Trump Administration Takes Another Step To Roll Back Obamacare


Trump Administration Takes Another Step To Roll Back Obamacare

Jonathan Cohn, HuffPost          February 20, 2018 

Republican efforts to roll back the Affordable Care Act’s insurance reforms continued Tuesday, when the Trump administration proposed regulations that would make it easier for health insurers to sell cheap, short-term policies that leave out key benefits and are available only to people in good health.

Announcement of the proposal, which has been in the works for several months, came two months after President Donald Trump signed Republican legislation eliminating the individual mandate, which makes people pay a financial penalty if they don’t have insurance.

Taken together, the two steps ― getting rid of the mandate and then changing the rules on short-term plans ― could accelerate an evolution already underway for people buying insurance on their own, rather than through an employer.

In many states, premiums have risen substantially in the past few years, as plans have struggled to attract customers in relatively good health. Federal tax credits, which the Affordable Care Act also created, insulate low- and many middle-income people from these increases ― allowing them to get comprehensive coverage, regardless of medical status, at low prices.

But people at higher incomes receive no such assistance and, in some cases, the premiums make it difficult or even impossible for them to get traditional insurance. This is particularly true in more rural parts of the country, and especially for older consumers, thanks to a combination of factors ― some related to the design of the ACA, and some related to the way hostile Republican officials at the state and national level have implemented it.

The regulation that the administration proposed on Tuesday would make it easier for some of these people to get short-term plans, which are generally cheaper because they do not have to follow all of Obamacare’s rules. They do not have to cover mental health and other “essential benefits,” for example, and they can have annual or lifetime limits on the bills they will pay.

But short-term plans are generally not available to people with pre-existing conditions and wouldn’t cover the expenses of people with some serious illnesses anyway. If short-term plans were to draw off a substantial number of relatively healthy customers, they would drive up the price of traditional, fully regulated insurance plans even more.

In the end, the new regulation could allow some people ― especially those who find current coverage unaffordable ― to buy ultra-cheap, relatively skimpy plans.

“It’s time to offer more affordable coverage options,” Seema Verma, administrator of the Centers for Medicare and Medicaid Services, said during a conference call Tuesday. “It’s about allowing individuals, not the government, to make decisions about what works for them and their families.”

But the new regulations would also render the law’s insurance reforms less effective, making it more difficult for people who need or want more comprehensive coverage to get it.

“This is the Trump administration’s end run around Congress,” Sabrina Corlette, research professor at Georgetown University’s Center on Health Insurance Reforms, told HuffPost. “The end result will be higher premiums and fewer plan choices for people with health care needs, as well as for healthy people who want the kind of benefits and financial protection that real insurance is supposed to provide.”

A key variable in all of this is the states, which have authority to regulate such plans on their own. Several already have strong rules on the book, as a recent survey of state policies from the Commonwealth Fund noted. More states could take similar action.

The Kind Of Insurance Obamacare Was Supposed To Eliminate

Short-term plans are a vestige of the old health care system, the one that existed before the ACA took effect and made comprehensive coverage more widely available. At least in theory, these plans are primarily for people with temporary gaps in coverage ― because they are in between jobs, or perhaps about to have a change in their life circumstance like getting married.

Obamacare allowed insurers to keep selling such plans, but it also gave the federal government authority to regulate them tightly.

The Obama administration did just that. When it wrote the rules for the individual mandate, the administration said that short-term plans would not count as qualifying coverage, which meant that people who had these plans would still have to pay the penalty. The administration also limited these short-term policies to durations of just three months — although that regulation just took effect this year, and some insurers have found ways to sell a year’s worth of coverage even with that regulation in force. (Basically, they allow customers to buy four plans, each for a duration of three months, at one time.)

The Obama administration made these decisions because the whole point of the ACA’s private insurance reforms was to transform the market for people buying coverage on their own, so that everybody ― healthy and sick, young and old ― was paying into one pool and was part of the same system. That way, insurers would have enough money to cover the bills of people with serious medical conditions.

But the Obama administration wasn’t simply out to ensure the newly reformed insurance markets could work. Regulations on short-term plans were also meant to protect consumers.

Frequently, people who bought short-term plans ended up facing crushing medical bills, because agents or insurers hadn’t made limits on these plans clear ― or because insurers had found reasons not to cover bills after the fact. In one case that’s currently the subject of a lawsuit in federal court, a heart attack victim who had a short-term policy is on the hook for $900,000, according to a story on short-term plans by Reed Abelson of The New York Times.

Now, Republicans are undoing these reforms. The regulations that the Trump administration just proposed would rescind the Obama administration’s limit on short-term plans, so that insurers could sell policies that last a full year. Starting in 2019, people buying such plans wouldn’t have to worry about paying the individual mandate penalty, since the GOP’s new tax legislation reduces that penalty to zero.

These steps could help split insurance markets into two ― one with relatively cheap, skimpy short-term plans that would be available to people who are in good health, and one with highly expensive comprehensive insurance that would be available to anybody, regardless of pre-existing conditions.

People who bought the short-term plans would frequently save money, as long as they didn’t get sick and find themselves on the hook for bills the short-term plans don’t cover. But premiums for those comprehensive policies could get even higher than they are now.

The majority of people buying coverage on their own are eligible for tax credits that offset premiums, which get bigger as premiums go higher. In general, they won’t have to pay more for coverage, even as it gets more expensive. But people who earn too much to qualify for the tax credits ― anybody with income above four times the poverty line, or $98,400 for a family of four ― would bear the full brunt of those higher premiums.

It’s a problem that already exists in some states, like Iowa and Tennessee, but it could get worse and affect even more Americans if the Trump administration regulations go into effect, especially if the new measures cause more insurers to abandon markets altogether.

Just how big a difference this regulation would ultimately make is difficult to say. In a fact sheet accompanying the proposed regulations, HHS said that for 2019 it expects 100,000 to 200,000 people to drop traditional coverage and buy short-term policies instead. That is not a huge number.

But over time, the plans could draw even more people, especially if insurers and the independent brokers who sell plans push them aggressively. And some experts think that rough estimate, of just 100,000 to 200,000 people shifting plans initially, is too low.

The Regulation Isn’t Final Yet ― And States Will Have Their Say

The regulations must go through a formal, 60-day comment period before they become final. During that period, the three departments issuing the regulation ― Health and Human Services, Labor, and Treasury ― are likely to hear from a variety of experts, advocates, and industry groups wary of the changes.

One of them is America’s Health Insurance Plans, the largest trade organization representing insurers. “While we are reviewing the proposed rule to understand its impact on the people we serve, we remain concerned that expanded use of short-term policies could further fragment the individual market, which would lead to higher premiums for many consumers, particularly those with pre-existing conditions,” Kristine Grow, group’s senior vice president for communications, said on Tuesday.

But not all insurers will be unhappy if these new regulations are finalized. UnitedHealth, which dropped out of AHIP a few years ago, already sells such policies. In an earnings call in October, the company’s chief executive said the opportunity to sell more of them ― along with so-called “association health plans,” which allow small businesses to buy policies that are also exempt from some of the Affordable Care Act’s regulations ― would be a profit opportunity.

The proposed regulation also seeks comment on the question of whether, somehow, these short-term plans should be “renewable” ― that is, whether insurers should allow people to stay on the same plans, year after year. Of course, doing so would seem to mean they aren’t really short-term plans at all, but rather an alternative form of long-term insurance that simply isn’t subject to regulations protecting people with pre-existing conditions. In theory, that is not legal under the Affordable Care Act.

If and when the regulation becomes final, as seems likely, attention will shift quickly to state officials, who can regulate insurance plans on their own. States could decide to keep the three-month limit in place, for example. Or they could go as far as New Jersey did, and prohibit short-term plans altogether.

They could also decide, separately, to introduce their own form of the individual mandate, as officials in at least some states are already talking about doing.

This article has been updated to include comment from an America’s Health Insurance Plans representative.

Watch police chief comments on Wisconsin gun law written by the NRA

NowThis Politics

February 18, 2018

Watch this police chief completely dismantle a horrifying gun law that’s backed by the NRA

Milwaukee Police Chief Tears Apart NRA-Backed Concealed Carry Law

Watch this police chief completely dismantle a horrifying gun law that's backed by the NRA

Posted by NowThis Politics on Sunday, February 18, 2018

Who is Trump’s Budget Director Mick Mulvaney?

February 17, 2018

Who is Mick Mulvaney? Narrated by Elizabeth Warren. Unbelievable!

Who is Mick Mulvaney? Narrated by Elizabeth Warren

From Ronald Reagan’s envelope stuffer to Donald Trump’s budget director, meet the self-diagnosed right-wing nutjob Mick Mulvaney (via Who Is?)

Posted by NowThis Politics on Saturday, February 17, 2018

If Pruitt Attempts to Muck Up Our Environment, People Will Be Angry!


EPA Says Scott Pruitt Flies First Class Because Angry People Yell At Him Too Much

Nick Visser, HuffPost          February 16, 2018 

Often costing thousands of dollars more than equivalent seats in coach. The report, citing EPA receipts obtained through a Freedom of Information Act request, noted several flights cost more than $90,000 in total during a few weeks last June.

Federal regulations mandate government employees travel in the “least expensive class of travel” for their needs, but individuals are allowed to book premium seats if there are security concerns.

The EPA briefly said this week Pruitt had a “blanket wavier” to travel first class but later rolled back its statement when Politico noted that the regulations state that such travel must be approved on a “trip-by-trip basis.” A spokesman later clarified to the news site that Pruitt’s office submitted a waiver seeking an exemption before each trip, citing security concerns.

Until Thursday’s report, it was unclear what those concerns were, although Pruitt defended the bookings in an interview with the New Hampshire Union Leader, blaming what he called a “very toxic environment politically.”

“We’ve reached the point where there’s not much civility in the marketplace and it’s created, you know, it’s created some issues and the (security) detail, the level of protection is determined by the level of threat,” he told the Union Leader on Tuesday.

Pruitt’s tenure at the EPA over the past year has been controversial among environmentalists. The agency has quickly worked to roll back many regulations meant to combat climate change. The agency has also moved to unravel the Clean Water Act and the Clean Power Plan, and Pruitt was one of the driving forces behind President Donald Trump’s decision to withdraw the U.S. from the landmark Paris climate deal.

He receives many more threats than his predecessors, E&E News reported in January, and is the first EPA administrator to have a full-time security detail.

The agency also refuses to release many details about Pruitt’s schedule in advance, citing similar security concerns.

Sheriff promises Florida vigil attendees: Politicians ‘will not get re-elected’ if gun laws don’t change

Good Morning America

Sheriff promises Florida vigil attendees: Politicians ‘will not get re-elected’ if gun laws don’t change

Julia Jacobo, Good Morning America      February 16, 2018

Florida school shooting victims identified as families, community grieve

Jimmy Kimmel gets emotional in call for action on gun violence: ‘Children are being murdered’

Good Morning America

Jimmy Kimmel gets emotional in call for action on gun violence: ‘Children are being murdered’

Mark Osborne, Good Morning America      February 15, 2018

Late-night host Jimmy Kimmel slammed President Donald Trump and Congress over inaction on gun control Thursday night in the wake of the shooting at a Florida high school which killed 17 people on Valentine’s Day.

What do NRA-backed politicians plan to do about gun violence beyond ‘thoughts and prayers’? Nothing

What do NRA-backed politicians plan to do about gun violence beyond ‘thoughts and prayers’? Nothing shared NowThis Politics‘s video.
February 15, 2018

“Have you taken any votes ever to take guns from the hands of criminals or crazy people? Can you point to a single vote?”

NRA-backed lawmakers offer thoughts and prayers, but their inactions speak louder than words.

NRA-Backed Politicians Have Nothing to Offer Outside 'Thoughts and Prayers'

What do NRA-backed politicians plan to do about gun violence beyond 'thoughts and prayers'? Nothing

Posted by NowThis Politics on Thursday, February 15, 2018

This woman was physically dragged from the microphone trying to expose politicians payoff from oil corps.

DeSmogBlog shared NowThis‘s video.
February 13, 2018

This woman was physically dragged from the microphone after announcing how much money her state’s politicians get from oil corporations (via NowThis Politics)

Woman Physically Dragged from Microphone For Pointing Out How Much Money Her State's Politicians Get from Oil Corporations

This woman was physically dragged from the microphone after announcing how much money her state's politicians get from oil corporations (via NowThis Politics)

Posted by NowThis on Monday, February 12, 2018

Donald Trump pushes deep cut to Great Lakes funding — again

Detroit Free Press

Donald Trump pushes deep cut to Great Lakes funding — again

Todd Spangler, Detroit Free Press     February 12, 2018

(Photo: Mike De Sisti/Milwaukee Journal Sentinel)

WASHINGTON – President Donald Trump’s budget proposal for next year again calls for drastic cuts in Great Lakes restoration efforts, as well as for slashing rental aid that tens of thousands of Michiganders rely on and toughening work requirements for able-bodied adults receiving nutrition assistance.

It also calls for investing $1.5 billion in programs that support private and charter schools while cutting about $5 billion overall from the U.S. Department of Education.

Like the budget proposal made about this time last year, Trump is looking to nearly eliminate funding for a $300-million program that helps restore Great Lakes water quality by improving fish habitat, cleaning up polluted waterways and protecting wetlands. Trump’s earlier efforts to defund it have so far been rejected, as the program enjoys the support of Republicans as well as Democrats in the Upper Midwest.

Unlike last year, however, Trump’s White House did not make the proposed cut — from $300 million this year to $30 million in the fiscal year beginning Oct. 1 — clear in its budget message or its list of major reductions and reforms, burying it in a line in a 96-page budget explanation by the Environmental Protection Agency without explanation.

President Donald Trump looks on before signing a proclamation to honor Dr. Martin Luther King, Jr. Day in the White House on Jan. 12, 2018 in Washington, D.C. (Photo: Olivier Douliery, Abaca Press, TNS)

“If there’s one thing we’ve learned, we can’t take it for granted that others understand how important our water is,” said U.S. Sen. Debbie Stabenow, D-Mich. “This is outrageous. People across Michigan spoke out and took action last year to stop these cuts and I know they’ll do so again.”

Added U.S. Rep. Dan Kildee, D-Flint Township, “Cutting Great Lakes investments by 90% — essentially eliminating the program — threatens the health of our lakes and jeopardizes Michigan’s economy.”

Trump’s budget also again looks to slash other programs considered important to Detroit and other cities in Michigan, including the Community Development Block Grant fund. But it’s unlikely he will be able to push through such draconian reductions — especially given that he was unable to do so in his first year in office with members of his own Republican Party in control of both chambers of Congress..

More on this topic:

Trump plan slashes funding for Detroit, Great Lakes and much more

$300 million for Great Lakes protected in funding bill, thwarting Trump

Trump announced the $1.2-trillion budget for the next fiscal year as expected on Monday, including in it $23 billion for border security, $21 billion for infrastructure and $17 billion to fund efforts to fight the ongoing opioid epidemic, as well as substantially increasing military spending by $80 billion or 13%.

But with Congress having final say over appropriations for programs and agencies, the president’s budget proposal has in recent years become more of a political statement of his own than a plan likely to be embraced by either the House or Senate.

Congress has already rejected, for now at least, many of Trump’s last-year proposals such as the elimination of CDBG funds and the popular Great Lakes restoration efforts as it has cobbled together a series of resolutions to keep government funded from month-to-month in the current fiscal year.

Trump’s proposal on Monday even suggested spending about $57 billion less overall on nondefense programs even though Congress authorized that higher level in a bipartisan deal — one signed off on by Trump — just last week.

“The budget reflects our commitment to the safety, prosperity and security of the American people,” Trump said in his budget message to Congress. “The more room our economy has to grow, and the more American companies are freed from constricting
overregulation, the stronger and safer we become as a nation.”

As a policy document, however, the annual budget release still presumably indicates where the chief executive would cut or spend if he could, and he continues to have his sights set on cutting certain programs, including the Supplemental Nutrition Assistance Program, or SNAP, which helped feed 1.3 million people in Michigan as of December.

Trump proposed cutting back on a portion of the financial benefits received by families and sending them regular packages of milk, cereal, meat, canned fruit and other goods, saying it would save money, improve nutritional benefits and reduce fraud. His budget message also said his administration would move to expand “previous reforms aimed at strengthening the expectation for work” among SNAP recipients though details on how that would be accomplished weren’t provided.

Able-bodied receipients already have some work requirements in many cases. The Trump administration suggested more than $213 billion over a decade could be saved through the president’s proposed changes.

Trump’s budget also calls again for eliminating the Low Income Home Energy Assistance Program — which helped more than 440,000 Michiganders pay home energy bills last year — and the Community Development Block Grant program, administered by the Department of Housing and Urban Development. The program helps pay for home shelters, transportation services, housing rehabilitation and more. In 2017, Michigan communities received more than $111 million in CDBG funds, including $31 million for Detroit.

The budget also suggests reforms to some HUD rental assistance programs —including increasing tenants’ share of rent they must pay from 30% of their income to 35%, which could save the government about $4.3 billion. The Washington-based Center on Budget and Policy Priorities estimated last year that about 145,000 low-income households in Michigan used federal rental assistance.

An addendum to the budget suggests adding about $2 billion from the recently agreed upon budget deal in Congress back into rental assistance to keep elderly and disabled renters from getting hit with higher rents.

Meanwhile, the proposal also argues for investing $1.5 billion in school choice programs under U.S. Education Secretary Betsy DeVos, with states applying for funding for scholarships that would allow students from low-income families to transfer to private schools and local school boards requesting funding to expand “open enrollment” systems. About $500 million or more would also go to start new charter schools.

Overall the Department of Education would be cut by $5 billion or so with several programs being eliminated, including $2 billion in a grant program to the states to help improve the quality and effectiveness of teachers, principals and other educators.

The grants, the White House said, “are poorly targeted and funds are spread too thinly to have a meaningful impact on student outcomes.”

“The president’s budget request expands education freedom for America’s families while protecting our nation’s most vulnerable students,” said DeVos, a former Michigan school choice advocate and state Republican Party chairwoman. “The budget also reflects our commitment to spending taxpayer dollars wisely and efficiently by consolidating and eliminating duplicative and ineffective federal programs.”

Trump on Monday clearly tried to steer interest toward an infrastructure proposal he argues could help attract about $1.5 trillion in new investments in roads, bridges and other projects by using $200 billion over 10 years to leverage state, local and private funding. What’s unclear, however, is whether Congress would be willing to put up such funding or whether states and local governments have the matching money needed to pay for the remainder of the program.

Gov. Rick Snyder’s office said he is “happy to see President Trump and his team discussing infrastructure across the board” and that he looks forward to “working with the Trump administration and serving as a role model for infrastructure development and solutions.”

But it wasn’t immediately clear what benefit the infrastructure proposal could mean to key Michigan projects, such as a sought-after navigation lock at Sault Ste. Marie. Shippers have been seeking a new super-size lock for decades to protect against any potential shutdown of the one aging lock there now that is large enough to handle the biggest ships carrying iron ore and other freight through the Great Lakes.

“It appears there is very little in the proposal that would benefit the Soo Lock project,” Glen Nekvasil, vice president of the Lake Carriers’ Association, which represents shippers on the Great Lakes, said after reviewing the White House’s infrastructure plan. “Nor does it seem to provide any additional funding for authorized projects such as the second (large) lock.”

Contact Todd Spangler: 703-854-8947 or Follow him on Twitter at @tsspangler. USA TODAY contributed to this report.

Trump’s long-awaited infrastructure plan is a fraud


Trump’s long-awaited infrastructure plan is a fraud

This is the way Infrastructure Week begins, not with a bang but a whimper.

Elham Khatami, Adam Peck       February 12, 2018

Credit: Michael S. Williamson/The Washington Post via Getty Images

President Donald Trump unveiled his long-awaited infrastructure plan on Monday, touting the proposal as a $1.5 trillion investment in the nation’s highways, bridges, waterways, and other infrastructure projects. The plan’s topline number sounds great on the surface, but it wildly misconstrues the actual investment being proposed by the federal government — and Trump knows it.

The proposal aims to turn $200 billion in federal funds into a $1.5 trillion investment over the next ten years by placing most of the financial burden on states and cities, which will have to cover at least 80 percent of the cost of any infrastructure project in order to qualify for federal grants, likely through higher taxes, tolls, and other user fees. The $200 billion number is a dramatic reduction in federal cost-sharing from years past.

In an interview with the Wall Street Journal in January, Trump conceded that the $200 billion in federal funds is “not a large amount,” going on to criticize the amount of money the United States has spent on the wars in Afghanistan and Iraq. In a tweet Monday morning, Trump reiterated his criticism:

Donald Trump: This will be a big week for Infrastructure. After so stupidly spending $7 trillion in the Middle East, it is now time to start investing in OUR Country!

But Trump’s plan barely makes a dent in what’s needed to fix the country’s ailing infrastructure. Instead, it places the onus on cash-strapped states and municipalities to come up with the revenue to improve their own infrastructure. As CityLab reported last year, this will be especially difficult for “cities that never financially recovered from the recession, like Detroit, Cleveland, Stockton, and Memphis,” which are limited in their spending ability and yet need infrastructure investments the most.

According to the American Society of Civil Engineers’ (ASCE) annual Infrastructure Report Card, the United States needs to invest $4.59 trillion by 2025 in order to improve the country’s infrastructure — a figure three times larger than even the rosiest estimate in Trump’s proposal and more than 20 times larger than the $200 billion actually allocated.

“If the United States continues on this trajectory and fails to invest, the nation will face serious economic consequences, including $3.9 trillion in losses to U.S. GDP and more than 2.5 million American jobs lost in 2025,” the ASCE report said.

The $200 billion in federal spending includes $100 billion in incentive grants, aimed at encouraging increased state, local, and private infrastructure investment; $50 billion in rural formula funds, which seeks to promote investment in rural infrastructure needs; and $20 billion in so-called transformative projects, described as projects “that can significantly improve existing infrastructure conditions and services” but are considered too risky to attract private or local investments.

Even calling it a $200 billion investment by the federal government is a misnomer. Instead of finding new sources of revenue, the funds will be entirely offset by cuts to other existing infrastructure programs, including a 19 percent decrease in funding for the Department of Transportation and a 3 percent decrease for the Department of Energy, as highlighted in Trump’s fiscal 2019 budget, which was also released today.

Pointing out the glaring lack of new sources of funding in the infrastructure proposal, Michael Linden, fellow at the Roosevelt Institute, said on Twitter, “All told, he’s basically proposing a $0 infrastructure plan.”

Michael Linden: No. No. No. This headline is budget-illiterate. Trump’s budget will include $200 billion in infrastructure spending, offset by 20% reductions in base funding for Depts. of Transportation and Energy. All told, he’s basically proposing a $0 infrastructure plan. …

It is unlikely that most lawmakers on either side of the aisle will support Trump’s proposal — with Democrats, and some Republicans, criticizing the plan’s lack of new revenue sources.

But even if the proposal made its way through Congress and money began flowing to projects around the country, it’s unlikely the spending would have any meaningful impact on the worsening condition of the most vital infrastructure programs.

By leaving local governments on the hook for 80 percent of the cost of a project, the Trump administration is encouraging investments in public-private partnerships. A city will partner with a private developer, for instance, to construct a new building as part of neighborhood revitalization. But spending is most needed where public-private partnerships are hard to come by. Private financiers seek to tap into sustainable revenue streams when deciding what projects to invest in, and there are few revenue streams to be had for street repairs or water pipe maintenance. In states that have ceded some authority to private companies for the management and maintenance of highways, regressive tolls have hit the poorest workers the hardest.