drugs don’t work at all if patients can’t afford them.
Drug companies won’t surrender the billions in profits they receive from U.S. consumers easily. The pharmaceutical industry is one of the most powerful political forces in this country. Drug companies have spent more than $3 billion lobbying since 1998 and have many members of Congress defending their interests; during the 2016 election alone, the industry made more than $58 million in political contributions.
So we will need to fight together to get Americans the medications they need at prices they can afford. If the president meant what he said during the campaign, he will join me in this fight. It can’t wait any longer.
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