Drowning out health care

Amid the chaos that passes for leadership in Washington these days, the fate of health care for millions of people, including in Massachusetts, hangs in the balance as President Trump continues to threaten to withhold subsidies that are the lifeblood for many.

Trump’s threats are roiling even the most stable markets such as in the Bay State with public and health industry officials unsure what is around the corner as 2018 bears down. State regulators put off approving next year’s rate increases for health insurers until at least next month because of the uncertainty of the federal subsidies that help reduce premiums and out-of-pocket expenses for lower-income people.

Massachusetts officials said the delay in setting rates was to see what happens in Washington. If the payments cease, health insurers here will have to reconfigure their requests to include the impact of the lost money. That will mean higher premiums for everyone and the changes will come with less than three months before they are implemented, making business people sweat their budget projections.

Trump made the August disbursements, which includes $132 million for Massachusetts, despite his vow to freeze the payments to force lawmakers to repeal and replace the Affordable Care Act passed under his predecessor. But there’s no guarantee he’ll do it in September. Or October. Or any time after that.

The subsidies are key component in trying to make Obamacare successful. They are also a key irritant to opponents who say they are a bailout to insurers. But Trump could end them at any time. Congressional Republicans declined to fund the subsidies and sued then-President Barack Obama, arguing they are illegal without congressional appropriation. A judge agreed but both Trump and GOP lawmakers have allowed the subsidies to continue through the first eight months for fear of destabilizing the market.

Their fears are well-founded. Earlier this week, as attention was focused on the racial violence in Charlottesville and Trump’s equivocal condemnation of what occurred, the Congressional Budget Office released a report that estimates if the subsidies ceased, premiums for the most popular health plans would rise by as much as 20 percent while the federal deficit would increase nearly $200 billion over the next decade. The CBO also says the rate of uninsured would climb to 5 percent of the country’s population in the subsidies ended, compared to less than half of 1 percent under the current system.

The instability had caused some states to have “bare” counties with no access to health care for those who had to purchase it through the exchanges as some insurers pulled out of the markets. But many of those holes have been filled and now just two small counties – one in Wisconsin and one in Ohio both with less than 400 people relying on insurance through Obamacare – are the only ones in the nation that have been left without access.

With Congress on its summer recess, little, if anything, will happen in the next 30 days. But the clock is ticking and with attention being diverted elsewhere, there is not much time or energy to deal with the complex issue of health care. But with open enrollments and renewals just around the corner, it’s time to pay attention.

JACK SULLIVAN


MUNICIPAL MATTERS

Hundreds gathered at the groundbreaking of a park dedicated to Martin Richards, the youngest victim of the Boston Marathon bombings. (Boston Globe)

A Stoughton selectman who is one of three being targeted in a recall petition asked the board to request the organizer of the signature drive to attend a meeting for questioning. (The Enterprise)

Swansea selectmen said they would entertain applications for medical marijuana facilities but not for commercial pot, which is perplexing since the town has no ban and voters approved the November ballot question. (Herald News)

Neighboring towns are considering their options, including court action, after state officials gave initial approval to Holbrook to build a controversial waste transfer station on the grounds of a former chemical plant that was once listed as one of the most contaminated sites in the country. (Patriot Ledger)

In an effort to raise revenues, Fall River Mayor Jasiel Correia will announce a plan to put billboards on city-owned property. (Herald News)

WASHINGTON/NATIONAL/INTERNATIONAL

Boston Globe columnist Joan Vennochi marvels at how President Trump’s inner circle is standing by their man despite his “lunacy” and “crazy talk.”

James Aloisi says Trump’s comparison of Robert E. Lee and George Washington shows he doesn’t understand the arc of history. (CommonWealth)

Jeffrey Lord’s suggestion to calm the roiling waters? Ban the Democratic Party. (American Spectator)

Trump disbands two CEO councils as the corporate officers bailed on the panels to separate them from the president’s stance on Charlottesville. (U.S. News & World Report)

It’s official. Boston will play host to a “free speech rally” and a “racial solidarity march” on Saturday and police have set very strict rules. (Boston Globe) Fitchburg State University distances itself from a student helping to organize the free speech rally. (State House News)

An unrepentant Steve Bannon calls up Robert Kuttner of The American Prospect and says the US is in an economic war with China.

A Lowell Sun editorial says North Korea’s leader blinked after President Trump’s straight and forceful talk.

BUSINESS/ECONOMY

Some Berkshire County merchants are holding their own sales tax holiday, paid for by offering discounts. (Berkshire Eagle)

A meeting in New Bedford with NOAA officials over the agency’s data on fish stocks resulted in tense exchanges with commercial fishermen who say officials are too slow to correct inaccurate approaches that result in strict quotas they say are killing the industry. (Standard-Times)

Microsoft founder Bill Gates discovered some loose coins in the cushion and donated $4.6 billion to his foundation while announcing a new global initiative to eradicate malaria. (Forbes)

EDUCATION

Ousted Suffolk University president Margaret McKenna compares herself to Reince Preibus in a Facebook post. (Boston Globe)

HEALTH/HEALTH CARE

Express Scripts, the nation’s largest pharmacy benefit manager, is limiting the number and strength of opioids prescribed to first-time users. (Associated Press)

A Boston City Council proposal would require pharmacies that sell needles to take used ones back for disposal. (Boston Globe)

TRANSPORTATION

A Boston Herald editorial stands by the Baker administration’s selection of Luis Manuel Ramirez as the MBTA’s new general manager and CEO despite his lack of transit and public sector experience. Beverly Scott had a lot of transit experience, and look where that got us, the editorial says.

WBUR culls the public record on Ramirez’s turnaround of Dallas-based Global Power Equipment Group, a company that botched its earnings reports going back to 2014 and is facing shareholder lawsuits and still trying to sort out the mess. Ramirez left the company abruptly in 2015.

An Eagle-Tribune editorial applauds the MBTA’s “modest” privatization efforts, and backs turning over bus maintenance to private firms.

State Police say one of their helicopters, on a training mission, nearly collided with a drone operating illegally in the airspace of the Lawrence Municipal Airport. (Eagle-Tribune)

Following the settlement of a civil rights complaint, Peter Pan Bus Lines details how it will make its buses handicap accessible. (MassLive)

ENERGY/ENVIRONMENT

Price shouldn’t be the sole focus of the state’s upcoming clean energy purchases, says Ron Gerwatowski. (CommonWealth)

Cape officials and researchers are encouraged about new shark-tracking technology to monitor the predators from hi-def cameras on balloons hovering over protected swimming areas. (Cape Cod Times)

Members of the Ashland Board of Health have asked state inspectors to investigate exhaust fume levels from idling school buses following complaints from neighbors who say the nearby lot has as many as 64 buses parked on it with a request by the company to add 20 more. (MetroWest Daily News)

CRIMINAL JUSTICE/COURTS

Natalee Holloway’s remains may have been found in Aruba, more than a decade after the 18-year-old Alabama girl went missing. (Time)

Local police departments are installing carbon monoxide detectors in Ford Police Interceptors after an officer who crashed one tested positive for carbon monoxide exposure. (Lowell Sun)

Police in Mashpee and Sandwich are investigating two acts of vandalism involving swastikas, including the arrest of a Holbrook man who they say was caught on camera using his putter to carve four swastika symbols into the ninth-hole green at Sandwich Hollows Golf Club. (Cape Cod Times)

MEDIA

Margaret Sullivan says this week should put the nail in the coffin of “both sides” journalism. (Washington Post)