As Republican leaders continue to push a bill to repeal and replace the Affordable Care Act (ACA), the deadline to renew critically needed funding for rural hospitals faced with high costs and limited resources may go unnoticed, Elham Khatami noted at ThinkProgress (9/21).

Hundreds of rural hospitals rely on payments provided by the Medicare Dependent Hospital (MDH) and the Low Volume Hospital Adjustment (LVHA) programs, both of which expire on Sept. 30. Rep. Tom Reed (R-NY) introduced the Rural Hospital Access Act in April, which would make the programs permanent, but the bill has not yet moved through committee as Republican lawmakers instead focused their efforts on a bill to repeal and replace the ACA, led by Sens. Bill Cassidy (R-LA) and Lindsey Graham (R-SC).

Under Graham-Cassidy, Medicaid would become a block-grant program, and funding would be distributed based on each state’s Medicaid expansion policy under the ACA. States that expanded Medicaid would see a decrease in funding and could be forced to reallocate funds from the already existing disproportionate share hospitals (DSH) program, which helps fund hospitals with a large number of uninsured patients and patients who rely on Medicaid.

For rural America, the impact of this policy would be especially devastating. If Graham-Cassidy passes, and the MDH and LVHA programs aren’t renewed on top of that, low-income residents depending on rural hospitals as their only means to get proper health care will doubly suffer.

“If these programs were allowed to expire, the number of hospitals that would close would be great,” Diane Calmus, government affairs and policy manager at the National Rural Health Association, told ThinkProgress. “These are programs that Congress designed recognizing that rural hospitals are different. They face different challenges.”

Calmus added that there is a strong sense of urgency both for the Rural Hospital Access Act and the Save Rural Hospitals Act, introduced by Reps. Sam Graves (R-MO) and Dave Loebsack (D-IA) in June. The latter would increase payments to rural health care providers under Medicare.

“These are very vulnerable classes of hospitals… it’s a big concern,” Calmus said. “Unfortunately, Congress often likes to wait until the last possible second to get its homework finished.”

Conversations surrounding health care in Congress have largely overlooked the challenges faced by rural hospitals, including constrained financial resources and limited staff. Approximately 51 mln people rely on the 1,800 rural hospitals in the country. Patients are typically older, uninsured, and more likely to suffer from chronic illnesses, such as hypertension, cancer, and chronic bronchitis.

Rural providers grapple with limited space, fewer services and technologies, and smaller staff. They also struggle to meet the high cost of drugs that treat rare diseases because of a little-known exclusion in the ACA that precludes rural hospitals from receiving discounts on these drugs.

Michael Topchik, national leader of the Chartis Center for Rural Health (CCRH), said a key reason for the financial constraints faced by rural hospitals is that “we’re caught in a time of retractable federal expenses.” Many hospitals are still dealing with the effects of the 2013 government sequestration, for instance, which resulted in a 2% cut in Medicare reimbursements.

“A cut matters to every provider in the country,” Topchik told ThinkProgress, adding that, for rural hospitals, the impact is greater. “Sixty percent of their reimbursements are from Medicare and Medicaid.”

Financial strife has led to cutbacks in services provided, including maternity care and substance abuse treatments, as well as hospital closures. Since 2010, more than 80 rural hospitals, primarily located in the South, have shut down due to financial instability — almost double the amount between 2005 and 2009. According to a study by iVantage Health Analytics, almost 700 rural hospitals are on the brink of being shut down.

The impact of these hospital closures could be disastrous, forcing patients to travel hours to receive treatment or opt not to receive treatment at all. Calmus said the closures have the potential to ruin entire communities, which rely on the hospitals as their main source of employment and industry.

Topchik said his office was awaiting the CBO score on the Graham-Cassidy health care bill before it issueed an assessment on the bill’s impact on rural health providers. However, that in their analysis of the Better Care Reconciliation Act (BCRA), an earlier Republican health care proposal that the Senate rejected in July, the effect on rural hospitals was “crushing.”

“Our research shows that the reimbursement loss to rural hospitals would be two times the amount under the sequester,” Topchik said.

Health care advocates released a statement Sept. 18 in opposition to the Graham-Cassidy bill, arguing that it “repackages the problematic provisions of the [BCRA].” The Federation of American Hospitals and the American Hospital Association have also come out against the bill due to its deep Medicaid cuts.

REPUBS SEEK $1.5T TAX CUTS. President Trump and Republican congressional leaders plan to cut the top tax rate for the wealthiest Americans to 35% and dramatically reduce taxes on corporations, according to Axios (9/23).

The GOP leaders plan to cut the corporate tax rate from 39.6% to 20%. (Most businesses in America do not pay the corporate tax. Sole proprietors and other mostly smaller businesses see their profits “passed through” to their owners and taxed at the individual income rate.)

The “Big Six” tax framework — named because it’s been hashed out behind closed doors between six top Republicans and administration officials — will set up a clash with Democrats over tax breaks that go to large corporations and upper income Americans.

Most Democrats have already drawn a red line on tax reform: 45 out of 48 Democratic senators signed a letter saying they wouldn’t support any tax bill that adds to the deficit or offers new tax breaks to the wealthiest Americans.

But Republicans are desperate for a win and appear on course to fund tax cuts with a blend of deficit spending and the closing of loopholes. They will dare Democrats, especially the 10 senators up for re-election in states Trump won, to vote against tax breaks for their constituents.

House conservatives — especially the Freedom Caucus — haven’t been involved in the Big Six discussions and they want the corporate rate to be much lower, at 16%. Republican leaders say there’s no way that’s going to happen, and Treasury Secretary Mnuchin agrees.

The Trump tax plan will likely add to deficits, at least in the short term, which will bother some deficit hawks. But Senate Republicans on the Budget Committee cut a deal that would reduce government revenue by as much as $1.5 tln over 10 years. Voodoo economists argue that, with economic growth spurred by the tax reform, there’ll be substantially less lost revenue than $1.5 tln.

PUERTO RICO DESPERATE AS TRUMP TWEETS ABOUT NFL, NBA. Puerto Rico was literally drowning in the aftermath of Hurricane Maria. CNN reported there was a “humanitarian crisis” in the making, Vox said “hysteria is starting to spread,” and the Washington Post added that “running out of supplies, parts of Puerto Rico near desperation.”

People were literally writing chalk messages in the streets that can be read during flyovers: “S.O.S We need water/food!” Kerry Eleveld noted at DailyKos (9/25).

And how are GOP officials in Washington, D.C., meeting the needs of American citizens in dire need of help in Puerto Rico?

Jennifer Bendery reported at HuffPost that the White House was expected to send a disaster aid request to Congress in the first half of October to get the ball rolling.

Eleveld noted, “Let’s be clear: people will literally die in that two-to-three-week window..”

Instead, Republican lawmakers were racing against time — to revise their ill-conceived health care bill and pass tax cuts that will result in “a massive windfall for the wealthiest Americans.” Donald Trump was posting insulting and inflammatory tweets at NFL and NBA players instead of addressing the needs of 3.5 mln American citizens in hurricane-ravaged Puerto Rico, most of which is expected to be without power for months.

When Trump noticed Puerto Rico (9/25), he effectively blamed the islanders – all of whom are American citizens – for their own misfortune.

“Texas & Florida are doing great but Puerto Rico, which was already suffering from broken infrastructure & massive debt, is in deep trouble,” he tweeted, without offering any additional federal government assistance for the US territory. He acknowledged that “much of the island was destroyed,” but caustically went on to say that its electrical grid was already “in terrible shape” and that Puerto Rico owed billions of dollars to banks. “which, sadly, must be dealt with.”

POLLS SHOW VOTERS REJECT GOP AGENDA. The Graham-Cassidy health deform bill is as unpopular as other Republican efforts to repeal the Affordable Care Act (“Obamacare”), a CBS News poll showed (9/25).

Most Americans — 52%— disapprove of the Graham Cassidy bill, while only 20% support the repeal bill, the CBS poll showed. By contrast, when Obamacare was signed into law in 2009, after a yearlong debate and after Republicans blasted the proposal for months, 46% of American supported the initiative. The CBS poll showed most people want the ACA to be improved, not repealed, as 9% said it should be kept in place and 65% said it has good things but needs changes.

It’s not surprising the GOP’s dreadful bill is so unpopular, given that it’s pushing such a warped agenda, Eric Boehlert noted at ShareBlue.com (9/25).

“What is astonishing is how closely GOP lawmakers want to be associated with landmark legislation that is nearly uniformly despised. Only 7% of Americans think the Republican health care bill would help them personally, according to the CBS News poll.

“And nearly nine in ten of all Americans believe that health insurance companies should be required to provide insurance to people with pre-existing conditions. The Graham-Cassidy bill allows states to obtain waivers from federal government on pre-existing conditions.

But the overwhelming disdain for the Republican health care initiative actually pales in comparison to the avalanche of opposition to the proposal of deporting undocumented immigrants who came to the US as children, Boehlert noted.

A new ABC News/Washington Post poll finds that a staggering 86% of Americans support the Deferred Action for Childhood Arrivals (DACA) program, which was established by President Barack Obama in 2012 via executive order. DACA allows those young undocumented immigrants to stay and work in the US without fear of deportation.

The bipartisan results, given today’s hyper-partisan environment in the US, are stunning.

ABC News noted, “Support spans demographic groups, including three-quarters of Republicans and conservatives, 86 and 87 percent of independents and moderates, and 97 and 96 percent of Democrats and liberals.”

“Two-thirds back a deal to enact such legislation in tandem with higher funding for border control,” ABC News added. But Gabe Ortiz noted at DailyKos.com (9/25) it’s important to note the federal government already spends more on federal immigration enforcement than on all other federal law enforcement agencies—including the FBI and Secret Service—combined. And by large numbers, the poll also found Americans oppose other key planks from Trump’s nativist agenda.

Only 12% of those polled believe that undocumented immigrants commit more crime than US-born Americans (they don’t, in fact), 62% oppose Donald Trump’s border wall that Mexico will never pay for (and that barely 24% of congressional Republicans endorse), and 55% oppose Trump’s proposal to cut legal immigration in half.

Together, the polls paint a picture of a Republican Party whose goals are opposed on an almost historic scale, Boehlert noted.

“If nothing else, Republicans are helping to unify the country as it comes together in opposition to their heartless agenda.”

REPUBLICANS PERSIST WITH TERRIBLE OBAMACARE REPEAL BILL. Standard & Poors estimated (9/25) that the Graham Cassidy health care bill would cause 580,000 lost jobs and $240 bln in lost economic activity by 2027, ensuring that GDP growth remains stuck in low gear of around 2% at best in the next decade. Kevin Drum noted at MotherJones.com, “Graham-Cassidy is—literally—opposed by every single constituency in the health care industry. That includes doctors, nurses, hospitals, patient advocates, and pharmaceutical companies. It is wildly unpopular, polling around 20% approval. The Republican base isn’t clamoring for it. It would leave more than 20 million people uninsured without saving very much money. It would remove protections for pre-existing conditions. And it would cost the country 580,000 jobs, tanking the economy for the next decade.

“And yet Republicans are still trying to pass it. Can anyone explain why?”

Carl Hulse offers this explanation at the New York Times (9/22): “As more than 40 subdued Republican senators lunched on Chick-fil-A at a closed-door session last week, Senator Cory Gardner of Colorado painted a dire picture for his colleagues. Campaign fund-raising was drying up, he said, because of widespread disappointment among donors over the inability of the Republican Senate to repeal the Affordable Care Act or do much of anything else.

“Mr. Gardner is in charge of his party’s midterm re-election push, and he warned that donors of all stripes were refusing to contribute another penny until the struggling majority produced some concrete results.

“‘Donors are furious,’ one person knowledgeable about the private meeting quoted Mr. Gardner as saying. ‘We haven’t kept our promise.’”

Republicans say the fund-raising drop-off has been steep and across the board, from big donations to the small ones the party solicits online from the grass roots. They say the hostile views of both large and small donors are in unusual alignment and that the negative sentiment is crystallized in the fund-raising decline.

Gardner told his colleagues that a major Colorado contributor who played a role in his own campaign says party donors are reluctant to give any more money until congressional Republicans demonstrate results.

TRUMP TO LIMIT ACCESS TO HEALTHCARE.GOV DURING INSURANCE ENROLLMENT PERIOD. As the latest effort to repeal and replace the Affordable Care Act founders in Congress, the Trump administration isn’t slowing down its efforts to undermine Americans from signing up for health insurance.

The administration announced (9/22) that healthcare.gov, the website most Americans use to sign up for insurance through the ACA marketplaces, would be down for maintenance for 12 hours every Sunday in the middle of the upcoming open-enrollment period, from Nov. 1 until mid-December in most states.

“No explanation was given for the outages, but given the administration’s previous efforts to sabotage the insurance markets, it’s not paranoid to view this maintenance schedule as a plan to keep down enrollment,” Benjamin Hart noted at NYMag.com (9/22). “At a minimum, it displays an indifference to the needs of the population it is supposed to be serving.

“As part of its mission to translate the false narrative that the Affordable Care Act is failing into reality, Tom Price’s Health and Human Services Department has already announced massive cuts to the navigator programs that fund Obamacare outreach, as well as the budget for ads that alert Americans to the existence of the open-enrollment period,” Hart wrote.

“The Trump administration is deliberately attempting to sabotage our health care system,” Senate Minority Leader Chuck Schumer said in a statement to Politico (8/31). “When the number of people with health insurance declines and costs skyrocket, the American people will know who’s to blame.”

About 12.2 mln people signed up for health plans during the last enrollment season and 10 mln people are still enrolled in the exchanges, according to HHS figures, reported by Politico.

DEMS FLIP GOP SEATS IN OK & NH. Democrats won two GOP-held legislative seats in Oklahoma and New Hampshire (9/12), bringing to six the total number of state legislative seats the party has flipped since November 2016.

The Democratic victory in Oklahoma was especially striking, Daniel Marans noted at HuffPost. Jacob Rosecrants (D), a schoolteacher, defeated Darin Chambers (R), a businessman, by nearly 21 points in a special election to represent District 46 in Oklahoma’s House of Representatives. The district encompasses part of the city of Norman, home of the University of Oklahoma.

Rosecrants had lost by a nearly identical margin in a previous race for the seat in November. The seat opened up, however, when Republican Scott Martin resigned to head the Norman Chamber of Commerce, prompting the special election in a district where Donald Trump defeated Hillary Clinton by over 10 points.

Democrats also took control of the New Hampshire House District 9, which includes Belmont and parts of Laconia. Charlie St. Clair (D), a retired teacher, defeated Steven Whalley (R) 1,267-1,009 votes. Trump had won the district by 16 points.

See more Dispatches at populist.com.

In Oklahoma, state Democrats have won in three formerly Republican seats. And it’s no big mystery as to why — Oklahoma Republicans have decimated the public school system with a self-inflicted budget crisis.

In New Hampshire, the combination of excellent community leaders stepping up to run and a winning strategy boosted by DLCC’s Legislative Majority PAC, brought two state House seats over to the Democratic column.

In New York, Christine Pellegrino carried Assembly District 9 by 16 points — a 23-point swing from Hillary’s 2016 performance.

In Mississippi, Kathryn Rehner secured a spot in the Oct. 3 runoff election for state House District 102, when she will have the opportunity to shatter the Republican supermajority. “This is a major opportunity for Democrats to stand up to Republican extremists and send a clear message of hope and state progress to Americans,” the Democratic Legislative Campaign Committee said in a press release.

SOLAR INDUSTRY BRACES FOR GIANT BLOW, AS TRUMP GETS TARIFFS. Donald Trump is looking for something to put tariffs on, and it looks like imported solar panels will fill the bill. The International Trade Commission (ITC), a federal agency that administers trade policy, voted (9/22) in favor of two solar cell companies that claim they were injured by low-priced Chinese solar imports, Samantha Page reported at ThinkProgress (9/22).

SolarWorld and Suniva, the companies that brought the case, have asked for a 40-cents per watt tariff on imported solar cells, but the broader solar industry, including its trade association, said those remedies would have a devastating effect on the industry, triggering 88,000 job losses and raising costs for anyone who wants solar power.

Suniva’s debtor, an investment company known as SQN, brought the case in May, shortly after Suniva declared bankruptcy. Suniva’s majority stockholder, a Chinese company, has opposed the petition. SolarWorld, a subsidiary of a German company, joined the petition the following month, then announced it would lay off more than half the workers at its Oregon factory. The solar industry has countered that the two companies suffer more from bad business decisions than from low-cost imports.

Moreover, prior to filing with the ITC, SQN suggested in a letter to the Chinese Chamber of Commerce that for $55 mln, this case would go away. The chamber has called on the US to reject SQN’s “blackmail.” 

Both Suniva and SolarWorld companies have manufacturing facilities in the United States, and both have had financial trouble in the past year, which they now blame on low-priced solar components, specifically crystalline silicon photovoltaic cells, from China.

The ITC’s investigation was carried out under Section 201 of the Trade Act of 1974. Rather than looking for illegal behavior, the ITC considers whether goods “are being imported into the United States in such increased quantities as to be a substantial cause of serious injury, or the threat thereof, to the domestic industry producing an article like or directly competitive with the imported articles.”

But federal government remedies to trade imbalances don’t always work as intended. Back in 2001, then-President George W. Bush imposed tariffs on foreign steel following a Section 201 ITC finding. The move backfired, giving only a temporary boost to the domestic steel industry before dealing a major blow to the US businesses that buy steel. Prices more than doubled, and US manufacturers started buying parts from overseas suppliers with access to cheap steel.

Trump has wide latitude to impose tariffs, set price floors, or undertake negotiations. And, so far, he has been staunchly focused on increasing jobs in fossil fuel sectors, particularly coal, which employs 50,000 miners in the US.

The industry hopes Trump will consider the effects of tariffs carefully.

“The president wants to create jobs, the president wants to maintain jobs, the president wants to incent innovation, the president wants increased energy security and economic prosperity — and that is the story of the solar industry,” Abigail Hopper, president and CEO of the Solar Energy Industries Association, said on a press call (9/22). “That is entirely resonant with his rhetoric and concerns.”

Hopper said her group remains “steadfast” that tariffs are not an appropriate remedy. There is also a “reasonable expectation” that the United States will see any tariffs challenged at the World Trade Organization, she said, although she cautioned against jumping to conclusions.

Hopper said she is skeptical that tariffs will help the companies that brought the suit. Manufacturing is a key component of the solar industry, but the US already has 36,000 manufacturing workers. The “vast majority” of those workers oppose tariffs, she said. And in the meantime, they are waiting to hear what Trump will do.

Any remedy that Trump decides on will go into effect 15 days after he signs the order.

CLIMATE DENIERS CHEER STUDY THAT SHOWS TRUMP POLICIES WILL DESTROY AMERICA. A widely misreported new study finds — just as many studies have found before — that without sharp and nearly instantaneous emissions reductions in carbon pollution, the world is headed towards catastrophic levels of global warming, Joe Romm noted at ThinkProgress (9/25).

But the authors’ original framing of their analysis — “Why the 1.5°C warming limit is not yet a geophysical impossibility” — led to Alice-in-Wonderland headlines, such as this one from Politico on Sept. 25: “Climate skeptics find new favorite talking point.”

Sure, it’s “not yet a geophysical impossibility” that the world could take the actions needed to keep total warming to about 1.5°C (2.7°F), Romm noted. It’s also “not yet a geophysical impossibility” that I could become the next President of the United States. But neither of those things are going to happen, and so neither merit a headline.

“The study has been readily misrepresented by the usual suspects in the climate denial echo chamber as calling into question the urgency of carbon emissions reductions, when it does absolutely no such thing,” climatologist Michael Mann explained in an email to ThinkProgress.

Of course, it bears pointing out that the climate change deniers invariably push absurd talking points (which SkepticalScience.com does a great job of debunking).

This study, which found that super-aggressive emissions reductions could prevent total global warming from hitting 2.7°F would raise alarm bells in a more normal media environment. After all, the world has not embraced instantaneous and sharp emissions reductions. Instead, President Trump has said global warming is a hoax and has adopted policies aimed at undermining US and global climate action.

The authors explain that there is a chance of limiting warming to 2.7°F, the level scientists and governments have declared is the safest — but only if we see “a straight line decrease in CO2 emissions from today’s values to zero in about 40 years.”

In reality, Romm noted, the world has not come close to adopting such policies. Worse, Trump’s domestic and global climate policies, which include leaving the Paris climate agreement, make them all but unattainable.

FLINT HAD A LEAD CRISIS. NOW IT HAS A FERTILITY CRISIS. In the year following the start of its water crisis, Flint, Mich., saw fewer pregnancies among its residents and higher fetal deaths, according to a working paper published in August and reported by Edwin Rios in (9/22).

Kansas University economics professor David Slusky and West Virginia University economics professor Daniel Grossman examined health statistics in Flint between May 2007 and March 2015 and compared them to 15 other cities in Michigan. What they uncovered was alarming: After April 2014—when, in an effort to cut costs, an emergency manager installed by Gov. Rick Snyder (R) ordered Flint officials to switch the city’s water supply from Detroit to the Flint River, leading to elevated lead levels in the city’s water lines—fertility rates among women in Flint dropped 12%. Fetal deaths spiked by 58%.

“This represents a couple hundred fewer children born that otherwise would have been,” Slusky said in a university press release (9/20). The researchers project that between 198 and 276 more children would have been born from November 2013, when the child was first conceived, to March 2015 had the city not switched its water supply. 

The researchers also conclude that the water change and the corresponding increased exposure to lead prompted a decline in the overall health of children born. Children exposed to high levels of lead can suffer from irreversible neurological and behavioral consequences. Moreover, children born in Flint since the start of its water crisis saw a 5% drop in average birth weight compared to those in other parts of Michigan during the same time period.

From The Progressive Populist, October 15, 2017


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