RUTHFULLY YOURS

Joel Zinberg, M.D., J.D., F.A.C.S., a visiting scholar at the American Enterprise Institute, is a practicing surgeon at Mount Sinai Hospital and an associate clinical professor of surgery at the Icahn School of Medicine.

In the near term, the health-care plan that the Senate released this week—officially, the Better Care Reconciliation Act (BCRA)—will provide stability to individual health-care markets and state governments. It commits to funding the cost-sharing reductions that insurers are required to provide, but which Congress had not funded adequately through 2019. This should calm insurers uncertain about staying in the individual-insurance markets. Anthem, a major insurance player in both the Affordable Care Act (ACA) marketplaces and Medicaid, has announced that the Senate bill “will markedly improve the stability of the individual market and moderate premium increases.” The Congressional Budget Office predicts that premiums will be 30 percent lower than under current law by 2020. The BCRA will also allow insurers to charge older enrollees up to five times what they charge 20-year-olds—the standard before the ACA—rather than the 3-to-1 limit that Obamacare imposes. This should make the market more attractive to insurers and insurance more affordable for young people, who have resisted signing up under the ACA.

The BCRA also delays the end of enhanced federal funding for Obamacare’s Medicaid expansion and begins phasing it out with a gradual reduction in the enhanced federal payment share between 2021 and 2024. States would be free after 2024 to continue coverage for the expanded population covered under the ACA, but at regular federal matching rates. This should give governors ample time to plan if and how they want to continue expanded Medicaid eligibility. It will also give them time to expand private insurance markets to those at or below the poverty line, since the BCRA removes the lower income limit on premium tax credits to purchase insurance. Adults displaced by the phase-out of the Medicaid expansion and residents of states that did not expand Medicaid could use these credits to purchase private insurance.

In the longer term, the BCRA makes it far more likely that Obamacare’s section 1332 “innovation waivers” can become effective tools for state-based experimentation and reforms to improve insurance coverage. These waivers let states modify or eliminate many central ACA provisions, including the rules regarding the premium tax credits and cost-sharing subsidies and which plans and essential health benefits (EHB) must be offered on the insurance exchanges. The BCRA ends ACA restrictions that have inhibited waiver applications. It also streamlines the application process and creates a $2 billion fund to motivate states to apply for waivers.

But the Congressional Budget Office’s prediction that the BCRA will lead to 22 million more uninsured by 2026 has dampened enthusiasm for the Republican proposal—even among Republicans. The problem is that the CBO’s estimates of coverage under current law are based on its March 2016 baseline, which is known to be inaccurate. The CBO predicts that the BCRA will decrease coverage in the non-group market, including marketplaces, by 7 million, yet concedes that “enrollment in the marketplaces under current law will probably be lower than was projected under March 2016 baseline used in this analysis.”

The CBO’s estimate that 15 million fewer people will be covered by Medicaid in 2026 as compared with current law is also suspect. About a third of this loss derives from people whom “CBO projects would, under current law, become eligible in the future as additional states adopted the ACA’s option to expand eligibility.” It’s unlikely that the 19 states that have thus far not expanded eligibility under the ACA would expand if the law remains unchanged, especially since, under Obamacare, states now have to start sharing some of the financial burden for these newly eligible enrollees with the federal government.

WASHINGTON—Cities and counties that don’t help federal immigration authorities could lose millions of dollars in federal grants under legislation that passed the House on Thursday, as Republicans ramp up their battle against so-called sanctuary cities.

The legislation represents the Republicans’ most aggressive effort yet to force local communities to cooperate with President Donald Trump’s aggressive immigration-enforcement policies.

Mr. Trump and his administration regularly spotlight undocumented immigrants who commit crimes, and on Wednesday he met with their victims. After the bills passed Thursday, Mr. Trump said the “implementation of these policies will make our communities safer.”

The bill, along with a companion enforcement measure, represents a contrast with the comprehensive immigration legislation long pushed by Democrats and some Republicans. Those proposals typically combine enforcement measures with pro-immigrant provisions such as the legalization of people living in the U.S. illegally. But Mr. Trump and his allies in Congress have showed little interest in a bipartisan approach.

Both bills passed largely on party lines, and both are expected to face strong opposition in the Senate, where they would need Democratic support to pass.

The first bill, called the “No Sanctuary for Criminals Act,” primarily aims to persuade local jurisdictions to hold people in jail when asked to do so by the Immigration and Customs Enforcement agency. Proponents in the Trump administration and elsewhere say releasing criminals who should be deported makes communities less safe, They add that asking a jail to hold someone for up to 48 hours is a reasonable request.

“By flagrantly disregarding the rule of law, sanctuary cities are putting lives at risk and we cannot tolerate that,” said House Speaker Paul Ryan (R., Wis.).

Many local communities don’t honor these ICE “detainer” requests today for a range of reasons. Some say cooperation would undermine trust in law enforcement in immigrant communities, making legal and illegal immigrants less likely to report crimes. Some cite court rulings that found local communities are liable if someone such as a U.S. citizen is wrongly held based on inaccurate information.

Under the legislation, jurisdictions would lose federal grants from the Justice and Homeland Security departments if they enact policies restricting assistance with the enforcement of federal immigration law. CONTINUE AT SITE

No immigrant who has come to America has had an easy beginning. The difficulties are reflected in learning a different language with its mind-boggling idioms, understanding a new culture, and ultimately needing to be self-sufficient. Often education in the immigrant’s country is insufficient or completely lacking. Even those who are well educated in their birth country need to return to school to become properly licensed according to American standards.

Yet “[b]etween 1850 and 1930, about one million Asians from China, Japan, Korea, the Philippines, and India came to the United States. But by the second half of the 19th century a backlash had developed [.]” The 1882 Chinese Exclusion Act created increasingly restrictive laws against Asians. At one point, a law passed by the California State Legislature and signed by the governor created a $50 tax per head for Chinese entering Californian ports that was to be paid within three days. The California Supreme Court later ruled the law unconstitutional.

This discrimination was not limited to the Chinese. In the early 20th century, “[h]otels and clubs refused Jews admittance, and universities established Jewish enrollment quotas. Industrialist Henry Ford, a popular public figure, openly expressed anti-Semitic sentiments.” A notorious incident of anti-Semitism took place in Georgia in 1913, when Leo Frank, a Jewish factory superintendent, was convicted, on circumstantial evidence, of murdering a young girl and was lynched.

Then there was the “[d]iscrimination against Roman Catholics in the U.S. [which] began in the Colonial era, when Catholics were few in number. However, in the 1840s, the Catholic population expanded significantly when thousands of Irish Catholics immigrated to the U.S. following Ireland’s potato famine. In the late 1800s, a second flood of Catholic immigrants came from Eastern Europe and Italy. Protestants feared Catholics, coming from customs which included communal religious hierarchies, would not adapt to the individualism promoted by democracy.”

Furthermore, “[a]mong the Italian immigrants arriving in the late 1900s were large numbers of young men from southern Italy who hoped to earn money for the impoverished families they left behind. Discrimination against southern Italians was rampant. Newspapers fostered theories that Sicilians and other southern Italians were intellectually inferior to northern Europeans.”

So, sadly, discrimination has existed against many groups who eventually became Americans and shared in the American dream.

There are never excuses for the irrationality of prejudice. The latest shift in this country is where whites are now demonized in subtle and blatant ways just for being white. It is an idea being fostered in the halls of higher learning.

In the Pacific Standard Magazine of March/April 2017, an essay titled “The Mexican American Dream” begins with the following: “Despite the rhetoric and hate crimes, Mexican immigrants are poised to reframe American culture, if white people would only let them.” Clearly a provocative opener, it sets the stage for the “us against them” mentality that seems to be propelling all conversations these days. The narrative has become a brown-black vs. white storyline and has taken on a decidedly nasty racist overtone.

With this backdrop, the reader is supposed to feel an emotional angst for the protagonist of the article, named Vianney, who was born to “undocumented” parents. Her father had a drinking problem, and there was domestic violence. Despite drinking, taking drugs, and almost “flunking out of school,” Vianney was propelled into the Music Academy at the Colburn School in L.A., where she excelled. Noting the differences between the “world she had grown up and the [white] world of privilege, wealth, and status,” at one point, she “really wanted to be white.” Eventually, she “stopped trying to make herself seem white and started to embrace her Latina heritage.”

WASHINGTON—President Donald Trump declared a new age of “energy dominance” by the U.S. on Thursday as he outlined plans to roll back Obama era restrictions and regulations meant to protect the environment.

In a speech at the Energy Department, the president promised to expand the country’s nuclear-energy sector and open up more federal lands and offshore sites to oil and natural-gas drilling.

Mr. Trump also celebrated his decision earlier this month to withdraw the U.S. from the 195-country Paris climate accord and the Environmental Protection Agency’s rescindment this week of the Obama administration’s clean-water rules that farmers and business groups found onerous.

“We don’t want to let other countries take away our sovereignty and tell us what to do and how to do it,” Mr. Trump said.

Mr. Trump also issued a special permit authorizing the construction of a new pipeline between the U.S. and Mexico that would carry fuels across the border in Texas, the State Department said.

The president’s intent to resurrect coal and nuclear power comes as many other countries are trying to curb their use. He made only scant mention of renewable energy such as solar and wind power, which now account for 10% of total U.S. electricity generation and a far higher percentage in some European countries.

Mr. Trump’s speech caps a week the White House has devoted to energy issues. The proposals Mr. Trump laid out are in keeping with the more robust approach to energy extraction he promised during last year’s campaign and offer another instance of the new administration acting quickly to reverse his predecessor’s policies.

“We applaud President Trump’s support of energy policies that secure and expand U.S. energy supplies and position our country as a world supplier,” Barry Worthington, executive director of the U.S. Energy Association, said in a statement. “An all-of-the-above energy strategy… advances U.S. energy security, but it also protects our allies.”

Environmental groups criticized the moves as shortsighted and perilous for the environment. “Trump’s dirty energy nightmare is a wake-up call for the country,” said Rhea Suh, president of the Natural Resources Defense Council. “We get the [environmental] harm, foreign countries get the power, and big oil, gas and coal take the profits.”

The Wilderness Society homed in on the Trump administration’s opening of more Arctic waters to exploration after President Barack Obama had excluded Arctic Ocean lease sales as one of his last moves in office.

Senate conservatives wish the health-care bill was more ambitious on deregulation, and so do we, though the benefits of its state waiver feature are underappreciated and worth more explanation. This booster shot of federalism could become the greatest devolution of federal power to the states in the modern era.

One of ObamaCare’s most destructive legacies is a vast expansion of federal control over insurance and medicine—industries that did not exactly lack supervision before 2010. This included annexing powers that traditionally belonged to states. The Obama Administration then used regulation to standardize insurers as public utilities and accelerate a wave of provider consolidation that has created hospital and physician oligopolies across the country.

Once in command, the federal government rarely eases off or returns control, but the Senate bill does. The Affordable Care Act included a process in which states could apply for permission to be exempted from some rules, but conditions are so onerous that these 1332 waivers have been mostly notional. The Senate Republican draft bill makes this process quicker, more flexible and broader, which could launch a burst of state innovation.

The Senate bill is broader than the House’s Meadows-MacArthur waivers that only apply to a few so-called Title I regulations. Creative Governors could use the 1332 exemptions to explore a wider variety of reforms to repair their individual insurance markets, lower premiums and increase access to care.

Introducing many competing health-care models across the country would be healthy. California and South Carolina don’t—and shouldn’t—have to follow one uniform prototype designed in Washington, and even a state as large as California doesn’t have the same needs from region to region.

If nothing else the repeal and replace debate has shown that liberals, conservatives and centrists have different health-care priorities, and allowing different approaches and experimentation would be politically therapeutic. The more innovative can become examples to those that stay heavily regulated.

Some conservatives in the Senate and the House are despondent because neither bill repeals the federal rules related to pre-existing conditions known as guaranteed issue and community rating. They’re right that these mandates are destructive. Community rating, which limits how much premiums can vary among people with different health status and risks, tends to blow up insurance markets, as ObamaCare is now showing.

But at least for now, conservatives have lost this political debate. There’s no Senate majority for catching the pre-existing conditions grenade, Governors aren’t hot on the idea either, and even insurers don’t want to return to the days of medical underwriting.

The Senate bet is that the 1332 waivers can help create enough of a recovery in insurance markets to overcome the distortions of these rules and bring down rates. The bill also relaxes ObamaCare’s age bands to a 5 to 1 ratio from a 3 to 1 ratio, meaning insurance for the oldest beneficiaries can be priced five times as high as for the youngest. Since age is a proxy for health risks and expenses, and a 5 to 1 ratio is close to the true actuarial cost of care, the policy result in practice is a wash.

Former President Barack Obama is joining the demagogic slugfest against the GOP’s latest bill to repeal and replace Obamacare. He claims the bill would “ruin Medicaid.”

Not so fast, Obama. Your health care law ruined Medicaid. Now, about half of all women who give birth in the United States are on Medicaid, a staggering figure.
The Republican bill, awaiting Senate action, will reform Medicaid, restoring its original mission and ensuring its future.

Medicaid was created in 1965 as a safety net for the poor. But Obamacare distorted it, edging the U.S. closer to a Medicaid-for-all or single-payer system. Swelling the Medicaid rolls — not making private insurance affordable — is the main way Obamacare dealt with the uninsured.

Almost 75 million people are now enrolled, 20 million more than in Medicare, the program for the elderly. If the repeal bill doesn’t pass, Medicaid enrollment will soar to 86 million by 2026, according to a Congressional Budget Office analysis released Monday.

Who’s picking up the tab for this vast Medicaid expansion? You. Worse, you pay twice — once as a taxpayer, and then again as an insurance consumer. Families with private insurance pay $1,500 to $2,000 or more in added premiums yearly already to keep Medicaid afloat. The more Medicaid expands, the higher their premiums will go. That’s because Medicaid shortchanges hospitals and doctors, paying less than the actual cost of care. They make up for it by shifting the costs onto privately insured patients. Ouch.

That cost shifting only works until Medicaid enrollment grows too large. The Mayo Clinic warned three months ago that Medicaid enrollment has reached the tipping point. The renowned clinic announced it will have to turn away some Medicaid patients or put them at the back of the line, behind patients with commercial insurance.

Years earlier, when Obamacare was still being debated in Congress, the dean and CEO of Johns Hopkins Medicine, Dr. Edward Miller, issued a similar warning: Allowing a vast expansion of Medicaid could have “catastrophic effects” at places like Hopkins.

His dire prediction came true. Obamacare loosened Medicaid eligibility rules and urged states to enroll as many people as possible, with Uncle Sam paying 100 percent of the tab until 2016 and 90 percent or more thereafter.

Medicaid enrollment spiked in many states, including New York, where it skyrocketed up by a third to 6.3 million. Blame the incentive to rake in federal dollars.

And waste money. Roughly 10.5 percent of Medicaid payments are in error. Any company with that record would be out of business.

Incoming elected administrations, especially the Obama transition team of 2008 in the case of Russia and Iran, seek contacts with foreign diplomats before formally entering office.https://amgreatness.com/2017/06/28/late-great-russian-collusion-myth/

Most presidential campaigns are staffed by at least a few free-lancing opportunists who see their candidate as a nexus for profiteering. There is no need for a reminder of the lucrative careers of Bill Clinton from 2009-2012, or of Hillary Clinton’s brother, or of the nature of some of John Podesta’s investments. And foreign governments, our own included as in the case of the Obama Administration’s entrance into the Israeli elections, are frequently accused of trying to sway or indeed interfere with another nation’s campaign cycles.

Yet what is strange about the charges of collusion between the Trump campaign and the Russian government is that those landscapes were concocted into something supposedly criminal and uniquely applicable to Donald Trump’s election and presidency. Indeed, one of the strangest events in recent political history was the post-election false news narrative that Trump and the “Russians” had colluded during the campaign to rob Hillary Clinton of a sure victory.

The discredited concoction lingers to this day, despite the fact that former FBI Director James Comey on three occasions told Trump that he was not the subject of any investigation about collusion with the Russians.

Both the former Director of National Intelligence James Clapper and former CIA Director John Brennan (both foes of Trump) at various times admitted that there was no intelligence, to their knowledge, that implicated Trump as a colluder with Vladimir Putin to gain advantage over Clinton. Former Homeland Security Secretary Jeh Johnson seconded that consensus by conceding there was no evidence of any Trump campaign effort to persuade the Russian to alter the elections. In a more general sense, Barack Obama (who had intelligence reports of Russian election-cycle hacking) three weeks before the election, and the assumed certain victory of Hillary Clinton, had dismissed entirely the idea that any party could taint a U.S. election. Obama went on to accuse Trump of whining for even suggesting that the impending election might be questioned by impropriety.

Even news producers at CNN, the chief engine that drove the collusion fairy tale, were caught on camera admitting that the entire story was mostly “bulls—t”. And one producer added, “And so I think the president is probably right to say, ‘Look, you are witch hunting me.’” Recently, three staffers, including a reporter and an executive editor, resigned from CNN in disgrace for peddling more fake news accounts of collusion between Trump and the Russians.

Who Really Blew the Election?

Here’s my problem: I’m a Bill of Rights guy in what’s become a Second Bill of Rights country. That’s why I can’t work up much of a pulse over the intramural healthcare debate among Senate Republicans.https://amgreatness.com/2017/06/27/progressive-washingtons-obamacare-train-wreck/

The Democrats, the party of Obamacare and the dream of socialized medicine, has for Trump-deranged reasons become the Party of No on the matter of addressing the catastrophe they have wrought. So, the Senate debate, like the GOP-controlled House debate before it, is a family fight. The family is splitting up, though. The dynamic that led to Donald Trump’s election tells us why. The party no longer stands for what it has long purported to stand for: freedom, self-determination, and limited government. Nothing better illustrates this than its Janus-faced approach to Obamacare.

Republicans, of course, have campaigned full-throatedly on the imperative to “repeal and replace” Obamacare for seven years. They’ve never been serious about it for a moment.

To be trendily trite, I’m old enough to remember when “repeal and replace” was deceptive because it understated the party establishment’s commitment to the GOP’s conservative base. In the beginning, Republicans boldly beat their chests and bellowed that they’d repeal Obamacare root-and-branch. “Repeal and replace” was actually the first moving of the goalpost, the first implicit admission that, in principle, they were all for a government-managed health-insurance system. If you really want to move to the free market, you repeal statism. When you’re talking “and replace,” you’re just haggling over the price.

In a few short years, “repeal and replace” has gone from a subtle understatement of what Republicans conned voters into believing they’d do, to a gross overstatement of what they’re willing to try. No one who has been paying attention can be surprised by this regression.

Obamacare has always been sleight-of-hand, on both sides. From the beginning, Democrats lied about its feasibility: “Like your doctor, keep your doctor,” “like your plan, keep your plan,” plunging premiums, lower costs, etc. All the while, they knew it was unworkable. That was not a flaw, it was the design. The plan was to orchestrate a collapse of the private insurance market, blame the private insurers rather than the death-spiral regulations, and gradually inure people to the need for a complete government takeover—the panacea of “single payer.”

Equally patent is that, at most, Republicans wanted to slow the train down, not stop it. Many of them, after all, have been on it from the get-go. “Repeal!” and, then, “repeal and replace” made for great fundraising and electoral wedge issues. But when it got down to brass tacks, it was always “Maybe the Supreme Court will strike it down,” or “Maybe we can sue Obama over these waivers,” or “Maybe it will collapse of its own weight.”

Republicans have controlled the House, where all spending originates, since 2010, and the Senate since 2014. Not a dime for Obamacare could have been spent had they not approved it. Never did they use the power of the purse as the Framers intended: Congress’s decisive check against ruinous policy.

Every year, the federal government pays $125 billion in tax dollars for federal pensions. In spite of this being such a large amount of money, there is a remarkable lack of transparency surrounding these funds.

Taxpayers deserve to know the details of the lucrative pensions of career bureaucrats and members of Congress. Basic questions deserve answers: How many years were worked, how much money was paid-in and by whom, how quickly did they break-even on their own contributions, and just how much did the taxpayers finance?

Releasing data on federal pensions will require an act of Congress, and we are leading the way. The Taxpayer Funded Pension Disclosure Act will empower citizens with the data and technologies to hold their government accountable like never before.

Today, pension data is not merely opaque; it is literally hidden in an undergroundcomplex in Pennsylvania. Federal employees hand-calculate federal pensions in a process that has not changed since the Cold War era. How many mistakes has the government made in that cavernous complex? No one knows because we’re all in the dark.

The case for greater federal pension transparency can easily be made by looking at the fraud that has already been exposed by non-profit organizations like Open The Books at the state level. In the 32 states that have pension transparency – including California, Illinois, New York and Oregon – citizens have exposed significant amounts of waste and mismanagement.

Auditors at Open the Books uncovered a pair of union bosses in Illinois who taught as substitutes for one day in public schools and then retired, in order to collect a pension that will amount to $1 million dollars over their lifetime.

At the Port Authority of New York and New Jersey, data shows that a police lieutenant with a final salary of $129,000 received a starting pension of $172,000. An assistant airport operations manager retired with a final salary of $89,000, but soon began collecting a $103,000 pension. An electrician quit with a base salary of $76,000 and collected a pension of $79,000.

With relatively little transparency, we’ve found numerous examples of waste and abuse across the country. Consider what we’d find if we could see more at the federal level.

For instance, former IRS chief Lois Lerner used her authority to infringe the rights of American citizens and consistently obstructed congressional investigations. Wouldn’t it be nice to see her pension information? Her pension is estimated to equal nearly $2 million in lifetime payout.

According to the Office of Personnel Management, in 2012, 21,000 retired federal employees were collecting pensions exceeding $100,000. Since then, the number has likely doubled or tripled. Moody’s estimates federal employee pensions have a $3.5 trillion-dollar unfunded liability, with taxpayers on the hook to guarantee it all. All of this information should be posted online in real time.

Feeling the prospective sting of accountability that socialist grifters rarely experience in their natural lives, Sen. Bernie Sanders is lashing out at those accusing his wife of an alleged financial fraud that caused Burlington College to collapse last year.

Media reports also indicate prosecutors could be investigating the Independent U.S. senator from Vermont for allegedly attempting to muscle the bank into approving the loan.

The leftist power couple lawyered up, reportedly hiring big-name defense attorneys. Rich Cassidy of Burlington, Vt., is representing Bernie, while Beltway insider Larry Robbins, who advised Lewis “Scooter” Libby, former chief of staff to Vice President Dick Cheney, is acting for Jane.

Sanders, who used to be mayor of Burlington, said it was “fairly pathetic” that his family was being attacked and seemed to hint that the allegations of fraud and undue influence materialized out of thin air. He described his wife as “about the most honest person I know.”

As the small college’s president from 2004 to 2011, Jane O’Meara Sanders apparently bankrupted the nontraditional institution of higher learning founded in 1972 through reckless spending – just as her husband promised to do to America if elected president of the United States. When it went under, the college sent out a press release blaming the “crushing weight of debt” Mrs. Sanders incurred for its demise.

The FBI is reportedly investigating Jane Sanders for allegedly misrepresenting donations to the college in a $10 million loan application to People’s United Bank in 2010. The money was to acquire 33 acres of land from a cash-strapped church to expand the college. The property was on the shores of Lake Champlain.

As a media outlet reported last year,

The purchase was huge—especially for a school whose annual budget didn’t crack $4 million. Jane Sanders plan was to bet big. To finance the deal, Burlington issued tax-free bonds, took a $3.5 million loan from the diocese, and received a $500,000 bridge loan from Tony Pomerleau, a wealthy local real-estate developer and close friend of the Sanderses.

Enrollment at the college and donations to it did go up but not enough to service the added levels of debt. After sowing the seeds of the school’s destruction, Mrs. Sanders grabbed her golden parachute and moved on.