House To Vote Again On Repealing ‘Obamacare’ Next Week

The House will vote again next week to repeal the 2010 health-care reform law, a decision by top Republican leaders designed in part to appease GOP freshmen lawmakers who have not had an opportunity to take a vote on the issue.

House Majority Leader Eric Cantor (R-Va.). (Jacquelyn Martin/AP)

House Majority Leader Eric I. Cantor (R-Va.), who sets the House schedule, announced on Twitter on Wednesday that the vote will occur next week: “It just keeps getting worse. I am scheduling a vote for next week on the full repeal of #Obamacare.”

Cantor’s decision to schedule the vote comes as he’s devoted most of the House calendar in recent months to a series of bills that fit within his “making life work” agenda that emphasizes kitchen-table issues over slashing federal spending. Among such bills is the “Working Families Flexibility Act,” which would give private employers the option of offering workers additional time off in lieu of overtime pay and is set for a vote Wednesday.

Cantor had to pull another bill, called the “Helping Sick Americans Now Act,” two weeks ago amid opposition from conservatives who didn’t like that the measure would redistribute millions of dollars in funding established by the health-care law, but not repeal the entire law.

Several Republican aides say that Cantor’s decision to hold a vote on repealing the law will serve two mutually beneficial purposes for House Republicans: It will give about 30 House GOP freshmen who’ve never voted on such a bill the opportunity to do so — and then likely secure Cantor enough support to finally pass the “Helping Sick Americans Now Act.” In turn, those freshmen will be able to go home and tell constituents that they’ve voted to repeal the unpopular law, and Cantor will have succeeded in advancing his agenda.

Depending on which congressional aides are asked, next week’s vote will be anywhere between the 33rd or 37th attempt to repeal all or part of the law since its passage in 2010. The count is disputed because Republican House and Senate lawmakers have tried in vain to use a series of legislative gimmicks — procedural moves, budgeting provisions and outright legislation — to undo the law.

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Afghan President Lodges Another Ridiculous Claim Against U.S. Troops

Afghan President Hamid Karzai

Afghan President Hamid Karzai, never one to mince words, on Sunday told the press that the United States and Taliban were each colluding to keep foreign troops in Afghanistan, albeit for different reasons.

Several explosions ripped through Afghanistan over the weekend during U.S. Secretary of Defense Chuck Hagel’s visit, killing 19 civilians and highlighting security concerns that continue apace ahead of a U.S. withdrawal from Afghanistan in 2014.

According to Karzai, the attacks by the Taliban were meant to show that international forces will still be required after the 2014 deadline passes. Karzai chose a curious time to air his theory, putting it forward while delivering a speech on Afghan women:

“The explosions in Kabul and Khost yesterday showed that they are at the service of America and at the service of this phrase: 2014. They are trying to frighten us into thinking that if the foreigners are not in Afghanistan, we would be facing these sorts of incidents” he said.

Defense Department officials quickly cancelled a planned joint press conference after Karzai’s statements, denying the cancellation had anything to do with Karzai’s statements. The head of the International Security Assistance Force (ISAF) — the coalition headed by the U.S. in Afghanistan — strongly denounced the idea that the U.S. would work with the Taliban to keep U.S. forces in the country. “We have fought too hard over the past 12 years. We have shed too much blood over the past 12 years. We have done too much to help the Afghan Security Forces grow over the last 12 years to ever think that violence or instability would be to our advantage,” said Marine Gen. Joseph Dunford.

Karzai has a lengthy history of inflammatory statements, usually intended to provide himself some form of leverage when dealing with his Western counter-parts or bolster himself domestically. In 2010, Karzai threatened to join Taliban after coming under pressure to launch reforms in the Afghan government. Karzai also warned against the continuation of NATO airstrikes in 2011, saying that NATO risked becoming an occupying force, adding that “history shows what Afghans do with trespassers and with occupiers.”

Tensions between the U.S. and Afghans stretch beyond difficulties in relations with Karzai. Reports on Monday say an Afghan police officer opened fire killing two U.S. troops and three of his fellow officers. These “green on blue” attacks — in which Afghan allies turn on their Western counterparts — have proved to be an ongoing impediment to lasting trust between U.S. and Afghan forces. Gen. John Allen, then the U.S. commander in Afghanistan, told 60 Minutes that coalition troops were willing to sacrifice for the Afghan campaign, but unwilling to be murdered.

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Lieberman joins American Enterprise Institute

Former Sen. Joe Lieberman (I-Conn.) is joining the American Enterprise Institute, the conservative think tank announced Monday.

Lieberman will serve as cochairman of the American Internationalism Project, alongside former Sen. Jon Kyl (R-Ariz.).

"The American Internationalism Project, under the leadership of Sen. Lieberman and Sen. Jon Kyl, is critical to opening a discussion about the challenges facing America in the coming decades--and strategizing about how to meet them," AEI president Arthur C. Brooks said in a statement.

Lieberman, who opted in 2012 not to run for reelection, said there is currently an "urgent need to rebuild bipartisan —indeed non-political— consensus for American diplomatic, economic, and military leadership in the world."

"That's why I am grateful to AEI for initiating and sponsoring this project and why I look forward to leading it with my friend Jon Kyl," Lieberman said.

Roughly a week ago AEI announced that Kyl had joined the American Enterprise Institute as a visiting fellow. Kyl served also decided to retire from the Senate in 2012.

Lieberman, formerly the chairman of the Senate Homeland Security and Governmental Affairs Committee, was one of the chief architects of a comprehensive cybersecurity bill that failed to pass the Senate last year. Despite the gridlock, Lieberman has continued his call for Congress to pass cybersecurity legislation to help protect American critical infrastructure from cyberattacks. 

Lieberman was former Vice President Al Gore's Democratic runningmate when Gore ran for president in 2000. Lieberman served as a Democrat until 2006 when he faced a primary challenge from businessman Ned Lamont. Lieberman eventually won reelection as an Independent in that race.

In 2008 Lieberman endorsed Sen. John McCain's (R-Ariz.) presidential candidacy and spoke at the Republican National Convention. More recently Lieberman has caucused with Democrats.

—Jennifer Martinez contributed reporting.

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Why Obamacare Is Oversold

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It’s the great moral imperative behind the Affordable Care Act (“Obamacare”): People should not be denied health care because they can’t afford insurance. Health status and insurance are assumed to be connected, and opponents have often been cast as moral midgets, willing to condemn the uninsured to unnecessary illness or death. The trouble is that health status and insurance are only loosely connected. This suggests that Obamacare may result in more spending and health services but few gains in the public’s health.

We now have a study based on Medicaid in Oregon implying just that. Judging the effect of insurance on health has always been difficult, because the uninsured are different from the insured: They’re poorer, younger and often sicker. How much of their worse health reflects a lack of insurance? To answer, researchers need to compare similar people with and without insurance.

Gallery

Oregon’s expansion of Medicaid — the federal-state insurance for the poor — unwittingly solved this problem. In 2008, the state decided to increase enrollment by 10,000. But there were 90,000 people on the waiting list, so the state adopted a lottery to decide who would receive coverage. The result was two similar groups of poor people — one with insurance (Medicaid) and one without — that could be compared. The New England Journal of Medicine recently published the study.

The most overlooked finding is that the uninsured already receive considerable health care. On average, the uninsured annually had 5.5 office visits, used 1.8 prescription drugs and visited an emergency room once. Almost half (46 percent) said that they “had a usual place of care,” and 61 percent said that they had “received all needed care” in the past year. About three-quarters (78 percent) who received care judged it “of high quality.” Health spending for them averaged $3,257.

True, when people were covered by Medicaid, many of these figures rose. The annual number of office visits went to 8.2; the number of drugs, to 2.5; the share of patients with a usual place of care, to 70 percent; the proportion receiving all needed care, to 72 percent. Preventive care also increased. The share of patients receiving screening for cholesterol moved from 27 percent for the uninsured to 42 percent; the share of women older than 50 having mammograms jumped from 29 percent to 59 percent; the share of men older than 50 getting PSA tests for prostate cancer doubled, from 21 percent to 41 percent. Spending rose to $4,429.

Unfortunately, the added care and cost didn’t much improve physical health. The study screened for high blood pressure, high cholesterol, diabetes and the risk of heart attack or stroke. No major differences were detected between the uninsured and Medicaid recipients. There was more treatment for diabetes, although no difference was found between the two groups on a key indicator of the disease.

The only major health gain was psychological. Depression dropped from about 30?percent to 21?percent between the groups. One reason may have been that Medicaid recipients don’t fear huge medical bills. Their out-of-pocket health costs were $337. For the uninsured, out-of-pocket costs were 64 percent higher. (Presumably, most non-out-of-pocket costs for the uninsured were covered by free clinics, charity care and uncollected debt.)

“Health insurance is a financial product that is aimed at providing financial security,” the study says. On that ground, the expansion succeeded; by most clinical measures, it didn’t. Perhaps it is too early. The expanded Medicaid coverage was only two years old at the time of the study. Maybe greater health improvements will emerge. But maybe they won’t, and not only because the uninsured already receive care. Many uninsured are relatively healthy; insurance won’t make them healthier. For others, modern medicine can’t cure every health problem. For still others, bad luck or bad habits are hard to change. About two-fifths of Oregon’s uninsured were obese or smoked; Medicaid didn’t alter that.

Much of this was known — or could have been surmised — during the debate over Obamacare. The Congressional Budget Office reported that the uninsured typically received 50 to 70 percent of the care of the insured. A study in 2007 of the 1965 creation of Medicare — insurance for the elderly — concluded that it had “no discernible impact on elderly mortality” in the first 10 years but improved recipients’ financial security by limiting out-of-pocket expenses.

Obamacare’s advocates ignored these ambiguities. They were too busy flaunting their moral superiority. Universal health insurance is a legitimate goal, but 2009 — in the midst of a major economic crisis — was the wrong time to pursue it. Predictably, it polarized public opinion and subverted confidence for what seem to have been, based on the available evidence, modest likely public health improvements. The crusade for universal coverage has been as much about advocates’ sense of self-worth as about benefits for the uninsured.

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New York Times Puff Piece About Focus On The Family Ignores Its Regular Anti-LGBT Rhetoric

Focus on the Family President Jim Daly

On Friday, the New York Times ran a puff piece about Focus on the Family, claiming that under the leadership of its president Jim Daly, the organization is softening by becoming one that “invites civil dialogue” and “turns down the rhetorical temperature on the debate.” It goes on to claim that Daly is “attesting to the divine love and grace that he firmly believes saved his life.”

Jeremy Hooper and David Badash have already penned extensive retorts, outlining the many odious anti-LGBT positions that Focus on the Family still holds. As a simple test of whether Focus on the Family and its political arm CitizenLink are engaging in more “civil dialogue,” here’s a look at some of the rhetoric they’ve put out over just the past six months:

Marriage equality will “shut down businesses” and is actually about “silencing Christian voices in the public square.”Marriage equality is a “pernicious lie of Satan.”Gender and sexuality are determined by procreation, not anybody’s own sense of their identities.Homosexuality isn’t a “super sin,” but it’s still a sin, just like adultery, lying, cheating, and gossiping.There’s no such thing as being gay; it’s just a “political statement.”Marriage equality passed in November because voters are “unchurched” and care more about themselves than about children.Transgender identities are unhealthy disorders that result from childhood trauma.Trans people should pursue ex-trans therapy to rectify their “confusion” with their “God given gender identity and destiny.”Gay people are in “pain” and at battle with God.Heterosexuality is society’s ideal because affirming homosexuality would be “normalizing brokenness.”“Satan roams the earth like a lion, using sexual and relational brokenness to destroy individuals, families, churches, groups, businesses.”Parents should be able to prevent their children from learning that gay people exist.There are “a variety of roads into homosexuality” including molestation, parents’ divorce, and trouble conforming to gender roles.

And that was just the rhetoric that ThinkProgress happened to cover since last September. Of course, Focus on the Family also sponsors the annual “Day of Dialogue,” which encourages Christian students to condemn their gay peers — a counterprotest to the “Day of Silence,” which is designed to bring visibility to that very kind of bullying.

The New York Times should better clarify that not a single position has changed at Focus on the Family. As the article inadvertently demonstrates, the organization has simply achieved better PR when individuals aren’t paying attention to what they actually believe.

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Bipartisan Group Calls For Broader Religious Exemptions In ObamaCare

House Republicans and Democrats have joined together to re-introduce a bill that would expand the religious conscience exemptions under ObamaCare.

Under the Equitable Access to Care and Health (EACH) Act, individuals would have the option of being exempted from the Affordable Healthcare Act's mandate to buy health insurance. People could avoid the mandate by filing an affidavit as part of their tax return saying their religious beliefs keep them from buying insurance that meets federal standards.

However, anyone filing this affidavit who then uses healthcare would lose their right to the exemption from the insurance mandate.

"We believe the EACH Act balances a respect for religious diversity against the need to prevent fraud and abuse," Reps. Aaron Schock (R-Ill.) and William Keating (D-Mass.) wrote in a letter seeking support for their bill.

"It is imperative we expand the religious conscience exemption now as the Administration is already developing a process to verify the various exemptions to the individual mandate," they wrote.

Religious exemption from ObamaCare has come up before, including the ruling from the Obama administration that religious-affiliated organizations must provide health insurance that covers contraception. The EACH Act, however, is unrelated to that issue, and deals only with exemptions from the insurance mandate.

The bill, H.R. 1814, enjoyed bipartisan support last year, and this year was introduced with 43 co-sponsors.

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Patrick Stewart’s Domestic Violence Campaign And Geek Feminism

I’m glad to see Sir Patrick Stewart calling on men to prevent violence against women, particularly given the vicious harassment campaign against feminist commenter Zerlina Maxwell that commenced after she dared to suggest that maybe we should teach rape prevention to men rather than asking women to take all sorts of precautions that might or might not work to guard themselves against assault. In an appearance on Friday:

The 72-year-old British-born actor, best known for his roles in “X-Men” and “Star Trek: The Next Generation,” served as host for the launch of “Ring the Bell,” a global campaign calling on 1 million men to make 1 million “concrete, actionable promises” to end violence against women.

“Violence against women is the single greatest human rights violation of our generation,” Stewart said.

“This is a call to action—not an action that will make things better in six months’ time or a year’s time,” he continued, “but action that might save someone’s life and someone’s future this afternoon, tonight, tomorrow morning.”

First, I think it’s great to see a genre-fiction icon like Stewart speaking out on violence against women, and speaking from a place of personal experience. That’s something women are often asked to do to personalize women’s issues, but that also gets them dismissed as subjective or overstating problems. Hearing that domestic violence affects men as well is powerful testimony, and takes some of the weight off women to repeat their stories, and to make the argument that such violence may be directed at women, but that doesn’t mean that its effects are confined to people who are physically damaged. To have Stewart define masculinity as solidarity with women strikes me as a useful thing in the geek community, though I think it’s definitely worth talking about concrete action that respects women’s agency, rather than setting up domestic violence survivors as simply another version of the Damsel In Distress.

And I think it’s important to talk about what concrete steps can look like for men who don’t conceive of themselves as violent (or in the conversation Maxwell started, as potential rapists), or who don’t have direct personal contact with domestic violence right now. How do men start and frame effective conversations with other men, whether it’s about the presentation of women’s issues and violence in the real world, or about content they’re consuming together that may be casually violent against women, or may employ violence against women and sexual assault as a lazy way of generating stakes? What are good ways to teach consent-seeking as that push back against pick-up artist techniques and attitudes, some of the only guides to being more socially engaged that some men in the geek community ever encounter (a point made valuably, and pushed back against, by the wonderful Dr. NerdLove, who I had the privilege to meet up with here in Austin)? Being committed to not being personally violent against women in a theoretical way is a wonderful thing, and one I’m glad to see men embrace, but it’s the kind of mentality that can also make men think that they’re the kind of people who could never possibly be violent towards women, which contributes to the inability to see one’s own bad acts. Trying to reduce a culture of violence, and to promote the idea that violence against women ought to be something that makes men feel uncomfortable for their own sakes, is something rather different.

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The Inevitable 2014 Headline: ‘Global CO2 Level Reaches 400 PPM For First Time In Human Existence.’

By Peter Gleick, via Science Blogs

Sometime, about one year from now, the front pages of whatever decent newspapers are left will carry a headline like the one above, announcing that for the first time in human existence (or in nearly a million years, or 3 million years, or 15 million years), the global atmospheric concentration of carbon dioxide — the principal gas causing climate change — will have passed 400 parts per million (ppm).

That’s a significant and shocking figure. Unfortunately, it’s only a temporary marker on the way to even higher and higher levels. Here are the most recent (March 2013) data from the Mauna Loa observatory showing the inexorable increase in atmospheric CO2 and the rapid approach to 400 ppm.

There is a range of estimates around the detailed time record of atmospheric composition, and the study of changes in atmospheric carbon dioxide concentrations over the billions of years of the Earth’s existence is an exciting area for research. A commonly cited figure with strong evidence comes from measurements of air trapped in ancient ice cores obtained from Antarctic ice. We now have a detailed 800,000 year record, which shows clearly that atmospheric CO2 levels never approached 400 ppm during this period.

In December 2009, a research team from UCLA published a paper in Science that suggested we would have to go back at least 15 million years to find carbon dioxide levels approaching today’s levels. This research used isotopic analysis of shells in deep sea sediments, and reported that CO2 concentrations may not have exceeded 400 parts per million since the Mid-Miocene Climatic Optimum (MMCO) — between 16 and 14 million years ago. The MMCO was associated with reduced planetary ice volumes, global sea levels 25 to 40 meters higher than today, and warmer ocean temperatures. Decreasing CO2 concentrations after that were associated with substantial global cooling, glaciations, and dropping sea levels.

Gavin Schmidt of NASA’s GISS has pointed me to research in a December 2011 article in the journal Paleoceanography by Gretta Bartoli, Bärbel Hönisch, and Richard E. Zeebe, reporting on paleoclimatic records that suggest CO2 concentrations (at least in the Northern Hemisphere) may have been around 400 ppm between 2 and 4.6 million years ago. This evidence comes from isotopes measured in planktic foraminifer shells spanning 2.0 to 4.6 million years ago and indicates that atmospheric CO2 estimates during the Pliocene gradually declined from just above 400 ppm to around 300 ppm in the early Pleistocene 2 million years ago.

800,000 years ago? Three million years ago? 15 million years ago? More research will continue to clarify the variability of Earth’s atmospheric composition over time, as well as the impacts for the planet as a whole of screwing with it. (That’s a technical term…)

But the more important point to remember is that never in the history of the planet have humans altered the atmosphere as radically as we are doing so now. And the climatic consequences for us are likely to be radical as well, on a time-scale far faster than humans have ever experienced.

– Dr. Peter Gleick is a climatologist. This post originally appeared on Science Blogs and is reprinted here with permission.

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Oregon Study Throws a Stop Sign in Front of ObamaCare’s Medicaid Expansion

Today, the nation’s top health economists released a study that throws a huge “STOP” sign in front of ObamaCare’s Medicaid expansion.

The Oregon Health Insurance Experiment, or OHIE, may be the most important study ever conducted on health insurance. Oregon officials randomly assigned thousands of low-income Medicaid applicants – basically, the most vulnerable portion of the group that would receive coverage under ObamaCare’s Medicaid expansion – either to receive Medicaid coverage, or nothing. Health economists then compared the people who got Medicaid to the people who didn’t. The OHIE is the only randomized, controlled study ever conducted on the effects of having health insurance versus no health insurance. Randomized, controlled studies are the gold standard of such research.

Consistent with lackluster results from the first year, the OHIE’s second-year results found no evidence that Medicaid improves the physical health of enrollees. There were some modest improvements in depression and financial strain–but it is likely those gains could be achieved at a much lower cost than through an extremely expensive program like Medicaid. Here are the study’s results and conclusions:

We found no significant effect of Medicaid coverage on the prevalence or diagnosis of hypertension or high cholesterol levels or on the use of medication for these conditions. Medicaid coverage significantly increased the probability of a diagnosis of diabetes and the use of diabetes medication, but we observed no significant effect on average glycated hemoglobin levels or on the percentage of participants with levels of 6.5% or higher. Medicaid coverage decreased the probability of a positive screening for depression [by 30 percent], increased the use of many preventive services, and nearly eliminated catastrophic out-of-pocket medical expenditures…

This randomized, controlled study showed that Medicaid coverage generated no significant improvements in measured physical health outcomes in the first 2 years, but it did increase use of health care services, raise rates of diabetes detection and management, lower rates of depression, and reduce financial strain.

As one of the study’s authors explained to me, it did not find any effect on mortality because the sample size is too small. Mortality rates among the targeted population – able-bodied adults 19-64 below 100 percent of poverty who aren’t already eligible for government health insurance programs – are already very low. So even if expanding Medicaid reduces mortality among this group, and there is ample room for doubt, the effect would be so small that this study would be unable to detect it. That too is reason not to implement the Medicaid expansion. This is not a population that is going to start dying in droves if states decline to participate.

There is no way to spin these results as anything but a rebuke to those who are pushing states to expand Medicaid. The Obama administration has been trying to convince states to throw more than a trillion additional taxpayer dollars at Medicaid by participating in the expansion, when the best-designed research available cannot find any evidence that it improves the physical health of enrollees. The OHIE even studied the most vulnerable part of the Medicaid-expansion population – those below 100 percent of the federal poverty level – yet still found no improvements in physical health.

If Medicaid partisans are still determined to do something, the only responsible route is to launch similar experiments in other states, with an even larger sample size, to determine if there is anything the OHIE might have missed. Or they could design smaller, lower-cost, more targeted efforts to reduce depression and financial strain among the poor. (I propose deregulating health care.) This study shows there is absolutely no warrant to expand Medicaid at all.

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Queen ‘Fights’ For Gay Rights Without Mentioning Them

Headlines this weekend praised The Queen for promoting gay rights in a new Commonwealth Charter, which includes this commitment to civil rights:

We are implacably opposed to all forms of  discrimination, whether rooted  in gender, race, colour, creed, political belief or other grounds.

The “other grounds” is meant to refer to sexuality, but was kept ambiguous because some of the commonwealth countries still have strict laws against homosexuality. Her live speech will add that rights must “include everyone,” apparently another nod at gay rights.

Though the public display of her signing and live speech is notable, British LGBT groups are not impressed by the allusion. Prominent activist Peter Tatchell had higher expectations:

TATCHELL: In her 61 years on the throne, the Queen has never publicly uttered the words lesbian or gay. She is a patron of hundreds of charities but none of them are gay ones. Never once has she visited or supported a gay charity. In truth, the Commonwealth Charter does not include any specific rejection of discrimination based on sexual orientation. This was vetoed by the homophobic majority of member states. [...]

While I doubt that Elizabeth II is a raging homophobe, she certainly doesn’t appear to be gay-friendly. Not once during her reign has she publicly acknowledged the existence of the LGBT community… Astonishingly, since she became Queen in 1952, the words ‘gay’ and ‘lesbian’ have never publicly passed her lips. There is no record of her ever speaking them. Even when she announced government plans for gay law reform in her Queen’s Speeches, she did not use the words lesbian or gay. Apparently, mentioning LGBT people is beneath the dignity of the monarch.

The Guardian’s Patrick Strudwick similarly notes that “to refrain from specification is to collude with silence, the Grand Pause that keeps lesbians and gay men invisible, suffocating in marriages of inconvenience or trapped in police cells.”

The charter is a worthwhile commitment to civil rights in commonwealth countries and also includes support for gender equality and women’s empowerment. Still, claims that The Queen is suddenly “fighting” for gay rights seems to be quite the overstatement.

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Landmark Study Shatters Liberal Health Care Claims

During the health care debate, liberals argued that government had a moral duty to enact legislation that expanded health insurance among lower-income individuals. This was rooted in the assumption that obtaining health insurance translates into improved health. But a landmark study published in the New England Journal of Medicine dramatically undermines this assumption and shatters the rationale behind the law’s Medicaid expansion.

In 2008, Oregon expanded its Medicaid program, but because the state could not cover everybody, lawmakers opened up a lottery that randomly drew 30,000 names from a waiting list of almost 90,000 and allowed them to apply for the program. This created a unique opportunity for health researchers, ultimately allowing them to compare the health outcomes of 6,387 low-income adults who were able to enroll in the program with 5,842 who were not selected.

Contrary to liberal assumptions, researchers found that those who enrolled in Medicaid spent a lot more on medical care than those who weren’t able to enroll, but didn’t significantly improve their health outcomes.

Specifically, researchers found that those who received Medicaid increased their annual health care spending by $1,172, or 35 percent more than those who did not receive Medicaid. Those with Medicaid were more likely to be screened for diabetes and use diabetes medication and to make use of other preventive care measures. The study also examined health metrics including blood pressure and cholesterol.

Ultimately, the authors concluded that, “This randomized, controlled study showed that Medicaid coverage generated no significant improvements in measured health outcomes in the first two years, but it did increase use of health services, raise rates of diabetes detection and management, lower rates of depression, and reduce financial strain.”

So, the study suggests that expanding Medicaid is one way of reducing financial pressure on low-income groups, but it’s costly and does not improve their health.

Another interesting finding was that though medical spending increased among Medicaid enrollees due to more prescription drug usage and doctors’ visits, the study “did not find significant changes in visits to the emergency department or hospital admissions.” This undercuts another favorite talking point of liberals, which is that expanding insurance actually saves money by reducing costly emergency room visits.

Of course, this is just one study, and the authors offer some caveats. Among others, the study measured an average of about 17 months of health outcomes, so longer-run results may differ. Also, the study applied to Medicaid, rather than private insurance. But given that it had a sample size of over 12,000 and was so well designed, its conclusions will reverberate.

As the authors explain, “our study provides evidence of the effects of expanding Medicaid to low-income adults on the basis of a randomized design, which is rarely available in the evaluation of social insurance programs.”

Starting next year, millions more Americans will become eligible for Medicaid as a result of President Obama’s health care law. As Cato’s Michael Cannon put it, “There is no way to spin these results as anything but a rebuke to those who are pushing states to expand Medicaid. The Obama administration has been trying to convince states to throw more than a trillion additional taxpayer dollars at Medicaid by participating in the expansion, when the best-designed research available cannot find any evidence that it improves the physical health of enrollees. The OHIE even studied the most vulnerable part of the Medicaid-expansion population – those below 100 percent of the federal poverty level – yet still found no improvements in physical health.”

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Head Of U.S. Pacific Forces: Climate Change Is Biggest Threat To Region’s Security

The Commander of the U.S. Pacific Command has identifued climate change as the most likely threat to the Pacific region, as ThinkProgress reported:

Admiral Samuel J. Locklear III, commander of the U.S. Pacific Command, gave a striking answer when asked about the greatest threat the region faces: climate change.

Locklear told the Boston Globe, the changing climate “is probably the most likely thing that is going to happen . . . that will cripple the security environment, probably more likely than the other scenarios we all often talk about.”

Among the issues that the Admiral cited as most concerning was the possibility that rising sea-levels result in the disappearance of whole countries, producing influxes of ‘climate refugees‘ in neighboring states.

It’s surprising to hear the head of PACOM talk so starkly about the threats we face from climate change, but not surprising to hear this from the military. In 2010, the Quadrennial Defense Review made it clear that climate change impacts U.S. military resources:

While climate change alone does not cause conflict, it may act as an accelerant of instability or conflict, placing a burden to respond on civilian institutions and militaries around the world. In addition, extreme weather events may lead to increased demands for defense support to civil authorities for humanitarian assistance or disaster response both within the United States and overseas.

Peter Sinclair made a good video on national security impacts in 2010:

Most of those interviewed in that video are retired or former military, which makes Admiral Lockclear’s comments that much more striking.

It’s good to see climate hasn’t slipped from all national security considerations. Last year the CIA closed down its Center on Climate Change and National Security which opened in 2009.

Admiral Locklear went on to describe in his interview how important it was to coordinate multilaterally with China and India to respond to climate impacts:

“The ice is melting and sea is getting higher,” Locklear said, noting that 80 percent of the world’s population lives within 200 miles of the coast. “I’m into the consequence management side of it. I’m not a scientist, but the island of Tarawa in Kiribati, they’re contemplating moving their entire population to another country because [it] is not going to exist anymore.”

The US military, he said, is beginning to reach out to other armed forces in the region about the issue.

“We have interjected into our multilateral dialogue – even with China and India – the imperative to kind of get military capabilities aligned [for] when the effects of climate change start to impact these massive populations,” he said. “If it goes bad, you could have hundreds of thousands or millions of people displaced and then security will start to crumble pretty quickly.”

If the American, Chinese, and Indian militaries are coordinating on responding to the threats of climate impacts, perhaps the militaries could provide some support to other bilateral and multilateral efforts that have stalled on climate in the past.

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The Affordable Care Act Negatively Impacts the Supply of Labor

Labor market distortions are common within the Patient Protection and Affordable Care Act (PPACA/Obamacare). Employers are faced with uncertainty at every turn. As observed from the recently released Federal Reserve beige book, this uncertainty restrains hiring.[1]

While substantial attention has been given to the employer side, the employee side also experiences many distortionary effects. Some of these distortions include incentives to reduce hours, not seek work, drop insurance coverage, drop dependent coverage, become divorced, or avoid marriage. It is apparent that Obamacare’s effects extend far past the number of employees a business will employ, or how many hours a week an employee will be allowed to work.

Obamacare Taxes and the Supply of Labor

Obamacare will negatively affect the reward to work for many workers, as noted by University of Chicago economist, Casey Mulligan. According to Mulligan, “The net result of all of this will be to reduce employment, especially among less skilled people.”[2]  Many individuals will be left facing tough decisions on whether or not to take a higher paying job or losing thousands of dollars in health care subsidies.[3]

When an individual faces higher tax rates, if they currently have a job, they may roll back on hours worked. Subsidies also have this sort of effect. According to Mulligan, “The [Affordable Care Act’s] subsidies will sharply reduce the financial reward to working because they will be phased out with household income.”

The Congressional Budget Office (CBO) also agrees, stating, “The expansion of Medicaid and the availability of subsidies through the exchanges will effective increases beneficiaries’ financial resources. Those additional resources will encourage some people to work fewer hours or to withdraw from the labor market.” The CBO found that the legislation would reduce amount of labor by half a percent.[4]  

Under the Affordable Care Act’s system of subsidies, as an individual makes more money, they are rewarded by losing subsidies. This creates a calculation that each person must make—whether or not to strive to increase their personal household income through working more or getting a better job, or choosing to stay in a similar place in life in order to keep the benefits.

In November 2012, the CBO estimated the increase in marginal tax rates due to Obamacare, adding evidence to Mulligan’s claim. According to the CBO, the introduction of the Medicaid expansion and the exchange subsidies would increase marginal tax rates for more individuals. Populations that have Medicaid face marginal tax rates above 75 percent in many instances. In terms of exchange subsides, for income between 100 percent and 133 percent of the poverty level, tax rates increase by 2 percent. For income between 133 percent and 400 percent of the poverty level, increases vary between 9.5 percent and 18 percent.[5]

Compared to previous law, individuals now experience even higher marginal tax rates from the ability to garnish health care subsidies at lower income. Obamacare ultimately discourages low income individuals from trying to move into higher paying jobs on the margin.

Low-wage workers are especially affected, because they are most responsive to higher tax rates or lower subsidies. The CBO believes that low-income workers have higher labor elasticies.[6] Low income workers will respond to changes in tax rates more intensely on the margin than individuals with higher incomes. Not only are marginal rates higher, but lower income individuals are expected to respond more vigorously to the changes. This effect could be further exasperated through the incentives for employers to drop coverage to lowering income employees.[7]

Dependent Coverage and Obamacare’s Treatment of Marriage

Several analysts point out that Obamacare develops a marriage penalty.[8] Simply put, individuals lose subsidies if they choose to marry without any change to earnings. Representative Darrel Issa (R­–CA) points out a simple explanation and example: “The result of linking the tax credit to the federal poverty level is that two individuals who make between $61,600 and $91,200 in 2014 will not benefit from the tax credit if they decide to marry.”

While this example only shows one case, it is true that most individuals that previously obtained exchange subsidies would lose some subsidies when becoming married. For a couple that has two individual earners between 100 percent and 400 percent of the Federal Poverty Level, choosing to get married would experience further increases in effective marginal tax rates—between 10 percent and 24 percent.[9]

The extension of dependent coverage in Obamacare attacks the labor market from several angles. First, young adults are discouraged from entering the labor force due to the law’s implementation. Heritage analysis shows that individuals can be as much as 15 percent more unlikely to be part of the labor force after the dependent coverage provision went into effect.[10]

This behavior makes the most sense for low-income earners where the benefit will be relatively large compared to the wage earned. While it is not necessarily true that a young adult would lose their dependent coverage upon getting a job of their own, this consideration could be coming into play, as well as a general decision to utilize the benefit to stay in school, or pursue other activities.

A second effect, as outlined in a previous Heritage Issue Brief, outlines the incentive for individuals dropping their own name coverage for dependent coverage.[11] Ultimately, this leads to increased incentives for employers to drop coverage, either by pushing employees to the exchanges indirectly or paying the penalty and adjusting benefits accordingly.

Labor Market Distortions Still to Come

Obamacare distorts incentives for employees to make positive changes in the labor market. Employees are encouraged to keep lower paying jobs in order to preserve subsidies, while also being encouraged to remain single, leave the labor force, or even not participate in the labor force.

While many economists and officials suggest that the Affordable Care Act will not result in drastic labor market distortions when it is fully implemented, basic economic evaluation of the situation shows that these distortions will occur. If the most recent Federal Reserve beige book’s further revelations about slow labor market recovery is any foreshadowing to what is to come, the United States labor market is in for rude surprise in the coming years.[12]

—Drew Gonshorowski is Policy Analyst in the Center for Data Analysis at The Heritage Foundation.

[10]Analysis Conducted by Author in Forthcoming Brief.

[12]Federal Reserve District, “Current Economic Conditions.”

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Head Start Teachers Name Obamacare As Biggest Problem

Head Start teachers and administrators told The Daily Caller that their most pressing concern is not budget impacts from sequestration but changes coming from President Barack Obama’s health-care law.

In 2014, the impact of 2010 Patient Protection and Affordable Care Act “is probably going to be a 9 percent [cost] increase, and significantly more the next year,” said Nancy Nordyk, director of the Head Start program in southern Oregon.

Rising healthcare costs will likely force Oregon to reduce some Head Start workers’ hours so they’re not eligible for the medical program, said Nordyk, who spoke to TheDC during a national Head Start conference held just outside D.C. in Maryland.

In one conference session on the pending healthcare bill, “some of the [managers for regional Head Start] organizations [said] ‘We don’t know what to do,’” said Elizabeth Steinberg, the CEO of Community Action Partnership in San Luis Obispo, Calif.

The worried managers come from “all over the country,” said Steinberg, whose Head Start program has 387 children.

The growing worry about Obamacare’s impact on Head Start has been obscured by the White House’s periodic efforts to portray the program as the victim of Republicans’ recent approval of sequestration, a slight reduction in the rate of federal spending growth that is erroneously described as a spending cut.

Administration officials announced April 29 that the Head Start funding would face a 5.27 percent budget cut in 2014.

“I know that there hasn’t been a lot of coverage of the [sequester] impacts on real people, on the families who had to be engaged in lotteries to see whether their child, on a Friday, was still going to be in Head Start on Monday,” White House spokesman Jay Carney said in a press conference in April.

However, in multiple interviews during a reception Thursday at the ritzy Gaylord National Resort & Convention Center, Head Start teachers and administrators told TheDC they’re coping with the cuts.

Sandra Deveux, a teacher in Florida’s Brevard County, said her program trimmed $220,000 from its budget by cutting contracts and counseling. So far, she said, there been ”no cuts in employees, no cuts in services.”

“No layoffs yet,” said Shelvy Deskins, a teacher from southern Virginia’s Buchanan county. “Everything for the children, we have to keep,” she said.

Theresa Baker, a parent on a Head Start unit at Jefferson County, Kentucky, said her district may close some classrooms just before the end of the financial year in August. “Everything is under a microscope… we’ve become very very frugal,” she said, adding that her district will likely trim costs by scaling back home-visits to children enrolled in the program.

In Oregon, the Head Start region has scheduled a three-week “summer furlough,” will close one class 12 days early, and will delay opening the 2014 school-year for kids aged four and five, said Nordyk. Her head Start unit has 1,215 students and 300 staff.

However, many attendees at the National Head Start Association’s 40th annual conference said they’re coping with the sequester. “We’re going to make it,” said Weldon Beard, director of the Head Start program in Nacogdoches, Texas.

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What You Need To Know About Thomas Perez, Obama’s Likely Labor Nominee

President Obama will reportedly choose Thomas Perez, an assistant attorney general who oversees the Department of Justice’s Civil Rights Division, to replace outgoing Labor Secretary Hilda Solis. Perez, a popular pick among labor and Latino groups, is expected to be nominated this week, according to various news reports. Should he be confirmed by the Senate, Perez will take over Labor at a time when Obama and Democrats are pushing for immigration reform and a minimum wage increase.

Before his current role began, Perez served in Bill Clinton’s Justice Dept., as a city council member in Montgomery County, Maryland, and as the head of Maryland’s state labor department. And while Perez has spent the last four years leading the administration’s challenges to new voter restrictions, his past also includes experience fighting to protect and expand workers’ rights:

Fought worker exploitation and human trafficking: Perez served on the Worker Exploitation Task Force, which sought to protect vulnerable workers, while working in the Justice Dept. under Attorney General Janet Reno. The task force aimed to fight “modern day slavery” that resulted from human trafficking, discrimination in labor markets, and other exploitative practices, according to Senate testimony from former officials. The task force secured multiple convictions involving the trafficking and exploitation of women and children workers, and helped lead to calls around the country for stronger anti-trafficking laws both at the federal and state level.

Pushed for labor protections for domestic workers: Millions of domestic workers in the United States make low wages because they aren’t protected by labor law, a problem Perez sought to address while serving on Montgomery County’s City Council, where he pushed for contractual labor law protections and a minimum wage for such workers. After three years of debate, and after Perez had left the council, those protections became law in 2008 and gave domestic workers contractual labor rights they still lack in most of the United States.

Protected immigrant workers from losing pay: Perez would take over the Dept. of Labor in the middle of Obama’s push for immigration reform, and he has experience dealing with immigration and labor issues. While serving in the Justice Dept., Perez investigated claims that employers were using Alabama’s new immigration law to avoid paying immigrant workers. “We continue to be concerned that certain employers may be using HB56 as an excuse not to pay workers,” he said, adding that he would “throw the book” at employers who weren’t paying workers. “We’re here. We will prosecute you. That is impermissible, period.”

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What Is To Be Done: Reveal And Replace Obamacare

Reps. Fred Upton, right, and Dave Camp, both R-Mich.

Millions of Americans now find themselves in the midst of a massive botched experiment called Obamacare. Nearly every poll-tested health care commitment is evaporating into thin air, leaving us with higher costs and headaches of uncertainty.

Unfortunately, this was both predicted and avoidable. Obamacare was premised on an outmoded, top-down approach to health care - a 40 year-old liberal aspiration, enabled by unified Democrat control of Washington in 2010.

Three years later, the implications are staggering. Despite the White House's claims to the contrary, we are faced with higher health care costs, many will lose or face substantial change to their insurance coverage, and job creation is threatened as hours and wages are reduced as a result of Obamacare. And the number of people dependent on the government for their health care will expand exponentially, exposing future generations to massive fiscal risks.

As Republicans we find ourselves in a challenging position witnessing this slow motion calamity. Repealing the bungled law and replacing it with a modern, common sense, bottom-up alternative is our preferred approach, which is why the House will vote tomorrow to fully repeal this government takeover of the health care system. Yet, while this vote is important, President Obama's reelection makes full repeal unlikely - at least for now.

So, if repeal is not a viable short-term option, reveal must be. Dissecting Obamcare's defective anatomy while offering alternatives is the way to get our health care system back on track. That's why the two committees we chair will continue our aggressive oversight, exposing Obamacare's failures - and discussing ways to provide more affordable health care to all Americans.

What have our efforts "revealed" so far?

For starters, Obamacare suffers from its own pre-existing condition: hyper-partisanship. You can't build an entirely new health care regime using a partisan hammer. But that's exactly what the Democrats in Congress did, with no Republican votes in the House or Senate.

Enduring health care change must garner some bipartisan support. So, we pledge to focus our efforts on policies that can actually make our health care system work better for families and employers struggling to continue providing benefits for their workers.

Second, the most important health care issue for Americans is cost. Health care costs are far too high for workers and employers. Democrats lost sight of the main priority. Roughly 85 percent of Americans already have health insurance. Instead of figuring out how to offer more affordable options for the uninsured, Obamacare upends the coverage of those that have it.

A recent investigation by one of our committees found that the new health law could drive individual premium increases as high has 400 percent and rates in the small business market could rise by as much as 200 percent.

It is a sad statement on Obamacare that Americans in the individual market will have to hope they only get hit with the average expected premium increase: 96 percent.

Republicans have a lot of affordability ideas. We support the creation of purchasing options across state lines, more flexibility for civic and fraternal associations to provide health insurance, incentives for states that control health care costs, the offering of high deductible plans, the creation of state-based high risk pools for people with pre-existing conditions, and medical liability reform. Unlike Obamacare's top-down mandates, these ideas would all reduce the cost of health care.

Consider this one example. A recent college graduate, Ashley, gets a job at a new start up company. She's excited about the work. Because the firm is just getting off the ground, it cannot yet afford to offer health care benefits.

Under Obamacare, Ashley is forced to buy a plan with all the bells, whistles, and coverage options designed for a woman two and three times her age who faces very different health care needs. We believe Ashley should have more options available to her and the ability to buy a plan tailored to her needs and her budget.

These affordability policies would allow us to remove one of the most unpopular features of Obamacare - the mandate that everyone must purchase government-approved insurance. We don't think it is right for Washington to force Ashley to buy a certain type of health care plan or face a tax.

Eliminating the mandate means the massive expansion of Medicaid, as well as most of the subsidies to purchase insurance in health exchanges, would no longer be necessary, saving taxpayers over a trillion dollars over the next ten years.

We are revealing better health care ideas. A bipartisan, affordability first approach, based on encouraging innovation and market-based choices must replace the bungled gambit of the massive old Washington spending and top-down regulatory mandates known as Obamacare.

Rep. Dave Camp, R-MI, is chairman of the House Ways and Means Committee. Rep. Fred Upton, R-MI, is chairman of the House Energy and Commerce Committee.

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