vox--2019-08-27--4 Senate Dems shaping the future of health policy explain what theyre thinking

4 Senate Dems shaping the future of health policy explain what they’re thinking

In 2010, it was the Senate’s Christmas morning vote that paved the Affordable Care Act’s passage into law. In 2017, it was John McCain’s dramatic thumbs-down that ended the Obamacare repeal. In 2020, even if Democrats take back the White House and the Senate, their majority will be slim — a couple of votes at most. Health reform will, once again, live or die in the US Senate.  But for all the attention health care has received in the Democrats’ presidential primary, there’s been relatively little focus on Senate Democrats’ thinking or plans. History suggests that’s a mistake. So in recent weeks, I’ve been interviewing key Democrats on the Senate Finance Committee — which controls Medicare, Medicaid, Obamacare, and the tax system, and thus will be the committee where the bulk of health reform is written. I asked them what they and their colleagues learned from the Affordable Care Act and where they see health reform going if they get another chance in 2021.  What I found was a more jaded group than in 2009. The grinding legislative gauntlet that produced Obamacare, combined with the decade-long Republican campaign of obstruction, sabotage, and legal challenge, has produced a grim realism. Senate Democrats recognize that failure is possible and the path to passage is slim. But they are cohering around a rough consensus on where the next bid at health reform should begin.  It starts with abandoning the political idealism behind the Affordable Care Act. Max Baucus, the powerful chair of the Senate Finance Committee, believed he could secure Republican votes with a hybrid public-private expansion based on Mitt Romney’s reforms in Massachusetts and slow, bipartisan negotiations. President Barack Obama, who still sought to make good on his promise to lead a more collegial political system, backed his plan. Everything about the ACA, from the policy to the messaging, reflected the belief that Republican support was possible.  Universally, Democrats look back on this as a mistake. “Some of us didn’t think there would be Republican votes in 2009,” says Sen. Sherrod Brown (D-OH). “They didn’t want to write a bill. They didn’t want to come together on a bill. And they didn’t want it to succeed after it passed. That’s what’s morally outrageous about their behavior. So next time, we go in with our eyes wide open.”  Sen. Debbie Stabenow (D-MI), the ranking Democrat on the Senate Finance Committee’s health care subcommittee, agrees. “It would be wonderful to have Republican votes,” she says. “But we don’t start with that as a working assumption. We have to write something Democrats agree with.”  The failure of Obamacare’s pluralistic approach has also soured key Democrats on the role industry should play. In 2009, Democrats cut deals with health insurers, pharmaceutical companies, hospitals, and other key groups in a bid to build support — including, they hoped, among congressional Republicans — for the legislation. Looking back, Sen. Ron Wyden, the Oregonian who will chair the Finance Committee if Democrats retake the majority, thinks that was a mistake. Getting industry on board meant watering down the policy — and for what?  “If you’re trying to tee up a proposal to drive down costs, you’ll have a lot of people mad at you,” he says. “I think the idea that we need to put everybody at the table, I don’t see that being the starting point in 2021. It certainly wouldn’t be for me as the senior Democrat on the Finance Committee.”  Wyden is arguably the Senate’s most committed health wonk. He once told me he read David Broder and Haynes Johnson’s giant history of the 1994 health reform, The System, four times, cover to cover, to understand why past efforts had failed. In the 2000s, he was the lead author of the bipartisan Wyden-Bennet Healthy Americans Act, an ambitious bill that sought to achieve universal coverage almost entirely through private insurance expansion. In 2011, he joined with Rep. Paul Ryan (R-WI) on a plan to reform Medicare.  If Democrats retake the Senate in 2020, Wyden’s position on Finance will make him the most powerful Democrat in the Senate, save Minority Leader Chuck Schumer, on health care. This unnerves some Democrats, as Wyden’s policy ideas, interest in compromise, and independent streak has sometimes put him crosswise with the party.  But today, Wyden holds out little hope of Republican support and emphasizes Medicare expansion. His evolution tracks the changing Democratic consensus more broadly: After Republicans proved they will attack a private insurance system just as fiercely as they would a public insurance system, the political case for pursuing private insurance collapsed.  “There is no question, in terms of the big picture, that 2009 was focused on a private approach to health care,” Wyden says. “Now Democrats are united around the proposition that Americans need and want Medicare-type choices.”  Which isn’t to say Senate Democrats are prepared to abolish private health insurance. As in Wyden’s comment, the word “choices” came up a lot in my conversations.  “As a practical matter, the way we move forward on health care has to be recognizing people’s current insurance system and allowing people to make choices,” says Stabenow. “If everyone chose the Medicare public option, then it would be very clear what the public wanted.”  “I understand the aspirational notions around Medicare-for-all, but if there’s one thing that I think we still have to wrestle with, it’s that Americans want to see more of their fellow citizens covered but they are very nervous about losing what they have,” says Sen. Mark Warner (D-VA). “There’s a huge risk aversion.”  Brown, who has long supported single-payer, agreed. “I think you want people to have choice still,” he says. “You don’t want to take people’s insurance away. A lot of people don’t want government insurance. I understand that.”  A striking feature of these conversations was how much Senate Democrats see themselves as completing the work of Obamacare.  “I’m proud of what we did,” says Stabenow. “Not only did we expand access to health care, we forever changed people’s expectations about the ability to get affordable health care. I think that’s why it’s been so hard for Republicans to repeal it. Once people get access to health care without being discriminated against for preexisting conditions, it’s very hard to take that back.”  Indeed, the three most oft-mentioned policies were the three ideas that Democrats tried to include in Obamacare, only to sacrifice them at the altar of 60 votes.  First is lowering Medicare’s eligibility age to 50. Brown negotiated a similar proposal — lowering the age to 55 — for Obamacare, but it died when Sen. Joe Lieberman swore to torpedo the entire bill if it dropped the Medicare eligibility age. The bitterness of that betrayal lingers.  “Lieberman killed it, saying it was a matter of conscience when it was clearly a matter of insurance industry interests in Hartford,” says Brown. “And I’m speaking on the record.”  Now, Stabenow has a bill lowering the Medicare age to 50, with 20 co-sponsors.  Second is the public option, which was excised from Obamacare. “We passed a public option in the Finance Committee in 2009,” says Wyden, sighing. “We lost it on the floor.”  But the intervening years have only strengthened the case for a public insurance option, as some state insurance marketplaces are dominated by just one or two private insurers. “As we’ve watched the costs of using the private insurance model, it’s clear, in my mind, that at minimum there needs to be a public option,” says Stabenow. “I believe it makes sense to expand Medicare and give people choices.”  The popularity of the idea is evident in the sheer number of Senate Democrats proposing some version of it. There’s Sen. Brian Schatz’s “State Public Option Act” (22 cosponsors), Sens. Jeff Merkley and Chris Murphy’s “Choose Medicare Act” (14 co-sponsors), Michael Bennet and Tim Kaine’s “Medicare X Act” (11 co-sponsors), Sen. Sheldon Whitehouse’s “CHOICE Act” (eight co-sponsors), and Sen. Ben Cardin’s “Keeping Health Insurance Affordable Act” (no co-sponsors, so lonely). These bills differ in their details and ambition, but they reflect the consensus around a public option — which will most likely be branded as a Medicare expansion.  Third, Senate Democrats lament that Obamacare didn’t do more to cut costs for the already insured. “I think if you look back on what happened, it’s clear Congress should have gone much further when it had the chance and had a laser-like focus on holding health care costs down — period, full stop,” says Wyden.  There are as many ideas for controlling health costs as there are members of the Senate, but the one Democrats seem most united on is letting Medicare bargain down prescription drug prices — an area where Democrats smell blood in the water after President Trump expressed support but never rallied his own party around the issue.  “There is real interest now in drug pricing,” says Warner. “Even the administration has acknowledged it’s not fair for Americans to pay the R&D costs for drugs for the whole world.”  All in all, it adds up to a simpler agenda and message, which Democrats feel they lacked in 2009.  “I thought about this a lot, and if I had run for president,” says Brown, “my message would’ve been: You don’t throw out Obamacare and start over. You build on it by opening Medicare to everyone over age 50 or 55 and letting it negotiate drug prices. That should be the Democratic message. We’re the party that wants to give you the choice to join Medicare early and negotiate drug prices.”  Lurking behind this discussion is the role of the filibuster, which forced Democrats to trim their reforms in 2009. With no hope of finding 60 votes in 2021, Democrats are left with two choices.  One option is they can use the budget reconciliation process, which is protected from the filibuster. The downside of the budget reconciliation process is it’s governed by an arcane set of rules that penalize ambitious reforms that rely heavily on regulatory changes. But if Democrats confine themselves to lowering the Medicare age, adding a public option, and negotiating drug prices, there’s reason to believe it might pass parliamentary muster.  A more radical option — albeit one that would give Democrats the maximum legislative room in 2021 — would be eliminating the filibuster altogether. “If a Democratic president wants to tackle the most important issues facing our country, then he or she must have the ability to do so — and that means curtailing Republicans’ ability to stifle the will of the American people,” wrote former Senate Majority Leader Harry Reid. “It’s time to allow a simple majority vote instead of the 60-vote threshold now required for legislation.”  Sen. Elizabeth Warren (D-MA) agrees. “When Democrats have the White House again, if Mitch McConnell tries to do what he did to President Obama, and puts small-minded partisanship ahead of solving the massive problems facing this country, then we should get rid of the filibuster,” she said. But so far, she’s the only member of the Senate running for president in 2020 to endorse outright abolition of the filibuster.  So which direction will Senate Democrats go? This was the one question no one I spoke to would offer an answer on.  “It’s too early to say that this is the parliamentary route you’re gonna have Democrats come down to,” says Wyden.  “Call Schumer and ask him,” says Brown.  What Democrats do recognize is that they can’t do what they did in 2009 and let the process drag on, mired in controversy and complex policy arguments that leave the public feeling confused and overwhelmed, and give Republicans time to marshal counterattacks.  “You’ll not see us get lost in the technical morass of yearlong-plus debate about all the nuances of various things,” says Wyden. “On the third day of his first term, President Obama had me to the Oval Office to talk health care. Just me and him. And I told him, ‘You should be able to describe it in a sentence.’ We have to be able to lay out in a sentence what we’re interested in.”  Correction: Sen. Brian Schatz is the lead sponsor of the “State Public Option Act,” not the “Choose Medicare Act,” which he is co-sponsoring. Sen. Chris Murphy is a lead sponsor of the “Choose Medicare Act.”


wsjwashingtonwire--2019-05-17--House Republicans Complain Democrats Would Rather Cut TV Ads Than Pass Health Policy

House Republicans Complain Democrats Would Rather ‘Cut TV Ads’ Than Pass Health Policy

The passage of a bundle of health-care bills in the House Thursday left Republicans accusing Democrats of playing politics with prescription drug prices. House Democrats wrapped seven health-care bills into one for a vote on Thursday, passing the legislation largely along party lines. Four of the component bills would preserve or enhance elements of the […]


ageofautism--2019-11-13--Children’s Health Advocates Will Gather to Demand Truth and Justice for the Vaccine-Injured

Government’s gift to Pharma of liability-free vaccines puts children’s health at risk states Children’s Health Defense (CHD) Chairman, Robert F. Kennedy, Jr.  Washington, DC – Thousands of advocates for children’s health will gather Thursday at the Vaccine Injury Epidemic (VIE) Event on the National Mall to mark the 33rd anniversary of National Childhood Vaccine Injury Act (NCVIA). The rally on Nov. 14th will spotlight the devastating impact NCVIA has had upon the state of children’s health. While children continue to be injured by vaccines daily, vaccine makers cannot be held accountable, thereby eliminating incentive for vaccine safety.  In his remarks, RFK, Jr. will address the ramifications of NCVIA and honor those whose lives have been impacted by vaccine injury and death. “It’s time to call out Congress, the CDC, and drug companies for allowing industry profits to trump children’s health,” said Kennedy. “There is no crisis more urgent than the epidemics of chronic health conditions among our nation’s children.”  Following NCVIA’s passage creating the National Vaccine Injury Compensation Program (NVICP), the childhood vaccine market sparked a gold rush for Pharma as more vaccines for routine childhood illnesses were developed. Coterminous with the burgeoning vaccine schedule, chronic health conditions in children rose from 12% to 54%. As vaccine industry profits grew to $50 billion annually, so did diagnoses of asthma, autism, ADHD, allergies, anxiety, depression, diabetes, obsessive-compulsive disorder and auto-immune diseases. Here are the facts: • An HHS-funded study found only 1% of vaccine injuries are reported. • Despite NVICP’s high burden of proof and two out of three claims dismissed, over $4.2 billion has been paid for claims of vaccine injury or death. • The vaccine-injured find NVICP to be a years-long, litigious program with no jury, discovery and precedent. While medical bills mount, the injured are up against DOJ lawyers and HHS “Special Masters” that act as judges. • The Department of Justice and the NVICP are accused of fraud and obstruction of justice in the Autism Omnibus Proceeding. • The Institute of Medicine reports that the vaccine schedule as recommended has never been studied for long-term health effects despite independent research suggesting that unvaccinated children are healthier. • Modern medicine acknowledges that not everyone responds the same to vaccination and the “one size fits all” vaccine policy is not science based.  Children’s Health Defense’s created these six steps to vaccine safety. RFK, Jr. interviews are available upon request.


breitbart--2019-06-29--Free Health Care for Illegal Aliens Could Cost American Taxpayers up to 660B a Decade

Free Health Care for Illegal Aliens Could Cost American Taxpayers up to $660B a Decade

This week, half of the 24 Democrats running for their party’s presidential nomination confirmed that their healthcare plans would provide free health care to all illegal aliens at the expense of American taxpayers — including former Vice President Joe Biden, Sen. Bernie Sanders (I-VT), Sen. Kamala Harris (D-CA), Mayor Pete Buttigieg, and Sen. Kirsten Gillibrand (D-NY).  Center for Immigration Studies Director of Research Steven Camarotta told Breitbart News that only rough estimates are available for what health care for illegal aliens will cost American taxpayers, and though a comprehensive study has yet to be conducted on this specific issue, taxpayers can expect to pay a “significant” amount.  “If we offered Medicaid for illegal immigrants, it is possible the costs could be over tens of billions of dollars,” Camarotta said. “However, it would depend on eligibility criteria as well as how many illegal immigrants actually sign up for program once it was offered. So while the actual costs are uncertain, the size would be significant for taxpayers.”  A reasonable estimate of health care for each illegal alien, Camarotta said, is about $3,000 — about half the average $6,600 that it currently costs annually for each Medicaid recipient. This assumes that a number of illegal aliens already have health insurance through employers and are afforded free health care today when they arrive to emergency rooms.  Based on this estimate, should the full 22 million illegal aliens be living in the U.S. that Yale University and Massachusetts Institute of Technology researchers have estimated there to be, providing health care for the total illegal population could cost American taxpayers about $66 billion a year.  Over a decade, based on the Yale estimate of the illegal population and assuming all sign up for free health care, this would cost American taxpayers about $660 billion.  Even if there are only 11 million illegal aliens living in the U.S., as the Pew Research Center and other analysts routinely estimate, American taxpayers would still have to pay a yearly bill of $33 billion a year to provide them all with free, subsidized health care.  Should only half of the illegal population get health care, it would cost American taxpayers about $16.5 billion a year — almost the price of what it currently costs taxpayers to provide subsidized health care to illegal aliens.  Today, Americans are forced to subsidize about $18.5 billion worth of yearly medical costs for illegal aliens living in the U.S., according to estimates by Chris Conover, formerly of the Center for Health Policy and Inequalities Research at Duke University.  Nearly every Democrat running for their party’s presidential nomination has endorsed having American taxpayers pay for free health care for illegal aliens. Those who have endorsed the plan include Biden, Sanders, Gillibrand, Buttigieg, and Harris, along with Sen. Elizabeth Warren (D-MA), Sen. Cory Booker (D-NJ), former Housing and Urban Development Secretary Julian Castro, Rep. Seth Moulton (D-MA), Sen. Michael Bennet (D-CO), author Marianne Williamson, Rep. Eric Swalwell (D-CA), entrepreneur Andrew Yang, and Gov. John Hickenlooper (D-CO).  John Binder is a reporter for Breitbart Texas. Follow him on Twitter at @JxhnBinder.


breitbart--2019-08-31--Dr Scott Barbour Trump Is Our Last Chance to Save Health Care

Dr. Scott Barbour: Trump Is Our Last Chance to Save Health Care

Health care is “probably the worst issue for Republicans heading into 2020,” estimated Marlow, inviting Barbour’s and Ortiz’s comments on the status of American health care.  Ortiz replied. “Because of Obamacare, about a third of small businesses had to drop their healthcare coverage for their employees because it just got too expensive. They just couldn’t afford it anymore.” He said, “about 52 percent of doctors are now in employee positions” as a result of increasing centralization of health care. Employee doctors are generally beholden to “big medicine,” he added, and are “effectively … not allowed to tell the truth” about the politics of the medical industry.  Barbour addressed the Affordable Care and Patient Protection Act, otherwise known as “Obamacare.”  “When we had the implementation of [Obamacare], we fundamentally altered the doctor-patient relationship, and bureaucrats and red tape were purposely inserted between patients and the access and ownership of their health care and has made it impossible for people to access the healthcare system when they need it,” Barbour explained. “Fundamentally, this is part of the rationing technique.”  Barbour described the health care industry’s leftward momentum over the past decades towards increasing government control over healthcare resource distribution.  “I got into this business twenty years ago,” recalled Barbour. “I remember doctors talking to me when I was coming up, saying, ‘Boy, medicine has changed so much for the worse,’ and then with the implementation of the current system, it really just took a nosedive. Just in the course of my career, I’ve seen how the relationship between doctors and patients has shifted so that doctors’ fidelity is primarily to the hospital system that employs them and away from patients.”  Performance metrics for doctors are largely government-run bureaucratic evaluations, lamented Barbour, noting how centrally planned assessments lack the flexibility to adapt to unique medical circumstances while pressuring doctors to adjust their prescribed treatments to fit bureaucratic demands.  “Doctors now are evaluated by their so-called performance, and I say ‘performance’ because it’s not a real measure. It’s the measure of a  bureaucrat,” said Barbour. “If a doctor readmits a patient within 30 days after discharge from a hospital, that’s going to be a knock against that doctor and it’s going to affect their reimbursement. If a doctor has a bad outcome — say, an infection — that’s going to be a knock against that doctor. So what it does is create these perverse incentives where doctors will either keep patients in a hospital too long for fear of releasing them, and they’ll be back in 30 days. Or, if they do release them, they do everything in their power to prevent that patient from coming back to the hospital, whether it’s necessary or not.”  Barbour added, “The other thing is when doctors come across patients who are sick — maybe they’re a smoker or have diabetes — they may decide different treatment because they’re worried if they do something more aggressive, they’re going to get a negative outcome.”  “We just really need to put the ownership of medicine back in the hands of patients and give them the freedom to choose their doctors and their health care when they need it,” determined Barbour. “We want patients to … spend money on only the things that they consume, only the hospital or healthcare resources they consume. … These largely free market solutions are going to bring down the cost of health care and give patients the most choice, affordability, and the quality of health care is going to be maintained.”  “Another thing we’ve seen over the last 20 years is that the quality of health care has just deteriorated so much,” assessed Barbour.  Political discussion regarding Obamacare “never” examined the policy’s effects on the quality of health care, remarked Marlow. “Did health care get better [with Obamacare]? … Why did no one ask this?”  Barbour replied, “It got much worse. … The direction we’re going rations our healthcare system.” Medical students are “learning how to do electronic medical records so that we can do effective coding and billing and collect metadata for bureaucrats,” he added. “This has got to stop. We have got to get back to nurture the doctor-patient relationship and putting the decision-making between doctors and patients.”  Ortiz observed, “Democrats are looking at trying to do single-payer [health care], with the Biden plan, and that’s what we need to be very, very afraid of because … it’s going to get worse and worse, and this glorified socialized medicine that they talk about is just going to continue to get worse and worse in our country.”  Barbour said, “I feel very fortunate. I got into this game at the last minute and was able, through my own personal experiences, to build a practice. I am somewhat free of the big medicine — not totally — but I have a level of independence that a lot of [other doctors] don’t have. I could never be me today because of so many regulations at the state level and federal level designed to choke out the supply of doctors so that this big medicine can control the supply, and they do this for profits.”  Politicians and bureaucrats advocating for centrally-planned health care want Americans “begging” them “for rationed health care,” Barbour arraigned.  “If we have one more cycle where we fail to reform our health care in a proper direction, you’re going to see the extinction of the doctor-patient relationship,” warned Barbour.  Breitbart News Daily broadcasts live on SiriusXM Patriot 125 weekdays from 6:00 a.m. to 9:00 a.m. Eastern.


breitbart--2019-10-11--Study: Health Care for Illegal Aliens Would Cost America $23 Billion a Year

A plan from 2020 Democrats to provide free, American taxpayer-funded health care to all illegal aliens living in the United States would cost up to $23 billion a year, a new study finds.  In June, the majority of 2020 Democrats running for president — including Joe Biden, Sen. Elizabeth Warren (D-MA), and Sen. Bernie Sanders (I-VT) — endorsed a plan that would force American taxpayers to provide free health care to all 11 to 22 million illegal aliens in the U.S. and anyone else who crosses the southern border.  The latest study by Center for Immigration Studies (CIS) researchers reveals that providing health care to all illegal aliens would cost American taxpayers up to $23 billion a year should every illegal alien enroll. This total includes at least 2.5 million low-income illegal aliens and their children who would cost almost $13 billion a year, alone, to be given health care.  Even if only about five million illegal aliens enroll in federal subsidies for health care, American taxpayers would be forced to foot a $10.4 billion bill every year, CIS researchers conclude. Overall, providing taxpayer-funded health care to each illegal alien costs Americans about $4,600 a year.  With a scenario in which higher-income illegal aliens are enrolled in Obamacare and poorer illegal aliens take Medicaid, that plan would still cost Americans nearly $20 billion a year assuming every illegal alien enrolls. Based on current enrollment trends, a lower enrollment rate among illegal aliens would nonetheless cost Americans $10.7 billion a year.  Previously, Breitbart News estimated, based on CIS analysis, that providing illegal aliens with taxpayer-funded health care would cost Americans about $66 billion every year and $660 billion every decade. This assumed that every illegal alien enrolled and each cost $3,000 to insure.  While 2020 Democrats have made giving health care to illegal aliens — paid for by U.S. taxpayers — a priority, experts have said that such a policy would drive “strong incentives for people with serious health problems to enter the country or remain longer than their visas allow in order to get government-funded care.”  The latest Wall Street Journal/NBC News poll finds that the 2020 Democrats’ health care for illegal aliens plan is the most unpopular policy position thus far in the race for president with opposition from 62 percent of all likely voters.  Today, Americans are forced to subsidize about $18.5 billion of yearly medical costs for illegal aliens living in the U.S., according to estimates by Chris Conover, formerly of the Center for Health Policy and Inequalities Research at Duke University.  John Binder is a reporter for Breitbart News. Follow him on Twitter at @JxhnBinder.


breitbart--2019-11-04--Video Emerges of Nancy Pelosi Backing Single-Payer Health Care in 1993

Video from 1993 has re-emerged showing Rep. Nancy Pelosi (D-CA) backing single-payer, government-run health care — though the current Speaker of the House claims to oppose that policy today.  Pelosi told a news conference: “I remain a staunch and ardent supporter of the McDermott-Conyers bill.”  She was referring to H.R. 1200 of the 103rd Congress, the “American Health Security Act of 1993,” which proposed a “single-payer,” government-run health insurance system.  The bill was introduced in the House by Reps. John Conyers (D-MI) and Jim McDermott (D-WA), and in the Senate by the late liberal stalwart Paul Wellstone (D-MN).  One version of the 1993 C-SPAN clip appears to have been generated in 2017, but resurfaced this weekend, after Pelosi criticized the “Medicare for All” plan proposed by Sen. Elizabeth Warren (D-MA), which would cost $52 trillion.  “I think the closer [President Bill Clinton] moves toward the single-payer [model], the better,” Pelosi said at the time.  The legislation was also backed by Rep. Jerrold Nadler (D-NY), who is now, coincidentally, playing a key role in the “impeachment inquiry” against President Donald Trump.  The proposal would have provided universal health care to every American who was legally resident in the country: notably, it did not automatically cover illegal aliens, though it left that issue up to the states’ discretion.  The program was to have been administered by the states, with federal assistance. The bill declared:  There is hereby established in the United States a State-Based American Health Security Program to be administered by the individual States in accordance with Federal standards specified in, or   established under, this Act. Every individual who is a resident of the United States and is a citizen or national of the United States or lawful resident alien (as defined in subsection (d) is entitled to benefits for health care services under this Act under the appropriate State health security program. In this section, the term “appropriate State health security program” means, with respect to an individual, the State health security program for the State in which the individual maintains a primary residence.  The new universal health care system was to be paid for by increases in income taxes, especially on the wealthy, who faced a “surtax” if they earned over $1 million.  Today, critics note, Pelosi has pronounced herself skeptical of plans such as “Medicare for All.”  Fox News noted on Sunday that Pelosi still wanted to achieve universal health care coverage, but preferred to do so by expanding Obamacare — which theoretically relies on private insurance — and not Medicare, a public insurance program that applies to seniors.  Joel B. Pollak is Senior Editor-at-Large at Breitbart News. He earned an A.B. in Social Studies and Environmental Science and Public Policy from Harvard College, and a J.D. from Harvard Law School. He is a winner of the 2018 Robert Novak Journalism Alumni Fellowship. He is also the co-author of How Trump Won: The Inside Story of a Revolution, which is available from Regnery. Follow him on Twitter at @joelpollak.


breitbart--2019-12-21--Pinkerton: Beyond Impeachment, Health Care Remains the GOP’s 2020 Weak Spot

While everyone is focused on impeachment, there’s another issue—an older issue, which hasn’t gone away—that’s nagging the voters. And it could be a sleeper-win for the Democrats next year. Yes, we’re talking about health care. Health care isn’t in the national news today, but it was big in the 2019 election campaigns, and that wasn’t good for the GOP.  What do the 2019 elections tell us about Donald Trump in 2020?  The off-year elections were not good for Republicans. They lost both chambers of the Virginia state legislature and were shellacked in suburban Philadelphia. Most saliently, of the three gubernatorial races—Kentucky, Louisiana, and Mississippi—they lost two. And one of those, Kentucky, was a Democrat pick-up.  So what do these elections portend for 2020? For Donald Trump reelection prospects? Short answer: We don’t know.  For the longer answer, we might recall a little history, looking at these same off-year elections in years past. And if we do, we see that the pattern is that states oftentimes—but not always—zig one way in the off-year election and zag the other way in the presidential election.  For instance, in the 1983 gubernatorial elections, when the same three states—Kentucky, Louisiana, and Mississippi—chose their chief executive, the Democrats swept all three, including a pick-up in the Pelican State. And yet the following year, 1984, President Ronald Reagan was not only reelected, but carried all three of those states.  Skipping ahead three election cycles, we can look at the 1995 gubernatorial elections. In that year, Republicans won two of three, including a Pelican State pick-up. Yet in the year after, 1996, Bill Clinton, running for reelection, carried two of those states.  So what should we conclude? That the voters are fickle? Maybe, but it’s more accurate to say that state issues are oftentimes distinct from national issues. State issues, such as schools and roads, are usually less ideologically fraught than national issues, and so successful gubernatorial candidates tend to be more pragmatic—crusaders are not wanted.  So that’s why one shouldn’t draw any great conclusions about 2020 from the ’19 elections—each ’19 outcome was, in its way, a one-off. (And yes, there was some good news for Republicans; the GOP made minor gains in New Jersey, and Gov. Greg Abbott of Texas notched a win for his anti-tax referendum.)  Of course, in this era when everything seems to polarize, pro or con, around Trump, it’s sorely tempting to attach a future narrative to the ’19 elections, such as, The results prove that Trump is doomed, or Trump will be triumphant. And it is true that since Trump’s approval rating is stuck in the low-to-mid 40s—as of this writing, it’s 43.9—there was an undertow pulling down Republican candidates this year.  In fact, we can reasonably surmise that Trump will have difficulty breaking 50 percent of the popular vote next year. Yet it’s worth remembering that he was elected three years ago with 46.1 percent of the popular vote, and so it’s possible that he could garner a similar percentage next year and win a second time. In fact, by a wide margin, the crowd-sourced betting site PredictIt finds that Trump is the 2020 candidate most likely to win.  Of course, gamblers don’t know the ultimate victor, either—they’re gambling!  Yes, there’s such a thing as the wisdom of crowds, but the course of future events is just as unknown to the crowd as to the individual. How will the impeachment process play out? How will the economy do? Will there be some military conflict somewhere? How ’bout a strong third-party or independent candidate? And to take a trans-Atlantic jaunt, what should we glean from the December 12 victory of Boris Johnson in United Kingdom? Starting with his shock of yellow hair, BoJo is more than a little Trumpian.  Yet there is one is one particularly scary issue barreling down on the GOP, and it’s a known known.  Of course, the realization that one can’t know the ultimate answer about a future outcome is no excuse for being ignorant of factors that will help shape that future outcome. And so that’s why it’s important to study clues, because even if we can’t know the future, we can know the past—and learn from it. So here’s a clue: Republicans are deeply vulnerable on the health care issue.  This is not a new discovery: Back in August 2017, this author compared Republican attempts to repeal Obamacare to World War One trench warfare; that is, a lot of slogging, and a lot of bleeding, for not much of anything. Most of Obamacare survived that year, and yet the voters didn’t like what Republicans were trying to do, and sent a loud signal of protest; Democrats won big victories in the 2017 off-year elections, including a gubernatorial pick-up in New Jersey. And oh yes, in a special election late that year, the Dems gained a U.S. Senate seat in, of all places, Alabama.  Then came the 2018 midterm elections, and more disappointment for the GOP. And what was the top issue, according to the exit polls? Health care.  Yes, the political dynamic has changed in the decade since Barack Obama signed the Affordable Care Act into law on March 23, 2010. For a while there, Republicans were on the offensive; they ripped into Obamacare and won big in the ’10 and ’14 midterms, as well as in the ’16 presidential.  Yet since then, the healthcare wheel has turned. According to the Kaiser Family Foundation’s monthly tracking poll, Obamacare’s popularity was mostly underwater until 2017, and yet since May of that year, it’s been all positive. Indeed, the latest data, from November 2019, show us that 52 percent of Americans have a favorable view of the program, while 41 percent have a negative view. A wise-guy might put these numbers another way, Obamacare is more popular than Trump.  So it was strange that Kentucky’s soon-to-be-former governor, Republican Matt Bevin. chose to devote much of the last four years fighting Obamacare, including one of its key components, expanded Medicaid. This in a state notable for its poverty, suffering greatly from the opioid epidemic—and most recently, an HIV outbreak tied to intravenous drug use.  In fact, back here in the U.S., we should pause to note that Medicaid expansion benefits the working class; that is, the non-working poor already have Medicaid. So we can see: These days, ideological opponents of Medicaid are seeking to deprive potential Republican voters of their health care. Sad! And also, not smart, politically.  Yet Bevin, a businessman by background, has always been a Tea Party ideologue. Indeed, he first came to political prominence in 2014, when he challenged incumbent Sen. Mitch McConnell in the Republican primary. We might pause and ask: Was anyone really supposed to believe that McConnell was some sort of liberal? Bevin lost that challenge, of course, although the following year, he managed to get himself elected governor. And yet even in the Frankfort statehouse, where practicality should have been his guide, Bevin was still the crusading “true believer.” Bad fit.  For insight into how Bevin approached the job of chief executive of a state, we might recall that in August, he asked an audience, “Do you stand with Donald Trump as the president of America or do you stand with The Squad or whatever they call themselves these days? That is the question.” Such a rhetorical question might have been effective if Bevin’s Democrat challenger, Andy Beshear, had, in fact, been a member of the The Squad. But he wasn’t, and so Bevin’s charge went flying off into New York City, or somewhere equally far from the Bluegrass State.  So we can see: Bevin attempted to run a national campaign from the Kentucky statehouse. As such, he flunked the basic test of pragmatism that governors must pass if they are to succeed. Thus Bevin lost in state that Trump had carried by 30 points.  Meanwhile, prior to the election, before any of this pardon scandalousness, challenger Beshear had stuck to his signature issue; he made full access to health care his signature issue. And after he won, the new governor-elect was quick to rescind Bevin’s anti-Obamacare directives.  The bottom line seems clear enough: Republican runs on anti-healthcare agenda and loses Republican state. Democrat runs on pro-healthcare agenda and wins Republican state.  In the meantime, Louisiana proved to be another healthcare election, underscoring, in an opposite way, the importance of gubernatorial leadership.  Democrat John Bel Edwards, just reelected in a state that Trump carried by 20 points, was full-throated about one big thing: He wanted everyone in the Pelican State to have health insurance. In the words of the Baton Rouge Advocate, Edwards “expanded the Medicaid rolls, which Republicans have refused to do elsewhere for years, to cover about half a million working poor adults.”  Admittedly, Edwards is a remarkable Democrat; his vision of health care extends to the unborn. Last May, he signed a pro-life “heartbeat bill,” much to the consternation of Planned Parenthood. Indeed Edwards is even capable of a Trumpian flourish; part of his campaign platform was “putting Louisiana first.”  Yet for Edwards, those were more than just words; he obviously cared about the health of each and every Louisianan. And that’s how a blue man wins in a red state. In the summarizing words of Breitbart News’s Rebecca Mansour, “Louisiana was another health care election. The GOP will continue to lose these elections until they can say these simple words: ‘Access to affordable health care is a right.’”  Of course, even now, not every Republican will agree with Mansour’s sharp formulation. Yet it does seem that Republican thinking is at least starting to catch up to the changed political reality—that the GOP is now the party of the working and middle class. That is, the poor have always been Democrats, and now the rich, too, are Democrats, and so Republicans need to focus on the votes they can get—the folks in the middle.  So that’s why forward-looking Republicans, such as Sens. Josh Hawley and Marco Rubio, are now shrewdly articulating a new “common good” agenda aimed at the middle class; indeed, they are saying what Republicans should have been saying all along: The market should serve people, and not the other way around.  And for Middle America, government protection against the whims of insurance companies is vital; it’s no wonder that a majority of Republicans wish to see guaranteed coverage for those with pre-existing conditions.  For the Republican Party, as it thinks about health care, the basic problem is this: Either you believe everyone should be covered, or you don’t. And if you do believe in universal coverage, then your healthcare plan starts to look a lot like Obamacare; that is, there must be some sort of mechanism for actually delivering insurance coverage.  Of course it is possible to envision a Republican health plan that’s superior to Obamacare. The GOP version could exclude, for instance, abortion and sex-change operations—and could be written to include only citizens. Yet still, to be popular, it would have to concede the bottom line of universal coverage. And it’s this question of universal coverage that’s been flummoxing Republicans for the past decade, because libertarian ideology has gotten in the way of political practicality.  As we have seen, it’s because of ideology that Republican Matt Bevin lost. And it’s because of practicality that Democrat John Bel Edwards won.  So amidst all of the unknowns about 2020, the Republican defeats in Kentucky and Louisiana tell us something about some of the underlying contours of next year’s election—there are some landmines ahead!  Yes, the big national news today is impeachment, and that effort seems to be boomeranging on the Democrats. And yet it’s a long way from now to November 3. Which is to say, the political environment could tumble like a load of laundry in a dryer—over, and over again. That is, nine or so months after the final sputtering of Nancy Pelosi’s impeachment crusade, some different issue(s) could be dominating the national agenda.  In the meantime, Republicans running for all offices next year are well-advised to pay attention to the recent election results, with an eye toward fortifying their position on health care.  Most immediately, Republicans need to wise up—and stop trying to pull down people’s health insurance in the courts, especially when there’s nothing to replace it. That’s been the risk of the ongoing lawsuit against Obamacare filed by a zealous group of Republican state attorneys general. The GOP AGs are seeking to invalidate the law on legal grounds, and they could potentially win.  If so, such a win would be what’s called a “catastrophic success”; that is, a legal victory, but a political defeat. Why? Because as of now, the GOP has no agreed-upon replacement for Obamacare, and so there’s the possibility that in the wake of an anti-Obamacare court ruling, ordinary people would left with no insurance. Most poignantly, those with pre-existing medical conditions—that’s somewhere between 50 and 129 million people—could lose their health insurance. What Republican pol wants to own that problem?  Fortunately for Republicans on the ballot next year, it appears that such a cataclysm can be avoided; a December 18 ruling by the Fifth Circuit Court of Appeals in New Orleans—kicking the case back down to a lower court—seems to suggest that there’s no chance that the anti-Obamacare case will be decided by the Supreme Court in the coming year. Yes, this is an instance where the wheels of justice turn ver-r-r-y slow, and for Republican politicos, that’s a good thing.  Of course, further down the road, the GOP will have to come up with a plausible healthcare policy, ideally one that is compassionate, fiscally responsible, and socially conservative, all at the same time.  After all, if the GOP is to be the party of the working and middle class, it should defend those classes and all their interests—including the obvious interest of health care. A Republican Party that takes care of workers, soldiers, first responders, and their families—that shouldn’t be such a hard concept to grasp.  Why Aren’t the Democrats Running This Man?  Interestingly, on November 25, the two Democrats we’ve been discussing, Beshear and Edwards, co-authored an op-ed in the Washington Post, headlined, punchily, “How Democrats can win, everywhere.”  The two election-winners recalled some of the details of their winning, such as visiting places in their states that were regarded as hostile territory. And among other centrist ideas that they embraced, they both recalled their campaign’s focus on health care: “Families in both Kentucky and Louisiana worried that their health-care coverage and our states’ Medicaid expansions were going to be ripped away by a Republican governor.”  There it is. Swing voters care about health care. A message all Republicans should take to heart, because the Democrats sure have, indeed, as Politico noted on December 13, whenever Democrats get in trouble because of some left-wing bender—in this case, impeachment—they default back to health care. Thus in the face of polls showing the impeachers hitting a brick wall, embattled Democrats across the country are running spots highlighting their position on … you guessed it, health care. So long as the GOP’s healthcare agenda is in the grip of Tea Party libertarians, at least optically, the healthcare issue will be the Dems’ happy place.  Or to put the matter another way, if Republicans really want to make permanent gains with the working- and middle class, they, too, will get on board with a socially conservative healthcare plan, state by state.  Oh, and a final thought: It should, indeed, be a relief to Republicans that Edwards is unique among Democrats. That is, Beshear ran as a moderate, even if we can all reach a judgment on his recent decision to let felons vote), but Edwards seems to count as a moderate conservative.  In fact, Edwards has grasped that the winning political model is slightly to the left on economics and government and slightly to the right on cultural issues. (Once again, as we absorb the possible implications that the recent U.K. elections might have for the U.S., we can observe that this is the same sort of agenda taken up by Boris Johnson–and he won in a landslide.)  Yes, this traditional nationalist-populist view—so in keeping with how ordinary folks see the world—is a winner on both sides of the Atlantic. And yes, not surprisingly, here in the U.S., such a Main Street view is exactly the opposite of elite bicoastal opinion, which tends to be libertarian on both economics (even rich Democrats don’t seem to be any more eager to pay taxes than rich Republicans) and culture.  In other words, were Edwards on the national ticket next year, he really could be competitive in other red states, as he just proved in Louisiana.  Thus Edwards stands out at a time when most Democrats, even in the South, are siding with the national party (and its donors) on life, guns, and cultural issues. And so Edwards—pro-life, pro-gun is by himself; he’s a lonely winner. But still, of course, a winner.  So if Democrats really wanted to win next year, they’d look to Edwards. Why isn’t he a national figure for the Democrats? The answer, of course, is that the Democrats don’t want to win that badly.  In fact, at the Democrat presidential debate in Atlanta on November 20, moderator Rachel Maddow asked the assembled candidates about Edwards specifically: “Is there room in the Democratic Party for someone like him, someone who can win in a deep red state but who does not support abortion rights?” And while none of the candidates said directly, No, there’s no place, neither did any of them say, Yes, there is a place. Instead, those who answered just reiterated their 100-percent support for abortion. The message seems clear enough.  All this is a bit strange because it would, indeed, spell big trouble for the GOP if there were more center-hugging Edwardses on more ballots—including on the national ballot. That is, pro-health, but also, pro-life. But that just isn’t going to happen, not in the national party–the party of Hillary, and Bernie, and AOC. That’s one prediction about 2020 that we can make with confidence.


businessinsider--2019-06-14--California just became the first state to expand health coverage to undocumented residents

California just passed a budget deal that expands health coverage to some undocumented young-adult residents, making it the first state to do so.  The plan will provide Medicaid coverage to approximately 90,000 undocumented residents between ages 19 and 25, at a cost of about $98 million, according to a budget report. It also helps some US citizens with higher incomes afford health coverage.  The deal was passed overwhelmingly by the State Assembly and Senate. Democrats dominate both chambers. Governor Gavin Newsom, also a Democrat, released the budget proposal on June 6 after months of negotiation with the legislature. Newsom hasn't yet signed the budget.  Undocument immigrants who are children are already covered under Medi-Cal, California's insurance plan for people with low incomes.  To help pay for the plan, the budget includes a fine for people who don't buy health insurance — a policy known as the "individual mandate". The requirement that people buy health insurance or pay a fine was included in the federal Affordable Care Act, passed in 2010. It was removed from the health law by the Republican tax-overhaul bill passed at the end of 2017.  Newsom has said the penalty will partially fund the coverage expansions and will help keep insurance prices down. Republicans argued it is unfair to penalize those who do not wish to buy insurance, while rewarding those who are in the country illegally.  Another important provision of the budget expands the availability of subsidies that help people who buy health insurance on their own. The premium assistance is linked to income and how many people are in a household.  Around 850,000 additional Californians will receive subsidies to help them buy health insurance starting next year, according to Kaiser Health News.  People earning up to six times the federal poverty line — that's roughly $150,000 for a family of four — will be eligible. That's an increase from the existing assistance provided under the ACA, which goes to people who earn up to four times the poverty level.  The budget deal should provide a modest boost for companies that offer health insurance coverage on California's insurance marketplace and in the state's Medicaid program. Companies that stand to benefit include Centene, Anthem, and Molina Healthcare, according to Scott Fidel, an analyst at Stephens.


buzzfeed--2019-01-08--Planned Parenthoods New President Wants To Focus On Nonabortion Health Care

Planned Parenthood’s New President Wants To Focus On Nonabortion Health Care

The organization is still committed to providing abortions and reproductive care but Wen, the first female physician to run Planned Parenthood, is embarking on a cross-country listening tour to learn how best add or expand nonabortion services.  WASHINGTON — Leana Wen sat in her new office behind a bare desk, surrounded by stark white walls. The rest of Planned Parenthood’s headquarters were decorated in bright pink protest signs, toys, hats, printed-out memes, pictures of Beyoncé and Sen. Kamala Harris, and pictures of Christine Blasey Ford testifying before Congress. But Wen’s office remained a blank slate. “Look at these gorgeous posters,” Wen said, unrolling a pink poster. “I haven’t had a moment yet to put them up, or anything else really.” The poster pictured a young woman looking steadily at the camera with the words “This Is Health Care” printed over her head. Wen, 35, is only about two months into her tenure as the new head of Planned Parenthood, but she hit the ground running with this new campaign that sent the clear message: Planned Parenthood is first and foremost a health care organization, not a political symbol. This message is not a new one, but the doubling down and commitment to it at the highest level is new and significant. “This Is Health Care” is a very different tone than former Planned Parenthood president Cecile Richards adopted with campaigns like “#Fight4BirthControl” or “I Stand With PP.” “People aren’t coming to Planned Parenthood to make a political statement,” Wen told BuzzFeed News sitting in her office in late December. “They’re coming because they need their vaccinations. They need their well woman exams. They’re getting HIV tests.” Wen is the first physician to be appointed Planned Parenthood president in nearly 50 years, and on Jan. 9, she is kicking off a five-month listening tour of 20 Planned Parenthood affiliates across the country. The aim of the trip is to learn how best to add or expand nonabortion services that are not normally associated with Planned Parenthood, like treatment for opioid addiction, diabetes management, and mental health counseling. “The last thing I would want is people to get the impression that we are backing off of our core services,” Wen said. “What we will always be here to do is provide abortion access as part of the full spectrum of reproductive health care, it’s who we are. But we also recognize that for so many of our patients we are their only source of health care.”  Planned Parenthood announced Wen’s appointment in September, nine months after BuzzFeed News broke the news of Richards’ plans to step down after more than a decade in her role as president. Richards officially left in late April, and Wen assumed her role on Nov. 12, becoming the first immigrant and first woman physician in the role.   Wen, who immigrated to the US from China with her family when she was 7 and grew up relying on Medicaid and Planned Parenthood services herself, was an emergency room doctor before becoming the Baltimore health commissioner in January 2015. Planned Parenthood is spotlighting her medical credentials even more by applying for her to be legally able to perform blood tests and screenings for Planned Parenthood patients herself, a service that is far outside of her job description as president, but a great photo opportunity. Wen will also continue to work at an urgent care clinic in Baltimore and wants to be able to practice at Planned Parenthood clinics as well. Wen is not a wholly apolitical choice, however. All Planned Parenthood press releases about her appointment made sure to emphasize that she successfully sued the Trump administration for cutting funds from the Teen Pregnancy Prevention Program, and that she has fought changes the Trump administration attempted to make to federal family planning funding. In the limited interviews she has given thus far, including with BuzzFeed News, she has made it clear she is ready to continue down that warpath. Wen has also spoken up frequently and passionately against Trump’s immigration policy. She told BuzzFeed News that she and her family could likely not have survived or prospered in the way they did under the policies Trump is proposing, and that she wants to make sure everyone in the US can access Planned Parenthood care. Still, strategists and advocates on both sides of the aisle see her presidency as a pointed and purposeful departure from Richards, and one that sends a clear message. “Smart move by Dr. Wen,” Adam Probolsky, a prominent political pollster and head of Probolsky Research told BuzzFeed News over email. “The hyper-political nature of Planned Parenthood in recent years has turned off many Americans who would ordinarily be more sympathetic to an organization that does so much to advance women’s health.” Vice president of the anti-abortion group March for Life, Tom McClusky, agreed, saying “It’s brilliant hiring her, I was preparing for another elected shill kind of person,” he told BuzzFeed News. “To hire someone with a Dr. in front of her name — I think they think, with the most pro-abortion Congress we’ve ever had, the time is right” to hammer home the view that abortion is health care. But some Democratic strategists are concerned that Wen’s shift to focusing on health care over politics is a sign Planned Parenthood is backing away from the fight. “It’s a symbol of fatigue, the battle has been a tough one and they’re tired,” Hank Sheinkopf, a veteran Democratic campaign consultant who worked with former president Bill Clinton and former New York City mayor Michael Bloomberg, told BuzzFeed News. “If you publicly project that you’re no longer an advocate but a provider of medical services, the presumption is the bad guys will no longer beat you up because you’re no longer poking a stick in their eyes all the time.”  Sheinkopf and another prominent Democratic strategist (who asked not to be named so as not to jeopardize his relationship with Planned Parenthood), said they saw this shift in messaging as a preemptive defense to attacks from the right, but that they didn’t think it would actually work and that the attacks would keep coming. All this would do, Sheinkopf speculated, is make advocates fighting on the ground feel abandoned. Wen insisted, however, that the organization isn’t backing away from politics. In fact, she said she plans to expand Planned Parenthood’s political work to collaborate with the Democratic, pro–abortion rights candidates who won 2018 midterm elections on the state legislature and gubernatorial levels around the country. The organization will be heavily involved in the 2020 presidential elections, she said, and will continue to challenge the Trump administration’s abortion and reproductive health care policies. But Wen comes to Planned Parenthood at a more peaceful time than it has seen in years, and the organization is in a very different position than it was when Richards was in charge. As of Jan. 3, Democrats hold the majority in the House. Among these new Democrats are several influential new members — like Alexandria Ocasio-Cortez or Ayanna Pressley, who supported Planned Parenthood and abortion rights as part of their campaigns — many of whom have already met with Wen, she told BuzzFeed News. In this new Congress, all legislative efforts to defund Planned Parenthood are likely dead on arrival. Since Republicans took Congress in 2015, Planned Parenthood has repeatedly been a hair (or thumb)’s breadth from losing its more than $500 million in government funding. This reached its pinnacle in the summer of 2015, when the anti–abortion rights activist David Daleiden released a series of videos accusing Planned Parenthood of profiting from the sale of “baby parts,” a term still used frequently by the organization’s opponents. The videos triggered more than a dozen Republican-governed states to investigate and temporarily defund Planned Parenthood, as well as a series of lengthy, Republican-led congressional investigations into the videos’ allegations, none of which were found to show evidence of wrongdoing. With Congress off its back, Planned Parenthood can finally move out of its defensive crouch and focus on new projects, like Wen’s idea to turn more Planned Parenthood affiliates into one-stop shops where you can come in for birth control, STI tests, or an abortion, and meet clinic workers prepared to diagnose and treat a range of other problems unrelated to reproduction, from diet to depression to addiction. There are no concrete plans for this expansion just yet, Wen told BuzzFeed News, but it could involve in-house mental health counselors, which a few clinics already have, and will likely include increased training for Planned Parenthood staff on how to provide “trauma-informed care.” Wen also says she is looking into increasing Planned Parenthood patients’ access to opioid addiction treatment and naloxone, a drug that reverses overdoses from heroin and other opioid drugs. Naloxone is already available at a few Planned Parenthood clinics around the country, including at a Northern California clinic that is on the itinerary for Wen’s tour, but Wen wants to expand its availability nationwide. Many of the low-income areas where residents rely heavily on Planned Parenthood for care are also areas ravaged by the opioid epidemic. As Baltimore’s health commissioner, Wen did significant work in the reproductive health sphere, including overseeing a maternal and child health program credited with reducing infant mortality in Baltimore by 40%. But some of her most revolutionary accomplishments were in the realm of opioid addiction treatment. In 2015, Wen issued a blanket prescription for naloxone to the entire city. Three years later, those free doses prevented more than 3,000 people from dying. Wen’s philosophy since early in her career has been to “treat the whole patient,” she said. This means focusing on mental, physical, and reproductive health, but also focusing on the societal causes and not just the symptoms. As an emergency room doctor, Wen would regularly see patients coming into the ER with life-threatening conditions because they were “cutting their medications into halves or quarters” out of an inability to pay for the correct dosage, saddling themselves with sky-high hospital fees instead. It was her job to treat the symptoms, she said, but she began wondering if she was being the best doctor she could be if she wasn’t trying to treat the cause. “It was my duty to ensure that my next patients didn't have to come in with a heart attack or stroke because they couldn’t afford their diabetes or high blood pressure medications,” Wen said she realized. And she will have to keep fighting for low-income patients in her new role as well. Planned Parenthood is in a better position than last year, but the attacks from the Trump administration are not behind them. “One of the biggest and most important fights we will see this year are the Title X restrictions,” Wen told BuzzFeed News over the phone Friday, referring to the federal family planning funding program. Planned Parenthood serves about 41% of all the patients in need of Title X coverage. A new rule proposed by the Trump administration could greatly affect those patients and limit or prevent many of Wen’s plans for the future from being implemented.  The rule prevents Title X funding from going to organizations that offer nonabortion services, like contraception or gynecological exams, in the same facilities where they perform abortions. In other words, it would partially defund Planned Parenthood. The rule was introduced by Trump’s Department of Health and Human Services in May but is expected to officially go into effect this month (although Planned Parenthood and other advocacy organizations are likely to sue, potentially blocking it from taking effect until the litigation is through). And the battle spurred by Daleiden’s videos over Planned Parenthood’s partnership with biomedical firms that use fetal tissue for scientific research has quietly and slowly continued under the Trump administration, with the Department of Justice taking up the cause last year. Wen is facing internal challenges as well. A little more than a month after Wen started in her role, the New York Times published an article that quoted several current and former Planned Parenthood workers who claimed that they faced discrimination at work because they were pregnant. And many Planned Parenthood clinics around the country offer no paid parental leave, a seemingly hypocritical policy for an organization that itself fights for increased paid parental leave policies. Wen told BuzzFeed News on Friday that when she accepted the job she did not know that some of the organization’s affiliates had this policy. Planned Parenthood is federated, so each state affiliate has its own board and individual policies. Under Wen’s direction, Planned Parenthood is investigating and launching an initiative to review the policies at all of its affiliates. It plans to publicly announce the results and specific plans to change those policies by fall of 2019. On Wednesday, Wen will make the first stop on her five-month tour, starting at an affiliate in Ohio. This is the kind of pilgrimage former Planned Parenthood president Richards took often, but for her, Wen said, it will be different. “Clinic visits through my eyes are different than the visits through her eyes,” Wen told BuzzFeed News, getting up to leave her new office. While Richards visited clinic workers as a political organizer and abortion rights champion, Wen said she’ll be talking to them medical worker to medical worker. “For me, I’m a frontlines health care fighter, I’m going back to my people. For her, she’s a frontlines organizer, going back to her people, but in a different way.”


buzzfeed--2019-03-16--Beto ORourke Says Hes No Longer Sure Single-Payer Is The Best Way To Get To Universal Health Car

Beto O'Rourke Says He's "No Longer Sure" Single-Payer Is The Best Way To Get To Universal Health Care

WASHINGTON, Iowa — Beto O'Rourke, on his first trip to Iowa as a presidential candidate, broke with prominent 2020 Democrats and some of his past statements in saying that his goal for health care is not necessarily a single-payer system.    Asked directly Friday if his goal is to get to a single-payer system, he said, “No, my goal is to get to guaranteed, high-quality universal health care for all, and I think there are many ways to get there."  In response to a separate question, that he's "no longer sure" that Medicare for All or a single-payer system would be "the fastest way for us to get there."  Like with other policy issues early in his campaign, O'Rourke said he is "very open to listening to others" as he decides on what the best way to get to universal coverage would be, particularly calling out a "Medicare for America" plan in the House that would allow people who choose to keep employer-based care and open up Medicare for people without employer-based insurance.  O'Rourke has been hard to pin down on health care. Early in his Senate campaign, in June 2017, O'Rourke said on Facebook that a "single-payer Medicare-for-all program is the best way to ensure all Americans get the healthcare they need." But he did not sign onto a Medicare for All bill in the House, telling the Texas Observer later that year that he disagreed with some of the plan's specifics. During his campaign last summer, he talked primarily about “universal, guaranteed, high-quality health care for all," not specifically mentioning single-payer or Medicare for All.  The Medicare for All plan, which would radically alter the current health care system in favor of a government-run single-payer system, is a pivotal policy for several 2020 Democrats. Sen. Bernie Sanders made it a hallmark of his 2016 campaign, and is doing so again now. His Senate Medicare for All bill is cosponsored by several of the other presidential candidates — Sens. Cory Booker, Kamala Harris, Elizabeth Warren, and Kirsten Gillibrand.  O'Rourke said Friday he has issues with people not having a choice under a single-payer system.  "Over time, I hope Medicare has the investment and buy-in necessary that people choose to leave employer-based insurance instead of being forced to," he said.


buzzfeed--2019-05-27--Trump Is Gutting Health Care Protections For Transgender People And Those Who Have Had Abortions

The Trump administration on Friday unveiled its long-expected proposal to reverse health care protections for transgender people and those who’ve had abortions, issuing a draft rule that seeks to rescind nondiscrimination policies established under the Affordable Care Act.  It’s the Trump administration’s third regulatory strike against transgender people this week. One rule, finalized Tuesday, would let health care workers recuse themselves from treating transgender patients on religious grounds, and a draft rule issued Wednesday would let homeless shelters turn away transgender people.  The 204-page proposal released Friday by the Department of Health and Human Services would change the way discrimination “on the basis of sex” is defined. Instead of stating that this includes transgender patients or abortion-related care, the term “sex” would be open to interpretation — thus removing those explicit protections.  HHS says this change is necessary as a response to lawsuits from conservatives who argued that the word was being interpreted too broadly.  “This proposed rule,” the draft says, “seeks to amend regulations that identify sexual orientation or gender identity as prohibited bases for discrimination for certain Department funded or administered programs.”  The new regulation would add, “Nothing in this chapter shall be construed to require or prohibit any person, or public or private entity, to provide or pay for any benefit or service, including the use of facilities, related to an abortion.”  The move is part of a broader effort under President Donald Trump's administration to undo LGBT and reproductive rights, many of which were created by his predecessor, former president Barack Obama, by asserting that civil rights laws banning “sex” discrimination should be interpreted narrowly.  "This rule dangerously encourages illegal discrimination, putting the lives of transgender people in jeopardy," Kris Hayashi, executive director at Transgender Law Center, said in a statement calling the draft rule "yet another outright attack from the Trump administration on the health, well-being, and survival of transgender people."  The HHS policy would reverse part of a 2016 regulation that says discrimination in medical care or insurance coverage due to gender identity or “termination of pregnancy” is illegal. A federal judge had blocked the Obama-era regulation the same year, and shortly after Trump took office, the administration announced plans to rewrite it.  As part of its latest moves, the HHS said Friday that it plans to amend 10 other regulations, issued by the Centers for Medicare & Medicaid Services, concerning discrimination on the basis of sex in order to make them consistent with the new draft rule.    Mara Keisling, executive director of the National Center for Transgender Equality, said the proposal "will abandon 2 million Americans" who were protected under the previous rule.    When Congress passed the Affordable Care Act in 2010, lawmakers included Section 1557 to establish nondiscrimination protections in health care services and insurance by referring to Title IX of the Education Amendments of 1972 and other civil rights laws — but it left the specifics up to future rule-making.  The HHS under then-president Obama fleshed out those details in a 2016 regulation asserting that Title IX’s ban on sex discrimination included discrimination on the basis of gender identity and termination of pregnancy.  The rule essentially prevented medical workers, insurers, or organizations from discriminating against transgender patients for any services — including transition-related care — and women who have had or are seeking abortions in some circumstances.  Pertaining to abortion care, the effects of the rule were slightly more complicated. Because of regulations in place preventing government funding of abortions, the nondiscrimination clause applied only when a health insurer or organization provided the same types of procedures for both abortions and nonabortion services. For example, a procedure called “dilation and evacuation” is used both in miscarriage care and abortion care. If a Catholic hospital provided this service for miscarriages, under the Obama administration’s rule, it would also have to provide it for abortions.  The rule affected the vast majority of health care workers because it applied to any hospitals, doctors, or clinics that accept federal reimbursement or remunerations, like Medicare or Medicaid payments. It also affected insurance companies that participate in the health insurance market.  But the rule was blocked after a group of states, joined by several organizations, sued the Obama administration in a remote Texas district with only one presiding judge, a George W. Bush appointee known for blocking the administration's liberal policies. After Trump took office, HHS indicated that it would reverse the regulation in order to make the lawsuit moot.  The dispute is at the heart of a much larger national debate over what “sex” means: sex as identified by birth, gender identity, or other factors.  Many conservatives have insisted that if lawmakers intended for sex discrimination laws to address transgender people, they would have written such language explicitly into the bills, as they did in the Violence Against Women Act.  “When Congress prohibited sex discrimination, it did so according to the plain meaning of the term, and we are making our regulations conform,” Roger Severino, director of HHS's Office for Civil Rights, said in a statement Friday.    HHS says in a fact sheet that the latest rule is “returning to the government’s longstanding interpretation of ‘sex’ under the ordinary meaning of the word Congress used.”  Yet courts have found the term “sex,” while arguably ordinary or plain, is actually ambiguous.    Laws concerning “sex” don’t necessarily need to name transgender people in order to protect them. Many courts have found that a law’s text, not its intent, must be the deciding factor. Several judges have concluded that transgender people are covered by the plain meaning of “sex” in laws against discrimination because they wouldn’t face discrimination “but for” their sex. For instance, they endured bias because their gender identities differed from their sex at birth, or they didn’t conform to gender stereotypes for someone of their birth sex.  Given that no federal law specifically bans anti-LGBT discrimination, advocates have pushed in courts and through regulations to argue that sex discrimination bans cover sexual orientation and gender identity. The Supreme Court has never ruled definitively on the issue.  The Trump administration, however, narrowed its definition of “biological sex” in March when the Department of Defense released a policy banning most transgender people from the military. The policy defined “biological sex” as a “person's biological status as male or based on chromosomes, gonads, hormones, and genitals.”  The administration had previously reversed certain policies from the Obama administration that said transgender people are covered by sex discrimination laws, such as in guidance for students and workers, but it had never formally asserted that sex — as a generic term — can be defined only by biological characteristics or sex at birth.  The proposal also fits in with a wider undertaking by Trump’s HHS to increase religious protections for health care workers. In early 2018, the Trump administration opened an office within HHS’s Office for Civil Rights (the same office that implemented Section 1557) to protect health workers who had moral or religious objections to performing certain procedures, including things like abortions or sex reassignment surgery.  Although the new regulation reflects the administration's opinion about the scope of antidiscrimination law, specifically Title IX, it does not prevent a victim from suing in court — indeed, transgender plaintiffs have prevailed in numerous recent sex discrimination lawsuits involving education and workplaces.  Abortion and LGBT rights advocates have told BuzzFeed News that they will almost certainly take legal action to block the proposed rule, depending on what the final version looks like after the comment period has ended.  Gretchen Borchelt, vice president for reproductive rights and health at the National Women’s Law Center, told BuzzFeed News that the Obama-era regulation was “the first time we had this broad of a civil rights law for health care. Whatever the final rule looks like, we would consider taking legal action if there’s any sort of rollback of patients’ rights put into place.”


cnbc--2019-04-29--More Americans likely to oppose Trump in 2020 because of his handling of health care poll

More Americans likely to oppose Trump in 2020 because of his handling of health care: poll

US President Donald Trump arrives to board Air Force One at Joint Base Andrews in Maryland on April 26, 2019.  More Americans say they are likely to oppose rather than support President Donald Trump in the 2020 presidential elections because of his handling of health care, according to a new ABC/Washington Post poll.  While 23% of those polled said Trump's stance on health care would compel them to vote for his reelection, 40% said they likely will not support him next year because of it. Of the remaining voters, 33% said health care is not a factor in who they'll vote for, while 5% said they had no opinion on Trump's handling of health care.  It's not surprising that health care has become a top priority for voters because the last few years have been "tumultuous" for the health-care system, said Rachel Nuzum, vice president for the Federal and State Health Policy initiative at The Commonwealth Fund.  "Americans need certainty when it comes to their health care," Nuzum said. And Trump's call to upend the health-care system "creates a lot of uncertainty," she added.  Trump and congressional Republicans have vowed to repeal the Affordable Care Act, or Obamacare, pledging to deliver on one of Trump's main campaign promises. Despite Trump's assertion that Republicans will become "The Party of Healthcare," Republicans don't have another health-care plan in place and are waiting until the GOP regains control of the House of Representatives to unveil a replacement proposal. Republicans currently hold control of the Senate, but need 21 more seats in the House to win the majority.  Lawmakers on both sides of the aisle widely believe the Republican-led Senate's failure to repeal Obamacare in 2017 led to Democrats regaining a majority in the House in last year's midterm elections.  Trump's cries to repeal Obamacare without a better proposal in place is a "very risky political proposition," according to John Hudak, a senior fellow and deputy director at the Brookings Institution's Center for Effective Public Management.  Hudak said Obamacare's individual provisions, like Medicaid expansion, protecting preexisting conditions and allowing children to stay on their parents' insurance plans until they are 26 years old, are "wildly popular" with citizens.  "These are all issues that are not just more popular than the president, they're more popular than a lot of other issues in America," Hudak said.  Obamacare is back in jeopardy once again after the Trump administration supported a lawsuit questioning the health-care law's constitutionality.  In December, U.S. District Judge Reed O'Connor of Texas said that without a rule that requires Americans to have health insurance or face a tax penalty, Obamacare cannot stand. The Trump administration reduced the tax penalty — called the individual mandate — to $0 in the 2017 Tax Cuts and Jobs Act.  Now O'Connor's ruling, which is backed by the Justice Department, awaits deliberation in the U.S. Court of Appeals for the 5th Circuit, though experts and even some top Republicans have said it's unlikely the law will be overturned.  Though some believe Obamacare is safe from a negative ruling from the Supreme Court, Hudak said Trump's attacks on Obamacare, which has become popular with many citizens despite failing to reduce health-care costs, can hurt his relationship with swing voters.  "Threatening to take away tens of millions of people's health care is not a great recipe from growing his political coalition," Hudak said.  According to the Kaiser Family Foundation, half of Americans support Obamacare, while 38% oppose it.  Looking forward to 2020, Nuzum said it'll be important for every presidential candidate to look through the voters' lens on health care. Nozum said voters seek certainty in the health-care system and want lower health-care costs and insurance plans that will allow them to make the best medical decisions.  "Thinking through from that lens is going to be really critical," Nozum said.  Though Republicans have yet to unveil a health-care plan, some Democrats have entered the presidential race with their own ideas to replace Obamacare. Presidential hopeful Sen. Bernie Sanders, I-Vt., has proposed a "Medicare for All" bill, which seeks to create a government-run health-care plan that would cover every American. The proposal has support from fellow Democratic presidential candidates like Sens. Kamala Harris, D-Calif., Cory Booker, D-N.J., Elizabeth Warren, D-Mass., and Kirsten Gillibrand, D-N.Y., though Republicans and centrist Democrats have spoken against Sanders' legislation.  White House did not immediately respond to CNBC's request for comment.


cnbc--2019-12-19--Mike Bloomberg calls for public option in his 2020 health-care proposal

Presidential candidate Mike Bloomberg on Thursday unveiled his health-care plan, which includes a public option and is similar to former Vice President Joe Biden's proposal.  The former New York City mayor's plan would allow voters to "buy a Medicare-like health insurance policy, administered by the federal government but paid for by customer premiums," his campaign explained.  In a statement, Bloomberg, who has a net worth of just over $54 billion, pledged to provide universal health care and reinvigorate President Barack Obama's signature health-care law, the Affordable Care Act, if he were to become president.  "President Trump has spent three years sabotaging the Affordable Care Act and offering nothing in return but empty promises," Bloomberg said. "We will reverse the president's attacks on the Affordable Care Act, reach universal coverage, reduce costs for all Americans, increase support for rural communities, and fix our broken healthcare system once and for all."  The plan stops short of the "Medicare for All" concept that's being pushed by more progressive candidates Sens. Elizabeth Warren and Bernie Sanders.  Here are the plan's top priorities, according to the website: • Extend tax credits for individuals and families with high insurance premiums • Allow families to buy health plans in the individual market with federal subsidies • Conduct aggressive efforts to sign people up for insurance  Biden, Sanders and Warren are ahead of Bloomberg in all of the national polls. Biden and Mayor Pete Buttigieg have both said they back health-care plans that give an option to voters to buy into a Medicare-like public option, while stopping short of Medicare for All.  Bloomberg offered four pillars for affordable health care, starting with "extending tax credits for individuals and families" whose premiums are more than 8.5% of their income. Another one of his ideas is "creating a permanent federal reinsurance program for the individual market which would reduce premiums by up to 10 percent."  Bloomberg's campaign for president released his plan as he spoke at a rally in Tennessee on Thursday. He plans to open a campaign office in Nashville.


cnbc--2019-12-26--A decade of Obamacare: How health care went from wrecking to boosting Democrats

House Speaker Nancy Pelosi lost her gavel and regained it in this decade. Obamacare played a major role each time. In 2010, a voter rebellion against the health-care law helped Republicans wallop Democrats and gain House control. Eight years later, Democrats made GOP efforts to scrap Obamacare the centerpiece of their campaigns and then won back the chamber. "I'll just tell you that the lesson from all of this is that health-care policy is treacherous politics," said Carlos Curbelo, a former Republican congressman. He won Florida's swing 26th District in 2014 after a campaign in which he promised to repeal Obamacare, then lost his seat to Democratic Rep. Debbie Mucarsel-Powell in 2018 following a vote to scrap the law. In the nearly 10 years since the Patient Protection and Affordable Care Act became law in March 2010, it has gone from political anchor to tailwind for Democrats. President Barack Obama's signature legislative achievement became one of the defining issues of the decade and shaped recent elections more than just about any other policy issue.  "Backlash to the ruling party's actions on health care were a significant part of both the 2010 and 2018 waves," said Kyle Kondik, managing editor of election forecasting site Sabato's Crystal Ball. He added that resistance to the law also probably helped the GOP in the 2014 midterms, especially after a messy rollout of the insurance exchange website in 2013. Obamacare sentiment reflects broader trends in American political opinion, Kondik said. Voters often buck the party in power, so the Affordable Care Act was less popular under Obama but gained traction once President Donald Trump took office. Both Democrats and independents started to feel better about Obamacare after Trump entered the White House, driving the increase in popularity, according to monthly Kaiser Family Foundation tracking polls. Democratic calls to maintain the law — particularly its provisions protecting Americans with preexisting medical conditions — appeared to resonate with voters when Republicans got a real chance to replace the health system. "Health care was on the ballot, and health care won," Pelosi told reporters in November 2018 after Democrats flipped House control.  The landmark law better known as Obamacare offered new subsidies for buying plans, barred insurers from denying coverage based on preexisting conditions, allowed states to expand the joint federal and state Medicaid program for low-income Americans and let children stay on their parents' plans until age 26, among other provisions. Last year, 8.5% of the U.S. population was uninsured, down from 13.3% in 2013, before Obamacare fully took effect. Before the shift, the Affordable Care Act appeared to hurt Democrats politically at the outset as Republicans billed it as a government takeover of health care. While a plurality of voters approved of the law a month after its passage, sentiment changed before the 2010 midterm elections, according to Kaiser surveys. In October 2010, 44% had an unfavorable view of the law, while 42% saw it favorably. In the 2010 elections, Democrats lost 63 House seats. Republicans flipped the chamber and kept control until this year. The GOP also gained six Senate seats. The incumbent president's party almost always loses seats in midterm elections. Even so, Obamacare appeared to propel the Democratic drubbing. Nearly half – or 45% – of voters said their 2010 vote was a message of opposition to Obamacare, according to exit polling cited by NBC News in 2014. Only 28% responded that their vote was a message of support for the law. After Republicans took over the House in 2011, then the Senate in 2015, they tried to repeal the Affordable Care Act dozens of times. The party made opposition to the law a central part of its political messaging for years — though Obamacare remained safe as long as its namesake president sat in the Oval Office.  The GOP gained another 13 House and nine Senate seats in the 2014 midterms. Following the election, then-House Speaker John Boehner said resistance to the health-care law drove the results. "The American people have made it clear: They're not for Obamacare. Ask all those Democrats who lost their elections Tuesday night. A lot of them voted for Obamacare," he said in November 2014. Exit surveys cited by NBC News suggest the health-care law had a smaller effect in 2014 than it did in 2010. Only 28% of voters said they wanted to express opposition to Obamacare, while 12 percent said they aimed to show support for the law.  When Trump won the White House and the GOP held control of Congress in 2016, Republicans finally got their chance to dismantle Obamacare. While the House passed a repeal bill in 2017, the Senate never could. The GOP fell one vote short in a dramatic late-night vote on a bill to roll back major parts of the ACA. The Trump administration has managed to dismantle pieces of Obamacare, both through administrative and legislative action. The GOP tax law passed in 2017 to end the individual mandate, a divisive provision that required most Americans to have health insurance or pay a penalty. Public opinion around the law started to shift after Republicans gained control of the White House and Congress and started to propose their own alternatives to Obamacare. For nearly all of the stretch from February 2013 to February 2017, monthly Kaiser polls found a larger share of adults had a favorable view of the law than unfavorable. But in every month since May 2017, Kaiser has found more adults like the ACA than dislike it. In November, 52% of adults surveyed by Kaiser had a favorable view of Obamacare, versus 41% who had an unfavorable opinion. Curbelo said opposition to Trump, and his most prominent policy push in trying to unravel Obamacare, helped to drive a rough 2018 election for the GOP. "A large part of the debacle that was that election, certainly in the House, can be attributed to health care," he said. The former congressman said he does not regret his vote to pass the American Health Care Act, the House Republican ACA overhaul, even now knowing he lost his seat. Curbelo said the vote "was about keeping [his] word" to repeal and replace Obamacare, which he had promised to do since he first ran for Congress.  How Obamacare is shaping the 2020 race  Health care will likely play a huge role in the 2020 elections, as well. Democrats have targeted the Trump administration over its decision not to defend Obamacare in a lawsuit seeking to toss out the law. Earlier in December, a federal appeals court ruled that the law's individual mandate was unconstitutional, but left the law largely intact as it punted to a lower court the question of whether the rest of the law should be thrown out. That decision could take another year or so.  At the same time, the top Democrats running for the party's presidential nomination all support Obamacare. They only disagree on how best to improve the system. Sens. Bernie Sanders, I-Vt., and Elizabeth Warren, D-Mass., want a "Medicare for All" system to move quickly to insure every American. Former Vice President Joe Biden and South Bend, Indiana, Mayor Pete Buttigieg want Americans to have the option to buy into public insurance while keeping the private system. "There is a significant segment on the left who appears to believe the ACA was insufficient, and even the candidates who are more moderate on health care, like Biden and Buttigieg, who want to do more on health care than the ACA did," Kondik said. "So at the very least, there seems to be some broad consensus that a future Democratic president/congressional majority should build on the ACA." As the popularity of Obamacare — and the former president himself— have grown, Democrats have become more comfortable tying themselves to the ACA and Obama. In a presidential debate in September, Biden pointed to the fact that Warren said she was with Sanders on health care. "Well I'm for Barack. I think Obamacare worked," he said. In releasing his health plan in July, Biden also defended the law passed when he was vice president. "I understand the appeal of Medicare for All," he said. "But folks supporting it should be clear that it means getting rid of Obamacare, and I'm not for that."