Trump contradicts himself

During the campaign Donald Trump proclaimed that he was a friend to the LGBT community, but this still isn’t surprising:

Attorney General Jeff Sessions has reversed a three-year-old Justice Department policy that protected transgender workers from discrimination under federal law.

In a memo to his US attorney offices and agency heads, Sessions said that Title VII of the Civil Rights Act of 1964 does not protect transgender people from workplace discrimination by private employers and state and local governments.

‘‘Title VII’s prohibition on sex discrimination encompasses discrimination between men and women but does not encompass discrimination based on gender identity per se, including transgender status,’’ Sessions wrote in the memo dated Wednesday.

Trump lies all the time so you should never trust what he says and he has surrounded himself with cultural warriors (Pence, Sessions, …).

Republicans always claim that they are against abortion but won’t go against contraception. You can trust them about as much as you can trust Trump:

The Trump administration issued a rule Friday that sharply limits the Affordable Care Act’s contraception coverage mandate, a move that could mean many American women would no longer have access to birth control free of charge.

The new regulation, issued by the Health and Human Services Department, allows a much broader group of employers and insurers to exempt themselves from covering contraceptives such as birth control pills on religious or moral grounds. The decision, anticipated from the Trump administration for months, is the latest twist in a seesawing legal and ideological fight that has surrounded this aspect of the 2010 health-care law nearly from the start.

And then there’s foreign policy. North Korea is a mess, especially now that it has nuclear weapons, so it’s a great time to try to pull out of the treaty with Iran that has kept Iran from developing nuclear weapons:

But Trump, after twice certifying the deal, has warned his aides that he would not do so again. As a result, the administration is looking for ways to claim Iran is in violation of the “spirit” of the accord, even if it has complied with inspection criteria.The International Atomic Energy Agency has said that Iran was in compliance. When the agency has found minor violations, they have been quickly fixed.

This will indeed isolate a country but it might not be the US:

Britain, France, and Germany, all signatories to the agreement, are watching Trump’s deliberations with deepening concern. Diplomats from the three countries, as well as from the European Union, met with dozens of senators this week to warn them that if the United States withdrew, Europe would not follow.

Trump has no problem with being inconsistent:

The United States is poised to permanently lift sanctions on Sudan, US officials said on Thursday, recognizing the long-estranged country’s progress on human rights and counterterrorism after decades of war and abuses.

Sure, Sudan has done a lot more worse things than Iran but … Trump just doesn’t like Iran.

For fun (if you like worrying about nuclear war):

‘‘You guys know what this represents?’’ Trump asked. ‘‘Maybe it’s the calm before the storm. Could be the calm, the calm before the storm.’’

‘‘What storm Mr. President?’’ one reporter shouted. ISIS? North Korea? Iran?

‘‘You’ll find out,’’ the president said.

Finally, via Kevin Drum, let’s look back at that IRS scandal where they targeted the Tea Party groups. Here’s KD’s summary:

In total, the IRS audited 111 left-wing groups and 19 right-wing groups based on BOLO criteria. (It’s unclear how the “healthcare” category broke out between left and right.)

The vast majority were left-wing groups, but the IRS was being so unfair to the TEA Party groups.

Republicans care

Let’s look at how Republicans care about the people.

First, they’ve so busy trying to take medical insurance from tens of millions of people they let medical insurance for children lapse:

Congress has allowed the Children’s Health Insurance Program, which provided low-cost health insurance to 9 million children, to expire.

If action is not taken soon to restore the funding, the effects will become obvious in schools across the country, with many of the children in the program unable to see a doctor for routine checkups, immunizations, visits when sick, and other services.

Second, they will probably get rid of a program that made it so students scammed by fake universities didn’t have to repay their loans:

Relief seemed to be on the way last year after she learned the Obama administration would forgive her Department of Education loans if she could prove she was defrauded by the for-profit college. But President Trump has brought the worries back.

Trump has thrust Cabrera Garcia and more than 65,000 other student borrowers across the country, including about 1,500 in New England, into a new state of financial limbo by suspending applications under Obama’s program of loan forgiveness.

I wonder why? Oh:

DeVos has investment ties to the for-profit education sector. She also has installed former executives and other officials from the for-profit education industry in her department.

Among them: Julian Schmoke Jr., as the Education Department’s top cop looking for schools that are cheating taxpayers and students of federal aid dollars. Schmoke is a former dean at DeVry University, a for-profit school that, along with its parent company, last year agreed to pay the Federal Trade Commission $100 million to settle allegations it lured students with false job and salary information. Critics also say he has little to no experience running investigations.

It’s obvious that DeVos just doesn’t care about public education.

Ruth Pfau

Now that I’m older, I look at the obituaries more often. Sometimes you run into ones like this:

Dr. Pfau, while not widely covered in the Western media, was renowned in Pakistan for her efforts to stop the spread of leprosy, a bacterial infection also called Hansen’s disease that when untreated can cause disfigurement and blindness. Around the world, its victims have often been relegated to “leper colonies” and regarded as outcasts.

The Express Tribune of Pakistan once credited Dr. Pfau with having “single-handedly . . . turned the tide of leprosy in Pakistan and won the gratitude and personal attentions of people ranging from military rulers to elected ministers to the general public.”

She has a couple great quotes:

But diverted to Pakistan while waiting for her visa in 1958, she was to stumble upon leprosy, a disease she had never heard of in a country she did not know existed.

“Well if it doesn’t hit you the first time, I don’t think it will ever hit you,” she recalled, after first seeing leprosy during a visit to a makeshift dispensary built on a disused graveyard in Karachi.

“Actually the first patient who really made me decide was a young Pathan.

“He must have been my age, I was at this time not yet 30, and he crawled on hands and feet into this dispensary, acting as if this was quite normal, as if someone has to crawl there through that slime and dirt on hands and feet, like a dog.”

and:

“Not all of us can prevent a war; but most of us can help ease sufferings — of the body and the soul.”

After helping Pakistan to become the first Asian country to have leprosy under control, she also:

She has also assisted the country’s many forgotten displaced people and rescued victims from the 2005 earthquake and floods of 2010.

Like Mother Teresa, she was a European nun working for decades among people with leprosy but she thought they weren’t all that similar:

She said her focus was on removing the root of the problem – not just dealing with its symptoms – the same ethos that has served her so well over the years in Pakistan when dealing with poor, displaced and marginalised people.

“The most important thing is that we give them their dignity back,” she insisted.

We need more people in the world like her.

Trump is trying to kill Obamacare

Donald Trump is trying to convince everybody that the ACA is in a death spiral. It isn’t according to the CBO:

Although premiums have been rising under current law, most subsidized enrollees purchasing health insurance coverage in the nongroup market are largely insulated from increases in premiums because their out-of-pocket payments for premiums are based on a percentage of their income; the government pays the difference between that percentage and the premiums for a reference plan. The subsidies to purchase coverage, combined with the effects of the individual mandate, which requires most individuals to obtain insurance or pay a penalty, are anticipated to cause sufficient demand for insurance by enough people, including people with low health care expenditures, for the market to be stable in most areas.

Nevertheless, some areas of the country have limited participation by insurers in the nongroup market under current law. Several factors could lead insurers to withdraw from the market—including lack of profitability and substantial uncertainty about enforcement of the individual mandate and about future payments of the cost-sharing subsidies to reduce out-of-pocket payments for people who enroll in nongroup coverage through the marketplaces established by the ACA.

Pay attention to that last bit because the Trump administration is trying very hard to kill the ACA:

As the fate of the Affordable Care Act dangled dramatically in the Senate last month, the Trump administration abruptly canceled contracts with two companies that have helped thousands of Americans in 18 cities find health plans under the law.

The suspension of the $22 million contracts, which ends enrollment fairs and insurance sign-ups in public libraries, is one of the few public signs of how an administration eager to kill the law will run the ACA’s approaching fifth enrollment season.

President Trump continues to stage photo ops at the White House and on travels with people he terms “Obamacare victims.” The Department of Health and Human Services is issuing weekly maps showing the few dozen counties that might lack an ACA health plan for next year.

Officials provided no assurances at that meeting, however, about whether the administration would continue the government’s other usual enrollment activities or promotion. (In January, it had halted most advertising aimed at encouraging consumers to sign up in the final crucial days before the deadline for 2017 coverage.)

For now, the largest mystery looming over the upcoming enrollment season is whether the president will carry out his stated resolve to end payments made to insurers on behalf of about 7 million lower-income customers to help them afford their ACA plans’ deductibles and copays.

There are other unknowns that also will shape — or upend — the enrollment period when it begins Nov. 1: Will the government contact the roughly 10 million people with ACA coverage to alert them that sign-ups will last just 45 days, about half as long as in the past three years? Will HHS run call centers for consumers who need help as they look for plans? Will the HealthCare.gov computer system be adjusted to accommodate a possible crush of shoppers given the shorter time frame?

And how will automatic enrollment be handled? In previous years, notices have been sent out in mid-December, informing customers with coverage about price changes for their current health plan and urging them to shop around. This year, Dec. 15 is when enrollment will end.

If the rates go way up ( or if insurance companies drop out of many more parts of the country) it will be largely because insurance companies won’t know how much the government will subsidize people and they don’t know if the mandate will be enforced; if the number of people who sign up for the ACA goes way down it will be for the same reasons and because the Trump administration won’t advertise and won’t help anyone if they want to sign up.

The only reason the ACA will fail is if the Trump administration kills it.

More about Medicaid cuts

The CBO has extended their estimate of what the Republican tax cut … errr healthcare plan will do to Medicaid:

In the Congressional Budget Office’s assessment, Medicaid spending under the Better Care Reconciliation Act of 2017 would be 26 percent lower in 2026 than it would be under the agency’s extended baseline, and the gap would widen to about 35 percent in 2036 (see Figure 1). under CBO’s extended baseline, overall Medicaid spending would grow 5.1 percent per year during the next two decades, in part because prices for medical services would increase. under this legislation, such spending would increase at a rate of 1.9 percent per year through 2026 and about 3.5 percent per year in the decade after that.

In CBO’s extended baseline, Medicaid spending is projected to be 2.0 percent of GDP in 2017 and 2.4 percent by 2036. The 35 percent reduction in that spending that CBO estimates for 2036 under this legislation would result in Medicaid spending of 1.6 percent of GDP.

That sure seems like a big cut.

Via here, Avalere Health looks at the impact for each state, for example my state of Massachusetts will see a decrease of 17% in funding for Medicaid by 2026 for a total cut of $9.7 billion. Thanks Republicans.

Senate version of Tax Cut bill cuts insurance for 22 million

So the CBO score for the Senate Republican’s tax-cut err healthcare bill is out and it’s about as bad as the House version:

CBO and JCT estimate that, in 2018, 15 million more people would be uninsured under this legislation than under current law—primarily because the penalty for not having insurance would be eliminated. The increase in the number of uninsured people relative to the number projected under current law would reach 19 million in 2020 and 22 million in 2026. In later years, other changes in the legislation—lower spending on Medicaid and substantially smaller average subsidies for coverage in the nongroup market—would also lead to increases in the number of people without health insurance. By 2026, among people under age 65, enrollment in Medicaid would fall by about 16 percent and an estimated 49 million people would be uninsured, compared with 28 million who would lack insurance that year under current law.

They also note that the ACA is not failing:

Although premiums have been rising under current law, most subsidized enrollees purchasing health insurance coverage in the nongroup market are largely insulated from increases in premiums because their out-of-pocket payments for premiums are based on a percentage of their income; the government pays the difference between that percentage and the premiums for a reference plan (which is the second-lowest-cost plan in their area providing specified benefits). The subsidies to purchase coverage, combined with the effects of the individual mandate, which requires most individuals to obtain insurance or pay a penalty, are anticipated to cause sufficient demand for insurance by enough people, including people with low health care expenditures, for the market to be stable in most areas.

Nevertheless, a small number of people live in areas of the country that have limited participation by insurers in the nongroup market under current law.

The rest of that second paragraph explains why there is a problem in small areas:

Several factors may lead insurers to withdraw from the market—including lack of profitability and substantial uncertainty about enforcement of the individual mandate and about future payments of the cost-sharing subsidies to reduce out-of-pocket payments for people who enroll in nongroup coverage through the marketplaces established by the ACA.’

Yup, they conclude it’s because of the actions of Donald Trump (who has told the IRS not to enforce the penalty for the individual mandate and has said he might cut the future payments for the cost-sharing subsidies) and Republicans in general.

So, the final analysis is we have to cut insurance for 22 million people so there can be large tax cuts for the rich, the ultra rich, and major corporations.

The GOP Tax Cut is here

The Senate GOP has finally released its plan for massive tax cuts for the rich, what they call their healthcare bill. Other places will look at all the details, so I’ll just look at the important bits:

The 400 highest-income taxpayers alone would receive tax cuts worth about $33 billion from 2019 through 2028, which is more than the federal spending cuts from ending the Medicaid expansion in any one of 20 expansion states and the District of Columbia.  In fact, the tax cuts for the top 400 roughly equal the federal cost of maintaining the expansion in Nevada, West Virginia, Arkansas, and Alaska combined.  (See Figure 1.)  Policymakers face a stark choice: maintain the Medicaid expansion coverage for 726,000 people in these four states, or advance the pending legislation and cut taxes by millions of dollars a year for 400 households whose annual incomes average more than $300 million apiece.

I left that last bit in just for laughs–the choice for Republicans is clear: tax cuts for the ultra rich.

Households with incomes above $1 million a year would get annual tax cuts averaging more than $50,000 apiece

Meanwhile, the House-passed bill would spend about $700 billion from 2019 through 2028 on tax cuts mainly for high-income people and wealthy corporations from repealing the ACA taxes that fall on them, we estimate based on Joint Committee on Taxation data.

Now if you cut taxes by $700 billion you’re going to have to cut benefits by about the same amount. Since Republicans are back in power they no longer care about the deficit but Reconciliation rules (this bill is going through the Senate using this) means it can’t increase the deficit by much.

So, remember that this is what Republicans are for: cutting benefits to millions of who are poor or middle-class to pay for massive tax cuts for the rich and especially the ultra-rich.

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