Tag Archives: health

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

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"

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?

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

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.

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.

View article: 

Tesla’s parking lot is a nightmare hellscape.

Posted in alo, Anchor, FF, G & F, GE, LAI, LG, ONA, Radius, solar, Ultima, Uncategorized | Tagged , , , , , , , , | Leave a comment