#Affordable Care Act subsidies

[dontmeantobepoliticalbut]

Republicans on the House Budget Committee offered a preview Wednesday of the programs they're looking to cut or overhaul as part of any agreement to lift the debt ceiling, a target list that includes food aid for low-income families, climate justice and electric vehicle funding, student debt relief, and Affordable Care Act subsidies.

The proposed cuts were outlined in a press release issued by Rep. Jodey Arrington (R-Texas), the chair of the House Budget Committee.

In total, Arrington put forth roughly $780 billion in proposed spending cuts, nearly half of which would come from reversing President Joe Biden's student debt cancellation—a plan that is currently blocked pending a decision from the U.S. Supreme Court.

Notably absent from the House GOP's outline was any mention of the U.S. military budget, which currently represents more than half of the federal government's discretionary spending and is a hotbed of the kind of waste and fraud that Republicans claim to oppose.

At $858 billion, the fiscal year 2023 military budget alone is larger than the $780 billion in cuts Arrington has floated.

Rep. Brendan Boyle (D-Pa.), the top Democrat on the House Budget Committee, said in a statement to Bloomberg that the GOP's proposed spending cuts are a needless attack on the vulnerable.

Experts have repeatedly warned that more stringent income verification and work requirements for Supplemental Nutrition Assistance Program (SNAP) recipients, for instance, would result in food aid cuts for many needy families.

"Why is it that whenever tough choices are required, Republicans want working families and children to make the sacrifice?" Boyle asked. "Why not keep our children fed and families healthy, and instead work with Democrats to ensure the wealthy pay their fair share in taxes?"

Arrington's recommendations come as the GOP is facing growing backlash over its efforts to use the debt ceiling—and the looming possibility of a U.S. default—as leverage to pursue steep spending cuts, something the party has done to disastrous effect in the past.

Advocacy groups and analysts were quick to assail Arrington's proposals.

The Debt Collective, an organization that supports student debt cancellation, wrote on Twitter that "it doesn't 'cost' $379 billion to cancel $379 billion of student debt."

"It's pure fiction to think that killing cancellation will mean the [Department of Education] will collect $379 billion," the group added. "Even the Federal Reserve knows there will be record defaults."

Krutika Amin, associate director of the Kaiser Family Foundation, noted that the GOP proposal to cap Affordable Care Act subsidies at 400% of the federal poverty line "would mean middle-income people pay more for coverage."

"A 60-year-old making $55,000 in 2023 pays 8.5% of their income on a silver plan," Amin observed. "Without subsidies, they would pay over 20% of their income on average."

[healthinsurance-org]

[mostlysignssomeportents]

When the app tries to make you robo-scab

When we talk about the abusive nature of gig work, there’s some obvious targets, like algorithmic wage discrimination, where two workers are paid different rates for the same job, in order to trick occasional gig-workers to give up their other sources of income and become entirely dependent on the app:

https://pluralistic.net/2023/04/12/algorithmic-wage-discrimination/#fishers-of-men

Then there’s the opacity — imagine if your boss refused to tell you how much you’ll get paid for a job until after you’ve completed it, claimed that this was done in order to “protect privacy” — and then threatened anyone who helped you figure out the true wage on offer:

https://pluralistic.net/2021/08/07/hr-4193/#boss-app

Opacity is wage theft’s handmaiden: every gig worker producing content for a social media algorithm is subject to having their reach — and hence their pay — cut based on the unaccountable, inscrutable decisions of a content moderation system:

https://pluralistic.net/2022/12/10/e2e/#the-censors-pen

Making content for an algorithm is like having a boss that docks every paycheck because you broke rules that you are not allowed to know, because if you knew the rules, you’d figure out how to cheat without your boss catching you. Content moderation is the last place where security through obscurity is considered good practice:

https://doctorow.medium.com/como-is-infosec-307f87004563

When workers seize the means of computation, amazing things happen. In Indonesia, gig workers create and trade tuyul apps that let them unilaterally modify the way that their bosses’ systems see them — everything from GPS spoofing to accessibility mods:

https://pluralistic.net/2021/07/08/tuyul-apps/#gojek

So the tech and labor story isn’t wholly grim: there are lots of ways that tech can enhance labor struggles, letting workers collaborate and coordinate. Without digital systems, we wouldn’t have the Hot Strike Summer:

https://pluralistic.net/2022/12/02/not-what-it-does/#who-it-does-it-to

As the historic writer/actor strike shows us, the resurgent labor movement and the senescent forces of crapulent capitalism are locked in a death-struggle over not just what digital tools do, but who they do it for and who they do it to:

https://locusmag.com/2022/01/cory-doctorow-science-fiction-is-a-luddite-literature/

When it comes to the epic fight over who technology acts for and against, we need a diversity of tactics, backstopped by tech operated by and for its users — and by laws that protect workers and the public. That dynamic is in sharp focus in UNITE Here Local 11’s strike against Orange County’s Laguna Cliffs Marriott Resort & Spa.

The UNITE Here strike turns on the usual issues like a living wage (hotel staff are paid so little they have to rent rooming-house beds by the shift, paying for the right to sleep in a room for a few hours at a time, without any permanent accommodation). They’re also seeking health-care and pensions, so they can be healthy at work and retire after long service. Finally, they’re seeking their employer’s support for LA’s Responsible Hotels Ordinance, which would levy a tax on hotel rooms to help pay for hotel workers’ housing costs (a hotel worker who can’t afford a bed is the equivalent of a fast food worker who has to apply for food stamps):

https://www.unitehere11.org/responsible-hotels-ordinance/

But the Marriott — which is owned by the University of California and managed by Aimbridge Hospitality — has refused to bargain, walking out negotiations.

But the employer didn’t walk out over wages, benefits or support for a housing subsidy. They walked out when workers demanded that the scabs that the company was trying to hire to break the strike be given full time, union jobs.

These aren’t just any scabs, either. They’re predominantly Black workers who rely on the $700m Instawork app for gigs. These workers are being dispatched to cross the picket line without any warning that they’re being contracted as strikebreakers. When workers refuse the cross the picket and join the strike, Instawork cancels all their shifts and permanently blocks them from new jobs.

This is a new, technologically supercharged form of illegal strikebreaking. It’s one thing for a single boss to punish a worker who refuses to scab, but Instawork acts as a plausible-deniability filter for all the major employers in the region. Like the landlord apps that allow landlords to illegally fix rents by coordinating hikes, Instawork lets bosses illegally collude to rig wages by coordinating a blocklist of workers who refuse to scab:

https://arstechnica.com/tech-policy/2022/10/company-that-makes-rent-setting-software-for-landlords-sued-for-collusion/?comments=1

The racial dimension is really important here: the Marriott has a longstanding de facto policy of refusing to hire Black workers, and whenever they are confronted with this, they insist that there are no qualified Black workers in the labor pool. But as soon as the predominantly Latino workforce struck, Marriott discovered a vast Black workforce that it could coerce into scabbing, in collusion with Instawork.

Now, all of this isn’t just sleazy, it’s illegal, a violation of Section 7 of the NLRB Act. Historically, that wouldn’t have mattered, because a string of presidents, R and D, have appointed useless do-nothing ghouls to run the NLRB. But the Biden admin, pushed by the party’s left wing, made a string of historic, excellent appointments, including NLRB General Counsel Jennifer Abruzzo, who has set her sights on punishing gig work companies for flouting labor law:

https://pluralistic.net/2022/01/10/see-you-in-the-funny-papers/#bidens-legacy

UNITE HERE 11 has brought a case to the NLRB, charging the Instawork, the UC system, Marriott, and Aimbridge with violating labor law by blackmailing gig workers into crossing the picket line. The union is also asking the NLRB to punish the companies for failing to protect workers from violent retaliation from the wealthy hotel guests who have punched them and screamed epithets at them. The hotel has refused to identify these thug guests so that the workers they assaulted can swear out complaints against them.

Writing about the strike for Jacobin, Alex N Press tells the story of Thomas Bradley, a Black worker who was struck off all Instawork shifts for refusing to cross the picket line and joining it instead:

https://jacobin.com/2023/07/southern-california-hotel-workers-strike-automated-management-unite-here

Bradley’s case is exhibit A in the UNITE HERE 11 case before the NLRB. He has a degree in culinary arts, but racial discrimination in the industry has kept him stuck in gig and temp jobs ever since he graduated, nearly a quarter century ago. Bradley lived out of his car, but that was repossessed while he slept in a hotel room that UNITE HERE 11 fundraised for him, leaving him homeless and bereft of all his worldly possessions.

With UNITE HERE 11’s help, Bradley’s secured a job at the downtown LA Westin Bonaventure Hotel & Suites, a hotel that has bargained with the workers. Bradley is using his newfound secure position to campaign among other Instawork workers to convince them not to cross picket lines. In these group chats, Jacobin saw workers worrying “that joining the strike would jeopardize their standing on the app.”

Today (July 30) at 1530h, I’m appearing on a panel at Midsummer Scream in Long Beach, CA, to discuss the wonderful, award-winning “Ghost Post” Haunted Mansion project I worked on for Disney Imagineering.

If you'd like an essay-formatted version of this thread to read or share, here's a link to it on pluralistic.net, my surveillance-free, ad-free, tracker-free blog:

https://pluralistic.net/2023/07/30/computer-says-scab/#instawork

[Image ID: An old photo of strikers before a struck factory, with tear-gas plumes rising above them. The image has been modified to add a Marriott sign to the factory, and the menacing red eye of HAL9000 from Stanley Kubrick's '2001: A Space Odyssey' to the sky over the factory. The workers have been colorized to a yellow-green shade and the factory has been colorized to a sepia tone.]

Image: Cryteria (modified) https://commons.wikimedia.org/wiki/File:HAL9000.svg

CC BY 3.0 https://creativecommons.org/licenses/by/3.0/deed.en

[simply-ivanka]

How the Biden-Harris Economy Left Most Americans Behind

A government spending boom fueled inflation that has crushed real average incomes.

By The Editorial Board -- Wall Street Journal

Kamala Harris plans to roll out her economic priorities in a speech on Friday, though leaks to the press say not to expect much different than the last four years. That’s bad news because the Biden-Harris economic record has left most Americans worse off than they were four years ago. The evidence is indisputable.

President Biden claims that he inherited the worst economy since the Great Depression, but this isn’t close to true. The economy in January 2021 was fast recovering from the pandemic as vaccines rolled out and state lockdowns eased. GDP grew 34.8% in the third quarter of 2020, 4.2% in the fourth, and 5.2% in the first quarter of 2021. By the end of that first quarter, real GDP had returned to its pre-pandemic high. All Mr. Biden had to do was let the recovery unfold.

Instead, Democrats in March 2021 used Covid relief as a pretext to pass $1.9 trillion in new spending. This was more than double Barack Obama’s 2009 spending bonanza. State and local governments were the biggest beneficiaries, receiving $350 billion in direct aid, $122 billion for K-12 schools and $30 billion for mass transit. Insolvent union pension funds received a $86 billion rescue.

The rest was mostly transfer payments to individuals, including a five-month extension of enhanced unemployment benefits, a $3,600 fully refundable child tax credit, $1,400 stimulus payments per person, sweetened Affordable Care Act subsidies, an increased earned income tax credit including for folks who didn’t work, housing subsidies and so much more.

The handouts discouraged the unemployed from returning to work and fueled consumer spending, which was already primed to surge owing to pent-up savings from the Covid lockdowns and spending under Donald Trump. By mid-2021, Americans had $2.3 trillion in “excess savings” relative to pre-pandemic levels—equivalent to roughly 12.5% of disposable income.

So much money chasing too few goods fueled inflation, which was supercharged by the Federal Reserve’s accommodative policy. Historically low mortgage rates drove up housing prices. The White House blamed “corporate greed” for inflation that peaked at 9.1% in June 2022, even as the spending party in Washington continued.

In November 2021, Congress passed a $1 trillion bill full of green pork and more money for states. Then came the $280 billion Chips Act and Mr. Biden’s Green New Deal—aka the Inflation Reduction Act—which Goldman Sachs estimates will cost $1.2 trillion over a decade. Such heaps of government spending have distorted private investment.

While investment in new factories has grown, spending on research and development and new equipment has slowed. Overall private fixed investment has grown at roughly half the rate under Mr. Biden as it did under Mr. Trump. Manufacturing output remains lower than before the pandemic.

Magnifying market misallocations, the Administration conditioned subsidies on businesses advancing its priorities such as paying union-level wages and providing child care to workers. It also boosted food stamps, expanded eligibility for ObamaCare subsidies and waved away hundreds of billions of dollars in student debt. The result: $5.8 trillion in deficits during Mr. Biden’s first three years—about twice as much as during Donald Trump’s—and the highest inflation in four decades.

Prices have increased by nearly 20% since January 2021, compared to 7.8% during the Trump Presidency. Inflation-adjusted average weekly earnings are down 3.9% since Mr. Biden entered office, compared to an increase of 2.6% during Mr. Trump’s first three years. (Real wages increased much more in 2020, but partly owing to statistical artifacts.)

Higher interest rates are finally bringing inflation under control, which is allowing real wages to rise again. But the Federal Reserve had to raise rates higher than it otherwise would have to offset the monetary and fiscal gusher. The higher rates have pushed up mortgage costs for new home buyers.

Three years of inflation and higher interest rates are stretching American pocketbooks, especially for lower income workers. Seriously delinquent auto loans and credit cards are higher than any time since the immediate aftermath of the 2008-09 recession.

Ms. Harris boasts that the economy has added nearly 16 million jobs during the Biden Presidency—compared to about 6.4 million during Mr. Trump’s first three years. But most of these “new” jobs are backfilling losses from the pandemic lockdowns. The U.S. has fewer jobs than it was on track to add before the pandemic.

What’s more, all the Biden-Harris spending has yielded little economic bang for the taxpayer buck. Washington has borrowed more than $400,000 for every additional job added under Mr. Biden compared to Mr. Trump’s first three years. Most new jobs are concentrated in government, healthcare and social assistance—60% of new jobs in the last year.

Administrative agencies are also creating uncertainty by blitzing businesses with costly regulations—for instance, expanding overtime pay, restricting independent contractors, setting stricter emissions limits on power plants and factories, micro-managing broadband buildout and requiring CO2 emissions calculations in environmental reviews.

The economy is still expanding, but business investment has slowed. And although the affluent are doing relatively well because of buoyant asset prices, surveys show that most Americans feel financially insecure. Thus another political paradox of the Biden-Harris years: Socioeconomic disparities have increased.

Ms. Harris is promising the same economic policies with a shinier countenance. Don’t expect better results.

[izooks]

Some of Joe Biden’s accomplishments:

**Domestic policy**

* **American Rescue Plan (2021)**: Provided $1.9 trillion in COVID-19 relief, including direct payments, enhanced unemployment benefits, and funding for vaccines and testing.

* **Infrastructure Investment and Jobs Act (2021)**: Allocated $1.2 trillion for infrastructure projects, including roads, bridges, broadband, and clean energy initiatives.

* **Bipartisan Safer Communities Act (2022)**: Expanded background checks for gun purchases and provided funding for mental health services.

* **Child Tax Credit Expansion (2021-2022)**: Temporarily expanded the Child Tax Credit to provide up to $3,600 per child in monthly payments.

* **Affordable Care Act Expansion (2021)**: Made health insurance more affordable for low- and middle-income Americans by reducing premiums and expanding subsidies.

**Foreign Policy**

* **Withdrawal from Afghanistan (2021)**: Ended the 20-year war in Afghanistan.

* **Re-joining the Paris Agreement (2021)**: Re-committed the United States to global efforts to address climate change.

* **Strengthening Alliances with NATO and the EU (2021-present)**: Repaired relationships with key European allies after strained relations during the Trump administration.

* **Supporting Ukraine in the Ukraine-Russia War (2022-present)**: Provided military, humanitarian, and diplomatic support to Ukraine in its defense against Russia's invasion.

* **Nuclear Deal with Iran (2023)**: Revived negotiations with Iran on a comprehensive nuclear deal, aimed at preventing Iran from developing nuclear weapons.

**Other Notable Accomplishments**

* **Appointing Ketanji Brown Jackson to the Supreme Court (2022)**: Made history by being the first Black woman appointed to the nation's highest court.

* **Signing the Respect for Marriage Act (2022)**: Ensured federal recognition of same-sex and interracial marriages.

* **Establishing the Office of the National Cyber Director (2021)**: Coordinated federal efforts to combat cybersecurity threats.

* **Creating the COVID-19 National Preparedness Plan (2021)**: Developed a comprehensive strategy to respond to future pandemics.

* **Launching the Cancer Moonshot (2022)**: Re-energized the government's efforts to find a cure for cancer.

[tomorrowusa]

Nope, Trump didn't "salvage" Obamacare as J.D. Vance claimed.

Some fact-checking from the vice presidential debate. From NPR.

During his presidency, Trump undermined the Affordable Care Act in many ways — for instance, by slashing funding for advertising and free "navigators" who help people sign up for a health insurance plan on HealthCare.gov. And rather than deciding to "save" the ACA, he tried hard to get Congress to repeal it, and failed. The Biden administration has reversed course from Trump's management of the Affordable Care Act. Increased subsidies have made premiums more affordable in the marketplaces, and enrollment has surged. The uninsurance rate has dropped to its lowest point ever during the Biden administration. The Affordable Care Act was passed in 2010 and is entrenched in the health care system. Republicans successfully ran against Obamacare for about a decade, but it has faded as a campaign issue this year.

So just the opposite of what J.D. claimed. The Trump administration didn't save Obamacare, it tried to sabotage and kill it.

People who have a weirdly nostalgic view of the Trump administration forget how he tried to kill Obamacare with help from the Republican majority 115th Congress. From its inception, Republicans in Congress have tried to kill Obamacare 70 times.

Obamacare may not be perfect, but it is superior to what existed previously. The bulk of people who hate it are connected to Big Pharma, for profit medical corporations, and the Republicans who get big campaign contributions from them.

The name Obamacare tells us a lot. It was coined as term of disparagement for the Affordable Care Act by Republicans. But it became so popular that Republicans ended up shooting themselves in the foot by eternally connecting the ACA to the Democratic president who was the driving force behind it.

Trump has had nine years to come up with a viable alternative to Obamacare. But the "stable genius" still can't put together a coherent sentence about what he'd replace it with.

For affordable healthcare, vote Democratic to improve it or vote MAGA Republican to destroy it.

[mariacallous]

A big, popular health care initiative could be on the chopping block if Donald Trump and his Republican allies win full control of the federal government in the November election. No, I’m not talking about the Affordable Care Act — although, as noted in these pages previously, its future really would be in peril.

I’m talking about the Inflation Reduction Act, the landmark legislation that Democrats passed and President Joe Biden signed in 2022. Most people know the IRA as a climate bill. And that’s completely understandable. Its subsidies and tax incentives for clean energy account for the largest commitment of federal resources in the legislation and could have the biggest effect on the American economy. But the IRA also had some health care provisions. The most significant of those was a series of steps to reduce the price of drugs in Medicare.

They include a cap on the price of insulin, a limit on out-of-pocket costs and penalties for drugmakers who raise prices faster than the rate of inflation. Yet another feature authorizes the government to negotiate directly with manufacturers over the prices of some drugs. That last feature is probably the best known ― and the most controversial politically. Vice President Kamala Harris, the Democratic presidential nominee, has called for extending those negotiations to more drugs, just as Biden has. Democratic leaders in Congress say they want to do the same. They know they can’t count on Republican support. The IRA got zero GOP votes when it went through Congress. The drug pricing negotiations in particular are exactly the sort of regulation that conservatives hate on principle ― and that GOP allies in the drug industry see as a threat to their bottom lines. So if Harris and the Democrats want to give the government even more leverage over prescription drug prices, they’re almost certainly going to have to do it on their own.

But the bigger question ― and one that would be great to ask Trump next Tuesday at the presidential debate with Harris ― is what happens if he and the Republicans are in charge come January. Would they let that provision stay in place? Or try to roll it back? There are several good reasons to suspect the latter.

[writerobscura]

The USA

Sorry for the radio silence; I'm still processing how 51% of my country thinks it's okay to elect a bigoted, misogynistic felon to the presidency.

This election is a reminder that half of this country is so fucking hateful that they're willing to elect someone that makes us a laughing stock around the globe while those who bought and paid for his campaign gut democracy.

Are you doing better than you were four years ago? Of course not. You were getting subsidy checks Biden pushed through a Republic congress post-pandemic.

Wages went up for essential workers, and that expense got passed on to you because corporations aren't going to short to their shareholders - and the President can do nothing about that without holding companies accountable to regulation - which our new president has no intention of doing.

The next two years:

My adult children will lose their healthcare when he and his Republican senate quash the Affordable Care Act - but hey, so long as you have a few extra bucks at the end of the month for cigs and beer, what do you care?

Some states will be able to seize the medical records of women and mothers and use those records to fine or put them in jail (abortion, IVF, getting your trans teen the care they need) - but hey, none of those things affect you personally, so fuck 'em and hey, women aren't even human, am I right you newly registered voting Gen Z fellas?

College debt, infrastructure repairs, social programs - kiss all that goodbye because fucking the planet up is a small price to pay so you can get gasoline for under $2.99. Oh, and that Latino spouse? All it takes is one call from a disgruntled 'Murican and our new INS will be there with 'post-citizenship deportation review' papers.

Wars? How easily everyone forgets that Ukraine is at war right now because your guy failed to help him when Russia flooded his country with separatists. You think he's going to stop arming Israel? Where's the money in that? Xenophobia may have worked when the USA was 100% self-sufficient in the 1900s, but it cannot be done in this day and age - but hey, going back to the old days is what it's all about, right?

Living in a hurricane or natural disaster vulnerability state? You better pray to whatever G*d you worship that nothing happens in the next 2 years because the Pubs have the Senate and the presidency - no more FEMA funds and 'emergency handouts.'

Tariffs instead of taxes on the rich? Zero-sum situation. Guess how many companies import basic things just to make the shit you eat and use daily? Monsanto is no longer an American company, most farmers in the USA 'import' their seed though because lack of corporate regulation has allowed them to destroy all farms that don't use their seed. While we're on the subject of tariffs, any foreign company can say, "We just won't sell to you, America." What's the backup plan, then? Oh, right, he has none.

Prices will rise, wages will stagnate, tariffs won't work, so guess who gets billed for that deficit? Not the wealthy—they spent billions electing this assclown, and there's no way they're investing one damned penny in the rest of us. But hey, they know you can take it because you voted to have all this...

You voted for all of the above at the expense of literally half your fellow countrymen. If Kamala won, you would've lost NOTHING. Your worst case scenario under her presidency is that you would've been running in place financially while those you consider morally or racially beneath you, might've been gotten ahead a few steps.

So yeah, 51% of my country would rather watch it all burn down than suffer anyone they consider anyone lessor be given an equal chance.

[robertreich]

The Truth About Corporate Subsidies

Why won't big American corporations do what's right for America unless the government practically bribes them?

And why is the government so reluctant to regulate them?

Prior to the 1980’s, the U.S. government demanded that corporations act in the public interest.

For example, the Clean Air Act of 1970 stopped companies from polluting our air by regulating them.

Fast forward to 2022, when the biggest piece of legislation aimed at combating the climate crisis allocates billions of dollars in subsidies to clean energy producers.

Notice the difference?

Both are important steps to combating climate change.

But they illustrate the nation’s shift away from regulating businesses to subsidizing them.

It’s a trend that’s characterized every recent administration.

The CHIPS Act –– another major initiative of the Biden administration –– shelled out $52 billion in subsidies to semiconductor firms.

Donald Trump’s “Operation Warp Speed” delivered over $10 billion in subsidies to COVID vaccine manufacturers.

Barack Obama’s Affordable Care Act subsidized the health care and pharmaceutical industries.

George W. Bush and Obama bailed out Wall Street following the 2008 economic crash while providing about $80 billion in rescue funds for GM and Chrysler.

And the federal government has been subsidizing big oil and gas companies for decades, to the tune of hundreds of billions of dollars.

Before the Reagan era, it was usually the case that America regulated rather than subsidized big business to ensure the wellbeing of the American public.

The Great Depression and FDR’s Administration created an alphabet soup of regulatory agencies — the SEC, FCC, FHA, and so on — that regulated businesses.

Corporations were required to produce public goods, or avoid public “bads” like a financial meltdown, as conditions for staying in business.

If this regulatory alternative seems far-fetched today, that’s because of how far we’ve come from a regulatory state to a subsidy state.

Today it’s politically difficult, if not impossible, for government to demand that corporations bear the costs of public goods. The government still regulates businesses, of course –– but one of the biggest things it does is subsidize them. Just look at the growth of government subsidies to business over the past half century.

The reason for this shift is corporations now have more political clout than ever before.

Industries that spend the most on lobbying and campaign contributions have often benefited greatly from this shift from regulation to subsidy.

Now, subsidies aren’t inherently bad. Important technological advances have been made because of government funding.

But subsidies are a problem when few, if any, conditions are attached — so there’s no guarantee that benefits reach the American people.

What good is subsidizing the healthcare industry when millions of Americans have medical debt and can’t afford insurance? What good are subsidies for oil companies when they price gouge at the pump and destroy the planet? What good are subsidies for profitable semiconductor manufacturers when they’re global companies with no allegiance to America?

We’re left with a system where costs are socialized, profits are privatized.  

Now, fixing this might seem daunting — but we’re not powerless. Here’s what we can do to make sure our government actually works for the people, not just the powerful.

First, make all subsidies conditional, so that any company getting money from the government must clearly specify what it will be spent on – so we can ensure the funds actually help the public.

Second, ban stock buybacks so companies can’t use the subsidies to pump up their profits and stock prices.

Third, empower regulatory agencies to do the jobs they once did — forcing companies to act in the public interest.

Finally, we need campaign finance reform to get big corporate money out of politics.

Large American corporations shouldn’t need government subsidies to do what’s right for America.

It’s time for our leaders in Washington to get this message, and reverse this disturbing trend.

[justinspoliticalcorner]

Gabriel Scheffler and Daniel Walters at Can We Still Govern?

Why is the federal government so unpopular? For many Americans, the answer to this question appears self-evident—the government is unpopular simply because it does a bad job. As law professor Peter Schuck writes, “across many different policy domains, the public perceives poor governmental performance – and generally speaking, the public is correct in this view.” Another prominent perspective focuses on ideological movements, primarily (though not exclusively) on the political right, that for decades have worked to sow distrust in government through anti-government rhetoric and actions designed to undermine government’s effectiveness. Although there is some truth to both of these perspectives, they do not tell the whole story. Another major factor is that even when the government is effective in providing benefits or addressing social problems, few Americans understand its achievements. For instance, consider President Joseph R. Biden’s signature legislation, the Inflation Reduction Act (IRA), which delivers historic investments in combatting climate change, curbs prescription drug prices, and expands subsidies to obtain health insurance. These are undeniably important achievements. Yet public opinion surveys have consistently shown that most Americans have no idea what this law does or how it will benefit them. Nor is this an isolated incident. For years, polling found a lack of awareness of President Barack Obama’s signature legislation, the 2010 Patient Protection and Affordable Care Act (ACA), which represented the largest expansion in health insurance coverage since the enactment of Medicaid and Medicare and drove America’s uninsured rate to historic lows. It was only when Republicans came close to repealing the ACA in 2017 that enough public support emerged to save the law—barely. Government also succeeds in other quotidian yet important ways, ranging from protecting Americans from airline and traffic accidents to ensuring clean air to funding the infrastructure and investments that enable the local weather report. Yet most of us tend to take these achievements for granted or to overlook them entirely. Why are more Americans not aware of the ways that government succeeds? And why does the government not do more to make the public aware of its successes?

As we argue in a recent article in the Wisconsin Law Review, an important part of the explanation is that Americans are not tuned into where most of the work of government is being done: the collection of agencies known as the “administrative state.” The administrative state comprises the agencies that deliver or oversee public benefits and services—for example, the Postal Service, the Social Security Administration, the Centers for Medicare and Medicaid Services—and the agencies that regulate industry to promote safety, health, and welfare—such as the Environmental Protection Agency (EPA), the Securities and Exchange Commission, and the Federal Trade Commission.

[...] Second, agency actions themselves are often designed or implemented in ways that obscure what agencies are doing or what role they are playing. For instance, despite numerous government initiatives designed to encourage agencies to use simple and straightforward language, many regulations (and accompanying explanations of these regulations) are still incomprehensible to the general public. This is in part due to the incentives created by administrative law, which places no limits on the information parties can submit in the regulatory process. This creates incentives for both agencies and affected interest groups to flood the rulemaking process with excessive information. 

[...] Yet, we believe agencies can and should do more to inform the public about their substantive expertise, the benefits they provide, and how to participate in administrative processes. New Deal programs such as the Works Progress Administration and the Civilian Conservation Corps once employed millions of Americans and built infrastructure all around the country that is still in use today proudly branding such projects as the work of government agencies. Tellingly, recent research suggests that such programs had a greater political impact when the government directly hired workers, making the programs more traceable to the government, than when they merely subsidized private companies’ hiring of workers.

Today, at the very least, agencies can reduce their reliance on private contractors, write regulatory preambles in ways that are easier for the public to understand, and do more to proactively solicit the public’s participation in the regulatory process. Congress and the judiciary should also consider scaling back some of the legal constraints that prevent agencies from communicating effectively with the public or that encourage agencies to make their actions less salient and traceable. These efforts could include revisiting and perhaps repealing laws targeting agency “propaganda,” which in some cases are arguably overbroad, as well as more general administrative law doctrines that have the effect of chilling agency communications. If the Supreme Court is unwilling to abandon the major questions doctrine altogether, it could, at the very least, cease relying on agencies’ communications to the public as indicia of “majorness,” which has the effect of incentivizing them to downplay their own actions. Outside groups such as the American Bar Association can do more to reward civil servants’ accomplishments and to inform the public about the non-political nature of the work they do.

Gabriel Scheffler and Daniel Walters co-wrote in Dan Moynihan’s Can We Still Govern? Substack about how Americans are often unaware of the full benefits of government agencies and administrative policy.

[dontmeantobepoliticalbut]

President Joe Biden will call for expanding a new cap on insulin prices to all Americans as part of his State of the Union address, the White House said Monday.

During the Tuesday speech, Biden plans to tout his administration’s efforts to make health care more affordable, which included imposing a $35-per-month limit on insulin that took effect in January.

But that price cap, which was passed as part of last year’s Inflation Reduction Act, only applied to those beneficiaries covered by Medicare. Biden is now expected to renew his push for the policy to be applied to anyone with an insulin prescription, the White House said in a fact sheet.

“The President will call on Congress to extend this commonsense, life-saving protection to all Americans,” the fact sheet said.

Democrats had originally planned to pass a universal insulin price cap last year as part of the Inflation Reduction Act, which was passed along party lines last August. But the policy was scaled back after Republicans successfully challenged its inclusion. Democrats since then have vowed to continue to push for its passage, arguing that it’s broadly popular and crucial to ensuring that people can afford essential medicines.

Still, Biden’s fresh support for expanding the price cap is unlikely to result in much concrete progress. Republicans remain opposed to the measure, and are unlikely to even allow a vote on it in the House now that they control the chamber.

Biden during his State of the Union speech is also expected to highlight a handful of other health care accomplishments, including landmark legislation granting Medicare the right to negotiate drug prices and cap certain out-of-pocket pharmacy costs. He will celebrate the three latest states to expand their Medicaid programs, while urging Congress to pass legislation that would close coverage gaps in the 11 holdout states that have yet to expand Medicaid.

The President also plans to call for continuing to lower health insurance costs, pointing to expanded Obamacare subsidies that the administration estimates lowered customers’ premiums by an average of $800 per year and pushed the nation’s uninsured rate to an all-time low.

[healthinsurance-org]

[comeonamericawakeup]

"Thanks to GOP vice-presidential nominee JD Vance, we finally know what Donald Trump's 'concepts of a plan' for replacing the Affordable Care Act might look like," said Catherine Rampell. In a Meet the Press interview last week, Vance revealed that the "plan" Trump recently alluded to was to eliminate Obamacare's protections of people with pre-existing conditions, and to create different "risk pools" one for healthy people and another for older people with "chronic issues." Insurers could again charge older, sicker people far more for health coverage. Young, healthy people could choose cheap plans that provide little coverage for serious illness, while in the high-risk pool, premiums would be so high many people would drop insurance, causing prices to rise even further "until the system falls apart." In theory, the government could prevent this "death spiral" by subsidizing high-risk patients, but several states tried to do that before Obamacare and found it to be "extraordinarily expensive." It's unlikely Republicans would agree to pay such costs, particularly since House Republicans are already trying to kill existing premium subsidies for Americans who buy coverage through Obamacare markets. "Remember this next time Vance or other Republicans promise vou 'choices' in vour health insurance."

THE WEEK October 4, 2024

[autisticadvocacy]

"Medicaid unwinding is likely contributing to the 2024 record high [ACA Marketplace] enrollment, with individual market enrollment already being elevated by at least 1 million people before open enrollment began." https://www.kff.org/policy-watch/another-year-of-record-aca-marketplace-signups-driven-in-part-by-medicaid-unwinding-and-enhanced-subsidies/

[ashleywool]

late-night health update info-dumping into the void

The neuroendocrine surgeon and her nurses were patient, compassionate, and highly informative.

I walked away with more questions than answers, and like most autistics, I'm not good at sitting peaceably with the unknown.

The tl;dr is that I may not need surgery after all, but if I do need surgery, it would be a riskier surgery than I previously realized. Either way, we will have to wait at least another six weeks to get a better guess. And from where I'm standing now, that feels like an eternity--especially since, as I've often mentioned, my health insurance runs out at the end of August and by September I'll have to pay the COBRA premium. If I'm as lucky as it's possible to get with the NYS COBRA subsidy for entertainment professionals, that'll come to around $292 a month...which would still be cheaper than a marketplace plan and an overall excellent deal as health insurance goes, but guess what else runs out in August? That's right, my unemployment. And guess what happens if I get another job where I can qualify for any old crap minimum-essential health insurance? That's right, I lose the COBRA subsidy and would be stuck paying the full monthly premium...which, for the coverage I'm getting, would STILL be a better deal than most marketplace plans.

But hey, back in 2009 before the Affordable Care Act, even THAT wasn't an option, and the fact that it IS an option now is one of the main reasons why I keep saying that SOMEDAY we will step back and appreciate how much of a healthcare legislation LEGEND Joseph Robinette Biden really is, but I know you're not here for my oversimplified political takes, so let's get back to the other thing you're not here for:

THE ENDOCRINOLOGY INFO-DUMP, July 30, 2024:

Turns out...it's possible that my overall cortisol production is still being skewed by the birth control medications I stopped taking in early June (at my own discretion, remember, because I knew they would affect the cortisol test results even though the first (mean) endocrinologist said they wouldn't, and then said that they did).

What I had read was that 72 hours off the BC meds was sufficient to avoid interference with the low-dose dexamethasone suppression test--so I went off them in advance of my appointment with the first endo, because I was anticipating the ordering of that test.

I'd also read that four weeks off the BC meds was usually sufficient to rule out any potential interferences. When my second LDDST last week showed an even higher cortisol level than the previous one (meaning, the dexamethasone had suppressed it even less), I took that to mean that no, the BC was clearly not playing a part.

Also, the lab screwed up my second 24-hour urine test by not including the total volume in the lab report (what, did they spill it or something?) so there was no way to extrapolate the necessary data...BUT my first and second set of saliva cortisol tests came back normal--even with a high cortisol concentration in my previous urine test and all my blood serum tests.

Apparently, this "saliva vs. the other bodily fluids" cortisol discrepancy has to do with the fact that the cortisol tests measure both "free" cortisol, and transcortin, which is a protein secreted by the liver that binds to cortisol. A serum cortisol test (blood test) will measure both, while urine and saliva tests are meant to measure "free" cortisol. BUT, apparently, these BC meds can cause increased production of transcortin for up to three months after stopping the medication, and that transcortin production might be reflected in the levels associated with the urine test, but NOT in the saliva test.

To definitively confirm a Cushing's diagnosis, we would need to rule out not only any potential interference with cortisol (e.g. glucocorticosteroids), but also rule out any potential interference with transcortin production (e.g. the birth control meds). And the only way to do that is to just...WAAAAAIT.

BUT WAIT, WHAT ABOUT THE PITUITARY TUMOR?

WELL...enhanced imaging seems to indicate that the growth on my pituitary gland is fluid-filled, which means it's far likelier to be a Rathke's cleft cyst (technically not a tumor) than a pituitary adenoma (technically a tumor).

I'm sick of speculating and over-explaining what it might be, so until further notice, I'm just gonna call it Otis.

The possible good news is, if the September lab work indicates that my hormone levels were just screwed up from the birth control meds, then Otis's presence might have nothing to do with anything, and therefore, I may not need surgery at all.

The downside of that scenario is that it may take my body a long time to fully recover from any deleterious effects of the BC meds on my endocrine system. And that would also likely mean that my periods would become more regular again, which means that monthly spells of sensory nightmares would become more regular as well.

On the other hand, if the cortisol tests and other lab work don't resolve after the BC is definitively out of my system, and the culprit of the issues turns out to be Otis after all...I would need surgery, but not the straightforward transsphenoidal or endoscopic endonasal surgery that I was expecting. Otis is very close to my brain stem and it might be too risky to attempt draining or removing it through the nasal canal. It's possible they'd try to attack it with radiation therapy, but usually they only do that for RCCs that recur after surgical draining, so who even knows.

I'm just gonna say right now, in terms of symptoms and my knowledge of my own experience, I have a sinking feeling that it is Otis causing the problems. But we aren't even going to be able to attempt making a better guess until mid-September.

And what sucks the most is, there's probably nothing to be done for my symptoms in the meantime. Depending on the results of the bloodwork they did today, they might give me Metformin to treat any possible underlying metabolic syndrome (which is also something I suspected early on), but other than that, it's more "hurry up and wait."

I gotta be honest...in addition to all the physical and emotional overwhelm, I feel like my commitment to unlearning internalized ableism is REALLY being tested right now.

Owning my autism was easier. It was liberating. But I'm realizing that some part of me really did want to "be the poster child for 'if [s]he can, then you can.'" Part of me thought, if I had to be autistic, I was going to be a Model Autistic who can do anything the abled neurotypicals can do. I was going to Set An Example. Not a perfect example, but a solid and consistent example of someone who maximizes her potential but stays woke and stays self-aware and checks her privilege and advocates for intersectionality.

That simply isn't true right now. I can't do everything abled neurotypicals can do. My body is tired, weak, and prone to sickness. My voice is exhausted from regular conversation. My skin is dry and itchy and my face can barely tolerate makeup. I have NO appetite, and yet I've gained so much weight, like I can't get comfortable anywhere because there's too much. My stomach and my lymph nodes feel (and are) constantly swollen, my sense of dehydration is constant and I'm not retaining water correctly.

I feel hideously, embarrassingly ineffectual.

And conventional wisdom says "don't put this on the internet, or else you won't get hired." Don't share your behind-the-scenes, don't share the cutting room floor, only share your highlight reel.

Well, I'm sorry, but if acting is "telling the truth," and if art is about "the fullest expression of the human experience," then following those "rules" seems awfully hypocritical to me. Besides, what sort of disability advocate would I be if I didn't share the truth of what's going on, and how it feels?

Disability pride doesn't have to mean being proud of every part of every disability.

In fact, pride really isn't even the right word.

Because I'm not proud. But I'm not ashamed either. I'm just real.

Being honest about what I'm going through doesn't automatically make me a better or more aspirational person, but it doesn't make me a worse person either. It doesn't make me much of anything, really, because what I'm going through does not need to be anybody else's business, but it also doesn't need to be kept a secret. It is mine to do with as I choose, and the value my story might bring to the world has nothing to do with me. It has everything to do with the people who hear it, internalize it, and take something away that's valuable to them.

I hope, if nothing else, someone does that.

[st-just]

In 2010, Congress passed the Affordable Care Act, pledging that by 2014, the government would have a website up in which uninsured Americans could buy health insurance with various subsidies. In perhaps one of the most embarrassing moments of the Obama administration, Healthcare.gov failed to launch the day the new health law came into force, and millions couldn’t sign up to take advantage of it. It’s hard to overstate the shame of that moment. The government had spent $400 million over four years - more time than it took the U.S. to enter and win World War II - and yet, the dozens of contractors couldn’t set up a website to take sign-ups. The whole thing was an embarrassing disaster, a festival of incompetence and greed. (Despite the failure, the main IT contractor’s CEO became a billionaire.)

-Matt Stoller