Saturday, February 18, 2017

Jazz Break: Brand X, Masques

EUGENICS WATCH: Right To Die Fight Hits National Stage

Kaiser Health News

Opponents of aid-in-dying laws are claiming a small victory. They won the attention of Congress this week in their battle to stop a growing movement that allows terminally ill patients to get doctors’ prescriptions to end their lives.

The Republican-led effort on Capitol Hill to overturn the District of Columbia’s aid-in-dying law appeared to have died Friday. But advocates worry the campaign will catalyze a broader effort to fully ban the practice, which is legal in six states and being considered in 22 more.

“The D.C. legislation has catapulted the issue of medical aid in dying onto the federal agenda at a time when Congress has the power to enact a ban on this end-of-life care option nationwide — even criminalizing the practice in the six states where this option is currently authorized,” warned Jessica Grennan, national director of political affairs and advocacy for Compassion & Choices, which supports right-to-die laws.

“If that happens, it will set the end-of-life care movement back to the last century,” Grennan said.

Despite the apparent defeat this week, both sides agree that the debate on Capitol Hill, featuring a Republican moral protest, could be only a taste of what’s to come.
In a vote that hewed closely to party lines, the Republican-controlled House Oversight Committee on Monday approved a bill that would knock down D.C.’s law, which won approval from the mayor and City Council in December. While D.C.’s law mirrors those passed in other states, Congress has unique power to intervene in D.C.’s affairs. Under the Home Rule Act of 1973, Congress has 30 legislative days to overturn any law D.C. passes.

“It’s of deep, personal moral conviction that I stand in opposition” to D.C.’s law, said Rep. Jason Chaffetz of Utah, who chairs the committee, in Monday’s hearing.

Chaffetz appears to have lost round one. Republicans in the House and Senate introduced joint resolutions attempting to block D.C.’s law, but the bills needed to pass the full House and Senate and gain President Donald Trump’s signature by Friday. Trump has declined to take a public stance on the matter.

Because Congress didn’t complete those steps this week, D.C.’s law successfully passes the congressional review period, Rep. Eleanor Holmes Norton, D.C.’s non-voting representative, announced in a press release Friday.

But “our defense of the Death with Dignity Act is only beginning,” Norton said.

That’s because Chaffetz has threatened to launch a second attack on the bill this spring, when Congress approves D.C.’s budget. The Death With Dignity Act calls for spending $125,000 in local money to build a database tracking the assisted-dying program. The law is set to take effect Oct. 1, at the beginning of the fiscal year, but only after the money is approved, according to D.C. mayoral spokeswoman Susana Castillo.

Dr. David Stevens, CEO of the Christian Medical & Dental Associations, which opposes medical aid in dying, said the Republicans’ effort to overturn D.C.’s law may still have broader impact.

“As representatives and senators become more educated about the dangers of physician-assisted suicide,” Stevens said, “I wouldn’t be surprised” if members of Congress introduce laws to “prohibit or at least more closely regulate” the practice.

If Congress passes such a law, the only hope for advocates such as Grennan “would be for the Supreme Court to intervene,” she said. But she noted that Trump’s pick for the Supreme Court, Neil Gorsuch, a federal appellate judge on the U.S. Court of Appeals for the 10th Circuit, has published a book against aid-in-dying efforts. The book, she said, notes “the Supreme Court’s power to overturn the state medical aid-in-dying laws.”

Away from Capitol Hill, the aid-in-dying movement has gained steam: The practice is legal in Oregon, Washington, Vermont, Colorado, California and Montana.

Energized by victories in California and Colorado last year, aid-in-dying supporters are pushing ahead to battlegrounds nationwide. So far this year, 21 states have introduced aid-in-dying legislation, according to Compassion & Choices. And in South Dakota, proponents are trying to get the practice approved through a ballot initiative.

Hawaii, Maryland and Maine appear the most likely to pass new legislation this year, said Peg Sandeen, executive director of the Death With Dignity National Center, another national advocacy group.

But opponents have beaten back similar measures in many states in recent years. And in Alabama, South Dakota and New York, they have gone on the offensive, introducing bills to preemptively outlaw the practice or prohibit insurance from paying for the lethal drugs.

Chaffetz, who is leading the charge against D.C.’s law, has enraged Democrats and D.C. officials, who accuse him of overreaching his power by meddling in local affairs. But Chaffetz and fellow House Republicans at Monday’s vote said moral concerns trump local autonomy.

“Only God gets to decide” when a person’s life ends, declared Rep. Paul Mitchell, a Michigan Republican, during the debate.

Republican Sen. James Lankford of Oklahoma, who introduced the Senate resolution blocking the bill, also made a legal argument, citing a 1997 law passed under President Clinton that bans the use of federal money for physician-assisted death. Because of that law, Medicare and the Department of Veterans Affairs do not pay for the lethal drugs, so patients must pay out-of-pocket or use private or state-funded insurance. Lankford challenged D.C. to show that its assisted-dying program wouldn’t conflict with that law.

Advocates dismissed that argument. Sandeen, of the Death With Dignity National Center, said D.C.’s program will not use any federal money to help people die. She called the legal argument a “red herring effort,” aimed at distracting attention from politicians’ true reasons for trying to strike down D.C.’s law.

“I’d rather that they said, ‘For religious purposes, I disapprove of this law,'” she said.

This story has been updated to reflect the end of Congress’s review period.

KHN’s coverage of end-of-life and serious illness issues is supported by The Gordon and Betty Moore Foundation.

Thank You Ms Baily and KHN.

EUGENICS WATCH: House Votes To Roll Back Obama's Ban On States Defunding Planned Parenthood

Kaiser Health Network

Democrats are calling the move a "backdoor attempt to restrict access" to abortion. 

The Wall Street Journal: House Votes To Let States Strip Money From Planned Parenthood
House Republicans took the first step Thursday to strip federal funding from Planned Parenthood and other abortion providers, starting what will become a broader battle over funding for the women’s health-services agency. The House voted 230-188 to rescind a regulation that bans states from denying certain funds to health-care providers that perform abortions, in essence freeing states to refuse to give the funds to Planned Parenthood Federation of America Inc. and similar organizations. (Andrews and Hackman, 2/16) 

CQ Roll Call: House Passes Resolution On Family Planning Funds
Congress appropriated about $286 million in fiscal 2016 for what’s known as Title X funding, which is supposed to be spent on family planning and reproductive health. The Obama administration finalized its rule in December after 13 states passed laws to redistribute the funding away from reproductive health providers, such as Planned Parenthood, and spend it at more general community health centers. (Siddons, 2/16) 

The Hill: House Votes To Let States Deny Federal Funds To Abortion Providers
Democrats argued the GOP's effort was aimed at defunding Planned Parenthood, even though the organization is legally prohibited from using federal funds for abortions. "It's no surprise that, once again, congressional Republicans are trying to undermine access to healthcare and basic family services," Rep. Barbara Lee (D-Calif.) said on the floor Thursday. Rep. Carolyn Maloney (D-N.Y.) called the resolution a "backdoor attempt to restrict access" to abortion. (Hellmann, 2/16) 

Politico Pro: House Backs Bill Overturning Protections For Planned Parenthood
House Republicans argued that the measure upholds states' rights and is not an attack on Planned Parenthood. “We are not voting to defund Planned Parenthood or reduced funding for Title X programs,” sponsor Rep. Diane Black (R-Tenn.) said on the floor ahead of the vote. “We are voting to affirm the rights of states to fund health care providers that best suit their needs.” (Ehley, 2/16) 

KCUR: In The Face Of More Missouri Abortion Restrictions, One Woman Tells Her Story
Anti-abortion groups in Missouri helped boost many Republican candidates to victory in November, and they’re now eagerly waiting to see how those lawmakers advance their cause. Missouri legislators have filed dozens of restrictive abortion bills, including two that would outlaw abortions after the 20th week of pregnancy rather than the current 21-weeks and six days. Supporters say late-term abortion bans protect the unborn, but opponents say they create undue hardships for women. One such opponent is a Missouri woman who had to leave the state to end her fraught pregnancy. (Smith, 2/16) 

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription

Thank You KHN. 

EPA Approved GMO Reliance On Toxic Chemicals Spawned A Profusion of Super Weeds

by Vera Sharav | Monday, February 6, 2017 

GMO reliance on toxic chemicals spawned a profusion of Super Weeds

How much herbicide is safe for human consumption? How much is safe for young children?

How much will Americans wind up consuming? Since the 1990s, when a National Research Council (NRC) panel warned lawmakers that exposing fetuses and young kids to these compounds can cause lifelong damage at doses that wouldn’t hurt their parent, federal law has required the EPA to protect children from pesticides — chemicals that kill weeds, insects or other harmful organisms.

EPA spiked the amount of 2,4-D deemed it “safe” for children by an increase of 41 times 
Under the Obama administration, the EPA radically lowered its safety standards for pesticide/herbicide exposure. In 2005, under the Bush administration, the EPA set the acceptable “safe” daily intake of 2,4-D at 0.005 mg/kg.  Under EPA’s new safety standards U.S. children ages 1 to 12 could consume 2,4-D (Agent Orange) “safely” at levels 41 times higher.

That amount of 2,4-D is deemed unsafe by the World Health Organization, Russia, Australia, South Korea, Canada, Brazil and China. For decades the EPA had considered that exposure level dangerous. Agent Orange is the defoliant used in Vietnam which has been linked to Parkinson’s disease, hypothyroidism and other health problems.
Over the years, federal and university researchers showed 2,4-D was worrisome on its own. Studies found increased odds of developing non-Hodgkin lymphoma, hypothyroidism and Parkinson’s disease among people who used the chemical as part of their jobs… the WHO’s cancer research agency ruled that 2,4-D is a possible carcinogen.”
Even some scientists who have spent their professional lives eradicating weeds oppose the new genetically modified crops and the chemical future they foreshadow. “Those herbicide increases are not OK,” said David Mortensen, a professor of weed and applied plant ecology at Pennsylvania State University. “To me, that is unconscionable that we can be OK with that, and I’m not an anti-chemical radical.”
“But the Obama administration’s EPA now says it is safe to allow 41 times more 2,4-D into the American diet than before he took office. To reach that conclusion, the Tribune found, the agency’s scientists changed their analysis of a pivotal rat study by Dow, tossing aside signs of kidney trouble that Dow researchers said were caused by 2,4-D.” (Chicago Tribune)
GE produce depends on high volume use of herbicides

The essential element in the production of genetically engineered crops is poison in the form of pesticides and herbicides. Initially Monsanto promised that GE crops that have been bred to tolerate glyphosate, widely known as Roundup, will reduce the use of herbicides. Glyphosate has served as the linchpin of Monsanto’s GMO business: Roundup is used as a weed killer in 80% of 120 million acres of GMO crops globally. Roundup Ready seeds are infused with glyphosate which is absorbed into the plant’s cellular structure – its DNA – in order to kill weeds and unwanted plants. The chemical cannot be removed from GMO crops and other plants by washing, peeling, baking or brewing grains.

Pigweed, glyphosate-resistant “super weed” a farmer’s nightmare
The weed killer, Roundup has spawned the proliferation of super weeds.

Inasmuch as Mother Nature does not take kindly to efforts aimed at suppressing natural evolution, the intensive use of glyphosate in biotech agriculture has resulted in the proliferation of “super weeds” which are also resistant to Roundup spraying; they grow 8 feet tall with stems as thick as baseball bats. Super Weeds have become farmers’ nightmare as a vicious cycle has taken root in biotech agriculture. Farmers are encouraged to use increased quantities of ever more toxic chemical combinations on food crops.

In the US, where approximately 90 percent or more of all cotton, soy, and corn plantings are of glyphosate-tolerant GMO varieties, the acres of farmland harboring glyphosate-resistant weeds nearly doubled between 2010 and 2012, from 32.6 million acres to 61.2 million acres.” (Modern Farmer, 2016)
Monsanto’s Roundup Ready crops created an environmental disaster by causing infestation of tens of millions of acres of farmland with herbicide-resistant weeds and spurring an enormous increase in pesticide use.” (Attorney Paul Achifoff, Sustainable Pulse, 2017)
EPA approved increasingly toxic chemical weapons for use in GMO food crops

During Obama’s presidency the EPA approved two especially controversial herbicides are: Monsanto’s XtendMax, a repackaged old chemical, Dicamba; and Enlist Duo, Dow Chemical’s combination of glyphosate and 2,4-D; the primary component of Agent Orange (which also contained the lethal chemical dioxin; and became infamous  during the Vietnam War). In 2015, the International Agency for Research on Cancer (IARC) an independent panel of the World Health Organization classified each of these poisonous chemicals – glyphosate and 2,4-D –as “probably” and “possibly” carcinogenic in humans. (Read AHRP post: Scientific review of pesticide cancer risk ignites war against scientists)

“The EPA quietly approved Monsanto’s XtendiMax on November 11, 2016, when all news outlets were focused on the presidential election outcome.
One of the major disadvantages of dicamba compared to glyphosate is that it is much more “volatile,” meaning it easily becomes airborne and drifts away from where it is applied. Historically, dicamba has been used in agriculture primarily as a pre-emergent (applied to the soil to kill weed seeds prior to planting a crop), since it could not be applied directly to crop plants.”(Modern Farmer, 2016)
 The volatility of dicamba drifts between farmers’ fields has caused massive damage to crops not targeted by the poison – soybeans, tomatoes, cantaloupes, watermelons, rice, peas, peanuts, cotton, alfalfa even peaches. Dicamba drifts have led to shootings that left one farmer dead. (EPA Challenged in Court over Approval of Monsanto’s New Toxic Pesticide, Sustainable Pulse, Jan 23 2017)
Monsanto invested $1 billion in producing its new dicamba formula, and expects 15 million acres to be planted with dicamba-resistant seeds in 2017 and 55 million acres by 2019. Monsanto distributed its dicamba-resistant seeds before it marketed the supposedly “less volatile” spray. The long-term consequences are unclear, though it is more than likely that many weeds will develop resistance to dicamba as it is sprayed on a wider scale. Indeed, a recent University of Arkansas study (2016) found that the dreaded pigweed weed, when sprayed with low doses of dicamba became resistant to the full legal dose after just three generations.
The research [ ] was conducted in the greenhouse [ ] resulted in a dicamba-resistant pigweed [it] illustrates how multiple resistances have developed. One pesticide quits working and so we replace it with another, and so on and so on, until you are left with a weed population or insects for that matter that can tolerant multiple modes of action. This is the inevitable result of using a single effective mode of action to control a given pest…the finding strongly suggests that there will be sizeable evolutionary consequences.” (Arkansas Agriculture study)

Center for Biological Diversity Scientists: Science is Real. Extinction is Forever

“We can’t spray our way out of this problem. We need to get off the pesticide treadmill. Pesticide resistant superweeds are a serious threat to our farmers, and piling on more pesticides will just result in superweeds resistant to more pesticides. We can’t fight evolution—it’s a losing strategy.” Nathan Donley, senior scientist with the Center for Biological Diversity (EcoWatch, Jan 2017)
In Jaunary 2017, Farmers and conservation groups filed a federal lawsuit on Friday challenging the Environmental Protection Agency’s approval of Monsanto’s new “XtendiMax” pesticide. They objected to the approval as it ushers a massive increase in use of the toxic pesticide. The suit charges that it will increase risks to farmers, community health, and the environment. Because these same crops are also engineered to withstand applications of Monsanto’s Roundup, the overuse of that glyphosate-based pesticide  will continue at current high levels. (Read: Sustainable Pulse, Jan. 23, 2017)

In 2014 and 2016, EPA approved registration of Dow Chemical’s herbicide Enlist Duo, composed of a combination of glyphosate and 2,4-D (Agent Orange).
an herbicide product containing 2,4-D and glyphosate, was first registered in 2014 for use on genetically engineered (GE) corn and soybean crops in 6 states, and later in an additional 9 states. At this time [2016], EPA is amending the registration to allow use on GE cotton in those 15 states and extend the use of Enlist Duo on GE corn, soybean and cotton to an additional 19 states.” (EPA Registration of Enlist Duo)
So how did the EPA make the determination that it was safe to increase U.S. children’s exposure to 2,4-D at levels 41 times higher than previously considered safe?

Chicago Tribune investigation uncovered evidence documenting EPA scientific misconduct

The investigation by Patricia Callahan uncovered documented evidence of corrupted science by EPA scientists who “paved the way” for the agency to reduce safety standards – in particular standards to protect children from ingesting harmful levels of poison.

Dow’s own scientists’ findings in a 2005 animal feeding study were altered by EPA scientists. Dow’s scientist reported that ingestion of 2,4-D at a high dose showed that rats fed 2,4-D experienced thyroid hormone changes, reproductive effects in male rats, and kidney lesions. The kidney problems occurred even at lower doses. The Tribune reports that in a poster presentation in 2010, Dow scientists acknowledged that “exposure-related kidney lesions occurred at a lower dose in male rat offspring than in their parents.”

EPA scientists who reviewed the data, at first agreed with Dow’s interpretation; but then EPA scientists embraced “an alternative interpretation of the data.” They discarded (“tossed aside”) evidence of adverse biological data documented by Dow scientists. They subsequently described in their report, that the kidney damage was “not treatment related.”  They did so, even though kidney damage at low doses had been confirmed by at least five studies submitted to the EPA in the 1980s.

Furthermore, EPA scientists also violated standard scientific practice by altering the way safe toxicity levels in humans is extrapolated from the animal toxic levels to determine the dose at which “there was no statistically or biologically significant indication of a toxic effect.” It is the most important measure in a pesticide toxicity study, called NOEL (“no observed adverse effect level“)  EPA dropped the mandatory calculation safeguarding children since the 1990s; and chose as their no-adverse-effect level a dose at which rats actually suffered toxic effects. EPA disregarded the toxic effects and determined that the “safe” level for 2,4-D could be spiked from a NOEL dose of 0.005 mg/kg to a dose of 0.007 mg/kg. The actions taken by the EPA researchers were to facilitate EPA approval of Dow Chemical’s herbicide Enlist Duo, a combination of glyphosate and 2,4-D.

Dr. Philip Landrigan, the pediatrician who chaired the NRC panel is so alarmed by the potential increase in children’s exposure to 2,4-D that he is calling for the federal National Toxicology Program to assess the safety of the mix of weedkillers that would be used on new genetically modified crops. His year long entreaties to EPA Administrator Gina McCarthy to reject the “notoriously toxic herbicide” fell on deaf ears. [Dr. Landrigan’s research showing the damaging effects of lead in children, resulted in its removal from paint and gasoline.]

petition to the 9th Circuit Court of Appeals was filed by a coalition of environmental protection advocacy groups, including Environmental Working Group and Natural Resources Defense Council (Oct. 2015) In the course of the litigation, a document Dow had submitted to the U.S. Patent Office revealed that
“Dow made contradictory claims to different parts of the U.S. government.” Dow had misinformed the EPA by claiming the combination herbicides in Enlist Duo was no more toxic than each separately. But in its patent application, Dow stated that the mixture of chemicals offers “synergistic herbicidal weed control.” (Busted: National Public Radio, Nov. 2015)
In light of the information subsequently submitted by Dow to the EPA about the synergistic effects, the EPA rescinded its approval of Enlist Duo (Nov 2015) acknowledging that:
“EPA is in receipt of new information regarding potential synergistic effects between the two ingredients on non-target plants, EPA seeks a voluntary remand in order to reconsider the Enlist Duo registration in light of the new information… specifically, Dow did not submit to EPA during the registration process the extensive information relating to potential synergism it cited (in applications) to the Patent Office; EPA only learned of the existence of that information after the registrations were issued and only recently obtained the information. EPA can no longer be confident that Enlist Duo will not cause risks of concern to non-target organisms, including those listed as endangered..” 
When the EPA approved Enlist Duo, officials ignored more than 400,000 comments on the Federal Register against the marketing of Enlist Duo, and ignored the objections by 35 members of Congress:
“We were concerned to learn that, during this process, EPA dismissed a key study linking 2,4-D to kidney abnormalities based on one scientist’s analysis, and in doing so, effectively gave the green light for 41 times more of the chemical to enter the America diet than was previously allowed.
 “Given the widely-known adverse impacts of 2,4-D on human health and the environment, and with little understood about the implications of combining 2,4-D and glyphosate, EPA should use the utmost caution in assessing the safety of Enlist Duo before approving it for continued use…. The public deserves to know how EPA intends to address all of these concerns.” (Chicago TribuneFebruary 2016)
In January 2016, the 9th U.S. Circuit Court of Appeals sided with Dow and rejected EPA’s request to vacate its 2014 approval of Enlist Duo.The three-sentence order did not elaborate on the judges’ reasoning.

Thank You Ms Sharav and AHRP.

Thursday, February 16, 2017

Trump Launches Full Attack on Opposition Party, . . . the "Mainstream Media"

We have Never enjoyed a Presidential presser even half as much as this one. Hysterical, and right on the nose.


Posted: Feb 16, 2017 10:50 AM

President Donald Trump continued his campaign against the mainstream media on Thursday,  attacking "FAKE NEWS" media and comparing major news outlets to the Democratic Party.

In two separate tweets, President Trump reminded Americans that Democrats and the mainstream media are trying to bring his movement and presidency to an end.

There is a seismic shift going on in the ways in which Americans obtain and comprehend the news.  Cable television and the archaic ways of distributing reality to the American people in a politically correct manner are slowly being delegitimized by Youtube and Twitter users who are beholden to no one.  

Yesterday, President Trump gave a reality check to the "opposition party" by only taking questions from conservative news sites like Townhall.  
CNN reacted with fury, claiming that the "fix is in."

Times are changing quickly.  Political correctness in the mainstream media has officially been exposed to the American people by President Trump and his loyal advisors.  
This is just the beginning.

It's so blatant that even Piers Morgan "gets it".

Congress Dragging Feet On ObamaCare Repeal and Replacement

Government Programs: Rule #1:

It is infinitely harder to get rid of a Government Program than it is to create it, which is why they shouldn't be created in the first place.


Some things never change.
Via CNN:
The days of swift and decisive Obamacare repeal are long gone.
Not a month into Donald Trump’s presidency, Republican leaders in Congress have run up against just about every speed bump imaginable in their quest to dismantle the Affordable Care Act.
Deep ideological divisions have burst into the open over how much of the health care law to roll back and how quickly, as well as the fate of Medicaid expansion and federal funding for Planned Parenthood — all as angry constituents who support Obamacare are hounding GOP lawmakers at town halls across the country.
Keep reading…
Thank You Zip and CNN.

Aetna CEO Bertolini: ObamaCare Individual Markets In A Death Spiral


By Paul Demko

02/15/17 09:54 AM EST

Updated 02/15/17 01:26 PM EST

Obamacare is in a “death spiral,” the influential CEO of Aetna, Mark Bertolini, declared Wednesday morning.

Bertolini’s doomsday prophesy: More insurers will pull out of the government-run marketplaces in the coming weeks and many areas will have no insurers to provide Affordable Care Act coverage in 2018.

“It’s not going to get any better; it’s getting worse,” Bertolini said in an interview at a Wall Street Journal event.

But he declined to say whether Aetna would completely pull out of Obamacare markets next year, though he said the population of covered people in the marketplaces has skewed older and sicker than expected.

Bertolini's broadside came just moments before the Trump administration released a proposed rule designed to make changes to Obamacare regulations that are designed to temporarily stabilize the law's insurance marketplaces as Republicans pull together a replacement plan. The proposal outlines several policies sought by health insurers that would shore up the market until Congress settles on an Obamacare repeal plan and possibly a replacement

Humana, which had already significantly limited its exchange footprint this year, announced Tuesday that it would completely pull out of the exchange markets next year after determining its customer base would still be unprofitable. That followed major pullbacks this year from other national insurers, including Aetna and UnitedHealth Group.

Caroline Pearson, a senior vice president with consulting firm Avalere Health, downplayed the significance of the moves by Aetna and Humana. She pointed out that Blue Cross Blue Shield plans are the dominant players in most markets and that their continued participation will be critical.

“They are no longer major participants in the market,” Pearson said of Aetna and Humana. “This is sort of a continuation of their previous strategy and not that surprising.”

The administration’s move to stabilize the marketplace drew praise from America’s Health Insurance Plans, the leading industry group.

“We support solutions that address key challenges in the individual market, promote affordability for consumers, and give states and the private sector additional flexibility to meet the needs of consumers,” said AHIP CEO Marilyn Tavenner in a statement. “We appreciate the Administration’s efforts in proposing policies intended to address stability, affordability, and choice, helping consumers get the coverage they need.”

But insurers believe more steps are needed before they can commit to competing in the Obamacare markets next year. The biggest question: What’s going to happen to the subsidies that more than eight in ten Obamacare customers rely on to afford coverage? The timeline is tight for clarity. Health plans will begin filing products for consideration by state regulators in April.

“Nonprofit community plans are in a real time crunch,” said Ceci Connolly, CEO of the Alliance of Community Health Plans. “They will be making very difficult decisions in March and they’re getting anxious about the uncertainty.”

Connolly said her members don’t agree with Bertolini’s belief that the markets are already in a death spiral.

“We’re concerned by any rhetoric that adds confusion to the existing uncertainty,” she said. “What we would like is to have a fact-based conversation about the future of the individual market.”

Pearson doesn’t think the proposed marketplace stabilization rule alone will fundamentally alter how health plans approach the markets for 2018.

“It’s not clear to me that that rule does enough to change health plan decision-making about whether to stay in the market,” Pearson said. “I don’t know that it’s going to keep insurers in if they were otherwise inclined to exit.”

Aetna’s $37 billion acquisition of Humana was blocked last month by a federal judge, in part because it would have limited competition in the Obamacare marketplaces. In particular, the judge ruled that Aetna had pulled out of 17 state exchange markets in order to avoid judicial scrutiny of the deal. The companies Tuesday mutually announced that they would walk away from the deal instead of fighting an uphill battle to overturn the ruling on appeal and preserve the deal.

During Wednesday’s talk, Bertolini embraced a couple of ideas that are part of many GOP blueprints for replacing Obamacare — though the GOP is for the moment stuck on which of those plans to embrace and whether to link repeal and replacement. Bertolini backed catastrophic-coverage plans linked to health savings accounts in order to entice more young, healthy customers into the marketplaces.

He also called for a pool of money to subsidize insurers who attract particularly sick, expensive customers. Obamacare included such a reinsurance fund, but it expired after three years. And Republicans in Congress blocked some other steps Obamacare had originally included to help insurers through the first uncertain years.

“The repeal is easy. They can do that tomorrow if they want to,” Bertolini said. “The question is what does the replacement look like and how long does it take to get there."

Thank You Mr Demko and Wash Ex.

Trump CMS Nominee Seema Verma Has Decried Agency Fostering Dependency

by Carla K. Johnson AP | Feb. 16, 2017 7:08 a.m. | Chicago

The businesswoman President Donald Trump selected to oversee Medicaid, the health care program for 74 million low-income Americans, has said the program is structurally flawed by policies that burden states and foster dependency among the poor.

Seema Verma heads Indianapolis-based SVC Inc., a consulting firm that works with GOP-led states seeking federal leeway in how they spend Medicaid dollars. Her proposed solutions can be seen most dramatically in Indiana, where Medicaid enrollees pay fees and a missed payment means a six-month lockout from the program. A still-pending proposal she developed for Kentucky includes work requirements for most adults.

Elsewhere, the poorest Medicaid recipients usually don’t pay monthly fees, although many states have experimented with fees for certain groups such as working adults with disabilities.

Democrats in Washington are concerned Verma’s methods may become a favored model as Republicans work to repeal the Affordable Care Act, making it harder for non-disabled adults to get access to health care. Underway for two years, the short track record of Indiana’s Medicaid expansion leaves questions about whether Verma’s ideas have helped poorer Americans or hurt them.

Medicare Pays For A Kidney Transplant, But Not The Drugs To Keep It Viable 

Indiana and Iowa, which also has a Verma-designed program with monthly fees, expanded coverage while saving taxpayers’ money, said Marcus Barlow, a spokesman for SVC. He extolled the results of Verma’s programs, pointing to data showing the two states spent less per capita on newly eligible Medicaid enrollees than the national average while keeping uninsured rates below average.

“We’re proud of the innovative solutions based specifically on each state’s needs,” Barlow said.

Verma, who faces a Senate Finance Committee hearing Thursday, has been highly critical of Medicaid.

“At Medicaid’s core is a flawed structure,” Verma said in 2013 testimony to a congressional subcommittee. States must endure a “cumbersome” and “capricious” procedure to get approval for innovative ideas, she said, and “rigid, complex rules” have created “an intractable program that does not foster efficiency, quality or personal responsibility.”

Federal Medicaid policies limiting copays and premiums, Verma said, “disempower individuals from taking responsibility for their health, allow utilization of services without regard for the public cost and foster dependency.”

In Indiana, Verma worked with then-Gov. Mike Pence, now Trump’s vice president, to win federal permission to expand Medicaid, gaining federal dollars under President Barack Obama’s Affordable Care Act while making the program look more like commercial insurance. Financial carrots and sticks are meant to discourage low-income families from overspending on health care.

The Future Of Medicaid May Be Found In Indiana, Where The Poor Pay 

“The only way Gov. Pence was going to pass coverage expansion was through this means,” said Doug Leonard, president of the Indiana Hospital Association. Hospital fees and a cigarette tax pay the state’s portion of the expansion.

The program, known as the Healthy Indiana Plan 2.0, requires people to pay $1 to $100 a month, depending on income, for beefed-up coverage that includes dental and vision care.

A missed payment means losing coverage and a six-month lockout before reapplying. More than 2,600 individuals were locked out in this way during the program’s first year.

Carol Irvin of Mathematica Policy Research, who led Indiana’s evaluation of the program’s first incarnation from 2009 through 2014, said its financial incentives are misunderstood by those who are supposed to be motivated by them.

“They didn’t necessarily understand the connection and, we would argue, they didn’t understand the incentives,” Irvin said. A separate evaluation of HIP 2.0’s first year showed similar findings.

Blacks and Hispanics are underrepresented, and it has been difficult for evaluators to survey non-enrollees to find out why some people haven’t signed up, Irvin said.

Many Indiana residents were able to get coverage because of the expansion, although not as many as the state had hoped. Seventy-three percent of the 559,000 projected to be eligible actually enrolled in HIP 2.0 for at least a month during its first year.

People below the poverty line don’t lose their coverage entirely if they miss a payment, but instead are bounced down to a “HIP Basic” plan that requires copays and doesn’t include dental or vision.

That’s what happened to 54-year-old fast food cook Michael Boone of Gary, Indiana. He missed a few $12-a-month payments and was moved from “HIP Plus” — under which he’d been able to see a dentist for “the first time in my adult life” — to the basic plan. Still, he said he appreciates the coverage and will be back on the “HIP Plus” plan soon.

“It’s been a godsend,” said Boone, who says he can afford $12 a month. “I never had health care before.”

Thank You Ms Johnson and OPB.