Gov. Greitens stumbles in bid to politicize the state education board

Gov. Eric Greitens’ clumsy efforts to replace the state’s respected education commissioner, Margie Vandeven, hit the latest of three obstacles when one of his State Board of Education nominees declined the governor’s appointment. Greitens was trying to replace a board member who says she was forced off the board after refusing to knuckle under to pressure from a Greitens aide to oust Vandeven.

Greitens’ attempt to politicize education by securing a majority of supporters on the eight-member, bipartisan board deserved the ridicule it received from longtime St. Louis board member Mike Jones, who labeled the latest bid “an amateur performance.” Jones said he doesn’t know why Greitens wants to get rid of Vandeven, who he said is well-regarded and has improved elementary and secondary education opportunities.

That’s the crux of the issue. Why does the governor want to replace someone with a proven record, who is respected by educators, simply so he can install his own choice? Performance on the job apparently isn’t a criterion. Greitens seems to want a commissioner blindly dedicated to a national Republican education agenda that gives budgetary priority to school choice over strengthening public education.

The board selects the education commissioner for grades K-12 and helps establish education policy. It also defines testing requirements, accredits school districts, sets teacher certification rules, oversees school operations and makes budget recommendations. There can be no more than four members from the same political party on the board.

The board is designed to be fairly independent and removed from partisan politics. The governor can appoint members who likely share his perspective on education, but it’s understood that the board is not an arm of the state executive’s office.

(Excerpted from St. Louis Post Dispatch 9/20/17

Graham-Cassidy ACA Repeal Bill Would Cause Huge Premium Increases for People with Pre-Existing Conditions

With only two weeks left to move forward with a partisan health care repeal bill, some Senate Republicans are trying one last time to rip coverage from millions of Americans. Their latest effort, introduced by Sens. Lindsey Graham (R-SC) and Bill Cassidy (R-LA), would make devastating cuts to Medicaid and cut and eventually eliminate funding that helps people in the individual insurance market afford coverage, leading to at least 32 million fewer people having coverage after 2026.

Those who did not lose coverage would see their premiums increase significantly. In the first year, premiums would increase by 20 percent. But the increases would be even greater for people with pre-existing conditions because the bill would let insurers in the individual market charge a premium markup based on health status and history, which could increase their premiums by tens of thousands of dollars.

Based on our analysis, we estimate that individuals with even relatively mild pre-existing conditions would pay thousands of dollars above standard rates to obtain coverage. For example, an individual with asthma would face a premium surcharge of $4,340. The surcharge for diabetes would be $5,600 per year. Coverage could become prohibitively expensive for those in dire need of care: Insurers would charge about $17,320 more in premiums for pregnancy, $26,580 more for rheumatoid arthritis and other autoimmune disorders, and $142,650 more for patients with metastatic cancer.

And this analysis does not account for surcharges that would result from individuals’ previous health conditions. Scarce data exist on pre-ACA rate-ups, but insurers raised premiums for individuals based on health history, not just current health status. Without pre-existing condition protections, cancer survivors now free of the disease or patients who underwent successful surgery years ago could find themselves facing significant surcharges as well.

(Excerpted from Center for American Progress 9/18/17)

Complacency Could Kill Health Care

Republican attempts to destroy Obamacare have repeatedly failed, and for very good reason. Their attacks on the Affordable Care Act were always based on lies, and they have never come up with a decent alternative.

The simple fact is that all the major elements of the A.C.A. — prohibiting discrimination by insurers based on medical history, requiring that people buy insurance even if they’re currently healthy, premium subsidies and Medicaid expansion that make insurance affordable even for those with lower incomes — are there because they’re necessary. Yet every plan Republicans have offered would do away with or undermine those key elements, causing tens of millions of Americans to lose health insurance, with the heaviest burden falling on the most vulnerable.

All this should be clear to everyone by now. So you might be tempted to assume that no plan along these lines can possibly pass, let alone one that, if anything, looks worse than what we’ve seen so far. But it’s precisely because so many people assume that the threat is behind us, and have turned their attention elsewhere, that health care is once again in danger.

The sponsors of the Graham-Cassidy bill now working its way toward a Senate vote claim to be offering a moderate approach that preserves the good things about Obamacare. In other words, they are maintaining the G.O.P. norm of lying both about the content of Obamacare and about what would replace it.

In reality, Graham-Cassidy is the opposite of moderate. It contains, in exaggerated and almost caricature form, all the elements that made previous Republican proposals so cruel and destructive. It would eliminate the individual mandate, undermine if not effectively eliminate protection for people with pre-existing conditions, and slash funding for subsidies and Medicaid. There are a few additional twists, but they’re all bad — notably, a funding formula that would penalize states that are actually successful in reducing the number of uninsured.

Did this bill’s sponsors — Lindsey Graham, Bill Cassidy, Ron Johnson and Dean Heller — manage to get through months of health care debate without learning anything about the issue? Maybe. But surely the rest of the Senate, not to mention much of the public, has wised up about false Republican promises. A huge majority of voters, almost two to one, consider it a good thing that previous attempts at repealing and replacing Obamacare failed.

Yet there is a real chance that Graham-Cassidy, which is similar to but even worse than previous Republican proposals, will nonetheless become law, because not enough people are taking it seriously.

As in the presidential election, we start from a baseline of extreme tribalism, in which 48 or 49 Republican senators will vote for anything, no matter how awful, that bears their party’s seal of approval. To make a bill the law, its sponsors only need to win one or two more votes.

The main reason Republican leaders couldn’t do that on previous health bills was public outrage and activism. Letters and phone calls, demonstrators and crowds at town halls, made it clear that many Americans were aware of the stakes, and that politicians who voted to take health care away from millions would be held accountable.

Now, however, the news cycle has moved on, taking public attention with it. Many progressives have already begun taking Obamacare’s achievements for granted, and are moving on from protest against right-wing schemes to dreams of single-payer. Unfortunately, that’s exactly the kind of environment in which swing senators, no longer in the spotlight, might be bribed or bullied into voting for a truly terrible bill.

(Excerpted from Krugman, New York Times 9/18/17)

Amid Opioid Crisis, Insurers Restrict Pricey, Less Addictive Painkillers

At a time when the United States is in the grip of an opioid epidemic, many insurers are limiting access to pain medications that carry a lower risk of addiction or dependence, even as they provide comparatively easy access to generic opioid medications.

The reason, experts say: Opioid drugs are generally cheap while safer alternatives are often more expensive.

Drugmakers, pharmaceutical distributors, pharmacies and doctors have come under intense scrutiny in recent years, but the role that insurers — and the pharmacy benefit managers that run their drug plans — have played in the opioid crisis has received less attention. That may be changing, however. The New York State attorney general’s office sent letters last week to the three largest pharmacy benefit managers — CVS Caremark, Express Scripts and OptumRx — asking how they were addressing the crisis.

ProPublica and The New York Times analyzed Medicare prescription drug plans covering 35.7 million people in the second quarter of this year. Only one-third of the people covered, for example, had any access to Butrans, a painkilling skin patch that contains a less-risky opioid, buprenorphine. And every drug plan that covered lidocaine patches, which are not addictive but cost more than other generic pain drugs, required that patients get prior approval for them.

In contrast, almost every plan covered common opioids and very few required any prior approval.

The insurers have also erected more hurdles to approving addiction treatments than for the addictive substances themselves, the analysis found.

Alisa Erkes lives with stabbing pain in her abdomen that, for more than two years, was made tolerable by Butrans. But in January, her insurer, UnitedHealthcare, stopped covering the drug, which had cost the company $342 for a four-week supply. After unsuccessfully appealing the denial, Ms. Erkes and her doctor scrambled to find a replacement that would quiet her excruciating stomach pains. They eventually settled on long-acting morphine, a cheaper opioid that UnitedHealthcare covered with no questions asked. It costs her and her insurer a total of $29 for a month’s supply.

The Drug Enforcement Administration places morphine in a higher category than Butrans for risk of abuse and dependence. Addiction experts say that buprenorphine also carries a lower risk of overdose.

(Excerpted from New York Times 9/18/17)

GOP eying ‘blue slip’ break to help Trump fill the courts

Momentum is building in the Senate for doing away with an arcane rule that allows senators to block some of President Trump’s judicial nominees.

The “blue-slip” rule — a precedent upheld by Senate tradition — allows a home-state senator to stop a lower-court nominee by refusing to return a sheet of paper, known as a blue slip, to the Judiciary Committee.

Conservatives have clamored for months to get rid of the rule, arguing Democrats are abusing the process to block qualified nominees.

They recently gained a powerful ally: Senate Majority Leader Mitch McConnell (R-Ky.), at least when it comes to picks for the U.S. courts of appeals.

“My personal view is that the blue slip, with regard to circuit court appointments, ought to simply be a notification of how you’re going to vote, not the opportunity to blackball,” McConnell told The New York Times.

He added that he supports keeping the blue slip rule for district court judges, whose decisions can get appealed to the circuit court.

With Trump and congressional Republicans struggling to rack up major legislative wins — they have, so far, failed to repeal ObamaCare and tax reform is months behind schedule — the courts offer perhaps the best path for the GOP to make lasting change in the majority.

Because the Senate’s “blue slip” practice isn’t a rule but a tradition enforced by the Judiciary Committee chairman, the decision on whether or not to move forward ultimately rests with Sen. Chuck Grassley (R-Iowa.). But Democrats are prepared to test the issue.

(Excerpted from The Hill 9/18/17)

Senate GOP tries one last time to repeal Obamacare

Obamacare repeal is on the brink of coming back from the dead.

Senate Majority Leader Mitch McConnell (R-Ky.) and his leadership team are seriously considering voting on a bill that would scale back the federal government’s role in the health care system and instead provide block grants to states, congressional and Trump administration sources said.

GOP leader has told his caucus that if the bill written by Sens. Lindsey Graham (R-S.C.) and Bill Cassidy (R-La.) has the support of at least 50 of the 52 GOP senators, he will bring it to the floor, Graham and Cassidy say. That would give Republicans one more crack at repealing the Affordable Care Act, a longtime party pledge.

Right now, support for the bill — which would replace Obamacare’s tax subsidies with block grants, end the law’s individual insurance mandate and scale back its Medicaid expansion — among Republican senators is short of 50 votes. But McConnell and his lieutenants will gauge support this week in private party meetings with help from President Donald Trump, administration and Capitol Hill sources said.

“McConnell and his team are engaged and serious about the vote and working with the conference to build support for Graham-Cassidy,” a source familiar with the bill’s prospects said Sunday. The “White House is also operating with all hands on deck.”

(Excerpted from Politico 9/17/17)

The Justice Department goes out of its way to side against a gay couple

SHOULD A Colorado baker have the right to turn away a gay couple seeking a custom wedding cake if he disapproves of their upcoming marriage? According to the Justice Department, the answer is yes.

The Supreme Court will soon hear arguments over the conduct of this unwilling baker in Masterpiece Cakeshop v. Colorado Civil Rights Commission. Though the federal government isn’t a party to the case, the Justice Department has made a point of weighing in on the side of Jack Phillips, the “cake artist” whose religious opposition to same-sex marriage led him to refuse to design a cake for a gay couple. (The pair eventually obtained a rainbow-layered cake.)

The Justice Department’s legal brief has — rightly — faced criticism from civil rights groups appalled by the government’s argument that Mr. Phillips’s religious beliefs grant him a constitutional right to discriminate against gay customers, despite a Colorado public-accommodations law prohibiting unequal treatment on the basis of sexual orientation. Indeed, the brief is a dispiriting signal of Attorney General Jeff Sessions’s priorities. The government went out of its way to side with Mr. Phillips, but it has been quiet on any number of other significant cases before the Supreme Court this term.

The Justice Department’s effort to craft a narrow exception to public-accommodations law risks blowing a hole through the fabric of that law entirely. Mr. Phillips is providing a service to his customers for pay. While he does so, he should be subject to anti-discrimination laws like every other business is.

(Excerpted from Washington Post 9/13/17

President Trump’s War on Science

The news was hard to digest until one realized it was part of a much larger and increasingly disturbing pattern in the Trump administration. On Aug. 18, the National Academies of Sciences, Engineering and Medicine received an order from the Interior Department that it stop work on what seemed a useful and overdue study of the health risks of mountaintop-removal coal mining.

The $1 million study had been requested by two West Virginia health agencies following multiple studies suggesting increased rates of birth defectscancer and other health problems among people living near big surface coal-mining operations in Appalachia. The order to shut it down came just hours before the scientists were scheduled to meet with affected residents of Kentucky

 From Day 1, the White House and its lackeys in certain federal agencies have been waging what amounts to a war on science, appointing people with few scientific credentials to key positions, defunding programs that could lead to a cleaner and safer environment and a healthier population, and, most ominously, censoring scientific inquiry that could inform the public and government policy.

This is a president who has never shown much fidelity to facts, unless they are his own alternative ones. Yet if there is any unifying theme beyond that to the administration’s war on science, apart from its devotion to big industry and its reflexively antiregulatory mind-set, it is horror of the words “climate change.”

This starts with Mr. Trump, who has called global warming a hoax and pulled the United States from the Paris agreement on climate change. Among his first presidential acts, he instructed Scott Pruitt, the Environmental Protection Agency administrator, to deep-six President Obama’s Clean Power Plan, aimed at reducing carbon dioxide emissions from coal-fired power plants, and ordered Interior Secretary Ryan Zinke to roll back Obama-era rules reducing the venting from natural gas wells of methane, another powerful greenhouse gas.

Even the official vocabulary of global warming has changed, as if the problem can be made to evaporate by describing it in more benign terms. At the Department of Agriculture, staff members are encouraged to use words like “weather extremes” in lieu of “climate change,” and “build soil organic matter, increase nutrient use efficiency” instead of “reduce greenhouse gases.” The Department of Energy has scrubbed the words “clean energy” and “new energy” from its websites, and has cut links to clean or renewable energy initiatives and programs, according to the Environmental Data & Governance Initiative, which monitors federal websites.

(Excerpted from New York Times 9/9/17

The First White President

His political career began in advocacy of birtherism, that modern recasting of the old American precept that black people are not fit to be citizens of the country they built. But long before birtherism, Trump had made his worldview clear. He fought to keep blacks out of his buildings, according to the U.S. government; called for the death penalty for the eventually exonerated Central Park Five; and railed against “lazy” black employees. “Black guys counting my money! I hate it,” Trump was once quoted as saying. “The only kind of people I want counting my money are short guys that wear yarmulkes every day.” After his cabal of conspiracy theorists forced Barack Obama to present his birth certificate, Trump demanded the president’s college grades (offering $5 million in exchange for them), insisting that Obama was not intelligent enough to have gone to an Ivy League school, and that his acclaimed memoir, Dreams From My Father, had been ghostwritten by a white man, Bill Ayers.

In Trump, white supremacists see one of their own. Only grudgingly did Trump denounce the Ku Klux Klan and David Duke, one of its former grand wizards—and after the clashes between white supremacists and counterprotesters in Charlottesville, Virginia, in August, Duke in turn praised Trump’s contentious claim that “both sides” were responsible for the violence.

(Excerpted from The Atlantic October2017)