Trumpcare fixes nothing

Yahoo News

Trumpcare fixes nothing

Rick Newman     June 22, 2017 

There are a lot of big problems with the US healthcare system. Costs and spending are way too high, with Americans shelling out far more per person on healthcare than other advanced nations and generally less for their money. Employers that provide insurance bear a huge cost burden their competitors in other countries don’t. The difficulty getting insurance outside an employer leads many workers to stay in jobs they’re not well-suited for, depressing economic dynamism and entrepreneurship. All told, an outdated and inefficient healthcare system is one reason economic growth in the US is chronically weak.

Congress is hard at work on sweeping healthcare legislation—that addresses none of these issues. Instead of aiming at the biggest problems affecting the most people, Republicans and Democrats are waging legislative war over a part of the system that affects only about 8% of everybody with healthcare. As for everybody else, well, if there are problems with cost or coverage, Congress doesn’t seem to be aware of that.

The battle over the Affordable Care Act, which Republicans are now trying to repeal, is, of course, a proxy war for bigger questions of government: Should Uncle Sam solve all big problems? Or have we gone too far in doling out benefits funded by wealthier taxpayers?

The latest move is a new Senate plan similar to one that passed the House in May, which President Trump praised. In general, Trumpcare, as the Republican approach is known, would rescind tax cuts passed in 2010 that help finance coverage for lower-income people who don’t get insurance from an employer. Trumpcare would also reduce the number of people who qualify for Medicaid, while killing the unpopular ACA requirement for nearly all Americans to have coverage. In general, fewer people would end up with health insurance and the government would be less involved in America’s healthcare system. If you’re a small-government conservative who won’t lose benefits under the GOP plan, you’re probably pleased.

Less popular than Obamacare

But the majority of Americans are not. The House bill introduced earlier this year is considerably less popular than Obamacare, which it is meant to replace, and the Senate version seems unlikely to win any new converts. The GOP approach is even less popular than the Wall Street bailouts of 2008 and 2009. AARP opposes Trumpcare because it would raise costs and reduce coverage for some people over 50. The American Medical Association is against it. The American Cancer Society is against it. Three Republican governors oppose it and none has come out in favor of it. It’s hard to think of another instance in which Congress pushed legislation opposed by so many constituents.

If Trumpcare passes and becomes law, America will still have an antiquated, dysfunctional healthcare system—with more uninsured people. The US spends about $9,450 per person each year on healthcare—150% more than the median for advanced nations. Yet the United States ranks 28th in life expectancy and infant mortality. Thirty-eight percent of adult Americans are obese, the highest rate by far among 36 advanced nations. There’s nothing in either the House or Senate bill meant to improve any of this.

If Trumpcare fails to pass in the Senate, and simply dies…. America will still have an antiquated, dysfunctional healthcare system, with no other plans on the books in Congress to do anything about it. In addition to lousy health outcomes, the American healthcare system distorts economic decisions affecting millions of ordinary families. Economists would like to see the “portability” of healthcare benefits, which means workers would get the same benefits for the same price, more or less, regardless of where they work. This would eliminate “job lock,” or the decision to stay in a job simply for the benefits, and allow more workers to start businesses or do something they’re more enthused about. Data is patchy on how widespread job lock is, but some estimates suggest it could affect 25% of the 156 million people who get healthcare through an employer. That’s 34 million Americans who might be more productive and more satisfied in a different job.

The enormous cost to employers

Another growing problem is age discrimination in the workplace, which has a lot to do with the higher cost of healthcare for older workers. Data on this is also incomplete, but many older workers who get laid off and can’t find work insist employers don’t want to hire them because of medical costs. Famed investors Warren Buffett and Charlie Munger addressed the burden healthcare costs put on companies at this year’s Berkshire Hathaway annual meeting. “Our manufacturers have a huge competitive disadvantage caused by the health system, because the manufacturers are providing medical care for all the employees,” Munger told Yahoo Finance editor-in-chief Andy Serwer at this year’s event.

With healthcare costs rising much faster than ordinary inflation, companies that provide healthcare benefits have an enormous cost problem to manage. But don’t worry, they’re handling that by cutting back on the raises everybody gets. While basic wages have barely risen since 1970, when adjusted for inflation, real compensation—which includes healthcare and other benefits—has jumped by 60%. So if you’re wondering where your raise went, it went toward healthcare.

The Affordable Care Act, aka Obamacare, was a flawed attempt to deal with some of these problems, by first extending coverage to more people. Over time, in theory, that ought to improve healthcare outcomes, as more people get better care. Obamacare critics are correct to point out that the law did nothing to lower healthcare costs for most people, and it actually hiked costs for many who buy individual plans and suddenly had to pay for new tiers of mandated care.

But killing the ACA isn’t going to make anything about the US healthcare system better, and it would probably lead to worse healthcare outcomes as more people lose coverage. There’s a chance it won’t pass, since even some Republicans are squeamish about bouncing people off insurance. That may be the best possible outcome, for now. But all the other problems will still be there. Somebody should tell Congress.

The National Memo

Smart, Sharp, Funny, Fearless

Like House Bill, Senate Trumpcare Version Would Deprive Millions Of Coverage

Steven Rosenfeld, June 22, 2017    Reprinted with permission from Alternet.

Senate Majority Leader Mitch McConnell released a summary of the latest Obamacare repeal legislation late Wednesday, ending a Washington waiting game after secret drafting sessions, but depicting a bill that will have dire consequences for much of America.

McConnell’s summary tries to put a softer spin on the Republicans’ most strident attack on health safety nets in decades. It preserves most of the features of the House-passed bill, which repeals Obamacare, shrinks future Medicaid funding by a quarter and rewards the rich with tax cuts. The non-partisan Congressional Budget Office said the House bill would leave 24 million Americans without health care while increasing insurance costs and reducing coverage for almost everyone apart from healthy young adults.

Unlike the House, the Senate bill phases in the cuts to federal health spending over the next few years, instead of immediately pulling the carpet out from millions of Americans who were resting a little easier because they had some measure of health security. It will “rejigger” Obamacare subsidies for lower-income people buying private insurance, while gradually limiting their eligibility.

That’s the takeaway as first reported by the Washington Post. On Thursday morning, McConnell is to meet with “wary senators,” the Post reported, adding he will likely tinker with the bill’s details to try to get to 51 votes to pass it.

“The bill largely mirrors the House measure that narrowly passed last month but with some significant changes,” the Post said. “While the House legislation pegged federal insurance subsidies to age, the Senate bill would link them to income as the ACA [Affordable Care Act, or Obamacare] does. The Senate proposal cuts off Medicaid expansion more gradually than the House bill, but would enact deeper long-term cuts to the health-care program for low-income Americans. It also removes language restricting federally subsidized health plans from covering abortions, which may have run afoul of complex budget rules.”

It’s likely many nasty details will come to light as interest groups, health policy experts, Senate Democrats and their staff parse the legislative language, as opposed to McConnell’s talking points.

In many respects, McConnell’s revisions are not a surprise. They resemble the anti-Obamacare bill he shepherded in late 2015, which included closing government health care exchanges, scrapping subsidies for premiums, repealing Medicaid expansion in 30 states, ending tax penalties for people who don’t buy insurance and employers who don’t offer it, repealing its taxes on businesses, individuals and medications, and eliminating funding for Planned Parenthood. Variations of those features have been resurrected in the new Senate bill, although there is new language giving states some flexibility in how they will draw down their Medicaid spending. The brunt of that may not take effect until 2020. But the end result is the same: Republicans have used the rallying cry of repealing Obamacare not just to gut the law, but to structurally change and shrink Medicaid and give wealthy people a tax cut.

The Senate GOP Isn’t Fixing Health Care. It’s Waging Class War.

The Nation

The Senate GOP Isn’t Fixing Health Care. It’s Waging Class War.

A draft bill released Thursday offers tax cuts to the rich at the expense of the poor and the elderly.

By Zoe Carpenter    June 22, 2017

After a writing process unprecedented in secrecy and speed, Republican leaders in the Senate have released a draft of a bill intended to repeal Obamacare. In short, the bill doesn’t do that: It just makes Obamacare worse. And while the basic structure of Obamacare survives—albeit in withered form—the Senate bill radically reshapes the traditional Medicaid program, which covers 59 million Americans.

The Senate’s “Better Care Reconciliation Act” follows the regressive contours of the House bill: It’s a tax cut for the rich paid for by gouging coverage for the poor and the elderly. One of the most significant tax cuts is on investment income earned by people making more than $200,000 a year. That giveaway—which, tellingly, was omitted from the summary of the bill—is made more egregious by the fact that it’s retroactive (with an effective date of December 2016), a detail that serves no purpose other than funneling extra cash to wealthy investors. Pharmaceutical companies, insurers, and other corporations also benefit from tax cuts in the bill. (By the way, the 13 men responsible for writing it received an average of $214,000 in campaign contributions from insurance and pharmaceutical companies between 2010 and November of last year.)

To pay for those tax cuts, the bill cuts deeply into Medicaid. Senate Republicans have tried to give the appearance of having “more heart” (to use President Trump’s phrase) than their colleagues in the House. So instead of cutting off federal money for the expansion all at once, as the House bill did, the Senate version gradually cuts off the money over several years. But that “glide path” is meaningless in eight states—Arkansas, Illinois, Indiana, Michigan, Montana, New Hampshire, New Mexico, Washington—where automatic triggers will end the expansion immediately if federal funding declines. The Senate’s phaseout is actually crueler than the House bill, because it affects people who are currently enrolled in the expansion, not just those who would become eligible in the future.

More significantly, the Senate bill makes truly drastic changes to the entire Medicaid program, which helps not only low-income Americans but also the disabled and elderly people living in nursing homes. As currently structured, the federal government pays a share of a state’s Medicaid load, with no caps. The Senate bill would upend that structure and impose per-capita limits on the federal contribution. That would cut federal spending on the program by about 25 percent, which health-care experts believe would force states to cover millions fewer people. The Senate bill would also tie Medicaid spending to inflation, which generally increases at a slower rate than health-care spending. Ultimately, the cut to Medicaid could be more than $800 billion.

It’s hard to overstate how radical these changes to Medicaid are, both practically and politically. Although gutting Medicaid has long been a pipe dream for Paul Ryan, it’s not something most Republicans campaigned on. In fact, Trump promised while campaigning that he would not cut Medicaid if elected. The GOP has no mandate for so deeply altering the 52-year-old program, and it’s not something the party has tried to justify to the public. Instead, Republicans pretend it’s not happening. “Medicaid is not being cut from our perspective,” South Carolina Senator Tim Scott told reporters as he left a meeting on Thursday morning.

Republicans could make a more plausible argument that they have a mandate to repeal Obamacare, but again, their bill doesn’t even do that (thought it does repeal the individual mandate)—it just exacerbates the things people already don’t like about the individual exchanges. Like Obamacare, the Senate bill provides income-based subsidies in the form of tax credits, and recalculates them in a way that may help low-income people. But the bill shrinks the subsidies overall, and particularly for the elderly. It also sets up a new waiver process to allow states to scrap requirements that plans cover certain essential health benefits—meaning lots of people would end up paying more for skimpier coverage and higher deductibles.

A small handful of Republican Senators are reportedly preparing to announce their opposition to the bill later today. The GOP can afford only two defections. But the text released Thursday is only a discussion draft; party leaders will no doubt tinker and fiddle with the language in order to give the appearance of adding even “more heart.” The baseline for comparison, however, shouldn’t be this Senate draft, or the bill that passed the House. The question is whether the GOP legislation improves on Obamacare and current coverage. It doesn’t come close—unless, of course, you happen to believe that we provide too much help to the poor and elderly, and not enough tax cuts to the wealthy.

Which Republican senators will walk the plank for this terrible health-care bill?

Chicago Tribune

Which Republican senators will walk the plank for this terrible health-care bill?

Jennifer Rubin, The Washington Post    June 23, 2017

GOP Senate leaders are presenting to their members for the first time Thursday a concrete health-care plan. Senate Majority Leader Mitch McConnell, R-Ky., has done what Republicans (falsely) accused Democrats of doing during the Affordable Care Act— drafted a bill in secret, rushed it through and ignored concerns of stakeholders, including governors.

The process is so reckless that you do wonder whether this is all for show. “According to two Republicans in close contact with Senate GOP leadership granted anonymity to describe private conversations, McConnell is threatening to bring the bill to a vote next week even if he doesn’t have the votes to pass it,” The Post reports. “But some believe that message is aimed at trying to pressure Republicans to support the bill, rather than an absolute commitment. A McConnell spokeswoman declined to comment.”

Senators should be smarter than to be bulldozed or bluffed into voting for something that does not meet the president’s or their own goals and which they will barely have time to consider before a vote. Senators should keep in mind the following:

  1. The bill must be measured against the Affordable Care Act, not the House’s American Health Care Act bill. It’s the ACA their constituents will lose and which will be used to assess whether Trumpcare is more or less generous.
  2. Thirty-one states expanded Medicaid under the ACA. That works out to 20 GOP senators. They will be asked to vote for a rollback in coverage and thereafter a reduced level of support for beneficiaries, ending Medicaid’s status as an entitlement. If their state must reduce benefits or narrow coverage even further, senators voting for the bill will be held responsible. That includes senators in states Hillary Clinton carried in 2016 — Sens. Dean Heller, R-Nev., (the most vulnerable incumbent) and Cory Gardner, R-Colo. Both their governors have inveighed against the Senate and House approach and pleaded with lawmakers to work with governors.
  3. There are plenty of states in which the ACA substantially lowered the number of uninsured. The nonpartisan Commonwealth Fund found:

“[Nine] states experienced 10 to 13 percentage-point reductions in their adult uninsured rate from 2013 to 2015. Six of these states – California, Kentucky, Oregon, Rhode Island, Washington, and West Virginia — sliced their uninsured rates by at least half over the two years. Some states that did not expand Medicaid as of the beginning of 2015 had declines of as much as 7 to 9 percentage points, including Florida, Georgia, Louisiana, Montana, North Carolina, South Carolina, and Texas. The ACA’s premium subsidies and insurance marketplaces were available in every state, leading to the decline in uninsured rates in states without the Medicaid expansion.

“By the end of 2015, more than a third of states (17 states and D.C.) had adult uninsured rates below 10 percent, compared to six states and D.C. in 2014 and only Massachusetts and D.C. in 2013. Despite these gains, uninsured rates remained high in some states, including Florida, Oklahoma, and Texas, where at least one of five adults was uninsured. Still, this marks an improvement over 2014, when 10 states had an adult uninsured rate of 20 percent or more, and 2013, when 22 states did.”

No matter how strenuously Republicans claim the number of covered adults doesn’t matter for the vast majority of Americans, coverage means access to health care, especially routine preventative care.

  1. While the Senate bill purportedly includes a restriction on Planned Parenthood funding, that likely will fall by the wayside in the reconciliation process
  2. A vote to deprive Americans of health care or limit it may make competitive seats into real pickup chances for Democrats in 2018. These include Heller in Nevada and Sen. Jeff Flake, R-Ariz. It may also move safe seats into less-safe seats or seats that invite credible primary challengers. That group would include Bob Corker, R-Tenn., and Deb Fischer, R-Neb.
  3. The bill is a huge wealth transfer from poor to rich. Cuts in benefits to low- and middle-income Americans will fund huge tax cuts for the very richest Americans. This will be fodder for opponents to claim that Republicans are phony populists, just another generation of right-wingers who favor the wealthiest among us.

Washington Post

Jennifer Rubin writes the Right Turn blog for The Post, offering reported opinion from a conservative perspective.

This Union Ironworker Has a Plan to Beat Paul Ryan

The Nation

This Union Ironworker Has a Plan to Beat Paul Ryan

A construction worker takes on the speaker of the House—and sparks fly.

By John Nichols   June 22, 2017

Randy Bryce thinks Paul Ryan is vulnerable to a challenge that offers voters a genuine, working-class alternative to the gold-plated speaker of the House. The union ironworker, who is challenging the most powerful Republican in Congress, is onto something. He recognizes that Ryan, a political careerist who had spent the better part of three decades as a Republican aide and congressman, represents southeastern Wisconsin’s first congressional district in name only.

The speaker of the House is still officially identified as Paul Ryan, R-Janesville. But everyone who is paying attention knows that the congressman serves as Paul Ryan, R–Wall Street.

“Let’s trade places. You can come work the iron, and I’ll go to DC.”—Randy Bryce to Paul Ryan

Bryce has never run for Congress before. He is one of several Democrats who are either running, or looking to run, against an incumbent who will be lugging Donald Trump’s political baggage in 2018. But the veteran union activist has gained lots of attention, and substantial support, since the launch of a strikingly well-framed challenge to Ryan that goes to the heart of the speaker’s vulnerabilities.

Bryce notes the fact of Ryan’s hyper-partisan allegiance to a president with a 36 percent approval rating by noting that, “Whether it’s healthcare or jobs, national security or education, our democracy or the environment—there’s not one issue where Paul Ryan and Donald Trump are headed in the right direction. It’s time for a change in Congress.”

But the essential element of Bryce’s challenge is an understanding that the deal-making work Ryan does to satisfy special-interest campaign donors in Washington is fundamentally different from the honest work Bryce does for a union wage as a member of Ironworkers Local 8 on job sites in Milwaukee and other southeastern Wisconsin cities. “Let’s trade places,” declares Bryce, in a video that went viral after he announced Monday. “Paul Ryan you can come and work the iron, and I’ll go to DC.”

That’s a working-class-versus-ruling-class argument that we need to hear a lot more of in American politics. And it is strengthened by Bryce’s determination to call out Ryan and other Republicans for serving Wall Street rather than Main Street—not just on the vital issue of health-care reform but on every issue.

Again and again, when it has come time to choose, Ryan has picked the side of the big banks and the investment houses, the insurance industry and the health-care profiteers that fund his campaigns over the best interests of a region that has been battered by Ryan’s policies. As Wall Street’s man on Capitol Hill, Ryan has steadily stacked the deck against Wisconsin workers, farmers, and small-business owners. In 2008, he rounded up Republican votes for the Wall Street bailout, which responsible conservatives recognized as crony capitalism at its worst. Ryan begged Republicans to back the bailout, warning that the United States might be “standing at the edge of this abyss” if Congress did not immediately steer tax dollars to the bankers who were crashing the economy.

The Wisconsin Republican has over the years appeared at Tea Party rallies and attempted to position himself as a champion of the movement’s opposition to DC deal-making. But when Congress gets to work on the big issues, Ryan backs the bailouts and policy shifts that steer tax dollars to big banks and the speculators. He also backs the trade deals that Wall Street wants but that have been devastating for Janesville.

The speaker’s hometown of Janesville has historically been a major manufacturing center. Now it has fallen on hard times. Like so many manufacturing communities in the Great Lakes region, it has been rocked by the outsourcing of US jobs. That’s not Ryan’s concern, however. Since his election to the House in 1998, Ryan has voted for free-trade pacts—including the extension of most-favored-nation trading status to China—that have been absolutely devastating to Janesville and other communities in his southeastern Wisconsin district.

In 2008—during the presidency of George W. Bush—General Motors announced that the sprawling plant that had been Janesville’s top employer for nine decades was closing. Thousands of jobs were lost. Unemployment soared. It has edged down since, but a lot of working families in Janesville and surrounding Rock County are still struggling.

How did Ryan respond to Janesville’s hard times? First he proposed schemes to shred the social safety net by gambling Social Security funds in the stock market and by undermining Medicare and Medicaid. Now, he proposes to undermine health-care protections for millions of Americans in order to fund tax cuts for the rich.

As Janesville and other communities that needed a congressman have taken hits, Ryan has risen in stature. He has run for vice president and now, as House speaker, he is second in the line of succession for the presidency. Ryan is a very powerful man. Yet he isn’t using that power to represent Janesville or Racine or Kenosha or the other communities of southeastern Wisconsin.

What connects the bailouts and the sellouts to trade with Ryan’s current attempt to leave 23 million more Americans without health care in order to fund a tax cut for the very rich is this speaker’s choice to serve the royals, the robber barons, the money changers of our time.

Paul Ryan has made a choice that reveals his values, which were forged in elite restaurants of Washington and Wall Street, where campaign donations are discussed and delivered with $350 bottles of wine.

Randy Bryce has a different set of values, forged on the work sites of Wisconsin. “My values are my neighbors’ values, and we know that Washington has gotten way off track,” says the challenger. If Bryce keeps emphasizing how and why Paul Ryan steered things off track, he has a chance to change the political debate—and the values debate that must underpin it if anything is ever going to change—in Wisconsin and America.

Senate Republicans set to release health-care bill, but divisions remain

Washington Post, Power Post

Senate Republicans set to release health-care bill, but divisions remain

By Paige Winfield Cunningham, Juliet Eilperin and Sean Sullivan, June 21, 2017

Senate Republicans on Thursday plan to release a health-care bill that would curtail federal Medicaid funding, repeal taxes on the wealthy and eliminate funding for Planned Parenthood as part of an effort to fulfill a years-long promise to undo Barack Obama’s signature health-care law.

The bill is an attempt to strike a compromise between existing law and a bill passed by the House in May as Republicans struggle to advance their vision for the country’s health-care system even though they now control both chambers of Congress and the White House.

The Senate proposal largely mirrors the House measure with significant differences, according to a discussion draft circulating Wednesday among aides and lobbyists. While the House legislation would peg federal insurance subsidies to age, the Senate bill would link them to income, as the Affordable Care Act does. The Senate proposal would cut off expanded Medicaid funding for states more gradually than the House bill but would enact deeper long-term cuts to the health-care program for low-income Americans. It also would eliminate House language aimed at prohibiting federally subsidized health plans from covering abortions, a provision that may run afoul of complex Senate budget rules.

But on the eve of the bill’s release, Senate Majority Leader Mitch McConnell (R-Ky.) faced the prospect of an open revolt from key conservative and moderate GOP senators, whose concerns he has struggled to balance in recent weeks. Republicans familiar with the effort said Senate leaders have more work to do to secure the 50 votes needed to pass the measure, with Vice President Pence set to cast the tiebreaking vote, from the pool of 52 GOP senators. No Democrats are expected to support the bill.

Republican aides stressed that the plan is likely to undergo more changes to secure the votes needed for passage, but there were major concerns Wednesday from senators on opposite ends of the GOP spectrum.

“My main concern is I promised voters that I would repeal — vote to repeal Obamacare. And everything I hear sounds like Obamacare-lite,” said Sen. Rand Paul (R-Ky.).

Sen. Shelley Moore Capito (R-W.Va.), whose state expanded Medicaid and has been pushing for a more gradual unwinding of that initiative than many conservatives prefer, said she is waiting to scrutinize what is released but has not seen anything yet that would make her drop her concerns with the proposal.

“Up to this point, I don’t have any new news — tomorrow we will see it definitively — that would cause me to change that sentiment,” she said.

Like the House bill, the Senate measure is expected to make big changes to Medicaid, the program that insures about 74 million elderly and lower-income Americans and was expanded in most states under the ACA. In effect, the revisions would reduce federal spending on the program.

The Senate measure would transform Medicaid from an open-ended entitlement to one in which federal funding would be distributed to states on a per-capita basis. The Senate measure would also seek to phase out the program’s expansion — although at a more gradual rate than the House version.

Yet the Senate bill is expected go further than the House version in its approach to cutting Medicaid funding in the future. In 2025, the measure would tie federal spending on the program to an even slower growth index than the one used in the House bill. That move could prompt states to reduce the size of their Medicaid programs.

That provision, a nod to conservative lawmakers led by Sen. Patrick J. Toomey (R-Pa.), risks alienating moderates, including Capito and Sen. Rob Portman (R-Ohio), who also represents a state that expanded Medicaid under the ACA. Some Republicans worry that such a move would force states to cut services or coverage, potentially leaving millions of low-income people without sufficient health care.

The growth rate that is applied to Medicaid spending going forward has major implications, said Sen. Susan Collins (R-Maine). “That inflater is critical, because it translates into billions of dollars over time,” she said.

Portman and Capito have also been pushing for the inclusion of a $45 billion fund to treat and prevent opioid addiction. As of early Wednesday afternoon, the opioid money was not included in McConnell’s proposal, according to a top GOP senator and Senate aide familiar with the discussions.

“I don’t think there is right now,” Senate Finance Committee Chairman Orrin G. Hatch (R-Utah) said when asked whether the legislation includes a distinct opioid fund. “It might have to be considered separately.”

But Portman and Capito, like all senators, will have a chance to introduce amendments to the bill when it heads to the Senate floor, which McConnell said is likely to happen next week. This process will allow senators to draw attention to the causes they have championed and potentially change the final bill.

Moderates who are on the fence about whether to support the Obamacare overhaul are likely to be pleased at the bill’s approach to insurance subsidies because they would be based on financial need, potentially preserving coverage for more people who got insurance under the ACA.

Subsidies are currently available to Americans earning between 100 percent and 400 percent of the federal poverty level. Starting in 2020, that threshold would be lowered to 350 percent under the Senate bill — but anyone below that line could get the subsidies if they’re not eligible for Medicaid.

That provision, said Larry Levitt, senior vice president for special initiatives at the Henry J. Kaiser Family Foundation, would be “a real benefit to poor people in states that don’t expand Medicaid.”

In a move that will please the health-care industry, the draft also proposes repealing all of the ACA taxes except for its “Cadillac tax” on high-cost health plans in language similar to the House version. Senators had previously toyed with the idea of keeping some of the ACA’s taxes.

It would also eliminate Medicaid reimbursements for Planned Parenthood for one year. Federal law already prevents taxpayer funding to pay for abortions except to save the life of the woman or in the case of rape or incest. But some Republicans want to ban all federal funding for Planned Parenthood, which also provides health services such as birth control, because their clinics provide abortion services.

Like the House measure, the Senate bill would eliminate two central requirements of the current health-care law: that individuals provide proof of insurance when filing their annual tax returns and that companies with 50 or more employees provide health coverage for their workers.

In a move that is critical to insurers, the Senate measure would continue to fund for two years cost-sharing subsidies that help 7 million Americans with ACA plans. House Republicans have challenged the legality of the $7 billion in subsidies — which help cover consumers’ deductibles and copays — in court, and insurers have warned that they will have to increase premiums dramatically next year unless the federal government commits to continuing the payments.

McConnell has told Republican senators that he wants to maintain protections for people with preexisting conditions under the law. But it was not clear to some lawmakers Wednesday what that would entail.

“I haven’t seen the draft yet. I like the idea of preexisting conditions being more firmly clarified,” Portman said.

Paul criticized GOP leaders for potentially keeping some of the ACA’s “most expensive regulations,” which he says are the primary drivers of higher premiums.

“It may well be that prices don’t come down at all,” he said.

But the Senate proposal may change rules for waivers that states can file with the Centers for Medicare and Medicaid Services that could allow them to potentially scale back some of these federal mandates.

While the details of McConnell’s proposal are expected to be made public Thursday, much of focus in recent weeks has been on the process used to draft the bill.

Democrats and even some Republicans have been critical of Senate GOP leaders for crafting the proposal behind closed doors without hearings and consideration of the legislation by the relevant committees.

Several GOP senators have expressed concern about moving quickly to a vote before they fully understand how it would impact health insurance markets and their constituents.

Sen. Ron Johnson (R-Wis.) said that in addition to reading the bill, “I’ll also want to get full input from constituencies in Wisconsin.”

Given that there may be just a week between the bill being posted and a final vote, he added, “I find it hard to believe we’ll have enough time.”

Amy Goldstein and Kelsey Snell contributed to this report.

Paige Winfield Cunningham covers health policy and authors PowerPost’s daily tipsheet The Health 202. A St. Louis native, she graduated from Wheaton College in Illinois and started her journalism career as a county board reporter at the Naperville Sun.

Juliet Eilperin is The Washington Post’s senior national affairs correspondent, covering how the new administration is transforming a range of U.S. policies and the federal government itself. She is the author of two books—one on sharks, and another on Congress, not to be confused with each other—and has worked for the Post since 1998. 

Sean Sullivan has covered national politics for The Washington Post since 2012.

We finally know what’s going to be in the Senate version of Trumpcare — and it’s not pretty

ThinkProgress

We finally know what’s going to be in the Senate version of Trumpcare — and it’s not pretty

An ugly process begets an ugly bill.

Judd Legum, Editor-in-Chief, ThinkProgress       June 21, 2017

For weeks, Senate Republicans have negotiated their version of Trumpcare in near total secrecy. There have been no public hearings — just private meetings among a select group of Republicans about a bill that could reshape one-sixth of the American economy. For many Americans, the contours of the bill could be a matter of life and death.

Text of the bill was released on Thursday, but key details began to leak Wednesday night (some from lobbyists who learned about the bill before the American people). Majority Leader Mitch McConnell (R-KY) is insisting on a vote before the July 4th holiday, which means everyone has a week to learn about this bill — including many of the senators who will be voting on it.

So let’s get started. Here are the most important things you need to know.

The bill would strip health care coverage from millions of low income Americans by rolling back the expansion of Medicaid — and then making even deeper cuts.

The core of the Senate bill, like the House version, is a massive cut to Medicaid, which millions of low income Americans rely on for health care coverage. The Senate bill will reportedly phase out the expansion of Medicaid under Obamacare, although the process won’t start until 2021. In the end, the impact is the same. The Congressional Budget Office found that rolling back Medicaid expansion would cost 14 million people their health insurance.

But the Senate bill makes even deeper, more dramatic cuts to Medicaid that, over time, would leave more low income Americans without health coverage. Instead of a program that pays for health coverage for people who need it, the House and Senate versions of the Republican health care bill place per capita caps on the program. In other words, the federal government will only send states, who administer the program, a certain amount of money no matter what the actual cost of care may be.

The Senate version, according to a report in Bloomberg, makes even deeper cuts than the House.

The House bill ties these per capita caps to the “growth rate of medical inflation (CPI-M) plus 1 percentage point.” The Senate version, however, ties caps to the general rate of inflation (CPI-U). Since medical costs consistently grow at a much faster rate than overall costs, this means states would receive a smaller and smaller percentage of the actual cost of care each year.

The bill would follow the Obamacare subsidy model, but help fewer people.

In the House version of the Republican health care bill, people receive premium subsidies based on their age. The Senate bill retains the Obamacare model where subsidies increase as incomes go down.

But while Obamacare provided subsidies to anyone making up to 400 percent of the poverty line, the Senate bill ends subsidies at 350 percent of the poverty line. This means fewer people will get help. For some people, the impact of this change could be dramatic.

The Senate bill is a massive tax cut for the rich.

At it’s heart, Trumpcare is less a health care bill than a tax cut bill. There was speculation that the Senate bill would leave more taxes in place, but it will largely mirror the House version, according to the Washington Post.

The Senate bill will repeal hundreds of million of dollars in taxes that Obamacare used to help more people afford health care providing a massive transfer of wealth to people with incomes over $200,000.

The bill will mean higher out-of-pocket medical costs for many people with insurance.

Republicans would like to reduce health care premiums. But the only mechanism to do so in the Senate bill is to allow insurers to provide fewer benefits. That means, for some people, premiums may be slightly lower. But those same people will end up with far greater costs if they do get sick.

The Senate bill will reportedly give “states more leeway in opting out of the ACA’s insurance regulations through expanding the use of so-called ‘1332’ waivers already embedded within the law.” (The House bill creates a new waiver program.) The waivers are not expected to allow states to let insurers reject or charge more to people with pre-existing conditions. But the waivers will let states allow insurers to offer skimpier plans, potentially leaving consumers with huge medical bills.

The bill also reportedly changes what percentage of costs, on average, an insurance plan must cover from 75 percent to 58 percent. This means more deductibles and out-of-pocket expenses. The Senate plan could increase these costs by 68 percent.

The bill will seek to limit the ability of insurers to provide coverage for abortions.

Senate rules may prevent the Republican health care bill from including explicit restrictions on coverage for abortion. The Senate is exploring an arcane way to limit abortion coverage anyway, according to Axios. The Senate may create a “stabilization fund” that insurance companies can tap into through the Children’s Health Insurance Program (CHIP). Most insurers will want to take advantage of this fund. But CHIP already has a restriction on abortion coverage. So insurers that take advantage of the stabilization fund will not be able to include coverage for abortion.

The bill will hit older Americans especially hard.

Across the board, older Americans who use the exchanges will be expected to pay a larger share of their income for health insurance. Those who make over 350 percent of the poverty line will now be expected pay full price.

Trumpcare’s passage is far from certain, with a number of moderate and conservative Republicans raising objections. Conservatives are likely to balk at keeping the basic Obamacare subsidy structure. Moderates are likely to object to the aggressive Medicaid cuts, particularly in states that have expanded Medicaid.

This is a developing story and will be update as we learn more details about the Senate bill.

Senate Republicans set to release health-care bill, but divisions remain

Washington Post, Power Post

Senate Republicans set to release health-care bill, but divisions remain

By Paige Winfield Cunningham, Juliet Eilperin and Sean Sullivan, June 21, 2017

Senate Republicans on Thursday plan to release a health-care bill that would curtail federal Medicaid funding, repeal taxes on the wealthy and eliminate funding for Planned Parenthood as part of an effort to fulfill a years-long promise to undo Barack Obama’s signature health-care law.

The bill is an attempt to strike a compromise between existing law and a bill passed by the House in May as Republicans struggle to advance their vision for the country’s health-care system even though they now control both chambers of Congress and the White House.

The Senate proposal largely mirrors the House measure with significant differences, according to a discussion draft circulating Wednesday among aides and lobbyists. While the House legislation would peg federal insurance subsidies to age, the Senate bill would link them to income, as the Affordable Care Act does. The Senate proposal would cut off expanded Medicaid funding for states more gradually than the House bill but would enact deeper long-term cuts to the health-care program for low-income Americans. It also would eliminate House language aimed at prohibiting federally subsidized health plans from covering abortions, a provision that may run afoul of complex Senate budget rules.

But on the eve of the bill’s release, Senate Majority Leader Mitch McConnell (R-Ky.) faced the prospect of an open revolt from key conservative and moderate GOP senators, whose concerns he has struggled to balance in recent weeks. Republicans familiar with the effort said Senate leaders have more work to do to secure the 50 votes needed to pass the measure, with Vice President Pence set to cast the tie-breaking vote, from the pool of 52 GOP senators. No Democrats are expected to support the bill.

Republican aides stressed that the plan is likely to undergo more changes to secure the votes needed for passage, but there were major concerns Wednesday from senators on opposite ends of the GOP spectrum.

“My main concern is I promised voters that I would repeal — vote to repeal Obamacare. And everything I hear sounds like Obamacare-lite,” said Sen. Rand Paul (R-Ky.).

Sen. Shelley Moore Capito (R-W.Va.), whose state expanded Medicaid and has been pushing for a more gradual unwinding of that initiative than many conservatives prefer, said she is waiting to scrutinize what is released but has not seen anything yet that would make her drop her concerns with the proposal.

“Up to this point, I don’t have any new news — tomorrow we will see it definitively — that would cause me to change that sentiment,” she said.

Like the House bill, the Senate measure is expected to make big changes to Medicaid, the program that insures about 74 million elderly and lower-income Americans and was expanded in most states under the ACA. In effect, the revisions would reduce federal spending on the program.

The Senate measure would transform Medicaid from an open-ended entitlement to one in which federal funding would be distributed to states on a per-capita basis. The Senate measure would also seek to phase out the program’s expansion — although at a more gradual rate than the House version.

Yet the Senate bill is expected go further than the House version in its approach to cutting Medicaid funding in the future. In 2025, the measure would tie federal spending on the program to an even slower growth index than the one used in the House bill. That move could prompt states to reduce the size of their Medicaid programs.

That provision, a nod to conservative lawmakers led by Sen. Patrick J. Toomey (R-Pa.), risks alienating moderates, including Capito and Sen. Rob Portman (R-Ohio), who also represents a state that expanded Medicaid under the ACA. Some Republicans worry that such a move would force states to cut services or coverage, potentially leaving millions of low-income people without sufficient health care.

The growth rate that is applied to Medicaid spending going forward has major implications, said Sen. Susan Collins (R-Maine). “That inflater is critical, because it translates into billions of dollars over time,” she said.

Portman and Capito have also been pushing for the inclusion of a $45 billion fund to treat and prevent opioid addiction. As of early Wednesday afternoon, the opioid money was not included in McConnell’s proposal, according to a top GOP senator and Senate aide familiar with the discussions.

“I don’t think there is right now,” Senate Finance Committee Chairman Orrin G. Hatch (R-Utah) said when asked whether the legislation includes a distinct opioid fund. “It might have to be considered separately.”

But Portman and Capito, like all senators, will have a chance to introduce amendments to the bill when it heads to the Senate floor, which McConnell said is likely to happen next week. This process will allow senators to draw attention to the causes they have championed and potentially change the final bill.

Moderates who are on the fence about whether to support the Obamacare overhaul are likely to be pleased at the bill’s approach to insurance subsidies because they would be based on financial need, potentially preserving coverage for more people who got insurance under the ACA.

Subsidies are currently available to Americans earning between 100 percent and 400 percent of the federal poverty level. Starting in 2020, that threshold would be lowered to 350 percent under the Senate bill — but anyone below that line could get the subsidies if they’re not eligible for Medicaid.

That provision, said Larry Levitt, senior vice president for special initiatives at the Henry J. Kaiser Family Foundation, would be “a real benefit to poor people in states that don’t expand Medicaid.”

In a move that will please the health-care industry, the draft also proposes repealing all of the ACA taxes except for its “Cadillac tax” on high-cost health plans in language similar to the House version. Senators had previously toyed with the idea of keeping some of the ACA’s taxes.

It would also eliminate Medicaid reimbursements for Planned Parenthood for one year. Federal law already prevents taxpayer funding to pay for abortions except to save the life of the woman or in the case of rape or incest. But some Republicans want to ban all federal funding for Planned Parenthood, which also provides health services such as birth control, because their clinics provide abortion services.

Like the House measure, the Senate bill would eliminate two central requirements of the current health-care law: that individuals provide proof of insurance when filing their annual tax returns and that companies with 50 or more employees provide health coverage for their workers.

In a move that is critical to insurers, the Senate measure would continue to fund for two years cost-sharing subsidies that help 7 million Americans with ACA plans. House Republicans have challenged the legality of the $7 billion in subsidies — which help cover consumers’ deductibles and co-pays — in court, and insurers have warned that they will have to increase premiums dramatically next year unless the federal government commits to continuing the payments.

McConnell has told Republican senators that he wants to maintain protections for people with preexisting conditions under the law. But it was not clear to some lawmakers Wednesday what that would entail.

“I haven’t seen the draft yet. I like the idea of preexisting conditions being more firmly clarified,” Portman said.

Paul criticized GOP leaders for potentially keeping some of the ACA’s “most expensive regulations,” which he says are the primary drivers of higher premiums.

“It may well be that prices don’t come down at all,” he said.

But the Senate proposal may change rules for waivers that states can file with the Centers for Medicare and Medicaid Services that could allow them to potentially scale back some of these federal mandates.

While the details of McConnell’s proposal are expected to be made public Thursday, much of focus in recent weeks has been on the process used to draft the bill.

Democrats and even some Republicans have been critical of Senate GOP leaders for crafting the proposal behind closed doors without hearings and consideration of the legislation by the relevant committees.

Several GOP senators have expressed concern about moving quickly to a vote before they fully understand how it would impact health insurance markets and their constituents.

Sen. Ron Johnson (R-Wis.) said that in addition to reading the bill, “I’ll also want to get full input from constituencies in Wisconsin.”

Given that there may be just a week between the bill being posted and a final vote, he added, “I find it hard to believe we’ll have enough time.”

Amy Goldstein and Kelsey Snell contributed to this report.

Paige Winfield Cunningham covers health policy and authors PowerPost’s daily tipsheet The Health 202. A St. Louis native, she graduated from Wheaton College in Illinois and started her journalism career as a county board reporter at the Naperville Sun.

Juliet Eilperin is The Washington Post’s senior national affairs correspondent, covering how the new administration is transforming a range of U.S. policies and the federal government itself. She is the author of two books—one on sharks, and another on Congress, not to be confused with each other—and has worked for the Post since 1998.

Sean Sullivan has covered national politics for The Washington Post since 2012.

12 Ways Trump Has Declared War on Food Safety

EcoWatch

12 Ways Trump Has Declared War on Food Safety

By Scott Faber    June 15, 2017

President Trump is waging a full-scale campaign to roll back decades of progress toward making America’s food safer, healthier and more clearly labeled. If successful, the Trump administration would do more to increase hunger, obesity and food-borne illness than any other administration in American history.

Since taking office Trump has:

  1. Proposed to cut food safety funding for the U.S. Food and Drug Administration by $117 million.
  2. Proposed to cut funding for the Supplemental Nutrition Assistance Program or SNAP, by $193 billion—a 25 percent cut—and cut international food aid by $2 billion.
  3. Delayed new labeling rules for menus and packaged foods that would give consumers more information about calories and added sugars, and so far failed to issue a draft rule to implement a new law on disclosing genetically modified ingredients in food.
  4. Weakened new rules designed to drive junk food out of U.S. schools.
  5. Proposed to eliminate several U.S. Department of Agriculture programs that helped farmers sell directly to local consumers.
  6. Proposed to eliminate funding for an entire division of the Centers for Disease Control and Prevention that works to reduce obesity.
  7. Withdrawn new rules to protect drinking water supplies from polluters and proposed cutting the U.S. Environmental Protection Agency’s (EPA) budget by 31 percent.
  8. Proposed to suspended two of the largest farmland stewardship programs and mothball others.
  9. Postponed new rules designed to strengthen animal welfare standards on organic farms and proposed to eliminate funding for programs that help farmers switch to organic farming.
  10. Reversed a ban on a pesticide linked to brain damage in kids and proposed cutting EPA funding for pesticide review programs by 20 percent.
  11. Punted on new rules to protect farm-workers from pesticides, and proposed to eliminate a program to train migrant and seasonal farm-workers.
  12. Mothballed new voluntary sodium guidelines that would drive reformulation of foods.

In addition, Trump has called for so-called regulatory “reforms” that would block agencies like the U.S. Food and Drug Administration and U.S. Department of Agriculture from adopting new rules designed to keep food safe, update food labels or provide students healthier meal options in schools.

Thanks to Trump, it may soon be harder for Americans to feed their families, build healthy diets, and eat food free of dangerous pathogens and pesticides.

Pelosi ‘very worried’ about Trump’s fitness for office

The Hill

Pelosi ‘very worried’ about Trump’s fitness for office

By Mike Lillis    June 9, 2017

Rep. Nancy Pelosi (D-Calif.) is questioning President Trump’s fitness to hold his office.

The House minority leader said Friday that Trump may simply lack the curiosity, discipline and stamina to be a competent commander in chief. Trump’s Friday Twitter attack on former FBI Director James Comey, Pelosi said, is just the latest evidence.

“The president’s fitness for office is something that has been called into question,” Pelosi said during a press briefing in the Capitol. “It takes a certain curiosity to learn the facts, to base your comments on evidence and data and truth. It takes a certain discipline to be able to prioritize what is important as we try to bring the country together. And it takes some kind of stamina to keep your thoughts together.

“And I’m very worried about his fitness.”

Pelosi said White House officials should rein in Trump’s impulsive Twitter finger but expressed doubt that anyone on Trump’s team has the “courage” to do so.

“His statements need some discipline, and I don’t know if anyone in the White House has the courage to discipline the president,” she said. “It’s too bad because he needs work. And he needs sleep.”

Comey’s testimony before the Senate Intelligence Committee captivated Washington on Thursday by providing his take on one-on-one conversations with the president.

The former FBI director said he took the president at his word that he had been fired for his handling of the investigation into Russia’s meddling in the election, including possible links to Trump’s campaign. He also said he believed Trump had directed him to end an investigation into former national security adviser Michael Flynn.

Comey stopped short of accusing Trump of obstructing justice, saying that determination is the purview of the current investigative team, being led by special counsel Robert Mueller, Comey’s predecessor atop the FBI.

“That’s a conclusion I’m sure the special counsel will work towards,” he said.

Trump remained silent throughout Thursday’s hearing, but returned to Twitter Friday morning with accusations that Comey had lied under oath.

“Despite so many false statements and lies, total and complete vindication…and WOW, Comey is a leaker!” Trump tweeted.

Comey also acknowledged in his testimony that he leaked through an intermediary his memo on a meeting with Trump that included the discussion about Flynn. That became an explosive story in The New York Times a week after his firing.

Pelosi rejected any suggestion that Comey’s testimony vindicated the president. But Trump’s approach to Comey, she quickly added, is consistent with his strategy as a longtime businessman.

“He operates this way: First he tries to charm you. … If that doesn’t work, he tries to bully you. If that doesn’t work, he walks away from the deal. And if that doesn’t work, he sues you,” she said.

According to CNN, Trump’s outside attorney is poised to file a complaint with the Justice Department against Comey over the leak.

“He’s true to form, true to his nature,” Pelosi said.

Pelosi said Trump had acted deliberately to clear the room after a meeting before talking with Comey.

“He knew that what he was doing was incriminating, and he didn’t want any witnesses,” she said.

But like Comey, Pelosi stopped short of charging Trump with obstructing justice. Trump has “abused power,” she said, but the deeper legal implications are still unclear.

“There’s no question he abused power,” she said. “Whether he obstructed justice remains for the facts to come forward, and that’s what we want are the facts.”

Pelosi amplified Democrats’ long-held request that GOP leaders create an outside, independent panel — akin to the 9/11 commission — to step in with its own investigation of Russia’s election meddling.

“We are limited,” she said, “by what the Republicans are willing to do.”

Business Insider

Pelosi: My first meeting with Trump as president was unlike anything I’ve experienced with other presidents

Veronika Bondarenko,   Business Insider     June 10, 2017

The first thing President Donald Trump said upon meeting congressional leaders was that he won the popular vote, House Minority Leader Nancy Pelosi said on Friday.

During an appearance on MSNBC’s “Morning Joe” talk show, Pelosi recalled her first meeting with Trump at the White House after he was elected.

“First thing he says to open the meeting: ‘You know, I won the popular vote,'” she said, later adding that she had to tell Trump there were no facts to support his assertion.

Trump won the 2016 election by a wide margin in the Electoral College but lost the popular vote to Hillary Clinton by about 3 million.

Trump’s disputing of these numbers and allegations of voter fraud created controversy for him in the wake of the election.

Pelosi said that even though she and President George W. Bush had disagreed on many things, they were at least operating from a shared understanding of facts.

“I wish he were president now,” Pelosi said of Bush, adding that he once told her she would end up missing him. “I wish Mitt Romney were president. I wish John McCain were president.

“We all have to start at a place when we’re dealing with facts, evidence, data, and then you can compromise,” Pelosi said.

As Climate Change Threatens Food Supplies, Seed Saving is an Ancient Act of Resilience

Resilience

As Climate Change Threatens Food Supplies, Seed Saving is an Ancient Act of Resilience

By Sarah van Gelder, originally published by YES! magazine    June 9, 2017

On Feb. 26, 2008, a $9-million underground seed vault began operating deep in the permafrost on the Norwegian island of Spitsbergen, just 810 miles from the North Pole. This high-tech Noah’s Ark for the world’s food varieties was intended to assure that, even in a worst-case scenario, our irreplaceable heritage of food seeds would remain safely frozen.

Less than 10 years after it opened, the facility flooded. The seeds are safe; the water only entered a passageway. Still, as vast areas of permafrost melt, the breach raises serious questions about the security of the seeds, and whether a centralized seed bank is really the best way to safeguard the world’s food supply.

Meanwhile, a much older approach to saving the world’s heritage of food varieties is making a comeback.

On a recent Saturday afternoon, a group of volunteers in the northern Montana city of Great Falls met in the local library to package seeds for their newly formed seed exchange, and to share their passion for gardening and food security.

“We don’t know what’s going to happen to our climate in the future,” said Alice Kestler, a library specialist. “Hopefully, as the years go by, we can develop local cultivars that are really suited to the local climate here.”

For millennia, people the world over have selected the best edible plants, saved the seeds, and planted and shared them in sophisticated, locally adapted breeding projects that created the vast array of foods we rely on today. This dance of human intelligence, plant life, pollinators, and animals is key to how human communities became prosperous and took root across the planet.

The Great Falls Library Seed Exchange is continuing that tradition even while a modern agribusiness model works to reduce the genetic diversity of our food stocks and consolidate control over the world’s seeds. Six seed companies now control three quarters of the seed market. In the years between 1903 and 1983, the world lost 93 percent of its food seed varieties, according to a study by the Rural Advancement Foundation International.

Perhaps we shouldn’t be surprised that giant agribusiness companies have no interest in the vast varieties and diverse ways people breed plants. It is hard to get rich off of an approach based on the distributed genius of people everywhere. Such a model doesn’t scale or centralize well. It is intensely democratic. Many people contribute to a common pool of knowledge and genetic diversity. Many people share the benefits.

Making big profits requires scarcity, exclusive knowledge, and the power to deny others the benefits. In this case, that means the appropriation of the knowledge built up over generations, coupled with the legal framework to patent seed varieties and punish those who fail to comply.

Especially in a time of climate change, though, genetic diversity is what we need to assure food security and resilience.

The Great Falls Library Seed Exchange is on the second floor of the library, which sits less than a mile from the Missouri River. Climb the brick building’s big, central staircase, and you can’t miss the brightly painted seed catalog. Borrowers are encouraged, but not required, to save some of the seeds and return them to the library for others to plant.

The exchange began just over a year ago, and is one of 500-some seed libraries worldwide. It sources its seeds from local organic farms and distant companies that specialize in plants that can grow in the rugged terrain of the northern plains, as well as heirloom varieties that have proven their worth over generations of seed saving. Locals also bring in their favorite varieties to share.

Each grower chooses which of each variety to save for seed, and those choices shape future availability.

“Since we have such a short growing climate here, getting seeds from plants that fruit early is really advantageous,” Kestler said. Some growers, though, select for the biggest fruit; others for the best-tasting. This built-in diversity helps to secure a resilient food supply.

“The seed in its essence is all of the past evolution of the Earth, the evolution of human history, and the potential for future evolution,” author and seed saver Vandana Shiva told me when I interviewed her in 2013. “The seed is the embodiment of culture because culture shaped the seed with careful selection. That is a convergence of human intelligence and nature’s intelligence.”

The Norwegian doomsday vault makes an important statement about the irreplaceable value of the genetic diversity of our planet, and it may prove to be an important failsafe in the event of disaster. But the time-honored process of saving and sharing seeds is dynamic. It naturally adapts to changing conditions, like climate change, and keeps the power with people everywhere to make choices that assure local resilience.

“Seed saving is such an important political act in this time,” Shiva said. “Save the seeds, have a community garden, create an exchange, do everything that it takes to protect and rejuvenate the seed.”