Trump Just Did A Big Favor For Employers, Including His Own Family Business

HUFFINGTON POST

The president’s conservative nominees for the National Labor Relations Board could reverse a progressive era at the agency.

YURI GRIPAS / REUTERS

 

WASHINGTON ― When it comes to the power balance between workers and employers, President Donald Trump just tipped the scales in favor of guys like himself.

Over the past week, Trump chose a management attorney and a former GOP staffer to fill vacancies on the National Labor Relations Board. Their nominations could help reshape labor policy in favor of corporations, potentially reversing Obama-era decisions and further weakening the U.S. labor movement.

If confirmed as expected, Trump’s picks ― William Emanuel, who was named Tuesday, and Marvin Kaplan, who was named last week ― will occupy two seats on a five-member board that serves as referee between businesses and labor groups. The NLRB’s decisions help determine how easy or difficult it is for workers to unionize ― which, in turn, affects unions’ footprint in the U.S. economy, and how much bargaining power rank-and-file workers have with their employers.

That includes Trump’s own family hotel business, which has come before the NLRB several times over labor disputes.

After years of rulings friendly to unions in the Obama era, the labor board put in place by Trump will be far more likely to side with employers in contentious, policy-setting cases. With its new Republican majority, the board may undo notable decisions in recent years that helped more workers secure collective bargaining rights in the workplace.

Industry lobbies like the National Restaurant Association applauded Trump’s nominations, as did the anti-union Workforce Fairness Institute.

The NLRB is an independent federal agency, meaning its members are nominated by the president, but don’t answer to him. The five members serve staggered terms, traditionally with three members hailing from the president’s party. What is currently a 2-to-1 Democratic majority held over from the Obama years would become a 3-to-2 Republican majority if Trump’s nominees are confirmed.

Emanuel is a lawyer at the management-side firm Littler Mendelson. Kaplan served as a lawyer for Republicans on the House Committee on Education and the Workforce; he’s currently a commissioner at the Occupational Safety and Health Review Commission.

The confirmation of Trump’s picks will not be difficult, thanks to the “nuclear” rules change made by Democrats during a previous fight over the labor board. When the Republican minority stonewalled Obama’s NLRB picks and prevented the board from functioning, Democrats reformed the rules in 2013 so that nominees only require 51 votes to pass the Senate. Republicans now hold 52 seats.

The NLRB found itself at the center of political fights on Capitol Hill during the Obama years, with Republicans accusing it of “killing” jobs and catering to unions. Trump would have nominated Emanuel and Kaplan with heavy input from business lobbies and GOP lawmakers, seeking to change course from the board’s progressive direction.

If Emanuel and Kaplan are installed, the board could gradually flip some of the Obama-era rulings that helped workers organize in the workplace. Union membership is hovering near an all-time low in the U.S. ― just 6.4 percent of private-sector workers belong to unions now ― but labor groups hoped the board’s liberal rulings could help.

One such ruling, Specialty Healthcare, allowed workers to unionize in small groups, which employers claim put them at a disadvantage in union campaigns. Another case, Browning-Ferris, broadened the definition of who can be considered a “joint employer,”potentially dragging franchisors like McDonald’s into labor disputes involving their franchisees. Yet another, involving Columbia University, paved the way for graduate students at private universities to unionize.

Republicans in Washington held congressional hearings to blast rulings like those. But once Emanuel and Kaplan are confirmed ― probably after the Senate’s summer recess ― the pendulum is bound to swing back toward employers.

Posted in Labor, NLRB, Uncategorized | Tagged , | Leave a comment

Analysis: Mitch McConnell Plans To Hide Trumpcare’s Pain Until After Midterms

KAISER HEALTH NEWS — REPEAL & REPLACE WATCH

June 27, 2017

Senate Majority Leader Mitch McConnell (R-KY) speaks following a closed-door Senate GOP conference meeting on Capitol Hill on June 27, 2017. Senate Republicans announced they will delay a vote on their health care bill until after the July 4 recess. (Drew Angerer/Getty Images)

Senate Majority Leader Mitch McConnell is well aware of the political peril of taking health benefits away from millions of voters. He also knows the danger of reneging on the pledge that helped make him the majority leader: to repeal Obamacare.

Caught between those competing realities, McConnell’s bill offers a solution: go ahead and repeal Obamacare, but hide the pain for as long as possible. Some of the messaging on the bill seems nonsensical (see: the contention that $772 billion squeezed out of Medicaid isn’t a cut). But McConnell’s timetable makes perfect sense — if you are looking at the electoral calendar.

Here are a few key dates in McConnell’s “Better Care Reconciliation Act” (BCRA) that seem aimed more at providing cover for lawmakers than coverage for Americans:

2019: First major changes and cuts to the Affordable Care Act exchanges happen after the 2018 midterm cycle, allowing congressional Republicans to campaign on a “fixed” health system, even though Obamacare is still largely in place next year.

2019: States share $2 billion in grants to apply for waivers under a much looser process through this fiscal year. These waivers could allow insurers to sell skimpy plans that have low price tags but don’t take adequate care of people with preexisting conditions. None of those waivers has to go into effect, however, until after 26 Republican governors face re-election in 2018.

2020: Stabilization cash that makes the markets more predictable and fair for insurers flows through the congressional midterm cycle and the 2020 presidential cycle. Then it disappears. Medicaid expansion funds hold steady through this crucial political window, too.

2024: States enjoy their last few sips of Medicaid expansion cash at the end of 2023 — just as, perhaps, a second Republican presidential term is ending.

2025: The bill changes the formula for the entire Medicaid budget (not just the Obamacare expansion), dramatically reducing federal funding over time. That starts eight years and two presidential election cycles from now.

McConnell insists everything about the bill has been aboveboard and transparent.

“Nobody’s hiding the ball here. You’re free to ask anybody anything,” McConnell said on June 13.

But he and his working group did literally hide the bill from Democrats and most Republicans, crafting it behind closed doors until there was just a week left before his goal to secure a vote on it. (That timing was thrown off Tuesday with the announcement the vote was delayed, but the dealmaking is just beginning.)

Meanwhile, at least two policy details in the bill may obscure the effects for several years and make the health insurance markets look better almost immediately by giving insurers a more predictable, more lucrative market.

One is a stipulation that compels the federal government, for two years, to pay the cost-sharing reduction payments to insurance companies that President Donald Trump has threatened to end. The payments are part of the Affordable Care Act, and they flow to insurers on behalf of low-income marketplace customers to cover their out-of-pocket health expenses. Republicans had sued to stop the payments, adding considerable instability to ACA marketplaces next year. McConnell ends that uncertainty for two years.

On top of that cash infusion, the BCRA proposes a “Short-Term Stabilization Fund” that would also aim to help lower premium costs and could attract a few more insurers into counties that are sparsely covered now. It would dish out $50 billion to insurers — $15 billion per year in 2018 and 2019 and $10 billion per year in 2020 and 2021.

The money would make up for the billions that the Republican-led Congress has refused to appropriate for insurance companies under the ACA’s risk corridors program. Risk corridors aimed to offset losses for insurers whose costs were more than 103 percent of expected targets. Congress has so far paid only 12.6 cents on the dollar of those obligations and faces lawsuits from insurers that were stiffed.

In short, the two pots of money would go a long way toward addressing the instability in Obamacare created by the Republican-led Congress, but only through the next presidential cycle in 2020.

Beyond timing, the legislation’s features allow senators to make truthful arguments that disguise negative effects.

Perhaps the key claim is that the Senate bill would increase access to insurance. It might, in that insurance companies in states that waive standards would be free to offer much cheaper plans. But those plans would be cheaper because they wouldn’t cover essential health benefits or adequately cover preexisting conditions. Lower-income Americans might be able to buy a plan — possibly a $6,000 deductible for someone who makes less than $12,000 a year.

A spokesman for McConnell did not answer a request for comment. But Democrats are keenly aware of the electoral machinations in the bill.

“Everything about this legislation, from the process to the effective dates of many of the provisions, is driven by political expediency,” said Brian Fallon, a Democratic consultant and former lead spokesman for Hillary Clinton’s campaign. “Mitch McConnell only cares about getting the ‘win,’ not about the substance of the bill.”

Senate Democratic aides who spoke on background were not sure that the steps the bill takes to shore up markets for the next two elections would work when insurance companies can see what lies ahead. But they agreed the timing and short-term fixes might help McConnell twist the arms of reluctant Republican senators.

“I think it will be enormously helpful to McConnell in a room with a moderate Republican who wants to be told, ‘Hey, a lot of this stuff that’s going to happen in this bill that you’re hearing about, that’s worrisome is past your re-elect, it’s past 2018, it’s past 2020,’” one senior aide said. “‘Just vote for it, it’ll be fine, we’ll figure the rest out later.’”

Democrats said McConnell’s hide-the-ball strategy will not work with voters, and they want Republican senators to know that before they vote.

“The polling already shows that, based on the fact that they control every aspect of government, Trump and the Republicans own everything that happens from now on in the health care system,” Fallon said.

Sen. Patty Murray (D-Wash.), the top Democrat on the Health, Education, Labor and Pensions Committee who has the task of leading the arguments against the GOP bill, thinks senators will imperil their political futures if they buy McConnell’s arguments.

“Sen. McConnell is doing everything he can to persuade Senate Republicans that Trumpcare won’t be devastating for the people they serve, but the facts are that Trumpcare is going to cause families to pay more, gut Medicaid, and take coverage away from millions of people,” Murray said. “Any Senate Republican who votes for Trumpcare and believes patients and families won’t hold them accountable is being sold a bill of goods.”

Still, McConnell knows how to work a legislative calendar. Expect a July full of closed-door dealmaking with reluctant senators, leading up to maximum leverage before the August recess.

Kaiser Health News, a nonprofit health newsroom whose stories appear in news outlets nationwide, is an editorially independent part of the Kaiser Family Foundation.

Posted in Better Care Reconciliation Act, Health Care, Medicaid, Trump, trumpcare | Tagged , , , | 1 Comment

A Cruel Joke — 13 men are in charge of healthcare for all American women.

POSTED IN THE GUARDIAN

Lucia Graves

Wednesday 28 June 2017  

 

Regressive gender politics are resurgent in 2017, as demonstrated by a Republican bill that would be devastating to women’s health

John Barrasso, Mitch McConnell, and John Cornyn: three of the men behind the Senate healthcare bill.
John Barrasso, Mitch McConnell, and John Cornyn: three of the men behind the Senate healthcare bill. Photograph: J Scott Applewhite/AP

A decade or two ago, the notion that 13 men would be plotting the fate of American women’s healthcare behind closed doors, that they would delight in defunding the women’s health organization Planned Parenthood and impeding healthcare access for millions of American women, would have felt like the politics of a bygone era.

Midway through 2017, it feels more like deja vu.

As Republicans prepare for their delayed vote on their updated measure to repeal and replace the Affordable Care Act, women’s groups and senators have vocally hit out against male dominance of the healthcare debate – exemplified by the GOP’s 13-man working group that crafted the Senate bill.

The Democratic senator Kamala Harris told the Guardian the bill “is terrible for women”, while her New York colleague Kirsten Gillibrand has described it as “a cruel joke” and a “blatantly partisan attack on women’s health”.

But for many, it’s more than the substance of the bill that rankles. Specifically, it feels like a return to a kind of regressive gender politics they hoped had passed in America: a politics in which men make the decisions about what happens to women’s bodies.

“It’s outrageous that the future of healthcare for millions of women lies in the hands of 13 men,” Cecile Richards, president of Planned Parenthood, said. “It’s clear they don’t care about our opinion or our lives – because if they had asked us what we thought, we’d all be in a very different position right now.”

The Senate healthcare bill would increase the number of uninsured people in the US by 22 million, according to the non-partisan Congressional Budget Office, and is opposed by the American Medical Association on the grounds that it violates the Hippocratic oath.

It would also be particularly devastating to women’s health, in a number of ways. Patty Murray, the top Democrat on the Senate’s health committee, called it “nothing less than an attack on women’s health and rights”.

Harris said: “It blocks millions of women on Medicaid from getting care at Planned Parenthood. It allows states to stop requiring insurance companies to cover essential health benefits – like maternity care and birth control. Women in this country will not be silenced on this issue. We will only get louder.”

Under the Republican bill, women could pay as much as $1,000 more per month for maternity care, Murray told reporters in a conference call on Friday, and millions would lose access to even the most basic preventive care services at Planned Parenthood.

As Dana Singiser of Planned Parenthood put it on the call: “If we listed all the cruel things this bill would do we’d be here all day.”

Often the men who tout defunding Planned Parenthood seem to have no idea what the organization actually does.

Donald Trump signs the global ‘gag rule’, surrounded by men.
Donald Trump signs the global ‘gag rule’, surrounded by men. Photograph: Ron Sachs / Pool/EPA

“Frankly, I am sick of coming down to the Senate floor to explain to Republicans what Planned Parenthood does,” Elizabeth Warren said in a recent statement posted to her Facebook page. “I am sick of explaining that it provides millions of women with birth control, cancer screenings, and STI tests every year. I am sick of pointing out again and again that federal dollars do not fund abortion services at Planned Parenthood or anywhere else.”

Because of the Hyde amendment, federal funding does not actually go toward abortion services, but to the other basic healthcare services Warren outlined, including life-saving cancer screenings and treatments.

It isn’t the first time in recent years she has had to explain to the men in charge of women’s healthcare how the largest US provider of reproductive healthcare operates. When the GOP mounted another effort to defund Planned Parenthood back in August 2015, she made a similar speech.

“Do you have any idea what year it is?” Warren asked at the time. “Did you fall down, hit your head, and think you woke up in the 1950s or the 1890s? Should we call for a doctor? Because I simply cannot believe that in the year 2015, the United States Senate would be spending its time trying to defund women’s healthcare centers.”

Perhaps she shouldn’t have been that surprised. For years, Republicans have worked to strip away women’s rights to make choices about their own bodies and more often than not, the efforts have been led by men. When Donald Trump signed the global “gag rule”, pulling US funding from any global organizations that so much as mention the word “abortion”, he did it flanked exclusively by white men in suits. A photo of President George W Bush signing a ban on a rare abortion procedure reveals yet another group of grinning, self-congratulatory men.

As Jill Filipovic, writing in the New York Times, has noted, in a way, men controlling women’s bodies is an election promise delivered. “At some point, we have to ask: Is this really a pattern of errors?” she writes. “Maybe these aren’t tone-deaf mistakes at all, but intentional messages to rightwing supporters.”

Warren seems to agree, at least with the notion that the bill is all about political messaging.

“Women come to the floor, we explain, we cite facts. But Republicans would rather base healthcare policy on politics than on facts,” she said recently, after the House speaker, Paul Ryan, called the bill “pro-life”. “Calling something pro-life won’t keep women from dying in back alley abortions; it won’t help women pay for the cancer screenings that could save their lives; it won’t help them take care of their families, have safe sex or afford their medical bills.”

Murray was even more sweeping in her assessment. “The moment we’re in right now is truly a pivotal one for women and women’s rights,” she told reporters Friday, adding that for every woman and everyone who cares about their access to healthcare, now is the time to fight back.

“Those 13 men cutting backroom deals about your healthcare access clearly didn’t want to hear from you, so make sure they do now,” she said.

Posted in AHCA, American Health Care Act, Birth Control, Family Issues, Family Planning, Health Care, Medicaid, Planned Parenthood, Pre-existing Conditions, Trump, trumpcare | Leave a comment

Let A Senator Know How You Feel About the BCRA

For those interested in pressuring senators to oppose the BCRA, here is a list of “No” and “Undecideds” compiled by Huffington Post.  A link to contact information appears at the bottom of the post.

Here’s a look at where McConnell’s conference stands on the legislation.

The Hill will be updating this list as Republican senators offer statements of support or opposition. Please send updates to mmali@thehill.com.

 

No (6)

Sen. Susan Collins (Maine) — The Maine centrist says she will not back a procedural motion on the bill after seeing the CBO score. “I cannot support a bill that’s going to make such deep cuts in Medicaid that it’s going to shift billions of dollars of costs to our state governments,” she said Sunday on ABC’s “This Week,” a day before the score came out.

Sen. Ted Cruz (Texas) — In a statement Thursday, the conservative former presidential candidate said he opposed the bill. Cruz said the bill did not do enough to lower health costs. He has floated an amendment that would let insurers sell plans that are not compliant with ObamaCare requirements.

Sen. Dean Heller (Nev.) — Heller said Friday he opposed the bill, raising concerns about the phaseout of the Medicaid expansion. “It’s going to be very difficult to get me to a yes,” he said. Heller is viewed as the most vulnerable GOP senator up for reelection next year, so his vote will be closely watched. Heller has indicated he would vote against taking up the bill in a procedural vote without changes.

Sen. Ron Johnson (Wis.) — Johnson on Thursday joined three of his colleagues in opposing the bill. He has expressed worries the bill doesn’t do enough to lower premium costs. On NBC’s “Meet The Press” Sunday, Johnson said “we should not be voting on this next week.” “I don’t have the feedback from constituencies who will not have had enough time to review the Senate bill.” He has also criticized GOP leaders for rushing the legislation and says he may not back a procedural motion unless the bill is changed.

Sen. Mike Lee (Utah) — The conservative joined Paul, Johnson and Cruz in a statement opposing the bill on Thursday. In a Friday blog post on Medium, he noted that conservatives have compromised on “every substantive question in the bill.” But added he hadn’t “closed the door” on voting for some version of it and would support it “if it allowed states and/or individuals to opt-out of the Obamacare system free-and-clear to experiment with different forms of insurance, benefits packages, and care provision options.”

Sen. Rand Paul (Ky.) — Paul is McConnell’s home-state fellow senator, but he may be a hard get. He also says he’ll oppose the procedural motion. “The current bill does not repeal Obamacare. It does not keep our promises to the American people. I will oppose it coming to the floor in its current form, but I remain open to negotiations,” Paul said in a statement Thursday.

Undecided/Unclear (20)

Sen. Bill Cassidy (La.) — Cassidy won headlines when he talked about how the bill needed to pass a “Jimmy Kimmel test” on whether it would prevent children with pre-existing conditions from getting coverage. Cassidy told CBS’s “Face the Nation” Sunday he needed more time to consider the bill. “Right now, I am undecided. There are things in this bill that adversely affect my state, that are peculiar to my state, but if those can be addressed, I will. If they can’t, I won’t,” Cassidy said about his vote.

Sen. Shelley Moore Capito (W.Va.) — Capito has been involved in talks about the phaseout of ObamaCare’s federal funding expanding Medicaid. She’s also worried about how Medicaid cuts could effect the opioid epidemic. Like other senators, she said she would be reviewing the draft. She did not mention any concerns, but said she wanted to access to affordable healthcare for those on Medicaid and those struggling with drug addiction.Sen. Bob Corker (Tenn.) — Asked if he would support the bill, Corker told reporters it would “irresponsible” for lawmakers to take a position already, adding that “this draft we’re looking at is not necessarily the draft that’s going to be entered into the record” and could undergo “significant amendments.”

Sen. Steve Daines (Mont.) — “I look forward to hearing directly from Montanans on this legislation,” Daines said in a statement Thursday.

Sen. Joni Ernst (Iowa) — Ernst, who has not yet taken a position on Senate Republicans’ ObamaCare repeal and replace plan, is polling her constituents to gauge their feelings on the bill.

Sen. Jeff Flake (Ariz.) — Flake, who is up for reelection in 2018, tweeted “just got my copy of the #healthcare bill and I’m going to take time to thoroughly read and review it.”

Sen. Cory Gardner (Colo.) — Gardner on Thursday said he was “carefully reviewing” the bill and called for more time. “If we can have opportunities to make the bill better, then by all means let’s take every chance and (all the) time we can,” he said, according to the Denver Post.

Sen. John Hoeven (N.D.)  — Hoeven said in a statement that he “will review this legislation to determine whether it meets this standard and we also want to see a CBO score on the bill.”

Sen. Johnny Isakson (Ga.) — Isakson said in a statement that “I am fully and thoroughly reviewing the draft of the Republican health care plan that was released today. The stark reality remains that if we do nothing, Obamacare will fail, and Americans will suffer.”

Sen. James Lankford (Okla.) — Lankford told CNN that he has found six areas where he has “problems and suggestions,” adding “none of them are showstoppers … but there are problems we need to fix before we get this into law.”

Sen. John McCain (Ariz.) — “I think it’s a good proposal overall. I’m going to have to look at it,” McCain told reporters Thursday.

Sen. Jerry Moran (Kan.) — Moran said in a statement that he is “awaiting the Congressional Budget Office score to gain a complete understanding of the impacts and consequences this bill would have on hardworking Kansans.”

Sen. Lisa Murkowski (Alaska) — Along with Collins, Murkowski has suggested she might not back a bill that defunds Planned Parenthood. The Senate bill would block funding for a year.

Sen. David Perdue (Ga.) — “I’m looking at this thing. I’m not ready to say yes or no on it because I want to read this in detail,” he said.

Sen. Rob Portman (Ohio) — “There are some promising changes to reduce premiums in the individual insurance market, but I continue to have real concerns about the Medicaid policies in this bill, especially those that impact drug treatment at a time when Ohio is facing an opioid epidemic,” he said in a statement Thursday. The opioid crisis is a huge problem in Ohio, and Portman has worked with Capito to seek support through the GOP bill on this issue.

Sen. Marco Rubio (Fla.) — Rubio’s office said in a statement that “Senator Rubio will decide how to vote on health care on the basis of how it impacts Florida. He has already spoken to Governor Scott, Senate President Negron and Speaker Corcoran about the first draft of this proposal.”

Sen. Ben Sasse (Neb.) — On Sunday at a Koch summit, Sasse said he is not committed to the GOP’s ObamaCare repeal bill. Sasse told conservative donors the bill was “largely a Medicaid reform package,” according to Vox. “This is not a full repeal or full replace piece of legislation, and that’s dictated by a whole bunch of circumstances. So we are having a conversation about something that’s much smaller than that.”

Sen. Dan Sullivan (Alaska) — In a statement Thursday, Sullivan said he “will read every word” of the bill, looking closely at stabilizing the state’s insurance market, cutting costs and “providing a sustainable and equitable path forward for Medicaid.”

Sen. Thom Tillis (N.C.) — Tillis said the Senate’s bill needs to be a “net improvement” over ObamaCare and “I look forward to carefully reviewing the draft legislation over the next several days.”

Sen. Todd Young (Ind.) — Young on Friday told a group in his home state of Indiana that he is in the undecided column, though he also repeated an earlier statement that “doing nothing is not an option.”

Contact information:  http://www.dailykos.com/stories/2017/6/12/1671161/-Republican-senators-say-their-phones-aren-t-ringing-to-save-the-ACA-so-here-s-the-contact-list?detail=emaildkre

Posted in AHCA, American Health Care Act, Better Care Reconciliation Act, Health Care, Trump, trumpcare | Leave a comment

I Would Short Tourism to the USA

I can personally confirm the unpopularity of DT and the USA in Switzerland where I am currently!

Apparently the sentiment is wide spread: http://www.reuters.com/article/us-usa-trump-image-survey-idUSKBN19I00F?utm_source=applenews

Image of the United States has plunged under Trump, survey shows

By Noah Barkin | BERLIN

 

The image of the United States has deteriorated sharply across the globe under President Donald Trump and an overwhelming majority of people in other countries have no confidence in his ability to lead, a survey from the Pew Research Center showed.

Five months into Trump’s presidency, the survey spanning 37 nations showed U.S. favorability ratings in the rest of the world slumping to 49 percent from 64 percent at the end of Barack Obama’s eight years in the White House.

But the falls were far steeper in some of America’s closest allies, including U.S. neighbors Mexico and Canada, and European partners like Germany and Spain.

Trump took office in January pledging to put “America First”. Since then he has pressed ahead with plans to build a wall along the U.S. border with Mexico, announced he will pull out of the Paris climate accord, and accused countries including Canada, Germany and China of unfair trade practices.

On his first foreign trip as president in early June, Trump received warm welcomes in Saudi Arabia and Israel, but a cool reception from European partners, with whom he clashed over NATO spending, climate and trade.

Just 30 percent of Mexicans now say they have a favorable view of the United States, down from 66 percent at the end of the Obama era. In Canada and Germany, favorability ratings slid by 22 points, to 43 percent and 35 percent, respectively

In many European countries, the ratings were comparable to those seen at the end of the presidency of George W. Bush, whose 2003 invasion of Iraq was deeply unpopular.

“The drop in favorability ratings for the United States is widespread,” the Pew report said. “The share of the public with a positive view of the U.S. has plummeted in a diverse set of countries from Latin America, North America, Europe, Asia and Africa”.

BELOW PUTIN AND XI

The survey, based on the responses of 40,447 people and conducted between Feb. 16 and May 8 this year, showed even deeper mistrust of Trump himself, with only 22 percent of those surveyed saying they had confidence he would do the right thing in world affairs, compared to 64 percent who trusted Obama.

Image of the United States plummets under Trump

The image of the United States in the world has been seriously damaged by President Donald Trump and an overwhelming majority of people in other countries have no confidence in his ability to manage world affairs, a Pew Research Center survey showed.

Screen Shot 2017-06-27 at 7.08.55 PM.png

The countries with the lowest confidence in Trump were Mexico, at 5 percent and Spain at 7 percent. The only two countries where ratings improved compared to Obama were Russia, where confidence in the U.S. president surged to 53 percent from 11 percent, and Israel, where it rose 7 points to 56 percent.

Globally, 75 percent of respondents described Trump as “arrogant”, 65 percent as “intolerant” and 62 percent as “dangerous”. A majority of 55 percent also described him as a “strong leader”.

The survey showed widespread disapproval of Trump’s signature policy proposals, with 76 percent unhappy with his plan to build the wall on the border with Mexico, 72 percent against his withdrawal from major trade agreements and 62 percent opposed to his plans to restrict travel to the U.S. from some majority-Muslim countries.

On the positive side, the survey showed that 58 percent of respondents had a positive view of Americans in general. And in many regions of the world, a majority or plurality of respondents said they expected relations with the United States to stay roughly the same in spite of Trump.

 

Posted in Uncategorized, foreign policy, Trump | Tagged , , , | Leave a comment

The Senate Health Reform Bill Slashes Medicaid Severely

Posted by AARP

The Better Care Reconciliation Act (BCRA) now under consideration in the Senate would drastically alter the Medicaid program. The proposed Senate bill would change the way the federal government currently funds Medicaid by limiting federal funding and shifting cost over time to both states and Medicaid enrollees. BCRA would subject older adults, adults with disabilities, expansion adults, and non-disabled children under age 19 to mandatory per enrollee caps beginning in 2020. State Medicaid programs would have the option to choose between block grants and per enrollee caps for non-elderly non-disabled non-expansion adults.

The Senate bill would start out using the medical care component of the Consumer Price Index (M-CPI)—a measure of the average out-of-pocket cost of medical care services used by an average consumer—as the growth rate for per enrollee caps.  However, beginning in 2025, it would slash the growth rate to the Consumer Price Index for all urban consumers (CPI-U)—a measure of general inflation that examines out-of-pocket household spending on goods and services used for everyday living. CPI-U does not tie closely to medical costs and will not reflect population growth or the impact of aging. To be clear, none of the proposed growth factors—M-CPI, M-CPI+1, and CPI-U— keep pace with the growth in Medicaid spending.

Although studies have examined the impact of Medicaid spending cuts in the House-passed healthcare bill over a 10 year period (e.g. [CBO] [CMS] [Urban Institute]) we know of none that examine the impacts over a longer time horizon. To fill this gap, the AARP Public Policy Institute has developed a model that looks out an additional decade to capture impacts on Medicaid spending between 2027 and 2036.

By dramatically reducing the per capita cap growth factor beginning in 2025, we project that the Senate bill would cut between $2.0 and $3.8 trillion from total (federal and state) Medicaid spending over the 20-year period between 2017 and 2036 for the four non-expansion Medicaid enrollment groups: older adults, adults with disabilities, children, and non-expansion adults (children with disabilities are excluded because BCRA does not subject them to capped funding). A cut of this magnitude threatens the viability of the program in unprecedented ways and will increase the number of people who no longer have access to essential healthcare services and critical supports.  The projections do not include the proposed cuts to the adult expansion population, which would also be considerable.

Previous analysis by the AARP Public Policy Institute discusses why capping Medicaid is flawed and would leave states and the poorest and sickest Americans holding the bag for the shortfalls that will most certainly occur.

Table 1 shows the cumulative 20-year cuts to Medicaid by eligibility group under the Senate health reform bill for three growth rate projections.  The bill would cap per enrollee cost growth using two measures of inflation (M-CPI and CPI-U), which are highly variable and uncertain, though well short of what is needed to maintain the integrity of the Medicaid program.  It is difficult to plan for such uncertain growth rates, and reasonable projections are far apart.

We present the high, middle, and low case for M-CPI/CPI-U growth rates based on the following:

  • Low Case. Based on historical growth rates. Over the last five years (2012-2016), the M-CPI growth rate has averaged 3.0% per year, and the CPI-U growth rate has averaged 1.32% per year.
  • Middle Case. Based on projections from the Congressional Budget Office. CBO projects M-CPI to grow by 3.7% per year, and CPI-U by 2.4% per year.
  • High Case. Based on projections from 2016 CMS Medicaid Actuarial Report.  From 2019 onward, this report projects M-CPI to grow by 4.2% per year, and CPI-U by 2.6% per year.

 

In short, the lower the cap growth rate, the more severe the Medicaid cuts will be.

The charts below demonstrate that for any projection of the bill’s cap growth rates, BCRA will lead to significant funding shortfalls for older adults, adults with disabilities, and non-disabled low-income children and adults. The end result is that states and beneficiaries will be left with severe funding shortages, and states will be forced to cut eligibility, provider rates, or covered services—or very likely all three.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Susan Reinhard is a senior vice president at AARP, directing its Public Policy Institute, the focal point for AARP’s public policy research and analysis. She also serves as the chief strategist for the Center to Champion Nursing in America, a resource center to ensure the nation has the nurses it needs.

 

 

 

 

Jean Accius is vice president of livable communities and long-term services and supports for the AARP Public Policy Institute. He works on Medicaid and long-term care issues.

 

 

 

Lynda Flowers is a Senior Strategic Policy Adviser with the AARP Public Policy Institute, specializing in Medicaid issues, health disparities and public health.

 

 

 

Ari Houser is a Senior Methods Adviser at AARP Public Policy Institute. His work focuses on demographics, disability, family caregiving, and long-term services and supports (LTSS).

 

 

 

Posted in AHCA, American Health Care Act, Better Care Reconciliation Act, Health Care, Medicaid, Trump, trumpcare | Tagged , , , | 1 Comment

Are you 64 and making $56,800 a year? Welcome to a $20,500 Trumpcare insurance premium

Posted on Daily Kos
SAN FRANCISCO, CA - JUNE 21:  Healthcare activists hold headstones as they stage a die-in while protesting the Trumpcare bill on June 21, 2017 in San Francisco, California. Dozens of healthcare activists and senior citizens staged a protest outside the San Francisco Federal Building to express their opposition of the American Heathcare Act bill that is being drafted behind closed doors by Republican senators.  (Photo by Justin Sullivan/Getty Images)

Popular vote loser Donald Trump freely admits he called the House version of Trumpcare “mean, mean, mean” and also claimed that he wanted a Senate bill that is “generous, kind, with heart.”  That’s not what he got with the Senate version of Trumpcare, the “Better Care Act.”  In fact, the Congressional Budget Office says it’s just as mean by the numbers, if not more so.

According to their estimates, 15 million people will lose their insurance next year, 2018. An election year.  By 2026, 22 million people who are now insured will have lost that insurance.  Compared to the Affordable Care Act, “an estimated 49 million people would be uninsured, compared with 28 million who would lack insurance that year under current law.”  The biggest hit, as in the House bill, lands on Medicaid.

The largest savings would come from reductions in outlays for Medicaid—spending on the program would decline in 2026 by 26 percent in comparison with what CBO projects under current law—and from changes to the Affordable Care Act’s (ACA’s) subsidies for nongroup health insurance.  Those savings would be partially offset by the effects of other changes to the ACA’s provisions dealing with insurance coverage: additional spending designed to reduce premiums and a reduction in revenues from repealing penalties on employers who do not offer insurance and on people who do not purchase insurance. […]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.

Keep in mind that “later years” part.  This estimate doesn’t go beyond 2026; however the CBO doesn’t think that the so-called “flexibility” for Medicaid that block granting would be for states is all that.  Instead, it would be a burden.  “With less federal reimbursement for Medicaid, states would need to decide whether to commit more of their own resources to finance the program at current-law levels or to reduce spending by cutting payments to health care providers and health plans, eliminating optional services, restricting eligibility for enrollment through work requirements and other changes, or (to the extent feasible) arriving at more efficient methods for delivering services.”  It also projects that post-2026, Medicaid enrollments would continue to fall.

People with individual plans will see “substantial increases in out-of-pocket spending, even though benchmark premiums would decline, on average, in 2020 and later years.” That’s because insurance would pay for a smaller share of benefits. That’s going to be true for “close to half the population, CBO and JCT expect—living in states modifying the EHBs [essential health benefits] using waivers.  People who used services or benefits no longer included in the EHBs would experience substantial increases in supplemental premiums or out-of-pocket spending on health care, or would choose to forgo the services.”

In some areas of the country—particularly sparsely populated ones (are you listening Lisa Murkowski)—the CBO foresees a market collapse, the classic death spiral.  “Some sparsely populated areas might have no nongroup insurance offered because the reductions in subsidies would lead fewer people to decide to purchase insurance—and markets with few purchasers are less profitable for insurers.”

Yes, this bill is mean, mean, mean. But hey, it’s got lots of tax cuts for the very rich, so expect most Republicans to overlook the other parts.

Posted in AHCA, American Health Care Act, Better Care Reconciliation Act, Health Care, Medicaid, Trump, trumpcare | Tagged , , , , , | 2 Comments