Tag Archives: Trump Administration

Don’t Look Behind The Curtain…

On the 12th of this month, media reported that HHS was deleting twenty years of medical guidelines from its government website.

The Trump Administration is planning to eliminate a vast trove of medical guidelines that for nearly 20 years has been a critical resource for doctors, researchers and others in the medical community.

Maintained by the Agency for Healthcare Research and Quality [AHRQ], part of the Department of Health and Human Services, the database is known as the National Guideline Clearinghouse[NGC], and it’s scheduled to “go dark,” in the words of an official there, on July 16.

Medical guidelines like those compiled by AHRQ aren’t something laypeople spend much time thinking about, but experts like Valerie King, a professor in the Department of Family Medicine and Director of Research at the Center for Evidence-based Policy at Oregon Health & Science University, said the NGC is perhaps the most important repository of evidence-based research available.

Why would the administration delete this information? Experts say it was a unique repository that got 200,000 visits a month.

Medical guidelines are best thought of as cheatsheets for the medical field, compiling the latest research in an easy-to use format. When doctors want to know when they should start insulin treatments, or how best to manage an HIV patient in unstable housing — even something as mundane as when to start an older patient on a vitamin D supplement — they look for the relevant guidelines. The documents are published by a myriad of professional and other organizations, and NGC has long been considered among the most comprehensive and reliable repositories in the world.

So what was the pressing issue that forced elimination of a well-regarded, well-used, totally unpolitical resource?

AHRQ agrees that guidelines play an important role in clinical decision making, but hard decisions had to be made about how to use the resources at our disposal,” said AHRQ spokesperson Alison Hunt in an email. The operating budget for the NGC last year was $1.2 million, Hunt said, and reductions in funding forced the agency’s hand.

Not even an archived version will remain.

It’s hard to credit the notion that fiscal restraints required the deletion. After all, our “President” is spending billions on such things as repainting Air Force One and requiring a military parade a la Third-World Dictators. Toward the end of the linked report, there’s a hint:

The NGC has a screening process designed to keep weakly supported research out. It also offers summaries of research and an interactive, searchable interface.

That gatekeeping role has sometimes made AHRQ a target. The agency was nearly eliminated shortly after its establishment, in the mid-90s, when it endorsed non-surgical interventions for back pain, a position that angered the North American Spine Society, a trade group representing spine surgeons. A subsequent campaign led to significant funding losses for AHRQ, and since then, the agency as a whole has been a perennial target for Republicans who have argued that its work is duplicated at other federal agencies.

Organizations writing the guidelines for the big drug companies are paid handsomely in order to promote the companies’ products. NGC’s process provided a vetted, evidence-based resource comparatively free of that kind of influence. Gee-I wonder why it became a target for the GOP?

In 2016, when former head of HHS Tom Price was still a Congressman, one of his aides insistently protested publication of a study that was critical of a drug manufactured by one of Price’s campaign donors. According to ProPublica, Price wanted the agency to pull the critical research down.

While Americans are transfixed and distracted by the antics of our demented (and probably traitorous) accidental President, the largely unrecognized and unseen functions of competent governance are being systematically dismantled.

Even if America survives this maniac and his cabinet of disreputable and incompetent tools, it will take generations to repair the damage.

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More Than Chutzpah

There are a number of translations of the yiddish term “chutzpah.” Among the best-known is some variation on the following: chutzpah describes the gall of a person who murders his mother and father and argues that he’s entitled to the mercy of the court because he’s an orphan.

The Trump administration may actually have gone that orphan one better.

After reluctantly beginning to comply with a court order requiring them to reunite families–to return the children to the parents from whom they had forcibly taken them at the border– the administration was going to charge the parents for the expenses incurred.

You want this kid back? It’ll cost you….

The judge was not amused.

A U.S. judge in California on Friday ordered President Donald Trump’s administration to pay the costs of reuniting immigrant parents with children separated from them by officials at the U.S.-Mexican border, rather than forcing the parents to pay…

“It doesn’t make any sense for any of the parents who have been separated to pay for anything,” U.S. District Judge Dana Sabraw, who last month ordered that the children be reunited with their parents by July 26, said at a hearing in San Diego…

A lawyer for the American Civil Liberties Union, which has sued the administration over the family separations, said at the hearing that immigrant parents had been told by immigration officials they had to pay for their travel. One parent was initially asked to pay $1,900 to be reunited with a child, according to ACLU court papers. Trump administration lawyer Sarah Fabian called the judge’s order on paying for the reunifications “a huge ask on HHS,” referring to the U.S. Department of Health and Human Services. Fabian said those decisions were handled at the field level, adding that HHS, which houses the detained children, had limited resources.

“The government will make it happen,” Sabraw responded.

So according to an administration lawyer, expecting the government to pay the costs of  cleaning up an inhumane mess of its own making is “a huge ask.” As Ed Brayton commented, first they kidnapped these children, and now they want to charge a ransom for them.

Words fail…..

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Controlling Our Brave New (Digital) World

Now that Net Neutrality rules have been eliminated by Trump’s FCC, the question is: how will the repeal affect ordinary Americans? What consequences will be seen by the millions of Americans who turn increasingly to the Internet for everything from information to entertainment to commerce?

The Brookings Institution has at least a preliminary answer.

On June 11, 2018, the Federal Communications Commission’s repeal of the Open Internet Order—the net neutrality rules—went into effect. In the wake of this change, Americans are wondering how the repeal will affect them, and what it means for the future of internet access. Though consumers may not see changes quickly, the shift on net neutrality undermines the nation’s history on network regulation, creating a new era in how these networks operate in America.

So–in this brave “new era,” what can we expect?

The “quick and dirty” answer is: it depends. For one thing, there is a pending court challenge to the FCC’s authority to repeal Net Neutrality. For another, the Senate has passed Senate Joint Resolution 52, officially disapproving the repeal.  (Under the Congressional Review Act,  Congress can undo recently created rules by federal agencies.)

It still has to pass in the House, and then be signed by the president, which makes its prospects dicey, but perhaps Mueller will have completed his investigation…

That said, the need for a vote in the House should make protection of Net Neutrality an issue in the upcoming midterms. Every Congressional candidate should be asked whether they will vote to reinstate the rules. In December of last year, the Hill reported that 83% of Americans support Net Neutrality.

The pending court case is a consolidation of twelve separate challenges to the FCC’s authority to repeal the rules. The 12 lawsuits were filed by more than three dozen entities, including state attorneys general, consumer advocacy groups, and tech companies.

(If there is a Justice Kavanaugh sitting on the Supreme Court, and the case reaches the high court, its prospects dim: Kavanaugh is on record opposing Net Neutrality on the grounds that Internet providers are publishers, and protected from government interference by the First Amendment. Equating companies like Verizon and AT&T with media outlets like the New York Times requires some convoluted logic. )

More encouraging, a number of states aren’t waiting for Congress or the courts. California, not surprisingly, looks to be first out of the gate with a “robust” protection of Net Neutrality, but a number of other states are in the process of crafting similar bills.

The latest version of the bill restores provisions that would prevent broadband providers from exempting some services from customers’ data caps and would ban providers from charging websites “access fees” to reach customers on a network or blocking or throttling content as it enters their networks from other networks, according to a fact sheet released by Wiener, Santiago, and state senator Kevin de León.

The enumerated practices are those that big telecom companies are expected to engage in now that the FCC has repealed national protections.

The new version of the bill needs to be approved by both houses of the California Legislature, then be signed by Governor Jerry Brown. From there, it could face legal challenges from the FCC, which prohibited states from adopting their own net neutrality protections when it repealed the national net neutrality rules. During the press conference, Santiago said the California bill would stand up to legal scrutiny. Legal experts have told WIRED they are unsure whether the FCC has authority to preempt state law on the issue.

As 83% of Americans understand (at least in this context), this administration’s indiscriminate war on all regulatory activity more often than not just favors big business over the rest of us.

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Sabotage

While the media and the country are being distracted by the daily crazy/sleazy coming from Washington, the Trump Administration is working feverishly behind the scenes to dismantle the rules: rules that protect us from dirty air and water, from discrimination in housing and education, and rules that guarantee us access to health care, among others.

The unremitting attack on the Affordable Care Act has been particularly effective. The GOP may not have been able to repeal it outright, but regulatory sabotage has been the next best tactic. Thanks to the administration’s actions–neutering and threatening to eliminate provisions of the ACA that were included in order to keep premiums affordable, health insurance rates continue to rise.

According to Larry Levitt at the nonpartisan, respected Kaiser Foundation,

New analysis: Insurers did very well in Q1 of 2018 in the individual market under the ACA. If not for looming repeal of the mandate penalty and expansion of loosely-regulated plans, we’d be looking at modest premium increases and even decreases for 2019.https://www.kff.org/private-insurance/issue-brief/individual-insurance-market-performance-in-early-2018/ …

Evidently, however, the administration has decided that killing affordability by raising costs was too incremental; a recent article from The Washington Post reported on a much more direct attack.

The Trump administration took another major swipe at the Affordable Care Act, halting billions of dollars in annual payments required under the law to even out the cost to insurers whose customers need expensive medical services.

In a rare Saturday afternoon announcement, the Centers for Medicare and Medicaid Services said it will stop collecting and paying out money under the ACA’s “risk adjustment” program, drawing swift protest from the health insurance industry.

Risk adjustment is one of three methods built into the 2010 health-care law to help insulate insurance companies from the ACA requirement that they accept all customers for the first time — healthy and sick — without charging more to those who need substantial care.

As the article goes on to explain, two of the three methods were temporary;  risk adjustment, however, was to be permanent. Federal health officials are supposed to annually calculate which insurers had relatively low-cost consumers, and which had more expensive customers. Those with the lower-cost customers would make an adjustment payment to those whose customers were more costly.

This idea of pooling risk has had significant practical effects: encouraging insurers to participate in the insurance marketplaces the ACA created for Americans who cannot get affordable health benefits through a job.

In its announcement, CMS said that it is not going to make $10.4 billion in payments that are due to insurers in the fall for expenses incurred by insurers last year.

The announcement that payments due under the law would simply not be made is just the most recent measure taken by the Trump administration to demolish a law the GOP was unable to repeal legislatively. (It’s a tactic Trump is undoubtedly comfortable with–throughout his “successful” development career, he routinely stiffed architects, engineers and contractors. Wheelers and dealers who are willing to ignore the terms of contracts to which they are party are unlikely to have qualms about ignoring the obligations imposed by laws to which they are subject. But I digress.)

The administration has taken a number of steps to dismantle the ACA through executive powers.

Last year, health officials halved the length of the annual sign-up period for Americans to buy ACA health plans and also slashed by 90 percent the federal funds for advertising and other outreach efforts to urge people to enroll. Last October, the president ended another important subsidy to insurers: cost-sharing reduction payments, which cushioned them from the law’s requirement to provide discounts on deductibles and other out-of-pocket costs to low-income customers.

This year, the Department of Labor and HHS have worked to make it easier for people and small companies to buy two types of insurance policies that sidestep benefits required under the ACA and some of the law’s consumer protections.

There have been a couple of lawsuits in the lower courts over past calculations of these payments, with inconsistent results, and the administration blamed the withholding of funds on one of those decisions–a transparently trumped-up excuse. (Pun intended.)

“Risk adjustment is a mandatory program under federal law,” said Scott Serota, president of the Blue Cross Blue Shield Association. “Without a quick resolution . . . this action will significantly increase 2019 premiums for millions of individuals and small business owners. . . . It will undermine Americans’ access to affordable coverage, particularly for those who need medical care the most.”

Matt Eyles, president of America’s Health Insurance Plans, noted in a statement that the timing of this latest move could be particularly disruptive, because this is the season during which insurers around the country decide whether to take part in ACA marketplaces for 2019 and, if so, what rates to charge. “This decision . . . will create more market uncertainty and increase premiums for many health plans,” Eyles said.

Of course it will. That’s the whole intent.

And if thousands of people are bankrupted or die as a result? Too bad. They weren’t Republican donors anyway.

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How Low Can We Go?

You have probably all seen this reported, and in the global scheme of things, it’s just one more (relatively minor) national embarrassment.

But still!

The United States government opposed a U.N. resolution recommending breastfeeding.

A resolution to encourage breast-feeding was expected to be approved quickly and easily by the hundreds of government delegates who gathered this spring in Geneva for the United Nations-affiliated World Health Assembly.

Based on decades of research, the resolution says that mother’s milk is healthiest for children and countries should strive to limit the inaccurate or misleading marketing of breast milk substitutes.

Then the United States delegation, embracing the interests of infant formula manufacturers, upended the deliberations.

American officials sought to water down the resolution by removing language that called on governments to “protect, promote and support breast-feeding” and another passage that called on policymakers to restrict the promotion of food products that many experts say can have deleterious effects on young children.

And it wasn’t just a pro-forma vote. U.S. diplomats “twisted arms” and threatened supporters of the resolution. Ecuador had planned to introduce the measure; according to reports,  American officials warned Ecuador’s representatives that if they refused to drop their sponsorship of the resolution, “Washington would unleash punishing trade measures and withdraw crucial military aid.”

The Ecuadorean government–understandably–caved.

Health advocates scrambled to find another sponsor for the resolution, but at least a dozen countries, most of them poor nations in Africa and Latin America, backed off, citing fears of retaliation, according to officials from Uruguay, Mexico and the United States.

Speaking of threats, some American delegates evidently went so far as to suggest that the United States might cut its contribution to the World Health Organization, which uses  America’s significant contribution to fund a variety of important global medical initiatives.

In the end, the Americans’ efforts were mostly unsuccessful. It was the Russians who ultimately stepped in to introduce the measure — and the Americans did not threaten them.

It wasn’t just breastfeeding. The thuggery was extensive.

The confrontation was the latest example of the Trump administration siding with corporate interests on numerous public health and environmental issues.

In talks to renegotiate the North American Free Trade Agreement, the Americans have been pushing for languagethat would limit the ability of Canada, Mexico and the United States to put warning labels on junk food and sugary beverages, according to a draft of the proposal reviewed by The New York Times.

During the same Geneva meeting where the breast-feeding resolution was debated, the United States succeeded in removing statements supporting soda taxes from a document that advises countries grappling with soaring rates of obesity.

The Americans also sought, unsuccessfully, to thwart a W.H.O. effortaimed at helping poor countries obtain access to lifesaving medicines. Washington, supporting the pharmaceutical industry, has long resisted calls to modify patent laws as a way of increasing drug availability in the developing world, but health advocates say the Trump administration has ratcheted up its opposition to such efforts.

Words fail.

We have an administration that separates desperate families that have come to us to escape violence and (often) certain death. We put their babies in cages. Now we discover that the American government–our government– bullies health professionals who are working to save lives, in order to protect the pocketbooks of its political donors.

Permit me to modify Joseph Welch’s immortal lines : “Until this moment, I think I never really gauged the Trump team’s cruelty or recklessness… Clearly, they have no sense of decency.”

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