Pro-Palestinian or Terrorist?

Yesterday, someone on X asked me why people are called antisemites, terrorists, and Hamas supporters for being pro-Palestinian. My response turned into this.

The answer is a combination of individual factors, mass definitional imprecision and confusion, as 

well as the existence of actual connections.

Obviously, these are not the same in a broad sense. Many people make these associations

reflexively, often emotionally. Perhaps fueled by fear, habit, developmental needs, neurotic anxiety, 

social pressure. Some may have political agendas, while others may be cognitively limited or 

intellectually lazy. Needless to say, associations amplified by organizations, media, and governments are also influenced by social and political pressures. 

But beyond reasons for individual and group proclivities for making and holding false associations, there is no consensus on the definition of the individual terms in the first place. Trying to define ‘pro-Palestinian’ illuminates this well. Does pro-Palestinian mean that one supports:

1. The Palestinian people continuing to be used as a tool by the Arab world to operationalize its 

wish to make the world Juden rein?

2. Palestinians no longer being governed by Hamas?

Or, in a more concrete sense, does being pro-Palestinian mean that one supports:

3. All the people living on the West Bank and in Gaza?

4. All the people living on the West Bank?

5. All the people living in Gaza?

6. All the people living in Gaza except senior leaders of Hamas?

7. All the people living in Gaza except all Hamas leaders?

8. All the people living in Gaza except Hamas members?

9. All the people living in Gaza except Hamas members and Hamas supporters?

To complicate this more, each of these has its own definitional rabbit hole. Take the term ‘Hamas 

supporter’, for example. Who counts? The 75% of Gazan Palestinians who support Hamas overall? The 60% who support Hamas but don’t support its violence? 

Adding individual factors to this wide definitional scatter often makes discussing the topic difficult, 

emotional, and potentially conflictual. From a neuropsychological perspective, people in such 

conversations have less access to the organizational and analytic systems in the brain, impairing the kind of parsing necessary to avoid wrongly associating Palestinians with terrorists, antisemites, or Hamas supporters.

That said, these associations are often correct. A small sample of the evidence.

1. Generations of Palestinian children have been taught in school (evidenced by countless videos) 

and at home to hate Jews and to seek to kill them 

2. Two uprisings (intifadas) were launched against Israel, initiated by the Palestinian Liberation 

Organization (PLO), the terrorist group that previously governed the Palestinians

3. Mahmoud Abbas, the leader of the allegedly non-terrorist version of the PLO, the Palestinian

Authority, recently sent a letter to all West Bank imams demanding they teach that Islam requires the 

killing of Jews

4. Gazans, Palestinians all, elected Hamas, a terrorist organization whose charter defines its mission as the annihilation of all Jews

5. Massacre of October 7 notwithstanding, 60% of Palestinians currently support Hamas

despite its vow to repeat this barbaric violence serially 

6. Importantly, the lines that should exist between pro-Palestinian and the other terms are consistently obfuscated by their supporters. Speakers and attendees at Pro-Palestinian rallies routinely call and chant for intifada against the Jews and for situations that would result in Jewish annihilation. Attendees at some rallies pin to their clothing pictures of the types of gliders used as vantage points to pick off the audience at a music festival on 10/7. Some even wear Hamas headbands. At universities, far Left academics who see the world through the lens of Frantz Fanon’s revolutionary anticolonialist claptrap have drawn a straight line from pro-Palestinian to Jewish genocide.

In summary, being pro-Palestinian is often associated with being an antisemite, terrorist, or Hamas supporter because of individual factors and the paucity of  accurate, shared definitions of terms. But, mostly it’s because being pro-Palestinian is, more often than not, actually linked to antisemitism, terrorism, and/or supporting Hamas. While we must not loose sight of the estimated 20 percent of Gazan Palestinians who are simply pro-Palestinian, we must also be realistic about the large majority of the weight on the scale being on the other side.

Making Sense of POTUS: Part VI--Traits 8 and 9

I started this post over five years ago, about the time I stopped adding to my blog. Having resurrected the blog, I finally finished the post. I trust you’ll enjoy it. 

This is the last in a six part series about Donald Trump's publicly visible traits. The final two are:
8--In his worldview, people are tools and not intrinsically valuable
9--For the former POTUS, history, precedent, and protocol are irrelevant

As in preceding parts of the series, the elements of the final two traits will be treated individually.

People Are Tools and Not Intrinsically Valuable 

It has been obvious for decades -even to the casual observer- that Mr. Trump values people only if, and only to the extent that, they fit into the current form of his pursuit of power and adulation. 

One oft seen form of this pursuit and objectification is his use of media surrogates. If well managed, surrogates can play a central role in effectively manipulating the media and electorate by acting at multiple levels, even simultaneously. For Trump, I’d guess the calculation is ‘more is better’. That is, until a surrogate criticizes him, or until a skilled journalist, and/or a surrogate’s grandiosity, forces the surrogate into admitting a truth uncomfortable for Trump. 

Chris Christie is the best known example because he serially publicly criticized and exposed Mr. Trump at the same time. The former New Jersey Governor is also the best known example of a Trump surrogate who fell out of grace because of the repeated, massive, public humiliations he endured as Trump slowly took his revenge. Here’s an excerpt from Musings on 11/28: Multitasking while Cabinet Building, with some details. After a series of critical comments about Trump’s public statements and comportment, some in real time, Trump’s vengeance came in the form of giving Christie a series of bones (for instance, allowing him to act as a surrogate, run the transition early on, and be interviewed for a cabinet position) without, in my opinion, any intention of ultimately giving him a position in the new government. Christie was dismissed from his transition job and finally seem[ed] to understand that he ha[d] nowhere to go in Trump-land.

Donald Trump views and reacts to being publicly contradicted -even if he’s lying- in the same way that he views and reacts to being criticized.  He views public contradiction as interrupting his receipt of all the power and adulation to which he’s entitled. Interrupters are disloyal. To him. Then they are publicly maligned, undermined, and discarded to balance the scales. To get them back. I give you as examples the end of the congressional careers of Senator Liz Cheney, as well as Representative Adam Kinzinger and seven other House members who voted to impeach then-President Trump for the Big Lie. Republicans all. 

History, Precedent, and Protocol Are Irrelevant

Donald Trump eschews history, precedent, and protocol for many reasons. Of course, bucking the system shows strength. Conversely, demurring to the system would put him in a relatively weak position. A position that, to Trump, threatens his ability to suck on the teets of his supporters to produce more power and adulation, his substitutes for a sense of self. 

Demurring would also require him to have stopped defending against becoming aware of the psychological abuse he suffered at his father’s hand. Defenses here take the forms of compulsively repeated reenactments of the interpersonal aspects of the abuse, and of identifying with his aggressive father in these reenactments. They also take the forms of denial, rationalization, and his well known affinity for the projection of his inadequacies, toxicity, immorality, and misdeeds onto others. 

Simply said, Donald Trump is unable to threaten the source of his sense of self or to deconstruct his defensive constellation. Even if he had sufficient insight to pursue the habituation of decades of conditioned patterns of cognition, emotion, and behavior, he’d never do it. It is unconsciously avoided by Trump because it would be completely intolerable and psychologically overwhelming.

Finally, there is a multitude of examples of the former president rejecting precedent, protocol, ritual, and rules. The most frequently occurring example is Trump ignoring the moral, ethical, religious, social, and legal dictates that demand honesty. The best known example is, of course, The Big Lie. That is, Donald Trump’s incessant lying about the outcome  of the 2020 presidential election.

For a scholarly dive into the topic, I commend to you Donald Trump and the Norms of the Presidency. https://pfiffner.gmu.edu/wp-content/uploads/2022/05/Donald-Trump-and-the-Norms-of-the-Presidency-Jim-Pfiffner.pdf

This essay was written in 2022 by James P. Pfiffner, Professor emeritus in the Schar School of Policy and Government at George Mason University. In it, three categories of norms flouted by Mr. Trump are explicated in detail. They are

• Norms of the Presidency and Common Civility
• Undermining Governance Institutions
• Abusing National Security Institutions

Sadly, there will be more of the same if Donald Trump is elected in 2024. In all likelihood, he will continue all of the atrocious behavior recounted by Professor Pfiffner because the former president is unable to change. To do so would require him to deconstruct his defensive structure, and disconnect from his source of a (false) self. This is instinctively prohibitive to the former president because it would be unbearable. Trump would be unable to cope; it would break him.

If voters give Trump the nod, surf’s gonna get real choppy again. 

Making Sense of POTUS: Part V--Trait 7

This is the fifth in a six part series about Donald Trump's publicly visible traits. The current focus is:

7--Mr. Trump is neither insightful nor prone to guilt

Following the outline of the preceding parts, these elements will be treated individually. And, as has been the case so far, examples abound.

Insight Definitions of insight run from inaccurate colloquial ones, like simply understanding a situation or that a mistake was made, to the technical. Technical definitions of insight typically include the abilities to accurately describe: 

• current thoughts, emotion and behavior
• triggers for such experiences, psychological and social
• personality factors related to the triggers
• the genesis and development of these factors, including those that are biological, psychodynamic, and conditioned

Some psychoanalysts, like Otto Kernberg for example, have added to this list a desire for change. All of this assumes authenticity and not being too encumbered by one's defenses. 

The comprehensiveness of technical explanations makes them too unwieldy for application to public action. Instead, behavioral indicators should be considered, the best of which is guilt.

Guilt Setting aside the roles of biology and reinforcement in guilt production, the concept can be defined using the first two bullet points above, with the addition of the ability to contrast cognition, emotion and behavior with norms.  (This also means that a certain degree of insight is necessary for guilt to be generated, a topic to which we will return shortly.)

The question at hand is, how can it be observed?

In the present scenario, silence and a hang-dog facial expression -best illustrated by Bill Clinton in the aftermath of the revelation of his affair with Monica Lewinsky- are not approaches likely to be adopted by Mr. Trump because they are antithetical to one of his two raisons d'etre, wresting adulation from others. (The second is accruing more power.) The most reliable way left to observe guilt is to listen. In a nutshell, we must examine what Mr. Trump says for evidence that he is aware of, and bothered by, his thoughts, feelings and actions being outside normal limits. 

And... the evidence is mixed. 

It is clear that POTUS looks for triggers. But it is also clear that, at the same time, he sees only social ones. Simply put, blaming and projecting preclude the consideration of contributing psychological factors. 

Further, Mr. Trump is aware of his effect on people. Indeed, this seems to be one of his major foci. But he is also unperturbed by it. 

Lastly, there is no evidence in either direction that he is able to accurately describe his thoughts or emotions, or that he is able to contrast them with norms. His only apology on record is for his comments on the Billy Bush tapes. The apology drips with insincerity and reeks of contradiction. It is grossly illogical and nakedly manipulative. It is neither an apology nor proof of guilt.

In sum, mixed evidence of guilt does not insight make.

From Arse To Outhouse: Spinning Trump’s Shit-Hole Comment

On Thursday January 11th, President Trump met with a small, bipartisan group of lawmakers to discuss immigration. In that meeting, during a discussion of the merits of the country-quota based system currently in place, POTUS reportedly asked why the US allows immigration “from shit-hole countries’ like Haiti and those in Africa.

And the blowback began. Celebrities, activists, senators, congresspeople, heads of state, as well as unions of countries have condemned the statement, calling it racist in one way or another. Many have gone further and demanded an apology, as well. 

Worse yet for Donald Trump, the story won’t go away. It’s been on top of the news for 8 days. For contrast, within the past five years, former President Obama called Libya a “shit-show”, and Senator Lindsay Graham called Mexico a “hell-hole”. Both were in the news for a day (and most people don’t remember either comment at this point).

The waxing of this conflict, and his paper-thin skin, have unsurprisingly prompted Mr. Trump to respond, albeit in an unusually coordinated fashion. Four days after the remarks, the White House AND the two Trump supporters at the meeting (Senators David Purdue and Tom Cotton) simultaneously began suggesting that the other attendees misheard the President, who actually called the countries “shit-houses”. [This is an old slang word for out-houses.]

But, what was the calculation behind switching from holes to houses? Why make this distinction? Here’s my fantasy about what the Trump team considered as it mulled over potential responses to the blowback from his shitty commentary.

Option A: Deny the original comment.

Option B: Respond generally to the topic but don’t actively deny the comment. (Sarah Sanders would be an excellent point person for this approach.)

Option C: Act as if the words shithole and shithouse are synonyms. This would accomplish two things. First, changing the initial readout would create a distraction from the original comment. There would be a good deal of media attention paid to the seemingly baseless switch, but not necessarily to the comment itself. Second, and at the same time, it would dial down the intensity of the comment and, therefore, the reaction to it. Simply put, likening a country to an anus is a more highly charged declaration than making the same comparison to an out-house.

There is evidence that this strategy is working. The redefinition was endorsed by none other than former President Obama's National Security Council Spokesperson, Tommy Vietor, who is by no account Trump friendly. And this is but one of many examples.

We’re watching to see what happens, and what else POTUS has to say about Shit-Hole Gate, on Twitter...

The Healthcare Policy Debate: Part IV--Last Ditch Efforts

This is the fourth in a series analyzing the political and policy aspects of the recent healthcare debate. Part I was a political analysis of the first House bill. Part II evaluated the second House bill, HR 1628. In Part III, we took up the Senate bill. Here, the major elements of the proposed amendments to the Senate's bills will be presented in chronological order.

AMENDED SENATE HEALTH CARE BILLS

Dubbed the Obamacare Repeal Reconciliation Act, this bill was posted by the Budget Committee on July 17, 2017. This bill:

• Repeals the ACA mandates of 2016
• Removes the premium and cost sharing subsidies due to take effect on 2020
• Retains private market rules
• Prohibits tax credits for plans covering abortion, beginning in 2018
• Keeps health insurance marketplaces and open enrollment periods
• Eliminates the Medicaid expansion
• Disallows Medicaid funding of Planned Parenthood clinics for one year
• Repeals all ACA revenue provisions

The Health Care Freedom Act was proposed in the Senate on July 27, 2017. This bill:

• Repeals the ACA's individual mandate, and suspends the employer mandate until 2025
• Retains private market rules
• Keeps health insurance marketplaces and Open Enrollment periods
• Changes some state waiver process provisions to expedite applications process and extend waiver periods 
• Disallows Medicaid funding of Planned Parenthood clinics for one year
• Increases fiscal year 2017 funding for Community Heath Centers by $422 million
• Suspends the medical device tax for three years
• Increases the maximum annual contribution to Health Savings Accounts for three years

The Graham-Cassidy-Heller-Johnson Amendment (to HR 1628), referred to as Graham-Cassidy, was proposed in September of 2017. This bill:

• Repeals the ACA mandates of 2016
• Removes the premium and cost sharing subsidies
• Replaces these subsidies, as well as Medicaid expansion funding, with a state block-grant program (costing $1.176 trillion over seven years)
• Retains some private market rules, and allows states to set rules for coverage under the block grant program
• Repeal the authority to cover Medicaid expansion for adults by 2020
• Converts federal Medicaid funding to a per capita allotment, and limits federal Medicaid spending growth, starting in 2020
• Adds a state option to require work as a condition of eligibility for Medicaid
• Encourages the use of Health Savings Accounts
• Disallows Medicaid funding of Planned Parenthood clinics for one year
• Increases fiscal year 2017 funding for Community Heath Centers by $422 million
• Repeals some ACA revenue provisions, keeping the medical device tax 

Did I mention that all three failed???





With thanks to KFF

The Confederacy Versus Political Iconoclasm

I started to write this piece several months ago, during a previous dust up over the very same issue. At that point, the foci were confederate monuments in New Orleans and confederate flags in South Carolina. Of late we've been talking about the statue of General Robert E. Lee in Virginia's Charlottesville.

Kind of. While there has been substantive discussion of the relative merits of removing, modifying, or allowing the monument, the argument has also been hijacked to serve as the latest Antifa ~ Alt-Right battleground. Exclusive of all things proxy, this post endeavors to examine the merit issues alone. 

It is safe to say that, over time, conservatives have opposed the removal of  Civil War monuments. All of the Right's rationales for this can be reduced to one or more of the following. The demolition is defined as an assault on Southern: history, preservation, culture, or autonomy.

Owning the racism and oppression in the states' rights arguments made by the Confederacy in the 1860's, some conservative southerners view allowing Civil War monuments to stand as providing a vehicle for teaching tolerance, perhaps thereby also acquiring absolution for the sins of their fathers. In other words, they assert, these icons should be used to facilitate education about the related historical events, and about their existential and cultural impacts, in order to promote inclusivity in young people.

The Left's perspective is persuasive, too: The naked, chilling truth is that the Confederacy advocated continuing the practice of

capturing Africans, selling them into slavery, and controlling them with violence and death. Simply put, progressives argue that these are monuments to the basest of human instincts, to subjugate and to kill. They ask, what descent society would pay homage to those who fought to continue such an abomination? Or, would endorse the racism inherent in these icons by letting them stand? Or, would allow the direct descendants of slaves to be unceasingly insulted by the presence of statues honoring their forbearers' oppressors?

Relatedly, this view begs the oft-heard liberal argument that conservatives are racists, evidenced by their veneration of historic oppressors. For the Left, this has long been a fruitful accusation to make. In the 1960s, for instance, the Democrat Party began to use the very same argument to successfully disown slavery and the ensuing Jim Crow era. [Consequently, most now erroneously ascribe both the Republican Party.]

What To Do

I advocate using a slightly modified utilitarianism to solve this problem. Here, utilitarianism means selecting the solutions that will provide the most satisfaction to the most constituencies (as opposed to individuals). These constituencies are comprised of individuals concerned with Southern history, preservation, culture, and autonomy. Here are my ideas. 

Government should continue to consign the highly charged confederate flag to museums. This assures the preservation of the icon and its history. Further, large confederate monuments - on pedestals in the public square - should be taken down. 

In my opinion, their centrality and size so strongly suggest a public endorsement of racism, that much of the didactic value they have is obfuscated. Moreover, this removes the most glaring of insults. As for statues of General Lee in particular, it is worth noting that he was explicitly opposed to the erection of monuments to confederate soldiers.

On the other hand, icons at historic sites and battlefields should remain unperturbed. Such places continue to be perfect venues for educating young people about racism and inclusivity. (Nothing drives home a point like a field trip.) Finally, confederate icons at cemeteries should also be preserved. As is the case with keeping monuments on battlefields and the like, cemetery preservation allows individual members of the Confederacy to be honored in the present day.

Assuming that my policy recommendations will not be adopted at any point in the near future, I'll have more to say on the matter very soon.

The Healthcare Policy Debate: Part III--Inside the Senate Bill

This is the third in a series analyzing the political and policy aspects of the current healthcare debate. Part I was a political analysis of the first House bill. Part II evaluated the second House bill, HR 1628. In Part III, we will take up the Senate bill. Called the Better Care Reconciliation Act, it was initially released on June 22, 2017, and updated four days later.

The Senate's health care bill was not assembled from the ground up. Rather, it is a modification of the House's bill. As such, they will be presented together, in the same format, and with their similarities and differences highlighted.

A COMPARISON OF THE HEALTH CARE BILLS FROM THE U.S. HOUSE AND SENATE

Effects on INDIVIDUALS

The House bill maintains the mandate to be insured but removes the tax penalty for not doing so. 
The Senate bill repeals the mandate and, by definition, the penalty.

Moreover, in the House bill, subsidies for individual policy purchasers (the amount of which depends on the purchasers' income and the price of their premiums) would be supplanted by age-dependent tax credits that must be utilized for premium payments.
The Senate bill also repeals these subsidies but substitutes a tax credit eligibility formula based on the Federal Poverty Line. Subsidies amount to 58% of the actuarial value of a cheaper benchmark plan. 

HR 1628 prohibits these tax credits from being applied to any policy that covers abortion. 

The Senate bill does not change this provision.

Further, taxes on high earners, designated to help defray the costs of the Patient Protection and Affordable Care Act (also known as the A.C.A. and Obamacare), would be eliminated by the House. But, Medicare premiums increase for them.
Similarly, the Senate bill removes the A.C.A. taxes on high earners and increases their Medicare premiums.

Lastly, premium subsidies can be applied to policies not purchased on the exchanges in 1628.
The Senate bill restricts subsidy use to premium payment for policies offered on the exchange, but allows states to apply to waive this restriction.

Effects on EMPLOYERS

The requirement for employers--with over 50 full time employees--to offer health insurance would be dropped in the House bill.

The Senate bill keeps this provision.

In the House and Senate bills, the tax on high-end, employer-sponsored health plans is repealed.

Tax deductions for employers who receive subsidies to provide Medicare Part D are reinstated in HR 1628.
Such is the case in the Senate's bill, as well. 

Effects on INDUSTRY

Taxes imposed by the A.C.A. on insurers, pharmaceutical companies, medical device

companies, and tanning salons, would be repealed by 1628.

The Senate bill maintains this provision. 

Insurers are obliged to surcharge policy purchasers (by 30 percent) who were uninsured for more than 63 days before requesting coverage by a non-group policy.
In the Senate's bill, the 63 day grace period is kept but the penalty for a longer coverage lapse is a waiting period, as opposed to a surcharge.

Insurers must also continue covering dependents until they are 26 years of age.

This is unchanged in the Senate bill. 

The requirement to include abortion coverage is removed in both H.R.1628 and the Better Care Reconciliation Act (BCRA).

Effects on STATES

Most of the language in H.R.1628 impacts the states. The whopper is the cessation of federal payments for the A.C.A.'s Medicaid expansion. Further, the disbursement methodology is fundamentally altered. Specifically, the Medicaid program would no longer use a fee-for-service model, substituting an annual block grant approach.

The Senate bill also ends funding for Medicaid expansion and adopts a similar block-grant approach to state funding.

States would also receive subsidies to help the newly insured afford coverage, splitting $13 billion a year for ten years. An additional $8 billion over five years is allocated to support state funded high-risk pools. Finally, $15 billion is allotted for certain types of specialty care, and another $15 billion for reinsurance costs. Total cost, $153 billion.

BCRA starts with a total cost of $112 billion, $41 billion less than the AHCA. $50 billion of this is allocated for three years of reinsurance (2018-2021). The remaining $62 billion would be used for reinsurance, high risk pools, cost sharing, and provider payments, all between 2021 and 2026.

One group of provisions in the House bill allows states to request waivers of certain federal insurance regulations. Specifically, states would be permitted to apply for waivers of regulations that:

• require insurers to offer a defined minimum benefit package with no annual dollar or lifetime limits: The Senate bill does the same.
• limit the amount that insurance companies can charge older policy holders, relative to younger ones, to a ration of 3:1. [Without a waiver request, this defaults to 5:1.] BCRA mirrors this provision, except for moving its start date to 2019. 
• prohibit insurers from charging higher premiums for policies issued to people with preexisting conditions. [Additionally, to qualify for the waiver, the state must have a high-risk pool or equivalent, and only allow this benefit to be applied to individuals who have not have been continuously insured.] BCRA's position on this is unclear.

In both bills, states may require able-bodied Medicaid recipients to work in order to maintain their eligibility.

Health insurance marketplaces are maintained, and the use of health savings accounts (HSA) is incentivized primarily by increasing contribution limits, in HR 1628. 

The Senate's bill maintains insurance marketplaces and incentivizes HSA use, as well.

The Prevention and Public Health Fund is defunded by the House bill.

BCRA does not include this provision.

Planned Parenthood clinics are defunded for one year by the AHCA.

The Senate bill calls for a year of defundng, as well. 

Neither plan provides for selling health insurance products across state lines. 

Finally, BCRA allows for the creation of association health plans for small businesses.

The bill failed, in dramatic style,  because five Republican Senators voted against it. (There was only room to loose two and still pass the legislation.) They are: Ted Cruz of Texas, Ron Johnson of Wisconsin, Rand Paul of Kentucky, Dean Heller of Nevada and Susan Collins of Maine.

Special thanks to the Kaiser Family Foundation

The Healthcare Policy Debate: Part II--Inside The House Bill

This is the second part in a series analyzing the political and policy aspects of the current healthcare debate. Part I examined the first House bill from a political perspective. Part II assesses the second House bill, and Part III the Senate bill. The same discussion outline--categorizing elements of the bill by their Effects on Individuals, Employers, Industry and States--will be utilized in all parts of the series.

THE U.S. HOUSE OF REPRESENTATIVES BILL:

H.R.1628 was passed (with amendments) on May 4, 2017. The vote on an earlier version was cancelled by Speaker Ryan

because GOP defections made passage impossible. [See The Healthcare Bill Vote: Why Canceling It Mattered on THE PoP BLOG! for more on this.] Here are the details on 1628.

Effects on Individuals

The House bill maintains the mandate to be insured but removes the tax penalty for not doing so. Moreover, subsidies for individual policy purchasers (the amount of which depends on the purchasers' income and the price of their premiums) would be supplanted by age-dependent tax credits that must be utilized for premium payments.

These tax credits can not be applied to any policy that covers abortion. 

Further, taxes on high earners, designated to help defray the costs of the Patient Protection and Affordable Care Act (also known as the A.C.A. and Obamacare), would be eliminated. But, Medicare premiums increase for them.

Lastly, premium subsidies can be applied to policies not purchased on the exchanges.

Effects on Employers

The requirement for employers--with over 50 full time employees--to offer health insurance would be dropped in the House bill.

The tax on high-end, employer-sponsored health plans is also repealed.

Tax deductions for employers who receive subsidies to provide Medicare Part D are reinstated.

Effects on Industry

Taxes imposed by the A.C.A. on insurers, pharmaceutical companies, medical device companies, and tanning salons, would be repealed by the 1628.

Insurers are obliged to surcharge policy purchasers (by 30 percent) who were uninsured for more than 63 days before requesting coverage.

Insurers must also continue covering dependents until they are 26 years of age, and refrain from using gender in premium calculations.

The requirement to include abortion coverage is removed in H.R.1628.

Effect on States

Most of the language in H.R.1628 impacts the states. The whopper is the cessation of federal payments for the A.C.A.'s Medicaid expansion. Further, the disbursement methodology is fundamentally altered. Specifically, the Medicaid program would no longer use a fee-for-service model, substituting an annual block grant approach.

States would also receive subsidies to help the newly insured afford coverage, splitting $13 billion a year for ten years. Additionally, $8 billion over five years is allocated to support state funded high-risk pools. Finally, $15 billion is allotted for certain types of specialty care, and another $15 billion for reinsurance costs. Total cost, $153 billion.

One group of provisions in the House bill allows states to request waivers of certain federal insurance regulations. Specifically, states would be permitted to apply for waivers of regulations that:

• require insurers to offer a defined minimum benefit package with no annual dollar or lifetime limits
• limit the amount that insurance companies can charge older policy holders, relative to younger ones, to a ration of 3:1. [Without a waiver request, this defaults to 5:1.]
  
• prohibit insurers from charging higher premiums for policies issued to people with preexisting conditions. [Additionally, to qualify for the waiver, the state must have a high-risk pool or equivalent, and only allow this benefit to be applied to individuals who have not have been continuously insured.]

States may require able bodied Medicaid recipients to work in order to maintain their eligibility.

Health insurance marketplaces are maintained, and the use of health savings accounts is incentivized primarily by increasing contribution limits, in the House bill.

The Prevention and Public Health Fund, and Planned Parenthood clinics, are defunded.

Stay tuned for Part II of this series, which will take up the Senate's healthcare bill... as soon as it passes.

Special thanks to the Kaiser Family Foundation

Making Sense of POTUS: Part IV--Traits 5 and 6

On to the next two traits! They are:
5--POTUS feels entitled to special treatment and thus also feels victimized by others' criticism of him.

6--When Mr. Trump feels victimized, he becomes angry and publicly shames the object(s) of his ire.

 

Examples of these attributes are ubiquitous. So, let's use the ongoing Trump Campaign-Russian Influence scandal to illustrate them. To frame the discussion, the elements of each attribute will be treated individually.

Entitled to Special Treatment The President requested a loyalty oath from James Comey, former Director of the FBI. The former seems to define loyalty as willingness to publically defend his antics. It is unclear whether Trump includes in this antics that are also illegal.

Criticism Narcissists, like those with other personality disorders, think in black or white terms at a significantly higher rate than the general population. As such, declining to pledge his loyalty (however gracefully it was done) would be interpreted by Trump to mean that Mr. Comey was declaring himself an adversary. 

This was tolerable until two things became clear. First, evidence was mounting that Trump himself would be implicated in the Campaign-Russia scandal. Since then, there have been several unconfirmed reports that POTUS was formally notified that he is the target of a federal investigation. Here is the Department of Justice' general explanation of what that means: 

 

 

Second, it became clear that Director Comey would likely be testifying before congress and, potentially, a grand jury. Since then, he has agreed to publically testify before the Senate Intelligence Committee, chaired by Richard Burr (R-NC), and the House Oversight Committee led by the retiring Jason Chafetz (R-UT).

 

Victimization The combination of being investigated by Mr. Comey's FBI, and likely being publically implicated by Comey's testimony, was not tolerable to Mr. Trump. He concluded that the disloyal Director aimed to bring him down. And at that moment, Comey became President Trump's victimizer. 

So, he fired the Director.

Anger and Shaming Equally important is the way in which Mr. Comey was terminated--disrespectfully and publically. It was done by letter, a copy of which was released to reporters by the White House as the original was in transit. Consequently, the public learned of the termination before Mr. Comey, who then found out from news reports that came out while he was addressing his staff. This outcome was calculated by POTUS, who was obviously acting out anger in the form of public shaming.

Still not a pretty picture. 

A BRIEF HISTORY OF MENTAL HEALTH PARITY POLICY

The following is an excerpt from: The History of U.S. Federal Mental Health Policy, also posted on this blog.

The 1980's saw employers’ mental health insurance costs rise an average of 60 percent per year (England and Vaccaro, 1991; Washington Business Group on Health, 1996). The resulting typical benefit design--matching the minimums set fourth in the federal HMO Act and its amendments--was patently discriminatory. 

Compared to benefits for physical health therapies, benefits for behavioral health therapies typically had higher deductible, copayment and coinsurance requirements; lower limits on the number of outpatient visits and hospital days covered in a given year; and more austere care management guidelines. This remained the case even though it has never been clear whether managed behavioral health care produces more savings than is created by the initial expense reduction from imposing managed care on a system or population anew. (See Goldman et al. 1998, for example.)

The Mental Health Parity Act of 1996 (P.L. 104-204), which was signed by President Bill Clinton, began to correct these inequities by prohibiting disparate annual or lifetime limits on coverage for mental health and general health care. The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008, which was signed by President George W. Bush and included in the Emergency Economic Stabilization Act of 2008 (PL 110-343), took this even farther. Primarily, it prohibits the discriminatory practices noted above. Moreover, in contrast to most state parity regimes, the Act extends parity requirements to all conditions in the latest issue of the Diagnostic and Statistical Manual of Mental Disorders (currently in its 5th edition), including addiction. Additionally, out of network parity is made compulsory.

Importantly, the Mental Health Parity and Addiction Equity Act (or MHPAEA) does not mandate mental health coverage. Instead it sets benefit parameters which are only in force IF mental health coverage is offered. Also worthy of note are two categories of exemptions. The first is of businesses with fewer than 50 employees. The second exemption applies to business that can show an actuarially certified 2 percent increase in healthcare costs in the first year, or a 1 percent annual increase thereafter (P.L. 110-343).