Tag Archives: health

Trump Is Playing Chicken With Millions of Health Plans. The Result Might Be a Government Shutdown.

by RoyceSteinmetz Posted on April 18, 2017

Mother Jones

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Members of Congress are home in their districts until next week, but when they come back to town they’ll be facing an imminent government shutdown—unless they manage to pass last-minute legislation to keep federal programs funded. A shutdown now appears a little more likely thanks to some gamesmanship from President Donald Trump over Obamacare that prompted Democrats to issue threats of their own last week.

The showdown involves an Obamacare program know as “cost sharing reduction,” which requires insurance companies to offer discounted copayments and deductibles to low-income people who buy health plans on the individual market. In return, the federal government makes payments to compensate insurers for this expense. Last week, Trump threatened to stop making these payments to insurers—a move that could lead to massive price spikes for millions of people and cause insurers to flee from the individual marketplaces.

By issuing the threat, Trump was attempting to scare Democrats into agreeing to repeal Obamacare. “Obamacare is dead next month if it doesn’t get that money,” Trump told the Wall Street Journal. “I haven’t made my viewpoint clear yet. I don’t want people to get hurt…What I think should happen and will happen is the Democrats will start calling me and negotiating.”

But Trump’s gambit may have backfired. Democratic leaders are now saying they might not vote to keep the government funded next week unless that funding bill includes a provision appropriating money specifically for the cost sharing reductions. “We will not negotiate with hostage takers,” Sen. Ron Wyden (D-Ore.) warned last week.

Democrats may actually have a surprisingly strong negotiating position. Despite controlling both chambers of Congress, the GOP needs their help to keep the government open. Republicans will need support from at least eight Democratic senators in order to avoid a filibuster. And given House Republicans’ penchant for defying party leadership, Speaker of the House Paul Ryan (R-Wisc.) might also need some Democratic votes to overcome conservative objections to the funding bill.

When it comes to the controversies surrounding Obamacare, the cost sharing reduction payments have received relatively little attention. But they are an essential component of how the law makes insurance affordable for lower-income families. For anyone who makes less than 250 percent of the federal poverty line ($30,150 for an individual, $61,500 for a family of four), the government pays insurance companies to lower out-of-pocket costs.

About 58 percent of people who purchase insurance through Obamacare’s marketplaces qualify for the reduced copays and deductibles, totaling more than 7 million people. For consumers, the savings can be substantial. The Kaiser Family Foundation found that for people below 150 percent of the poverty line, average deductibles dropped from $3,609 to $255 thanks to the program. It all adds up to $7 billion in federal spending for 2017, and it’s projected to rise to $10 billion next year and $11 billion in 2019.

The current debate revolves around a quirk in the way the law was written. The Affordable Care Act requires the government to reimburse insurance companies, but lawmakers apparently failed to include a provision to explicitly “appropriate” money for these payments. (It’s not enough for Congress to authorize a program; under the Constitution, Congress must also appropriate funds for a program before the government can spend money on it.) The Obama administration started to dole out the funds anyway, citing a different appropriation authority, but House Republicans objected and sued. A federal judge sided with Republicans last year, though that decision was stayed pending appeal. (The details are too convoluted to explain in full here, but Vox has a great description.)

After Trump won the presidency, House Republicans asked the courts to hold off on the case, since they’re hoping they can end the program by repealing Obamacare. Now, the Trump administration has until May 22 to let the court know if it still plans to appeal the ruling. If Trump chooses, the administration could unilaterally drop the case and let stand the lower court decision barring the payments.

But while the administration can choose to stop making the payments to insurance companies, insurers would still be required to offer discounted policies. On that point, the law is explicit: Insurance companies must reduce out-of-pocket costs for low-income consumers. In other words, they would still have to offer cheaper copays and deductibles—just without the government assistance they were promised.

An analysis by the Kaiser Family Foundation found that, in order to offset those lost funds, insurers would have to increase premiums by 19 percent on average. That increase would not be evenly distributed across the country, though. The rate increase would likely be far less drastic in states that expanded Medicaid under Obamacare, since Medicaid provides government-sponsored insurance to low-income people who would otherwise use the individual marketplaces. North Dakota would see the smallest premium spike if the payments to insurers stopped—a 10-percent increase. By contrast, insurance premiums would rise 27 percent in Mississippi and 25 percent in Florida and Alabama.

It isn’t just Democratic politicians who are crying foul over Trump’s threats. The health care industry industry last week implored Trump to maintain funding for the subsidies. In a letter to the president—signed by the American Medical Association, America’s Health Insurance Plans, BlueCross BlueShield, and the US Chamber of Commerce—industry groups warned that unless Trump makes clear that he’s going to continue the payments, insurers will flee the markets in 2018, and premiums for the remaining options will skyrocket.

“The most critical action to help stabilize the individual market for 2017 and 2018,” the letter says, “is to remove uncertainty about continued funding for cost sharing reductions.”

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Trump Is Playing Chicken With Millions of Health Plans. The Result Might Be a Government Shutdown.

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Don Lemon Rips Into Jeffrey Lord for Describing Trump as "MLK of Health Care"

by KelseyMackinnon Posted on April 14, 2017

Mother Jones

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CNN commentator Jeffrey Lord drew instant outrage on Thursday after he described President Donald Trump as the “Martin Luther King of health care,” while supporting Trump’s reported plan to cut subsidies to the poor in order to force Democrats into negotiating on a health care bill. According to Lord, the two were comparable because they were willing to put “people in the street in harm’s way” to pass legislation.

By evening, the conservative pundit was still defending the outrageous remarks. During a segment with Don Lemon, Lord repeatedly refused to apologize and dismissed Lemon’s claim that the comparison was insulting. Lord even attempted to tell an anecdote about his father losing employment after defending a black waitress, before Lemon swiftly cut him off.

“Don’t take me to some before-the-war crap,” Lemon said. “I want to hear what you’re saying to the coworkers you work with now, Jeffrey. Answer the question now.”

“I want to hear now to the coworkers, to the people of color you work with on this network every single day, who were offended by your remarks.”

Lord responded by claiming, “We don’t judge people by color in this country.”

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Don Lemon Rips Into Jeffrey Lord for Describing Trump as "MLK of Health Care"

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Could we get climate action from … Republicans?

by AnaFinlayczw Posted on April 13, 2017

You can’t fight what you can’t measure. But Davida Herzl has a solution: Her company, Aclima, builds sensor networks that monitor environmental impacts at a hyperlocal scale. Clients can deploy sensors on city streets, inside buildings, even on vehicles, to compile data on pollutants, carbon footprint, and more.

Think of it as a Fitbit for a planet trying to take more steps toward carbon reduction. In addition to working with the Environmental Protection Agency, Aclima has partnered with Google’s Street View fleet to map greenhouse gas emissions and air quality in California.

Herzl ultimately wants her sensor networks to create changes in behavior, both from large institutions and from individuals who can follow their lead. “One of the things we know is that emissions from non-electric vehicles influence climate change — but now we’ve learned that the proximity of my house to a freeway increases my health risk,” she says. “That can influence whether I choose to buy an electric vehicle or a nonrenewable-fuel-based vehicle … That personal moment motivates me every day.”

Workplace culture matters to Herzl, too: She sees Aclima’s multiracial, gender-diverse crew as part of a new vanguard in Silicon Valley dedicated to solving the world’s biggest problems through industry and innovation.

Meet all the fixers on this year’s Grist 50.

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Could we get climate action from … Republicans?

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Trump Is Now Threatening to Sabotage Millions of Insurance Plans

by DeneenConley6 Posted on April 13, 2017

Mother Jones

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President Donald Trump is now threatening to wipe out health insurance for millions of people in order to make a political statement. In an interview with the Wall Street Journal Wednesday, Trump suggested that unless Democrats agree to his plans to dismantle Obamacare, he might use his executive authority to intentionally trigger a death spiral for the individual insurance markets.

Specifically, Trump threatened to stop making payments to insurance companies to reimburse them for subsidies that help offset the costs of deductibles and copayments for low-income people. Those subsidies are mandated by Obamacare; if the feds stopped reimbursing insurers for this expense, they would likely abandon the individual markets and leave millions without coverage.

The president seemed to acknowledge in the interview that halting the reimbursements would likely result in the healthcare markets collapsing, but he said he might go through with it in order to extract concessions from Democrats. “Obamacare is dead next month if it doesn’t get that money,” Trump told the paper. “I haven’t made my viewpoint clear yet. I don’t want people to get hurt…What I think should happen and will happen is the Democrats will start calling me and negotiating.”

Obamacare includes a host of mechanisms to make buying insurance easier and more affordable for people who don’t receive coverage through their employer and have to buy it on the individual market. The law primarily does this by offering subsidies—varying by income—to offset the costs of premiums for people who earn up to 400 percent of the poverty level. But the law was also designed to provide $7 billion per year in “cost sharing reduction” payments to insurance companies so that people below 250 percent of the poverty line would have lower deductibles and copayments.

These payments were explicitly included in the health care law, but through the convoluted quirks of legislative procedure, Republicans have alleged that Congress technically didn’t “appropriate” money for the program. The Obama administration went ahead and started making the payments anyway, and in 2014 House Republicans sued the White House, saying that the administration shouldn’t be able to spend that money. A federal district judge sided with Republican last year, and the Obama administration appealed.

After Trump’s inauguration, both the White House and Congress sought to stall the lawsuit, asking the courts to give them more time to figure out whether or not Obamacare will be repealed. When the GOP repeal bill failed last month, Trump was faced with a dilemma: He could order the his administration to keep fighting the House’s lawsuit, or he could ditch the appeal and end the reimbursement payments. It sounds like Trump may now be leaning toward the latter. In addition to his Journal interview, Trump reportedly has become active behind-the-scenes, as well. According to Politico, the president called Health and Human Services Secretary Tom Price and dictated a statement that he wanted the agency to release on the issue.

As Trump himself said, ending the program would be a disaster for Obamacare. It would cause insurance companies to flee the individual markets (which, in some parts of the country, already suffer from a lack of insurance options). And the remaining insurance offerings would jump in price. An analysis by the Kaiser Family Foundation found that premiums for a baseline plan would jump 19 percent if cost sharing disappears.

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Trump Is Now Threatening to Sabotage Millions of Insurance Plans

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Tesla’s parking lot is a nightmare hellscape.

by YoungLubfmlrnd Posted on April 12, 2017

You can’t fight what you can’t measure. But Davida Herzl has a solution: Her company, Aclima, builds sensor networks that monitor environmental impacts at a hyperlocal scale. Clients can deploy sensors on city streets, inside buildings, even on vehicles, to compile data on pollutants, carbon footprint, and more.

Think of it as a Fitbit for a planet trying to take more steps toward carbon reduction. In addition to working with the Environmental Protection Agency, Aclima has partnered with Google’s Street View fleet to map greenhouse gas emissions and air quality in California.

Herzl ultimately wants her sensor networks to create changes in behavior, both from large institutions and from individuals who can follow their lead. “One of the things we know is that emissions from non-electric vehicles influence climate change — but now we’ve learned that the proximity of my house to a freeway increases my health risk,” she says. “That can influence whether I choose to buy an electric vehicle or a nonrenewable-fuel-based vehicle … That personal moment motivates me every day.”

Workplace culture matters to Herzl, too: She sees Aclima’s multiracial, gender-diverse crew as part of a new vanguard in Silicon Valley dedicated to solving the world’s biggest problems through industry and innovation.

Meet all the fixers on this year’s Grist 50.

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Tesla’s parking lot is a nightmare hellscape.

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The High Cost of Health Care Is Stealing Years of Life From Poor Americans

by Hildega86H Posted on April 6, 2017

Mother Jones

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According to a new series of studies in The Lancet, the United States risks a “21st century health-poverty trap” if it does not address low-income Americans’ growing inability to access or afford quality health care. The five papers published today in the British medical journal describe how the high cost of health care is intensifying the widening gap between the rich and poor and issue a call for a single-payer health care system.

The studies highlight several alarming trends: America’s richest 1 percent live more than a decade longer on average than the poorest Americans; 40 percent of poor Americans skip going to the doctor because they can’t afford to; the neediest 20 percent of Americans spend almost twice what the richest 20 percent Americans spend on private health insurance; and 1 out of every 10 households facing high medical costs declares bankruptcy, even after the implementation of Obamacare.

“We are witnessing a slow-moving disaster unfolding for the health of lower-income Americans who have spent their working lives in a period of rising income inequalities,” says Dr. Jacob Bor, an assistant professor at the Boston University School of Public Health.

Some of the health effects of poverty documented in the studies are staggering. The average life expectancy rates of the poorest 5 percent Americans have not budged since 2001, despite gains by middle and high-income Americans, who can now expect to live an extra two years on average. Instead, entrenched poverty is elevating mortality rates: The wealthiest 1 percent now can expect to live 10 to 15 years longer than the poorest 1 percent of Americans.

The Lancet series kicks off with an introduction by Vermont Sen. Bernie Sanders calling for a single-payer health care system. “Health care is not a commodity. It is a human right,” he writes. “The goal of a health-care system should be to keep people well, not to make stockholders rich. The USA has the most expensive, bureaucratic, wasteful, and ineffective health-care system in the world.”

The studies also conclude that America would benefit from a single-payer health care system. Authors Dr. Adam Gaffney of the Cambridge Health Alliance and Dr. Danny McCormick of Harvard Medical School argue that offering comprehensive health coverage to all Americans would close the current gaps in access to health care: “A single-payer, Medicare-for-all reform—championed by Senator Bernie Sanders during his upstart presidential campaign, as well as by many physicians and the nation’s largest nurses union—would, in our view, best address health-care inequalities.”

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The High Cost of Health Care Is Stealing Years of Life From Poor Americans

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The Senate Should Grill Trump’s FDA Pick on Antibiotics

by Arterisa Posted on April 5, 2017

Mother Jones

When President Donald Trump tapped Scott Gottlieb to lead the Food and Drug Administration, the pharmaceutical industry breathed a “sigh of relief,” reported Reuters and the Financial Times. That’s because he is “entangled in an unprecedented web of Big Pharma ties,” as the watchdog group Public Citizen put it. If confirmed, he’ll jump to the federal agency that regulates the pharmaceutical industry from the boards of GlaxoSmithKline and several other pharma companies. His work for those industry players netted him “at least” $413,000 between 2013 and 2015, Public Citizen reports. Gottlieb is also a partner at New Enterprise Associates, a venture capital firm that invests in the health care sector.

But Gottlieb, whose Senate confirmation hearing is scheduled for Wednesday, has a scant track record on another aspect of the FDA job: managing the rising crisis of antibiotic resistance. According to the Centers for Disease Control and Prevention, germs that have evolved to resist antibiotics sicken at least 2 million people every year and kill at least 23,000. Last fall, all 193 countries in the United Nations—including the United States—signed a declaration calling antibiotic resistance the “biggest threat to modern medicine.”

The FDA’s most direct contribution to the battle to save antibiotics lies in its regulation of farms. About 70 percent of the antibiotics used in the United States go to livestock operations, and the FDA itself, along with the CDC, the World Health Organization, the UK government, and other public health authorities, warn that overuse of drugs in meat farming is a key generator of antibiotic-resistant pathogens.

Meat operations feed their animals regular low doses of antibiotics for two reasons—to help them gain weight faster, and to avoid infections despite tight, unsanitary conditions. Way back in 1977, the FDA acknowledged that these practices undermine the ability of antibiotics to fight human infections—and then for decades, it neglected to do anything about it, under severe pressure from the meat and pharmaceutical industries (more on that here).

On January 1, 2017, the agency at long last finalized a voluntary set of new rules designed to rein in the meat industry’s addiction to antibiotics. But even if meat companies comply with the new policy, the FDA’s plan leaves a gaping loophole: It asks farmers not to use the drugs as a growth promoter, but blesses the practice of using them to “prevent” disease. As the Pew Charitable Trust notes, the “lines between disease prevention and growth promotion are not always clear”—and for many antibiotics crucial to human medicine, farmers can continue as usual, changing only the language they use to describe their antibiotic reliance.

A recent report from the Government Accountability Office chastised the FDA for leaving the loophole, complaining that the agency failed to crack down on “long-term and open-ended use of medically important antibiotics for disease prevention.” It also found that the FDA doesn’t demand nearly enough usage data from meat companies or pharmaceutical suppliers to assess whether its voluntary program is working.

David Wallinga, who covers antibiotic resistance for the Natural Resources Defense Council, says the Senate Committee on Health, Education, Labor and Pensions, which will hold Gottlieb’s confirmation hearing, should grill him about how the agency will handle farm antibiotic use. A senator should brandish the GAO report and ask how the FDA nominee plans to address its criticisms of the agency’s current antibiotic policy.

Wallinga says that, despite all his ties to Big Pharma, Gottlieb does not seem to be directly involved with companies like Zoetis and Elanco, which specialize in animal drugs. But Gottlieb’s one public statement on antibiotic resistance does not inspire confidence that he fully grasps the issue. In a 2007 post for the conservative American Enterprise Institute, Gottlieb opined that “preventative efforts alone won’t solve our bacterial challenges.” What’s needed, he argued, are incentives for the pharmaceutical industry to develop new antibiotics, which aren’t profitable enough to draw the heavy investment in research and development required for new drugs. That’s true, Wallinga says, but any new antibiotics will quickly succumb to resistance, too, if farm use isn’t reined in.

And this issue is especially relevant for anyone dealing with cancer—that is, everyone. (Gottlieb himself is a cancer survivor, as Wallinga notes. Antibiotic resistance is one of the major threats to chemotherapy patients. A 2015 Lancet study found that at least 26 percent of pathogens causing infections after chemotherapy are resistant to common antibiotics.

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The Senate Should Grill Trump’s FDA Pick on Antibiotics

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A Lot of Trump Voters Only Heard One Thing: Build the Wall

by FinnZ48tawaen Posted on April 3, 2017

Mother Jones

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The Washington Post has a story on the front page today that’s already become so common it’s almost a cliche. It’s about the small-town folks who voted for Donald Trump but somehow didn’t realize he was going to do things that might harm them. Today’s example features on-the-ground reporting from Durant, Oklahoma, and Exhibit A is Betty Harris:

She likes the president’s promises to crack down on illegal immigration, which she thinks has hurt the job market, and to bully manufacturers into staying in the country. She said both of her daughters were out of work for months because they worked for companies that moved overseas.

But Harris is upset by the president’s proposed budget, which would dramatically cut funding for the Robert T. Davis Senior Center, managed by the Bryan County Retired Senior Volunteer Program.

There seem to be an awful lot of people who heard only one thing from Trump during the campaign: He was going to build a wall and keep out all the Mexicans. Now, as best I can tell, the unauthorized population of Durant is at most 1 percent. But no matter. Illegal immigration still seemed like a scary thing, and Harris was all in favor of stopping it cold.

Over and over, I read stories where I hear this. Trump got the votes of people who liked his promise to stop illegal immigration. And that was about it. They didn’t really hear the part about repealing Obamacare. They didn’t hear the part about cutting the budget. They didn’t hear the part about climate change being a hoax. They didn’t hear the part about 86ing regulations that protect workers but are disliked by big corporations. They didn’t hear the part about big tariffs, which would make the stuff they buy more expensive. They didn’t hear the part—or didn’t care—about gigantic tax cuts for the rich.

Over and over, it’s illegal immigration. And now they’re shocked that Trump wants to take away their health care and their senior center and their workplace safety rules and all the financial regulations that protect consumers. They didn’t notice him talking about all of that. Or else they didn’t think he was serious. Or they didn’t realize that when they voted for Trump, they were voting for a White House full of true-believing conservatives who have never cared about the working class and still don’t.

The saddest part, from their point of view, is that they’re probably not even going to get their wall. They’re just going to get all the stuff they didn’t want.

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A Lot of Trump Voters Only Heard One Thing: Build the Wall

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Trump, on Twitter Rampage, Threatens Republican Group

by DarinLeyva Posted on March 30, 2017

Mother Jones

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President Donald Trump took a swipe at the House Freedom Caucus on Thursday, threatening on Twitter to “fight” the hard-line conservative Republican group if its members fail to get in line with his agenda.

The unusual move to target lawmakers in his own party comes less than a week after the failure of a bill to repeal and replace the Affordable Care Act. Freedom Caucus members had petitioned the president to make deeper cuts to Obamacare. That prospect alarmed more moderate Republicans who were already wavering in their support for the legislation, and the bill was pulled from consideration.

After attacking the House Freedom Caucus, Trump turned his aim to one of his favorite Twitter targets, blasting the New York Times and suggesting libel laws be changed to make it easier to sue the paper for coverage he has routinely deemed unfair.

Trump initially blamed Democrats for the health care bill’s failure. He also encouraged his supporters to watch a Fox News segment that urged House Speaker Paul Ryan to resign amid the fallout.

On Thursday, Ryan said that Trump called him to apologize, claiming he “had no idea” that the segment would be critical of Ryan.

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Trump, on Twitter Rampage, Threatens Republican Group

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A Senator Is Taking on the Pharma Companies Behind the Opioid Epidemic

by trinidadgloucest Posted on March 28, 2017

Mother Jones

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On Tuesday, Sen. Claire McCaskill (D-Mo.) launched an investigation into how the nation’s leading painkiller manufacturers fueled the current opioid crisis—the most deadly drug epidemic in US history.

McCaskill requested internal sales and marketing materials, addiction studies, and details on compliance with governmental organizations from the top five opioid manufacturers: Purdue, Janssen/Johnson & Johnson, Insys, Mylan, and Depomed. If the companies refuse to comply, McCaskill would need support from her Republican colleagues on the Senate Homeland Security and Governmental Affairs Committee in order to subpoena the documents.

This is the most far-reaching senate investigation into the opioid manufacturers to date, following a 2012 Senate Finance Committee investigation into payments to pain advocacy groups.

It comes at a time when drug overdoses are killing more Americans than car accidents or gun violence. Of the 52,000 overdose deaths in 2015, two thirds were associated with opiates such as OxyContin, Vicodin, heroin, and fentanyl.

Experts trace the epidemic back to the early ’90s, when doctors started treating pain more aggressively. As I wrote last year:

Fueling the storm were pharmaceutical companies, which aggressively—and, in many cases, misleadingly—marketed painkillers to doctors and patients. Purdue Pharma, which introduced OxyContin in 1995, funded more than 20,000 pain-related educational programs between 1996 and 2002, according to an article last year in the Annual Review of Public Health.

Noting that doctors were wary of prescribing opioids because of concerns about addiction, the company funded studies finding that “physical dependence” on opioids is different from addiction and “clinically unimportant.” It provided financial backing to the American Pain Society, which introduced the “Pain is the Fifth Vital Sign” campaign, and the Joint Commission, which accredits health care organizations, in addition to other physician and patient groups. Purdue Pharma and its executives were fined more than $600 million in 2007 after they were found guilty of misleading regulators, doctors, and patients about the drug’s addictive qualities.

“All of this didn’t happen overnight—it happened one prescription and marketing program at a time,” said McCaskill in a statement. “This investigation is about finding out whether the same practices that led to this epidemic still continue today, and if decisions are being made that harm the public health.”

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A Senator Is Taking on the Pharma Companies Behind the Opioid Epidemic

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