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Trumpcare Will Make the Opioid Crisis Worse

Mother Jones

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There are plenty of reasons why the Obamacare repeal bill that House Republicans passed Thursday afternoon is so controversial. It slashes funding for Medicaid, threatens to raise health insurance premiums for older Americans, and allows states to roll back protections for people with preexisting medical conditions.

But there’s another, less publicized, way in which the GOP’s American Health Care Act could disrupt health care throughout the country. In the midst of the most devastating drug epidemic in US history, the legislation could disrupt addiction coverage for millions of Americans. And thanks to a provision added to the bill last week, insurance companies in some states might no longer include mental health and substance abuse coverage in their health plans.

Because of the speed with which Republicans rushed the bill through the House, the Congressional Budget Office hasn’t yet had time to estimate the number of Americans who would lose their health insurance or how premiums would be affected. But according to a CBO report from March, an earlier version of legislation would have resulted in 24 million fewer people having coverage than under Obamacare. The current legislation will likely result in a similar number of uninsured Americans, says Richard Frank, a professor of health economics at Harvard University. Frank and his colleague, Sherry Glied of New York University, estimate that if Obamacare is repealed, 3 million Americans with addiction disorders would lose some or all of their coverage.

Many of the states that voted Trump into office are among the hardest hit by the opioid epidemic—and are the most dependent on Obamacare for substance abuse treatment. The maps below, produced by the US Department of Health and Human Services in the last days of the Obama administration, show this overlap: Red states on the left have the highest overdose rates per capita; red states on the right have the highest rate of residents who would lose coverage if Obamacare is repealed.

US Department of Health and Human Services

Obamacare was particularly important for those seeking addiction treatment, according to Keith Humphreys, a Stanford University psychiatry professor who advised the Obama administration on drug policy. “It was designed to be very broad, but at the same time we knew that if there was anything that this would help a lot for, it’s addiction,” he told me in February.

That’s largely because of two big changes that Obamacare made to insurance markets—changes that the GOP legislation would roll back or undo completely.

First, Obamacare required insurance companies to cover certain “essential benefits,” including substance abuse and mental health treatment. In order to sell insurance in the individual marketplaces, companies would have to cover addiction treatment, as well as other care such as contraception, emergency services, and pediatric services. (Here‘s the full list of essential benefits.) This was a significant change. In 2011, before Obamacare went into effect, “somewhere close to 40 percent of individual and small group market plans didn’t offer substance abuse and mental health coverage,” says Frank. “And when they did, it was quite limited.”

The bill passed by the House would allow states to opt out of the essential benefits requirements, which means that insurers might once again refuse to cover treatment for mental health and addiction.

The second big Obamacare change for substance abuse treatment was the expansion of Medicaid coverage to millions of additional poor Americans. As I wrote earlier this year:

Under the Affordable Care Act, those who earn up to 138 percent of the federal poverty level are eligible for this government-funded insurance program. In 2012, the Supreme Court ruled that states could choose whether or not they wanted to participate in the program, and 31 states have done so—resulting in health coverage for an additional 11 million Americans through Medicaid expansion. Of those, an estimated 1.3 million used their newly acquired insurance for substance abuse or mental health services, according to an analysis by researchers Richard Frank of Harvard Medical School and Sherry Glied of New York University. In states that expanded Medicaid, 20 percent of hospital admissions for substance abuse and mental health disorders were uninsured in 2013, before the bulk of the expansion provisions kicked in. By the middle of 2015, the uninsured rate had fallen to five percent.

The Republicans’ health care plan would freeze Medicaid expansion, cutting off funds for states adding new enrollees starting in 2020. Those already enrolled in Medicaid expansion plans by 2020 would continue to receive the benefits, but they would be at constant risk of losing that insurance. Anyone who has a gap in insurance coverage of more a month—say because they miss a deadline or their income temporarily changes—would lose eligibility. (A lack of private health insurance would be penalized too: Going more than 63 days without coverage would increase premiums by 30 percent for a year.) These provisions have a lot of public health advocates worried. It’s not uncommon for people, particularly those with serious mental health and addiction problems, to drift in and out of insurance coverage.

Without Obamacare, said Humphreys, “We’re back where we were before: bad access, low quality of care, and a lot of patients being turned away.”

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Trumpcare Will Make the Opioid Crisis Worse

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Chart of the Day: The Obamacare Website Has Been Working Pretty Well Since Early November

Mother Jones

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Yesterday the Obama administration released a report showing that the website is now working pretty well. Not perfectly. Not flawlessly. But pretty well. This confirms anecdotal reports that the site is now quite useable, and it’s important because it’s a proof of concept: if the site can go from disaster to workable in a couple of months, it means that its problems aren’t so deeply structural that they’re never going to be fixed. They were just bugs. And bugs get corrected.

But here’s the thing that struck me when I looked at the HHS report last night: if their metrics are to be believed, they actually had the site working pretty well by early November. It’s just that they didn’t say much about it, instead waiting until their self-imposed December 1 deadline—due, I assume, to an abundance of caution after the horrible rollout. Still, take a look. The charts below are both big and barely legible (perhaps suggesting a whole different federal government IT problem) but what they consistently show is that the site was working tolerably well by November 9 and pretty acceptably well by November 16 (marked by the red bubbles). These metrics still don’t show great performance—especially the 95 percent uptime metric, which really needs to be 99+ percent—but if you need to buy health coverage via, you can do it. And that means that Obamacare is working too.

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Chart of the Day: The Obamacare Website Has Been Working Pretty Well Since Early November

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Why the Left Sucks at Trolling

Mother Jones

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Ben Terris writes today about “Why the Left Sucks at Trolling.” His case study is Alan Grayson, the firebrand lefty who recently compared the tea party to the KKK, earning himself plenty of tut tutting from liberals:

For this type of behavior, it’s easy to label Grayson as the left’s equivalent of a tea party congressman. (Remember, Paul Broun comparing President Obama to Hitler?) But the problem for Grayson is, without a cadre of equally recalcitrant colleagues, he has the bark, but not the bite of his Republican counterparts.

….”We don’t have a pathway to progressive fantasyland,” Rep. Keith Ellison, the chairman of the progressive caucus, conceded. “We’re probably not going to get arrested on the Capitol lawn in favor of single payer in the next three weeks.”

Why is it, in the words of congressional scholar Norm Ornstein, that the “more radical wing of the Republican Party holds the center of gravity and the radical wing of the Democratic Party is just an appendage and not a significant force”?

Ornstein thinks that for Republicans, it’s about feeling the underdog as a minority party in Washington. It doesn’t help that tea party-linked lawmakers also appear to live in a right-wing echo chamber.

You know, I read this kind of psychoanalyzing all the time. Hell, sometimes I do it myself. But there’s a simpler answer: there are more extreme conservatives than extreme liberals, and the extreme wingers really and truly believe that Democrats are destroying America. There just aren’t that many lefties who believe the same thing about Republicans. The truth is that the American left is basically pretty moderate. If you want an explanation for why liberals don’t have the same apocalyptic approach to politics as tea party conservatives, that’s why. It’s simple.

Now, I’ll grant that it’s worthwhile to ask why so many conservatives believe deep in their guts that Democrats are destroying America. Ornstein may have a point when he mentions their underdog status, but the Republican Party has had an extremist wing for a very long time, and it’s always been convinced that liberals are undermining the American way. The belief itself isn’t really anything new. What’s changed is that the extremist wing essentially controls the Republican Party these days, and that really is new. However, the dynamic that led to this began with the Gingrich Revolution in 1994, which marked the first time in decades that Republicans weren’t the minority party in Washington. So I’m not sure their underdog status is really the explanation.

However, the rise of the apocalyptic, Gingrichian attitude toward politics does coincide with the early days of the rise of right-wing media. Also with the rise of the South as the driving force in GOP politics. That’s probably where the answer lies. Liberals just don’t have anything like that.


Why the Left Sucks at Trolling

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14 Surprising Uses for Cable Ties

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14 Surprising Uses for Cable Ties

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The Weird Politics of Republican Hostage Taking

Mother Jones

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So there’s a weird thing going on with the Republican hostage-taking strategy. All of them agree that taking hostages is hunky dory, but there’s a split over which hostage should be taken. Some Republicans think the party should go ahead and fund the government and then have an all-out fight using the debt ceiling as leverage. John Boehner, Charles Krauthammer, and Marc Thiessen are in this crew. On the other side, we have Republicans who think we should go ahead and raise the debt ceiling and use the government shutdown as leverage for conservative demands. Tea party firebrands Erick Erickson and Matt Kibbe are on this team.

Here’s the weird part: The (relative) moderates want to rely on the debt ceiling for leverage, even though breaching the debt ceiling would be far more catastrophic than a government shutdown. The (relative) extremists are shying away from the horror of a debt ceiling breach and just want to continue the shutdown. Doesn’t this seem backward?

It depends on what the real motivations are. Team Boehner claims that they want to use the debt ceiling as a hostage because it’s better leverage. But Team Erickson doesn’t believe them. They apparently think this is just cover. The moderates know perfectly well that a debt ceiling breach would cause a market panic that in turn would force Republicans to cave in. So they’re only pushing this line because they want a way out of the fight, and this will do it. Conversely, a fight over the government shutdown could go on for a long, long time, and eventually Democrats might end up caving in.

That’s my take on the oddness of which players are on which team, anyway. Is it correct? I’m not sure. I need Dave Weigel or Robert Costa or someone like that to help interpret the wall posters here.

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The Weird Politics of Republican Hostage Taking

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Friday Cat Blogging – 27 September 2013

Mother Jones

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Today you get two Dominos in one. For reasons that escape us, she decided a few weeks ago that her new favorite thing was drinking water out of the tap. So whenever I brush my teeth, she hops up on the counter and demands that I turn on the water. I figure she’ll get bored of it eventually. Note the untouched water bowl on the floor, which she passed directly by on her way to the sink. If I pick it up and put it on the counter, she’ll drink out of it. But not if it’s on the floor.

(When I’m around, anyway. When I’m not around, she’s perfectly happy to drink out of it. Kinda makes you think there’s some ulterior motive at work here, doesn’t it?)


Friday Cat Blogging – 27 September 2013

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Detroit’s dirty petcoke piles disappear, but where did they go?

Detroit’s dirty petcoke piles disappear, but where did they go?

Detroit’s Petroleum Coke Piles Facebook page

A petcoke pile in June.

The Koch brothers finally took their towering piles of tar-sands oil refinery waste away from Detroit.

But where did they send the stuff? That’s a bit of a mystery.

Huge piles of petroleum coke started building up along the city’s riverfront after a refinery began processing tar-sands oil from Canada in November. Koch Carbon, an affiliate of Koch Industries, peered into the dark mass and saw, ka-ching, opportunity, so it bought up all the waste.

The material has little commercial value in the U.S., where burning it would likely violate clean air laws unless expensive emissions-control equipment were used. But it can be sold for a decent-enough price in other countries with laxer air pollution laws. Indeed, we told you in June that ships were hauling some of the waste back to a power plant in Canada — but not enough of it to keep the piles from growing.

Detroit ordered the petcoke piles to be removed by Aug. 9. That order was ignored, so the mayor’s office issued another order, saying they had to be removed by Aug. 27. That deadline was also not met. But this week, The Columbus Dispatch reported that the waste had finally been removed from the riverfront:

A four-story mound of black, gritty refinery waste that recently was ordered off the banks of the Detroit River likely was moved to Ohio. Where? Those who know aren’t saying. …

Brad Wurfel, spokesman for the Michigan Department of Environmental Quality, said he was told that the pile was shipped to Ohio. But he said he didn’t know where. And Koch Carbon isn’t talking.

If you happen to notice an enormous pile of black waste in your neighborhood, do let us know, won’t you?

John Upton is a science fan and green news boffin who tweets, posts articles to Facebook, and blogs about ecology. He welcomes reader questions, tips, and incoherent rants: this article interesting? Donate now to support our work.Read more: Business & Technology


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Detroit’s dirty petcoke piles disappear, but where did they go?

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Maryland chickens out on farm pollution rule

Maryland chickens out on farm pollution rule

Shutterstock Poultry produces lots of poop.

The Chesapeake Bay is shit out of luck.

The state of Maryland planned to tighten the rules on how much chicken manure farmers could spread over their fields — part of an effort to slow the flow of nutrients into the East Coast’s largest estuary. That would have helped reduce the size of the bay’s dead zone, but it would have left the state’s powerful chicken farmers in a smelly bind: What would they do with their copious streams of waste?

On Monday, just two days before a legislative hearing, Gov. Martin O’Malley’s administration caved to poultry farm opposition and yanked the proposal — for now. From The Daily Times:

“We heard feedback from the agricultural community as well as environmental groups,” said Julie Oberg, spokeswoman for the Maryland Department of Agriculture. “As a result of those concerns raised, we decided to withdraw the request.”

Worcester County farmer and Commissioner Virgil Shockley said he thinks the emergency proposal was withdrawn because of the response from the farming community.

“I think there was an underestimation of the alarm that this would send through the Eastern Shore elected officials and the poultry industry,” he said. “The big question that no one is willing to stand up and answer is ‘What happens when poultry is no longer part of the Eastern Shore and Maryland?’”

Environmentalists are disappointed by the delay but they are being patient — they say they want to make sure the state gets the rules right. And as the Baltimore Sun reports, Maryland’s ag officials have pledged to reintroduce the proposed regulations:

Agriculture Secretary Earl “Buddy” Hance said in a statement that the O’Malley administration wants to give farmers more time to adjust to the changes and intends to resubmit them next month after meeting with “key stakeholders.” The rules, which would have taken effect this fall, would be put off until next year at the earliest.

The stakes are high — the Sun reports that nearly half the farms in the state are “saturated” with phosphorus, a chemical from chicken manure that feeds algae in the bay, killing off all life in a huge swath of the estuary. In fields in the Lower Eastern Shore, which is east of the bay, that figure rises to more than 80 percent. Left unchecked, all that chicken shit could mean shutters for Maryland’s other famous food export: blue crabs, which are already in steep decline. Hope all those buffalo wings are worth it.

John Upton is a science fan and green news boffin who tweets, posts articles to Facebook, and blogs about ecology. He welcomes reader questions, tips, and incoherent rants:

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Maryland chickens out on farm pollution rule

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On Believing 2 Things at Once About Edward Snowden

Mother Jones

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Jeffrey Toobin is not a fan of Edward Snowden:

The assassinations of Martin Luther King, Jr., and Robert F. Kennedy led directly to the passage of a historic law, the Gun Control Act of 1968. Does that change your view of the assassinations? Should we be grateful for the deaths of these two men?

Of course not. That’s lunatic logic. But the same reasoning is now being applied to the actions of Edward Snowden. Yes, the thinking goes, Snowden may have violated the law, but the outcome has been so worthwhile. According to Glenn Greenwald, the journalist who was one of the primary vehicles for Snowden’s disclosures, Snowden “is very pleased with the debate that is arising in many countries around the world on Internet privacy and U.S. spying. It is exactly the debate he wanted to inform.”

The rest of Toobin’s piece is surprisingly unpersuasive, but the question he asks above is a worthwhile one. Leaving aside the obvious provocation of his assassination analogy, he’s asking whether any of us think that we should actively approve of what Snowden did just because we like the results. And if we do, does that mean we think that anyone working in the intelligence community who dislikes America’s surveillance policies should feel free to disclose whatever information they feel like?

For anyone who’s not already a full-blown Snowden hater or defender, this may seem like a troubling question. But it shouldn’t be. You might not know this if you subsist on a diet of cable news shouting matches, but it really is possible to believe two things at once:

Intelligence agencies are a necessary fact of life and governments have a legitimate interest in keeping their operations secret. Anyone who works in the intelligence community knows this, and knows that security breaches are a serious business that will lead to prosecution.
Americans have recently learned a lot about how pervasive our surveillance operations are, and it’s laughable to think we would have learned any of it if Snowden hadn’t done what he did. In the end, even if he’s made some mistakes along the way, he’s done a public service.

I believe both these things. I believe that 30-year-old contractors shouldn’t be the ones who decide which secrets to keep and which ones to reveal. I also believe that, overall, Snowden has been fairly careful about what he’s disclosed and has prompted a valuable public conversation.

So how do you prevent an epidemic of Snowdens while still allowing the salubrious sunlight of the occasional Snowden? The answer to the former is that intelligence workers need to be afraid of prosecution if they reveal classified documents. It can’t be a casual act, but a deeply considered one that’s worth going to prison for. The answer to the latter is that prosecution needs to be judicious. There’s no question in my mind that Snowden should be prosecuted for what he did. That’s the price of his actions. But he shouldn’t be facing a lifetime in a Supermax cell. The charge against him shouldn’t be espionage, it should be misappropriation of government property or something similar. Something that’s likely to net him a year or three in a medium-security penitentiary.

In other words, I don’t think Toobin’s implied question is as hard as he thinks it is, especially since the rest of his piece is remarkably unconvincing about the possible damage done by Snowden. The bottom line is that I’d like to see Snowden come back to America and make a public case by standing for trial. It would be a sign of how strongly he believes that he was right to do what he did. But I can hardly expect that under the current circumstances. The wild overreaction of my own government to the notion of allowing the public even the slightest knowledge of what it’s up to has made it impossible.


On Believing 2 Things at Once About Edward Snowden

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Climate Change Is Sending Marine Life to the Poles in Search of Colder Waters

Many marine creatures, including whale sharks, are expect to move closer to the planet’s poles as the ocean waters warm because of climate change. Photo: Noodlefish

According to a new study, led by Australian researcher Elvira Poloczanska, marine creatures are heading to the poles. Of all the extra energy trapped on Earth because of global warming, more than 80 percent of it has gone into the world’s oceans. And the animals that live there? They’ve noticed. They’re swimming towards the poles, heading for colder waters, as the ocean warms around them.

Most studies looking at how changing ocean temperatures are affecting marine life have focused on specific animals or specific places, often over a limited time period. Poloczanska and her team were interested in a bigger view, so they pulled together all the information they could find—208 different studies, looking at 1,735 different populations of a total 857 different species of marine animal. (And, for the haters out there, the scientists “included responses irrespective of whether they were consistent with expectations under climate change or not, as well as null responses.”)

Then they looked for big picture trends.

Not every animal that was studied is responding to climate change, they found, but around 82 percent are. And those animals are moving. The team found that, because of climate change, the ranges of these animals are growing towards the poles at around 45 miles per decade, on average. The more mobile critters, like fish and phytoplankton, are moving at around 172 and 292 miles per decade, respectively. This is way, way faster than the 3.75 miles per decade on average that land animals are moving to escape the heat.

So, climate change is here, and the marine critters have noticed. What happens next is the big question. After all, what happens when you tug on the threads of the food web? Poloczanska and her colleagues sum it up:

In conclusion, recent climate studies show that patterns of warming of the upper layers of the world’s oceans are significantly related to greenhouse gas forcing. Global responses of marine species revealed here demonstrate a strong fingerprint of this anthropogenic climate change on marine life. Differences in rates of change with climate change amongst species and populations suggest species’ interactions and marine ecosystem functions may be substantially reorganized at the regional scale, potentially triggering a range of cascading effects.

More from

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Climate Change Is Sending Marine Life to the Poles in Search of Colder Waters

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