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The Affordable Care Act has real problems, but Republicans don’t have the solutions.

The Trump administration is so concerned that the Affordable Care Act is failing that it wants the program to fail even more. 

On Monday the Department of Health and Human Services released a report on insurance coverage trends for people who obtain coverage on their own rather than through employers. Although the report provided a broad overview of enrollment trends, as previous agency reports have, this brief focused much more heavily on one group: people who buy private plans without the help of federal tax credits that the Affordable Care Act has made available.

Mostly, these are people who make more than four times the poverty line, or roughly $49,000 a year for an individual or $100,000 a year for a family of four, because that’s the income cutoff for the tax credits. They get their insurance through a variety of sources ― in some cases through or one of the state-run exchanges like Covered California and in other cases through brokers, privately run websites or directly from insurers.

Average monthly enrollment among people in this group fell by 20 percent from 2016 to 2017, HHS found. That works out to about 1.3 million fewer people buying unsubsidized private coverage. The government’s findings are broadly similar to the results of a study that researchers at the Henry J. Kaiser Family Foundation, using data from the consulting firm Mark Farrah Associates, unveiled last week.   

This trend toward declining coverage among unsubsidized buyers is worrisome. It’s consistent with a broader story that close observers of the health care system have understood for some time ― namely, that the impact of the Affordable Care Act varies a lot depending on where you live and, especially, how much money you make.

A central question in health care policy right now is what to do for those people who are really struggling.

How Obamacare Works ― And Doesn’t Work

The basic idea behind the Affordable Care Act’s regulation of private coverage was to upgrade the policies available to people who buy policies on their own, to take care of people who couldn’t get or afford decent coverage before. That meant prohibiting insurers from charging higher premiums or denying coverage to people with existing conditions. It also meant requiring that all policies limit out-of-pocket expenses and include 10 essential benefits, including mental health and maternity care.

These changes, though popular, have necessarily made insurance more expensive, because they mean insurers must pay medical bills they were once able to avoid. By design, the new federal tax credits offset that effect, in much the same way that people with job-based health benefits get an indirect tax subsidy through their employers.

People who qualify for the Affordable Care Act’s premium tax credits can get coverage at relatively low cost. But
People who qualify for the Affordable Care Act’s premium tax credits can get coverage at relatively low cost. But the minority of buyers who don’t qualify for that assistance can face staggering premiums.

The majority of Americans buying coverage on their own qualify for those subsidies and, by and large, they’re doing OK. They are finding insurance, sometimes for dirt cheap or even no cost at all, and it’s helping them get care they need, even if they live with diabetes, survived cancer or have other medical issues that would have disqualified them from coverage in the old days.

But the minority of consumers who don’t qualify for assistance ― that is, the ones the HHS report spotlights ― have to pay full price for coverage that, for many of them, is simply more expensive than they can afford.

These people aren’t poor, but in many cases they aren’t rich either. Some would have to fork over one-fifth of their income for premiums, not even accounting for the out-of-pocket costs they face with virtually every instance of medical treatment. (Deductibles on some family plans exceed $10,000.) Many people are dropping coverage rather than pay such high rates.

How Neglect And Sabotage Affected The Program

Republicans have long used stories of people struggling with these premiums to attack Obamacare, and on Monday, Seema Verma, the administration official who oversees Affordable Care Act implementation, did just that, saying the new figures are proof that the law is failing consumers and that some markets are in the throes of a “death spiral.” 

“The market is NOT WORKING for the unsubsidized,” she said in a tweet.

Almost nobody, not even the law’s most ardent defenders, disputes that the law has real and serious shortcomings ― or that those shortcomings have meant sky-high premiums for some people, especially those whose incomes are just above the threshold to qualify for assistance. 

Progressive analysts and even some Democrats worried a lot about this in 2009 and 2010, when the program was coming together in Congress. Some pushed, unsuccessfully, to make the tax credits more generous and available to more people ― precisely to make sure consumers didn’t get stuck with premiums they couldn’t handle.

Sen. Marco Rubio (R-Fla.) led a successful effort to cut funding for a program that was supposed to insulate insurers from lo
Sen. Marco Rubio (R-Fla.) led a successful effort to cut funding for a program that was supposed to insulate insurers from losses in the ACA’s early years. It was a major blow to the newly reformed insurance markets.

But design flaws in the Affordable Care Act are by no means the full story here. Almost from Day One, the law has been subject to neglect and sabotage by Republican officials. In states like Florida, state-level Republicans refused to promote enrollment and in some cases issued regulations that made outreach even more difficult. In states like Iowa and Tennessee, GOP officials made it easy for insurers to keep offering plans that didn’t comply with the Affordable Care Act’s rules. This reliably drew healthy customers away from comprehensive plans, forcing insurers to raise prices for those plans and depressing enrollment.

In Washington, Republicans in Congress gutted funding for a risk corridor program that was supposed to let insurers absorb losses in early years. That dealt a heavy blow to insurers, knocking some out of the market.

And that was all before Donald Trump took office. Since early 2017, even as efforts to repeal the Affordable Care Act have faltered, the administration has cut funding for outreach (and is proposing to further cut it next year) while yanking a special set of payments that reimburse insurers for plans they offer for the lowest-income consumers.

Probably the single biggest blow came late last year, when Republicans passed and Trump signed a tax bill targeting the individual mandate, which requires people to have coverage or face a financial penalty. That penalty, which the tax bill will reduce to zero, is supposed to induce healthy people to get coverage, thereby stabilizing markets and allowing insurers to keep premiums lower. Insurers across the country have already proposed extra premium increases for 2019, when the penalty zeroes out, because they expect to get fewer healthier customers.

Not all GOP sabotage efforts worked out as intended. And the program has in many respects proved surprisingly resilient, which is why, absent a full repeal, millions will continue to get financial security and health care because of it.

But the overall effect has been to weaken the program and make insurance more expensive for the unsubsidized.

Yes, that’s the very problem Verma was bemoaning on Monday.

What The Trump Administration Will Do Next

And things will almost surely get worse next year because of another regulatory change the administration is about to introduce. Sometime this month, HHS is expected to finalize a rule that will loosen restrictions on short-term insurance plans that, like the old plans, usually lack key benefits and aren’t available to people with existing conditions.  

The original idea of short-term plans was to provide stopgaps for people with coverage lapses. Once the rule change is in place, more people will be able to use these plans as a substitute for year-round insurance ― in other words, as their primary way of paying medical bills. 

Verma and other Trump administrations officials say these plans are a form of relief, because, after all, they will be a lot cheaper than the coverage available today. In addition, some of those unsubsidized people currently priced out of coverage will start buying these plans and be better off than if they had no insurance at all.

But the short-term plans will have many benefit holes. Most of the ones available now don’t even cover prescriptions. As a result, anybody who needs medical attention could face staggering, potentially ruinous medical bills with one of these plans.

And of course, the plans will be available only to people who don’t have existing conditions. About 1 in 4 nonelderly adults has a condition that would trigger coverage denial, Kaiser Foundation researchers concluded.

Donald Trump campaigned on a promise to give people “great, great” health insurance. The plans his admi
Donald Trump campaigned on a promise to give people “great, great” health insurance. The plans his administration is about to approve leave out key benefits. Some don’t even cover prescriptions.

The promotion of short-term plans is emblematic of the GOP’s general approach to health care, which is to scale back or eliminate the requirements for what insurance covers. This frees up insurers to offer cheap, skimpy plans that are attractive to people in relatively good health while transferring the financial burden for medical problems onto those who get sick.

Alternatives exist. Democrats have talked with increasing urgency about addressing the needs of people who still can’t afford coverage ― whether through straightforward increases in financial assistance or more sweeping schemes that envision creating a new public insurance program like Medicare that would be available to all Americans and perhaps even displace private insurance altogether.

Each of these ideas has its upsides and downsides. But Democrats can’t do much with any of them until they have power in Washington. That would take an election cycle and probably two. Until then, the future of the Affordable Care Act remains in the hands of officials and lawmakers determined to undermine it ― and then cite its shortcomings as reason to wreck it even more.



Rochester School Won’t Let Its First Black Valedictorian Speak, So Mayor Does

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Jaisaan Lovett of Rochester, New York, became the first black valedictorian in his school’s history. As graduation approached, he expected to give a speech at the commencement ceremony for the University Preparatory Charter School for Young Men, just as past valedictorians had done.

But for reasons that remain unclear, that speaking invitation didn’t come. And according to Lovett, when he sought permission to give remarks from the school’s principal, Joseph Munno, the answer was no. 

“He didn’t want to see the speech or what it said, nothing,” Lovett said in an interview with The Rochester Democrat and Chronicle. “He just said no.”

Rochester Mayor Lovely Warren, for whose office Lovett works as an intern, intervened. Upon hearing what happened to Lovett, who will go on to study with a full scholarship at Clark Atlanta University, she gave him a platform to deliver his speech. Then she posted video of the speech to YouTube, and shared the post on Facebook and Twitter. 

″Unfortunately Jaisaan’s school did not allow him to give his valedictorian speech,” Warren said before handing the mic over to Lovett. “For some reason, his school, in a country where freedom of speech is a constitutional right, and the city of Frederick Douglass, turned his moment of triumph into a time of sorrow and pain.” 

Lovett then delivered his speech, which sought to inspire others to succeed and thanked his parents for supporting him during his time at UPrep. He also took a moment to address his principal, who he said he had clashed with in the past.

“I’m here as the UPrep 2018 valedictorian to tell you that you couldn’t break me. I’m still here, and I’m still here strong,” Lovett said.

As news of the school’s refusal and the mayor’s intervention went viral, the UPrep Board of Trustees posted a message on the school’s Facebook page indicating they were looking into the situation and unable to comment publicly due to privacy reasons. The school did not respond to HuffPost’s request for comment.

“We are aware of the concern with the Valedictorian not speaking at graduation. The Board will be reviewing the circumstances regarding what happened and looking into the related guidelines and school policies,” the message states. “UPrep wishes Jaisaan Lovett, the first black Valedictorian in the school’s four year graduation history, much success as he continues his education at Clark Atlanta University.”

The UPrep ruckus comes weeks after school officials cut the mic during a valedictorian’s commencement address in California. 

Petaluma High School senior Lulabel Seitz was abruptly silenced when she was about to talk about being sexually assaulted at school and the administration’s handling of her experience. She finished her remarks without a microphone at graduation and posted video of her speech in its entirety to YouTube.

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Russia Tried To Help Trump Win 2016 Election, Senate Intelligence Committee Reaffirms

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“The Russian effort was extensive and sophisticated, and its goals were to ... hurt Secretary Clinton and to help Donald Trump.”

A Senate Intelligence Committee report released on Tuesday supports three U.S. intelligence agencies’ conclusion that Russia tried to help Donald Trump win the 2016 U.S. presidential election.

The Republican-led committee’s finding suggests the panel continues to conduct a bipartisan inquiry into the issue amid political rancor between Republicans and Democrats on allegations that Moscow interfered in the election.

“As numerous intelligence and national security officials in the Trump administration have since unanimously re-affirmed, the (Intelligence Community Assessment’s) findings were accurate and on point,” said committee Vice Chairman Mark Warner, a Democrat.

“The Russian effort was extensive and sophisticated, and its goals were to undermine public faith in the democratic process, to hurt Secretary Clinton (Democratic candidate Hillary Clinton) and to help Donald Trump,” Warner said.

Separate from congressional inquiries, U.S. Special Counsel Robert Mueller is investigating whether any Republican Trump’s election campaign members coordinated with Moscow officials.

Neither the Office of the Director of National Intelligence, which reported the intelligence agencies’ findings in January 2017, nor the Senate committee has concluded that Trump’s campaign or aides colluded with Russia.

The committee is still investigating any possible collusion, interviewing witnesses and collecting evidence, officials said.

White House spokesman Hogan Gidley, asked by reporters on Tuesday about the Senate panel’s report while traveling with Trump on Air Force One to West Virginia, said: “The president has been very clear and has said it many times that he feels the Russians meddled in the election.”

The U.S. House of Representatives Intelligence Committee, dominated by Republicans sympathetic to Trump, found no conclusive evidence proving collusion. But House panel Republicans, in a report on April 27, did say that Russia ran an information warfare campaign to disrupt the election.

The Kremlin denies meddling and Trump denies collusion. On June 28, Trump said on Twitter that “Russia continues to say they had nothing to do with Meddling on Our Election!”

The following day, however, he told reporters that he planned to raise the issue with Russian President Vladimir Putin when they meet on July 16 in Helsinki.

According to public records and congressional officials, the Senate Intelligence Committee report is the latest of four election-related inquiries on which the panel’s Republicans and Democrats continue to cooperate.

Earlier, the committee held a public hearing and issued a report on the security of U.S. election systems, on which there was no partisan dissent. 

Committee Democrats also are collaborating with Republicans on an inquiry that is likely to cite former President Barack Obama and his administration for moving too slowly to probe evidence of Russian interference in the 2016 election.

Committee Democrats and Republicans also are working together on an examination of the role social media played in influencing U.S. voters, and may hold hearings on that issue.





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