DISPATCHES

TRUMP FREEZES OBAMACARE PAYMENTS, FURTHER UNDERMINING AFFORDABLE CARE

The Trump administration is freezing a critical Affordable Care Act (ACA) insurance payment program that discourages insurers from cherry picking healthier enrollees by compensating them for sicker ones.

The cold-blooded move could rattle insurance companies at the very moment they’re deciding whether to continue selling ACA plans and setting premiums for 2019. It could further limit choices and drive up premiums.

The suspension of payouts under the program, known as risk adjustment, come in the wake of a recent decision by a federal judge in New Mexico, who ruled that part of its implementation was flawed and hadn’t been adequately justified by federal regulators, people familiar with the plans said.

“We were disappointed by the court’s recent ruling. As a result of this litigation, billions of dollars in risk adjustment payments and collections are now on hold,” said the Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma in a statement (7/7). “CMS has asked the court to reconsider its ruling, and hopes for a prompt resolution that allows CMS to prevent more adverse impacts on Americans who receive their insurance in the individual and small group markets.”

CMS argues the ruling prevents it from making further collections or payments in the risk adjustment program, including amounts for the 2017 benefit year which amount to $10.4 billion, until the litigation is resolved. However, outside experts are skeptical of the claim, since a Massachusetts based-federal judge upheld the risk adjustment formula, which means the Trump administration doesn’t need to end the payments, Amanda Michelle Gomez noted at ThinkProgress (7/7).

“Although the ongoing litigation raises the question of whether there will be a delay in risk adjustment transfers for 2017 and 2018, the payments themselves should not be at risk,” said Health Affairs’ Katie Keith.

Former CMS administrator Andy Slavitt added on Twitter that there’s “[n]ot a reason to stop all the payments unless politically motivated.”

To make it easier for people with pre-existing conditions to buy coverage and ensure market stability in the process, the risk adjustment program moves money from insurers who cover healthier populations than the statewide average to insurers who cover sicker populations.

For 2016, risk-adjustment payments were valued at 11% of total premium dollars, so insurers could lose a good amount of money. But this doesn’t affect all insurers who participate on the marketplaces, as ACA policy expert David Anderson points out. For example, insurers who are the only carriers in the state for 2017 and 2018 should remain unaffected. Nor does it mean big loses for all insurers participating in the program, as ending risk adjustment could mean windfalls for others, as Kaiser Family Foundation’s Larry Levitt said on Twitter.

The government uses a complicated formula to determine which insurers pay in and this formula was the point of contention, prompting two nonprofit insurers to file two different lawsuits.

So far, ACA marketplaces have proven to be resilient, defying expectations that Trump sabotage would destroy the exchanges. Roughly 12 million people signed up for the ACA marketplace in 2018 and insurance options are growing for 2019. That’s because companies have learned how to turn a profit, and are now joining the ACA marketplaces. That said, insurers are still submitting pricey premium rates for 2019, citing uncertainty and repeal of the individual mandate. For this reason, the market will be even less affordable for people who don’t qualify for federal subsidies.

Ending the risk adjustment program or temporarily freezing payments could unnerve insurers who thought they were in for a relatively calm ACA season. CMS added in its statement that it will issue guidance shortly on how insurers should treat the news, in terms of financial losses.

Georgetown health policy expert Edwin Park said should the risk adjustment program end, insurers over the long run “would be forced to sharply raise premiums or reconsider participation.”

LOUISIANA MEDICAID EXPANSION MAY HAVE SAVED THOUSANDS OF LIVES. In the two years since Democratic Gov. John Bel Edwards expanded Louisiana’s Medicaid health care program, more than 400 women enrolled have been diagnosed with breast cancer and are receiving treatment, Elizabeth Crisp reported in The Advocate. Nearly 8,000 adults have had precancerous colon polyps removed, and another 330 are being treated for newly diagnosed colon cancer. More than 57,000 people are receiving mental health treatment, and more than 21,000 people have received substance abuse treatment.

“This is about saving people’s lives,” Louisiana’s Health Secretary Dr. Rebekah Gee told The Advocate. More than 477,000 people who were uninsured in Louisiana now have coverage and thousands have received lifesaving care.

But all Louisiana Republicans see—like Republicans everywhere—is money being spent on what they consider an undeserving population, Joan McCarter noted at DailyKos (7/9. In fact, one Republican is considering challenging Bel Edwards for re-election on Medicaid expansion alone. “The governor’s decision to expand Medicaid without any consideration for the cost of doing so has grown the cost of health care in Louisiana at the expense of other important priorities,” says Sen. Sharon Hewitt (R-Slidell). That brought a stinging rebuke from Gov. Edwards, who nailed it. “Maybe if she doesn’t want working poor people to have health care she should just say it.”

“That’s the simple reality,” McCarter wrote. “Republicans don’t want poor people—whether they’re working or not—to have health care. Or adequate food. Or shelter. Or financial security in their old age. If they’ve proven anything in the evolution of their party, culminating in Trump, it’s that.”

BRETT KAVANAUGH — THE MAN TRUMP PICKED TO KILL THE ‘ADMINSTRATIVE STATE’. If you could grow a judge in a vat, and design every moment of their life to appeal perfectly to the Republican establishment, the man who would emerge fully-formed from that vat would be Brett Kavanaugh. A two-time Yale graduate, Kavanaugh clerked for the retiring Justice Anthony Kennedy, worked for Bill Clinton inquisitor Ken Starr, and served as one of President George W. Bush’s top aides.

Ian Millhiser noted at ThinkProgress (7/9) that Kavanaugh was a frequent opponent of President Barack Obama’s Environmental Protection Agency (EPA), and he ruled against abortion rights in one particularly heart-wrenching case. Judge Kavanaugh is smart, understands the inner workings of the federal government as well as any judge, and, if confirmed to replace Kennedy on the Supreme Court, is likely to play a major role in neutering agencies like the EPA and the Department of Labor.

Yet it is also worth noting that, when faced with conservative litigants seeking maximalist remedies from his court, Kavanaugh sometimes looked for narrow solutions. He would have allowed the Trump administration to delay the abortions to some patients, for example, without ruling that these same patients could be denied an abortion altogether. Judge Kavanaugh’s record indicates that he is very conservative, but that he may not be a nihilist in the vein of Neil Gorsuch.

If confirmed to the Supreme Court, Kavanaugh is likely to vote with the Court’s conservative bloc in nearly all cases. But he may hand conservatives incremental victories at times when they seek transformative change. The open question is whether Kavanaugh sought out incremental solutions because that is his natural preference, or because he was trying to appear relatively moderate in anticipation of a Supreme Court nomination.

Trump largely delegated the task of identifying candidates for the Supreme Court to the conservative Federalist Society, and specifically to Federalist Society executive Leonard Leo. Beginning in the later part of the Obama presidency, this Society grew obsessed with a single issue — what former Trump adviser Steve Bannon referred to as the “deconstruction of the administrative state.”

If confirmed to the Supreme Court, Kavanaugh will not disappoint the Federalists, Millhiser noted.

TRUMP ADMINISTRATION COMES OUT AGAINST BREASTFEEDING. These days, the US is on the outside looking in when it comes to global consensus on many things: Climate change, the Iran deal, and now breastfeeding.

This past spring at the World Health Assembly, the Trump administration fought a resolution to encourage breast-feeding, the New York Times reported (7/8). The resolution, which was based on decades of scientific research, encouraged countries to limit false or deceptive advertising of breast milk substitutes, and called on governments to publicly support breastfeeding.

Hundreds of government delegates at the assembly expected the resolution to be approved swiftly. But the US stepped in and took the side of infant formula manufacturers.

At first, the US delegation tried to just water down the language in the resolution, but when that didn’t work, they began to threaten and bully countries who were supporting the resolution.

Patti Rundall, the policy director of the British advocacy group Baby Milk Action, told the Times that what occurred was “tantamount to blackmail, with the US holding the world hostage and trying to overturn nearly 40 years of consensus on best way to protect infant and young child health.”

Ecuador, which was to introduce the resolution, was the first country targeted by American officials. The Times says the US threatened trade sanctions and the removal of military aid, among other things:

The Americans were blunt: If Ecuador refused to drop the resolution, Washington would unleash punishing trade measures and withdraw crucial military aid. The Ecuadorean government quickly acquiesced.

The showdown was recounted by more than a dozen participants from several countries, many of whom requested anonymity because they feared retaliation from the US.

Health advocates scrambled to find another sponsor for the resolution, but at least a dozen countries, most of them poor nations in Africa and Latin America, backed off, citing fears of retaliation, according to officials from Uruguay, Mexico and the US.

Eventually Russia decided to introduce the measure. Interestingly enough, the US did not threaten Russia like it dJid Ecuador. The resolution ended up passing, though the US did succeed in getting the language altered slightly.

The US Department of Health and Human Services, which said it did not threaten Ecuador, defended its decision to push back against the resolution.

“We recognize not all women are able to breastfeed for a variety of reasons. These women should have the choice and access to alternatives for the health of their babies, and not be stigmatized for the ways in which they are able to do so,” a spokesman told the Times.

While it is crucial, of course, to acknowledge that breastfeeding is not an option for everyone, this resolution does not mandate breastfeeding. It simply acknowledges the scientific consensus that breastfeeding is the healthiest option for infants, and works to regulate infant formula manufacturers so that they are not lying to consumers.

Officials at the assembly this spring were shocked by the Trump administration’s reaction to the resolution and support for infant formula manufacturers, but perhaps they shouldn’t have been.

At the same assembly, US leaders sided with the pharmaceutical industry and fought unsuccessfully against an effort to help poor countries get access to lifesaving medications. It also pushed, successfully, to get statements supporting soda taxes removed from guidelines for countries dealing with skyrocketing obesity rates, Lindsay Gibbs noted at ThinkProgress (7/8).

Kevin Drum noted at MotherJones.com that Trump tweeted (7/9): “The failing NY Times Fake News story today about breast feeding must be called out. The US strongly supports breast feeding but we don’t believe women should be denied access to formula. Many women need this option because of malnutrition and poverty.”

Drum added, “There is nothing in the UN resolution about denying anything to anybody. It merely encourages breastfeeding and opposes deceptive marketing of formula. As usual, Trump is lying about the whole thing.”

PRUITT’S SUCCESSOR AT EPA MAY BE MORE DANGEROUS. With scandal-plagued former Environmental Protection Agency (EPA) chief Scott Pruitt finally out, Trump supporters and industry officials are eager to portray his replacement as a vast improvement — despite the fact that he is expected to pick up right where Pruitt left off on key policies, Mark Hand noted at ThinkProgress (7/9).

Andrew Wheeler, who began his first day as acting EPA administrator (7/9), has worked almost his entire career in Washington. He’s served as an EPA staffer, top GOP aide on Capitol Hill, and high-paid coal industry lobbyist.

Republicans point to Wheeler’s tenure as a senior staffer on Capitol Hill, where he occasionally worked with Democrats to pass legislation, as an indication that he will be more amenable to compromise than Pruitt. During this time, however, Wheeler primarily worked as a top aide to Sen. James Inhofe (R-OK), one of the most anti-environment members in Congress, who did not cut many deals with Dems.

On the policy front, there’s no evidence that Wheeler intends to break from Pruitt’s pro-industry, anti-environment agenda.

In his first tweet as acting administrator, Wheeler linked to a Wall Street Journal article about him that emphasized his plan to stick with Trump’s priorities, including “changing the Clean Power Plan, de-emphasizing climate-change initiatives and improving how the agency deals with polluters and environmental crises.”

In April 2009, Wheeler wrote in a tweet, “Climate alarmists refuse to debate or leave their facts at home when they do,” E&E News reported Monday. The tweet linked to an article in the American Thinker titled “No Wonder Climate Alarmists Refuse to Debate.”

Wheeler will be more dangerous in implementing Trump’s anti-environment agenda because he’s “a lot smarter than Pruitt” and “won’t get caught doing all the stupid things that Pruitt did,” according to Scott Edwards, co-director of the food and water justice project at Food & Water Watch, a Washington-based environmental group.

“We have a bigger uphill battle because it wasn’t the policies that drove Pruitt out; it was the other craziness. But we will absolutely keep up the pressure,” Edwards said in an interview with ThinkProgress.

And in his new position as head of a regulatory agency, working in a bipartisan manner will no longer matter. Wheeler won’t need to pursue legislative compromises. His agency can act on rolling back important air and water rules and then deal with lawsuits and adverse court rulings when they come.

“Wheeler may have had to reach across the aisle to move a dirty energy agenda forward in Congress, but as EPA administrator, he won’t be constrained by needing to appear bipartisan,” Janet Redman, climate campaign director at Greenpeace USA, said in a statement emailed to ThinkProgress.

HEAT WAVES COULD RISE ANOTHER 12°F. Extreme heat smashed temperature records around the country and around the world the first week of July. But if we fail to curb emissions of carbon pollution — the path set forth by President Trump’s climate policies — these severe and deadly heatwaves will become the normal summer weather over the next few decades, Joe Romm noted at ThinkProgress (7/9).

Typical five-day heat waves in the US will be 12°F warmer by mid-century alone, according to the US National Climate Assessment (NCA), which the White House itself reviewed and approved last November.

Other studies also show the devastating heat-related impacts the nation and the world face from Trump’s policies of abandoning the Paris climate deal, undoing Obama-era climate rules, and boosting carbon pollution.

For instance, America (and much of the world) will start seeing monster “humid heat waves” — where the heat index hits a fatal 131°F — every other year by century’s end.

Heat wave records have been falling at an astonishing rate in recent days around the country and around the globe. The brutal heat has spurred wildfires, water shortages, asthma attacks, power emergencies, and the like.

In many cases, records were not simply beaten, they were obliterated. NOAA reported in Southern California, where temperature records go back 140 years, records for July 6 were disintegrated by 14°F in downtown Los Angeles and Camarillo, and by 16°F in San Luis Obispo.

The NCA also makes clear that temperature extremes rise at an even faster rate than average temperatures.

For instance, the average temperature over the country is projected to rise about 9°F by late in the century (2071-2100) in the high emissions scenario where the Paris climate agreement fails and climate action stalls. But the temperature of the warmest five-day period during a once-in-a-decade heat wave is projected to rise some 12°F just by mid-century (2036–2065) in that case.

The NCA scientists explain that to achieve the low-emissions scenario, not only does every nation — including ours — have to meet its Paris climate pledge. But we all also have to keep ratcheting down the targets “with continually increasing ambition” until global emissions of carbon pollution are near zero by century’s end.

Current extreme heat waves — and the droughts and wildfires that accompany them — are already wreaking havoc on this country and the world.

Tragically, Trump’s policies will make such heat waves simply our normal climate, and create new monster heat waves with catastrophic impacts, Romm noted.

SURELY TRUMP WILL STRIP CITIZENSHIP CAREFULLY. Here’s a bit of dark poetry: just as Alan Dershowitz suggests his banishment from Martha’s Vineyard social circles is “McCarthyism,” the Trump regime breaks out a weapon last put to use in the Red Scare — a task force formed in June to identify people who might be stripped of their citizenship. That’s at least according to Columbia University history professor Mae Ngai, who joined NPR’s Ailsa Chang to put the administration’s new denaturalization task force in context:

CHANG: Naturalization ceremonies carry with them a sense of permanence. They signify an end to an often long immigration process. But last month, US Citizenship and Immigration Services started a task force to review cases where people may have lied in order to get citizenship. And now the administration says it could be denaturalizing potentially a few thousand people ... Is what the Trump administration doing here new? I mean, is there historical precedent for devoting resources like this to trying to detect citizenship fraud?

NGAI: The last time the federal government tried to denaturalize citizens was during the McCarthy period. And they went after people who they were accusing of being Communists who were naturalized citizens. And they took away their citizenship and deported them. It wasn’t that many people because, actually, it’s not that easy to do. But that was the last time that there was a concerted effort. So it’s been...

CHANG: Wow.

NGAI: ...Almost 75 years...

CHANG: Wow.

NGAI: ...Since the government has tried to do it. And I think most people would say that the Red Scare, or the McCarthy period, was not the nation’s proudest moment.

Jack Holmes noted at Esquire (7/5) that “while the government has always investigated when someone comes forward with a charge against a naturalized American citizen, this is the first time since Joe McCarthy we have a dedicated task force to try to ferret people out. As Jamelle Bouie put it very neatly in Slate, this is simply the latest attempt on the part of Republicans-before and, with a turbo charge, under this president-to prevent the browning of America, or at least the American electorate.

“But perhaps the most immediately pressing issue is that this administration cannot be trusted to restrict the task force’s operations to investigating people who allegedly lied during the naturalization process. Trump’s White House has displayed a generalized hostility to immigration best summed up in its proposal to cut legal immigration in half. At the border, Attorney General Jeff Sessions has sought to criminalize asylum-seekers-who are pursuing a human right under international law and treaties to which the United States is a signatory-by preventing them from presenting themselves at official checkpoints and restricting the criteria for seeking asylum.

“And most precisely, Immigrations and Customs Enforcement (ICE) has a pattern of arresting people without warrants, denying them due process, and even accusing people of having gang affiliations without evidence in order to detain them. Clearly, this is not an administration whose respect for individual rights or domestic and international law outweighs its desire to remove Certain People from the country. It would be foolish to believe that will change once they start trying to strip people of citizenship.”

RURAL GROUPS URGE CONGRESS INVEST IN RURAL BUSINESS. Days after the House of Representatives passed its version of the Agriculture and Nutrition Act of 2018, commonly known as the farm bill, 23 rural organizations participating in the Rural Microentrepreneur Assistance Program (RMAP) joined a letter calling on senators to fund $3 million annually for the program in their competing farm bill proposal.

RMAP provides access to loan capital through grants to organizations that provide training, technical assistance, or small loans to rural businesses nationwide. Since its creation in 2008, the program has helped 2,100 small businesses by creating jobs and expanding consumer access to goods and services in underserved areas.

The Senate passed its farm bill proposal (6/28), failing to include funding for RMAP.

Organizations endorsing the letter span 15 states and are engaging senators as they head to the Joint Conference Committee where a final deal will be reached with the House.

“Rural businesses play an important role in our nation’s economy, and it is critical that Congress supports RMAP with mandatory funding,” said Cora Fox, policy associate at the Center for Rural Affairs, which also endorsed the letter. “Without RMAP, countless small businesses will lose access to funds that make them economic anchors in tens of thousands of rural communities.”

Between 1995 and 2015, many rural banks closed, increasing the percentage of rural areas without a local bank from 12 to 32 percent and further restricting access to loans for many small businesses.

“RMAP helps spark innovation and economic activity in rural areas where it is sorely needed,” said Anna Johnson, senior policy associate at the Center for Rural Affairs. “Small scale entrepreneurship is a proven strategy to revitalize rural communities, and RMAP can help create genuine opportunity across rural America with modest public investment.”

Funding for RMAP is set to expire on Sept. 30, 2018, unless renewed in the farm bill.

Organizations signing the letter include Arkansas: Communities Unlimited, Inc., Fayetteville; California: California FarmLink, Santa Cruz; Feed the Hunger Foundation, San Francisco; Jefferson Economic Development Institute, Mount Shasta; Terra Green Community Development Corporation, Alameda; Colorado: Community Resources and Housing Development Corporation, Westminster; Idaho: Clearwater Economic Development Association, Lewiston; Kentucky: Community Ventures Corporation, Lexington; Maine: Community Concepts Finance Corporation, Lewiston; MaineStream Finance, Bangor; Northern Maine Development Commission, Caribou; Maryland: Eastern Shore Entrepreneurship Center, Easton; Massachusetts: Quaboag Valley Community Development Corporation, Ware; Michigan: Northern Initiatives, Marquette; Montana: MoFi, Missoula; Nebraska: Center for Rural Affairs, Lyons; First Ponca Financial, Grand Island; New Jersey: Cooperative Business Assistance Corporation, Camden; Oregon: Klamath Lake Regional Housing Center (KLRHC), Klamath Falls; Pennsylvania: Community First Fund, Lancaster; South Dakota: Glacial Lakes Area Development, Britton; Lakota Funds, Kyle; Washington: Seattle Economic Development Fund dba Business Impact NW, Seattle.

From The Progressive Populist, August 1, 2018

Populist.com