WASHINGTON — A federal appeals court on Friday left in place a decision blocking Blue Cross-Blue Shield insurer Anthem’s bid to buy rival Cigna, saying that a bigger company is not better for consumers. The 2-1 decision upholds a federal judge’s ruling in February that said the proposed $48 billion acquisition would further reduce competition in the already concentrated health insurance market. Industry experts suggested any consumer impact from the deal would take years to materialize and could lead to savings in some areas but higher costs elsewhere. Writing for the majority, Judge Judith Rogers said the lower court was correct to halt the acquisition “based on Anthem’s failure to show the kind of extraordinary efficiencies necessary to offset the conceded anticompetitive effect” of the deal. Reported by SFGate 28 minutes ago.

Merriam-Webster defines the word “bailout” as “a rescue from financial distress.” The concept is pretty simple: Someone does something that results in a bad outcome, and someone else helps them out of the jam. The word itself refers to bailing water out of a leaky boat, so the metaphor fits.

In the midst of the financial crisis that happened in the last decade, President George W. Bush and Congress bailed out the giant banks that caused the problem, concluding that this distasteful action was better than the alternative, which could have been a worldwide collapse of the financial system and a depression that would’ve made the Great Recession look like a boom time. President Barack Obama bailed out the auto industry. And President George H.W. Bush bailed out failing savings and loan institutions back in the 1980s.

People don’t like these government bailouts. They really, really don’t like them. The idea that a business made decisions so bad that the only way to prevent a catastrophe is for taxpayers to fix it doesn’t sit right with Americans.

That’s why “bailout” is a go-to insult politicians like to use to to describe things they don’t like. This pejorative has been especially popular with Republicans in recent years. Take President Donald Trump, seen here using the term to describe a part of the Affordable Care Act. 


Democrats are trying to bail out insurance companies from disastrous #ObamaCare, and Puerto Rico with your tax dollars. Sad!

— Donald J. Trump (@realDonaldTrump) April 26, 2017


The Democrats want to shut government if we don't bail out Puerto Rico and give billions to their insurance companies for OCare failure. NO!

— Donald J. Trump (@realDonaldTrump) April 27, 2017


Democrats jeopardizing the safety of our troops to bail out their donors from insurance companies. It is time to put #AmericaFirst

— Donald J. Trump (@realDonaldTrump) April 27, 2017

Trump and members of his administration, along with a few GOP lawmakers, recently have started talking like this. It’s nonsense.

So what’s Trump referring to here? It’s a once-obscure, difficult-to-explain element of the Affordable Care Act called cost-sharing reductions. Right now, it’s about the most fraught subject in health policy.

Trump is threatening to cut off the money that makes cost-sharing reductions work, which would deal instant damage to the Affordable Care Act’s health insurance system and the people who rely on it. This threat might sound familiar to anyone who has followed Trump’s lengthy history of not paying his business partners.

Remember Merriam-Webster: A bailout is an action taken after something bad has occurred to help the party that did the bad thing, or at least is suffering from that bad thing. What a bailout isn’t is when someone pays a bill for services rendered, or when the federal government carries out a program as written. (This isn’t the first time Republicans have called an existing part of the regular structure of Obamacare a “bailout.” It wasn’t true before, either.)

As most people know, the Affordable Care Act offers tax credits to low- and middle-income households that reduce the monthly premiums for health insurance policies purchased via the law’s exchange marketplaces. But the lowest-income enrollees are eligible for a second kind of financial assistance ― those cost-sharing reductions, sometimes called CSRs.

Here’s how they work: A person goes to the exchange and shops for coverage. If their income is low enough — up to 2.5 times the federal poverty level, which is $30,015 a year — their plans will come with lower deductibles and copayments. It’s a huge benefit for these enrollees who can, for example, take a deductible in the thousands of dollars and shrink it to just hundreds. More than 7 million people ― 58 percent of Obamacare enrollees ― received these subsidies this year.

Health insurance companies are required by the law to reduce these out-of-pocket costs and to pay the difference to the hospitals, doctors and other medical providers who treat their customers. Then the federal government pays the insurers back.

That last part is what Trump controls. No matter what he does, the insurers must lower these costs for their policyholders. But if Trump refuses to pay the companies back, some states would allow them to cancel their customers’ policies and leave the market altogether this year. And the companies that do continue to sell insurance through the exchanges would dramatically hike premiums next year to make up for the lost money. The White House went so far as saying they’d halt the payments next month, but backed down Wednesday.

Paying this money is not a “bailout.” These health insurance companies didn’t screw up and come to Uncle Sam with their hands out. They entered into contracts with the government to sell certain kinds of health insurance under a certain set of rules, and one of those rules is they’d get the money they’re owed.

Acting in bad faith with a business partner is part of Trump’s modus operandi, but it doesn’t really fly when it’s the federal government doing the reneging. That’s a big reason why a slew of health care and business groups are urging Trump and Congress to stop messing around and pay the money.Here’s a partial list of the organizations making this plea: the American Medical Association; the American Hospital Association; the Federation of American Hospitals; America’s Health Insurance Plans; the Blue Cross and Blue Shield Association; the American Benefits Council (a group of large businesses); and the U.S. Chamber of Commerce.

The nation’s governors are worried, too. The National Governors Association — which represents all 50 governors from both political parties — asked Congress to fix this. It’s not often that every single governor agrees about something, and this is one of those times.

The power to blow up the health insurance market is in Trump’s hands because of a lawsuit House Republicans filed against the Obama administration in 2014. Lawmakers argued that Obama was making these cost-sharing reduction payments to insurers in violation of the law, because Congress authorized them, but didn’t approve the specific spending.

A federal court ruled in favor of House Republicans last year, but allowed the Obama administration to continue making the payments while the case worked its way through appeals. When Trump became president, his administration became the defendant in the case, and along with House Republicans, asked the appeals court to delay proceedings on the lawsuit while the two parties figure out what to do.

In the meantime, the money keeps flowing to the insurance companies — but no one knows for how long, because Trump keeps saying he might cut them off. The result, as Molina Healthcare CEO Mario Molina explained to HuffPost this week, would be millions more uninsured, fewer choices for consumers because some insurers would refuse to sell plans under these circumstances, and much higher premiums for the insurance that remained.

Put all that together, and it’s the American people who are going to need a bailout.

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-- This feed and its contents are the property of The Huffington Post, and use is subject to our terms. It may be used for personal consumption, but may not be distributed on a website. Reported by Huffington Post 4 minutes ago.

As a family-medicine physician, I agree that the Affordable Care Act has been a success in Washington and in other states across the country where I travel to provide care. I’ve had the opportunity to closely watch health-insurance policies evolve, beginning in 2008 when I was regularly assisting at low- and no-cost health-care clinics where […] Reported by Seattle Times 1 day ago.

There’s a new argument circulating on Capitol Hill, as conservative House Republicans try to win over more moderate colleagues who oppose the GOP’s bill to repeal Obamacare.

It goes like this: Thanks to an amendment to the American Health Care Act introduced this past week, states would ultimately have discretion over whether to keep two of the Affordable Care Act’s most popular and important provisions: a prohibition on charging higher premiums to people based on health status and a requirement that all plans cover an “essential” set of benefits.

Conservatives argue that these provisions make insurance premiums more expensive. Moderates worry that without these requirements, people with pre-existing conditions would lose access to comprehensive coverage.

Under the amendment, the two requirements would technically remain in place, but states could seek permission from the federal government to waive them.

The measure was formally introduced by Rep. Tom MacArthur (R-N.J.), who negotiated the terms with Rep. Mark Meadows (R-N.C.), head of the ultra-conservative House Freedom Caucus.

“If a governor of New Jersey wants to keep Obamacare just like it is, with the very few exceptions that were in the base bill, they can do that,” said Meadows on MSNBC’s “Morning Joe” on Friday. “But a governor of another state, whether it be Texas or Nebraska or Florida, can waive out some of those things that drive up premiums. It’s the best of both worlds.”

In other words, states that like Obamacare would get to keep its best parts.

But could they really?

What’s Not Clear: Whether States Would Seek Waivers

In the old days, before Obamacare, only a small handful of states had laws prohibiting insurers from charging higher premiums to people with pre-existing medical problems. None mandated that all plans cover a set of essential benefits.

A big reason for that was a recognition that these requirements don’t work well on their own. They need generous subsidies (so lower-income people can afford coverage with reasonable benefits) and financial penalties for declining coverage (so people won’t wait until they get sick before they buy insurance). In states that introduced the requirements on their own (without the subsidies and penalties), premiums skyrocketed ― leading states like Kentucky to abandon the reforms and others like New York to end up with deeply dysfunctional insurance markets.

That experience loomed large in the minds of the Affordable Care Act’s architects. It’s why the law introduced both an individual mandate to obtain insurance and a set of subsidies that offer the most help to people who would otherwise struggle the most with insurance costs. The GOP replacement would eliminate the mandate, while shifting financial assistance away from people with low incomes or high insurance costs. And it would do that in all states, not just the ones seeking waivers.

The cumulative effect of all these changes is far from clear-cut. Chris Jacobs, a former Heritage Foundation analyst who is now CEO of Juniper Research Group, is among those experts who doubt that many states would even try for waivers from the pre-existing conditions and essential benefits requirements. But other analysts believe states would find it difficult to resist the pressure from insurers, who would fear a replay of what happened in Kentucky and New York.

If “you dramatically scale back subsidies and have no individual mandate to avoid adverse selection and keep premiums down,” said Edwin Park, vice president for health policy at the Center on Budget and Policy Priorities, then states would be under “immediate pressures to roll back more and more” of those protections.

What’s Clear: Millions Would Lose Coverage

More important, even states that didn’t seek waivers would be subject to the rest of the American Health Care Act’s changes ― which would be every bit as severe as they were a month ago, when support for the bill crumbled following a Congressional Budget Office estimate of its likely effects on health insurance.

It’s gotten a bit lost in the last few weeks, with all the focus on pre-existing conditions, but the most consequential part of the GOP bill is arguably the way it yanks financial aid away from people who can’t get health insurance simply because they can’t afford it on their own.

This includes the proposed change in the formula for calculating tax credits, which currently offer much more assistance to people with lower incomes, higher insurance costs or both. It also includes a massive cut to Medicaid that, according to the CBO, would reduce federal spending by $839 billion over 10 years ― and drive up the number of people without coverage by 14 million.

These cuts would devastate not just poor people who, without Medicaid, have no way to pay their medical bills. They would also devastate hospitals, which depend on those Medicaid dollars to finance care for the poor.

Consider how this would play out in a state like New York, where the number of uninsured residents fell by 259,000 because of Obamacare’s Medicaid expansion, according to the Center on Budget and Policy Priorities. New Yorkers might think their state officials could protect them from the worst effects of the GOP bill. But they couldn’t. The state would lose the federal support it gets for expanded Medicaid, forcing it either to come up with a lot of extra money or (more likely) to cut the program, so that many more people would end up uninsured.

Meanwhile, New Yorkers buying coverage on their own would face total annual costs ― that is, premiums plus out-of-pocket costs ― that were $2,708 higher on average, according to a report from the Center on American Progress. That’s because of the way the GOP bill’s changes to insurance regulations and financial assistance would interact with each other: There would be savings for some people, particularly the young and the healthy, but big new costs for others.

Earlier this week, when Rep. Chris Collins (R-N.Y.) appeared on CNN to defend his support of the GOP bill, he said, “Some aspects of this are troublesome to a few of our members ― not me, because this would not impact New York in the least.”

It wasn’t clear whether Collins was speaking specifically about the new amendment or the bill as a whole. But the idea that people in districts like his could avoid serious pain from the American Health Care Act is fanciful ― as he and his fellow Republicans will discover if it becomes law.

-- This feed and its contents are the property of The Huffington Post, and use is subject to our terms. It may be used for personal consumption, but may not be distributed on a website. Reported by Huffington Post 23 hours ago.

Washington D.C., Apr 29, 2017 / 05:27 am (CNA/EWTN News).- Catholic leaders have found cause for both praise and concern after the first 100 days of Donald Trump’s presidency.

“Catholics have reason for optimism. But like the first 100 days, the road ahead remains difficult,” Brian Burch, president of CatholicVote.org, said on the organization’s scorecard for the first 100 days of the Trump presidency.

*Abortion*

Pro-life leaders have found a lot to like from the Trump administration so far.

“President Donald Trump and Vice President Mike Pence have been game changers for the pro-life movement,” Susan B. Anthony List president Marjorie Dannenfelser stated. “Not only have there been several pro-life victories within the first 100 days of their administration, we are confident that pro-life progress will continue. This is a new era.”

A week after Trump was inaugurated, Vice President Mike Pence addressed the 44th annual March for Life on the National Mall, the first time a sitting vice president has done so. Senior advisor Kellyanne Conway also addressed the pro-life rally.

“Life is winning in America,” Pence insisted to cheering attendees, as he exhorted them to “let this movement be known for love, not anger” and “let it be known for compassion, not confrontation.”

On Jan. 23, Trump reinstated the Mexico City Policy which bans U.S. funding of international non-government organizations that promote or perform abortions.

This is traditionally one of the first policy decisions a new president makes and serves as a signal of the administration’s policy on abortion. President Reagan first introduced the policy in 1984. It was repealed by President Clinton when he took office, reinstated by President Bush in 2001, and repealed again by President Obama in 2009.

In April, the Trump administration pulled its funding of the UNFPA over its involvement in China’s infamous two-child policy, formerly a one-child policy, which has resulted in mass forced sterilizations and abortions. Funding was redirected to USAID for family planning purposes.

Cardinal Timothy Dolan, chair of the U.S. bishops’ pro-life committee, called the funding withdrawal a “victory for women and children across the globe.”

Shortly afterward, the administration signed a joint resolution passed by Congress that nullified an Obama administration rule that pro-life leaders had called a “parting gift to Planned Parenthood.”

That rule forbade states from withholding federal Title X funds to health providers simply because they performed abortions. Now with the rule nullified, states can once again block Planned Parenthood and other abortion groups from Title X funding. Cardinal Dolan also approved of that rule change, calling it a reversal of “very bad public policy.”

In addition to signing bills into law, “personnel is policy,” Jeanne Mancini, president of the March for Life, insisted to reporters on a Thursday conference call on Trump’s first 100 days.

She pointed to the picks of Vice President Mike Pence and senior advisor Kellyanne Conway as two examples of President Trump surrounding himself with persons with strong pro-life records.

Burch agreed that “President Trump has assembled a great Cabinet.”

He pointed to the pro-life appointments at the Department of Health and Human Services as examples of this. Former pro-life congressman Dr. Tom Price was tapped to be Secretary of Health and Human Services; Dr. Charmaine Yoest, former CEO of the pro-life group Americans United for Life, has been named to be assistant secretary of public affairs at HHS; and lawyer Matt Bowman, formerly of Alliance Defending Freedom, was also picked to join HHS.

“The Trump administration is staffed with thousands of high-caliber individuals like this,” Burch said.

Mancini also pointed to Trump’s nomination of Judge Neil Gorsuch to replace the late Supreme Court Justice Antonin Scalia as another positive sign for the pro-life movement.

“Justice Gorsuch is a constitutionalist, committed to respecting the text and intent of lawmakers rather than legislating from the bench,” Burch stated, giving Trump an “A+” grade for the Supreme Court nomination.

CatholicVote provided a report card for Trump’s first 100 days. They gave Trump an “A” grade on the “sanctity of life” issues, noting that other achievements like the defunding of Planned Parenthood are still expected.

Although Gorsuch had not ruled specifically on an abortion case as judge, pro-life leaders have noted his dissent in a Tenth Circuit decision that overturned Utah’s defunding of Planned Parenthood.

Additionally, in his confirmation hearings, when asked by Sen. Dianne Feinstein (D-Calif.) if a “super-precedent” existed for the Court’s Roe decision that legalized abortion, Gorsuch would not say that one existed, only saying that the Roe decision had “precedent,” according to EWTN’s Dr. Matthew Bunson.

Gorsuch was confirmed by the Senate on April 7 after Democrats threatened a filibuster. Republican Majority Leader Mitch McConnell (Ky.) invoked the “nuclear option” to end the filibuster threat, whereby Gorsuch could then be confirmed with a simple majority vote. He was confirmed by the Senate 54-45.

*Religious Freedom*

Gorsuch’s appointment is expected to impact religious freedom cases for years to come. One of the first major cases he heard from the Supreme Court bench was the religious freedom case of Trinity Lutheran, a preschool in Columbia, Mo. operated by Trinity Lutheran Church. That case is expected to be the premier religious freedom case of the Spring 2017 term.

Gorsuch sat over high-profile HHS mandate cases while he was on the Tenth Circuit, ruling both times with plaintiffs – Hobby Lobby and the Little Sisters of the Poor – in favor of their religious freedom to not comply with the birth control mandate and the supposed “accommodation” offered by the government to objecting non-profits.

Another significant move by Trump administration was to stop fighting in court for the Obama administration’s “transgender mandate.” That policy had directed schools to let students use the bathroom of their current gender identity and not their birth gender.

Leading U.S. bishops had criticized the mandate as infringing on the “privacy concerns” of young students and said it “contradicts a basic understanding of human formation so well expressed by Pope Francis: that ‘the young need to be helped to accept their own body as it was created’.”

After the administration announced it would drop its appeal for the policy in court, the Supreme Court sent a Virginia transgender bathroom case back to the lower courts.

However, the administration’s accomplishments in upholding religious freedom have ultimately been mixed, advocates argue, and one large reason why is that Trump has not issued a broad executive order upholding religious freedom and the rights of conscience as expected.

This is vital, Dr. Jay Richards of the Busch School of Business at The Catholic University of America said, because for any entity contracting with the government – or institutions receiving federal funding like Christian schools that provide federal student loans – they could be subject to actions from the government stemming from Obama-era orders on LGBT status.

Thus, charities or schools that uphold traditional marriage as part of their mission could be subject to actions from the government, unless a new executive order protects them.

The U.S. Conference of Catholic Bishops tried to get support for such an executive order, insisting that “any Executive Order should make it clear that religious freedom entails more than the freedom to worship but also includes the ability to act on one's beliefs. It should also protect individuals and families who run closely-held businesses in accordance with their faith to the greatest extent possible.”

CatholicVote gave Trump a “C-“ grade on religious freedom issues, noting that “a leaked draft of an excellent Executive Order” on religious freedom “was stymied, according to reports, by Jared and Ivanka Trump along with outside left-wing groups.”

“Catholics are patient, but want action on religious liberty. And soon,” Burch said.

*Refugees and Immigration*

Early in his first 100 days, Trump issued an executive order to temporarily halt refugee admissions into the U.S. for four months and indefinitely suspend the admission of Syrian refugees. The order also halted visa admissions for most persons from seven countries: Iraq, Syria, Iran, Sudan, Libya, Somalia and Yemen.

The order was ultimately halted from going into effect by the Ninth U.S. Circuit Court. A revised executive order that was released later left out the indefinite ban on Syrian refugees and left Iraq off the list of countries from which most nationals would be barred from entering the U.S. It still halted refugee admissions for four months and capped the overall intake for FY 2017 at 50,000 refugees.

Bishop Joe Vasquez of Austin, Tex., the chair of the U.S. bishops’ migration committee, was “deeply troubled” at the revised order and said that the refugee admissions program was already well-vetted and secure. Catholic Relief Services said that since global forced displacement is at its highest levels ever recorded, the U.S. must not shut off its refugee admissions program.

The order was ultimately halted from going into effect by federal judges in Hawaii and Maryland.

Trump also signed an executive order in January that would bar federal funding of “sanctuary cities,” or cities that publicly did not follow through with federal laws on deportation of undocumented immigrants. The chair of the U.S. bishops’ migration committee, Bishop Joe Vasquez of Austin, Tex., stated that the move “would force all jurisdictions to accept a one-size-fits-all regime that might not be best for their particular jurisdictions.”

In February, the Department of Homeland Security, enforcing the immigration orders, released new rules that did away with protections for unaccompanied children and asylum seekers coming to the border, created new detention centers, sped up the deportation process, and increased the punishments for undocumented parents who have their children smuggled into the U.S.

Bishop Vasquez warned that the new rules “greatly expand the militarization of the U.S.-Mexico border.”

CatholicVote, meanwhile, rated Trump’s immigration policies so far a “B,” saying that “his poorly drafted and delivered order on restricting refugees from dangerous countries was revised and continues to face legal opposition,” but “his stepped-up enforcement has rightly focused on hardened criminals while moderating on those who immigrated illegally as children (Dreamers).”

“Illegal immigration has plummeted, even without a wall,” Burch stated.

*Health Care*

Another major priority for Trump’s first 100 days was health care. A replacement for the Affordable Care Act was introduced in March with the goal of passing it on March 23, the seven-year anniversary of the ACA being signed into law.

The proposed American Health Care Act attempted to keep in place some policies of the original health care law like a ban on insurers denying coverage based on pre-existing conditions, and young people being able to stay on their parents’ health plans until the age of 26.

However, it sought to replace other major parts of the law. The individual mandate – enforced by fines for people not having health insurance – would be replaced with a fine of up to 30 percent of one’s new premium for a significant gap in coverage. Federal subsidies would be replaced with tax credits for purchasing insurance.

The U.S. Conference of Catholic Bishops had ultimately opposed the Affordable Care Act under Obama because of provisions they said allowed for abortion funding in health plans. They praised the original health care law’s expansion of coverage for low-income and sick groups, although they opposed its lack of coverage for immigrants.

With the new proposal, leading bishops praised its protections against federal funding of elective abortions, but expressed serious concerns with its lack of conscience protections for doctors and other health care providers against government mandates like the transgender mandate.

Additionally, Bishop Frank Dewane of Venice, Fla., chair of the bishops’ domestic justice committee, worried that the new legislation could result in less affordable coverage for groups that need it the most: the elderly, the chronically ill, and the poor. For instance, the tax credits replacing subsidies were not favorably written for the elderly, he said. The 30 percent fine for a gap in coverage could act as a deterrent for someone to purchase health coverage.

Groups like the Catholic health care ministry (CMF) CURO, however, supported passage of the new bill as a step in the direction of more patient-centered health care reform, as well as a law that would help reduce abortion funding in health care.

Ultimately, the American Health Care Act failed to even make it to the House floor for a vote, but has been amended and brought back to consideration in the House. Among the new additions is an amendment that allows states to do away with “essential health benefits” like coverage for maternity care and hospitalizations that were mandated under the Affordable Care Act.

Bishop Dewane issued a strong statement this week criticizing the revised health care bill for similar reasons as he opposed the original AHCA. Members of Congress should not vote for the revised bill, he said on Thursday.

*Foreign Policy*

On foreign policy, Trump ordered missile strikes earlier this month on a Syrian airbase in response to a chemical weapons attack in Idlib that killed around 100 and hospitalized hundreds. After the Syrian air force had bombed a neighborhood in the Idlib province, hundreds of civilians either died or were hospitalized with symptoms of exposure to sarin, a deadly nerve agent.

The U.S. said that forces of Syrian president Bashar al-Assad were responsible for the attack, and a U.S. aircraft carrier in the Mediterranean launched Tomahawk cruise missiles against the airbase that was used by Syrian forces for the bombing.

Moral theologian Joseph Capizzi of The Catholic University of America told CNA that the response was “judicious” and was needed to uphold international agreements against the use of chemical weapons. Dr. Tom Farr of Georgetown University said “the strikes were fully justified, both as a means of punishing the evil acts that took place - especially (but not only) the slow torture and execution of babies by means of Sarin gas - and as a means of deterring the regime from further acts of evil like this.”

Meanwhile, Syrian clerics decried the attack, saying that an investigation should have been first conducted to prove who the perpetrators of the chemical attack were. Melkite Archbishop Jean-Clement Jeanbart of Aleppo told CNA he hoped the U.S. “would have done something toward peace and reconciliation and a political solution” in Syria.

  Reported by CNA 11 hours ago.

By Dave A. Chokshi, New York University Langone Medical Center

In medicine, we speak of “seeing patients” when we are rounding in the hospital or caring for those who come to our clinics. But what about those people who may be sick but do not seek care? What is our responsibility to the patients we do not see?

This question takes on greater urgency in the current political climate, as patients face the threat of losing health insurance. Renewed efforts to repeal and replace the Affordable Care Act leave millions wondering whether they will be covered.

For me, as a physician practicing in the safety net, abstract numbers evoke the very real stories of my uninsured patients. One of my patients, whom I’ll call Elsa, had not seen a doctor since immigrating to the United States 15 years ago. That abruptly changed one morning: She awoke to find the room spinning around her and, terrifyingly, she could not articulate the words to explain to her husband what was going on. She was having a stroke.

There are many reasons that patients like Elsa may not seek care – until they have no choice. Although she felt no symptoms before her stroke, Elsa was one of about 13 million U.S. adults with undiagnosed high blood pressure. I wondered if making her aware of her blood pressure would have been enough to avoid her suffering.

But even if high blood pressure may sit atop the list of problems I write out, from his or her perspective it may not crack the top five. Food security, job stability, child care and affordable housing understandably feel more urgent. Time and again, I have learned that taking care of my patients starts by trying to walk a mile in their shoes.

*Why patients may not seek care*

Sometimes, forgoing care is a symptom of social isolation. I asked another patient of mine – whom I had recently diagnosed with uncontrolled, likely longstanding diabetes – about his eating habits. I learned that in his routine, he would go for days at a time without interacting with another person; he did not have any family nearby and worked from his home computer.

Aside from deterring access to care, loneliness and social isolation have direct effects on health. One review of 148 studies showed that the influence of social relationships on the risk of death was comparable with risk factors such as obesity and alcohol use.

In other cases, the health care system must take responsibility for barriers to patients that we ourselves erect. Beyond costs, structural barriers include inadequate language interpretation services and the assumption of health literacy when conveying information. Meanwhile, historical inequities often underlie wary attitudes toward health care.

Dr. Mary Bassett, the health commissioner of New York City, has spoken plainly about this: “We must explicitly and unapologetically name racism in our work to protect and promote health…We must deepen our analysis of racial oppression, which means remembering some uncomfortable truths about our shared history.”

In the same vein, new immigration policies may have a chilling effect on the willingness of people like Elsa to see a doctor, if they perceive negative repercussions for themselves or their families.

Many patients with the greatest unmet needs are therefore marginalized, with only glancing interactions with the health system – or none at all, in the most wrenching cases of suicide, drug overdose and other chronic illnesses that end in catastrophe.

When they do seek care, it is sporadic. They may show up in the ER, but not to a primary care follow-up appointment. If an ensuing phone call goes unanswered, or their phone is out of service, we label them as “lost to follow-up” and move on to the next patient on the list.

*What needs to change*

Doing better by these patients will require moving the locus of accountability for health further into communities. It means bringing more of a public health mindset to health care; that is, not reflexively restricting our purview to those who happen to cross our clinic’s threshold.

Hospitals and health systems must have the humility to reach across boundaries and partner with local institutions that are sometimes more trusted, and often more relevant, in people’s daily lives, including churches, schools, food pantries and parks.

In one recent example, the 54 branches of the Free Library of Philadelphia were shown to be vital community nodes for health-related services like literacy programs, healthy eating initiatives, job fairs and food preparation courses. Public libraries are particular safe havens for those experiencing mental illness, substance use disorders and homelessness – as well as youth and recent immigrants. We should consider how the these locations are therefore already a part of our health ecosystem.

Doctors and other clinicians may balk at trying to take care of the patients we do not see. After all, with the harried pace set by the 15-minute office visit, it is hard enough to keep up with the patients we do see. But the goal is not to schedule doctor’s appointments for all library-goers, but rather to equip them to be better stewards of their own health, which sometimes involves health care providers, sometimes not. While physicians can’t do it alone, we can lend our voices to those calling for greater outreach, less stigma and protection of the most vulnerable.

*Prevention, not regression*

In Elsa’s case, when she had her stroke, she was rushed to the ER and received excellent care from the hospital team. Neurologists treated the blocked vessels in her brain and diagnosed her with a narrowed heart valve and high blood pressure.

As a doctor in a system that accepts all patients, regardless of ability to pay, I was proud to be a part of her follow-up care. She underwent heart valve surgery, and we put her on blood thinners and blood pressure medicines to reduce her risk of another stroke. Her rehabilitation, all things considered, was going well. The health care system had reacted to Elsa’s crisis with swift competence.

At our last clinic visit, my mind turned to what could have been done to prevent her stroke. But the chances to intervene were too few. She and her husband made a living as bottle-pickers; they spent hours every day sifting through trash for bottles to recycle. Elsa told me they made enough money to get by, since they lived with her nephew. But visiting me in clinic, not to mention a cardiologist, neurologist and physical therapist, cost her time and thus cash.

And so for every Elsa who walks into our clinic I know there is another patient we do not see.

With health coverage for millions of Americans in limbo, we must speak out and organize just to keep seeing the many patients who have been newly brought into care. And at the same time, we must develop better ways to find and support people like Elsa – even before we see them as patients.

 

Dave A. Chokshi, Physician, New York University Langone Medical Center

This article was originally published on The Conversation. Read the original article.

-- This feed and its contents are the property of The Huffington Post, and use is subject to our terms. It may be used for personal consumption, but may not be distributed on a website. Reported by Huffington Post 7 hours ago.

Tomorrow, in case you hadn’t heard, will be Donald Trump’s 100th day as president. Grading his performance has been a weeklong event in the media. Rather than our normal Friday format, what follows is our honest evaluation of Trump’s first 100 days, which might be summed up as: “Coulda been better, coulda been a lot worse.”

The most heartening conclusion for liberals, after 99 days, is that Trump’s incompetence is his saving grace. Imagine how much worse things could have been right now if Trump really did have his act together, in other words.

The most obvious conclusion to be drawn is one that everyone should know already ― Trump likes style a lot more than he has ever cared about substance. He loves signing things in media photo opportunities, not caring in the slightest what is actually on the papers he’s signing. The media attention is what he craves, not making actual policy changes. Which, as previously mentioned, is a huge relief to his political opponents.

Most presidents pay attention to the voters they didn’t convince, in their first 100 days. Some sort of effort at reaching out to the other side of the aisle normally gives an incoming president a “honeymoon” period with the public, as even those who hadn’t voted for him decide to give him the benefit of the doubt. Trump ― again, unsurprisingly ― didn’t do any such thing, and the concrete result was the complete absence of a honeymoon. The highest job approval average he’s managed yet has been 46 percent ― which is smaller than the percent that actually voted for him.

Trump has lurched between trying to please his base by making good on promises he made on the campaign trail and smacking his base in their metaphorical face by either completely flip-flopping on other promises or just going along with anything Paul Ryan and Mitch McConnell put on his desk, no matter how bad the impact of such actions among his own base is going to be.

A perfect example of this is Trump now bragging about how many executive orders he’s signed. All throughout the campaign, Trump excoriated President Obama for doing exactly the same thing. “Tyranny!” was the cry, or “He thinks he’s an emperor, not a president!” Concerns about tyrannical imperialism are heard no more, however, because Trump is now downright proud of doing exactly what he supposedly disapproved of when Obama was doing it. Such a reversal has been par for the course for Trump. Everything he said on the campaign trail was some sort of performance art, as far as Trump is concerned, and he will be held to none of it now that he’s in office. On balance, this is a good thing, because it allows him to disavow all sorts of inane things he promised he’d do.

In fact, Trump has seemed to get into the most trouble when he actually tries to follow through on his promises. Perhaps he’s learning the lesson “don’t even try,” one would like to think.

But we do try to be fair, so let’s take a realistic look at what Donald Trump has and has not accomplished during his first 99 days in office. These can be broken down into four main categories: stuff he’s undone, stuff he’s done, stuff he’s tried but failed at, and stuff he hasn’t done at all.

*Stuff Trump has undone*

Republicans in Congress have ― very quietly ― been undoing all they can of Barack Obama’s legacy. They discovered a law that had only been used once before, which allowed them to undo Obama’s final actions as president. They’ve only got a few more weeks of this legislative window being open, though, so this will soon cease to be even a possibility. But the larger impact of their frenzied undoing may be that it becomes a regular event. Congresses in future may go through similar “tear it all down” periods at the start of future presidents’ terms, in other words. Time will tell.

The reason they (and Trump) have been very quiet about all this is that most of the regulations they’ve been so busy overturning were actually good ones that poll very favorably with the public. There simply was no outcry to undo this stuff ― in some cases, exactly the opposite was true. What possible constituency of actual voters were demanding that everyone’s browser history be sold to the highest bidder? If the media hadn’t been so distracted by all of Trump’s tweets and other bumbling, this would have been an incredibly unpopular thing to do, but Congress snuck it by while most people weren’t even looking.

The other Obama actions that Republicans overturned were almost as breathtaking as the browser history fire sale. Who was demanding that mentally unfit people be given easier access to purchase guns, after all? Other rules overturned (that few noticed) have resulted in the following: making it easier for coal companies to destroy streams and rivers with toxic pollution, making savings for retirement harder, letting Wall Street completely off the leash again, allowing Trump to “take back” designations of National Monuments from previous presidents, not requiring federal contractors to disclose violations of labor regulations, getting rid of a rule requiring records of worker injuries, and allowing bears to be shot while hibernating. Other than a few small interest groups (and a few large corporate interests), who was clamoring for any of this to happen?

What’s really astonishing about all of this is that this is the area where Trump has actually accomplished the most. Bills passed Congress, Trump signed them, and the new policy became law. The way things are supposed to normally work in Washington, in other words. But due to Trump’s amusing antics (on Twitter and in person), the media largely yawned at all of it. If these new laws had been the only thing happening, more attention would have been paid, and the public may have gotten outraged over at least a few of these extremely unpopular actions.

Trump has been most effective when the media is not paying attention ― a fact which surely must annoy him on some level.

*Stuff Trump has done*

A recent Saturday Night Live sketch had “Trump” in the Oval Office, demanding to be read a list of his accomplishments in advance of the 100-day milestone. The list consisted of: “Neil Gorsuch is on the Supreme Court,” and nothing else.

It was funny because it’s so close to being the entire truth. Trump has not managed to achieve any major goal at all during his first 100 days beyond getting his nominee confirmed to the highest court in the land. All of those grandiose things he promised while campaigning ― many of which he promised “on Day One” ― simply have not happened. No major bill has even made it through a single chamber of Congress, much less been put on Trump’s desk. The wall remains unbuilt. Obamacare still exists. Muslims are not being banned, nor are they being subjected to “extreme vetting.” China is now our best buddy. There is no magic plan to defeat ISIS.

But we’re getting ahead of ourselves ― this category is supposed to be stuff Trump actually has done. And, late-night comedy aside, Trump has managed to score some minor victories even while his major promises remain almost completely unfulfilled.

To accurately measure Trump’s 100 days, we started with his own explicit 100-days promises. Trump, very late in the campaign, gave a speech in Gettysburg, Pennsylvania. It was in many ways the most concrete speech he ever gave as a candidate, because it made 28 solid promises that Trump said he would achieve in his first 100 days. Read off a TelePrompTer (rather than ad-libbed), Trump pledged to the public that these things would all be quickly accomplished.

Trump has successfully done five of them, and partially done at least seven more. Here are the things Trump promised that he achieved, in some fashion or another [Note: in all of the below lists, many items have been reworded for brevity, but the ones in quotes are taken directly from Trump’s speech]:
· Federal workforce hiring freeze (this was temporary and has already been lifted, but Trump did follow through on his promise early in his term).· Requirement that every new regulation requires getting rid of two other regulations (Trump signed this into being, but the effects of it have yet to be seen, really).· Allowing the Keystone XL pipeline (and other pipeline projects) to move forward.· Withdraw from the Trans-Pacific Partnership trade deal (largely symbolic, since it was dead on arrival in Congress, but Trump did formally withdraw very early on in his presidency).· Nominate a Supreme Court justice.
On that last one, Trump was even more successful than he promised, since he couched it as “begin the process of selecting a replacement,” but he not only named Gorsuch, he also got the Senate to confirm him. So on the one big thing he’s achieved, he actually did better than he promised.

Trump has at least partially succeeded on several other promises:
· Lift restrictions on oil and coal.· “Cancel every unconstitutional executive action, memorandum and order issued by President Obama” (Trump has certainly tried his best to live up to this one).
The other three on this list all deal with lobbying. Trump promised a 5-year ban on White House and congressional officials becoming lobbyists, a lifetime ban on White House officials lobbying on behalf of a foreign government, and a complete ban on foreign lobbyists raising money for elections. While some of this was announced by the White House, there also have been stories of “waivers” being issued already, so that Trump White House officials can indeed move right into a cushy lobbying job. Also, all that insistence on stopping foreign influence has to be seen as more than a little ironic, given all the problems Trump and his team have been having over Russian influence in his own campaign. So Trump may have achieved some sort of Potemkin-village “lobbyist ban” (to use an appropriate Russian metaphor), but in reality the swamp has not been drained one tiny bit.

There are two other items that Trump could claim at least partial credit on as well:
· “I will direct the Secretary of Commerce and U.S. Trade Representative to identify all foreign trading abuses that unfairly impact American workers and direct them to use every tool under American and international law to end those abuses immediately.”· “Begin removing the more than 2 million criminal illegal immigrants from the country and cancel visas to foreign countries that won’t take them back.”
On the first, Trump just announced a new tariff on Canadian softwoods. But all Trump really promised was to begin the process, so perhaps other tariffs will be forthcoming in the next 100 days. On the second, Trump has indeed created a much more aggressive deportation policy, but he hasn’t gone nearly as far as many of his supporters had hoped. This too will be a developing story, but in all fairness Trump has to be given some sort of credit for at least starting the processes he said he would.

*Stuff Trump tried but failed to do*

There are three big items in this category. Two of which failed (so far) in the courts, and one of which failed (so far) in the House of Representatives. Here they are, in Trump’s language from the Gettysburg speech:
· “Suspend immigration from terror-prone regions where vetting cannot safely occur. All vetting of people coming into our country will be considered extreme vetting.”· “Cancel all federal funding to Sanctuary Cities.”· “Repeal and Replace Obamacare Act. Fully repeals Obamacare and replaces it with Health Savings Accounts, the ability to purchase health insurance across state lines, and lets states manage Medicaid funds. Reforms will also include cutting the red tape at the FDA: there are over 4,000 drugs awaiting approval, and we especially want to speed the approval of life-saving medications.”
Trump has tried to do the first one twice now, and both times federal judges have stopped him. Trump made it pathetically easy for judges to rule against him because all the judges have to do is to listen to Trump’s announcement of the policy idea on the campaign trail to see how unconstitutional the intent behind it truly is. Trump wasn’t helped by a Chris Christie interview, either, where Christie admitted that Trump directed him to “make a Muslim ban legal” somehow.

Just last week, another federal judge halted Trump’s policy towards sanctuary cities as well. The federal government is not supposed to blackmail states or cities in this fashion, to put it bluntly.

But while Trump has so far been stymied, liberals shouldn’t get complacent about the status quo quite yet. Yes, Trump has been blocked. But Trump can appeal, and he just put a staunch conservative on the Supreme Court ― so he might just win these cases in the end.

As for repealing and replacing Obamacare, Trump doesn’t even get partial credit. All throughout the campaign, Trump promised voters the moon, the sun, and the stars on healthcare reform. His plan would be wonderful. He knew how to fix everything. Everyone would be covered. Everyone’s costs would go down. It would be far, far better than Obamacare in every conceivable way. Trust him, he knew exactly what to do.

Once in office, Trump did nothing. Not a thing. He had no plan. He couldn’t come up with even the bare-bones outline of a plan. Not even a one-page memo on what his goals were. Nada. Zip. Zilch. Trump never had a plan and couldn’t create one if his life depended on it (as indeed many Americans’ lives do).

Then Trump thought he was saved by Paul Ryan’s hastily-assembled trainwreck of a bill. “Aha!” Trump thought, “I’ll just get behind this and sign it and then I can say I repealed Obamacare!”

But Ryancare was (and continues to be) nothing short of a spectacular failure. When the public learned what was in it (and how many of them would lose health insurance), only 17 percent backed the Ryancare plan. During the same period a rather astonishing thing happened ― Obamacare suddenly became very popular, for the first time since the law’s passage. Obamacare began polling at higher than 50 percent approval, something it had never managed previously, as the public finally learned what all of the components of it were (all of which were under threat of removal in Ryancare). So the only thing Paul Ryan achieved was to make Obamacare a success. That’s gotta hurt ― but don’t worry, Obamacare covers that pain.

The White House increased the pressure on Ryan as the 100-days marker approached, and there was supposed to be a last-minute push to revive Ryancare ― after making it even worse in an attempt to get Tea Partiers to vote for it. No vote has happened, because by making it worse Ryan alienated moderate members of his own party. All of Trump’s pressure tactics have not even moved the bill through the Republican House.

So not only did Trump fail to come up with his own big, beautiful healthcare plan (as he had promised), the one he got behind is a total Dumpster fire and will not pass even one house in Congress. That is an abject failure, any way you look at it.

*Stuff Trump hasn’t done*

The first eighteen points on Trump’s Gettysburg agenda were actions he was going to personally take as president. He has failed to deliver on four of them:
· Propose a constitutional amendment to impose term limits on Congress.· Label China a currency manipulator (Trump completely flip-flopped on this one).· Renegotiate or withdraw from NAFTA (this one is somewhat of an embarrassment for Trump, since he was all set to announce he was withdrawing on his 100th day, but then some advisors talked him down off the ledge, so now he’s merely promising to renegotiate at some unspecified future point).· “Cancel billions in payments to U.N. climate change programs and use the money to fix America’s water and environmental infrastructure.”
Anyone think that last one is going to happen? Billions for water and environmental infrastructure? Yeah, right. Trump has (so far) not backed out of the Paris agreement on climate change, but could do so at any time.

But the big list of things Trump has not even attempted yet is the last ten items in his Gettysburg speech. This was a list of all the wonderful bills Trump was going to personally propose to Congress, and “fight for their passage within the first 100 days.” Not a single one of them has happened. Trump has gone zero-for-ten, on a list he created.

Donald Trump has not proposed a single item on this list as a bill Congress could pass. Here are eight of the ten things Trump promised, but has not delivered:
· “End The Offshoring Act. Establishes tariffs to discourage companies from laying off their workers in order to relocate in other countries and ship their products back to the U.S. tax-free.”· “American Energy & Infrastructure Act. Leverages public-private partnerships, and private investments through tax incentives, to spur $1 trillion in infrastructure investment over 10 years. It is revenue neutral.”· “School Choice And Education Opportunity Act. Redirects education dollars to give parents the right to send their kid to the public, private, charter, magnet, religious or home school of their choice. Ends Common Core, brings education supervision to local communities. It expands vocational and technical education, and make 2- and 4-year college more affordable.”· “Affordable Childcare and Eldercare Act. Allows Americans to deduct childcare and elder care from their taxes, incentivizes employers to provide on-side childcare services, and creates tax-free Dependent Care Savings Accounts for both young and elderly dependents, with matching contributions for low-income families.”· “End Illegal Immigration Act. Fully funds the construction of a wall on our southern border with the full understanding that the country Mexico will be reimbursing the United States for the full cost of such wall; establishes a 2-year mandatory minimum federal prison sentence for illegally re-entering the U.S. after a previous deportation, and a 5-year mandatory minimum for illegally re-entering for those with felony convictions, multiple misdemeanor convictions or two or more prior deportations; also reforms visa rules to enhance penalties for overstaying and to ensure open jobs are offered to American workers first.”· “Restoring Community Safety Act. Reduces surging crime, drugs and violence by creating a Task Force On Violent Crime and increasing funding for programs that train and assist local police; increases resources for federal law enforcement agencies and federal prosecutors to dismantle criminal gangs and put violent offenders behind bars.”· “Restoring National Security Act. Rebuilds our military by eliminating the defense sequester and expanding military investment; provides veterans with the ability to receive public V.A. treatment or attend the private doctor of their choice; protects our vital infrastructure from cyber-attack; establishes new screening procedures for immigration to ensure those who are admitted to our country support our people and our values.”· “Clean up Corruption in Washington Act. Enacts new ethics reforms to Drain the Swamp and reduce the corrupting influence of special interests on our politics.”
Not a single item on that list has appeared from the White House.

The remaining two Trump tried to “accomplish” right before the bell rang, but can’t be counted as any sort of serious efforts towards achievement. The first was:
· “Repeal and Replace Obamacare Act. Fully repeals Obamacare and replaces it with Health Savings Accounts, the ability to purchase health insurance across state lines, and lets states manage Medicaid funds. Reforms will also include cutting the red tape at the F.D.A.: there are over 4,000 drugs awaiting approval, and we especially want to speed the approval of life-saving medications.”
Trump gets no credit for this, even with the Ryancare bill, because he never came up with even a shadow of his own plan, which is why it’s in both our “tried and failed” and “didn’t even try” categories. The final item is one where Trump thought he could do his homework on the bus and hand it in for some sort of partial credit:
· “Middle Class Tax Relief And Simplification Act. An economic plan designed to grow the economy 4% per year and create at least 25 million new jobs through massive tax reduction and simplification, in combination with trade reform, regulatory relief, and lifting the restrictions on American energy. The largest tax reductions are for the middle class. A middle-class family with 2 children will get a 35% tax cut. The current number of brackets will be reduced from 7 to 3, and tax forms will likewise be greatly simplified. The business rate will be lowered from 35 to 15 percent, and the trillions of dollars of American corporate money overseas can now be brought back at a 10 percent rate.”
Trump did announce his “tax plan” this week. It was a joke, really ― a one-page document with fewer than 200 words, and only seven actual numbers. All that talk about big benefits for the middle class didn’t make the final cut, although all the goodies for corporations did. But a one-page memo isn’t any sort of “Middle Class Tax Relief And Simplification Act.” It’s a one-page memo, no more. And even Trump advisors aren’t now cheerfully talking about four percent growth rates, instead they’re guardedly speaking of three percent growth. In the first quarter of this year, the American economy grew at 0.7 percent, if anyone wants a reality check.

We wrote yesterday about one glaring conclusion that pretty much everyone in the political and media world has missed, when considering Trump’s tax plan ― with one change, Trump would save himself 81 percent of the taxes he paid on the one form we have for him (from 2005). Thank you, Rachel Maddow and DCReport.

Trump paid $38.4 million in taxes, on gross earnings of over $150 million. But if the Alternative Minimum Tax is abolished (as Trump’s tax plan calls for), he would only have paid $7.2 million in taxes in 2005. That’s an effective rate of only 4.7 percent, and it would mean Trump would save a whopping 81 percent of his tax bill. Why aren’t Democrats screaming this from the mountaintops? We have no idea, because it’s pretty obvious and pretty egregious. It would make a dandy talking point, in other words, for any Democrat who cares to point it out.

*Other Trump promises*

All of the items we discussed above come directly from that one Trump speech in Gettysburg. But Trump made plenty of other promises to the voters, and he’s either failed to follow through or completely reversed course on so many of them it’s hard to keep track of them all.

Trump was going to release his tax returns, now he’s not ever going to. He was going to renegotiate the Iran nuclear deal, but has not. He was going to pay off the entire national debt in a few years (sometimes ten, sometimes eight, sometimes “in my first term”), and yet everything he’s even proposed at this point would explode the deficit and debt enormously (his tax plan, by some estimates, would blow a $7-trillion hole in the budget, in the first ten years alone). He was going to appoint a special prosecutor to hound Hillary Clinton, but (thankfully) decided not to. He was going to sue all the women accusing him of sexual misconduct, but (thankfully) decided not to. NATO was obsolete, until it suddenly wasn’t.

First, Trump already had a secret plan to defeat ISIS. Then he was going to have one “in his first 30 days.” Then he punted entirely to “the generals,” who were going to create such a plan in 30 days. It’s been 99 days, and no plan has been announced. Thankfully, he’s largely following the Obama plan, which has been chalking up success after success in the fight against ISIS (especially in Iraq).

Trump was also going to reverse Obama’s Cuba policy, but hasn’t. He was going to sock it to all those nasty hedge fund managers by eliminating the carried interest loophole, but this didn’t make it into his tax memo.

Trump was going to build a wall, deport all 11 million undocumented immigrants, and institute “extreme vetting” in 90 days. None of these have happened. Trump is caught in the fight over what was supposed to be a “temporary travel ban” and apparently forgotten about why it was only going to be temporary (because once the extreme vetting started, it wouldn’t have been necessary).

Here’s a Trump promise for anyone craving a belly laugh: “I would not be a president who took vacations. I would not be a president that takes time off.” Or you could listen to any of the numerous times Trump took Obama to task for playing too much golf ― all real knee-slappers, now.

Trump has followed through on a few of his campaign promises, to be scrupulously fair. He signed a bill allowing states to defund Planned Parenthood. He promised to accept no salary, and donated his first paycheck to the National Park Service (while simultaneously proposing a budget which would severely slash their funding).

*Conclusions*

On big-picture items, Trump’s first 100 days certainly resembles that SNL list. He got a Supreme Court justice confirmed, and not much else. No big legislative victories at all ― not even if you only count “passed the House of Representatives” (usually a pretty low bar, when your own party controls it).

On smaller-bore stuff, Trump is touting his achievements using the same executive powers he once disparaged Barack Obama for using (Trump even sneered at Obama because he “couldn’t get anything through Congress”). But while Trump gets his signing ceremonies for each of these, most of them don’t really have any effect at all. He signs orders which instruct a cabinet member to, essentially, do their job. “Use the powers of your office to get some stuff done” isn’t really that groundshaking a policy statement, in other words.

The Trump administration’s incompetence is at least partially a self-inflicted wound. Trump has famously disdained staffing the executive branch, letting hundreds of positions remain unfilled. Because of this, he has nobody to go to who has the experience of actually turning policy ideas into legislation. So nothing gets sent to Congress, and the policy goal remains no more than an early-morning Trump tweet. Call it “small government in action” (or, perhaps, “inaction”).

This is good news for liberals, of course, because as we began by pointing out, the first 100 days would have been a lot worse if Trump did actually have a full and experienced staff who knew how to get things done.

On the domestic policy front, Trump has done nothing major. He has not proposed an actual piece of legislation yet. He put out a bare-bones budget paper which is never going to see the light of day in Congress (it’s too brutal for even Republicans to act on), and he put out a one-page memo of bullet points on taxes. That’s it.

On the foreign policy front, Trump has not started World War III or dropped a nuclear weapon on anyone. This normally wouldn’t be seen as much of an achievement, but for Trump it truly is. Sad!

Snark aside, though, we already wrote about Trump’s first-100-days military actions earlier, where he has had mixed success at best. He launched a botched raid in Yemen, he sent 59 cruise missiles into Syria, and he dropped one whale of a big bomb in Afghanistan. He finally figured out where his aircraft carrier was, and it’s now where he said it was supposed to be a few weeks ago.

More generally in foreign policy, Trump has tried to appear distant from Russia and has fully embraced China. Tensions are at an all-time high with North Korea, but with all the bluster coming from the White House, Trump is seriously constrained by what he can even threaten, due to nobody wanting to see North Korea destroy Seoul.

Trump cleaned out the incompetents he originally hired in the national security area, and the second-stringers he put in are actually sane and know the limits of American military power, so that’s something in his favor. The whole Michael Flynn fiasco may still come back to bite Trump, though, if recent revelations of illegal payments from Russia are any indication. The whole “Russian influence” storyline is not going away any time soon, either, on a more general level.

One thing Trump has been able to achieve success at is keeping his base happy. No matter how many times Trump fails to come through on his promises to the working class, they still solidly support him for now. Over 90 percent of Trump voters say they’d still vote for him, which is kind of astonishing, but has to be seen as a clear win for Trump at this point.

Overall, however, Trump making zero moves towards Democrats or even independents has kept his poll numbers historically low. On job approval, Trump’s average has fluctuated from just under 40 percent to a high of 46 percent. That represents not just the lowest first-100-days ratings since polling began, but a jaw-droppingly-low ceiling of support. Trump likes superlatives (especially about himself), but it’s doubtful he’ll be bragging about being the “Most unpopular president ever!” any time soon. Trump had no honeymoon, because he refused to even attempt reaching out to anyone other than his base, and he hasn’t even gotten a bump in the polls after successful military actions (the traditional “rally ‘round the president” bump for Trump was only two percent ― much lower than usual).

Donald Trump’s first 100 days are almost over. So far, they’ve been pretty unimpressive. Granted, this measure may be a false one to judge the success of any president (nobody remembers George W. Bush’s first 100 days, they remember what happened after 9/11, for instance). But at this point in time, it’s what we’ve got to work with.

The overarching conclusion that has to be drawn is that Trump is an ineffectual president. He doesn’t know much about following through when it comes to governing, which is obvious in many ways. He still loves making news (especially with his tweets), but it usually turns out to be a lot of sound and fury, signifying not very much. The other conclusion worth drawing is that Trump is a very reactive president. His daughter can show him something on cable news, and he is immediately convinced that he should launch a missile attack. He planned on announcing his withdrawal from NAFTA, and then a few phone calls changed his mind. Right or wrong, he makes snap decisions with immediate consequences. He has shown a willingness to ignore just about any of his campaign promises, and his base forgives him for doing so each and every time.

Of course, to be fair, he could always improve. Eventually maybe he’ll staff up the departments under his control with some people with real governing experience. Eventually maybe his “we’re going to study this for the next few months” executive orders may come to fruition, and actual policy may appear. Eventually he may figure out how to work with the Republican Congress to actually pass some bills. Anything’s possible, in other words.

For now, though, liberals are all breathing a lot easier after seeing Trump’s peripatetic first 100 days. Trump can’t seem to get his act together on multiple issues, and the Republican Congress is fast becoming the “can’t-do” Congress. That’s all to the good, when you consider what their stated goals are. Other than confirmation battles, we simply haven’t had a big showdown in the Senate yet ― because the House hasn’t been able to pass any important bills. Today, we avoided a government shutdown, showing (for the time being) that Paul Ryan is fully aware of the futility of letting the Tea Party run rampant over must-pass bills. Democrats are cheerfully embracing the concept of congressional gridlock, in much the same way Republicans did after Barack Obama became president. Nothing getting done is a lot better than seeing them competently pass a Republican agenda, in other words.

Meaning that Trump’s first 100 days were a lot better than any liberal probably hoped for. Trump couldn’t get anything done, Paul Ryan couldn’t get anything done, and this was all good news. The White House spent all their time and energy over internal squabbling and jockeying for access to Trump.

So, realistically, we’ve got to end with an honest statement to sum up Donald Trump’s first 100 days: “It could have been a lot worse.” Let’s hope that he stays just as unfocused and ineffective for his entire term in office, because so far that has been the best restraint on the damage he could be capable of. That’s not exactly a rousing statement for the history books, but it is an honest assessment of Trump’s first 100 days in office. It could have been much, much worse.

Chris Weigant blogs at:

Follow Chris on Twitter: @ChrisWeigant

Full archives of FTP columns: FridayTalkingPoints.com

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Following a two-year public battle with breast cancer, former “Beverly Hills, 90210” star Shannen Doherty revealed she is in remission.

The actress made the moving announcement on her social media accounts Friday, sharing her innermost feelings in a heartfelt post.

“Moments. They happen. Today was and is a moment. What does remission mean? I heard that word and have no idea how to react. Good news? YES. Overwhelming. YES. Now more waiting. As every single one of my fellow cancer family knows, the next five years is crucial. Reoccurrences happen all the time. Many of you have shared that very story with me. So with a heart that is certainly lighter, I wait. In the meantime, decisions. Reconstruction which is several surgeries. Decision on taking a pill for the next five years that comes with its own set of problems and side effects. I am blessed, I know that. But for now…. remission. I’m going to just breathe. #cancerslayer”

*Also Read:* 'Beverly Hills 90210' Alums Luke Perry, Jennie Garth Pay Tribute to Shannen Doherty



Moments. They happen. Today was and is a moment. What does remission mean? I heard that word and have no idea how to react. Good news? YES. Overwhelming. YES. Now more waiting. As every single one of my fellow cancer family knows, the next five years is crucial. Reoccurrences happen all the time. Many of you have shared that very story with me. So with a heart that is certainly lighter, I wait. In the meantime, decisions. Reconstruction which is several surgeries. Decision on taking a pill for the next five years that comes with its own set of problems and side effects. I am blessed, I know that. But for now…. remission. I’m going to just breathe. #cancerslayer

A post shared by ShannenDoherty (@theshando) on Apr 28, 2017 at 4:06pm PDT



*Also Read:* Shannen Doherty's Husband Sues Her Ex-Manager, Claims Breast Cancer Hurt Their Love Life

Doherty was diagnosed with breast cancer in 2015. Her battle with the disease was made public when she sued her former business management firm after her health insurance lapsed.

In February she announced that she was finished with chemotherapy, writing, “Last day of chemo. Exhausted. Now that I’m done with chemo and radiation, the waiting game is here. Waiting for test. Waiting to see if I’m clear or not.”

Two months later, she is indeed in the clear, for now, and will continue to breathe.

*Related stories from TheWrap:*

Shannen Doherty's Husband Sues Her Ex-Manager, Claims Breast Cancer Hurt Their Love Life

'Heathers' Reboot: Shannen Doherty Confirms Role on TV Land Series

'Beverly Hills 90210' Alums Luke Perry, Jennie Garth Pay Tribute to Shannen Doherty Reported by The Wrap 4 hours ago.

What we're about to talk about is much bigger than Donald Trump. It's bigger than 'Make America Great Again' and fake news. It's bigger than Brexit, and it's bigger than France's National Front.

What we're about to talk about is trust, and how it demonstrates its presence in markets. We're going to talk about cooperators and non-cooperators. We're going to talk about world peace.

But let's start small.

Over the last week, Donald Trump has turned his back on the world's best hope for wealth and happiness — global trade. He has reignited an old, failed fight over Canadian lumber, upsetting our allies to the north. He has played on the fears of Americans by using national security as an excuse to investigate steel and aluminum imports.

He has opened the door for American corporations willing to use the power of the White House for their own ends.

And yet, there are many in the United States, the richest country in the world, who cheer this bullying.

On both the extreme right and left, trade has become maligned as a harbinger of economic catastrophe — a violent force with the power to decimate the industries employing entire nations. And that can be true.

But what is also true, is that trade is a powerful force for good. We've known that for decades. More importantly, perhaps, we know that trade is an approximation for trust.

"Unhampered trade dovetailed with peace; high tariffs, trade barriers, and unfair competition with war," said Cordell Hull, the US Secretary of State from 1934 to 44."It is a fact that war did not break out between the US and any country with which we had negotiated a trade agreement."

If trade leads to trust and cooperation, turning away from trade creates mistrust and animosity. While some think that globalization — a leap of trust and cooperation if there ever was one on this planet — started with the end of WWII, many economists and historians believe it actually started in 1870, only to collapse with the rumblings of WWI in 1913.

What these academics have found is that cooperation and trust, like trade, do not move in a straight line. Instead, they move in cycles — in ups and downs, in moments of darkness and light.

Guess where we're headed.

*Perhaps you're familiar with Professor Nowak*

This idea of the cycle is based on the work of mathematical biologist, Martin Nowak of Harvard University. He posited that trust and cooperation are cyclical simply because decisions have consequences, and those decisions impact people's worlds. That world, in turn, impacts people's decisions. It's a conversation.

Here's an example. Say you buy a tank of two dozen piranhas, and within about 10 days of setting up the tank with all your gorgeous fish, one piranha realizes that it can eat one of its tankmates. And it likes the taste. This is a very high form of non-cooperation to say the very least.

All of the sudden all of the piranhas realize that non-cooperation is delicious and that its tankmates are dangerous and not to be trusted. There is a feeding frenzy and by day 14, there are only 5 piranhas left swimming. They decide at that point, after all the decimation, that cooperation is better. Trust is better. Without it, they'll all die.

That's how the cycle of trust and cooperation works. 

Economists Mariko J. Klasing and Petros Milionis, Professors at the Netherlands' University of Groningen then gave us the data to overlay Nowak's cycle onto the history of global trade. In their paper, Reassessing the Evolution of World Trade, 1870-1949, they figured out that trade was a much bigger deal before WWI than economists initially thought. 

"Our estimates indicate that trade shares during the 1870-1949 period were on average 32% higher compared to existing accounts and the world ís level of openness to trade in 1913 had been comparable to that in 1974. This implies that the rise and fall of world trade that took place over this period were much more pronounced than previously documented," they wrote.

In other words, we've already had a period where globalization came and went when deep cooperation turned into non-cooperation in markets. Indeed, back in 1914 legendary economist, John Maynard Keynes extolled the virtues of his globalist era, one marked by the ease of transportation thanks to deflated costs.

"What an extraordinary episode in the economic progress of man that age was which came to an end in August, 1914." he wrote. "The inhabitant of London could order by telephone, sipping his morning tea in bed, the various products of the whole earth, in such quantity as he might see fit, and reasonably expect their early delivery upon his doorstep; he could at the same moment and by the same means adventure his wealth in the natural resources and new enterprises of any quarter of the world, and share, without exertion or even trouble, in their prospective fruits and advantages; or he could decide to couple the security of his fortunes with the good faith of the townspeople of any substantial municipality in any continent that fancy or information might recommend."

In short: What a time to be alive.

But of course, as we know, this globalization did not benefit everyone. While income convergence was taking place on a global scale, some members of society were being left behind. Returning to Nowak's thesis, these people are the non-cooperators. They are the ones who want to throw out the elites and rip it all down. 

You see, every cycle has them.

*Non-cooperators in the 2nd era of globalization*

Our non-cooperators are Nigel Farage and Donald Trump, they are scared because this second wave has left them behind in a world they no longer recognize. In the US economy — and indeed in the world — during second globalization era, service goods like banking and healthcare have become more tradeable than manufactured goods. People who made the latter, especially those in the developed world, are no longer comfortable in this economy. For many, instead of converging, their incomes are disintegrating. That's why a populist message is resonating.

But populism and protectionism needn't go hand in hand. It was President Theodore Roosevelt, America's most successful populist, who opened up trade with Canada and the Caribbean. He had his reservations about free trade, but he also saw it as a challenge that the U.S., as a strong nation, should face with energy. After all, he loved a competition.

This is the opposite of the lethargy Trumpians recommend. Instead of innovating our economy, they prefer to reignite old fights. The 20% tariff the administration just put on softwood lumber is a perfect example. 

Commerce Secretary Wilbur Ross announced the tariff arguing that, because lumber harvested from Canada's state-owned timber lands is cheaper than lumber from U.S. private lands, the country has an unfair advantage. The United States has argued this before the World Trade Organization before, and we've lost.

Structural differences in domestic economies do not count as a trade advantage in the eyes of international law.

But here we are.

"It is an old subject, unfortunately, it's coming back," Carl Grenier, a former executive vice-president (1999-2006) of the Free Trade Lumber Council and current professor at the University of Leval in Canada told Business Insider. "There is a pattern in the three deals that have been made in the past... each deal has been more restrictive to the US market than the previous one. That's why it [this fight] keeps coming back even though we've beaten them every time, it never seems to die."

Grenier accuses the US lumber industry of seeking a hand-out, and hurting Canada's industry in the process.

"The only thing they [American lumber companies] want is more money," Grenier told Business Insider. "When they bring countervailing duties the price of lumber and land goes up in the U.S... "The fit is perfect but the US lumber industry has found a quick way, a cheap way, and an easy way to make money."

Of course, it's at the expense of goodwill with one of our country's best allies. Grenier called this issue a "major irritant" for Canada.

After it was announced, The National Association of Homebuilders put out a statement saying that this lumber tariff would be devastating for housing. The group agrees with Grenier in that it believes the US lumber industry doesn't have enough supply to meet domestic demand alone anyway.

“If the 20 percent lumber duty remains in effect throughout 2017, NAHB estimates this will result in the loss of nearly $500 million in wages and salaries for U.S. workers, $350 million in taxes and other revenue for the governments in the U.S. and more than 8,200 full-time U.S. jobs," according to Granger MacDonald, chairman of the National Association of Home Builders. "Lumber prices have already jumped 22 percent since the beginning of the year, largely in anticipation of new tariffs, adding nearly $3,600 to the price of a new single-family home."

In other words, protectionism makes things more expensive.

It also makes things more complicated. Consider Trump's 'Buy American, Hire American' mandate. It requires companies to do more research into who and what they're buying (kind of like a regulation, wouldn't you agree?). It will require that products be made with more expensive American components. That cost will be passed on to the consumer.

*The word 'credit' actually comes from the Latin word for 'trust'*

This trust and cooperation deficit is happening at a bad time for the driver of our domestic economy — the almighty American consumer. Right now, US consumer debt takes up 20% of gross domestic product, and the consumer is starting to show strain. 

This showed up in the country's dismal first quarter GDP print, 0.7%, below the 1% expected by economists. This was in large part due to a lag in personal spending.

"Real personal consumption grew by just 0.3% in the first quarter, down from an increase of 3.5% in the fourth quarter of 2016," Business Insider's Bob Bryan noted following the reading. "It's the smallest increase since Q4 2009, just two quarters removed from the recession."

Now there are a bunch of reasons for all this. Despite the fact the country dug itself out of a mortgage debt hole after the great financial crisis, other things gave. Student loans for one, auto loans for another. Some of this is much deeper than that though. Some of it is that income divergence we were talking about.

"Higher income inequality seems to have been conducive to unsustainable consumer borrowing in the run-up to the Global Financial Crisis (GFC)," Morgan Stanley said in a note to investors last year. "After disadvantaged households bumped up their consumption possibilities through borrowing, they found themselves with impaired balance sheets, limited income prospects, and heavy debt loads in the aftermath of the crisis. Unsurprisingly, they are frustrated by their dim prospects."

This, Morgan Stanley, is a global phenomenon. It hasn't gone away either. To solve this problem, the bank suggests investing in "access to education, enhance social mobility and improve financial stability."

But that's not what we're doing. Here in the United States we have an Education Secretary who barely believes in public education. We have a Republican Congress callous enough to call for kicking millions of Americans off of health insurance. We have a President who is willing to abuse something that builds trust, connects nations, fosters cooperation, and makes up 28% of our country's economic output. 

We're in a tight spot. 

Join the conversation about this story »

NOW WATCH: These are the small, agile new aircraft carriers meant to take F-35s into battle Reported by Business Insider 10 hours ago.

The 101st day of Donald Trump’s presidency sounded an awful lot like the first, with Trump talking utter nonsense about health care.

In a series of tweets and during an interview on CBS’s “Face the Nation” on Sunday, Trump made the same basic promise he’s been making ever since he started running for president ― that his plan for repealing and replacing the Affordable Care Act would reduce both premiums and deductibles, while protecting people with pre-existing conditions.


...healthcare plan is on its way. Will have much lower premiums & deductibles while at the same time taking care of pre-existing conditions!

— Donald J. Trump (@realDonaldTrump) April 30, 2017

This is not an accurate description of the American Health Care Act, the repeal bill House Republicans have been trying to pass since March.

That bill would definitely help some people ― in particular, younger, healthier and wealthier people who buy insurance on their own today and end up paying high prices because they get little or no financial assistance from the Affordable Care Act.

But the proposal would cause real hardship for many millions of Americans ― whether by raising their premiums or deductibles or both, or depriving them of coverage altogether. And it’d be the poor and the sick struggling the most, even as the wealthiest Americans walked away with a sizable tax break.

Whether Trump understands all of this is an open question. During the “Face the Nation” interview, host John Dickerson kept pressing Trump to explain how the health care law could do all of these things ― and Trump, in response, kept modifying his answers.


Trump appears to reverse himself on pre-existing conditions 2x in 2 mins—first by saying it's guaranteed (it isn't), then kicking to states.

— Dan Diamond (@ddiamond) April 30, 2017

But Trump isn’t the only prominent Republican making false promises about what the party’s proposal would do. Vice President Mike Pence and House Speaker Paul Ryan (R-Wis.) have made similar comments in the past few days ― Pence during an appearance on NBC’s “Meet the Press” and Ryan during his weekly press conference.

The timing is not coincidental. Pence and Ryan are working hard with their allies to round up votes for the AHCA in the House. Right now the challenge is winning over less conservative Republicans who are anxious about what the AHCA would mean for health insurance coverage ― and how that would play in their districts.

The promise to provide health insurance that is simultaneously less expensive and more comprehensive, all without excluding people who have serious medical problems, is designed to reassure these lawmakers.

But the promises belie what the Republican proposal would actually do.

GOP Bill Would Shift Costs Onto The Poor, Sick And Old

Republicans are calling for a series of dramatic changes to the so-called non-group insurance market ― that is, coverage for people buying insurance on their own, rather than through employers.

Specifically, the bill would shift financial assistance away from people with low incomes and high insurance costs, while giving insurers new freedom to vary prices by age, so that carriers could charge older customers more than five times what they charge younger customers. The bill would also allow insurers to offer skimpier coverage than the law permits today.

And thanks to the amendment that Republicans introduced last week, states could opt out of some of the law’s most important regulations ― a ban on charging higher premiums to people with pre-existing conditions, and a requirement that all plans include a set of “essential” benefits including mental health, maternity care and prescription drugs.

“On net, the new bill has to be worse with this than even the original,” Linda Blumberg, senior fellow at the Urban Institute, told HuffPost. “This doesn’t give new protections to [states that want to keep existing consumer protections], it gives new flexibility to the states that want to set the clock back to the pre-ACA days.”

Although the effect of all the changes to the individual market would vary from person to person and place to place, the net effect would be cheaper coverage for the young, healthy and wealthy, but more expensive coverage for the old, sick and poor ― to the point that many could not get decent coverage at all.

Republicans claim that other provisions of their bill, designed to reimburse insurers for expensive beneficiaries or to create separate programs for people with pre-existing conditions, would take care of people with serious medical problems.

“They say we don’t cover pre-existing conditions, we cover it beautifully,” Trump said on “Face the Nation.”

But as multiple analysts have pointed out, these programs have never provided adequate protection in the past, even though Republican leaders like Ryan keep claiming otherwise. 

GOP Bill Would Blow Away Medicaid Coverage For Millions

The changes to the individual market represent just one part of what the American Health Care Act would do. The proposal would also cut Medicaid by a whopping $839 billion over 10 years.  

The amendments that supposedly make the proposal so much more appealing don’t do a thing about this. And it’s this cut that would have the single biggest effect on insurance coverage ― with the number of people getting Medicaid coverage falling by 14 million over 10 years, according to the Congressional Budget Office.


Reminder: the #AHCA revised still cuts #Medicaid for the poor and reduces coverage pic.twitter.com/SxEz1A5Iay

— Diane Rowland (@dr_dianerowland) April 27, 2017

That Medicaid cut alone would probably represent the single biggest rollback of a public benefit in American history ― and cause widespread hardship to the millions of people who depend on it for everything from opioid treatment to cancer care.  

The vast majority of Americans oppose these proposals, polls now show consistently. Those numbers ― and the backlash Republicans have faced in town hall meetings ― undoubtedly explain why the American Health Care Act hasn’t passed the House yet.

But Republican leaders haven’t given up trying ― and, based on their recent comments, they haven’t given up distorting the truth about their plans, either.

-- This feed and its contents are the property of The Huffington Post, and use is subject to our terms. It may be used for personal consumption, but may not be distributed on a website. Reported by Huffington Post 1 hour ago.

Amid ongoing federal debate over the future of America's health care laws, Colorado's health insurance regulators have officially given companies until June 19 to file their 2018 plans for approval, with the plans being made available for public comment by mid-July. Reported by Denver Post 2 days ago.

Republicans are trying very hard to disguise what the American Health Care Act would actually do.

They keep insisting their bill, which would repeal the Affordable Care Act, would “lower premiums and improve access to quality, affordable care,” as House Speaker Paul Ryan (R-Wis.) put it last month.

Any time analysts point out the ways in which those promises are misleading or false ― or cite the Congressional Budget Office prediction that the AHCA would leave about 24 million people without health insurance ― Republicans insist that a combination of new tax credits, state innovation, and so-called high-risk pools will take care of people better than the current system does.

This is not true. And perhaps the clearest evidence is in those CBO numbers.For all of the policy gobbledygook flying around these days, health care policy is a pretty straightforward question of resources. People who are sick or injured need expensive medical care, the kind that requires insurance. Most poor people can’t afford that insurance on their own and many middle-class people can’t either.

The Affordable Care Act, the 2010 health care law known as Obamacare, addressed this problem by putting new federal money into the health care system ― primarily by offering tax credits to help people pay for private coverage and giving states money to expand their Medicaid programs. 

The AHCA would reverse that, putting less money into private insurance assistance and taking a huge chunk out of Medicaid funding.

All told, it works out to about $1 trillion less in federal spending on health care.

“Even in our expensive health care system, cutting a trillion dollars in federal support is a big deal,” Larry Levitt, senior vice president at the Henry J. Kaiser Family Foundation, told HuffPost. “Without that funding, millions of people couldn’t afford health insurance, and many would go without needed health care and face medical debt.”

Take that money away, and the people who now depend on it will mostly be stuck. Some will be poor, some will be middle class, and some will be people with serious medical conditions. All will face a difficult choice: They won’t be able to pay for the medical care they need, and so they will face financial hardship ― or go without care altogether.

It’s roughly $200 billion less for private insurance

Broadly speaking, the American Health Care Act makes two main sets of changes to insurance coverage. The first would affect people who buy private insurance on their own, rather than through employers. The GOP bill would take away the tax credits available under the Affordable Care Act, and replace them with tax credits that use a different formula.

These credits would mean less assistance for people with low incomes or high insurance premiums. The new tax credits would also add up to substantially less money than the existing ones. Under the GOP bill, tax credits would cost the federal government $357 billion over 10 years, instead of the $663 billion that the Affordable Care Act’s tax credits would cost.

In other words, under the GOP bill, the federal government would end up spending $306 billion less on financial assistance for people buying coverage on their own.

The Republican bill does have some provisions to offset that decline. The best-known is a provision to fund high-risk pools, which are special insurance programs for people with pre-existing conditions. But these provisions add up to just a little more than $100 billion over 10 years, which is not nearly enough to make up the gap.

This is a big reason many experts think the high-risk pools wouldn’t work. To provide the kind of comprehensive coverage now available through the Affordable Care Act, they would need a lot more government money.

It’s roughly $800 billion less for Medicaid

Of course, the really big fiscal change in the American Health Care Act is the one that, at least in the last few weeks, has received the least attention: the proposed cuts to Medicaid.

Under the Republican proposal, the federal government would phase out funding for expanded Medicaid eligibility ― and then, going forward, change the formula for calculating federal support for the program. The result would be $839 billion in cuts over the next 10 years.


States wouldn't be able to compensate for these large and growing federal funding shortfalls.
Edwin Park, Center on Budget and Policy Priorities
Republicans frequently insist that these Medicaid cuts won’t hurt anybody, because the program needs reform anyway and the cuts would encourage states to innovate. But Medicaid’s shortcomings have as much to do with underfunding as waste. (Many doctors won’t see patients at such low reimbursement rates, making it hard for some Medicaid recipients to find specialists.) No serious analyst thinks it’s possible to take that much money out of the program without people losing access.

This is why the single biggest source of people losing coverage under the AHCA would be from declining Medicaid enrollment ― to the tune of 14 million over the next decade, according to the CBO projection.

“States wouldn’t be able to compensate for these large and growing federal funding shortfalls without harming beneficiaries through cuts to eligibility, benefits and provider payments,” said Edwin Park, vice president for health policy at the Center on Budget and Policy Priorities.

The Republican bill does throw a little money at safety-net hospitals, in order to help those institutions offset the costs of doling out more uncompensated care. But the total investment is just $48 billion.

That’s a pittance, relative to the size of the Medicaid cuts.

It won’t get better with the amendments

When experts think about the net effect of the GOP repeal bill, they frequently cite an additional set of changes: elimination of the mandates on employers (to provide insurance) and individuals (to get coverage). Those mandates generate revenue today, and the CBO includes those amounts in its tallies of “coverage” provisions because they cause more people to get health insurance. 

But those provisions amount to $200 billion total, which is hardly enough to offset the nearly $1 trillion reduction in spending and tax credits. And, in any event, they are more like a new tax break than putting money into helping people pay for health care.

The other footnote to these figures is that they are a bit dated. The CBO hasn’t analyzed the bill since late March, and since that time Republicans have introduced new amendments that would give states the option of waiving key insurance regulations, including the prohibition on charging higher premiums to people with pre-existing conditions.

It’s difficult to be sure how those amendments would change the agency’s assessment and it’s possible that, given the chance to analyze this latest version of repeal legislation, the CBO would conclude the new bill represents a smaller reduction in what the federal government is spending to help people pay for their medical care. 

But it would still be a cut, and a pretty massive one at that ― which means, one way or another, the overall effect of the bill would be greater exposure to punishing medical bills, not less.

Republicans might still think their legislation is defensible on the merits, because they favor smaller government on principle ― or because they are so eager to reverse the tax increases on corporations and wealthy Americans that the Affordable Care Act put in place.

But that is not the case Republicans are making. They are promising their proposal would make it easier for people to pay their medical bills, even as they drain the health care system of nearly $1 trillion in federal funding.

That is not a credible argument.

-- This feed and its contents are the property of The Huffington Post, and use is subject to our terms. It may be used for personal consumption, but may not be distributed on a website. Reported by Huffington Post 2 days ago.

The late night talk show host held back tears as he announced his support for health insurance coverage of people with pre-existing conditions and continued funding for the National Institute of Health Reported by CBS News 1 day ago.

WASHINGTON ― House GOP leaders, unable to find the votes for their health care bill simply by pressuring reluctant Republicans, are now considering changes that will win over moderates.

House Majority Leader Kevin McCarthy (R-Calif.) began a closed-door meeting on Tuesday by telling members, “Now is not the time to decide what to do or how to do it; now is the time to do it,” according to a Republican present.

But just hours later, after it was clear that strategy wasn’t working, leaders were toying with an amendment that would add more funding for the high-risk coverage pools that states would set up to insure people with costly pre-existing conditions.

“Obviously some members are looking for changes, but we’ve not made any at this point, and don’t know that we will,” AshLee Strong, a spokeswoman for House Speaker Paul Ryan (R-Wis.) told HuffPost.

If the current legislation isn’t doing the trick, however, the need for an amendment may become obvious.

According to the last Congressional Budget Office estimate, Republicans have roughly $150 billion in savings over the next 10 years that they could dole out to bolster the high-risk pools and mollify centrists. But that assumes other changes in the bill won’t reduce those savings.

It’s unclear how the Congressional Budget Office will score other GOP modifications, partly because the office would have to predict whether states will opt out of the protections for people with pre-existing conditions. Some members believe that lowering premiums for healthy young people could increase the number of people taking advantage of the government’s tax credits, thereby increasing the overall cost of the bill and eating into the savings.

And while Republicans argue that high-risk pools would work for sick people, that historically hasn’t been the case. The Center for American Progress estimated on Tuesday that the Republican health care plan falls $200 billion short of sufficiently funding high-risk pools.

Either way, leaders are considering how to shore up support from moderates. And while there isn’t any firm proposal at this point, some moderates on the fence could probably be won over with additional funding for the high-risk pools.

“That sounds good,” Rep. Kevin Yoder (R-Kan.), who is undecided on the bill, said when HuffPost asked him about adding money to the high-risk pools. “That sounds positive.”

Another undecided Republican, Rep. Adam Kinzinger (R-Ill.), said he’d be willing to look at that change, and Rep. Don Young (R-Alaska), also undecided, said that sort of amendment “might help.”

(Young also told HuffPost on Tuesday that he thought the GOP health care bill, which would change how rural states are reimbursed for costs, “hurts Alaska,” so his vote might be more difficult to get than leaders think.)

Those members are just undecided, however. When HuffPost described the potential amendment to Republicans who have taken firmer stances against the GOP health care bill, it didn’t seem to entice them much.

Rep. Frank LoBiondo (R-N.J.) said that sort of amendment probably wouldn’t change his vote and that he was “not really in play” at this point. Former Energy and Commerce Chairman Fred Upton (R-Mich.), who came out in opposition to the bill on Tuesday, also said the proposal wouldn’t change his mind if Republicans didn’t fix the protections for people with pre-existing conditions. “More money does not do the trick,” Upton said.

When HuffPost asked Rep. Chris Smith (R-N.J.) about how an amendment adding money to high-risk pools would affect his vote, he interrupted, raised his hand and said, “I’m just ‘No.’”

Still, the margins on this bill are so tight that any proposal that flips even a few members may make a difference. Various whip counts show a very tight situation.

One constant, however, has been a number of hard “No” votes that do not seem to be moving. If Republican leaders can’t start flipping those members, they may never be able to pass the bill. They can only lose about 22 Republicans ― depending on absences ― and they’ve already lost about 20.

“Seems to me that adding money to the high-risk pools is probably the easiest way for leadership to attempt to coax some moderates without losing the Freedom Caucus,” one senior GOP aide with a sense of the vote told HuffPost. “The question is, does it flip your hard ‘No’ members, or continue to just help with the undecideds? Seems like at some point, they need to pick off a few of the ‘No’ and ‘lean-No’ members.”

Many moderates are having a hard time with a number of the bill’s provisions. The legislation would allow insurers to charge seniors five times as much as young people (currently they can only charge three times as much) and would cut $880 billion from Medicaid over the next 10 years.

CBO projects that 24 million more people would not have health insurance in 10 years if the legislation is enacted ― to say nothing of these latest changes, which could dramatically increase prices for sick people and undermine what’s covered by health insurance.

Moderates also worry that handing the conservative Freedom Caucus a win, particularly when this legislation doesn’t look like it’d go anywhere in the Senate, is a dangerous precedent to set in lawmaking.

“There is a concern that this is going to be the model: Try to placate the hard right and get these bills out of the House knowing they have an uncertain fate in the Senate,” said Charlie Dent, the chairman of the moderate Tuesday Group. “Because we know darn well that the bill on the rebound from the Senate won’t satisfy those on the hard right.”

“All this political capital is being expended on the first launch, knowing damn well that on the battle that matters ― the last one ― you won’t get the support of those very same people,” Dent added.

The other complication with an amendment that adds money to the high-risk pools is that GOP leadership could lose some conservative support, though conservatives seem relatively happy with the bill after the latest changes. While Freedom Caucus members have always said this bill should cost less than Obamacare, that’s never been the primary reason they want to repeal the Affordable Care Act.

“That’s important,” former Freedom Caucus Chairman Jim Jordan (R-Ohio) said of saving money. “But what’s most important is we keep our word ― which this bill doesn’t quite get there, but it’s a good start ― and that we lower premiums. That’s been our position from the beginning. That’s most important.”

Jordan reiterated that the Freedom Caucus would have to review any new changes, but he seemed to support tweaks if they’ll get the legislation over the finish line.

It’s just a matter of whether more changes actually will get Republicans there. As it stands now, the current bill appears to fall short.

As Dent said on Tuesday, “if they had the votes, we would have voted.”

Here is the current HuffPost whip count on the latest version of the GOP health care proposal. This whip count is based on conversations with lawmakers and staffers with knowledge of how members are voting. Not every lawmaker on this list has confirmed how he or she will vote ― this is our best guess:

*No (20)*
Mark Amodei (Nev.)
Andy Biggs (Ariz.)
Barbara Comstock (Va.)
Ryan Costello (Pa.)
Jeff Denham (Calif.)
Charlie Dent (Pa.)
Dan Donovan (N.Y.)
Brian Fitzpatrick (Pa.)
Jaime Herrera Beutler (Wash.)
Walter Jones (N.C.)
John Katko (N.Y.)
Leonard Lance (N.J.)
Frank LoBiondo (N.J.)
Billy Long (Mo.)
Thomas Massie (Ky.)
Patrick Meehan (Pa.)
Ileana Ros-Lehtinen (Fla.)
Chris Smith (N.J.)
Fred Upton (Mich.)
David Young (Iowa)

*Lean No (8)*
Paul Cook (Calif.)
Carlos Curbelo (Fla.)
Mario Diaz-Balart (Fla.)
David Joyce (Ohio)
Michael Turner (Ohio)
David Valadao (Calif.)
Daniel Webster (Fla.)
Rob Wittman (Va.)

*Undecided (13)*
Justin Amash (Mich.)
Mike Coffman (Colo.)
John Faso (N.Y.)
Darrell Issa (Calif.)
Adam Kinzinger (Ill.)
Steve Knight (Calif.)
Erik Paulsen (Minn.)
Bruce Poliquin (Maine)
Dave Reichert (Wash.)
Ed Royce (Calif.)
Elise Stefanik (N.Y.)
Kevin Yoder (Kan.)
Don Young (Alaska)

*Lean Yes (13)*
Rod Blum (Iowa)
Ted Budd (N.C.)
Bradley Byrne (Ala.)
Tom Emmer (Minn.)
Rick Crawford (Ark.)
Jeff Fortenberry (Neb.)
Rodney Frelinghuysen (N.J.)
Peter King (N.Y.)
Hal Rogers (Ky.)
Peter Roskam (Ill.)
Scott Tipton (Colo.)
Glenn Thompson (Pa.)
Lee Zeldin (N.Y.)

Arthur Delaney and Laura Barron-Lopez contributed to this report.

-- This feed and its contents are the property of The Huffington Post, and use is subject to our terms. It may be used for personal consumption, but may not be distributed on a website. Reported by Huffington Post 1 day ago.

House Speaker Paul Ryan (R-Wis.) won over support for his health care reform bill from his most conservative members by letting them water down the Affordable Care Act’s guarantee of coverage for people with pre-existing conditions. Now he’s trying to sell more moderate lawmakers ― and the American people ― the idea that those protections have not, in fact, been watered down.

There’s a lot about the House GOP push this year that’s been disingenuous and plainly at odds with the rhetoric Ryan, President Donald Trump and other Republicans have thrown around ― “Everyone will be covered! Everyone will be better off!” ― but this may be the most easily debunked.

It also reveals a fear among Republican leaders that if their own members and the public actually understood what’s in their bill, they wouldn’t like it. Advancing the bill without an evaluation by the Congressional Budget Office on how it would affect spending, premiums and the number of people with health coverage is another such sign.

But there’s one primary thing that distinguishes the American Health Care Act as revised under a deal brokered by Rep. Tom MacArthur (R-N.J.) from the one that Ryan couldn’t even get to the House floor in March: It’s worse on pre-existing conditions.

House leadership and the White House gave in to demands from the conservative House Freedom Caucus to undo the Affordable Care Act’s ironclad promise that insurers cannot refuse to cover people with pre-existing conditions, nor charge anyone higher premiums based on their health status or medical history.

As Ryan and his leadership team struggle to win over GOP “moderates” who have cold feet over voting for a bill that would gut protections for pre-existing conditions and increase the number of uninsured by millions, the speaker’s office issued a press release Tuesday that appears to be based on a very different piece of the legislation than the one he and Trump are pressing lawmakers to support.

What follows is what Ryan’s office says, and why it’s not true. (The “VERIFIED” tags cite no outside sources, so presumably Ryan is just verifying his own claims.)

Here’s how the MacArthur amendment helps us lower premiums while keeping protections for the most vulnerable in place:

*VERIFIED: The MacArthur amendment protects people with pre-existing conditions.*

The amendment is very clear: Under no circumstance can people be denied coverage because of a pre-existing condition. Current law prohibiting pricing customers based on health status remains in place and can only be waived by a state if that state has chosen to take care of the people through other risk-sharing or reinsurance mechanisms. Even if a state asks for and is granted a waiver, no person may be priced based on health status if they have maintained continuous coverage. In addition to these protections, the AHCA provides significant resources at the federal and state level for risk-sharing programs that lower premiums for all people.  

Again, the Affordable Care Act absolutely guarantees that no one can be turned down or charged more because of a pre-existing condition. The American Health Care Act seems to offer the same, but the promise is empty.

This is the bill language, which looks strong: “NO LIMITING ACCESS TO COVERAGE FOR INDIVIDUALS WITH PREEXISTING CONDITIONS. — Nothing in this Act shall be construed as permitting health insurance issuers to limit access to health coverage for individuals with preexisting conditions.”

But then there’s the rest of the bill. The latest draft of the GOP health care bill would allow states to seek waivers of that and other federal health insurance regulations, and permit insurers to charge higher rates to people who are sick or ever have been if they ever suffer a lapse in coverage because, say, they lost their jobs. Other parts of the bill would set up special insurance programs for these individuals, but these are woefully underfunded.

*VERIFIED: It provides a strict process to receive a waiver from federal mandates.*

Although it gives states an option to tailor coverage limitations, the process is very strict. A state must explain how a waiver will reach the goals of lowering premiums, increasing enrollment, stabilizing the market/premiums, and/or increasing choice. States must lay out the benefits they would provide. And most importantly, states may only apply for a waiver if they have their own risk pool in place. Again, the coverage of people with pre-existing conditions will be protected.

The waiver process in the bill is anything but “strict.” States that submit requests are automatically approved if the Department of Health and Human Services doesn’t intervene within 60 days, for starters. And states basically have to just state that they’re planning to set up a system to take care of people with pre-existing conditions, not show how.

Here’s a rundown, via Washington & Lee University law professor Timothy Jost writing in the journal Health Affairs, of the how states receive one of these waivers. They only have to include one of those items, such as that premiums would be lower, not all of them. And they don’t have to prove their plans would work; they just have to say they have plans.
· *Be submitted in the time and manner required by HHS;*· *Describe how the waiver would:*·    Reduce average premiums for health insurance coverage in the state;·    Increase insurance enrollment;·    Stabilize the market for insurance coverage;·    Stabilize premiums for people with preexisting coverage; or·    Increase the choice of health plans in the state;· *Specify the period for which the waiver would be effective (which could not be more than 10 years unless an extension were granted by HHS);*· *Specify the higher age ratio that the state intends to allow;*· *Specify the essential health benefits the state intends to require; and*· *If the state allows health status underwriting for people who fail to maintain continuous coverage, demonstrate that it has a program in place that meets the requirements described above, which must remain in place for the duration of the waiver.*
“Essentially, any state that wanted a waiver would get one,” Jost concluded.

*VERIFIED: It gives states flexibility in addressing health care premiums.*

The populations in different states have different health care needs. The health care system in Wisconsin is different than the health care system in Arizona. This amendment gives states the flexibility to address these diverse needs without letting the most vulnerable — whether it’s the elderly, children, or people with pre-existing conditions — fall through the cracks.

The vulnerable are very much at risk of falling through the cracks, for the reasons explained above ― and because this bill still would undo the Affordable Care Act’s Medicaid expansion to poor adults and dramatically scale back financial assistance for low-income households buying private insurance.

Moreover, the relatively meager financial assistance in the American Health Care Act wouldn’t factor in how “the health care system in Wisconsin is different than the health care system in Arizona,” because they wouldn’t adjust the value of tax credits by geography. Health care is more expensive, for example, in Alaska than it is in Minnesota, which makes the insurance costlier in Alaska. But the bill’s tax credits would be the same in both states, making them less valuable in high-cost Alaska.

*VERIFIED: The MacArthur amendment will help lower premiums for Americans. *

Right now, under Obamacare, there are many states with only one choice of health care provider. The premiums are out of control and many people, due to Obamacare’s costs, don’t really have health care. This flexibility will increase competition in the marketplace, giving Americans more choices when deciding upon their health care plans and ensuring that health care premiums will decrease.

No one knows how the new health care bill would actually affect premiums because there’s no Congressional Budget Office score of the legislation.

The CBO’s analysis of the old version of the legislation concluded that premiums would go up in the early years, then go down over time. But those changes largely are the result of older people being unable to afford health insurance and becoming uninsured, taking them off the insurers’ books, and of the return of skimpy health plans that cover less and cost less but put more of the burden of medical expenses on patients in the form of higher out-of-pocket costs like deductibles and copayments.

The “fact sheet” from Ryan’s office put in writing the bogus argument Ryan and Trump have been making lately.

Ryan’s office delivered these transparently untrue talking points to the press, presumably hoping the media would repeat them to the public.

But the real audience for Ryan and Trump’s messaging campaign right now is the House Republicans who oppose the legislation or are on the fence. This might work on some GOP lawmakers, but it’s not fooling others.

Take conservative Rep. Billy Long (R-Mo.), via The Hill:

“I have always stated that one of the few good things about ObamaCare is that people with pre-existing conditions would be covered,” Long said in a statement. “The MacArthur amendment strips away any guarantee that pre-existing conditions would be covered and affordable.”

Or here’s Rep. Fred Upton (R-Mich.), the former chairman of the energy and commerce committee and previously a leader in the Obamacare repeal effort, via WHTC radio and MLive:

“I’ve supported the practice of not allowing preexisting illnesses to be discriminated against from the very get-go ― this amendment torpedoes that …. I’ve got a line in the sand. This is a principle I’ve stood on.”

Neither Long nor Upton preceded their statements with the word “VERIFIED” in bold and all-caps, but their assessments of the legislation certainly are verified by the bill’s actual contents.

-- This feed and its contents are the property of The Huffington Post, and use is subject to our terms. It may be used for personal consumption, but may not be distributed on a website. Reported by Huffington Post 1 day ago.

Reported by DallasNews 1 day ago.

Molina Healthcare, a major insurer in Medicaid and the individual insurance exchange market in California, abruptly dismissed its president and chief executive, Dr. J. Mario Molina, and Chief Financial Officer John Molina Tuesday. The move fueled speculation from industry analysts that the Long Beach company, which has been run by the Molina family since its founding 37 years ago, may be sold to a larger health care organization. White will become chief financial officer and interim CEO while the board searches for a new permanent CEO, the insurer announced Tuesday. “In light of the company’s disappointing financial performance, the board has determined to change leadership in order to drive profitability through operational improvements,” Dale Wolf, chairman of the company’s board, said in a statement. Many health insurance executives are careful not to publicly criticize the Trump administration or Congress for their remarks about upending the federal health care law. In a quarterly earnings call with analysts Tuesday, Molina Healthcare executives said they are still deciding whether to continue selling insurance on the ACA exchanges next year. [...] the insurer took a hit in 2016 from a provision in the law known as “risk adjustment,” which requires insurers like Molina that enrolled more healthy people than they expected to pay insurers that enrolled more sick people than expected. Reported by SFGate 1 day ago.

In a surprise shake-up Tuesday, Molina Healthcare Inc. — a major player in Obamacare health insurance markets — ousted its two top executives, both sons of the firm’s founder. The company cited poor financial results.

The growing, Long Beach-based health insurer has nearly 5 million customers in... Reported by L.A. Times 1 day ago.

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· Strong demand at Taco Bell drives Yum Brands' profit beat (Reuters)
· Uber in U.S. court reckoning on possible shutdown of self-driving program (Reuters)

 

*Overnight Media Digest*

WSJ

- Lawmakers on Tuesday warned U.S. airlines they faced more regulation if they didn't follow through with pledges to improve customer service following the widespread outcry over the treatment of a United Continental Holdings Inc passenger last month. on.wsj.com/2oW5gtG

- Apple Inc extended its rebound in the latest quarter with rising profit and revenue, but reported tepid iPhone demand that adds pressure on the technology giant to deliver a hit with its new 10th-anniversary handset later this year. on.wsj.com/2oWbZE4

- North America was the only region where Mondelez International Inc comparable sales fell in the first quarter, as food makers struggle with a turn by U.S. consumers toward fresher foods. on.wsj.com/2oW4Kfu

- Aetna Inc will again scale back its presence in the Affordable Care Act exchanges in 2018, saying it expects losses on the business this year despite sharply reduced enrollment in its individual plans. on.wsj.com/2oWlHXc

- Etsy Inc is replacing its chief executive and cutting about 8 percent of its workforce after the online marketplace reported a first-quarter loss and what it described as "a challenging February." on.wsj.com/2oWcoGA

 

FT

- Gold miner Avocet Mining's shares have been suspended after it failed to meet a deadline to publish its annual accounts. It's biggest shareholder is Elliott Associates.

- Vladimir Putin and Donald Trump talked paths towards Syria's peace, in a second interaction between both the presidents since Trump took office in January.

- EU has raised the opening demand for Britain's Brexit bill to be a payment of up to 100 billion euros ($109.32 billion). EU negotiators revised initial calculations to maximise the liabilities Britain is asked to cover.

- KKR blocked Barclays from winning new mandates at the U.S. private equity group in protest on how the bank's CEO Jes Staley took his brother-in-law's dispute over a failed Brazilian deal.

 

NYT

- Apple Inc said Tuesday that the number of iPhones sold globally fell 1 percent in the first calendar quarter, compared with the same period a year ago, although revenue rose to $52.9 billion as more customers bought the supersized, more expensive iPhone 7 Plus. nyti.ms/2p7gU0W

- Dr. Mario Molina, chief executive of the California health insurance company founded by his father, was abruptly removed from his position at Molina Healthcare Inc, according to an announcement by the company on Tuesday. His brother, John, the company's chief financial officer, was also immediately replaced. nyti.ms/2p7aoY9

- Facing new corporate demands and political pressure from a Trump administration that wants to curb immigrant work visas, Infosys Ltd, one of India's leading tech outsourcing companies, said Tuesday that it will hire up to 10,000 Americans to serve its clients in the United States. nyti.ms/2p6OyUR

- The head of President Trump's re-election campaign accused CNN of "censorship" on Tuesday afternoon after the broadcast network refused to run the group's latest advertisement. nyti.ms/2p7gfg0

- With two days left before an 11-day recess and no vote scheduled, House Republican leaders worked on Tuesday to win votes one at a time for their latest bill to repeal the Affordable Care Act after an influential Republican voice on health care came out against the measure. nyti.ms/2p7bHGB

 

Canada

THE GLOBE AND MAIL

** Mortgage lender Home Capital Group Inc delayed the release of financial results on Tuesday as the company recruits new board members in a bid to restore its credibility, stem the bleeding of deposits and find a potential buyer or investor. tgam.ca/2pEQUer

** British Columbia Liberal Leader Christy Clark wants to slap a hefty carbon levy on exports of thermal coal from British Columbian ports, a move that would devastate producers in both the United States and Alberta while sparking a rift over interprovincial trade. tgam.ca/2pEABhI

** Defence Minister Harjit Sajjan, under pressure to deliver a new purchasing plan for big-ticket military goods, is preparing to lower expectations for the amount of cash available by blaming the former Conservative government for leaving the Canadian Armed Forces with a budget shortfall. tgam.ca/2pEwvpP

NATIONAL POST

** Negotiators and senior trade officials from 11 Pacific Rim nations gathered in Toronto Tuesday to discuss whether it's possible to salvage the Trans-Pacific Partnership. bit.ly/2pEAVwW

** WestJet Airlines is expanding its international reach with the purchase of at least 10 Dreamliner aircraft from Boeing Co part of a larger strategy that will see the Calgary-based airline look for growth in both ultra-low-cost and longer-haul segments. bit.ly/2pExiam

 

Britain

The Times

* ITV bought a majority holding in World Productions, the company behind the popular BBC series "Line of Duty," for an undisclosed sum. bit.ly/2oVqI2f

* Kohlberg Kravis Roberts, the private equity giant, has expressed anger at Barclays' CEO Jes Staley's alleged behaviour relating to a battle it is waging against Jorge Nitzan, the brother of Staley's wife. bit.ly/2oVAFwC

The Guardian

* It will take an extra 15 billion pounds ($19.41 billion) of spending cuts or tax rises to eliminate the budget deficit by the time of the 2022 election, the Institute for Fiscal Studies said as it laid bare the damaging legacy of the financial crisis on UK living standards and public finances. bit.ly/2oVfNp0

* Alitalia has filed for administration for the second time in a decade, a move that could see the troubled Italian national carrier restructured, sold or finally wound up. bit.ly/2oVdyCt

The Telegraph

* The London Stock Exchange has fired back at Brussels' proposal to restrict London's ability to host euro-clearing, warning that any restriction on the clearing of Euro swaps would "damage European issuers, savers, investors, pension funds and intermediaries." bit.ly/2oVzaP5

* Morgan Stanley has sold Affinity Water for 1.6 billion pounds to a consortium of investors including FTSE 250 investor HICL Infrastructure and German insurance giant Allianz. bit.ly/2oVujNJ

Sky News

* Some 300 jobs are to be created and many more safeguarded in a 100 million pounds deal to sell part of Tata Steel's operations in the UK. bit.ly/2oVkIWY

* Staff at Ineos' petrochemical plant in Grangemouth have been evacuated due to a gas leak that police have described as a "major incident." Ineos confirmed the leak at the petrochemical plant on Twitter, adding: "Our on-site responders are continuing to manage the incident with support from the emergency services." bit.ly/2oVhvqq

The Independent

* Banks stung their customers with a combined 300 million pounds in unarranged overdraft fees last year, often for going only a few pounds over their agreed limit, according to research by price comparison service uSwitch. ind.pn/2oVlxPO

* More than half of university students are now forced to pay more than 100 pounds per week for accommodation as rents have soared in recent years, accommodation search engine University Cribs found. ind.pn/2oVfFGp

  Reported by Zero Hedge 19 hours ago.

I may only have two days left before I am handed a death sentence. House Speaker Paul Ryan and President Trump are pushing a new healthcare bill that would lead to my death or bankruptcy. You see, I have a pre-existing condition. Without the protections from the Affordable Care Act, buying, obtaining or keeping health insurance will, once again, be nearly impossible for me. Why don’t I deserve the opportunity to fight for my life?

I’m not, nor have I ever, looked for others to pay my medical bills. In fact, in the last 14 years I’ve paid $168,000 out of pocket for my care; not to mention the lost wages from my job. Yet, I’ve held down a full-time job, paid my taxes and voted in elections. I’ve been a good American. Why should I, as a taxpayer, have to fight for medical coverage when it is given to the people who represent us in Congress?

I am being asked to choose between keeping myself alive or losing everything I’ve worked hard to maintain because I was born with a condition that has no cure. Why is my life so disposable? How can confessional leaders vote in favor of a plan that endangers their most vulnerable constituents? I’m not sure whether those who are determined to repeal and replaced so-called Obamcare believe this is the right thing to do for all Americans. I think they’re using this measure to settle a political score. Should human life be treated like a political pawn or the previous gift that it is? Why is no one considering my right to life?

I certainly don’t believe those who penned the Constitution, which guarantees the right to life, liberty and the pursuit of happiness, believed these rights were solely dependent on wealth. Clearly, our confessional leaders do. Without guarantees for pre-existing conditions will only the wealthy will survive medical trials? Is that the America they really want?

-- This feed and its contents are the property of The Huffington Post, and use is subject to our terms. It may be used for personal consumption, but may not be distributed on a website. Reported by Huffington Post 12 hours ago.