Planned Parenthood Fighting Back Against Republicans

Planned Parenthood is fighting back–launching ads such as the one above against vulnerable Republicans. They are targeting Senator Kelly Ayotte (R-N.H.), Rob Portman (R-Ohio), Ron Johnson (R-Wis.) and Pat Toomey (R-Pa.) who are expected to be in tough reelection races next year. The ads concentrate on the problems which might be created if there is a government shutdown over funding Planned Parenthood, as some Republicans have threatened:

“First Pat Toomey voted to defund Planned Parenthood — risking healthcare for millions of women,” the Pennsylvania ad says. “Now Republicans want to shut down the government — to block funding for Planned Parenthood. What would a shutdown mean for Pennsylvania?”

The ad then shows a veteran wondering about getting benefits and a senior worrying about Social Security checks.

“Tell Senator Toomey: Stand up for Planned Parenthood healthcare — not a government shutdown,” the ad ends.

The threats to defund Planned Parenthood arose from false attacks on Planned Parenthood, claiming they were selling fetal tissue. The videos spread by anti-abortion groups actually showed negotiations over reimbursement for costs. Payments for collection, preservation, and transportation of biological specimens are customary and legal, and are quite different from selling specimens. The fetal tissue is donated for valuable research which can save lives, as opposed to discarding the tissue.

Defunding Planned Parenthood would also be counterproductive for opponents of abortion as this would lead to a greater number of abortions if women did not have access to contraception and counseling from Planned Parenthood. Both men and women also receive other services, such as cancer screening, from Planned Parenthood.

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Clinton Out-Nixons Nixon And Erases The Email

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The conventional wisdom is that Richard Nixon would have survived Watergate if he had erased the tapes. Democrats were outraged by the eighteen and a half minutes which were “accidentally” erased by Nixon’s secretary, Rose Mary Woods. In a late Friday news dump we learned that Hillary Milhouse Clinton, who once accused the Bush administration of shredding the Constitution with their use of private email, out-Nixoned Nixon. The New York Times and Politico reported that Clinton has deleted all of what she claims to be private email after October 28 when the State Department first requested that Clinton turn over the email kept on her private server, violating rules in effect as of 2009. The server has been wiped clean.

Clinton had given contradictory answers regarding the email at her news conference, in which media fact checkers found multiple untrue statements. From The New York Times:

At a news conference this month, Mrs. Clinton appeared to provide two answers about whether she still had copies of her emails. First, she said that she “chose not to keep” her private personal emails after her lawyers had examined the account and determined on their own which ones were personal and which were State Department records. But later, she said that the server, which contained personal communication by her and her husband, former President Bill Clinton, “will remain private.” The server was kept at their home in Chappaqua, N.Y., which is protected around the clock by the Secret Service.

Multiple investigations so far have failed to show any evidence for the Republican conspiracy theories on Benghazi, but the disclosure from Clinton on Friday that she has deleted email requested by Congress will only serve to keep the witch hunt alive. While Republicans deserve to be faulted for the witch hunts they are pursuing, this does not excuse Clinton’s actions of using her private server to prevent disclosure of requested evidence to a Congressional committee. Clinton also used her private server to avoid complying with Freedom of Information Act requests for information from the news media.

One of Clinton’s many bogus excuses for failing to follow government protocol in maintaining her email on a government server was that her email would be preserved because of being sent to State Department email addresses. It has since been found that the entire State Department was sloppy in maintaining email. Current Secretary of State John Kerry, who has admirably followed the law in using government email since assuming the post, has asked the Inspector General’s office to conduct “a review of our efforts to date on improving records management, including the archiving of emails as well as responding to FOIA and Congressional inquiries.” There have also been requests from the Republican National Committee and from House Benghazi Committee Chairman Trey Gowdy for the Inspector General to get involved. With the revelations that Clinton has erased the email, it might also be time for a special prosecutor to be appointed to handle the investigation of her actions.

The claim that her email is public due to being sent to State Department or other government addresses is also bogus as not all of Clinton’s email regarding State Department matters was even sent to government addresses. The first reports of Clinton’s private email came when Gawker found the email address on hacked email from Sidney Blumenthal in 2013. Gawker has recently discussed her email further, reporting that “longtime Clinton family confidante Sidney Blumenthal supplied intelligence to then Secretary of State Hillary Clinton gathered by a secret network that included a former CIA clandestine service officer.” The post has further information regarding information sent to Clinton by Blumenthal regarding the situation in Benghazi. At this point it is not known if Clinton responded to Blumenthal while in office or if email from Blumenthal is included in the email she did release.

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Senator Stabenow Takes Legislative Action Against Cotton Letters

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Senator Debbie Stabenow of Michigan is taking legislative action to prevent a repeat of the type of letter sent by Senator Tom Cotton, attempting to sabotage diplomatic talks regarding nuclear energy in Iran. She introduced an amendment (pdf here) which would defund “the purchase of stationary [sic] or electronic devices for the purpose of members of Congress or congressional staff communicating with foreign governments and undermining the role of the President as Head of State in international nuclear negotiations on behalf of the United States.”

The letter signed by 47 Republican Senators was highly irresponsible, and it is understandable why Senator Stabenow would like to defund any future such letters. The letter not only interferes with efforts to attempt to prevent Iran from developing nuclear weapons, it undermines the ability of the current and every future president to negotiate on behalf of the United States.

Of course Democrats might also like to keep this issue alive considering how unpopular the letter was with voters. It never hurts to remind the voters of how utterly irresponsible and bat-shit crazy the Republican Party has become.

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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

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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?

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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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