Lone Candle
Champion of Truth
“Trump’s 11th-hour decision to get involved in negotiations, weighing in via social media (and seemingly without coordinating with congressional allies), is reminiscent of his first-term approach to Capitol Hill, when he regularly blew up funding talks and directly caused the longest government shutdown in US history.”
https://www.vox.com/politics/392197/trump-government-shutdown-musk
“House Speaker Nancy Pelosi, who announced she’d step down from leading the House Democrats on Thursday, made history as the first woman to ever hold the position and was a political target — and thorn in the side — of Republicans for the better part of two decades. All that frequently obscured her mastery of her job and her singular skills as a legislator, according to Molly Ball, a Time political correspondent and author of the biography Pelosi.
Pelosi has been central to many of Democrats’ biggest policy wins in recent years. She kept a divided caucus unified to pass landmark bills, including the Affordable Care Act, Dodd-Frank banking reforms, and the American Rescue Plan. She won so many concessions from Treasury Secretary Steve Mnuchin on Covid-19 relief that he had to be pulled from the talks, according to Ball. And she’s corralled members time and again when the party seemed on the verge of fracturing over their differences.
“Here’s someone who had a 30-year career being the force behind all kinds of major legislation and liberal accomplishments in the House, chief among them the ACA. But when people talked about her, the only thing they seemed to talk about was just how disliked she was,” says Ball of the misconceptions people held of Pelosi when she first began reporting on the speaker.”
“Under the legislation, $750 million would be allotted over the next five years to help states implement red flag laws, which allow authorities to temporarily confiscate guns from individuals deemed a threat to themselves or others. (Similar laws already exist in 19 states and the District of Columbia.) The legislation allows for the implementation of these programs through mental health, drug and veterans’ courts.
Republicans involved in the negotiations pushed to make sure no one is flagged without “the right to an in-person hearing, an unbiased adjudicator, the right to know opposing evidence, the right to present evidence, and the right to confront adverse witnesses,” as well as a right to bring counsel to the hearing.
“Under this bill, every state will be able to use significant new federal dollars to be able to expand their programs to try to stop dangerous people, people contemplating mass murder or suicide, from being able to have access to the weapons that allow them to perpetrate that crime,” Murphy said in a floor speech.”
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“While spouses, co-parents or cohabitating partners convicted of domestic violence are already banned from purchasing firearms, abusers in relationships between people who are not married and live separately are still able to purchase guns, creating the so-called “boyfriend loophole.” (According to Everytown, a gun safety advocacy group, about 70 women are shot and killed by an intimate partner every month.)
Under the new legislation, anyone convicted of domestic violence against a former or current dating partner would be banned from purchasing a weapon.”
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“The legislation calls for an expansion of background checks into buyers under 21 years of age, providing three business days for the check into their criminal and mental health history to be completed. If that background check finds something questionable in a potential buyer’s record, the legislation would provide for an additional seven business days to look into the buyer.”
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“The bill provides funding for expanding access to mental health services, including making it easier for Americans on Medicaid to use telehealth services and work with “community-based mental health and substance use disorder treatment providers and organizations.” And it would provide additional funding for the national suicide prevention hotline (since guns accounted for a majority of suicide deaths in 2020) while schools would receive funding to increase the number of staff members providing mental health services.”
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“The bill also provides $300 million for the STOP School Violence Act for increased security at schools, although some Democrats had expressed concern about this aspect of the bill.”
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“The legislation would also require more sellers to register as “Federally Licensed Firearm Dealers,” including anyone who sells guns to “predominantly earn a profit.” These sellers would in turn be required to run background checks on potential buyers and keep records of the sales.
The bill would also impose penalties on “straw” purchasers who buy guns for people who can’t pass a background check.”
“the latest CR means that government agencies are still operating on a budget from December 2020. Not only is that budget insufficient to meet the funding needs of major portions of the government, such as the Defense and Transportation departments, but the use of the CR prevents the implementation of new programs from legislation Congress has already passed, like the infrastructure bill. Without individual appropriations bills or an omnibus bill that accounts for all of the programs and funding needed for different agencies, the government can’t get started on a number of major projects despite the clear need for infrastructure upgrades and bipartisan support for the legislation.”
“The law, which takes effect Jan. 1, protects patients from receiving expensive bills for unexpected out-of-network care but doctors, hospitals and insurers are still at odds over which factors an independent arbitrator should rely on to decide who picks up the tab.
The outcome could swing billions of dollars in payments, significantly influence how doctors and hospitals negotiate prices with insurers and possibly affect premiums for millions of Americans.
“This is probably one of the most significant overhauls in the health system since the [Affordable Care Act] ACA,” said a spokesperson for the Coalition Against Surprise Medical Billing, which represents insurers, employer and union groups, and works with patient groups. “We certainly don’t see any end in sight in terms of the battle in making sure that these regs are implemented.”
The coalition supports the Biden administration’s interim final rule that instructs arbitrators to rely primarily on a single factor — the median in-network rate in a geographic area — when settling disputes between providers and payers. It has sponsored multiple six-figure digital ad-buys, including one that runs through Christmas, urging regulators to stay the course.”
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“Hospitals and doctors allege the Biden administration’s decision to emphasize the median in-network rate, a figure the insurance companies calculate, gives large insurers a huge advantage when negotiating how much a service should cost.
Insurers would have an incentive to keep the in-network rates lower to avoid paying more to out-of-network doctors. And they say payers would know doctors and hospitals have little recourse if they choose to remain outside an insurer’s network.
“Being out of network is really the physicians’ only control over how their contracts look,” said Randall Clark, the president of the American Society of Anesthesiologists. “If the insurance companies can treat us the same whether we’re in network or out of network, there is no impetus on the part of the insurance companies to negotiate fair contracts.”
Trade groups representing providers say the law lists several other factors that should be equally weighted when calculating how much a service costs, such as the doctor’s experience and the complexity of the procedure. While these metrics can still be introduced during the dispute resolution process, the Biden administration’s rules don’t give them as much weight as the median in-network rate metric, which providers say puts them at a disadvantage before the process even begins.”
“Note, however, the bill stipulates that it only covers firms that are over the $600 billion line “as of the date of enactment.” In other words, if a company has a market cap under $600 billion on the day the bill becomes law, then that company is permanently exempt—even if it later crosses the threshold.
Two companies that are currently under the $600 billion line and thus exempt from the bill are mega-retailers Target and Walmart. These companies are both worth hundreds of billions of dollars, and their e-commerce platforms are growing at a faster rate than Amazon’s. But under the Klobuchar/Cotton law, it wouldn’t matter if Target and Walmart overtake Amazon—they would be immune from this new antitrust action, as long as they are small enough on the day the bill is signed.
Readers may be interested to note that Target is headquartered in Minneapolis, Minnesota. Walmart is headquartered in Bentonville, Arkansas. Isn’t that interesting? It’s probably just a coincidence that the $600-billion-at-date-of-enactment provision would shield the two most important companies in Klobuchar and Cotton’s home states.”
“The House bill — H.R.3 — has a few mechanisms for reducing prescription drug prices, but most notably, it would allow the US health department to directly negotiate the prices it will pay for up to 250 drugs every year. The Congressional Budget Office (CBO) has estimated the bill would save Medicare up to $450 billion over 10 years because of those new negotiating powers. CBO has also projected about eight fewer drugs (out of an expected 300 over 10 years) would come to the market in the next decade because of the decrease in revenues for drug makers.
Despite Trump’s promises on the 2016 campaign trail that he would support proposals allowing Medicare drug negotiations, the White House threatened to veto the House plan. They called it a plan to institute government “price controls,” and said it would limit access to medicine, a favored talking point of the pharmaceutical lobby.
Even without this veto threat, H.R.3 is expected to be dead-on-arrival in the Senate. Senate Majority Leader Mitch McConnell has shown no interest in taking up the bill.”
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“Instead, Trump has aligned himself more with Republican Sen. Chuck Grassley, who has advanced a narrower set of reforms from his perch as the Senate Finance Committee chair. (Grassley has also accused McConnell of sabotaging his bill, which moved out of Grassley’s committee with bipartisan support.)
His committee sent a bill to the full Senate in the fall, though it has languished there in the months since. It’s unclear if Trump’s quasi-endorsement — he did not call out Grassley’s bill directly Tuesday night, instead praising the senator generally for his individual work on the issue — will provide any new momentum for the plan. Grassley’s bill, as the Brookings Institution documented, achieves pricing reform through a mix of technical changes to the rebates that drug makers pay under Medicare and Medicaid as well as provisions to cap out-of-pocket drug costs for seniors.
Right now, neither of the bills seems on a fast track to anywhere. Part of this is because Trump’s interest in drug pricing has been scattershot at best, and many Republicans are reluctant to place too many new regulations on an innovation industry.”