“It is true that, as of right now, Medicare is projected to be unable to pay all of its bills as early as 2028. Without congressional action, a stronger economy, or more likely, both, the government could end up without enough money to cover everything it promises enrollees within five years.
That would be unprecedented and would likely provoke a political crisis. But it is not quite the same thing as Medicare going bankrupt and ceasing to exist entirely. Alarm bells have sounded about Medicare’s trust fund for decades, with the exact date of when it would run out of money moving forward and back. But, eventually, Congress will need to act.
To understand the program’s financial situation, start with how Medicare is structured. Medicare is broken down into several different parts. Part A covers hospital care, stays at skilled-nursing facilities, and home health care. Part B pays for outpatient physician care. Part D is the prescription drug benefit, which is administered by private insurance plans. Most Medicare beneficiaries — anyone over age 65 — get their insurance directly through the government. But almost half are now insured through Medicare Advantage (also known as Part C) in which patients sign up for a private plan, paid for largely by the federal government, which provides a comprehensive suite of benefits. (Those plans are also more expensive to the government and their growing enrollment is contributing to the solvency problem”
…
“Different parts of Medicare are funded in different ways, but when we’re talking about a Medicare funding crisis, we’re talking about the benefits paid by Part A: hospital services. Hospital bills for Medicare enrollees are funded almost entirely through the program’s dedicated payroll taxes. If those benefits cost more than the government receives in Medicare payroll taxes in a given year, as can happen in an economic downturn, the difference comes out of a trust fund earmarked specifically for Part A. The Medicare trustees, who issue annual reports on the program’s finances, project that Medicare spending will begin outpacing revenue again in 2024, requiring the program to dip into the trust fund. The trust fund is projected to be fully depleted by 2028 without further policy changes.”
…
“Part B and Part D, however, are not facing the same financial crunch. They are funded primarily by general tax revenue, instead of an earmarked payroll tax, and premiums paid by beneficiaries. Their trust funds are projected to be sufficient for the foreseeable future.”
…
“Medicare Advantage plans receive funding based on the type of service provided to their customer, which means money for hospital care comes from Part A. Annual Part A payments to Medicare Advantage plans is expected to increase from about $176 billion in 2022 to $336 billion by 2030.
Separate from the new budget proposal, the White House is attempting to rein in the payments to Medicare Advantage plans (from an 8 percent increase last year to a proposed 1 percent increase in the coming year). Republicans and the health insurance industry have slammed that proposal as a cut to Medicare, an example of how it can be politically difficult to get Medicare spending under control.
Biden’s budget will likely jumpstart a new debate about Medicare solvency. But it’s only a beginning.
Congress has passed provisions to reduce Medicare spending in recent years, such as the Inflation Reduction Act’s plan for the program to negotiate some prescription drug prices. But lawmakers have also acted to avert any cuts to how much the program pays doctors, hospitals, and other medical providers.
Both tax increases and any spending reductions can be a tough sell in Congress. So can increasing the eligibility age, an oft-floated idea that still amounts to cutting benefits for seniors.
Biden is going with tax hikes in his budget plan. But it’s not yet clear if lawmakers are really willing to act on his or any proposal to improve Medicare’s finances.
They still have five years before the Part A trust fund will run out, according to the latest available projections. The Medicare trustees urged Congress to act soon to avert the crisis, in order to minimize the risks for patients and providers. But unfortunately, lawmakers have a habit of waiting until the last minute to act.”
“The Biden administration is about to undertake one of its most complicated international initiatives, installing a new leader at the World Bank who can steer the organization toward a sweeping climate change agenda.
Bank President David Malpass’s abrupt announcement that he will step down from his post a year early opens the way for President Joe Biden to choose someone who embraces the new goal of fundamentally overhauling the bank’s work to focus more on climate and other global challenges.”
“The Biden administration unveiled a new policy for transferring or selling arms to foreign countries that puts more weight on protecting human rights, in theory setting a lower bar for denying sales.
The Conventional Arms Transfer Policy was last updated in 2018 under the Trump administration, and it placed an explicit emphasis on the economic benefits of selling more military equipment overseas.
At issue is whether the U.S. thinks the customer nation will use the weapons on its own population. Under the old standard, the U.S. had to have actual knowledge that a government would use the weapons to harm civilians. Now, if the U.S. determines a country would “more likely than not” harm its population, a sale could be denied, a senior State Department official told reporters.”
…
“The Biden administration had already tweaked its arms sales policy by refusing to sell Saudi Arabia offensive missiles and bombs after the regime used U.S. weapons to strike civilian targets in its war in Yemen.
Sales of defense weapons to Riyadh continue, however, including air defense and air-to-air missiles.”
“Republicans began ignoring the blue slip process for circuit court judges when they had Senate control in 2018, a policy Democrats have continued. Activists now want Democrats to do the same for district court nominees, who could potentially get held up by Republicans looking to slow Biden’s selections. The idea is that if Republicans don’t want a seat to get filled, they could theoretically keep it open by refusing to submit blue slips regardless of who the nominee is.
Some advocating for the change, like those at the Times, argue the system is fundamentally undemocratic. Others, including many progressive activists, say that it should be changed to ensure Democrats can confirm every judge they can in the next two years.
“If they remove the blue slip impediment, they can fill all their vacancies. If they don’t, they won’t be able to fill all those vacancies,” says Alliance for Justice president Rakim Brooks.”
“As the White House gears up for the end of one Trump-era border policy this spring, it has its sights set on resurrecting a version of another much-maligned immigration program put in place under the previous administration.
The Departments of Homeland Security and Justice on Tuesday announced a proposed rule that will bar some migrants from applying for asylum in the U.S. if they cross the border illegally or fail to first apply for safe harbor in another country. The rule was previewed by President Joe Biden in January. Following a 30-day public comment period, it will be implemented upon the May 11 end of the Covid public health emergency, according to a senior administration official who briefed reporters.
May 11 is also the end date of the Title 42 public health order currently being used to bar entry to most migrants at the southern border. The rule announced on Tuesday would stay in place for two years following its effective date.”
…
“Administration officials also used Tuesday’s announcement to criticize Congress, arguing that the White House has been left to roll out new policies to fill the “void” left by inaction on the Hill.
“To be clear, this was not our first preference or even our second. From day one, President Biden has urged Congress to pass comprehensive immigration reform and border security measures to ensure orderly, safe and humane processing of migrants at our border,” a senior administration official said.”
“Daleep Singh, deputy national security adviser for international economics, National Security Council, White House: We thought we had quelled his appetite for territory by meeting him in Geneva and trying to address some of the strategic concerns he’d been raising, but then here we were again, with an even larger force.”
…
“Gen. Mark Milley: It’s 30 days after the exit from Afghanistan. Some people said that the invasion of Ukraine was a result of the withdrawal. I don’t agree. It’s obvious the invasion was planned before the fall of Afghanistan.”
…
“Bill Burns: [While I was in Moscow,] I was talking to [Putin] on a secure phone. It was a strange conversation. He was in Sochi — this was the height of yet another wave of Covid, Moscow itself was under a curfew — so he was isolating himself. The conversation was pretty straightforward. I laid out what the president had asked me to lay out to him. His response was a lot of what I had heard before from him about his convictions about Ukraine, and in many ways, his cockiness about Russia’s ability to enforce its will on Ukraine. His senior advisers were pretty consistent as well. Not all of them were intimately familiar with his own decision-making, so at least one or two of them were a little bit surprised with what I laid out to them because the circle of advisers had gotten so small.”
…
“Bill Burns: My own impression, based on interactions with him over the years, was a lot of this had to do with his own fixation on controlling Ukraine. He was convincing himself that strategically the window was closing on his opportunity to control Ukraine.”
…
“Bill Burns: His conviction was that without controlling Ukraine and its choices, it’s not possible for Russia to be a great power and have this sphere of influence that he believes is essential. And it’s not possible for him to be a great Russian leader without accomplishing that.”
…
“Wally Adeyemo: The diplomacy between the president and the secretary getting people aligned on sanctions before Russia invaded was probably the biggest difference between this time and Crimea in terms of our ability to act quickly and effectively — things that we were unable to do back then.”
…
“Gen. Paul Nakasone: We sent a [U.S. Cyber Command] team forward, and they land in Kyiv on the fourth of December. Within a day or two, the leader calls back, and she tells my Cyber National Mission Force commander, her boss, “We’re not coming home for a while. In fact, send more people.” We sent our largest “hunt forward” package into Kyiv. That stays there for a little over 70 days. What is a “hunt forward” operation? A hunt forward operation is focused at the partner’s request to look at a series of networks — we identify malware, tradecraft and anomalous behavior in those networks that point us to adversaries and allow the partner — in this case, Ukraine — to strengthen those networks.
The interesting thing that she — the team leader — said: “They’re really serious about this.” This is the third time that we had been back in Ukraine, and there was just a different feeling in terms of how Ukraine was approaching it. When we provided information, they were moving on it, correcting the vulnerability, and looking for more.”
…
“Amb. Michael Carpenter: We thought, “OK, if there’s a crisis of European security, then let’s talk about it. Let’s identify the Russian concerns and see if there’s a way that we can address them through diplomacy.” Poland assumed the chairperson-ship of the OSCE on January 1, 2022, and so I immediately went to go visit with the Polish Foreign Minister to talk about the diplomatic angle. He was very receptive, and subsequently launched a process called the renewed European Security Dialogue. Russia basically refused to engage, and that’s when it became increasingly clear the Kremlin really had no interest in diplomacy all along. It was bent on war.
All of its alleged concerns — everything that it was putting out there in the public domain — was really a smokescreen. They turned their backs completely on the diplomacy that we were proposing at the OSCE, the diplomacy that was being proposed on behalf of NATO and then also bilaterally what we were discussing with the Russians. There was nothing to offer them, because they didn’t even want to talk.”
…
“Bill Burns: I saw Zelenskyy in the middle of January to lay out the most recent intelligence we had about Russian planning for the invasion, which by that point had sharpened its focus to come straight across the Belarus frontier — just a relatively short drive from Kyiv — to take Kyiv, decapitate the regime and establish a pro-Russian government there. With some fair amount of detail, including, for example, the Russian intent to seize an airport northwest of Kyiv called Hostomel, and use that as a platform to bring in airborne forces as well to accelerate the seizure of Kyiv.”
…
“Antony Blinken: I saw Foreign Minister Lavrov in Geneva in late January, the 21st, because we were determined to exhaust every diplomatic avenue. It was incredibly blustery in Geneva — I’ve never seen Lake Geneva more agitated in my life, like an ocean with a major storm setting in. I alluded to that and said, “You know, we have a responsibility to see if we can calm the seas — calm the lake.” Lavrov was uncharacteristically focused on his talking points, and there wasn’t much extemporaneous give and take, which is not usually the case with him.
I wanted to see if there was some final way of breaking through and suggested we spend some time alone after the meeting with our teams. We sat in chairs about a foot from each other. I asked him, “Tell me, what are you trying to do? What is actually going on here? Is this really about your purported security concerns? Or is this about something theological, which is Putin’s conviction that Ukraine is not an independent state and has to be subsumed into Russia? If it’s the former, if this is genuinely from your perspective about security concerns that Russia has, well we owe it to try to talk about those and our own profound security concerns about what Russia is doing, because we need to avert a war. But if it’s about the latter, if this is about this profoundly misplaced view that Ukraine is not its own country, and you’re determined to subsume it into Russia, well, there’s nothing to talk about.” He couldn’t or wouldn’t give me a straight answer.”
…
“Emily Horne: We decided Jake was going to go out to the podium with [White House spokesperson] Jen [Psaki] the next day and do a couple of things: One, was going to make very, very clear that any American or dual nationals in Ukraine needed to get out immediately and that the calvary would not come to rescue Americans after an invasion has begun. That was certainly a lesson learned from Afghanistan: You can’t over-message that, and you have to be extremely clear, even at the risk of causing a little bit of panic. The Ukrainians were not terribly happy about that message, but we absolutely did not have a choice, given what we were seeing. The new phrase that Jake deployed on that February 11 press conference was “We are in a window where an invasion could begin at any time.””
…
“Gen. Mark Milley: I know that was a huge lot of diplomacy. There’s a lot of effort being done by Secretary Austin, Secretary Blinken, Jake Sullivan, myself, the president himself, to try to dissuade Russia from doing this and to warn them if they did it these will be likely consequences.
Derek Chollet: There have been multiple attempts — not just by us. There were other countries, the French, the Germans, others were engaging Putin. No one was getting anywhere.”
…
“Antony Blinken: The invasion didn’t take place for another week, precisely because we were able to call Putin out publicly. The fact that we were able to continue to declassify information, call him out at the Security Council, have the president use the ultimate bully pulpit to call him out — that put them a little bit off the timeline that we had seen.”
…
“Jake Sullivan: This was uncharted territory — the idea that there would be a major land war in Europe, with all of the ripple effects that that could cause, that felt like an enormous weight on me, on the whole team, most especially on the president. It was extremely hard to sleep.”
…
“Gen. Mark Milley: The Ukrainians, at the very end — probably about two weeks prior — really begin to mobilize their country into a nation at arms. They really got into full swing, where you started seeing all the men — and a lot of the women — learning how to use weapons, mines, hand grenades, explosives and all that stuff. Then you also saw a significant mobilization of Ukrainian people into the army — reservists — and you saw the disposition of the Ukrainian forces to begin to change into their wartime locations.
There was a large evacuation of civilians out of what was expected to be the frontline areas, a real flurry of diplomatic activity, and then also decisions made by the international community — most countries pulled out their embassies out of Kyiv. That’s a big, big decision. When you start seeing stuff like that happening, you start realizing that war is getting close.”
…
“Matthew Miller: There is sometimes this unrealistic sense that America can wave a magic wand and control the world. That’s just not true. We don’t have magic wands.”
…
“Colin Kahl: Sometimes people say, “Well, if you were going to give them this stuff, why didn’t you give them all at the beginning?” And the reality is, as a matter of dollars and logistics, we couldn’t. We’ve given $27 billion of security assistance. We didn’t have $27 billion at the beginning of the war. As a matter of actual and bureaucratic physics, you have to prioritize. What the secretary has been ruthless about is, “What does Ukraine need right now for the fight?” In the initial phases of the conflict, that was anti-armor, man-portable and short-range air defense systems, and artillery and ammunition for their Soviet legacy systems, and more Soviet legacy air defense systems. We poured in the Javelins and the Stingers and scoured our own stocks from the Cold War for Soviet era ammunition and stuff we swept up around the globe.”
…
“Gen. Mark Milley: People don’t think about war — even today. When I say to people, “There have been 35,000 or 40,000 innocent Ukrainians killed in this war, a third of their economy has been destroyed, an estimated 7 million internally-displaced persons, and another 7 million refugees out of a pre-war population of 45 million — you’re looking at 30 to 40 percent of that country displaced out of houses.” People sit there and go: “Oh?””
“Social Security will be insolvent by 2034. One of the trust funds for Medicare will be insolvent even sooner. When insolvency hits, both programs will be subject to mandatory benefit cuts. The exact size of the cuts will depend on payroll tax collections in that year, but the current estimate is that Social Security will be able to pay only 80 percent of promised benefits in 2034.
As I wrote last month, when Republicans such as former President Donald Trump were making similar vows not to cut Social Security benefits: Promising to do nothing amounts to promising a roughly 20 percent benefit cut in a little more than a decade. There is no getting around that fact.”
…
“Standing up for seniors (and everyone else who has been paying into Social Security and Medicare for their entire working lives) requires acknowledging that there is no reality in which the politicians do nothing and the entitlement programs continue functioning normally. The choice is between making changes now or accepting mandatory cuts in about a decade.”
“Biden announced a new carrot-and-stick immigration framework that would welcome tens of thousands of migrants to the U.S. each month and step up expulsions for unauthorized border crossers. David J. Bier, associate director of immigration studies at the Cato Institute, told Reason at the time that he expected “a meaningful reduction in unlawful crossings by incentivizing people to wait for the legal option to become available to them.””
…
“According to CBS, unlawful crossings at the border dropped by 40 percent in January—”the lowest levels of illegal migration along the U.S.-Mexico border since President Biden’s first full month in office in February 2021.”
Biden does deserve credit for recognizing that more opportunities for legal immigration mean fewer people are driven to migrate illegally. He could have also mentioned, but didn’t, another thing he’s done right: The plan’s private sponsorship aspect allows ordinary citizens to sponsor Nicaraguans, Cubans, Haitians, and Venezuelans.
He also neglected to mention a big thing he’s done wrong. As migrant arrivals swelled, Biden leaned into Trump-era policies that made the problem worse.
His administration upheld President Donald Trump’s Title 42 order, which has allowed federal immigration officials to immediately expel migrants, ostensibly in the name of stopping COVID-19. Since Title 42 carries no reentry penalty, repeat crossings have ballooned, artificially inflating the number of repeat encounters. The American Immigration Council has noted that from FY 2021 through April 2022, one in three border encounters “was of a person on their second or higher attempt to cross the border.””
…
“Yet while the president says he supports “comprehensive immigration reform,” his record paints a murkier picture. “Biden has enacted rules that shut countless farmers and small businesses out of the visa programs they depend on,” notes Sam Peak, an immigration policy analyst at Americans for Prosperity. “The fees and bureaucracy alone cost roughly $10,000 to hire just one farm worker….Biden insists on adding more red tape to these programs and fueling a black market for illegal immigration.””
“These requirements have long been found to increase the costs of infrastructure projects, but the promise of creating even more cost-increasing American jobs makes them a popular provision.
The $1.2 trillion Infrastructure Investment and Jobs Act (IIJA), which Biden signed into law in November 2021 re-upped requirements that federally funded infrastructure use American-made iron and steel. It also expanded those requirements to construction materials like drywall, copper wire, fiber optic cables, and lumber.”
…
“Those requirements were supposed to kick in within 180 days of the law’s passage. Right before they did, the Biden administration’s Department of Transportation (DOT) issued a sweeping 180-day waiver for new Buy America provisions for construction materials, citing the cost and complexity of complying with those provisions.
Public comments from state departments of transportation, public transit agencies, and contractors all generally supported this waiver and, in fact, asked that it last for at least 18 months and as long as four years.
The reason is pretty straightforward: Buy America provisions greatly increase the costs of infrastructure projects.”
…
“Expanding Buy America provisions, and cracking down on waivers, are a staple of all administrations and most State of the Union addresses. The fact they keep exempting themselves from these requirements shows that Biden—and his predecessors—understand at some level that they’re a bad idea.”