Iran, ObamaCare

Trump’s Decertification of Iran Nuclear Deal Isolates and Weakens U.S.
Interview with Jamal Abdi, policy director with the National Iranian American Council, conducted by Scott Harris

President Donald Trump announced on Oct. 13 that he is formally “decertifying” the international nuclear agreement with Iran. While Trump has stated that “The Iran deal was one of the worst and most one-sided transactions the United States ever entered into,” he declined to terminate the Iran nuclear agreement. Instead, he moved the issue to Congress, where legislators will engage in a 60-day period of debate on whether or not to re-impose economic sanctions against Iran that had been in effect before the nuclear deal was signed in 2015. Re-imposition of the sanctions will effectively withdraw the U.S. from the nuclear agreement.

While Trump has repeatedly stated that Iran has violated the “spirit” of the agreement, the U.N.’s International Atomic Energy Agency says that Iran is in compliance. The other signatories to the deal: Russia, China, France, Britain and Germany all have maintained their support for the deal, just as Trump’s own Defense Secretary James Mattis, Secretary of State Rex Tillerson and the Pentagon’s Chairman of the Joint Chiefs of Staff Gen. Joseph F. Dunford have publicly expressed support for the agreement.

Between The Lines’ Scott Harris spoke with Jamal Abdi, policy director with the National Iranian American Council, who assesses the fallout from Trump’s decision to decertify the Iran nuclear deal and warns that a move to withdraw the U.S. from the agreement will isolate and undermine U.S. credibility around the world.

JAMAL ABDI: By decertifying, it doesn’t do anything on its own. But what it does is it kicks off a 60-days period in Congress where there are expedited rules to introduces sanctions legislation to snap back the sanctions that were eased under the nuclear deal. Now, that 60-day window is open and what it means it that if the majority or minority leaders in either the House or the Senate – if they introduce legislation that specifically snaps back the nuclear sanctions – no other sanctions, only the sanctions that were lifted under the deal – that legislation is guaranteed to get a vote. It can’t be stopped in committee, it goes to the floor in the Chamber it’s introduced in, it gets a vote it gets passed to the other Chamber and the key is that in the Senate, there is no filibuster. It is a straight, simple majority vote.

So unlike when the deal actually got through Congress and you had every single Republican voting against it, but they had to hit that 60-vote threshold. Now, we’ve got this simple majority, and so, this is sort of a conundrum that this Congress has had under Trump – this Republican Congress – his responsibility of governing. So really, nobody in Congress, even those people who oppose the deal, they don’t actually want to kill the thing, they just want to rack up these political points and say how much they hate it.

But what Donald Trump has effectively done unwittingly is kind of call their bluff and now it’s up to either Kevin McCarthy in the House or Mitch McConnell in the Senate, if they introduce that snap-back legislation, it’s going to get a vote. Either enough Republicans are going to have to vote to protect the deal, or they vote against it; the sanctions snap-back and then the U.S. is then in violation of the deal.

That means basically, the U.S. exits the deal and then we find out okay, can the deal be salvaged by just, you know Europe, Russia, China and Iran. Or does Iran end up wanting to back out of elements of the deal? And it’s sort of a nightmare. Nobody really knows how that process plays out.

BETWEEN THE LINES: What’s the likely response in Iran to this ongoing process in the United States that jeopardizes this nuclear agreement? Especially from the hardline factions within the Tehran government?

JAMAL ABDI: For the hardliners, this a “I told you so” moment. The supreme leader, Ayatollah (Ali) Khamenei, who has final say over these things. What the supreme leader said was, “Okay you can go ahead with these negotiations, that’s fine. But at the end of the day, you can’t trust the United States. Even if we deal with the nuclear issue, they’re just going to pivot and say there’s some other reason that they’re our enemy. And so, this a futile exercise. But you go ahead with it, I’m not going to stop you.”

And now, they’re really saying, “I told you so.” But I think inside of Iran, the challenge here is that actually, really, it sort of empowers the hard-liners and it sort of forces (Iranian President) Hassan Rouhani and the moderates – they’ve actually had to … Rouhani actually sort of challenged the IRGC (Islamic Revolutionary Guard Corps) and the hardline military wing in Iran, challenged them in his election, which is unprecedented and now, after what Trump did, he’s actually having to stand up to the IRGC.

So you sort of see the homogenization of the politics in Iran because of Trump’s move.

BETWEEN THE LINES: One last quick question. If either Congress or Donald Trump abrogate this international nuclear agreement with Iran, what are the consequences for U.S. credibility in the world? And I’m thinking about any hope there might be for some kind of nuclear control agreement with North Korea? It’s hard to understand how a country would approach the United States with Donald Trump in the White House to sign onto such an agreement.

JAMAL ABDI: Yeah, and we’re sort of talking about pulling up a thread of all of our diplomatic tools here. I think some of the damage has already been done. Now there’s a question of, well, we’ll deal with one president, and then the next president – who knows who’s going be elected. And they apparently don’t feel that they are beholden to the agreements that the country signed previously. So I think that, especially, when we look at North Korea, where this is going to be a huge diplomatic undertaking if we’re going to able to solve that challenge peacefully.

And all this has done is just sap our credibility and sapped our leverage to be able to ask for anything now that we’re not a trustworthy actor. So I think it’s extremely damaging to diplomacy and it sort of puts the U.S. in the position of the only tool that you can actually view as credible is military force. And that’s a really dark prospect, I think, going forward – not just for this presidency but for administrations to come, potentially.

For more information, visit the National Iranian American Council website at niacouncil.org.

With Obamacare Subsidy Cut, Trump Will Raise Insurance Premiums, Reduce Coverage
Interview with Eagan Kemp, health care policy advocate with Public Citizen, conducted by Scott Harris

After several major attempts to repeal the Affordable Care Act, commonly known as Obamacare, President Trump issued two executive orders on Oct. 12 with the stated goal of dismantling his predecessor’s landmark healthcare legislative achievement. The first executive order asks the Labor Department to loosen rules that permit small companies to form associations and buy the kind of coverage available to larger businesses. These plans would have lower standards and cover far fewer healthcare costs. The second executive order ends $9 billion in subsidies paid under the Obamacare program to reduce the cost of health insurance for low-income Americans. Ironically, nearly 70 percent of those benefiting from subsidies cut by the president live in states Trump won in the 2016 presidential election.

Taken together, Trump’s two executive orders will result in an increase in the number of Americans without health insurance, the erosion of health insurance standards, substantial increases in insurance premiums, market instability and increased expenses for the federal government. The day after the executive orders were issued, 18 U.S. states sued the president to stop him from ending the payment of Obamacare subsidies.

Meanwhile, Sen. Lamar Alexander, R-Tennessee, and Sen. Patty Murray, D-Washington, agreed in principle on a bill that would cover the subsidy payments for two years, but the fate of that legislation is uncertain at best. Between The Lines’ Scott Harris spoke with Eagan Kemp, health care policy advocate with Public Citizen and a former senior policy analyst at the U.S. Government Accountability Office. Here, he examines the impact of President Trump’s recent executive orders on the U.S. health care system.

EAGAN KEMP: Millions of Americans will experience either higher premiums or they may be scared away from getting coverage because there’s going to be some sticker shock even if their premiums might cover some of the cost changes.

BETWEEN THE LINES: Do we have an estimate of how many people could lose their health insurance over the course of the next year once these specific subsidies disappear?

EAGAN KEMP: We don’t have an exact estimate but there’s a potential of millions of folks losing their coverage. The other that Trump had said that he was hoping that this was do was to save money, but that we also know that’s not the case based on estimates from the Congressional Budget Office. Ultimately, even though they’re cutting these subsidies, it will cost the federal government nearly $200 billion over the next decade because the insurance companies are now going to need to charge higher premiums, but because of the way the law is structured, those increases will be covered by the federal government.

There will be around 1.5 to 2 million folks that are going to see direct increases that won’t be covered by the subsidies that they’re getting.

BETWEEN THE LINES: Now how about the association health plans. What kind of impact does the Trump executive order on the association health plans have on the overall insurance market?

EAGAN KEMP: That one’s pretty significant as well, and the implications there could be far-ranging. And the implications there could be far-ranging. So this particular executive order, it directs certain parts of the federal government to make new rules or regulations. And what’s scaring people is that the way it could be written it could allow companies to sell across state lines and so, something that we experienced before the Affordable Care Act was a race to the bottom in terms of insurance standards.

So there were companies offering junk plans that could be sold across state lines and that’s sort of the fear that it could go back to that. So things that often weren’t covered previously were maternity care, or mental health services or severe limitations on prescription drugs. And the real fear is that folks could end up thinking that they’re less, but what they’re paying for is a junk plan that won’t cover them when they get sick.

BETWEEN THE LINES: What are the wider societal ripple effects from having these plans that don’t really cover what they cover currently because of the ACA standards?

EAGAN KEMP: One of the benefits of the Affordable Care Act is a reduction in the amount of debt Americans are taking on due to medical expenses. Folks are able to get coverage earlier. They’re able to maintain coverage without the proper regulation, someone could think that they’re signing up for something good, and then once they get sick realize that they have to bear all that expense, which may mean taking on medical debt. It may mean declaring bankruptcy.

BETWEEN THE LINES: As I’ve been reading about these changes, one of the warnings that has been written about by a lot of commentators in those inside the health insurance industry, is a general concern about what they call destabilization of the health insurance marketplace – which means you might have more health insurance companies pulling out of the Obamacare exchanges. But the effects could go further than that, I’ve been reading. Tell us what your concerns are about the stability of the marketplace.

EAGAN KEMP: Some states they had their insurance companies provide two sets of rate increases. And so some states, insurers said, “We expect to raise it 8 to 10 percent” and then if the state asked them for the second set, it might have been 20 to 30 percent. And that’s a big difference. And all of a sudden, if you’re an insurer you’re about to start opening your market and start recruiting folks, so now you’re having to have these much higher premiums. So anyone looking on any sort of state exchange or federal exchange, they’re seeing some really high prices and they might step away. And if there’s less folks enrolling, that means that the folks that are left who may be sicker, are going to be facing even high premiums over time. And that’s one of the real concerns about sort of the destabilization – you’d have insurance companies with these junk plans cherry-picking the healthy people out of the market, which are just going to leave sick folks in the actual ACA-regulated plans, meaning they’re going to be paying outrageous sums and just may not be solvent. An insurance company can’t only be insuring the sickest folks.

BETWEEN THE LINES: Eagan, what do we know about public opinion on Obamacare, whether to repeal, replace this kind of direct sabotage that we see from the White House? Do know how Americans, by and large, feel Congress and the White House should be moving in terms of improving the health care system of the country?

EAGAN KEMP: One thing we’re seeing is that throughout the repeal and replace efforts, the Affordable Care Act has only gotten more popular. We’re seeing the majority of Americans of approving of what the Affordable Care Act does and wanting it to get continued. It’s a very small amount of Americans that want it repealed or repealed and replaced. Americans are realizing the importance that the Affordable Care Act has meant for them. And I think that’s only going to continue, especially if Americans continue to see higher premiums and polling also indicates that Trump doesn’t think he’s going to get blamed for this – he’s said that again and again that – but the polls don’t say that. The polls indicate that the Congress and Trump will be held accountable for the sabotage.

Citizen.org.

Trump Guts Obamacare Birth Control Mandate in Another Blow to Reproductive Rights
Interview with Laurie Sobel, associate director of women’s health policy at the Kaiser Family Foundation, conducted by Melinda Tuhus

In early October, the Trump administration announced a major rollback in coverage under the Affordable Care Act, which the Republican-dominated Congress has so far failed to repeal. Under the ACA, a suite of more than a dozen birth control options were required to be made available at no cost for women to choose the method best for them. That element of Obamacare was immediately challenged in court based on the argument that employers should not be forced to provide birth control if they objected based on their religious beliefs. A convoluted system was later devised to respond to those concerns, which allowed women to receive the birth control insurance coverage they needed.

According to the latest regulation issued by the Trump administration’s Department of Health and Human Services and the Department of Labor, the head of virtually any company can now decide that providing birth control coverage violates their religious beliefs or moral view, and deny female employees free birth control coverage. The regulation went into effect on Oct. 6.

Between The Lines’ Melinda Tuhus spoke with Laurie Sobel, associate director of women’s health policy at the Kaiser Family Foundation. She discusses how exemptions to the birth control mandate have grown over time, how the new rules change may affect women and how groups across the U.S. are fighting back.

LAURIE SOBEL: So, under the Obama administration, there were rules that were drafted to allow for religious employers to have an exemption, and that was limited to houses of worship, which had the effect of the women insured by those policies would not get contraceptive coverage.

Then there was a second category allowing for an accommodation, which allowed religiously affiliated non-profits, and then after the case of Hobby Lobby, closely held for-profits, to have an accommodation, which meant the employer had to notify someone – either their insurer or third party administrator or the government – that they had a religious objection to providing some or all contraceptive coverage and then the insurer was required to provide the coverage. So the effect on the people insured by those policies was that they still had full coverage for contraceptives with no cost sharing. It shifted who paid for the coverage.

BETWEEN THE LINES: But the Trump administration really blew a much bigger hole in the exemptions, right?

LAURIE SOBEL: Right. So now the exemption is expanded to everyone who previously had that accommodation, they can choose to stay with the accommodation or shift to an exemption, which has this impact that workers and their dependents would not have coverage anymore. So there was a group of non-profits in particular that had been litigating the accommodation, saying it didn’t go far enough to meet their needs in terms of their religious beliefs, that they felt they were complicit in providing that coverage if they had to notify someone who would then provide that coverage. So those non-profits that have litigated will likely opt for an exemption now, in addition the closely held for-profits can also opt for an exemption. That group of employers has not litigated the accommodation, but we don’t know to what extent they have been complying with the accommodation.

There’s a whole new group of employers that would now be eligible for the exemption, outside of those groups. So, in addition, any employer, regardless of whether they non-profit or for-profit, including publicly held companies, that have a religious objection to providing some or all contraceptive coverage, can be exempt. In addition, there’s a new category of employers that have a moral objection, and that’s open to any employer except publicly traded for-profits. So, all non-profits, and all for-profits that are not publicly traded can opt for an exemption based on a moral objection to some or all contraceptive coverage. There’s no definition of moral objection in the regulations.

BETWEEN THE LINES: So do the employers have to provide any kind of proof of their moral or religious opposition?

LAURIE SOBEL: There’s no proof that’s required.

BETWEEN THE LINES: Laurie Sobel, is there any way to figure out how many women could be impacted by these changes?

LAURIE SOBEL: No, we really don’t know. We certainly have no idea how many employers would take up a moral objection. There are numbers in the regulations that are really speculative; by regulations I mean the preamble before the regulations that the agencies wrote, that basically tried to figure out how many employers had litigated and based upon that how many would take the exemption as opposed to the accommodation and then trying to figure out how many employees each of those organization had. And the truth is, we really have no idea because this expands the categories so greatly that we don’t know which employers would take this up.

Certainly this is a big expansion of the exemption for this benefit, and it would be very hard to track how many women are affected because of the lack of notice that’s required to have this exemption, so there’d be no central place to know that employers notified their insurer or the government that they have a religious or moral objection. So it will become very difficult to track the number of women affected or the number of employers that have taken this on.

BETWEEN THE LINES: So these changes have already gone into effect, but what’s happening in the fight back?

LAURIE SOBEL: There’s active litigation going on already. The groups that I know about – I’m not entirely clear if they’ve all filed, but they’ve all announced they’re going to litigate – is the National Women’s Law Center, the ACLU, the Center for Reproductive Rights, the attorney general of California, and the attorney general of Massachusetts.

BETWEEN THE LINES: There’s a silver lining for women who live in states that guarantee more coverage than the federal government, right?

LAURIE SOBEL: There’s eight states that have their own laws that are at least as expansive as the ACA in terms of what’s required, so no cost sharing for coverage of contraceptive of all 18 methods; essentially it’s the ACA benefit required at the state level, and most of those states have a more narrowly defined exemption than is now in the federal law. So we know 61 percent of workers across the country that are covered; workers are insured by self-insured plans, and those aren’t regulated by the states. So that’s where the gap will be. So, if you’re an employer in California that has a moral objection and you have a self-insured plan, then you’re exempt from the federal law and you’re not covered by the state law.

This week’s summary of under-reported news

Compiled by Bob Nixon

The government of Indian Prime Minister Narendra Modi is waging an active campaign to discredit a new global estimate of modern slavery developed by the International Labor Organization, the International Organization for Migration and the Australia based Walk Free Foundation. The recently published reports estimate that 40 million people across the globe are victims of forced labor, forced marriage and human trafficking. The research found that over 60 percent of the victims of slavery live in the Asia-Pacific region. (“U.N. Denies India Singled Out Over Slavery Estimates,” Reuters, Oct. 6, 2017; “India Slammed for Slavery, We Need to Counter: IB to Govt,” Indian Express, Oct. 4, 2017)
Under intense pressure to end Chicago’s epidemic of violence, politicians and federal law enforcement agencies waged a new campaign against street level gun dealers. The new drive used paid informants who set up gun deals that entrapped numerous inner-city residents for selling guns. (“How Chicago Gets Its Guns,” ProPublica Illinois, Oct. 10, 2017)
Amid the fury of recent hurricanes Harvey, Irma and Maria, Louisiana had made substantial investments in coastal land protection. This includes developing a new coastal floodgate system of levees and locks to protect Terrebonne Parish from storm surges. It’s one of the costliest infrastructure projects made without the aid of US government funding. (“In Race against Rising Seas, Louisiana Scrambles to Save Dwindling Coast,” Christian Science Monitor, Aug. 3, 2017)


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