President Trump is expected to instruct three key agencies to rewrite a series of regulations that affect health insurance, the Wall Street Journal reported (10/7). Details were still in flux, sources familiar with the proposal told Jonathan Cohn of HuffPost (10/9). But the ultimate goal would be to accomplish through executive action what, so far, Trump and the Republican Congress have been unable to pull off through legislation. Specifically, they would undermine the rules that guarantee comprehensive coverage to people with pre-existing conditions.

How far the administration can take this effort is not clear, Cohn noted. Laws that govern health care include not just the Affordable Care Act, but also a 1974 law that affects insurance plans for large employers. Together, these laws limit leeway the executive branch has when it comes to redrawing the restrictions on how insurance companies operate.

Still, few experts doubt that the Trump administration has some latitude, and that it’s probably enough to weaken at least some of the new rules that the ACA has put in place. In the worst-case scenario, Trump’s executive action could destabilize insurance markets ― making coverage much more expensive or even unavailable to some small businesses and individuals, especially those with serious medical problems, even as it would make coverage cheaper for others in relatively good health.

The main focus will be “association health plans,” or AHPs, which are basically special insurance plans that insurers sell through organizations representing either small employers, self-employed individuals, or members of voluntary organizations. An insurer could sell an AHP through an association of real estate agents, for example, or through a local chamber of commerce.

AHPs have been around for a long time. But after the ACA became law, the Obama administration determined that they should be subject to the same rules as other insurance plans. As a result, an AHP available to small businesses today must operate according to the same rules as other insurance policies for small businesses. Similarly, an AHP available to individuals must operate according to the same rules as other insurance policies for individuals.

In either case, it means that all plans must cover “essential” benefits, including mental health, maternity care and prescriptions. In addition, insurers can’t vary premiums based on the likely medical expenses of the small business or individual members seeking coverage.

These regulations tend to make coverage more expensive, and for that reason conservatives have agitated to make AHPs exempt from the rules. Doing so, conservatives have argued, would create new, cheaper alternatives for small business and people frustrated with the high cost of coverage now available under the ACA.

But the plans would tend to draw younger, healthier small businesses and individuals away from plans providing comprehensive benefits. As a variety of experts, officials, and industry groups have pointed out repeatedly, the end result could be a bifurcated insurance market with healthy people buying skimpy, cheap coverage, and sicker people stuck in the older, more expensive plans. The latter would frequently be a money-losing proposition for insurers, and many carriers would likely decide to abandon markets altogether.

The most persistent and effective advocate for making these changes has been Sen. Rand Paul (R-Ky.), who ended up opposing the most recent effort to pass repeal legislation because he said it did not do enough to dismantle Obamacare. As soon as GOP leaders abandoned that effort, because it lacked the votes it needed to pass, Paul began agitating, publicly and privately, for the administration to consider his idea. In his ideal world, pretty much anybody would be able to join an AHP.

Paul’s idea, in a nutshell, is to allow AHPs to sell loosely regulated plans and to do so across state lines, overriding any regulations that states have put in place. That last part could be difficult, because Trump administration would have find some way of reinterpreting a 1974 law, called the Employee Retirement Income Security Act, so that it covered AHPs. Many legal experts think ERISA would not allow such leeway, so an effort to rewrite the rules as Paul has urged would swiftly run into a legal challenge ― and likely a successful one.

But even if the Trump administration can’t go as far as Paul would like, the experts acknowledge, it may still have authority to loosen existing regulations on AHPs in ways that would alter insurance markets substantially. One very real possibility is that each state could decide how closely to regulate AHPs ― and that, left with such discretion, some would decide to weaken the rules, allowing AHPs to sell skimpy plans and hike premiums for people or small businesses with a history of high medical claims.

Broadly speaking, the kinds of changes that Trump’s executive order could unleash are similar to the changes that previous GOP repeal bills would have. But for all of the Affordable Care Act’s real problems — and the genuine frustration many people feel with it — those Republican proposals proved to be highly unpopular and aroused intense grassroots opposition.

One question is whether these new orders provoke a similar reaction ― or whether, because they are going through the regulatory process rather than Congress, they end up escaping public outrage.

TRUMP WON’T LET STATES IMPROVE THEIR HEALTH OFFERINGS. As states prepare for the fifth enrollment season under the Affordable Care Act, starting 11/1, health care advocates say the Health and Human Services Department has done more to suppress the number of people signing up than to boost it. HHS has slashed grants to groups that help consumers get insurance coverage, for example. It also has cut the enrollment period in half, reduced the advertising budget by 90% and announced an outage schedule that would make the HealthCare.gov website less available than last year, Juliet Eilperin reported at the Washington Post (10/5).

The White House also has yet to commit to funding the cost-sharing reductions that help about 7 mln lower-income Americans afford out-of-pocket expenses on their ACA health plans. Trump has regularly threatened to block them and, according to an administration official who was not authorized to speak publicly, officials are considering action to end the payments in November.

Eilperin noted that a more obscure battle within the administration over several states’ proposed changes for their marketplaces speaks volumes about the president’s approach to the law.

The Wall Street Journal reported on Iowa’s request for a Section 1332 waiver — a provision that allows states to adjust how they are implementing the ACA as long as they can prove it would not translate into lost or less-affordable coverage.

Iowa’s aim was to foster more competition and better prices. The story said other states hoping to stabilize their situations were watching closely.

Trump first tried to reach Tom Price, who was then secretary of Health and Human Services, but Price was traveling in Asia and unavailable. The president then called Seema Verma, administrator of the Centers for Medicare and Medicaid Services (CMS), the agency charged with authorizing or rejecting Section 1332 applications. CMS had been working closely with Iowa as it fine-tuned its submission.

Iowa State Insurance Commissioner Doug Ommen has described the “Iowa Stopgap Measure” as critical to expanding marketplace options there. The plan would abolish the ACA exchange there and convert consumer subsidies into a type of GOP-styled tax credit. New financial buffers would help insurers handle customers with particularly high medical expenses.

Without the measure, “over 20,000 middle class farmers, early retirees and self-employed Iowans will likely either go uninsured or leave Iowa,” Ommen warned in a statement (9/19). Those who sign up for 2018 exchange coverage face premium rate increases of 57% on average from the single insurer participating.

Some administration officials are still pressing for the waiver to be granted, according to interviews with several Republicans. The HHS spokesman confirmed last week that Iowa’s application “has been deemed complete and is currently under review” but did not address the president’s directive on the matter.

Oklahoma officials also were frustrated that administration officials had not provided an answer to the state’s request for a waiver request “after months of development, negotiation, and near daily communication over the past six weeks.”

“While we appreciate the work of your staff, the lack of timely waiver approval will prevent thousands of Oklahomans from realizing the benefits of significantly lower insurance premiums in 2018,” wrote Terry Cline, the state’s health secretary.

In at least one case, CMS has approved a waiver in a way that upended a state’s plan to maximize health coverage for its residents. Minnesota applied to CMS for permission to establish a reinsurance program, which can lower premiums by giving insurers a guarantee that they will have limited financial exposure for customers with particularly high medical expenses. The agency informed Gov. Mark Dayton (D) on 9/22 that it would provide $323 mln for the program since the lower premiums would mean savings to the federal government on subsidies to Minnesotans with ACA health plans.

But, Verma added, the federal government also would cut $369 mln in funding for a separate program aimed at residents who earn between 138% and 200% of the federal poverty level and don’t qualify for the same subsidies.

TRUMP JOB APPROVAL WORSENS. Trump’s approval ratings have gone from bad to worse over the last nine-and-a-half months since he took office. HuffPost’s Pollster, which averages 35 publicly available polls, showed Trump was a 39.9% approval rating (10/7) while 56,2% disapproved of Trump. On Jan. 22, Pollster showed 44.1% approval for Trump and 43.2% disapproval.

Democrats also hold a lead in generic House races next year, as Pollster also showed an average of 41% support Democrats in the 2018 House elections, while 35.6% support Republicans (10/1). On Jan. 24, Pollster showed 48% support for Dems and 42% support for Republicans.

On the Affordable Care Act, also known as Obamacare, Pollster showed an average of 47.1% support the law while 41.2% oppose it (10/1). On Jan. 24, Pollster showed 49% support and 47% opposed.

LIBERAL GROUPS GOT IRS SCRUTINY TOO, INSPECTOR GENERAL BELATEDLY FINDS. A federal watchdog has identified scores of cases in which the Internal Revenue Service may have targeted liberal-leaning groups seeking tax-exempt status for extra scrutiny based on their names or political leanings, a finding that could undermine claims that conservatives were unfairly targeted under President Barack Obama, Mike DeBonis reported in the Washington Post (10/4).

The Treasury Inspector General for Tax Administration (TIGTA) reviewed cases between 2004 and 2013, which includes the period TIGTA previously examined in a 2013 report that faulted the IRS for using inappropriate political criteria to select groups for heightened scrutiny.

That earlier report found that 96 groups with names referencing “Tea Party,” “Patriot” or “9/12” were selected for intensive review between May 2010 and May 2012, and the House Ways and Means Committee later identified another 152 right-leaning groups that were subjected to scrutiny. Those findings fueled accusations by Republican lawmakers that the Obama administration engaged in politically motivated targeting of conservatives.

But Democrats have challenged those claims, arguing that liberal-leaning groups were given close scrutiny alongside the conservative groups. The 2013 TIGTA report, they argued, was based on selective criteria that omitted numerous liberal groups that were also subjected to close IRS review.

The new report examines a broader range of criteria, including affiliation with the now-defunct Association of Community Organizations for Reform Now (ACORN), as well as names referencing “Progressive,” “Green Energy,” “Medical Marijuana,” and “Occupy.”

Together, the watchdog identified 146 cases in which the IRS examined groups for suspicion of engaging in disallowed political activity using those criteria. The inspector general found 83 of those cases were definitively chosen for scrutiny because of the selection criteria.

IRS personnel were told starting in 2010 to watch out for groups that had affiliations with ACORN, a national network of community-based organizations that had collapsed amid allegations of wrongdoing by conservative activists. Ultimately, at least 13 applications for tax exemptions were flagged for scrutiny based on possible ACORN ties, and most of those groups waited over a year for their cases to be resolved, the report said—mirroring many of the allegations leveled regarding conservative groups.

DON’T GIVE CORKER TOO MUCH CREDIT. The big news on Oct. 9 was that Scott Pruitt, the EPA who had made his reputation as Oklahoma attorney general suing to prevent the EPA from enforcing regulations to protect the environment, took a jaunt down to Hazard, Ky., to announce that “the war on coal” was over and that he would be rolling back the Obama Administration’s Clean Power Plan, which mandated cuts in carbon-dioxide emissions from power plants. “This is because Pruitt is as complete a tool as one can find at Home Depot and because he no more belongs as head of the EPA than an elephant does performing at the Bolshoi,” Charles Pierce noted at Esquire.com (10/9).

“Bob Corker thought that Scott Pruitt was just the man for the job. Bob Corker also voted in favor of making a discreet racist the Attorney General, for putting a grifter at the head of Health and Human Services, and for putting unqualified buffoons at the head of the Departments of Education and Housing And Urban Development. Bob Corker was altogether fine with stiffing Merrick Garland for a year in order to hijack a Supreme Court seat for Neil Gorsuch who, apparently, even John Roberts can’t stand. It was cool with Bob Corker, several times, if millions of Americans lost their healthcare and if even the surviving restrictions on Wall Street brigandage and campaign finance went up in smoke. Bob Corker voted with the administration 88% of the time. And as Alec MacGillis pointed out on the electric Twitter machine, Bob Corker stepped in and monkeywrenched a union drive at an automobile plant in Tennessee.”

That is just in case you were thinking that Bob Corker is now your favorite Republican because he told the New York Times that President Trump was treating his office like “a reality show,” with reckless threats toward other countries that could set the nation “on the path to World War III” and he was alarmed about a president who acts “like he’s doing ‘The Apprentice’ or something … He concerns me,” Corker added. “He would have to concern anyone who cares about our nation.”

The elite political press may be hailing Corker as a man of principle, but Pierce is having none of it. “The free ride is over,” he said. “Conservative Republicans don’t get to disavow Breitbart without first acknowledging that they’ve been playing footsie with neo-Confederates in the South, and with seditious lunatics in the West, since everything got rolling in the 1970s. Conservative Republicans don’t get to disavow Steve Bannon—assuming any of them have—without acknowledging the importance of Lee Atwater and Karl Rove to their ascendancy. They don’t get to call this president* [sic] unqualified or crazy without acknowledging the science behind the climate crisis and abandoning the crackpot magical thinking of supply-side economics.

“They need to clean their whole house instead of simply railing at the maniac they invited into the front parlor. Once, at a presidential debate, a third of the Republican field admitted publicly that they didn’t believe in evolution. And that was 13 years ago. The prion disease has been running wild ever since. There’s no strategy for triage anymore. All are infected. All must be quarantined.”

DEMS UNVEIL TAX PLAN THAT HELPS WORKING FAMILIES. Coming on the heels of the Republican tax plan, Sen. Tammy Baldwin (D-WI) and Sen. Cory Booker (D-NJ) have announced a tax reform plan of their own.

Their plan, called the Stronger Way Act, markets itself as “tax reform to reward work.” In contrast to the GOP tax plan, Booker and Baldwin’s plan doesn’t change the actual tax code, but rather uses the existing tax code to help working families, Rebekah Entralgo noted at ThinkProgress (10/9).

At the center of their plan are two tax measures that would benefit lower and middle income families: expanding the Earned Income Tax Credit (EITC) and the Child Tax Credit.

An expansion of the EITC, a refundable tax credit that primarily benefits lower- to middle-income families, has been embraced at one point or another by both sides of the aisle. House Speaker Paul Ryan (R-WI) and former President Barack Obama both put forth plans that included increasing the EITC. Booker and Baldwin’s plan would allow workers with earnings above 50% of the poverty line to receive the maximum EITC. Their proposal suggests a single working mother of two with an income consistent with the poverty level could earn a tax credit increase of more that $2,200 under their plan. Additionally, a working married couple with three children on an income of $20,000 per year would earn a tax credit of of $3,500.

The Baldwin-Booker plan would also expand the EITC to workers without dependent children as a way to boost income for workers and to ensure they aren’t taxed into poverty. More than 20 mln workers without dependent children would be affected by a EITC expansion. The duo estimates that a 30-year-old worker without dependents making roughly $12,500 a year currently receives an EITC of about $180.

The GOP tax plan, by contrast, raises the bottom tax rate from 10% to 12%, cuts the top rate to 35%, and also doubles the standard deduction. A recent analysis by the Tax Policy Center found that by 2018, the Republican plan would allow taxpayers in the top 1% (which includes incomes of above $730,000), to receive roughly 53% of the total tax benefit and their after-tax income would increase an average of 8.5%. Meanwhile, taxpayers in the bottom 95% would see average after-tax incomes increase between 0.5 and 1.2 percent.

Bloomberg estimates that under the GOP tax plan a middle-class couple with three kids would actually have to add $20,250 to their taxable income to make up for measures of their tax plan like the elimination of the personal exemption. That amounts to nearly double the “benefit” they would receive by a doubled standard deduction. It’s difficult, however, to determine the exact impact on a particular family because the plan lacks critical details, particularly the details that affect working families the most.

GM EMBRACES ELECTRIC VEHICLE FUTURE. General Motors’ head of global product development announced the car manufacturer would accelerate the transition to electric vehicles (EVs), with two new EV models coming out in 2018, and “at least” another 18 by 2023. On the same day, Ford Motor Co. announced it would release 13 new EV models in the next five years.

“General Motors believes in an all-electric future,” Mark Reuss announced in a corporate press release (10/9).

When you add in plans from huge, fast-growing markets like China and India to quickly shift to EVs and end the sale of internal combustion engine cars, it’s clear that upending the car market will also upend the oil market.

The electric vehicle revolution has been supercharged by plummeting lithium-ion prices, which are half of what they were in 2014. Bloomberg New Energy Finance (BNEF) forecasts EVs will be as cheap as gasoline cars by 2025 and keep dropping in price until EVs overtake them in yearly sales, by which time EVs will be displacing 8 mln barrels of oil a day — more than Saudi Arabia exports today.But BNEF pointed out last year that the 2014 oil price collapse was triggered by a global glut of just 2 mln barrels a day. So they’ve already told investors to expect the big crash in oil as soon as 2023.

WHITE HOUSE TIES DREAMER PROTECTION TO INCREASED BORDER CRACKDOWN. Funding for a wall along the US-Mexico border and a crackdown on children fleeing Central America are among the demands laid out by President Trump’s administration in exchange for protecting hundreds of thousands of young undocumented immigrants who came to the US as children, E.A. Crunden reported at ThinkProgress.

The White House told Congressional leaders (10/8) it wants to crack down on so-called sanctuary cities in addition to funding Trump’s long-sought border wall and accelerating the deportations of children back to countries like Guatemala and Honduras — even if their safety is at risk from escalating violence. Family members of immigrants in the US will also be barred from joining them. Other measures include hiring thousands of new immigration officials to oversee the proposed measures and appointing 370 additional immigration judges, along with 300 federal prosecutors.

But the demands threaten to unravel a precarious deal struck between Trump and Democratic leaders in September. Following Trump’s decision to end the Deferred Action for Childhood Arrivals (DACA) initiative established by former President Barack Obama, Democratic lawmakers lobbied the president to reconsider. Approximately 690,000 undocumented immigrants are currently covered by the program, a temporary legal status that came at a steep price — recipients handed over a staggering amount of private data and information to the government in exchange for protection from deportation. Trump’s decision to phase out DACA has left the initiative’s recipients, also known as DREAMers, in a terrifying limbo, with many unsure of how their families and futures will be impacted.

In the weeks following Trump’s announcement, Democratic leaders Rep. Nancy Pelosi (CA) and Sen. Chuck Schumer (NY) appeared to strike a deal with the president, one that would protect DREAMers from deportation following a six month delay period laid out by the administration. According to initial reports, the agreement included an increase in funding for border security, without any additional funds for Trump’s border wall. But that relief was short-lived — administration officials pushed back almost immediately, arguing that no such deal had been made.

“The administration can’t be serious about compromise or helping the Dreamers if they begin with a list that is anathema to the Dreamers, to the immigrant community and to the vast majority of Americans,” said Schumer and Pelosi in a statement shortly after the list’s circulation.

“We told the President at our meeting that we were open to reasonable border security measures,” the letter continued. “But this list goes so far beyond what is reasonable. This proposal fails to represent any attempt at compromise.”

NFL PLAYERS ASSOCIATION RESPONDS TO PENCE ASSAULT ON FREE SPEECH. Vice President Mike Pence carried out a pre-planned, costly publicity stunt on Sunday (10/8), traveling hours at taxpayer expense estimated by ABC News at nearly $250,000 to an NFL game where he knew that players would kneel during the national anthem in order to walk out in a huff over the silent protest. Laura Clawson noted at (10/9) that the NFL Players Association responded with remarkable restraint, while making clear just how big the issues here are:

“NFL players are union members and part of the labor movement that has woven the fabric of America for generations. Our men and their families are also conscientious Americans who continue to be forces for good through our communities and some have decided to use their platform to peacefully raise awareness to issues that deserve attention.

“It is a source of enormous pride that some of the best conversations about these issues have taken place in our locker rooms in a respectful, civil and thoughtful way that should serve as a model for how all of us can communicate with each other.

“We should not stifle these discussions and cannot allow our rights to become subservient to the very opinions our Constitution protects. That is what makes us the land of the free and home of the brave.”

Showing a little less restraint, Clawson noted: “Donald Trump and his lap dog Mike Pence hate the Constitution and its guarantee of free speech.”

EPA NOMINEE WON’T COMMIT TO RECUSALS IF CONFLICT OF INTEREST. President Trump’s nominee to head the EPA’s chemical and pesticides office refused (10/4) to pledge that he would recuse himself from decisions connected to the companies for whom he worked during his long career as a toxicologist for the chemical industry.

At a contentious confirmation hearing, Democrats on the Senate Environment and Public Works Committee repeatedly asked Michael Dourson, nominated to serve as assistant administrator of the EPA’s Office of Chemical Safety and Pollution Prevention, whether he would recuse himself from decision-making where he saw a conflict with his past work. Dourson balked, saying he would rely on EPA ethics officials to make any decision on recusal.

Sen. Tom Carper (D-DE), ranking member of the committee, brought a chart to the hearing room that listed some of the chemicals that companies had paid Dourson to study. “In each and every case, you concluded that the right safety standard for the chemicals should be tens, hundreds, even thousands of times less protective than the federal or state regulators did,” Carper said. “It is regrettably difficult to look at your record and conclude that you could be an impartial regulator.”

“One way that you could remedy the perception that you may not be able to be an impartial regulator would be to promise to recuse yourself if confirmed from working on any chemical that industry has paid you to study,” he said. But Dourson declined to promise he would recuse himself.

COAL LOBBYIST NOMINATED FOR #2 SPOT AT EPA. The White House announced (10/5) that President Trump has nominated Andrew Wheeler, a former coal lobbyist, to be deputy administrator of the Environmental Protection Agency (EPA).

Until recently, Wheeler was a registered lobbyist for Murray Energy; he de-registered as a lobbyist (8/11), following months of speculation that he would be tapped for the number two position within the EPA. Murray Energy is the country’s largest privately owned coal company; its CEO, Bob Murray, is an ardent Trump supporter who hosted an invitation-only fundraiser for Trump during the presidential campaign and donated $300,000 to his inauguration.

An outspoken advocate for the coal industry, Wheeler has long questioned the mainstream consensus on climate change. In 2006, while working for the Senate Environment and Public Works committee, Wheeler suggested that the Earth might actually be going through a “cooling phase.” In March of 2010, he commented on a National Journal article about the UN’s International Panel on Climate Change, arguing that the body had “blurred the lines between science and advocacy to the point where they are unable to separate situational awareness from proposed remedies.”

He also suggested that the EPA’s 2009 Endangerment Finding — which relied on scientific evidence to determine that greenhouse gas emissions pose a threat to public health, and therefore could be subject to regulation under the Clean Air Act — should be reconsidered. Overturning the endangerment finding has been a major priority for conservative groups like the Competitive Enterprise Institute and the Heartland Institute, as it would strip away the EPA’s legal authority to regulate greenhouse gas emissions.

Wheeler represented Murray as a lobbyist beginning in 2009. Before that, he worked for Sen. Jim Inhofe (R-OK), who famously brought a snowball onto the floor of the Senate in an attempt to disprove the scientific evidence behind climate change. Wheeler also worked for more than a decade as a staffer on the Senate Environment and Public Works Committee, serving as both staff director and chief counsel. Early in his career, Wheeler worked at the EPA as a special assistant in the Office of Pollution Prevention and Toxics.

From The Progressive Populist, November 1, 2017


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