Thursday Themes: Happy Birthday Mr. President

President Obama turns 50 today. He celebrated at a fundraiser in Chicago with his home-town crowd. As for the rest of us, "let them eat cake." Oh, yeah. That was Marie Antoinette. Well, whatever. Here's the news:

Members of Congress are jockeying for position on the new super-committee that will negotiate (or try to) the next phase of debt reduction. There are members of Congress who don't want this "honor" considering that it's likely to be a thankless task. It's unlikely that either party will nominate people who are inclined to compromise. Indeed, the Republicans have vowed not to appoint anybody who would even consider revenue raisers like ending tax loopholes for the wealthy and corporations. I expect this committee to get pretty much nowhere. And then the trigger cuts in and decimates domestic programs, including many key aspects of health reform. Although some think the trigger would be better for health programs than the super-committee would. And will the super-committee meet in public? Some GOPers think it should, as do I. What's really amazing about how all of this is playing out is that the GOP has held us all hostage for their positions on the economy while President Obama takes the blame for the results.

Meanwhile, expect your August to be full of the Tea Party at town halls pushing the Paul Ryan plan to end Medicare as we know it. Really?

Rates continue to drop for the Pre-existing Condition Insurance Plan. You still have to go without insurance for 6 months in order to qualify, though.

States are stepping up their scrutiny of health insurance premium rates. About time.

The American Psychological Association has unanimously voted in favor of marriage equality. They cite recent research that shows that gays want stable home and family lives, and that anti-marriage equality campaigns are a great source of stress in LGTB households.

HIV rates continue at even levels despite advances in treatment. It's still concentrated in gay men, and is growing among Black gay men.

A new AARP study found that there's a huge burden on families to cover the long-term care needs of the elderly.

And that's today's news. Have a GREAT day! Jennifer

Hump Day Headlines

Well, the President signed the debt deal -- and said now, he can shift his focus to jobs and the economy. That would be good. After all that, though, the estimates are that we haven't really shrunk the deficit -- just cut the rate of growth. But the President says it's only the first step, and we need to raise revenue to get a balanced approach. So now we will have a super-committee that has to come up with the next phase of debt reduction by November 23 or the trigger -- automatic, horrible cuts -- will kick in. Imagine the lobbyists lining up to talk to these 12 members of Congress. Expert economists say we cannot solve this problem without a tax overhaul. There's very little confidence in Washington, so stocks went down and foreign governments who have funded our debt are not convinced we have done much to solve the problem. However, the ratings agencies are maintaining our AAA credit rating. Interestingly, the Tea Party isn't taking credit for this deal; the old Republican guard in the guise of Mitch McConnell won the day. McConnell says there won't be clean votes on debt ceiling increases ever again. But the real driver of debt is health care spending, and nobody knows how to get that under control -- and certainly not by November 23. Medicare and Medicaid growth continues. The super-committee will have to address health care somehow.

Here's a new study that says employers are unlikely to drop health insurance coverage because of health reform.

Republicans want HHS to do something to encourage insurers to offer child-only policies even though they have to cover pre-existing conditions under health reform.

When we forget about focusing on mental health, tragedy is all too likely.

Colon cleansing is unhealthy. I've been saying this for a long time, but it's all the rage. For those of you who think it's cool, I hope you will read this.

And that's the news this morning. Have a great day! Jennifer

Breaking News - Anti-climax

The Senate passed the debt deal. The President is expected to sign it later today. Jennifer

Tuesday Tidbits

The House passed the deficit reduction deal. It was a bipartisan vote representing the middle of the political spectrum. Nobody's really happy. The Senate is expected to vote today. In an amazing turn of events, Congresswoman Gabrielle Giffords came to the floor of the House and placed her vote in favor of the deal. It was terribly moving. It overshadowed the partisan rancor and maneuverings it took to put the deal together. It all came down to VP Biden and Mitch McConnell. Still, many liberals are angry about the deal, which largely capitulated to GOP and Tea Party demands. Tea Partiers aren't happy either. Some say this "deal" had more to do with the 2012 elections than it did with the deficit. It may not guard us from a downgrade of our credit rating. States and cities brace for less federal money. What will happen when unemployment runs out at the end of the year? Some say this deal is a disaster for workers -- those with jobs and those without. Some federal workers may lose their jobs. The super-committee may make cuts to Medicaid and Medicare, including raising the Medicare eligibility age, and it's highly likely that payments to providers will be cut. But the deal as passed does not fix the big dilemma -- raise taxes or cut Medicare? So all eyes will be on the super-committee that's supposed to report out a proposal by November 23.

OPINION: I wrestled with this all day yesterday as I learned more about the details of the deal. In the end, I am opposed. It's bad precedent to allow our entire economy -- indeed, the world's economy -- to be held hostage to extremists on the right. The President insisted on raising revenues, and allowed things to get to the brink of disaster, only to cave in. His people worked hard yesterday to convince us all that it won't be that bad. But in the end, I agree with the economists who say this deal will harm our economy and, in particular, job growth by taking money out of the economy at a time when we should be pumping it in. A default was unthinkable, though. So what would I have done as the clock ran out? I would have unilaterally raised the debt limit and let the Tea Party sue me for it. It would take forever for a court to rule, if it ever did get involved in what's called a "political question." In the meantime, I'd have saved the economy without agreeing to another 6 months of craziness by a 12 member bipartisan committee. Why should we think the super-committee will get any further than Congressional leaders got in their negotiations with the White House? We shouldn't. So the trigger -- massive additional cuts -- will go into effect on January 1, 2013. By then, either President Obama will have been re-elected, in which case the Bush tax cuts will expire even if the super-committee does nothing; or he won't, in which case the trigger will never happen because the GOP will undo this deal. But most of all, I think you don't negotiate with hostage-takers, and that's what the Tea Party and, indeed, the GOP as a whole has done -- they held our economy hostage. They should be blamed. They should pay the consequences. That's where I ended up after a lot of thought.

The Obama Administration has adopted the Institute of Medicine's proposal that contraceptives be available for free, as preventive medicine.

As Exchanges are set up by states, the role of insurers becomes a question. Should they have seats on the Exchange? We fought hard to keep them off of the Exchange Board here in Connecticut and we won that fight, but in other states, that's not the case. The Exchange should be making decisions with consumers in mind, not insurers. Or that's my opinion.

A federal court found that there is no taxpayer funded abortion permitted under the health reform law. So can we put this one to bed finally? I sort of doubt it.

An experiment by an insurer, a large hospital chain and a large group of doctors has saved big simply by working together.

Michelle Andrews, a health care columnist, became a patient in a Canadian emergency room. Read about her experience.

In New York, nonprofits that serve the disabled are able to rake in millions.

Software added to mobile phones helped diabetics control their illness.

And that's it for this morning. Have a great day! Jennifer

White House Conference Call: From the Horse's Mouth

I just got off a Connecticut conference call explaining the debt deal and I thought it was somewhat helpful, so here's what I took away:

First, there is a $1 trillion "downpayment" on spending cuts -- $350 billion are defense and $650 billion phased in over 10 years is domestic discretionary spending -- NOT including Medicaid, Medicare, Pell grants, Social Security.

Second, a super-committee of 12 members (3 House Dems, 3 House GOP, 3 Senate Dems, 3 Senate GOP) selected by caucus leadership (Nancy Pelosi, Speaker Boehner, Harry Reid, Mitch McConnell, respectively) that will be charged with finding $1.5 trillion in additional deficit reduction, which may (according to the White House will) be achieved through tax reform. & of the 12 committee members must agree on a plan by November 23, with the bill passed into law by around Christmas. This bill will be fast-tracked, so no filibuster, no amendments.

If the super-committee fails to report out something that will pass, enforcement will kick in on January 1, 2013 -- the same date on which the Bush tax cuts expire. The enforcement action will be $500 billion in defense cuts and $500 billion in domestic discretionary spending phased in over 10 years -- NOT including Social Security, Medicaid, Medicare beneficiary cuts (but will include a 2% provider cut), food stamps, PELL grants, LIHEAP, TANF, SCHIP and a few others I couldn't write down quickly enough.

I asked two questions: (1) is a Balanced Budget Amendment part of this deal? No, I was told. (2) what gives us reason to believe that tax reform will be considered by the super-committee? The answer is pretty clever -- the Bush tax cuts will expire if the committee does nothing (assuming President Obama is re-elected). That gives the GOP members of the super-committee an incentive to come up with alternative tax reforms that go into the savings column.

It was stressed that the cuts are phased in over 10 years. So those of us who are concerned about pulling the rug out from under a weak economy have to keep in mind that these cuts are not happening today or even tomorrow.

It seems to me that the Dems did a better job than is being reported on preserving the social safety net. And although Advocacy for Patients does not endorse any candidates for public office, there is no question that this plays out very differently if President Obama is not re-elected. For some of you, that's enough reason to vote against him, I'm sure.

That's what I got from the call. I'll update you on press accounts in the morning. Jennifer

Message from the White House

Please join White House officials today at 11:00AM (EDT) for a Debt Ceiling Update Conference Call.

We hope you are able to join.

WHAT: White House Debt Ceiling Update

WHEN: Monday, August 1st

START TIME: 11:00AM EDT (please dial in 10 minutes prior to the call)

DIAL IN: (800) 288-8968

TITLE: White House Debt Ceiling Update

The call is off the record and not for press purposes.

THE WHITE HOUSE

Office of the Press Secretary

FOR IMMEDIATE RELEASE

July 31, 2011

BIPARTISAN DEBT DEAL: A WIN FOR THE ECONOMY AND BUDGET DISCIPLINE

• The debt deal announced today is a victory for bipartisan compromise, for the economy and for the American people. The agreement:
  
  
• Removes the cloud of uncertainty over our economy at this critical time, by ensuring that no one will be able to use the threat of the nation’s first default now, or in only a few months, for political gain;
  
  
• Locks in a down payment on significant deficit reduction, with savings from both domestic and Pentagon spending, and is designed to protect crucial investments like aid for college students;
  
  
• Establishes a bipartisan process to seek a balanced approach to larger deficit reduction through entitlement and tax reform;
  
  
• Deploys an enforcement mechanism that gives all sides an incentive to reach bipartisan compromise on historic deficit reduction, while protecting Social Security, Medicare beneficiaries and low-income programs;
  
  
• Stays true to the President’s commitment to shared sacrifice by preventing the middle class, seniors and those who are most vulnerable from shouldering the burden of deficit reduction. The President did not agree to any entitlement reforms outside of the context of a bipartisan committee process where tax reform will be on the table and the President will insist on shared sacrifice from the most well-off and those with the most indefensible tax breaks.

Mechanics of the Debt Deal

Immediately enacted 10-year discretionary spending caps generating nearly $1 trillion in deficit reduction; balanced between defense and non-defense spending.

President authorized to increase the debt limit by at least $2.1 trillion, eliminating the need for further increases until 2013.

Bipartisan committee process tasked with identifying an additional $1.5 trillion in deficit reduction, including from entitlement and tax reform. Committee is required to report legislation by November 23, 2011, which receives fast-track protections. Congress is required to vote on Committee recommendations by December 23, 2011.

Enforcement mechanism established to force all parties – Republican and Democrat – to agree to balanced deficit reduction. If Committee fails, enforcement mechanism will trigger spending reductions beginning in 2013 – split 50/50 between domestic and defense spending. Enforcement protects Social Security, Medicare beneficiaries, and low-income programs from any cuts.

1. REMOVING UNCERTAINTY TO SUPPORT THE AMERICAN ECONOMY

• Deal Removes Cloud of Uncertainty Until 2013, Eliminating Key Headwind on the Economy: Independent analysts, economists, and ratings agencies have all made clear that a short-term debt limit increase would create unacceptable economic uncertainty by risking default again within only a matter of months and as S&P stated, increase the chance of a downgrade. By ensuring a debt limit increase of at least $2.1 trillion, this deal removes the specter of default, providing important certainty to our economy at a fragile moment.
  
  
• Mechanism to Ensure Further Deficit Reduction is Designed to Phase-In Beginning in 2013 to Avoid Harming the Recovery: The deal includes a mechanism to ensure additional deficit reduction, consistent with the economic recovery. The enforcement mechanism would not be made effective until 2013, avoiding any immediate contraction that could harm the recovery. And savings from the down payment will be enacted over 10 years, consistent with supporting the economic recovery.

2. A DOWNPAYMENT ON DEFICIT REDUCTION BY LOCKING IN HISTORIC SPENDING DISCIPLINE – BALANCED BETWEEN DOMESTIC AND PENTAGON SPENDING

• More than $900 Billion in Savings over 10 Years By Capping Discretionary Spending: The deal includes caps on discretionary spending that will produce more than $900 billion in savings over the next 10 years compared to the CBO March baseline, even as it protects core investments from deep and economically damaging cuts.
  
  
• Includes Savings of $350 Billion from the Base Defense Budget – the First Defense Cut Since the 1990s: The deal puts us on track to cut $350 billion from the defense budget over 10 years. These reductions will be implemented based on the outcome of a review of our missions, roles, and capabilities that will reflect the President’s commitment to protecting our national security.
  
  
• Reduces Domestic Discretionary Spending to the Lowest Level Since Eisenhower: These discretionary caps will put us on track to reduce non-defense discretionary spending to its lowest level since Dwight Eisenhower was President.
  
  
• Includes Funding to Protect the President’s Historic Investment in Pell Grants: Since taking office, the President has increased the maximum Pell award by $819 to a maximum award $5,550, helping over 9 million students pay for college tuition bills. The deal provides specific protection in the discretionary budget to ensure that the there will be sufficient funding for the President’s historic investment in Pell Grants without undermining other critical investments.

3. ESTABLISHING A BIPARTISAN PROCESS TO ACHIEVE $1.5 TRILLION IN ADDITIONAL BALANCED DEFICIT REDUCTION BY THE END OF 2011

• The Deal Locks in a Process to Enact $1.5 Trillion in Additional Deficit Reduction Through a Bipartisan, Bicameral Congressional Committee: The deal creates a bipartisan, bicameral Congressional Committee that is charged with enacting $1.5 trillion in additional deficit reduction by the end of the year. This Committee will work without the looming specter of default, ensuring time to carefully consider essential reforms without the disruption and brinksmanship of the past few months.
  
  
• This Committee is Empowered Beyond Previous Bipartisan Attempts at Deficit Reduction: Any recommendation of the Committee would be given fast-track privilege in the House and Senate, assuring it of an up or down vote and preventing some from using procedural gimmicks to block action.
  
  
• To Meet This Target, the Committee Will Consider Responsible Entitlement and Tax Reform. This means putting all the priorities of both parties on the table – including both entitlement reform and revenue-raising tax reform.

4. A STRONG ENFORCEMENT MECHANISM TO MAKE ALL SIDES COME TOGETHER

• The Deal Includes An Automatic Sequester to Ensure That At Least $1.2 Trillion in Deficit Reduction Is Achieved By 2013 Beyond the Discretionary Caps: The deal includes an automatic sequester on certain spending programs to ensure that—between the Committee and the trigger—we at least put in place an additional $1.2 trillion in deficit reduction by 2013.
  
  
• Consistent With Past Practice, Sequester Would Be Divided Equally Between Defense and Non-Defense Programs and Exempt Social Security, Medicaid, and Low-Income Programs: Consistent with the bipartisan precedents established in the 1980s and 1990s, the sequester would be divided equally between defense and non-defense program, and it would exempt Social Security, Medicaid, unemployment insurance, programs for low-income families, and civilian and military retirement. Likewise, any cuts to Medicare would be capped and limited to the provider side.
  
  
• Sequester Would Provide a Strong Incentive for Both Sides to Come to the Table: If the fiscal committee took no action, the deal would automatically add nearly $500 billion in defense cuts on top of cuts already made, and, at the same time, it would cut critical programs like infrastructure or education. That outcome would be unacceptable to many Republicans and Democrats alike – creating pressure for a bipartisan agreement without requiring the threat of a default with unthinkable consequences for our economy.

5. A BALANCED DEAL CONSISTENT WITH THE PRESIDENT’S COMMITMENT TO SHARED SACRIFICE

• The Deal Sets the Stage for Balanced Deficit Reduction, Consistent with the President’s Values: The deal is designed to achieve balanced deficit reduction, consistent with the values the President articulated in his April Fiscal Framework. The discretionary savings are spread between both domestic and defense spending. And the President will demand that the Committee pursue a balanced deficit reduction package, where any entitlement reforms are coupled with revenue-raising tax reform that asks for the most fortunate Americans to sacrifice.
  
  
• The Enforcement Mechanism Complements the Forcing Event Already In Law – the Expiration of the Bush Tax Cuts – To Create Pressure for a Balanced Deal: The Bush tax cuts expire as of 1/1/2013, the same date that the spending sequester would go into effect. These two events together will force balanced deficit reduction. Absent a balanced deal, it would enable the President to use his veto pen to ensure nearly $1 trillion in additional deficit reduction by not extending the high-income tax cuts.
  
  
• In Securing this Bipartisan Deal, the President Rejected Proposals that Would Have Placed the Sole Burden of Deficit Reduction on Low-Income or Middle-Class Families: The President stood firmly against proposals that would have placed the sole burden of deficit reduction on lower-income and middle-class families. This includes not only proposals in the House Republican Budget that would have undermined the core commitments of Medicare to our seniors and forced tens of millions of low-income Americans to go without health insurance, but also enforcement mechanisms that would have forced automatic cuts to low-income programs. The enforcement mechanism in the deal exempts Social Security, Medicaid, Medicare benefits, unemployment insurance, programs for low-income families, and civilian and military retirement.

They Have a Deal ... And Other News

They finally have a deal, but many of us will not be happy with it. It's a 2 step deal. $400B in credit is available right away, with $900B total in the first installment, raised by President Obama with Congress being able to vote against it but the President would veto their disapproval and they would not have the votes to override. When that runs out, there will be another $1.2 to $1.5 trillion, again with Congress only able to disapprove and the President able to veto their disapproval. This allows all the Republicans to vote against raising the debt ceiling while still getting it done. At the time of the second stage, a special Congressional Committee of 12 members would be created to cut the deficit by an equivalent amount. If the Committee can't agree on the plan, Congress would either have to accept a balanced budget amendment or there would be across-the-board cuts in spending. The cuts would come from defense and cuts to Medicare would be capped, with additional cuts to education and transportation, while Social Security and other programs would be exempt. The defense cuts would be massive. And you can bet that the Committee's plan will not satisfy the GOP if it includes revenue enhancements, and the Dems are going to be mighty angry if it doesn't -- and if they don't have the votes, we have cuts of unprecedented levels to Medicare, education, and defense -- right before the Presidential election. Here's a graphic showing who got what, and who gave what. And here's an analysis of the winners and the losers. And here's how the White House frames the agreement.

It sure looks to me like a GOP win. I don't see anything that says that any part of this has to come from revenue raising or an overhaul of the tax system. The President says the Congressional Committee in charge of lowering the deficit could do so in part through taxes. However, Speaker Boehner will still have a tough time getting the votes -- he did not get a second debate 6 months from now, like they wanted. He may lose the Tea Party, so he will have to pick up enough Dems to pass this. But Nancy Pelosi hasn't yet pledged her support. They have to get the deal on paper and voted on by Tuesday in order to avoid a debt default. Still, the President will face opposition from his base. But with both sides grumbling, that may mean this is a good compromise -- everybody gave up something that mattered to them.

It seems, though, that much of the damage to the economy is already done. USA Today says the deal harms both President Obama and Speaker Boehner. Our ability to lead the world is in serious question since we can't even lead ourselves, although Asian and European markets are surging. And cutting spending in a bad economy is, according to economists (and me), the exact wrong thing to do when what we really need is an influx of cash. Indeed, our credit rating may still be cut. But Wall St. is optimistic now that there won't be a default. Did President Obama give in, or was this cagey politics? Paul Krugman says the President surrendered. I hate to say it, but I think I agree. Still, lots of GOPers are unhappy -- as are lots of Dems.

I'm not happy about this deal. I think the President gave too much. I also think there was no chance of getting something through the House or the Senate that didn't have at least some Republican support. So maybe this is the best that could be done while still avoiding a default. If that's true, then we better hope that the votes are there. Votes should come today.

There's still other news.

Health reform implementation is happening, as we start to see how the theory of it actually works in practice. Meanwhile, Politico has run a bunch of opinion pieces. Paul Ryan hates health reform, as we already knew. Nancy-Ann DeParle heads the White House reform office, so she's in favor. GOP-er Joe Pitts opposes. Don Berwick -- head of the Centers for Medicare and Medicaid Services -- is in favor. And a center-right group is working on an alternative if the health reform law is repealed.

The Administration has provided $71 million in grants for nursing to encourage people to join the nursing profession.

Medicare will begin penalizing hospitals for readmissions.

Many medical devices are not tested before they're approved because they're similar to already approved devices. Some are critiquing this system. What would be a better approach?

A hospital here in Connecticut is serving gourmet food at affordable prices, defying the stereotypes of hospital cafeterias.

A group of doctors says hot dogs are as unhealthy as cigarettes.

Have a great day! Jennifer