Trump’s EO on the ACA

The Trump administration issued its first executive order. The subject is the ACA. The order seeks to destabilize the non-subsidized and off-Exchange portions of the risk pool by minimizing enforcement of the individual mandate.  Dan Diamond at Politico had the first link to the actual order that I saw:

Section 2 is the critical component for the individual market. Section 3 has significant impact for both Exchanges and Medicaid.

Analysis below the fold:
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Government, Meet Bathtub

It’s easy to run a government that does (next to) nothing.

Here’s where Trumpism — or really Pence-ism, or really, exactly what the GOP has been promising (threatening) will have its most immediate, and quite possibly its most damaging impact:

Staffers for the Trump transition team have been meeting with career staff at the White House ahead of Friday’s presidential inauguration to outline their plans for shrinking the federal bureaucracy, The Hill has learned.

The departments of Commerce and Energy would see major reductions in funding, with programs under their jurisdiction either being eliminated or transferred to other agencies. The departments of Transportation, Justice and State would see significant cuts and program eliminations.

The Corporation for Public Broadcasting would be privatized, while the National Endowment for the Arts and National Endowment for the Humanities would be eliminated entirely.

Overall, the blueprint being used by Trump’s team would reduce federal spending by $10.5 trillion over 10 years.

The NEH and NEA cuts are at once symbolic — the GOP is killing stuff liberals like, which is reward enough in those quarters — and, I think, intended to distract from other hugely reckless choices:

The Heritage blueprint used as a basis for Trump’s proposed cuts calls for eliminating several programs that conservatives label corporate welfare programs: the Minority Business Development Agency, the Economic Development Administration, the International Trade Administration and the Manufacturing Extension Partnership. The total savings from cutting these four programs would amount to nearly $900 million in 2017.

At the Department of Justice, the blueprint calls for eliminating the Office of Community Oriented Policing Services, Violence Against Women Grants and the Legal Services Corporation and for reducing funding for its Civil Rights and its Environment and Natural Resources divisions.

At the Department of Energy, it would roll back funding for nuclear physics and advanced scientific computing research to 2008 levels, eliminate the Office of Electricity, eliminate the Office of Energy Efficiency and Renewable Energy and scrap the Office of Fossil Energy, which focuses on technologies to reduce carbon dioxide emissions.

Under the State Department’s jurisdiction, funding for the Overseas Private Investment Corporation, the Paris Climate Change Agreement and the United Nations’ Intergovernmental Panel on Climate Change are candidates for elimination.

The single most important point I can make is that this is the Kansas-ification of America.  This isn’t a Trump policy choice.  This is Mike Pence shepherding plans the Republican Party has been trying to implement for years, decades even.  I doubt it will all get through, but much of it will, I’d guess, and when it does we will need to hang every shitty outcome and terrible choice around the neck of every Republican officeholder.

This is what they want. This is what they told us they wanted. They’re likely going to get it, to some approximation.  And they’re going to have to own it, so that once again, Democrats can come in and fix the serial catastrophes we’re going to witness very damn soon.

Also, too — who wants to bet all the pieties about the deficit and restoring balance to the budget will fall to the tax cuts to come?

Fuck it.  I’m heading back to the seventeenth century.

Image: Francesco de Rossi, Bathesheba at her Bath1552-1554.



Thursday Morning Open Thread: Keep Going After the Bastids

Per Crooks & Liars:

A frustrated Senator Warren asked Rep. Price direct questions about his own policy prescriptions, but he refused to give a definitive answer, even about the cuts he has repeatedly called for.

Sen. Warren discussed his calls to cut funding and asked, “You recently authored as chair of the House Budget Committee would have cut spending on Medicare by $449 billion dollars over the next decade, is that right?

Rep. Price replied, “I don’t have the numbers in front of me.”

She replied, “I have the numbers.”

He said, “I assume you’re correct.”…

Sen. Warren then brought up Trump’s positions on both health care plans, in which he states there will be no cuts to the programs, funding-wise. She asked if Trump was telling the truth and he replied, “yes.”…

Warren said, “Can you guarantee to this committee that you will safeguard president-elect Trump’s promise and while you are HHS secretary, you will not use your authority to carry out a single dollar of cuts to Medicare or Medicaid eligibility or benefits?”

Price said, “What the question presumes is that money is the metric. In my belief from a scientific standpoint, if patients aren’t receiving care even though we’re providing the resources, it doesn’t work for patients.”

Warren said, “We’re very limited on time. The metric IS money. The President-elect…said he would not cut dollars from this program. So that’s the question I’m asking you. Can you assure this committee you will not cut one dollar from Medicare or Medicaid should you be confirmed to this position?

Price replied, “I believe that the metric ought to be the care that the patients are receiving.”

Warren said, “I’ll take that as a no.”…

***********

Apart from applauding Women Who Take No Shit, what’s on the agenda for the day?
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Evidence based care in Medicaid

We want to do evidence based care.  We want to do things that work and avoid things that don’t work.  This sounds simple.  Let’s look at two very good natural experiments on unintended pregnancy rates:

Colorado:

    Since 2008, Colorado has successfully increased access to family planning services throughout the state, particularly for the most effective contraceptive methods, such as intrauterine devices (IUDs) and implants.

  • The Colorado Family Planning Initiative has increased health care provider education and training and reduced costs for more expensive contraceptive options, enabling more than 30,000 women in the state to choose long-acting reversible contraception….
  • When contraception, particularly the long-acting methods, became more readily available in Colorado between 2009 and 2013, the abortion rate fell 42 percent among all women ages 15 to 19 and 18 percent among women ages 20 to 24.
  • Colorado is a national leader in the use of long-acting reversible contraception, and reducing teen pregnancy and repeat pregnancies.

    • Teen birth rates in our state have declined more rapidly than in any other state or the nation as a whole.
  • The birth rate for Medicaid-eligible women ages 15 to 24 dropped sharply from 2010 to 2012, resulting in an estimated $49 million to $111 million avoided expenses in Medicaid birth-related costs alone.

More reliable and effective contraception was made available to Colorado women who had the choice to elect Long Acting Reverisble Contraception (LARC) or do something else.  A significant number of women elected to use LARC and the increased autonomy and reliability produced amazingly good results.

Texas

 

Reducing contraceptive availability led to higher abortion rates and higher unplanned pregnancies. Earlier live births have massively negative multi-generational repercussions for both the parents and kids.

The evidence strong suggests that significant improvements in quality of life can be made and significant expenditures reduced if contraception is made readily available.

And guess what Congress will consider to be a high priority:

House Speaker Paul Ryan announced Thursday that Republicans will move to strip all federal funding for Planned Parenthood as part of the process they are using early this year to dismantle Obamacare.

Wahoo… the evidence will strongly support the hypothesis that this policy will lead to more unintended pregnancies, more abortions and far worse outcomes for far more Americans.

Evidence based policy making — Hoo Yaa



If You Don’t Know Who The Patsy At The Table Is, Dear Trumpkins…

...it’s you:

Again and again, President-elect Donald Trump presented himself as the coal miners’ candidate. During the campaign, he promised to bring coal back into the economy, and jobs back into struggling Appalachian towns.

But now some in coal country are worried that instead of helping, Trump’s first actions will deprive miners — and their widows and children — of the compensation they can receive if they are disabled by respiratory problems linked to breathing coal mine dust.

That’s because buried in the Affordable Care Act are three sentences that made it much easier to access these benefits. If Trump repeals Obamacare — as he vowed to do before the election — and does not keep that section on the books, the miners will be back to where they were in 2009, when it was exceedingly difficult to be awarded compensation for “black lung” disease.

coal_mining_18th_c

This is by no means a done deal, given that at least some coal-country legislators (Joe Manchin, for one) have declared their support for retaining this in whatever comes out of the health care catastrophe the GOP is determined to commit.  But McConnell is, as usual, mum on the matter, and if I were a coal mining family depending on the pittance they do get (top payment for a miner with three dependents: $1,289/month), I’d be getting ready not for hard times — they’re already here — but worse.

[update: obligatory post soundtrack]

The key change the ACA implemented in black lung cases was to shift the burden of proof: instead of a miner having to prove that the work caused the disease, under the new rules,

If a miner has spent 15 years or more underground and can prove respiratory disability, then it is presumed to be black lung related to mine work, unless the company can prove otherwise.

This wasn’t a case of free money all around. As reporter Eric Boodman writes,  “In 2009, 19 percent of claims for black lung benefits were successful; in 2015, that percentage had jumped to 28.” That’s a big jump — but hardly evidence that the black lung compensation process is a wild government grab of beleaguered coal company assets.

Those companies hate the rule, with a spokesman telling Boodman that it’s created “a supplemental pension program” rather than the compensation for occupational disease, which is as fine a bit of high priced turd polishing as I’ve seen in a while.

TL:DR?  Think of this as Mencken’s rule in action:

Democracy is the theory that the common people know what they want, and deserve to get it good and hard.

Trump voters in coal country — West Virginia, Pennsylvania, Ohio, Kentucky — were promised their country back.

What will they receive?

The shaft, deeper and darker than any hole miners have dug in the hunt for what will continue to kill them where they stand.

Image: Léonard Defrance, Coal Mining, before 1805.



If His Lips Move, He’s Lying…part [n]

Donald Trump has yet to meet with the prime minister of the United Kingdom — arguably the closest ally of the United States.  He has found time to meet with representatives of Britain’s Lets-Play-Footsie-With-Fascists UKIP party including its well-dressed proto-fascist leader, Nigel Farange.

In that meeting Hair Führer focused on what really matters in the trans-Atlantic alliance.

Offshore wind farms in Scotland [h/t TPM]:

[Andy] Wigmore, who coordinated the communications effort for the push for Britain to leave the European Union, told The Express and the New York Times that Trump asked them to oppose new wind farms….

Wigmore told The Express that Trump “is dismayed that his beloved Scotland has become over-run with ugly wind farms which he believes are a blight on the stunning landscape.”

Rich guy doesn’t like looking at windmills. Rich guy manages to grasp real power. Rich guy starts f**king with other nations’ energy policy, land use decisions and the rest because…he can.

Welcome to the post policy presidency.  Trump has no idea what energy mix makes sense and he doesn’t care.  Just doesn’t like looking at turbines.  So lose the buggers, amirite!

paul_gauguin_-_the_queens_mill

Apparently, Trump’s intervention appears to have worked, sort of:

Wigmore said that Trump “did suggest that we should campaign on it” and that the conversation “spurred us in and we will be going for it,” according to the New York Times.

Going for it, in this case, meaning that a party and a leadership roundly loathed in Scotland will argle bargle pwfft or something.  But gotta stroke the ferret-heedit shitgibbon, and talk is cheap.

The lagniappe, utterly unsurprisingly, is that the default position of the Trump crowd to any challenge is to lie:

Trump spokeswoman Hope Hicks denied to the New York Times that Trump discussed wind farms during his meeting with Farage. When the Times told Hicks that Wigmore gave an account of the wind farm discussion, Hicks did not respond with further comment, according to the Times.

With every passing day it becomes yet more clear that there is no way that Donald Trump can handle the presidency.  With each passing day his presidency draws closer.

WASF.

Image:  Paul Gauguin, The Queen’s Mill, Østervold Park1885.



Friday’s Breaking News is Now Irreparably Broken

Michael Isikoff* has committed an act of actual journalism:

Exclusive: FBI still does not have warrant to review new Abedin emails linked to Clinton probe

When FBI Director James Comey wrote his bombshell letter to Congress on Friday about newly discovered emails that were potentially “pertinent” to the investigation into Hillary Clinton’s private email server, agents had not yet been able to review any of the material, because the bureau had not yet gotten a search warrant to read them, three government officials who have been briefed on the probe told Yahoo News.

At the time Comey wrote the letter, “he had no idea what was in the content of the emails,” one of the officials said, referring to recently discovered emails that were found on the laptop of disgraced ex-Rep. Anthony Weiner, the estranged husband of top Clinton aide Huma Abedin. Weiner is under investigation for allegedly sending illicit text messages to a 15-year-old girl.

As of Saturday night, the FBI had still not gotten approval from the Justice Department for a warrant that would allow agency officials to read any of the newly discovered Abedin emails, and are therefore still in the dark about whether they include any classified material that the bureau has not already seen.

“We do not have a warrant,” a senior law enforcement official said. “Discussions are under way [between the FBI and the Justice Department] as to the best way to move forward.”

Oooopsie!

* Also, NY Times, if someone else reports something out before you, you’re supposed to give them credit…