Trump approves Arkansas Medicaid work requirements

Arkansas on Monday became the third state to get the Trump administration’s permission to impose work requirements on Medicaid beneficiaries.

The Centers for Medicare and Medicaid Services approved a Medicaid waiver that included a requirement for recipients to work, or participate in job training or job search activities for 80 hours a month.

State officials said they will begin implementing the work requirements June 1, making them the first state to do so. If a person fails to meet the requirements for three months, he or she will lose coverage for the rest of that calendar year.

However, the state did not get approval to roll back the eligibility level for Medicaid beneficiaries. If that provision had been approved, an estimated 60,000 people would have lost coverage.

Arkansas expanded Medicaid under ObamaCare to people earning up to 138 percent of the federal poverty level, and receives federal funding to pay for those new enrollees. But Gov. Asa Hutchinson (R) sought to restrict the program so that only people who are at the federal poverty level would be eligible.

The so-called “partial expansion” was a key test of the limits of the Trump administration’s power on how far states could go to limit Medicaid enrollment. Arkansas officials sought to reduce eligibility, while still getting the same level of federal funding.

[The Hill]


Work requirements don’t make more people work, because most recipients already work, they just throw them off benefits.

Trump fires council advising on HIV/AIDS

President Trump has fired the entire council that advises his administration about the HIV/AIDS epidemic, the Washington Post reported on Saturday.

Patrick Sullivan, an epidemiologist at Emory University in Atlanta who works on HIV testing programs, told the newspaper the members were informed by letter this week that their terminations were effective immediately.

The Washington Post said the council, which was set up in 1995, makes national HIV/AIDS strategy recommendations — a five-year plan which sets out how health officials should respond to the epidemic.
The council is made up of doctors, members of industry, members of the community and people living with the disease.

The Washington Blade, an LGBTI newspaper, cited sources with knowledge of the terminations as saying that the terms of several council members appointed during the Obama era still had time to run.

Anger Over Trump’s Health Cuts
The mass dismissal follows the resignation in June of six other representatives of the Presidential Advisory Council on HIV/AIDS, who said at the time they were frustrated with Trump’s health care policies.

Several members slammed Trump’s planned American Health Care Act (AHCA), saying it would leave many of the 1.1 million Americans with HIV/AIDS without access to proper treatment. AHCA failed to pass in Congress this year, despite several attempts.

Council members also complained that, since taking office, Trump had failed to appoint a director of the Office of National AIDS Policy, a position first created during the Clinton administration.

Trump Falsely Claims GOP Tax Bill ‘Repealed Obamacare’

The Republican tax-overhaul bill may have only ended the individual mandate aspect of Obamacare, but that won’t stop President Trump from gloating to his base that he “repealed” his predecessor’s signature legislation. “When the individual mandate is being repealed, that means Obamacare is being repealed,” the president told the press during a cabinet meeting. “Obamacare has been repealed in this bill.”

Contrary to his claim, however, the Affordable Care Act is still largely intact—from its Medicaid expansion to the insurance exchanges it set up to regulations on insurance companies, including those mandating coverage for pre-existing conditions.


Trump Tells Republicans to Cut Taxes for the Rich, Like Trump

President Donald Trump pushed Republicans on Monday to cut taxes on the rich by using money that’s slated to help lower-income Americans purchase health insurance.

Trump’s request, which the president relayed by Twitter from his trip through Asia, comes at a sensitive moment in tax negotiations. It also goes against his repeated insistence that tax legislation should be focused on providing middle-class tax relief rather than cutting taxes for wealthy filers like himself.

At times, the president has even predicted that he would pay more under a GOP plan (Trump has not released his tax returns, but multiple provisions in the House and Senate bills appear likely to benefit his business and family).

The House and Senate have released competing bills, neither of which ends the individual Obamacare mandate to maintain insurance coverage or lowers the top rate nearly as far as the president requested on Monday.

In the case of the House bill, the top rate would stay at the current 39.6 percent but would apply it to a higher income threshold: For married couples, it would only kick in after the first $1,000,000 in income versus $470,000 now.

The Senate bill would lower the top rate to 38.5 percent and also have a $1,000,000 threshold for married filers.

Republicans have weighed repealing the individual mandate in recent weeks, which the Congressional Budget Office estimates would free up $338 billion over 10 years for tax reform.

But the savings occur only because CBO predicts 13 million fewer people would have health insurance by 2027. It’s not clear whether that’s enough to reduce top rates to Trump’s desired levels or provide additional middle-class benefits.

In general, rich households already do well in analyses of the current tax plans thanks to provisions like ending the alternative minimum tax, reducing or repealing the estate tax, and cutting taxes for pass-through entities, all of which could potentially benefit Trump himself.

Under the new Senate bill, for example, the conservative Tax Foundation estimates the top 1 percent of taxpayers would see a 7.5 percent increase in after-tax income, versus less than 2 percent for the bottom 80 percent.

Democrats, who have spent weeks attacking the Republican tax bills as a boon to the rich, quickly seized on Trump’s remarks.

“Sooner or later, President Trump’s core supporters will realize that he’s selling them out,” Minority Leader Chuck Schumer, D-N.Y., said in a statement. “This proposal would send premiums for millions of Americans skyrocketing, all so that the wealthy can get an even bigger tax giveaway than they’d get under the original Republican plan.”

[NBC News]

Scott Pruitt Declares War on Air Pollution Science

The Trump administration’s environmental denialism runs much deeper than global warming. That became clear just one month into the presidency, at the annual Conservative Political Action Conference, where panelist Steve Milloy—formerly a paid flack for the tobacco and fossil fuel industries and member of the president’s Environmental Protection Agency transition team—argued that the mainstream science on the health risks of air pollution was wrong. Contra the Centers for Disease Controlthe World Health Organization, the National Institutes of Health and most publishing epidemiologists, Milloy insisted that excessive particulate matter is not linked to premature death—and that scientists who advise the EPA made up evidence to support the Obama administration’s regulatory priorities. “These people validate and rubber-stamp the EPA’s conclusion that air pollution kills people,” he said. His co-panelists nodded in agreement.

Milloy called for EPA Administrator Scott Pruitt to overhaul the agency’s scientific advisory boards, the bodies that ensure public health regulations are based on sound, peer-reviewed science. Milloy said scientists who receive EPA grants are biased toward regulation, and thus Pruitt should ban them from serving on the boards. He and his co-panelists also argued for more representation from polluting industries, which clearly do have a bias against regulation.

Milloy and others on the anti-environmental fringe are getting their wish. On Tuesday, Pruitt announced massive changes to the EPA’s Scientific Advisory Board and Clean Air Scientific Advisory Council, both of which advise EPA on the science behind proposed regulations. Pruitt announced that EPA will no longer appoint scientists who have received grants from the agency to these boards. “From this day forward, EPA advisory committee members will be financially independent from the agency,” he said. Pruitt is also expected to replace every single member whose term is expiring instead of renewing some for a second term, as is common practice. Terry Yosie, former director of the Science Advisory Board during the Reagan administration, told me, “It’s fair to say that this has never happened to this sweeping degree before of existing board members whose terms are expiring this year.”

These changes have been expected for several weeks, but it’s all the more concerning when we look at who these new advisors are. A list of expected appointees to the EPA’s Science Advisory Board, obtained by the Post, E&E News, and The New Republic, shows that Pruitt is expected to appoint multiple people who have downplayed the impact of air pollution on public health. These deniers will have the influence to contort EPA science, leading to the weakening or even repeal of clean-air regulations that protected Americans for decades.

Of the 17 new members expected to be appointed to the EPA’s Scientific Advisory Board (SAB), three hail from large fossil-fuel companies: Southern Company, Phillips 66, and Total. Three are from red-state governments; one is from a chemical industry trade association; the rest are from various universities and consulting groups. Five of the 17 hold views on air pollution that are outside of the scientific mainstream. Of the three new members expected to be appointed to the Clean Air Scientific Advisory Council (CASAC), one is an air pollution skeptic.

Most toxicologists and epidemiologists accept that air pollution can harm humans, and that excessive air pollution can lead to death in vulnerable populations (like children and the elderly). That’s why the government regulates it—principally under the Clean Air Act, a widely popular law passed in 1963 and amended multiple times with unanimous or overwhelming support in the Senate. Through that law, we have various regulations on specific air pollutants, including National Ambient Air Quality Standards for particulate matter and ground-level ozone.

Several expected SAB appointees will likely argue that these regulations should be weakened. Michael Honeycutt, the director of toxicology at the Texas Commission on Environmental Quality (TCEQ), has been aggressively seeking a spot on one of the scientific advisory boards since last year. He is “one of the top ozone science doubters in the state,” according to a 2016 profile in the Houston Press:

Honeycutt is the guy who has been leading the charge against making any changes to air quality standards in Texas. He and a bunch of TCEQ scientists have followed in the footsteps of Republicans in Texas and across the country in vowing to oppose EPA air quality changes until the end of time, more or less. He’s stated in the past he’s against any measures to reduce air pollution mainly because he feels they would be too expensive. Aside from that, Honeycutt reasons that ozone levels aren’t an issue at all because  “most people spend more than 90 percent of their time indoors” so they’re rarely exposed to significant layers of ozone.

The EPA considers ozone a harmful air pollutant. “Reducing ozone pollution makes breathing easier,” the agency’s website reads. “Breathing ozone can trigger a variety of health problems, particularly for children, the elderly, and people of all ages who have lung diseases such as asthma.” Honeycutt, who’s been trying to undercut the scientific basis for smog regulations since 2010, argues that people aren’t outside long enough for high levels of ozone exposure to make a difference.

Robert Phalen, who directs the Air Pollution Health Effects Laboratory at the University of California Irvine, is not an obvious ideologue like Honeycutt, but his research findings would support a deregulatory agenda for air pollution. “The relative risks associated with modern [particulate matter] are very small and confounded by many factors,” he wrote in a 2004 study. “Neither toxicology studies nor human clinical investigations have identified the components and/or characteristics of [particulate matter] that might be causing the health-effect associations.” Phalen has argued that the air is currently too clean, because children’s lungs need to breathe irritants in order to learn how to fight them. “Modern air,” he said in 2012, “is a little too clean for optimum health.”

Anne Smith, an analyst at NERA Economic Consulting, has argued against President Barack Obama’s signature climate change regulation, the Clean Power Plan. Specifically, she took issue with how his administration classified the health risks of particulate matter. She contends that one can’t know for certain whether a death during, for instance, a smog event was directly caused by air pollution. Mainstream scientists acknowledge as much, but say the strong statistical correlation between death rates and pollution rates are enough to prove the risks. Smith disagrees.

The rest of the expected nominees are similarly skeptical. The University of North Carolina’s Richard Smith is the author of a recent peer-reviewed study that found “No association of acute deaths with levels of PM2.5 or ozone.” Stanley Young, a listed expert at the climate-denying Heartland Institute, has written that there is “empirical evidence and a logical case that air pollution is (most likely) not causally related to acute deaths.” And Tony Cox—the one expected to be appointed to the clean air board—has long argued that the public health benefits of reducing ozone pollution are “unwarranted and exaggerated.”

Unlike with climate change, which scientists overwhelmingly agree is driven by humans, some peer-reviewed studies cast doubt on air pollution’s health impacts. But other peer-reviewed studies say air pollution’s health risks are even greater than we currently assume. And the majority of scientists agree that air pollution poses a threat to public health, and can trigger death in vulnerable populations. The disproportionate number of doubters on Pruitt’s science advisory team doesn’t reflect that robust debate happening within the scientific community. Instead, it drastically tips the scales in favor of Pruitt’s deregulatory policy agenda. Or as Milloy, the EPA transition team member and CPAC panelist put it on Tuesday afternoon, “More winning!”

[New Republic]

Trump: I want to focus on North Korea not ‘fixing somebody’s back’

President Trump praised health care block grants on Saturday, saying they allow the states to focus on health care, but said he would rather focus his energy on tensions with North Korea than “fixing somebody’s back or their knee.”

“You know in theory, I want to focus on North Korea, I want to focus on Iran, I want to focus on other things. I don’t want to focus on fixing somebody’s back or their knee or something. Let the states do that,” the president told Mike Huckabee on the Trinity Broadcasting Network’s “Huckabee.”

“The block grant concept is a very good concept, and if you have good management, good governors, good politicians in the state, it’ll be phenomenal,” he continued.
“I could almost say we are just about there in terms of the vote, so I expect to be getting health care approved,” he said.

Trump’s comments come after Senate Republicans failed twice this year to fulfill a seven-year campaign promise of repealing and replacing ObamaCare.

The latest repeal and replace failure was the Graham-Cassidy bill, which included block grants to states.

However, the legislation failed after Sens. John McCain (Ariz.), Rand Paul (Ky.) and Susan Collins (Maine) announced their opposition to the bill last month, effectively killing it.

Trump has expressed frustration in his Republican colleagues in the Senate for their health care failure, so much so that he called Senate Minority Leader Charles Schumer (D-N.Y.) on Friday to discuss the issue.

The move is likely to unsettle Republicans on Capitol Hill who have been working with Trump on tax reform in recent weeks.

[The Hill]

Trump buried in mockery for false claim he ‘has the votes’ to repeal Obamacare: ‘News to everyone in the Senate’

During his Indianapolis speech touting tax reform, President Donald Trump claimed the GOP “has the votes” to pass the party’s unpopular Obamacare repeal and replace bill — despite it being pulled from a Senate floor vote and effectively killed the day prior.

Naturally, Twitter took Trump to task for this week’s latest false claim.

“This would be news to literally everyone in the Senate,” Reuters’ Pete Schroeder tweeted.

“Fact check: No, he doesn’t,” CNN’s Jim Acosta responded.

His bold claim during his tax reform speech was not the first time Trump claimed the GOP had votes that didn’t exist that day. Earlier, he said they had the votes, but could not pass it because “there’s an ailing senator in the hospital” — another false claim.

[Raw Story]


Trump Keeps Lying Graham-Cassidy Failed Because a Senator’s in the Hospital

Appearing on Fox & Friends this morning, Donald Trump explained that Republicans “have the votes” to pass the Graham-Cassidy health care bill but the legislation nonetheless can’t pass because a crucial senator is in the hospital.

In reality, there is no hospitalized senator. But Trump has constructed for himself an alternative version of reality in which not only is there a hospitalized senator but the budget reconciliation instructions which expire tomorrow somehow return early next year, meaning that when the fake senator’s hospitalization ends they’ll be able to come back and pass the bill.

Fox & Friends host Pete Hegseth, remarkably, did not press Trump on this extraordinary claim.

But Trump keeps saying it. The “hospitalized senator” theory first appeared on his Twitter account Wednesday morning.

Then during his tax reform comments later that day he made a modified version of the claim, saying the issue was that “we have a wonderful senator, great, great senator, who is a yes vote, but he’s home recovering from a pretty tough situation.”

This appears to be a reference to Sen. Thad Cochran who, though not hospitalized, is at home recuperating from some kind of urological issue.

However, Trump appears to have cause and effect reversed here. According to Cochran’s staff, he is resting in Mississippi because there are no crucial senate votes rather than the senate not holding votes because Cochran is in Mississippi. No less an authority than Bill Cassidy stated flatly on Tuesday that “we don’t have the votes” with John McCain, Susan Collins, Lisa Murkowski, and Rand Paul all publicly opposed. Indeed, the real question regarding the whip count seems to be whether or not the bill really has the unanimous support of all the other senators, or if a handful of private opponents are simply laying low and letting those four take the heat.

Either way, the situation poses the obvious question of why Trump is saying this.

Is he trying to mislead his supporters? Is someone on his staff trying to mislead him? Has he become confused and nobody on his staff wants to correct him?



Trump Falsely Claims Americans With Pre-Existing Conditions Are Guaranteed Coverage Under New Health Bill

President Donald Trump and Republicans on Capitol Hill are trying to assure Americans their latest effort to repeal and replace the Affordable Care Act (ACA) covers people with pre-existing conditions.

Both the president and Senator Lindsey Graham (R-S.C.), who with Senator Bill Cassidy (R-Louisiana) is co-sponsoring the health care bill known as the “Graham-Cassidy plan,” took to Twitter to defend the legislation, expected to be up for a vote on the Senate floor next week. “I would not sign Graham-Cassidy if it did not include coverage of pre-existing conditions. It does! A great bill,” Trump wrote Wednesday night. “Repeal & Replace.”

Graham quoted the president’s tweet later Wednesday, adding that any claims his bill doesn’t cover those with pre-existing conditions should be called “#FakeNews on steroids!”

Unlike former President Barack Obama’s landmark health care law, however, the new Republican bill would not guarantee coverage for people living with pre-existing conditions. Instead, the Graham-Cassidy plan would disproportionately harm sick people and Americans living with a variety of medical factors, who could see their insurance costs soar if the legislation were to pass.

The bill would allow states to opt to waive Obamacare rules requiring basic health benefits, essentially cutting protections for sick people in an effort to keep premiums from rising. The waivers allow states to charge more for health insurance offered to people with pre-existing conditions—including cancer, heart disease, Alzheimer’s (or dementia), cerebral palsy and even pregnancy, among other medical factors that could have resulted in denied coverage prior to Obamacare—while continuing to receive federal block grant funding.

Experts say the bill could raise health care costs for those with pre-existing conditions to a point where insurance would be virtually unaffordable for millions of people.

The Graham-Cassidy plan would allow states to more easily gut protections for sick people than the previous Senate bill, the Better Care Reconciliation Act, as well as the House’s failed effort, the American Health Care Act. The earlier Senate bill would have let states request a reduction from the federal government in what was considered “essential health benefits,” while the House bill would have allowed states to charge more for people living with certain pre-existing conditions when searching for insurance.

The new bill—seen by House Majority Leader Paul Ryan as “our best, last chance” to repeal Obamacare—has received criticism from the even health care industry, which said it would damage existing benefits and do little to reduce insurance premiums that continue to tick upward for millions of Americans.

“The Graham-Cassidy plan would take health insurance coverage away from millions of people, eliminate critical public health funding, devastate the Medicaid program, increase out-of-pocket costs and weaken or eliminate protections for people living with pre-existing conditions,” Georges Benjamin, executive director of the American Public Health Association, said in a statement.

Meanwhile, Democrats are warning that if a sudden vote on the legislation is held before the nonpartisan Congressional Budget Office (CBO) can issue a full report on it, there could be serious implications for years to come.

“Thus far, every version of Republicans’ effort to repeal and replace the ACA has meant higher health costs, millions of hard-working Americans pushed off coverage, and key protections gutted with devastating consequences for those with pre-existing conditions,” House Minority Leader Nancy Pelosi wrote in a letter Monday to CBO Director Keith Hall. “A comprehensive CBO analysis is essential before Republicans force a hasty, dangerous vote on what is an extreme and destructive repeal bill.”

So, while those with pre-existing conditions wouldn’t have their insurance suddenly ripped away, the Graham-Cassidy plan could make it increasingly difficult for sick Americans to afford any insurance at all. Until the CBO is able to fully assess the latest Republican-led attempt to overhaul the nation’s health care system, the bill’s total impact will remain unknown.



The key section lies in the bill’s rules for state waivers from many regulations in the Affordable Care Act (starting at page 8 in the bill.) If a state says it “intends to maintain access to adequate and affordable health insurance coverage for individuals with pre-existing conditions,” then it can allow insurance companies to charge sick people more than healthy ones.

Interior Dept. Halts Study Into Appalachian Mining Technique’s Likely Health Hazards

The Trump administration has halted a study of the health effects of a common mining technique in Appalachia, which is believed to deposit waste containing toxic minerals in ground waters.

A letter from the Interior Department directed the National Academies of Sciences, Engineering and Medicine to “cease all work” on a study of the potential health risks of mountaintop removal mining for people living near surface coal mine sites in central Appalachia. The Interior Department acknowledged in a statement that it had “put on hold” $1 million in funding for the two-year project as part of a review of its grants, which is focused on “responsibly using taxpayer dollars.”
“The Trump Administration is dedicated to responsibly using taxpayer dollars and that includes the billions of dollars in grants that are doled out every year by the Department of the Interior,” the statement said.

Still, the National Academies — a nongovernmental institution that researches and advises the government on science and technology — plans to move forward with part of the research, and will hold previously scheduled public meetings this week in Kentucky, the Academies said in a statement.

Political reaction was swift to the Trump administration’s decision to suspend the study of “the potential relationship between increased health risks and living in proximity to sites that have been or are being mined or reclaimed for surface coal deposits,” which began last year and was expected to take two years to complete.

“Mountaintop removal mining has been shown to cause lung cancer, heart disease, and other medical problems,” Democratic Rep. Raul Grijalva of Arizona, the ranking democrat on the House Committee of Natural Resources, said in a statement.
“Clearly this administration and the Republican Party are trying to stop the National Academy of Sciences from uncovering exactly how harmful this practice is,” Grijalva said.

“It’s infuriating that Trump would halt this study on the health effects of mountaintop removal coal mining, research that people in Appalachia have been demanding for years,” said Bill Price, Senior Appalachia Organizing Representative for environmental advocacy group Sierra Club’s Beyond Coal campaign.


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