Two Democratic Congressmen Propose Bills To Legalize Marijuana At Federal Level

It is probably only a matter of time until marijuana prohibition ends. Like gay marriage, we will reach a tipping point where conservative opposition loses its impact. Also, like marriage equality, the majority of Democratic politicians will probably lag behind the country in openly adopting more liberal views, but two House Democrats have introduced bills to end marijuana prohibition. Sam Stein reports:

Two congressmen filed separate House bills on Friday that together would legalize, regulate and tax marijuana at the federal level, effectively ending the U.S. government’s decades long prohibition of the plant.

Rep. Jared Polis (D-Colo.) introduced the Regulate Marijuana Like Alcohol Act, which would remove marijuana from the Controlled Substances Act’s schedules, transfer oversight of the substance from the Drug Enforcement Administration over to the Bureau of Alcohol, Tobacco, Firearms and Explosives, and regulate marijuana in a way similar to how alcohol is currently regulated in the U.S.

Rep. Earl Blumenauer (D-Ore.) introduced the Marijuana Tax Revenue Act, which would set up a federal excise tax for regulated marijuana.

The bills would not force states to legalize marijuana, but a federal regulatory framework would be in place for those states that do decide to legalize it. To date, four states and the District of Columbia have legalized recreational marijuana (however, D.C.’s model continues to ban sales), 23 states have legalized marijuana for medical purposes and 11 other states have legalized the limited use of low-THC forms of marijuana for medical use.

During the Bush administration, the federal government would often raid medical marijuana facilities which were legal in the states the states where they were legal, and the Obama administration was slow to turn this around. With Obama going to be out of office in a couple of years, it is becoming more important to change federal law. Hillary Clinton has been to the right of most Democrats on this (as well as most other issues) and we cannot trust either Clinton or her likely Republican opponent to continue the liberalization finally seen under Obama. While unlikely to be accomplished in the current Congress, it would be preferable to take this issue out of the hands of either Clinton or a future Republican president.

Last year The New York Times argued for legalization of marijuana. Jeffrey Miron discussed the case for marijuana legalization in op-ed at CNN:

Marijuana legalization is a policy no-brainer. Any society that professes to value liberty should leave adults free to consume marijuana.

Moreover, the evidence from states and countries that have decriminalized or medicalized marijuana suggests that policy plays a modest role in limiting use. And while marijuana can harm the user or others when consumed inappropriately, the same applies to many legal goods such as alcohol, tobacco, excessive eating or driving a car.

Recent evidence from Colorado confirms that marijuana’s legal status has minimal impact on marijuana use or the harms allegedly caused by use. Since commercialization of medical marijuana in 2009, and since legalization in 2012, marijuana use, crime, traffic accidents, education and health outcomes have all followed their pre-existing trends rather than increasing or decreasing after policy liberalized…

Federal law still prohibits marijuana, and existing jurisprudence (Gonzales v. Raich 2005) holds that federal law trumps state law when it comes to marijuana prohibition. So far, the federal government has mostly taken a hands-off approach to state medicalizations and legalizations, but in January 2017, the country will have a new president. That person could order the attorney general to enforce federal prohibition regardless of state law.

As long as marijuana is illegal at the federal level we will continue to have many of the adverse consequences of prohibition, including inhibiting the use of medical marijuana. This includes states where medical marijuana is legal under state law. Besides the previous problems of DEA raids, having medical marijuana illegal under federal law makes many physicians unwilling to treat patients who are legally using medical marijuana under state law.

I have seen many individuals who are taking medical marijuana legally under state law discharged from pain clinics which outright refuse to treat anyone using medical marijuana. This is both due to fears of violating federal law and due to personal biases.  I received a consult letter just last month from a pain specialist who opposed giving pain medications to a patient who was using medical marijuana, making arguments which are contradictory to the medical literature which demonstrates that using marijuana as part of a pain management regimen results in decreased opioid use and a decreased risk of overdoses.

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Democrats Seek To Fix Bug In Obamacare Deadline

The Affordable Care Act has been a tremendous success in increasing the number of people insured, reducing the cost of health care coverage, and eliminating the ability of insurance companies to deny coverage to those who develop medical problems. However it is not surprising that a law of its complexity does get some details wrong. When I first heard that open enrollment would end in mid-February I thought this was a mistake.

Some of those who failed to purchase coverage last year might not realize that they risk paying penalties, and they might not realize this until around April 15 if they wait until the last minute to complete their taxes. If the goal of the mandate is to encourage people to sign up to avoid penalties, enrollment should extend through April 15. That way people could sign up for insurance to avoid the mandate.

I was glad to see that some Democrats have realized this and are working to fix the problem by urging the Obama administration to have a special enrollment period:

Three senior House members told The Associated Press that they plan to strongly urge the administration to grant a special sign-up opportunity for uninsured taxpayers who will be facing fines under the law for the first time this year.

The three are Michigan’s Sander Levin, the ranking Democrat on the Ways and Means Committee, and Democratic Reps. Jim McDermott of Washington, and Lloyd Doggett of Texas. All worked to help steer Obama’s law through rancorous congressional debates from 2009-2010.

The lawmakers say they are concerned that many of their constituents will find out about the penalties after it’s already too late for them to sign up for coverage, since open enrollment ended Sunday.

That means they could wind up uninsured for another year, only to owe substantially higher fines in 2016. The fines are collected through the income tax system.

This year is the first time ordinary Americans will experience the complicated interactions between the health care law and taxes. Based on congressional analysis, tax preparation giant H&R Block says roughly 4 million uninsured people will pay penalties.

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Republicans Plan To Impose Huge Tax Increase On Middle Class In Opposing Obamacare Fix

Republicans are increasingly seeing King v. Burwell as a way to do what they couldn’t accomplish in over fifty votes–repeal the Affordable Care Act. While it defies logic, the Supreme Court could conceivably rule that the Affordable Care Act only provides subsidies for plans purchased on state exchanges but not on the federal exchange.

A majority of people want Congress to pass a simple legislative fix should this occur, guaranteeing a continuation of the subsidies for those who purchase plans over the federal exchange. The health care and insurance industries also support such a fix.

This does not mean that the Republican Party will take the rational path. The Wall Street Journal reports:

Congressional Republicans say they won’t move to preserve consumers’ health insurance tax credits if the Supreme Court strikes them down, raising the stakes in the latest legal challenge to the Affordable Care Act…

Leaders in the GOP-controlled House and Senate see the court challenge as their best hope for tearing apart a law they have long opposed. If the court strikes down the subsidies, Democrats are expected to clamor for lawmakers to pass a measure correcting the language in the law to revive them. Congressional Republicans say there is no possibility they would allow that.

“No, no, no, no,” said Sen. Dan Coats (R., Indiana). “Even Democrats have acknowledged that this needs fixing.”

That position would force lawmakers to confront people in as many as 37 states where the federal government is currently running some or all of the exchange where consumers buy plans and tap the tax credits. There are 6.1 million people in those states who have the credits for 2015, according to federal data released this week. The average tax credit this year is $4,330, the Congressional Budget Office said this week.

Eleven of the states where the federal government has a hand in running the insurance exchange – including seven with Republican governors – signed onto a brief submitted late Wednesday asking the Supreme Court to uphold their tax credits. The brief said the loss of the credits “would deprive millions of low-and moderate-income Americans of billions of dollars in federal premium assistance essential to buy health insurance, thereby disrupting state insurance markets throughout the United States.”

The brief was filed by a group of mostly Democratic attorneys general. The lone Republican, North Dakota’s Wayne Stenehjem, declined to comment…

Nobody in the Senate Republican caucus has said the party should tweak the law so it can continue as it is, particularly since such a move would preserve the unpopular requirement for people to buy coverage or pay a fine, said Don Stewart, a spokesman for Senate Majority Leader Mitch McConnell of Kentucky.

Republicans are also increasingly preparing to use the budget procedural tactic known as reconciliation to repeal large parts of the law and potentially enact alternative provisions after the court ruling, whatever the outcome. The reconciliation process allows party leaders to pass changes with a simple majority, rather than the 60 votes most bills need to clear procedural hurdles in the Senate.

A loss of the subsidies would amount to a tax increase on the middle class. Republicans tend to concentrate on lowering taxes for the wealthy, at the expense of the middle class, and therefore see no problem in this. They mistakenly believe this will not affect their more affluent supporters, who do not qualify for the subsidies. What they fail to realize is that reducing the number of people in the risk pool will result in higher premiums for everyone.

Republicans are again talking about proposing their own plan, but they have repeatedly failed at doing so. The last time the Republicans did propose a plan it was remarkably similar to Obamacare, except then it was proposed as the conservative alternative to Hillarycare.

Any Republican plan which avoids harming millions of people will not only have to provide a mechanism for assisting those who cannot afford insurance coverage. Any plan must also ensure that insurance companies could not return to denying coverage to those who have medical problems. Republicans will find that this is not so simple, and will require the type of compromises seen in the Affordable Care Act.

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CMS Agrees To Demands From Physicians & Congress To Modify Rules For Electronic Medical Records

I recently discussed the problems with the government regulations for conversion to electronic medical records. The majority of doctors have been unable to comply with the regulations which were scheduled to begin this January (already postponed from last October) for reasons beyond our control. A bill with bipartisan sponsors was introduced in Congress to postpone the current requirements further until October, 2015. While this would be helpful, further changes are also needed in the requirements.

CMS has responded to the complaints, sending out an email to physicians today stating that the rules will be reevaluated this spring. This includes considering changing the requirement from a 365 day reporting period for 2015 to a 90 day reporting period, which would essentially postpone the requirements until October. The email also stated they would be “Modifying other aspects of the programs to match long-term goals, reduce complexity, and lessen providers’ reporting burden.” Modifications have already been made in the past to the regulations to reduce their complexity, but further modifications remain necessary.

While no official changes were announced at this time, it seems inconceivable that they will not go long with recommendations to postpone when the changes are due until October now that they have announced plans to consider this. It will also be necessary to make other revisions to the rules, which also now is under consideration. Complicating matters further, in addition to these requirements for electronic medical records, conversion to ICD-10 diagnoses codes (which has also been postponed several times) is also now scheduled to occur in October.

CMS has also announced plans to reconsider the regulations on their blog.

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A Bigger Computer Fiasco For The Obama Administration Than Healthcare.gov

The fiasco with the initial opening of the exchanges at healthcare.gov has become a well-known IT glitch from the Obama administration, but that might not turn out to be their biggest mistake regarding computers and health care. As it primarily involves physicians and hospitals, as opposed to the general public, far fewer people are aware with the ongoing problems regarding implementation of Meaningful Use Stage 2 requirements for electronic medical records.

The original stimulus package after Barack Obama took office included a program to provide funds to medical practices to be used for conversion to electronic medical records. In order to qualify for the incentive payments, physicians and hospitals have to follow a set of Meaningful Use requirements which have increased requirements for each stage. Initially there would be incentive payments (which turned out to be far less than the costs of conversion to electronic medical records), and subsequently there are penalties for failing to comply. The first stage was successful in terms of getting large numbers of doctors to adopt electronic medical records, but it is more questionable as to whether this is really resulting in the desired cost savings.

Stage 2 was initially required by October 2014. This would have greatly increased the use of electronic medical records, possibly resulting in more medical cost savings, but the requirements were unrealistic. The law originally required that physicians comply with the requirements of Stage 2 for a 90 day period in 2014, which essentially meant that we could wait until October 1 to implement them. When it was apparent that most physicians could not comply with this, the government postponed this until January 2015.

It was quickly apparent that this was no solution, partially as the new requirements required a full twelve months of compliance with the Stage 2 rules. By requiring compliance by this January, this only gave an additional three months. The same problems which prevented compliance with the rules by October 2014 are still present this January.

The biggest obstacle is that the rules require communication between systems which do not exist in the present software. Before making such requirements, the government should have set up a secure system for communication between computer systems rather than hoping that each individual vendor would offer a solution. Another problem is that the requirements include factors which are outside of a medical office’s control. For example, a medical office could set up a patient portal as required in order for patients to assess medical information. However, there are requirements not only to establish this, but for five percent of patients to utilize it. Many physicians, such as those with primarily elderly patients are especially concerned that not enough will even be interested in using such computerized tools. Fortunately this requirement was at least reduced from ten percent in the original regulations to five percent.

Compliance with the rules is further complicated by it being all or nothing. A medical office might follow 90 percent of the rules but will get zero incentive money and pay the full penalties for non-compliance. There are some exclusions and some flexibility in some areas, but this still creates far too great a burden on physician practices.

When the government first changed the rules last fall delaying the requirements for Stage 2 until January, some members of Congress did realize that this was not long enough to have any impact. There was a bipartisan bill introduced to reduce the requirements for a 90 day period in 2015, essentially giving physicians until October instead of January. This was not introduced until shortly before Congress went on recess prior to the election, and died before the end of the last session. Earlier this month Renee Ellmers (R-N.C.) and Ron Kind (D- Wis.) introduced The Flexibility in Health IT Reporting (Flex-IT) Act of 2015 to restore the 90 day requirement. The bill also has the support of organizations including the American Academy of Family Physicians, American Hospital Association, American Medical Association, College of Healthcare Information Management Executives and Medical Group Management Association.

Even this only postpones the problem and we don’t know if the technology will be any better this fall than it is now. A recent survey of physicians found that 55 percent do not plan to attest to Stage 2, despite the financial penalties.

This failure in the implementation of computerized medical records could be a far worse fiasco than the initial roll out of the exchanges under the Affordable Care Act. The manner in which the Obama administration quickly fixed that problem turned out to be a tremendous success, and this problem is also fixable. A real fix will take more than just postponing requirements.

The government must rethink the logic behind the requirements. Most industries have computerized on their own without being forced to by the government. Some government assistance in conversion to electronic medical records would be helpful, such as establishing standards for communication between systems. Physicians must also be given flexibility to determine for ourselves which aspects of computerization are really of value for caring for our patients and which are not, rather than being forced to follow a long set of rules and only receive credit for 100 percent compliance, or being dependent on factors beyond our control.

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Senate Republicans Agree Climate Change Is Real But Continue To Deny Cause

Climate-vote

With Republicans controlling the Senate, Democrats are largely limited to symbolic votes. Democrats wanted to attach an amendment to the Keystone XL Pipeline bill which would get Republicans on record with regards to climate change. There was little difficulty in passing an amendment agreeing that climate change is real, and not a hoax. Only one Republican, Roger Wicker of Mississippi, voted no. The catch is that, while they agreed that the climate is changing (a fact which some conservatives do deny), they do not accept the view of 97 percent of climate scientists that human action is the cause.

Senator Brian Schatz introduced a stronger amendment: “To express the sense of the Senate that climate change is real; and human activity significantly contributes to climate change.” Under the rules of the Senate, this amendment failed with a 50-49 majority. Most Republicans voted against it, but there were a handful of exceptions–full list here.

I’m not sure what all this proved, but next could we have a vote to determine which Republicans don’t believe in evolution, or that the earth is not flat?

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Will The State Of The Union Address Matter After This Week?

Obama SOTU

I certainly liked Obama’s State of the Union Address while listening to it. In a room dominated by Republicans, Obama was once again the adult in the room–the sensible one interested in governing and not bogged down in extremist ideology. His economic numbers provided real evidence of success, despite Republican obstructionism, and Obama was right in addressing the need to extend the benefits of economic recovery to more in the middle class.

The question is whether the speech, and Obama’s aggressiveness on policy matters, will make a difference matters beyond this week. David Corn summed up some of my concerns:

Barack Obama is very good at getting elected president (two for two!) and pretty darn good at policy (Obamacare; the stimulus; the auto industry rescue; Wall Street reform; ending Don’t Ask, Don’t Tell; Cuba; immigration reform executive action; dumping DOMA; middle-class tax cuts; new EPA limits on emissions that cause climate change; banning torture; downsizing the wars in Iraq and Afghanistan, and killing Osama bin Laden). But there’s one key piece of the job description where he’s fallen short: shaping the ongoing political narrative of the nation.

The president is the country’s storyteller in chief. And despite his inspiring powers of oratory (see Campaign 2008) and his savvy understanding of the importance of values in political salesmanship (see Campaign 2012), Obama, as his aides concede, has not effectively sold the nation on his own accomplishments, and, simultaneously, he has failed to establish an overarching public plot line that explains the gridlock in Washington as the result of GOP obstructionists blocking him on important issues where public opinion is in his favor. With his State of the Union speech Tuesday night, Obama had one last chance to take a swing at forging this narrative. Though he did adopt a muscular stance in presenting a forceful and vigorous vision—going on offense in the fourth quarter of his presidency, as his advisers have put it—the president let the Republicans off easy.

Throughout his presidency, as the GOP has consistently sought to block him, Obama has responded inconsistently. He often has pleaded for reason and looked to craft a deal—frequently (and justifiably) to prevent a hit to the economy. (This was the adult-in-the-room strategy.) At times, he has praised House Speaker John Boehner, while pointing to Boehner’s tea party wing as the cause of the partisan paralysis. And then he has occasionally—but not too often—flashed anger and slammed Republicans for being irresponsible and reckless (the debt ceiling scuffle, the assorted government shutdown showdowns). He has not presented a steady and stark tale in which he stars as the fighter for the middle- and lower-income Americans who are stymied repeatedly by always-say-no Republicans aligned with plutocrats, the gun lobby, corporate polluters, and other foes of progress. Consequently, he has often borne blame for the sluggish economy and the mess in Washington, with the Democratic Party paying the price for the dips in his approval rating.

For this to have meaning, Obama must stick to pushing his views, and the Democratic Party must be there behind him. The reaction of the Democratic Party has been even more inconsistent than Obama’s. Here’s what I thought during the speech:

Of course the general election is an entirely different ballgame than the midterms, and Democrats who thought there was benefit in running as Republican-lite in a midterm election where the big contests were in the red states might act more boldly. Or maybe not.

On the other hand, maybe we should just be happy that Obama had a good speech, the positive results from his policies are real, and that the speech was well accepted. Beyond that, I’m not sure that a State of the Union address ever really matters all that much.

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Goals Of The New Republican Congress: Repeal Obamacare Despite Success In Lowering Uninsured, Declare War On Math, Promote Pseudoscience To Restrict Abortion

Uninsured 2015

While Republicans are probably on the verge of voting yet again to repeal the Affordable Care Act, and will continue to make false claims that it has been a failure, Gallup shows once again how successful the law has been. The uninsured rate has fallen to 12.9 percent, down from 17.1 percent a year ago. The open enrollment period for 2015 remains open making it likely that the uninsured will fall further, especially if there is a last minute surge in people enrolling as last year. The number will further increase if more states go ahead and accept the expanded Medicaid program, and more people are also likely to receive insurance from employers with the trend towards decreased unemployment. Gallup also found that most who have obtained insurance plan to continue coverage, either through the same or a different insurance company.

Even before the inevitable vote to repeal Obamacare, the new Republican controlled Congress has declared war on math, as Jonathan Chait described it, and have introduced a national ban on abortions after twenty weeks. I recently discussed the pseudo-science used by Republicans to justify this, and there is more at Think Progress.

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Red State Republicans Are A Minority Of Population Despite Senate Gains

Congress

The Senate is probably the strongest example of how our political system is (small-d) non-democratic. Each state receives two Senators, regardless of size, and the District of Columbia, with a population greater than several states, receives zero. The difference in size between the smallest and largest states has also increased significantly since this compromise was reached in the writing of the Constitution. A combination of factors including Senate races primarily in red states, the usual problems faced by either party in the sixth year of a presidency (with Republicans even losing control of the Senate under Ronald Reagan), and several tactical errors by Democratic candidates, led to the Republicans taking control. However, Vox has an interesting calculation:

But here’s a crazy fact: those 46 Democrats got more votes than the 54 Republicans across the 2010, 2012, and 2014 elections. According to Nathan Nicholson, a researcher at the voting reform advocacy group FairVote, “the 46 Democratic caucus members in the 114th Congress received a total of 67.8 million votes in winning their seats, while the 54 Republican caucus members received 47.1 million votes.”

Republicans also receive an advantage in the House due to a combination of gerrymandering and the fact that Democratic votes are more concentrated in cities, leading to Democrats winning a smaller number of districts by higher margins, and in some years allowing Republicans to control the House with a minority of the vote.

Republicans will be forced to defend more seats in blue states in 2016 but the magnitude of the Republican pick up in 2014 will make it much harder for Democrats to actually regain control. The Atlantic looked at key election races, pointing out:

Democrats will be benefiting from a favorable landscape, with Republicans defending 24 seats (many of them in blue territory) while Democrats will be defending only 10. To leverage that advantage into control of the Senate, however, Democrats need to net at least four seats (five, if Republicans win the presidency). That requires sweeping out blue-state freshman Republicans in states such as Illinois, Pennsylvania, and Wisconsin while also defeating a couple of brand-name senators, such as Rob Portman or Marco Rubio, in perennial swing states.

Other factors could help Democrats in 2016 beyond the geography. The economy will hopefully be even stronger, unless the Republican-controlled Congress, or even factors beyond political control, create further problems. The Affordable Care Act will be even more established, assuming Republicans aren’t successful in dismantling it in Congress or the courts, and might be less of a divisive political issue. Perhaps most importantly, the Democrats will be running a more national campaign behind a presidential candidate as opposed to running as Republican-lite and hiding from Obama.

The Los Angeles Times reports, Obama to hit the road, selling economic progress:

Eager to stay on the offensive as new Republican majorities are seated in Congress, the president plans to take a more bullish economic message on the road next week in something of an early test drive of his State of the Union message.

During stops in Michigan, Arizona and Tennessee, Obama plans to draw a connection between actions his administration took early in his presidency and increasingly positive economic trends in sectors such as manufacturing and housing.

Officials say he’ll also offer specific new proposals — some that he’ll pursue with Congress and others he’ll advance with his own authority — that are intended to build on that progress, particularly for the middle class.

It’s an approach that upends the traditional White House script to start the year, when new policy rollouts are usually reserved for the president’s annual address to Congress.

But the White House is eager to sustain momentum  it says started to build after November with major actions on immigration and Cuba as Obama began what he calls the “fourth quarter” of his presidency.

Obama, and other Democrats, should have been made the successes of Democratic policies the major point of the campaign, as opposed to running away from their successes. They might have still lost in deep red states, but Democratic turnout would have been better and they would have done better in less red areas. Besides the benefits of running on Obama’s previous record, as a result of Obama’s post-election actions his approval has shot up in the Gallup and other polls.

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Obama Approval Reaches 48%

Obama Affordable Care Act

Gallup reports that President Obama’s job approval has increased to 48 percent, the highest since August, 2013. This matches his disapproval rate, being the first time this gap has not been negative since September, 2013. They don’t give firm data to explain this improvement, but note that this partially can be explained by an improvement among Hispanics. They further speculate that the increase might be due to improved views on the economy, as well as people being more generous in their ratings around Christmas.

I wonder if other factors are involved, including his recent successes on foreign policy, the disappearance of the Ebola crisis in the United States which Republicans spread considerable misinformation about prior to the midterm elections, and the success of the Affordable Care Act.

As a sign of how desperate conservatives are to deny the considerable success of Obamacare in both expanding insurance coverage and making it more affordable, they are going further in cherry picking and distorting statements from Jonathan Gruber going back to 2009, with many conservative sites falsely calling him both the architect of Obamacare and its leading spokesman. Strangely, they don’t pay any attention to the far greater statements from him on the benefits of the Affordable Care Act. The Tea Party New Network, which is essentially a dishonest propaganda outlet like Fox but more honest about its political position, even defends Sarah Palin for her rants about death panels, and repeats all the other claims greatly distorted by conservatives. Their complaints about Obama’s poorly worded statements about keeping one’s own doctor or insurance are hardly meaningful considering that their policies would greatly increase the likelihood that people would lose their doctor and insurance, while Obamacare (even if unable to guarantee this will never happen in a market-based system) greatly reduces this risk.

Obama’s improvement in the polls could be a consequence of him becoming more aggressive after the midterm elections, no longer being fearful of taking actions which might place Democratic candidates at risk in red states (a foolish plan which backfired when it led to Democrats staying home). I believe that the Democrats would have still lost seats because of the seats which were up for grabs in 2014, but would have done better if they hadn’t run as Republican-lite. On the other hand,  Dan Pfeiffer told Huffington Post that he believes that if Obama had not waited until after the election, his actions would have been overwhelmed by politics.

The big question is whether this is a transient bounce or if this improvement will continue. Either way his approval is certainly far greater than for Congress. The Republican Congress might give Obama an opportunity to gain further public support if the Republicans actually proceed to pass legislation pushing many elements of their agenda which will be unpopular with a majority of American voters.

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