Rss Feed
Tweeter button
Facebook button

Cleanup From California Fires Poses Environmental and Health Risks

And the process of cleaning it all up, which has not even begun, is very likely to bring its own thorny set of issues, in the costs, timetables and liability questions — all compounded by scale, in the thousands of properties that must be repaired and restored.

“In modern times this has got be an unprecedented event, and a major hazard for the public and for property owners,” said Dr. Alan Lockwood, a retired neurologist who has written widely about public health. He said an apt comparison might be the environmental cleanup after the terrorist attacks of Sept. 11, 2001, in New York, as debris and dust swirled through Lower Manhattan.

Photo


National Guard members helped returning residents dig through the debris of their homes in the Larkfield area of Santa Rosa, Calif.

Credit
Jim Wilson/The New York Times

As could well happen too in California, Dr. Lockwood said, the health and environmental effects were felt long after the attack, in the chemicals or pollutants workers and responders at the site, and the public at large, may been exposed to as the cleanup went on.

Household building materials are obviously different from the components of a concrete tower. But they pose risks too. Treated wood in a house’s frame, for instance, put there to prevent bacteria growth, can contain copper, chromium and arsenic. Consumer electronics contain metals like lead, mercury and cadmium. Older homes might have asbestos shingles. Even galvanized nails are a concern because when they melt they release zinc. All are potentially harmful.

“It’s a completely complex mixed bag of different stuff that’s there,” said Geoffrey S. Plumlee, associate director for environmental health with the United States Geological Survey.

Dr. Plumlee led a study after several Southern California wildfires in 2007 that found that ash from burned-out residential areas contained elevated levels of arsenic, antimony and metals including lead, copper and chromium. In most cases the levels were above federal Environmental Protection Agency guidelines for soil remediation.

After a fire in Slave Lake, Alberta, in 2011 that destroyed about 400 homes, the city landfill was found to be leaching toxins after fire debris was deposited there.

Advertisement

Continue reading the main story

In California, the road ahead to cleanup and the safe return to properties will probably not be smooth or fast, public health officials and cleanup experts said. The sheer number of communities affected and properties destroyed creates a greater challenge than any the state has faced in recent history.

Local and state agencies, focused on active fires, have not yet sorted out who will take the leadership roles. Even determining how severely lands are affected and the estimated costs of remediation lay ahead in the weeks and months to come.

At a packed public meeting in the basketball gym at Santa Rosa High School on Saturday, some residents said they worried that the cleanup could go on for years and asked state officials if they could proceed on their own.

Photo


Chris Pierce, left, and Nick Mueller moved a bell that belongs to Mr. Pierce’s 98-year-old grandmother.

Credit
Jim Wilson/The New York Times

The answer they got was a qualified yes. An approved contractor can be hired, if one is available. Otherwise the cleanup should be free in most cases, residents were told, paid for with taxpayer money or private insurance if a homeowner has a debris-removal clause in the insurance policy on the house.

But state and federal officials said on Monday that many of the details of how this cleanup would work remained unsettled. That is partly because the focus has been on response to the fires and the fatalities, and the 40,000 people still evacuated from their homes, but also because of the complex mix of properties affected on both public and private lands.

“There are more questions than answers,” said David Passey, a spokesman for the Federal Emergency Management Agency. He said, for example, that FEMA, the federal government’s lead disaster response agency, typically concentrated on public property, not private, unless individual counties declare the private properties a public health and safety risk. Counties and cities can also take the lead on cleanup, he said, and that too has not been fully sorted out.

Newsletter Sign Up

Continue reading the main story

“We don’t know yet which of those solutions, or mixture of those solutions, the cities and counties will choose,” Mr. Passey said.

Mark Oldfield, a spokesman for the California Department of Resources Recycling and Recovery, which administers state-managed waste handling and recycling programs, said a typical situation for cleanup would include a kind of triage, with the most hazardous materials as a site handled first, typically by the California Department of Toxic Substances Control. That agency would evaluate and remove hazardous debris, which can range from asbestos siding or pipe insulation to paints, batteries, flammable liquids and electronic waste like computers and monitors.

After that, contractors under CalRecycle’s auspices could focus on remaining debris removal for recycling (metals and concrete) or disposal (ash and contaminated soil), Mr. Oldfield said. Then the land could be prepared for potential rebuilding. But, he added, “With fires still active in many areas, there is not yet a timetable for cleanup efforts to begin.”

Advertisement

Continue reading the main story

Dr. Relucio, Napa County’s public health director, said that in the meantime, people who go back to their properties should protect their eyes, lungs and skin, with long sleeves and pants, boots, glasses, and a good quality N95-rated mask available in most hardware stores.

Dr. Lockwood said a secondary caution for anyone entering a burned site is human idiosyncrasy, in the things people store in garages, use in their hobbies or just never got around to throwing away.

“One never knows what people have stashed in their homes,” he said.


Continue reading the main story

Article source: https://www.nytimes.com/2017/10/16/us/california-fires-cleanup.html

Health insurance is good not just for individuals but for democracy


President Trump holds up an executive order on health care after signing it during a ceremony in the Roosevelt Room of the White House on Oct. 12, 2017. (Michael Reynolds/European Pressphoto Agency/EFE/REX/Shutterstock)

For the past seven months, Americans have watched and weighed in as Congress considered the continued existence of the Affordable Care Act (ACA). Last Thursday, the Trump administration announced that the government would stop subsidizing insurers for making premiums and deductibles more affordable for low-income customers. Most of the discussion to date has been about whether these plans are good for families, and if so, which ones. But what if insurance had another value, beyond protecting individuals from financial and health risks? What if it was good for democracy?

Here’s how we’ve talked about insurance up to now

This year’s debates about health-care reform have produced some memorable sound bites. In March, House Speaker Paul D. Ryan (R-Wis.) said: “The fatal conceit of Obamacare is that ‘we’re just going to make everybody buy our health insurance at the federal government level.’ … The people who are healthy pay for the people who are sick. It’s not working, and that’s why it’s in a death spiral.” In September, Trump economic adviser Stephen Moore told CNBC’s John Harwood that “people want insurance for their own families, not other people’s.”

Ryan and Moore’s harshest critics suggested that neither of them understand how health insurance works. But their comments reveal something else: Their baseline assumption is that individuals evaluate the worth of health insurance based on self-interest and personal economic calculus.

It’s true. People do want health insurance to protect themselves and their families, and oftentimes we articulate this in financial terms. Congressional Democrats have appealed to this idea in opposing ACA repeal. Their refrain is that families shouldn’t go bankrupt if someone becomes sick and that no one should die because they cannot afford medical coverage. They argue that keeping the ACA, or making it more inclusive through reforms, will protect individuals and families medically and financially.

These are important considerations, as any person who has ever lived on a budget and needed to go to the hospital knows. But they’re not the only ones.

There’s also an argument for the broad value of insurance for democracy

Daniel Defoe — a 17th- and 18th-century businessman and writer best known for his novel “Robinson Crusoe” — argued that insurance is a public good.

In An Essay Upon Projects (1679), Defoe evaluates (among other ideas) “friendly societies,” mutual aid associations formed by ordinary people. In these voluntary organizations, members paid fees to create a pool of assistance that would be available to any member who needed it. Friendly societies provided, in a word, insurance — fire insurance, livestock insurance, life insurance and health insurance.

Defoe generally approves. He argues that friendly societies have outsized potential to help protect members from the “miseries … and distresses” the future might hold — and to make life better for everyone. He even suggests these insurance pools may even harbor the potential for world peace.

Why such a bold claim?

Defoe’s argument for the positive potential of friendly societies depends on two values they embody: solidarity and equity.

Friendly societies promote solidarity because they encourage interdependence among individuals. Members regularly paid dues and fees into a common pool, with no knowledge of whether they would ever draw on them as individuals, on the off-chance they would need help themselves one day.

Defoe focuses on the larger picture, though. He stresses that these societies were a social project, one that offered security to the group (or to use his word, “mankind”) through solidarity. The political value of friendly societies is that they bonded people together against a risky future.

Defoe also identifies equity as a core principle of the friendly society, although a challenging one to achieve. He worries about whether friendly societies were organized fairly and shares ideas for promoting equity within them. He suggests, for example, that people in high-risk professions form their own insurance pools instead of banding together with people in lower-risk jobs.

But Defoe still praises friendly societies for at least trying to live up to the principle of equity. He says, “To argue against the lawfulness of [friendly societies] would be to cry down common equity as well as charity: for it is kind that my neighbor should relieve me if I fall into distress or decay, so it is but equal he should do so if I agreed to have done the same for him.” When we make such solidaristic commitments to our fellow citizens, we commit to treating them equitably. Defoe saw social insurance as one way to inject more equity into society.

Of course, “friendly societies” are a far cry from vast insurance companies

Defoe’s ideas about friendly societies might seem out of step with the concerns of 21st-century Americans. He was talking about small voluntary groups, and most Americans today buy insurance from large, for-profit corporations. Even those who turn to social welfare programs like Medicare and Medicaid interact with large bureaucracies. Is his defense of insurance as a relationship of solidarity and equity still applicable to us?

In a mass democracy like the United States, solidarity and equity are hard values to realize, but they are ones we still hold. We can see that, for example, in what Tennessean Jessi Bohon said when she stood up in a town hall in February and argued for the ACA’s individual mandate: “As a Christian, my whole philosophy in life is to pull up the unfortunate. So the individual mandate, that’s what it does. The healthy people pull up the sick.” She supported her position using the value of solidarity. (As an aside, Bohon’s link between the mandate and Christian charity would have made sense to Defoe, too.)

We’ve also seen appeals to equity. For example, when Planned Parenthood supported passage of the ACA, they did so based on the principle of fairness, arguing that by subsidizing birth control and mammograms it corrected a gender imbalance in health care costs. Similarly, when Sen. Lindsay O. Graham (R-S.C.) reflected on why the ACA should be replaced, he said that it didn’t recognize that different states have very different needs. He argued it isn’t equitable.

These scattered comments point us toward a conversation about the social value of insurance. Although politicians and policymakers will continue to appeal to individual self-interest as they try to gain support for their reforms, they might also wish to explain how their plans embody democracy’s social goods: solidarity, equity and fairness.

Emily Nacol is an assistant professor of political science at the University of Toronto. She is the author of An Age of Risk: Politics and Economy in Early Modern Britain.

Article source: https://www.washingtonpost.com/news/monkey-cage/wp/2017/10/16/health-insurance-is-good-not-just-for-individuals-but-for-democracy/

Jimmy Kimmel on Health Care, National Tragedies and Twitter Feuds

This week, Mr. Kimmel is in New York, where he will record “Jimmy Kimmel Live!” from the Howard Gilman Opera House at the Brooklyn Academy of Music. On Sunday, Mr. Kimmel spoke in an interview there about how he sees his role as a host, comic and commentator on events of the day. These are edited excerpts from that conversation.

Advertisement

Continue reading the main story

How is Billy doing?

He’s doing well. He’s going to have another operation coming up soon, and another when he’s around 8 to 10 years old. But he’s doing well.

Thinking back to that first monologue where you talked about him and the circumstances of his birth, was that difficult for you to perform? Did you hesitate to share that with your audience?

No, but in retrospect, perhaps I should have. Because what I didn’t think through was that, everywhere I went, every day of my life, people would be asking me how my son is doing.

As I just did.

But thank God I can say he’s doing well. If that wasn’t the case, each day would be very, very painful. But I also felt like I had to say something. Because I’d been talking about the fact that my wife [Molly McNearney, the co-head writer of “Jimmy Kimmel Live!”] was pregnant for six months. I left for paternity leave and then I didn’t come back. That was something I had to address.

Looking at the totality of these monologues, the ones that have dealt with health care and gun control, do you feel that you, or how you approach the show, have been changed in a way that can’t be undone?

It does make you think a little bit more about what you say and maybe you choose your words a bit more carefully. I don’t ever want to get in a situation where I feel compelled to speak about every tragedy, every natural disaster, every murder or car accident or whatever horrible things are going on in the world. If I do that, no one will be interested. You can overdo it.

One of the criticisms you faced for your monologues about health care was that you’d gotten some of your information from Senator Schumer. Is that correct that you did, and is this a fair criticism?



The Best TV Shows and Movies New to Netflix, Amazon and More in October

New movies and TV shows are added to streaming platforms each month. Here are the titles we think are most interesting in October.


I did, but I will say I talked to Chuck Schumer three times for, probably, a total of less than eight minutes. As I’ve said, I didn’t know anything about health care and I wanted to educate myself beforehand. I reached out to a lot of people so I could get my facts straight and find out what the arguments would be.

Advertisement

Continue reading the main story

This notion that they were pulling my strings is one created by right-wing media outlets. It’s just a way of putting a pin in something that scares them. I don’t know why the idea of making sure every American is taken care of should scare a politician. It certainly doesn’t scare the average guy who’s got a job that he doesn’t like and is afraid to quit it because he’s got a pre-existing condition and he may well not get another good job with insurance.

Do you think some of your detractors are trying to influence what you can or can’t talk about on your show?

Newsletter Sign Up

Continue reading the main story

I think some of them are. I think some of them are just trying to get Fox News to hire them as on-air commentators. It’s sad. You see people try to engage me in battle that are just trying to give their careers a boost. I won’t be a part of that. With the rare exception.

Like your back-and-forth on Twitter with Donald Trump Jr.?

I think he’s just trying to position himself as someone of importance, and he seems to be looking for high-profile media figures to fight with. If you go through his Twitter feed, it’s one desperate cry for attention after another. For whatever reason, I decided to give some to him.

Has there ever been a moment over these recent months, as you’ve waded further into these politicized debates, where ABC stepped in and said, “You can’t do that”?

No, never. They had more concerns about my beard.

Some people have looked back to the comedy you were doing on “The Man Show,” which was often crude and chauvinistic, and said, who is he to get up on his high horse? Does that past work invalidate what you’re saying now?

Of course not. One has nothing to do with the other. It is almost impossible to offend me when your intent is to make a joke. Sometimes people go too far, and that is one of the perils of being a comedian, and if you don’t ever go too far, you’re probably not a particularly interesting comic. Comedians need a place to experiment, to try things, to bounce things off the wall. Comedy will be worse for it if we don’t allow it.

You hosted “The Man Show” with Adam Carolla and “Win Ben Stein’s Money” with Ben Stein, who are both more politically conservative than you. Are you still close with them?

To this day, they’re two of my best friends. I’ve had 15 email interactions with Ben Stein over the last 96 hours. Not quite as many with Adam, he’s not a big emailer. It helps me to figure out what I believe. It teaches me and it teaches them how to have a real conversation without just declaring someone the enemy and retreating to your corner.

Advertisement

Continue reading the main story

For viewers who perhaps once thought of you as a more all-around host — a political centrist, or a refuge from politics altogether — does it concern you if some of these viewers drift away from the show?

It concerns me, but not enough to change what I’m doing. Of course, you want as many people to watch your show as possible. But some things are more important than bringing in a big audience. I hope that we, as a nation, get back to a time where I can have a normal, well-rounded show, that’s more focused on Beyoncé and Jay-Z than Donald and Ivanka. But for the time being, this is what’s at the forefront of people’s minds.

Jimmy Fallon said in a recent interview that he doesn’t care as much about politics and is not trying to do so many Trump jokes. Is that even possible anymore as a late-night host? Does every comedian have to have a political point of view now?

I don’t think so. Jimmy Fallon, he’s just being true to himself. There are people who don’t care about politics. I certainly know people who care much more about football. Although it’s hard to tell what is football and what is politics nowadays.

Continue reading the main story

Article source: https://www.nytimes.com/2017/10/15/arts/television/jimmy-kimmel-politics.html

Collins: Trump should back effort to resume health subsidy

A key moderate Republican is urging President Donald Trump to support a bipartisan Senate effort to reinstate insurer payments, calling his move to halt the subsidies an immediate threat to millions of Americans who could now face rising premiums and lost health care coverage.

“What the president is doing is affecting people’s access and the cost of health care right now,” said Sen. Susan Collins of Maine, who has cast pivotal votes on health care in the narrowly divided Senate. “This is not a bailout of the insurers. What this money is used for is to help low-income people afford their deductibles and their co-pays.”

“Congress needs to step in and I hope that the president will take a look at what we’re doing,” she added.

Her comments Sunday came amid rising attention on the bipartisan bid led by Sens. Lamar Alexander, R-Tenn., and Patty Murray, D-Wash., to at least temporarily reinstate the payments.

Congressional Republicans are divided over the effort. And White House budget director Mick Mulvaney has suggested that Trump may oppose the agreement unless he gets something in return — such as a repeal of former President Barack Obama’s health care law or funding of Trump’s promised wall on the U.S.-Mexico border.

The insurer payments will be stopped beginning this week, with sign-up season for subsidized private insurance set to start Nov. 1.

“The president is not going to continue to throw good money after bad, give $7 billion to insurance companies unless something changes about Obamacare that would justify it,” said Sen. Lindsey Graham, R-S.C., who golfed with Trump Saturday at the Trump National Golf Club in Sterling, Virginia.

“It’s got to be a good deal,” Graham said.

In his decision last week, Trump derided the $7 billion in subsidies as bailouts to insurers and indicated he was trying to pressure Democrats into negotiating an Obamacare repeal, a bid that repeatedly crashed in the GOP-run Senate this summer.

The subsidies are designed to lower out-of-pocket costs for insurers, which are required under Obama’s law to reduce poorer people’s expenses — about 6 million people. To recoup the lost money, carriers are likely to raise 2018 premiums for people buying their own health insurance policies.

Alexander and Murray have been seeking a deal that the Tennessee Republican has said would reinstate the payments for two years. In exchange, Alexander said, Republicans want “meaningful flexibility for states” to offer lower-cost insurance policies with less coverage than Obama’s law mandates.

On Sunday, House Minority Leader Nancy Pelosi, D-Calif., described Trump’s demand for a sit-down with congressional Democratic leaders as “a little far down the road,” noting that nothing in Trump’s proposals to repeal Obamacare indicates what would replace it. Pelosi pointed to the bipartisan effort in the Senate and said ultimately it will be up to a Republican-controlled Congress and executive branch whether the federal government can avert a shutdown by year’s end.

The government faces a Dec. 8 deadline on the debt limit and government spending.

“We’re not about closing down government. The Republicans have the majority,” Pelosi said. “In terms of the health care, we’re saying ‘Let’s follow what Sens. Murray and Alexander are doing.’”

“They’re trying to find common ground, and that should be encouraged,” she added.

The scrapping of subsidies would affect millions more consumers in states won by Trump last year, including Florida, Alabama and Mississippi, than in states won by Democrat Hillary Clinton. Nearly 70 percent of the 6 million who benefit from the cost-sharing subsidies are in states that voted for the Republican.

Republican Gov. John Kasich of Ohio said Sunday his state had anticipated that the insurer payments would be halted, but not so quickly. He called for the payments to be reinstated right away, describing a hit to Ohio — a state also won by Trump last November — for at least the “first two or three months.”

“Over time, this is going to have a dramatic impact,” Kasich said. “Who gets hurt? People. And it’s just outrageous.”

Nineteen Democratic state attorneys general have announced plans to sue Trump over the stoppage. Attorneys general from California, Kentucky, Massachusetts and New York were among those saying they will file the lawsuit in federal court in California to stop Trump’s attempt “to gut the health and well-being of our country.”

Collins appeared on ABC’s “This Week” and CNN’s “State of the Union,” Pelosi spoke on ABC, Graham appeared on CBS’ “Face the Nation,” and Kasich was on NBC’s “Meet the Press.”

———

Follow Hope Yen on Twitter at https://twitter.com/hopeyen1

Article source: http://abcnews.go.com/Health/wireStory/collins-trump-back-effort-resume-health-subsidy-50503047

AP FACT CHECK: Trump’s tax plan, health care distortions

President Donald Trump presented a distorted picture of his tax plan this past week and claimed he was trying to keep the Obama health law’s insurance markets afloat even as he took steps that could well sink them.

A look at his statements on a grab-bag of hot topics spanning the economy, Iran, health care and the way he treats his subordinates:

TRUMP on President Barack Obama’s health overhaul: “What we’re doing is trying to keep it afloat, because it’s failing.” — Forbes interview, conducted Oct. 6 and reported this past week.

THE FACTS: Days later, Trump pulled the plug on payments to insurers that are critical to making copayments and deductibles more affordable in the subsidized individual insurance market. Barring a reversal by Congress, the courts or administration policy, the move probably will drive up costs substantially for many in the health exchanges, send insurers fleeing from the already troubled marketplace, or both. Trump makes no secret of his wish to repeal the Affordable Care Act. But he had been casting a lifeline to those exchanges by making the payments month to month. Now he’s yanked that back.

Trump also directed his administration to rewrite federal rules to ease the way for “association health plans” that could offer cheaper coverage with fewer protections than are guaranteed in the law’s health plans. That, too, potentially undermines the 2010 law. Furthermore, his administration said before this week that it is sharply cutting programs that promote health insurance enrollment under the law for next year.

———

TRUMP: “I’m giving the largest tax cuts in the history of this country.” — comments Tuesday after meeting Henry Kissinger.

THE FACTS: His tax plan is, at most, fifth largest in its estimated cost, says Marc Goldwein of the nonpartisan Committee for a Responsible Federal Budget. It could end up being even lower on the ladder historically.

The estimated cost of the tax plan has dropped by half or more since the spring, when only the contours were known. In an analysis in April, Goldwein’s group found that the $5.5 trillion plan that was then expected would have been the third largest since 1940 as a share of gross domestic product, behind President Ronald Reagan’s package in 1981 and tax cuts enacted in 1945 to phase out revenue generated for World War II. But, citing estimated costs of $1.5 trillion to $2.5 trillion for Trump’s plan now, Goldwein said several other historically significant tax cuts also would surpass Trump’s: from 2013 and 1964.

———

TRUMP: “Since the election on November 8th, I’ve increased the value of your U.S. assets by more than the $20 trillion that we currently owe.” — comparing rising values with the national debt, in a speech Wednesday to truckers in Pennsylvania.

THE FACTS: Trump’s suggestion that his election is the solitary explanation for higher stock and home prices does not reflect how the economy works. Trump’s election and the promise of a tax overhaul certainly helped the stock market at first. But recent gains also reflect better global growth and other factors that are beyond the president’s control.

Most Americans’ primary asset is their home, and there is little evidence that home values are rising because of Trump’s presidency. Much of the increase in home values reflects a dwindling supply of properties on the market relative to demand from would-be buyers. People’s net worth has improved because mortgage debt is being repaid, increasing the equity they have in their homes.

Meantime, the International Monetary Fund expects world economic growth will reach a six-year high this year. Three-quarters of the globe is experiencing growth, the first synchronized worldwide upswing in a decade. That’s a big boost for U.S. companies that earn much of their money overseas, and a lift for the U.S. stock market.

Also, people’s rising stock and home values do not mean a paying down of the federal government’ debt.

———

TRUMP: “When it comes to the business tax, we are now dead last among developed nations. Our rate is the least competitive rate. We have the highest tax rate anywhere in the world. How foolish is this?” — Pennsylvania speech.

THE FACTS: This is a misleading picture and one he paints continually. The U.S. does have the highest statutory corporate tax rate, but that doesn’t tell the full story. Other countries with lower corporate taxes also charge a separate tax on consumption, known as a Value Added Tax, that lets them keep corporate rates lower. The overall tax burden in the United States is among the lowest in the developed world.

———

TRUMP: “We are nearly doubling the amount of income that is based at the zero bracket.” Democrats are “not telling you the truth, because they pretend there isn’t a zero rate. And there is, and it’s expanding very substantially under my plan.” — Pennsylvania speech.

THE FACTS: Some people who accept that statement at face value are bound to get sticker shock at tax time, if his plan is adopted.

With the “zero” tax rate, Trump is talking about his proposed doubling of the standard deduction. While the higher standard deduction would exclude the first $24,000 in family earnings from taxes, the plan would also get rid of the personal exemption. The loss of the exemption would expose some families — particularly larger ones — to higher taxes than the doubling of the standard deduction.

———

TRUMP: “The Iranian regime has committed multiple violations of the agreement. For example, on two separate occasions, they have exceeded the limit of 130 metric tons of heavy water.” — remarks Friday criticizing Iran’s behavior while stopping short of pulling the U.S. out of the nuclear agreement.

THE FACTS: Iran is meeting all its obligations under the deal that suspended its nuclear program in return for eased international sanctions, according to International Atomic Energy Agency investigators. They did note some minor violations that were quickly corrected.

Trump is right that Iran exceeded the limit on heavy water in its possession on two occasions. Both times international inspectors were able to see that Iran made arrangements to ship the excess out of the country so that Tehran could come back into compliance.

Supporters of the deal argue that this shows the agreement works. Opponents say that because Iran sells the surplus on the open market, it is therefore being rewarded for violating the deal.

Trump and other critics of the agreement point in particular to Iran’s continuing missile tests, which may or may not defy the U.N. Security Council resolution that enshrined the deal. But those tests do not violate the deal itself.

———

TRUMP: “I will tell you, I left Texas and I left Florida, and I left Louisiana, and I went to Puerto Rico, and I met with the president of the Virgin Islands. These are people that are incredible people.” — speech to religious conservatives Friday.

THE FACTS: He met the governor of the U.S. Virgin Islands, Kenneth Mapp, not a president. It’s not a country so it doesn’t have a president. He correctly referred to the Virgin Islands and Puerto Rico as territories. At a congressional hearing a day earlier, Energy Secretary Rick Perry called Puerto Rico “a country that already had its challenges before the storm,” and apologized when told of the flub.

———

TRUMP: “I don’t believe in undercutting people.” — comments to the press Tuesday, when asked about Secretary of State Rex Tillerson.

THE FACTS: If a boss’s public disparagement of those who work for him counts as undercutting, Trump undercuts.

He used Twitter to undercut Tillerson’s diplomatic outreach to North Korea (“save your energy, Rex”), then suggested he’s got a higher IQ than his chief diplomat. This, after NBC News reported that Tillerson had described Trump as “moron.”

Trump also used Twitter and other forums in the summer to humiliate his “very weak” and “beleaguered” attorney general, Jeff Sessions.

If publicly disparaging political associates counts as undercutting, too, the list is very long.

He barked at Senate Majority Leader Mitch McConnell, R-Ky., to “get back to work” after the collapse of an effort to repeal the health law; said Republican senators “look like fools”; and branded Sen. Bob Corker, R-Tenn., “Liddle’ Bob Corker” after the senator slammed him on multiple fronts.

Consciously or not, Trump’s energy-saving advice to Tillerson and his comment on Corker’s height recalled the taunts he directed against his 2016 Republican primary rivals, “low energy” Jeb Bush and “Little Marco” Rubio, the Florida senator.

Trump spokeswoman Sarah Huckabee Sanders argued it’s impossible for a president to undercut his Cabinet because “the president is the leader of the Cabinet. He sets the tone, he sets the agenda.”

———

TRUMP: “The Failing @nytimes set Liddle’ Bob Corker up by recording his conversation. Was made to sound a fool, and that’s what I am dealing with!” — tweet Tuesday.

THE FACTS: The Times wasn’t sneaky in recording the interview. Corker asked that he be recorded, mentioning that his aides were also on the line: “I know they’re recording it, and I hope you are, too,” he told his interviewer. He also said: “I understand we’re on the record.” Corker said in the interview that Trump risked putting the U.S. on a path to world war and treated his office like a reality TV show.

———

TRUMP: “So GDP last quarter was 3.1 percent. Most of the folks that are in your business, and elsewhere, were saying that would not be hit for a long time. You know, Obama never hit the number.” — interview with Forbes magazine.

THE FACTS: Yes, Obama did, repeatedly. Growth topped 3 percent in eight quarters during Obama’s presidency.

When Forbes pointed out that Obama had reached that benchmark, Trump amended his claim: “He never hit it on a yearly basis.”

That’s true. The economy never grew by more than 3 percent for a full calendar year under Obama. That hasn’t happened since 2005. It is unlikely to happen this year, either.

———

TRUMP: “I’ve had just about the most legislation passed of any president, in a nine-month period, that’s ever served. We had over 50 bills passed. I’m not talking about executive orders only, which are very important. I’m talking about bills.” — Forbes interview.

THE FACTS: He’s signed little of consequence into law, a thin record all the more striking because of the Republican majority in the House and Senate. His record pales not just next to Franklin Roosevelt’s but with Obama’s and others. Trump, like his predecessors, has signed a lot of routine legislation, naming federal buildings after people and the like. He’s also signed emergency hurricane aid into law.

But the only far-reaching bill he’s signed is one he didn’t like but went along with, tightening sanctions on Russia and Iran. His promised repeal and replacement of Obama’s health care law has yet to materialize after twice failing in Congress. His proposed tax overhaul is in play, not in place, and the big-ticket infrastructure initiative he promised hasn’t come to Congress.

———

TRUMP: “Now, we’re going to have to do something with Obamacare because it’s failing. Henry Kissinger does not want to pay 116 percent increase in his premiums, but that’s what’s happening.” — after meeting Kissinger on Tuesday.

THE FACTS: Kissinger is going to be OK. The 94-year-old former secretary of state and national security adviser, chairman of his own international consulting firm and prolific author, is surely not bothered by rising premiums. People on Medicare can’t sign up for the insurance exchanges anyway.

But what to make of Trump’s suggestion that people in the exchanges are seeing premiums rise 116 percent? That comes from one state, Arizona, where unsubsidized premiums for a hypothetical 27-year-old buying a benchmark plan under Obama’s law increased 116 percent this year, according to an earlier government estimate. That cost, however, could be reduced significantly with subsidies available to low- and moderate-income people.

———

WHITE HOUSE PRESS SECRETARY SARAH HUCKABEE SANDERS: “Sen. Corker worked with Nancy Pelosi and the Obama administration to pave the way for that legislation and basically rolled out the red carpet for the Iran deal.” — briefing Tuesday.

TRUMP tweet Oct. 8: “He is also largely responsible for the horrendous Iran Deal!”

THE FACTS: Corker, chairman of the Senate Foreign Relations Committee, had no role in crafting the 2015 international agreement forged by the U.S. and other world powers to constrain Iran’s ability to build a nuclear arsenal. Corker actually was a vocal opponent of the accord and argued Obama should have made the international pact a treaty subject to approval by the Senate.

When Obama didn’t do that, Corker helped fellow senators write legislation that subjected the accord to periodic congressional review. The legislation would have stopped the deal from moving forward if that effort got enough votes. It didn’t. In any event, the ultimate decision to bring the deal into effect was made by Obama, not Congress.

———

Associated Press writers Ricardo Alonso-Zaldivar, Donna Cassata, Christopher S. Rugaber and Richard Lardner contributed to this report.

———

Find AP Fact Checks at http://apne.ws/2kbx8bd

EDITOR’S NOTE _ A look at the veracity of claims by political figures

Article source: http://abcnews.go.com/Health/wireStory/ap-fact-check-trumps-tax-plan-health-care-50479730

Sword Swallower Makes Triumphant Return As He Battles Severe Health Issues

Johnny Fox hugs a fan at the Maryland Renaissance Festival. This fall, Fox has made a triumphant comeback even as he battles with health issues.

Mark Mitton/NPR


hide caption

toggle caption

Mark Mitton/NPR

Johnny Fox hugs a fan at the Maryland Renaissance Festival. This fall, Fox has made a triumphant comeback even as he battles with health issues.

Mark Mitton/NPR

When Johnny Fox was a boy, all his friends were obsessed with superheroes.

“Friends of mine were reading comics about Superman and Batman and I thought, ‘You know, this is cartoons and made-up stories,’ ” he says. “I want a real superhero. There’s got to be real superheroes out there.”

When he was 8 or 9, his parents took him to the Eastern States Exposition near Springfield, Mass. That’s where he found those real superheroes.

“I saw these big banners,” he says. “One of them said: ‘The Giant From Rekjavik, Iceland, 8 foot-8,’ and it said ‘Alive.’ Another one said: ‘The Lobster Boy, Alive.’ Another one said: ‘The Monkey Girl, Alive.’ “

More than a half century later, Fox — now a sword swallower and audience favorite at the Maryland Renaissance Festival — still remembers when he first saw the giant, a man named Jóhann Pétursson.

“He stood up from his chair, and he came walking very slowly to the edge of the stage,” he recalls. “And so I’m looking up at this man who’s probably about 7-foot-7 … and I’m telling my dad, ‘Hey, is this guy real? What’s going on?’ And he says, ‘That’s not a robot, that’s a real man.’ “

Fox was fascinated by these performers.

“Those people have the courage and the bravery to go up on stage and say, ‘This is who I am.’ They seemed just like ordinary people with a story to tell,” he says.

Fox eventually became a sideshow performer himself; a magician who would gather crowds on the streets of Boulder, Colo., with a fire-eating performance.

One night as he performed, the winds shifted just as he blew a fireball into the air. It burned the left side of his face and marked an end to that aspect of his show. But he still wanted to include an element of danger in his act, so he started looking for other options.

“I was thinking, you know, sword swallowing, I haven’t seen sword swallowing in a long time,” he says.

Johnny Fox performs at the Maryland Renaissance Festival, where he’s been a sword swallower for decades.

Mark Mitton/NPR


hide caption

toggle caption

Mark Mitton/NPR

Johnny Fox performs at the Maryland Renaissance Festival, where he’s been a sword swallower for decades.

Mark Mitton/NPR

Fox gave himself six months to learn sword swallowing. He got a sword and smoothed down any rough spots to reduce the risk of injury while practicing. He also began studying human anatomy and, as he regularly tells audiences, developed the ability to control muscles in his throat.

“Those are the muscles above the esophagus, and that’s where the blade goes, into the esophagus,” he said during one performance. “Longer blades will go further down into … into other areas like, I don’t know, the fallopian tubes, I guess.”

Fox is best known for his long tenure at the Maryland Renaissance Festival, where he has been performing since the early 1980s. Over the years, he’s swallowed not just swords, but also a giant mixing spoon, an oversized screwdriver and balloons.

“It’s gross,” he acknowledges to his audiences. “But you’ll watch it.”

And he’s right. Those who have watched Fox perform for decades speak with emotion about the first time watching his show, and of the feeling they get when bringing their own children or other loved ones to experience his mix of wisecracks, bravado and charm.

“I was first brought to the Renaissance Festival when I was 18 years old and I saw his show,” says Virginia resident Crystal Barltrop. “I was absolutely smitten with it. It’s a lost art. It’s iconic, it’s amazing.”

Barltrop came from the Richmond area twice this year to see Fox perform, and like many festival patrons, she’s been closely monitoring a Facebook page called Friends of Johnny Fox. For much of the past year, Fox’s friends and fans have been receiving updates there about the serious health issues that he’s been struggling with.

Fox says those issues began during last year’s Renaissance Festival. He wasn’t feeling well and got tested for Lyme disease. That’s when doctors discovered that he actually had Hepatitis-C.

“They told me, they said, not only do you have Hep-C, but you have cirrhosis of the liver and you have tumors,” he says.

One night, as Fox was coming to terms with the diagnosis, he slipped on black ice at his home in Connecticut. He got up and went inside but could not get out of bed the next day. Or the day after that.

“The pressure of falling and hitting my back squarely on the ground made all the blood that was in my liver burst and go into my esophagus,” he says.

He eventually slipped into a coma and was unconscious for several days. When he woke up, the prognosis was grim. Friends and loved ones who had gathered around his hospital bed asked him if he wanted hospice care.

“And he’s like, ‘Well, I don’t want hospice, but I might have to get it just to get out of here,’” recalls his friend Susanna Mitton. “He’s like the ultimate escape artist.”

The place Fox wanted to escape to was a cancer treatment facility in Arizona that specializes in alternative medicine. Fox’s friends began working to help him get there. They launched a GoFundMe page for his medical care, and organized a fundraiser performance. Several of them accompanied him in an RV on the cross-country trip.

Once he arrived in Arizona, Fox says he began treatments that included a combination of low-dose chemotherapy, high doses of Vitamin C and B-17, medical-grade turmeric, among other therapies. Slowly, he says, his health started to improve. One day, he was able to get out of his wheelchair and walk.

“And then I realized that I could swim. One day I challenged myself to see if I could swim a couple laps, and I swam a lap and felt really good. Like, wow, I can swim,” he says.

As his strength came back, so did his drive to make it to this year’s Renaissance Festival to see fans who have been rooting for his recovery. In recent weeks, many of those fans have given him standing ovations from the moment he walks on stage. They’ve stood in long lines after his show, waiting for the opportunity to wish him well, give him a hug and get an autograph for their kids.

Johnny Fox, middle, gives a thumbs up with fans at the Maryland Renaissance Festival.

Mark Mitton/NPR


hide caption

toggle caption

Mark Mitton/NPR

Johnny Fox, middle, gives a thumbs up with fans at the Maryland Renaissance Festival.

Mark Mitton/NPR

“How did I deserve all this help behind me?” he asked after a recent show, his voice cracking. “There’s no way I’m going to stop now. I’m going to live to be 200!”

Fox says he was determined to perform this fall because the Maryland Renaissance Festival is a special community. It’s the place he keeps coming back to, even as he’s pared back performances in other parts of the country.

“The people that come out to this fair — a lot of them have classified jobs that they can’t talk about in D.C. So they put on costumes and really get into enjoying their time here at the fair,” he says. “They’ll come every weekend, and they have their little groups and cliques that hang out.”

During most of his performances, Fox routinely pauses to pour what he jokes is protective “water from India” around himself. This fall, audiences have cheered particularly loudly as he goes through that ritual, and Fox himself says he’s “fiercely optimistic” about his future.

“Gratitude and optimism and being content have gotten me through so much of my life, and if I can share those things with others and help each other out … we’re all in this crazy world together,” he says.

“There’s love, and there’s fear. I choose love.”

Article source: http://www.npr.org/2017/10/14/557821266/sword-swallower-makes-triumphant-return-as-he-battles-severe-health-issues

Timing of White House actions unrolling parts of ACA ‘couldn’t be worse,’ states say

After threatening for months to end billions of dollars in payments promised to health insurers, President Trump finally dropped the ax with timing that could inflict maximal disruption on the Affordable Care Act enrollment season scheduled to begin in two weeks.

The most immediate upheaval is playing out in a set of states where regulators had ignored the risk that the president might carry out his threat and told insurers not to include any cushion in their 2018 rates for ACA health plans. Officials in at least three states are now debating whether to delay the Nov. 1 start of enrollment as they rush to consider higher premiums to make up for the abrupt loss of federal money.

But even in states that prepared for a possible cutoff of the “cost-sharing reduction” payments, Trump’s action so close to the fifth year’s sign-up period is sowing widespread confusion among consumers, according to leaders of insurance exchanges and ­enrollment-assistance organizations around the country. Along with other steps the White House has taken since late summer to undercut the ACA marketplaces, they predict this latest move is almost certain to suppress the number of Americans insured under the law next year.

“The timing couldn’t be worse,” said Allison O’Toole, chief executive officer of ­MNsure, the marketplace Minnesota created under the ACA. Hundreds more consumers than usual have phoned its call center in recent days, uncertain whether they can still get and afford health plans.

“Will the [president’s] drumbeat of ‘it’s a failing marketplace’ affect enrollment? Absolutely,” said Peter V. Lee, executive director of Covered California, which calculates that the payments’ end will cost its 11 marketplace insurers $188 million for the last three months of 2017 — more than the small profits many were anticipating for the year.

Insurers themselves could compound the damage, depending on how they respond. The Trump administration’s timing meant its announcement late Thursday came after the deadline for insurers in three dozen states relying on the ACA’s federal insurance marketplace to sign government contracts and lock in their rates for 2018 coverage. But a clause in the contracts lets insurers pull out within 90 days if the payments stop.

So far, no insurers have said they would defect. But concerns remain acute. As the number of companies selling ACA coverage has dwindled in the past two years, an increasing number of the nation’s counties have found themselves with just one participating insurer. Scores of counties recently appeared as if they would lack any insurers until state officials lured in replacements. If more leave this fall, states would have difficulty attracting others on such short notice.

“It seems entirely possible that some insurers will now exit the marketplace for 2018 and potentially leave bare counties,” said Larry Levitt, senior vice president of the Kaiser Family Foundation, a health policy organization.

The late changes in insurance rates, deterrence of would-be customers and potential unavailability of ACA coverage are the biggest ground-level effects of the president’s decision — a step so strident that health policy wonks for months had made a parlor game out of debating whether the president would have the nerve to do it.

The federal payments have been the more obscure of two types of subsidies created by the sprawling 2010 health-care law to help Americans afford coverage if they cannot get such benefits through a job. The better-known subsidies help lower the monthly premiums owed by nearly 85 percent of the roughly 10 million Americans with ACA coverage.

The CSRs, as they are called, provide discounts for deductibles and other out-of-pocket insurance expenses to people with somewhat lower incomes — up to 250 percent of the poverty line, or about $30,000 for a single person and $61,000 for a family of four. Under the law, ACA health plans must continue those discounts. Trump’s move means that health plans will not be reimbursed for the last three months of the year or in the future. The payments had been expected to total $7 billion for 2017.

Dramatic as it is, the payments’ elimination does not go nearly as far as Trump and most congressional Republicans have sought this year as they attempted unsuccessfully to rewrite federal health-care law. Still intact is the ACA’s requirement that most Americans carry health coverage, though administration officials have hinted they may stop penalizing people who violate that mandate. Other consumer protections in the law still guarantee specific benefits in insurance sold to individuals or small businesses, forbid insurers to charge more or refuse to cover people who have had medical conditions, and ban yearly or lifetime limits on coverage.

Hours before the White House announced the end of the CSRs, the president took another significant step that could foster a proliferation of insurance capable of making end runs around such protections. Under an executive order that Trump signed on Thursday, federal agencies will develop new rules to widen access to “association” health plans and short-term insurance policies — both exempt from the ACA’s insurance regulations — and allow more policies to be sold from one state to another without meeting each state’s regulations.

As state officials prepared in the spring and summer for the upcoming enrollment period, most instructed insurers either to include a surcharge assuming the federal cost-sharing would end or to file two sets of rates as a Plan A and Plan B.

In Colorado, one of the states that asked for two sets, the insurance commission approved the higher rates on Friday. The state’s marketplace, Connect for Healthy Colorado, is now scrambling to load the necessary information into its computer system, according to Kevin Patterson, its chief executive. Colorado wants to start enrollment on time, Patterson said Saturday — but he is not yet sure whether it will be ready.

In Washington state, Insurance Commissioner Mike Kreidler also told insurers to file two rates. “In order to get the smoke to clear,” he said, the marketplace there “may consider holding back on when” enrollment begins.

Maryland is in worse shape, because the two insurers in its marketplace were told by regulators to file only rates that assumed the CSR payments would continue. Chet Burrell, chief executive of CareFirst BlueCross BlueShield, said officials asked state insurance regulators Friday to allow it to submit new rates — about 20 percent higher — to make up about $50 million it had been expecting in CSR money next year.

Maryland’s open enrollment, Burrell said, might need to be delayed.

At the Missouri Association of Area Agencies on Aging, executive director Catherine Edwards acknowledged the challenges. “It’s just another hurdle that we’re going to have to get over,” she said Saturday. “We’re just holding our breath to see what this does to the people coming to us.”

Carolyn Y. Johnson contributed to this report.

Article source: https://www.washingtonpost.com/national/health-science/timing-of-white-house-actions-unrolling-parts-of-aca-couldnt-be-worse-states-say/2017/10/14/bab688bc-b0f0-11e7-9e58-e6288544af98_story.html

We Have to Ration Health Care

In health policy, cost-effective is not just a useful adjective. To wonks, it alludes to the highly technical practice of cost-effectiveness analysis, which is what it sounds like—studies, normally conducted by health economists, evaluating both the relative costs and the therapeutic benefits of a drug or medical intervention. The costs can be an individual’s, an insurance carrier’s, a government’s, or even those borne by society as a whole. The therapeutic benefit, or “effectiveness” part, is usually measured in quality-adjusted life years, or QALYs, which assign utility scores to different states of health based on population surveys—a QALY of 1 represents a year of perfect health. Together, they form an incremental cost-effectiveness ratio, or an ICER, quantifying how much bang for the buck a choice in medicine or public health may have. The lower a choice’s ICER, the more cost-effective it is.

Article source: http://www.slate.com/articles/health_and_science/medical_examiner/2017/10/we_should_ration_health_care.html

Key questions and answers about Trump’s health care move

President Donald Trump’s move to stop paying a major “Obamacare” subsidy will raise costs for many consumers who buy their own health insurance, and make an already complicated system more challenging for just about everybody.

Experts say the consequences will vary depending on how much money you earn, the state you live in, and other factors.

Overall, Trump’s decision will make coverage under the Affordable Care Act less secure, because more insurers may head for the exits as their financial losses mount.

All of this is happening with the Nov. 1 start of sign-up season a couple of weeks away.

Here are some questions and answers as state regulators, insurance executives, consumer groups and number crunchers try to analyze the potential impacts:

Q: What exactly did Trump do, and why?

A: Trump said he’d immediately stop paying the Obama health law’s cost-sharing subsidies, which reimburse insurers for reducing copays and deductibles for people with modest incomes.

The subsidies are under a legal cloud because of a partisan dispute over the wording of the health law.

The law requires insurers to reduce costs for low-income people, and specifies that the government must reimburse the companies. But Republicans and the Trump administration say the law failed to include a congressional appropriation, a specific instruction to pay that’s required by the U.S. Constitution before federal money can be spent.

The dispute has been going on for years, and the government had continued to make monthly payments.

Trump had been threatening for months to stop the payments. Apparently he decided to bring things to a head, to force congressional Democrats to negotiate on a new health care law.

Q: How many people benefit from these subsidies?

A: About 60 percent of the estimated 9 million to 10 million people signed up for coverage through the health law’s insurance markets qualify for reduced copays and deductibles, which are available to individuals making up to about $30,000.

Q: Does this mean they’ll get no help?

A: No. Insurers are legally obligated to provide the discounts, and if the government doesn’t reimburse them, the companies are expected to raise premiums.

In some states regulators have allowed insurers to increase premiums preemptively for 2018 because of the uncertainty over what Trump would do. Other states have contingency plans.

And there’s another wrinkle: “Obamacare” also subsidizes monthly premiums, not just copays and deductibles.

So people getting premium subsidies will be shielded from those increases, for the most part.

Q: What about people who buy individual health insurance policies outside the “Obamacare” market and don’t get help under the ACA?

A: This is where it could get tricky.

Many of these “off marketplace” customers are solid middle-class and don’t qualify for financial assistance, so potentially they could face a big hit.

It depends on where they live, said Larry Levitt of the nonpartisan Kaiser Family Foundation.

In some states, regulators directed insurance companies to limit potential rate increases only to plans sold on the ACA markets. Unsubsidized customers would be protected in those states.

In other states, however, they might be in for a shock.

A crystal-clear picture of winners and losers will emerge in the weeks to come.

Q: Trump says this money is a bailout. What’s the impact for insurance companies?

A: The National Association of Insurance Commissioners estimates that Trump’s immediate cancellation of monthly payments will cost insurers about $1 billion they would have been owed for the remainder of the year. There’s no way to raise premiums now for a few months to try to recoup any of that.

The nonpartisan organization representing state regulators says Trump’s order will only add more disruptions to already shaky markets.

Elizabeth Carpenter of the consulting firm Avalere Health says more insurers may drop out if they can’t figure out a way to recoup losses. About half of U.S. counties will only have one ACA insurer next year.

Q: Is there any way this can be fixed?

A: Congress could appropriate the money, quickly removing the legal doubt. Or a court may put a hold on Trump’s order to consider objections being raised by state attorneys general.

———

Associated Press editor Kevin Vineys contributed to this report.

Article source: http://abcnews.go.com/Health/wireStory/key-questions-answers-trumps-health-care-move-50477460

End to Health Care Subsidies Puts Congress in a Tight Spot – The …

But Republicans in Congress are divided. Some worry that ending the subsidies would hurt their constituents. Others are loath to do anything that could be seen as propping up the health law that they had promised to tear down.

For their part, Democrats are convinced that any blame for rising premiums and shrinking choices will fall on Republicans, who now control the White House and Congress. After spending the year trying to preserve the Affordable Care Act, Democrats did not appear ready on Friday to make major concessions.

“Unless our Republican colleagues act, the American people will know exactly where to place the blame when their premiums shoot up and when millions lose coverage,” said Senator Chuck Schumer of New York, the Democratic leader.

The uncertainty over the payments to insurers has loomed over Congress for months, but Mr. Trump’s action is forcing lawmakers to confront the issue head on less than three weeks before the start of the annual open enrollment season under the Affordable Care Act.

Even with the president’s move, it was far from clear whether lawmakers could agree on steps to continue the payments. The negotiations between Mr. Alexander and Ms. Murray had stalled over how much latitude to give states seeking waivers from requirements of the Affordable Care Act.

Still, Ms. Murray expressed optimism and called on Republican leaders to support the efforts.

About seven million people benefit from the cost-sharing subsidies. The president’s decision, by destabilizing insurance markets and driving up premiums, could adversely affect millions of others who buy insurance on their own and do not receive federal subsidies, health policy experts said.

Representative Tom Reed, Republican of New York and co-chairman of a bipartisan group of lawmakers called the Problem Solvers Caucus, said Mr. Trump’s decision “increased the stakes” for Congress. More than two months ago, Mr. Reed’s group offered a series of proposals to shore up insurance markets, including funding the subsidies.

Advertisement

Continue reading the main story

“It’s only going to get worse as this marketplace continues to destabilize,” Mr. Reed said. “If we stay where we are and do nothing, I think this is going to be a pox on all of our houses.”

Representative Mark Meadows, Republican of North Carolina and the chairman of the hard-line conservative House Freedom Caucus, said he had been in discussions with other Republicans over proposals to drive down premiums that could be tied to a continuation of the subsidies for insurers.

“The fundamental question is, what do you get in terms of relief for insurance premiums and health care costs, broadly, in exchange for continuing a bailout to the insurance companies in the short run or long run?” Mr. Meadows said.

As lawmakers mulled how to move forward, doctors, hospitals, insurers, state insurance commissioners and advocates for patients denounced Mr. Trump’s decision.

“Our patients will ultimately pay the price,” said Dr. David O. Barbe, the president of the American Medical Association. “We urge Congress to accelerate its efforts to reinstate these payments before further damage is done.”

Governors also weighed in, expressing alarm at the termination of the subsidies. “We are deeply concerned that the administration has declined to continue these payments, further increasing uncertainty for state marketplaces,” the National Governors Association said.

Gov. Brian Sandoval of Nevada, a Republican, told The Nevada Independent that the president’s decision was “going to hurt kids.” He continued: “It’s going to hurt families. It’s going to hurt individuals. It’s going to hurt people with mental health issues. It’s going to hurt veterans. It’s going to hurt everybody.”

The attorneys general of 18 states, including California, Massachusetts and New York, filed suit on Friday to prevent any interruption in the payments.

Advertisement

Continue reading the main story

But the Trump administration insisted that a federal district judge was right in ruling last year that the payments were unconstitutional because Congress never explicitly provided money for them.

Photo


People signing up for health care under the Affordable Care Act in San Antonio in 2016.

Credit
Eric Gay/Associated Press

“Congress has the power of the purse, and it is up to Congress to decide which programs it will and will not fund,” Attorney General Jeff Sessions said in a legal opinion, adding: “The executive branch cannot unilaterally spend money that Congress has not appropriated.”

The cost-sharing subsidies are available to people with incomes of 100 percent to 250 percent of the federal poverty level, or about $12,060 to $30,150 a year for an individual.

“Cost sharing reductions are critical to low income Americans,” Representative Carlos Curbelo, Republican of Florida, wrote on Twitter. “Congress should guarantee their funding through the appropriations process.”

In fact, the consequences of the president’s action would ripple through the individual market. The premium increases would be felt most by middle-class consumers who do not qualify for federal aid with either their premiums or their out-of-pocket costs.

The government’s costs are also likely to rise, since subsidies to purchase insurance through the marketplaces increase as premiums rise. The Congressional Budget Office said in August that if the cost-sharing subsidies were cut off, premiums would shoot up 20 percent next year, and federal budget deficits would increase by $194 billion in the coming decade.

Yet conservative Republicans made clear they have no appetite for providing billions of dollars to insurers.

“Under no circumstance should Congress attempt to expand Obamacare by cutting a check for President Obama’s bailout of insurance companies,” said Representative Mark Walker of North Carolina, the chairman of the conservative Republican Study Committee.

Advertisement

Continue reading the main story

Representative Dave Brat, a conservative Republican from Virginia, said Mr. Trump was simply correcting a “constitutional error” made by the Obama administration.

Mr. Brat said he did not want to provide money for the subsidies because they would just “prop up a failing system in which the government coerces people to buy gold-plated insurance policies that no one can afford.”

The showdown increased tensions over a fiscal deadline facing lawmakers. Mr. Trump and Democrats struck a deal in September that included a stopgap spending measure to keep the government funded through Dec. 8.

Now, the fate of the cost-sharing reduction payments could wind up intertwined in the negotiations over a spending measure to avert a government shutdown. Already, the contentious issue of immigration could become part of those spending talks, as Democrats are determined, in the coming months, to secure protections for the young undocumented immigrants known as Dreamers.

Mr. Schumer said the coming spending measure offered a “very good opportunity” to secure money for the subsidies.


Continue reading the main story

Article source: https://www.nytimes.com/2017/10/13/us/politics/trump-congress-obamacare-insurance-subsidies.html