March 18, 2018
Case Study on Disruption/Disintermediation in health care (10 posts)
“After months of speculation about when Amazon would officially enter the drug distribution market, the online retail giant offered a definitive answer on Thursday, announcing the acquisition of the online pharmacy PillPack.
The full-service pharmacy offers presorted packaging and home delivery and provides Amazon with a nationwide distribution network. PillPack holds mail order pharmacy licenses in all 50 states.” (A)
“It seems only natural for the Everything Store to be doing, well, everything. It is also a necessity.
Amazon.com AMZN 0.82% just gave the world a strong reminder of its ambitions. On Thursday, the company announced a new effort to beef up its own package-delivery network by recruiting small-business owners to operate fleets of Amazon-branded vehicles. On the same day, Amazon also announced its acquisition of online pharmacy PillPack for a reported $1 billion.
The latter move inserts Amazon squarely into the $400 billion U.S. prescription drug market. That is likely only part of the company’s health-care ambitions. Amazon is also working with Berkshire Hathaway and JPMorgan Chase on a new venture aiming to reimagine health-care delivery for their own employees, now collectively numbering close to 1.2 million.” (B)
“In the last 24 hours, Amazon announced a program that all but franchises its last-mile deliveries and bought the popular online pharmacy PillPack. At first glance, these may seem like utterly unrelated deals — another case of Jeff Bezos digging into his very deep pockets to reach even further into your life.
Step back, though, and you can see these two developments coming together to make dealing with a pharmacy as easy as thumbing your phone: Place your order and an Amazon-branded truck delivers your amoxicillin, along with tissues, all-natural cough drops and organic chicken noodle soup from Whole Foods.
Right now, going to the pharmacy can be a tough pill to swallow. Get your prescription, schlep to the drug store, wait in line. It’s even worse when you’re fevered and sneezing and generally feeling lousy. Bezos is betting you’d rather have those meds delivered to your door, along with everything else Amazon sells, in almost no time at all.
“This is going to have serious implications for the brick-and-mortar retail pharmacies,” said Arielle Trzcinski, a senior analyst at Forrester who covers health care and technology.” (C)
“E-commerce retail giant Amazon (Nasdaq: AMZN) is making waves into the health care space, but the company has also been building a means to service providers in a more traditional way.
Amazon Business, the retailer’s B2B service line, is shaping the supply chain process for health care providers by enabling them to order in a familiar way online. After launching Amazon Business three years ago, the platform has more than 1 million business customers that use it to order everything from office supplies to certain medical equipment.
While Amazon doesn’t break out its customer base by provider type, the business platform services home health care providers, doctors, nursing homes, skilled nursing facilities, ambulatory surgery centers and more.
“[We] offer [the service] to businesses of all sizes—single doctors and offices with five employees or a 10,000-employee system, and everything in between,” Chris Holt, global health care leader at Amazon Business, told Home Health Care News. “[We have] home health customers and nursing homes, that’s right in our mid-size sweet spot, where it’s a company that maybe doesn’t have huge purchasing power, a lot of employees and a consumes a lot of products.”” (D)
“Deep inside Amazon, a secretive group called Grand Challenge, led by the creator of Google Glass, is working on a series of bold projects involving cancer research, medical records and last-mile delivery, according to people familiar with the matter.
Similar to Alphabet’s experimental research lab, X (formerly Google X), Grand Challenge is a research team set up to explore ambitious new ventures that can eventually expand Amazon’s already wide footprint, said the people, who asked not to be named because the work is confidential.
The group, which also operates under the monikers 1492 and Amazon X, has added over 50 people since 2014, when Babak Parviz left Google X to head up the effort. The makeup of Parviz’s team illustrates how far out Amazon is going to pursue innovative projects, beyond its primary businesses of e-commerce, consumer devices and Amazon Web Services, while still using resources from those divisions for some of its initiatives…
One person with knowledge of Grand Challenge said the group gets to take a longer time horizon than teams that focus on commercial products. An internal job listing for Grand Challenge quotes astronomer Carl Sagan in the post: “Somewhere, something incredible is waiting to be known.” (E)
“Microsoft has been playing in the healthcare waters for some time now. Since wading into the wearables market in 2014, the company has teamed up with Twist BioScience on the capabilities of DNA digital data storage, partnered with UPMC to create innovative AI-enabled care delivery products and collaborated with Cigna to leverage Microsoft’s HoloLens technology for interactive game-based health screenings.
As healthcare’s digital transformation continues, many organizations are looking to the cloud to modernize their IT infrastructures, EHRs and data analytics capabilities to foster value-based care. Microsoft Healthcare stated it will draw on the company’s AI and the cloud expertise to create products that tackle those goals…
“We are taking concrete steps with an initial ‘blueprint’ intended to standardize the process for the compliant, privacy-preserving movement of a patient’s personal health information to the cloud and the automated tracking of its exposure to machine learning and data science, for example to support external audit,” Lee wrote.”” (F)
“Many eyes are watching the likes of Amazon, Apple, Google, Microsoft and other tech stalwarts for some kind of signal about their healthcare intentions. While some moves are already out in the open, such as Apple Health Records and Amazon Web Services expressing interest in longitudinal health records and analytics, the companies also have patents that potentially foretell the future.
As of Jan. 23, Amazon-owned 7,096 U.S. patents, according to the United States Patent and Trademark Office.
In addition, Amazon Technologies, Inc., had filed and published 870 patent applications in the U.S. as of Jan. 23, and Amazon.com, Inc., had filed and published 16 patent applications.
Amazon has been granted patents for thousands of inventions spanning one-click buying, drones, virtual-reality mirrors and Alexa, the company’s AI–powered voice assistant.
Google, for instance, – with 186 patents – focused mostly on investments for DeepMind, its artificial intelligence technology, and also on Verily, its healthcare and disease research entity among its 186 patents, according to the new Kalorama report.
Apple filed 54 patents to turn its iPhone into a medical device that can monitor biometric data such as blood pressure and body fat levels and to develop algorithms to predict abnormal heart rates. Microsoft filed 73 patents based on expanding its AI capabilities and developing monitoring devices for chronic diseases.
Microsoft, meanwhile, has a number of projects that are impacting – or will impact – the digital health arena including: Microsoft Genomics, Microsoft Azure Security and Compliance Blueprint. The tech giant is also expanding Microsoft’s Intelligent Network and plans to create an AI-focused network in cardiology.” (G)
“Apple has filed over 50 patents that will allow the iPhone to be used as a medical device to track patient health. Microsoft’s patents include expanding on its AI technology to help monitor chronic disease.
Microsoft also has other healthcare projects in the works including:
• Microsoft Genomics – Microsoft’s Azure provides researchers and clinicians with highly accelerated, cloud-powered genomic processing services
• Microsoft Azure Security and Compliance Blueprint: HIPAA/HITRUST – Health Data & AI – Microsoft’s availability of an end-to-end application development foundation to help health organizations move to the cloud efficiently and safely.
• Microsoft’s Intelligent Network – Microsoft is expanding its Microsoft Intelligent Network for Eyecare, now AI Network for Healthcare, to create an AI-focused network in cardiology.
• Microsoft 365 Huddle Solution Templates- Microsoft’s solution so that health teams can benefit from collaboration tools to drive quality and care outcomes.
• Project InnerEye – This will feature new integration with TeraRecon and Intuitive Surgical
• Project Empower MD – This is a research collaboration that will create a system that listens and learns what doctors say and do in situations.” (H)
“Amazon Business, the B2B purchasing arm of the e-commerce behemoth, is looking to disrupt the healthcare supply chain amid accelerating hospital operating expenses, flattening admissions and an increasing need to cut costs.
Under pressure to pare down unnecessary spending, supply chain professionals are increasingly rethinking traditional distribution and supplier models to gain a competitive advantage.
Some have turned to Amazon, whose shadow looms ever larger in the healthcare space. Much has been discussed concerning the Amazon-BerkshireHathaway-JPMorgan employee health cost endeavor (along with Amazon’s recent acquisition of PillPack) but one can’t ignore Amazon’s subtle foray into the supply chain sector.
Amazon Business provides a marketplace for medical supplies in a format very similar to its popular Amazon Prime service. The B2B purchasing venture has generated more than a billion dollars in sales its first year alone and introduced three business verticals last year — education, government and healthcare. Already, hundreds of thousands of medical products are available on Amazon Business, from hand sanitizer to biopsy forceps.
“The shopping experience feels the same, but in the background we’ve configured that organization’s procurement practices and policies,” Chris Holt, global healthcare leader at Amazon, told Healthcare Dive in an interview. “So, if they want to service particular suppliers in a given category or focus on diversity suppliers, women-owned businesses, quality-certified suppliers, they can search for things based on their own company-specific credentials, and that drives the algorithms that feed our search results.” (I)
“Here are five major inroads Microsoft has made in the healthcare industry during the past year:
Microsoft’s flagship healthcare initiative is Healthcare NExT, an effort the company launched in early 2017. The initiative serves as an umbrella program for various AI and cloud computing projects related to healthcare, such as an AI-chatbot the company rolled out at Milwaukee-based Aurora Health Care and Pittsburgh-based UPMC in December 2017…
A range of healthcare companies already use Microsoft’s cloud services. New Orleans-based Ochsner Health System is developing an AI platform to predict adverse patient outcomes using Epic’s machine learning capabilities and Azure, Microsoft’s cloud computing service. Health IT vendors like Allscripts and SnapMD also offer customers the option to purchase select platforms on Azure.
WannaCry hit healthcare organizations across the world, with the U.K. National Health Service canceling almost 20,000 appointments as a result of the ransomware attack. One year after the attack, the U.K. Department of Health and Social Care, which oversees the NHS, announced it had entered into a deal with Microsoft to improve the health service’s cybersecurity resilience.
Genomics and precision medicine..
In February, Microsoft launched a set of cloud-based processing tools for clinicians and scientists pursuing genomics research in the U.S., Western Europe and Southeast Asia. Microsoft developed the service, dubbed Microsoft Genomics, in partnership with Memphis, Tenn.-based St. Jude Children’s Research Hospital and DNAnexus, a genomic data management platform Microsoft has helped finance.
Microsoft on July 2 unveiled a project to expand broadband coverage in rural areas. For the project, Microsoft partnered with broadband wireless solutions provider Radwin to introduce internet solutions that leverage TV white spaces, or the unused spectrum between TV stations, to deliver internet connectivity to underserved communities. The partnership with Radwin is part of Microsoft’s Airband Initiative…” (J)
(A) Amazon’s acquisition of online pharmacy PillPack spooks retail drugstores, by Evan Sweeney, https://www.fiercehealthcare.com/tech/amazon-pillpack-drug-distribution-pharmaceuticals-walgreens-cvs
(B) Why Amazon Needs to Do Everything, by Dan Gallagher, https://www.wsj.com/articles/why-amazon-needs-to-do-everything-1530369827
(C) Amazon could radically change how you get prescriptions, by Kaya Yurieff, http://money.cnn.com/2018/06/28/technology/amazon-health-care/index.html
(D) Amazon Business Streamlines Supply Chain for Home Health, by Amy Baxter, https://homehealthcarenews.com/2018/06/amazon-business-streamlines-supply-chain-for-home-health/
(E) Inside Amazon’s Grand Challenge — a secretive lab working on cancer research and other ventures, by Michael S. Williamson, https://www.cnbc.com/2018/06/05/amazon-grand-challenge-moonshot-lab-google-glass-creator-babak-parviz.html
(F) Microsoft doubles down on healthcare with formal unit, new hires, by https://www.healthcaredive.com/news/microsoft-doubles-down-on-healthcare-with-formal-unit-new-hires/526719/
(G) Patents hold clues about Apple, Amazon, Google and Microsoft plans for healthcare, by Bernie Monegain, http://www.healthcareitnews.com/news/patents-hold-clues-about-apple-amazon-google-and-microsoft-plans-healthcare
(H) Microsoft, Apple, Google Secure HIT Infrastructure Patents, https://hitinfrastructure.com/news/microsoft-apple-google-secure-hit-infrastructure-patents
(I) Amazon Business’ medical supply chain ambitions: 4 things to know, by Rebecca Pifer, https://www.healthcaredive.com/news/amazon-business-medical-supply-chain-ambitions-4-things-to-know/526985/
(J) How Microsoft is shaking up healthcare, by Jessica Kim Cohen, https://www.beckershospitalreview.com/healthcare-information-technology/how-microsoft-is-shaking-up-healthcare.html
“The newly enacted right-to-try law allows drug makers to earn a profit by selling unproven therapies to desperate and dying patients. The FDA is powerless to stop it.
You’d think no drug maker would be dumb enough to actually try to make money this way, given prevailing public opinion that already views the drug industry as greedy, price-gouging profiteers.
But you’d be wrong. Enter BrainStorm Cell Therapeutics, which intends to start a “semi-commercial enterprise with modest profits” that would sell its experimental stem cell therapy to patients with amyotrophic lateral sclerosis, or ALS, according to a story from Bloomberg…
But the precedent that BrainStorm will set by turning what should be an altruistic act into a money-making venture is extremely dangerous and potentially exploitive. Unscrupulous drug companies will be incentivized to skip the traditional clinical trial and FDA review process altogether. Drugs no better than snake oil — but deemed safe — could be sold to desperate patients at a profit. The FDA would have no power to stop it from happening…
There’s little evidence that ALS patients, especially those with advanced disease, will benefit from NurOwn. In BrainStorm’s Phase 2 study, NurOwn was unable to slow the progression of ALS compared with a placebo. The company turned to a responder analysis to eke out a signal of efficacy, which it’s now trying to confirm in the Phase 3 study.
The idea that BrainStorm could make a profit from NurOwn before the treatment is proven effective and approved by the FDA is a bad look for the company and the entire pharmaceutical industry. It reeks of opportunism, even when couched in compassionate rhetoric.
Right-to-try should not be right-to-die-poorer, but that’s what the law will end up being for patients if profit motive takes hold.” (A)
The balance between investigational new drug access and protection of patients from therapies without established safety the FDA built during the past 20 years could be compromised by the new Right to Try law, a new study in JAMA Network Open suggests.
“To our knowledge, no studies have examined the timing and duration of drugs made available through expanded access programs to determine whether the program was serving its original purpose,” Jeremy Puthumana, MS, of the division of medical ethics at Yale School of Medicine, and colleagues wrote.
Researchers used ClinicalTrials.gov to locate investigational medicines made obtainable through expanded access and compassionate use programs prior to FDA approval and ascertained the start date of each program and several “key regulatory dates” — investigational new drug application activation, initial NDA submission and FDA approval — and timing and duration of expanded access availability in regard to NDA submission and FDA approval…
“For medicines that ultimately receive FDA approval, these findings suggest that the FDA and pharmaceutical industry have established a balance between investigational new drug access and protection of patients from therapies without established safety,” Puthumana and colleagues wrote.
“This balance may be compromised by policymakers seeking to speed access to investigational medicines through the Right to Try Act,” they added.
Despite more than 100 advocacy groups, including the American Lung Association and American Society of Clinical Oncology sending a letter to Congress strongly opposing the law, the bill passed both chambers. President Donald J. Trump signed Right to Try into law on May 30. An expert who spoke to Healio before the bill signing indicated the effect of the law on patients remained unclear.” (B)
“In essence,” says Klein, “patients and their doctors have had the ‘right to try’ investigational agents when all else fails and the company is willing to make the product available, for decades.”
For more than 30 years, people with serious diseases have had access to investigational drugs, vaccines, devices and biologics via the FDA’s expanded access pathway. Under the current program, which is also referred to as compassionate use, once a company agrees to provide an investigational product, the FDA and an institutional review board (IRB) must approve the product before it is administered to the patient. And the FDA retains the right to deny certain requests for drugs that it has not yet approved for safe use within the general population.
“Expanded access is really a ‘pathway,’ a regulatory process that permits companies to provide unapproved therapeutic agents to a patient if the company decides to do so. There are many reasons companies might say no. But the FDA allows more than 99 percent of requests to go forward. The small number of situations where the FDA doesn’t allow the expanded access use of the drug to proceed involves situations where there is a known risk that outweighs the potential benefit for the patient,” says Klein.
The expanded access program began in 1987 during the HIV/AIDS epidemic, when sick patients demanded that protocols be established for those not enrolled in a clinical trial who wanted to try potentially life-saving medications when nothing else was available.”..
Klein offers this scenario of how it works: “Suppose a patient came into the hospital late at night and had a stroke and the doctor thought a particular investigational drug was an appropriate option for this particular patient. The physician could contact the emergency call center, which would contact the medical officer on duty. They would review the case, ask a few pointed questions as necessary and provide an IND number by email or possibly over the phone. The IND allows the investigational product to be administered.” (C)
“Anyone with a smidgen of knowledge about healthcare understood that the right-to-try legislation signed by President Trump on Wednesday was a scam, perpetrated by the Koch brothers and their henchmen.
Masquerading as a “compassionate” measure aimed at providing victims of terminal diseases with a last bit of hope that an experimental treatment might save them, it really was aimed at undermining the authority of the Food and Drug Administration to make sure our drugs are safe and effective.
Among those who bought into this pretense out of sheer ignorance was Trump, who claimed the measure would save “hundreds of thousands” lives, which was just fantasy.
This law intends to diminish the FDA’s power over people’s lives, not increase it.
Now, the measure’s chief sponsor has pulled open the curtain, so that even laypeople can understand how horrible this law is. He’s Sen. Ron Johnson, R-Wisc. In a letter Thursday to FDA Commissioner Scott Gottlieb, who was critical of the law, Johnson wrote:
“This law intends to diminish the FDA’s power over people’s lives, not increase it.”
Apparently under the misbegotten impression that he was doing the public a favor, Johnson proceeded to underscore some of the more egregious provisions of his own bill. Among them is a prohibition against the FDA’s using clinical results from these last-chance treatments as the drugs continue through its regulatory process.
Put simply, if a drug is found not to work or even to be harmful in right-to-try cases — findings the FDA normally considers of paramount importance in judging a drug’s fitness for approval — the FDA can’t use those findings in the approval process.”
FDA Commissioner Gottlieb drew Johnson’s ire by suggesting, just prior to the bill’s passage, that his agency would have to promulgate guidance and regulations to balance the measure’s broadening of access to experimental drugs with “appropriate patient protections.”
Johnson made clear that he has no use for any additional patient protections. His bill, he wrote, “is not meant to grant FDA more power or enable the FDA to write new guidance, rules, or regulations.” (D)
“So what’s the catch? Did something just happen that everyone loves, and will save hundreds of thousands of lives?
If that were the case, of course, the bill would’ve passed long ago. In fact, many ethicists and doctors and patient advocates quite emphatically oppose it, as do former FDA commissioners. The American Society of Clinical Oncology is among nearly 40 health organizations that have publicly dragged the bill, saying it “could do more harm than good to seriously ill patients.” In a February letter to Congress, the groups reminded legislators that the current regulatory system for medical products was created as a result of serious harm and exploitation that occurred early in the 20th century: “Birth defects resulting from Thalidomide are an example of what happens when drugs are given to humans without proper safety review and approval.”
The legislation is a product of the conservative advocacy organization the Goldwater Institute, and backed by the Koch Brothers’ Americans for Prosperity. The name is cynical but effective. As Trump said on Wednesday, “‘Right to Try.’ It’s such a great name. Some bills, they don’t have a good name. Okay? They really don’t. But this is such a great name, from the first day I heard it. It’s so perfect.”
The name is certainly catchier than the existing name for the program that already does almost exactly the same thing—allowing people with serious diseases to obtain experimental medicines. It is known as expanded access, or more commonly, “compassionate use.”
The difference is that the current program operates through the Food and Drug Administration, which retains the ability to deny some requests for drugs it has not yet approved for use in the general population. The FDA reports that it already authorizes more than 99 percent of requests—so the upcoming change could be minimal. But the potential to exploit this lack of oversight is a risk. In the rare cases when access to unapproved drugs is denied, it can be because of serious concerns about risks on behalf of the pharmaceutical company, or because a physician has overlooked an obviously better alternative.
Under “right to try” this safeguard will be gone, and drugs can be usable after just phase one of clinical trials. As David Gorski, a cancer surgeon and professor at Wayne State University, wrote on Twitter this week, “Claiming phase I testing is enough to show that a drug is ‘safe’ enough for #RightToTry … is utterly insane, as anyone who’s ever had anything to do with clinical trials knows.” …
The goal should not be a right to try, but a right to have safe, effective, affordable drugs that do not drive people to medical bankruptcy. When we remain so far from that, there is no celebration in offering people untested substances and crossing our fingers and then claiming that we have improved the health-care system, much less that we have saved even one life.” (E)
(A) Here come the right-to-try profiteers. The FDA is powerless to stop them, Adam Feuerstein, https://www.statnews.com/2018/06/20/right-to-try-opportunism/?utm_source=STAT+Newsletters&utm_campaign=daf8644f20-DC_Diagnosis&utm_medium=email&utm_term=0_8cab1d7961-daf8644f20-149527969
(B) New study suggests ‘Right to Try’ may undo efforts on patient safety, by Janel Miller, https://www.healio.com/family-medicine/practice-management/news/online/%7B106cd5cf-fa34-4c42-93dc-441ac64d9461%7D/new-study-suggests-right-to-try-may-undo-efforts-on-patient-safety
(C) FDA’s Expanded Access Pre-dates Right to Try by Decades, https://health.howstuffworks.com/medicine/healthcare/fdas-pathway-to-experimental-drugs-pre-dates-right-to-try-by-decades.htm
(D) GOP senator reveals the truth: Right-to-try bill was a scam tailored to harm public health, by Michael Hiltzik, http://www.latimes.com/business/hiltzik/la-fi-hiltzik-right-to-try-20180604-story.html
(E) The Disingenuousness of ‘Right to Try’, by James Hamblin, https://www.theatlantic.com/health/archive/2018/06/right-to-try/561770/
“After failing to get a comprehensive Affordable Care Act repeal through Congress — you know, the place where laws are supposed to be made — and then winning a repeal of one of the law’s provisions in last year’s massive tax cut, the Trump administration now asks a judge to undo the rest of the law through the courts.
This is a brazen act of executive overreach. If it succeeds, it will endanger the coverage of thousands of sick Americans.
In federal court in Texas Thursday, where 20 states are suing to undo pieces of Obamacare, the Justice Department jumped in on the states’ side with a stunning argument…
It is one thing for states to claim in court that these interwoven pieces of the federal legislation should be invalidated. It is another and far more dangerous step for this administration to abandon, on the flimsiest rationale, a law duly passed by a previous Congress and signed by a previous President…
If the President gets his way, that’s just the early stage of a disease that’s about to get a whole lot deadlier.” (A)
“The Affordable Care Act, by contrast, has withstood numerous legal challenges in the eight years since it became law, including two at the Supreme Court. The current lawsuit against it hinges not on big questions of equality and justice, but on a technicality.
If that technicality were to carry the day, insurance companies could once again deny coverage, or charge much more for it, to people who have battled cancer, or are pregnant, or who have diabetes, or a heart condition, or arthritis. There’s no clear-cut definition of “pre-existing condition,” so this list goes on and on, affecting Americans of all political stripes. And even if the current law prevails in court, at least some damage will already have been done; uncertainty created by the Justice Department’s stance will almost certainly lead to higher premiums for Americans.
Add this latest move to a growing list of similar efforts — eliminating the mandate tax penalty to begin with, allowing more short-term plans on the market — and it becomes clear where the administration’s priorities lie: not in helping more Americans get good health care, not even in supporting the will of the people, but in dismantling what some political opponents built, just for the sake of doing so.” (B)
“In April, a group of conservatives put together guidance for another bid to overhaul the Affordable Care Act. The effort was and is being spearheaded by the Heritage Foundation and entails meetings with health-policy analysts to generate a consensus plan that would make it to the president’s desk. Those involved acknowledge the heavy lift, but the hope is that activists might pressure lawmakers to move before they potentially suffer losses in the midterm elections…
But for some directly involved with the plan, it’s vitally important to at least try to get something accomplished, precisely because, as it stands, Democrats are using Republican inaction on health care as an electoral cudgel.
“We need to have a plan that we can talk about as we go through the elections,” one source working on the initiative, requesting to speak on background, told The Daily Beast. “What it’s going to take is a political imperative to act. Republicans thought it was an existential crisis if they didn’t get tax reform done.”..
“‘Blame John McCain, then pivot to how great it is that the [individual mandate] is taken care of,’ is the president’s messaging strategy for this. Shift blame, show a win,” a senior Trump aide told The Daily Beast.” (C)
“For the first time since it became law in 2010, Obamacare is a political asset for Democrats heading into an election—a striking turn after several cycles in which the law’s unpopularity helped Republicans sweep into power in legislative races across the country. Still, Democrats face a challenge: President Trump’s attacks on Obamacare prompted a broad reassessment of its merits and hurt his party’s political standing. To successfully exploit the issue, Democrats have to find a way to cut through the din of Trump news and scandal coverage and convince voters they’ll defend the health-care law from ongoing GOP sabotage and repeal efforts…
Democratic strategists are convinced voters aren’t ignoring the assaults on Obamacare, even if press coverage has been dwarfed by Trump. “It’s the biggest disparity I’ve ever seen between what’s being covered on cable news and what candidates are actually running on in their home states: Medicare, Medicaid, the ACA, opioids,” Priorities USA’s Cecil says. That could change soon. Insurers have begun notifying states of their plans to increase premiums—some by double digits. Those rate hikes, set to take effect in October, could deliver voters a shock. “There’s a land mine waiting,” candidate Harder says. “That’s going to be an area where we’re going to have a pretty strong closing argument.”..
BOTTOM LINE – Democrats finally have something to sell with health care, which is the top issue for voters, according to a poll. The trick will be cutting through the noise to get voters’ attention.” (D)
“Conservative health care think tank scholars have published a new proposal to repeal and replace Obamacare, hoping that they can persuade Congress to take up the issue one more time before November. Can it succeed where prior efforts have failed?…
The Consensus Group proposal improves upon Graham-Cassidy by requiring that “at least 50% of the block grant goes toward supporting people’s purchase of private health coverage” in the individual insurance market. Under the new program, states would be required to offer Medicaid enrollees the opportunity to purchase “commercially available coverage” with their Medicaid dollars, and plans sold under the block grants would be exempted from costly Obamacare rules, like 3:1 age bands that double or triple the cost of insurance for young people…
It comes down to a tension among conservatives between those who most highly value individual rights, and those who most highly value states’ rights.
The states’ rights wing believes that the best policy outcomes can be achieved by consolidating control of taxpayer funds in the hands of state governments…
On the other hand, the individual-rights wing believes that central planning by state governments often leads to the same results as central planning by federal governments, and that true free-market reform involves helping individuals directly purchase the health insurance and health care services that best suit their needs…” (E)
“The first Sunday after his inauguration, New Jersey Gov. Phil Murphy signed an executive order directing state agencies to report everything they could do to ramp up the visibility of the Affordable Care Act and persuade more people to buy health coverage under the law.
Four months later, the Democratic governor signed into law a requirement that makes New Jersey the first state in a dozen years to compel most residents to carry insurance….
Several states are erecting barriers against rules the Trump administration is writing to promote short-term health plans that are comparatively inexpensive because they lack benefits and consumer protections guaranteed by the ACA. And some states, led by Democrats and Republicans alike, are trying to slow insurance rate increases through methods that Congress considered but did not pass.
“There are all these federal changes that are happening, and some states are pushing back on them and some states are taking advantage of them,” said Jason Levitis, a consultant who led the development of the ACA’s tax components at the Treasury Department during the Obama administration. “The most important and interesting health policy action is in states.” (F)
“Associate Justice Anthony Kennedy’s retirement from the Supreme Court may lead to big changes in constitutional law, some court-watchers say, but others are not so sure…
“This suit has a greater likelihood of attracting a majority,” he wrote in an email. “With a more reliable conservative, and Roberts having dug his own hole after basing the constitutionality of the ACA on the mandate being a tax — and the tax now having been repealed, that leaves the door open to a different decision in the Supreme Court.”
Indeed, “several of the recent decisions have been 5-4,” said Gail Wilensky, PhD, senior fellow at Project HOPE, in Bethesda, Maryland, in an email. “With a second Trump appointee, the conservative wing of the court will be clearly strengthened. However, as became clear in the [NFIB v. Sebelius] decision regarding the constitutionally of the ACA, predicting Supreme Court decisions is not always straightforward.” (G)
“The Trump administration’s decision to join a conservative lawsuit challenging some of the most popular parts of the Affordable Care Act continues to be the gift that keeps on giving, at least politically, for Democrats ― first in the midterms and now in the upcoming Supreme Court fight…
Democrats immediately went to town on the suit, blasting out ads and fundraising emails warning that the Trump administration wants to take away coverage for people with pre-existing conditions.
And now, Democrats say they plan to use the suit to their advantage when Trump picks his Supreme Court nominee, expected to be announced July 9.
The lawsuit, brought by 20 states led by Republicans, argues that the law’s protections were supposed to work in tandem with the mandate that individuals have health insurance. Because Congress is no longer enforcing the mandate, they say, insurers no longer have to sell policies to everyone regardless of medical status.
Democratic senators are assuredly going to question the nominee as to whether he or she supports Trump’s position on the lawsuit. Normally, nominees punt on these sorts of questions, arguing that the issue could come before them if they are confirmed to the court.” (H)
“Forget the Affordable Care Act: The future of our health care system will be shaped by a much bigger and broader fight — one that will likely culminate with a 2020 choice between private markets and an authentic government-run program in the form of a Bernie Sanders-style Medicare for All…
This is one of America’s great unsolved problems: We have the world’s best care, talent and innovation. But before it gets to patients, the magic goes through a hodgepodge of inexplicable, expensive and unnecessary hurdles.” (I)
“Trump administration highlights customers being ‘priced out’ of Obamacare. The health law is “increasingly failing” to cover people who don’t get the government to pay for premiums, according to the Trump administration. Twenty percent of people who don’t receive subsidies dropped their Obamacare coverage in 2017 due to increasing costs, show data from the Centers for Medicare and Medicaid Services, highlighting a trend that has been occurring since 2015. Between 2015 and 2016, unsubsidized enrollment fell in 23 states, with 10 states seeing double-digit declines. “As the Trump administration took office, there were warning signs that we were dealing with a crisis in the individual health insurance market and Obamacare was failing its consumers,” Seema Verma, CMS administrator, said in a statement. “These reports show that the high price plans on the individual market are unaffordable and forcing unsubsidized middle class consumers to drop coverage.”” (J)
“As health insurers across the country begin filing their proposed rates for 2019, one thing is clear: The market created by the Affordable Care Act shows no signs of imminent collapse in spite of the continuing threats by Republicans to destroy it.
In fact, while President Trump may insist that the law has been “essentially gutted,” the A.C.A. market appears to be more robust than ever, according to insurance executives and analysts. A few states are likely to see a steep spike in prices next year, but many are reporting much more modest increases. Insurers don’t appear to be abandoning markets altogether. In contrast to last year, regulators are not grappling with the prospect of so-called “bare” counties, where no carrier is willing to sell A.C.A. policies in a given area.
“The market is in a better position now than it has ever been since the exchanges have opened,” said Deep Banerjee, who follows insurers for S & P Global Ratings. The companies first began selling policies in the state exchanges, or marketplaces, five years ago. After years of losses, the insurers are now generally making money.” (K)
“Republicans could still repeal and replace ObamaCare if they are able to keep the House majority and gain seats in the Senate, Republican National Committee (RNC) spokeswoman Kayleigh McEnany told Hill TV’s “Rising” on Thursday.
McEnany specifically noted legislation proposed by GOP Sens. Lindsey Graham (S.C.) and Bill Cassidy (La.), which was defeated last fall.
“We were a big proponent of Graham-Cassidy. That, of course, was the Senate bill that gave the states the power and allowed each state to select what the best way forward was for them on health care,” McEnany told Hill TV’s Krystal Ball and Buck Sexton on “Rising.”
“That was one vote short, and if we maintain the House as we expect we will, pick up a few Senate seats, Graham-Cassidy can become a reality,” she said.” (L)
“The Trump administration on Saturday halted billions of dollars in payments to health insurers under the Obamacare healthcare law, saying that a recent federal court ruling prevents the money from being disbursed.
The Centers for Medicare and Medicaid Services, which administers programs under the Affordable Care Act, said the action affects $10.4 billion in risk adjustment payments.
President Donald Trump’s administration has used its regulatory powers to undermine Obamacare after the Republican-controlled Congress last year failed to repeal and replace the law. About 20 million Americans have received health insurance coverage through the program.
The payments are intended to help stabilize health insurance markets by compensating insurers that had sicker, more expensive enrollees in 2017. The government collects the money from health insurers with relatively healthy enrollees, who cost less to insure.
CMS, which is overseen by the U.S. Department of Health and Human Services, said the move was necessary because of a February ruling by a federal court in New Mexico, which found that the federal government was using an inaccurate formula for allocating the payments.” (M)
“Republicans could still repeal and replace ObamaCare if they are able to keep the House majority and gain seats in the Senate, Republican National Committee (RNC) spokeswoman Kayleigh McEnany told Hill TV’s “Rising” on Thursday.
McEnany specifically noted legislation proposed by GOP Sens. Lindsey Graham (S.C.) and Bill Cassidy (La.), which was defeated last fall.
“We were a big proponent of Graham-Cassidy. That, of course, was the Senate bill that gave the states the power and allowed each state to select what the best way forward was for them on health care,” McEnany told Hill TV’s Krystal Ball and Buck Sexton on “Rising.”
“That was one vote short, and if we maintain the House as we expect we will, pick up a few Senate seats, Graham-Cassidy can become a reality,” she said.” (N)
“The Trump-era attack on the Affordable Care Act has left the nation’s health system plagued with uncertainties: Will “Obamacare” insurance survive? Can independent hospitals make it? What’s next for doctors? And will patients ever really get “affordable” care?
But one certainty is prevailing: No matter what the outcome, it will be a bonanza for health-care consultants.
These fixers—the visionaries, the mercenaries and everyone in between—have been dramatically increasing their role in the economy since the Affordable Care Act was passed in 2010. A Modern Health Care Magazine survey of just 25 prominent national consultant firms found that revenue rose from $2.3 billion in 2008—the year before Obama took office—to $6.6 billion in 2014, the start of the ACA coverage expansion. Deloitte, for instance, which topped the list in 2014, saw its health-related revenue rise from $725 million to $2.2 billion in that time…
The reasons for the health care fixing frenzy are varied: Digitization forced doctors to abandon their bulging file folders in favor of computerized records. Obamacare expanded insurance coverage at a pace not seen since the creation of Medicare in 1965—and Trumpcare has begun to contract it. And doctors, hospitals, government and the private sector are all grappling with how to pay for medical care in ways that reward the quality, not quantity, in a system that may not really be the “best in the world,” but is certainly the most expensive…
THE ONLY THING that can compare to the rapid change of the Obama years is whatever’s next under Donald Trump’s administration—and that changes tweet by tweet. Repeal fervor has dissipated, and a more concrete anti-ACA framework is taking shape: repeal of the Obamacare mandate as part of the tax law, the emergence of skimpy health plans that will cost less than Obamacare but lack its comprehensive protections, and vast but still ill-defined “state flexibility” that has already generated a rash of lawsuits.” (O)
(A) Unhealthy and unwise: Trump undermines Obamacare, and the American people will suffer, http://www.nydailynews.com/opinion/ny-edit-unhealthy-and-unwise-20180608-story.html
(B) The Health Care Stalkers, https://www.nytimes.com/2018/06/11/opinion/the-health-care-stalkers.html
(C) A ‘Suicide’ Mission: White House and GOP Leadership Fear New Obamacare Repeal Push, https://www.thedailybeast.com/a-suicide-mission-white-house-and-gop-leadership-fear-new-obamacare-repeal-push
(D) The Dems Take Obamacare on the Road, by Joshua Green and SahilKapur, https://www.bloomberg.com/news/articles/2018-06-25/democrats-see-health-care-as-boon-not-burden-as-midterms-near
(E) Once More Into The Breach: Conservative Think Tankers Publish A New Obamacare Replacement,by Avok Roy, https://www.forbes.com/sites/theapothecary/2018/06/20/once-more-into-the-breach-conservative-think-tankers-publish-a-new-obamacare-replacement/#4492f4422c32
(F) States act on their own to fill holes Washington is knocking in Affordable Care Act, by Amy Goldstein, https://www.washingtonpost.com/national/health-science/states-act-on-their-own-to-fill-holes-washington-is-knocking-in-affordable-care-act/2018/07/01/15374aae-73f8-11e8-9780-b1dd6a09b549_story.html?noredirect=on&utm_term=.cdc891785d12
(G) How Will SCOTUS Roll on Healthcare Without Kennedy?, by Joyce Frieden, https://www.washingtonpost.com/national/health-science/states-act-on-their-own-to-fill-holes-washington-is-knocking-in-affordable-care-act/2018/07/01/15374aae-73f8-11e8-9780-b1dd6a09b549_story.html?noredirect=on&utm_term=.cdc891785d12
(H) Obamacare To Be Central To Democrats’ Fight Against Trump’s Supreme Court Pick, by Amanda Terkel, https://www.huffingtonpost.com/entry/obamacare-trump-supreme-court_us_5b3a7ab4e4b09e4a8b262965
(I) What’s next: The health care debate is no longer a linear fight over a straight repeal of President Obama’s health care law. Instead, it has metastasized into a multi-front war, Special report: The next health care wars, by David Nather, https://www.axios.com/health-care-wars-medicare-for-all-insurance-bernie-d91da849-6c0e-4cd0-8662-091cc51676a9.html
(J) Daily on Healthcare: Trump administration highlights customers being ‘priced out’ of Obamacare, by Philip Klein, by Kimberly Leonard, & Robert King, https://www.washingtonexaminer.com/daily-on-healthcare-trump-administration-highlights-customers-being-priced-out-of-obamacare
(K) Obamacare Is Proving Hard to Kill, by Reed Abelson, https://www.nytimes.com/2018/07/03/health/obamacare-insurance-rates.html
(L) RNC spokeswoman: ObamaCare repeal possible if GOP keeps House, by Julia Manchester, http://thehill.com/hilltv/rising/395574-rnc-obamacare-repeal-possible-if-gop-keeps-house
(M) Trump administration halts billions in insurance payments under Obamacare, https://www.cnbc.com/2018/07/07/reuters-america-trump-administration-halts-billions-in-insurance-payments-under-obamacare.html
(N) RNC spokeswoman: ObamaCare repeal possible if GOP keeps House, by Julia Manchester, http://thehill.com/hilltv/rising/395574-rnc-obamacare-repeal-possible-if-gop-keeps-house
(O) The one big winner of the Obamacare wars, by JOANNE KENEN, https://www.politico.com/agenda/story/2018/07/07/affordable-care-act-health-consulting-000680
From REPEAL & REPLACE to WRECK & REJOICE (from Obamacare to Trumpcare) (April 25th)
“This would appear to be Republicans’ last-ditch attempt (well, their latest last-ditch attempt) to repeal Obamacare.” (June 7th)
“A migrant mother said her 14-month-old son was “full of dirt and lice” after being separated from his family for months by the Trump administration.
Olivia Caceras’s claims are included in a lawsuit against the Trump administration’s immigration policy separating families that was filed by 17 states and the District of Columbia, PBS News Hour reported Thursday.
Caceras’s testimony is one of many in the nearly 1,000-page court filing.
Caceras said she was separated from her son for roughly 12 weeks before they were reunited.
“He continued to cry when we got home and would hold on to my leg and would not let me go,” Caceras said in her testimony, as reported by PBS. “When I took off his clothes, he was full of dirt and lice.”
“It seems like they had not bathed him the 85 days he was away from us,” she added.” (A)
“The Trump administration asked a judge Friday for more time to reunite families who were separated at the border under its “zero-tolerance” policy to prosecute every person who enters the country illegally.
Hours before a hearing in San Diego, the Justice Department filed papers seeking an extension of the deadline, which is July 10 for all parents with children under 5 and July 26 to reunite everyone else.
The administration says federal law requires it to ensure that children are safe and that requires more time. Administration officials also say that they won’t be able to confirm a child’s parentage by the deadline if DNA testing is inconclusive. They will need more time to collect DNA samples or other evidence from parents who have been released from government custody.” (B)
“Government lawyers said Friday that they cannot locate the parents of 38 migrant children under the age of 5, as a federal judge indicated he is open to extending the deadline for reuniting nearly 3,000 children separated from their mothers and fathers while crossing the US-Mexico border.
In a status hearing with U.S. District Judge Dana Sabraw of the Southern District of California, who ordered the reunification, government lawyers said the Health and Human Services Department would only be able to reunify about half of approximately 100 children under the age of 5 by the court-ordered deadline of July 10.
For 19 children, their parents have been released from custody into the U.S. and their whereabouts are unknown. The parents of another 19 children have been deported.
“The way [a family separation] is put in the system is not in some aggregable form, so we can’t just run it all,” said Sarah Fabian, the Justice Department attorney representing the government before Sabraw.
Sabraw said he would agree to delay the deadline for reunifying the youngest children if the government could provide a master list of all children and the status of their parents. Sabraw ordered the administration to share a list of 101 children with the American Civil Liberties Union by Saturday afternoon.” (C)
“Records of the separated children are embarrassingly spotty, a Health and Human Services (HHS) spokesperson admitted on a July 5 call with press. HHS is charged with reuniting the children, who were originally separated and processed by agents from another federal agency, the Department of Homeland Security. Its own records must therefore be cross-checked with data from other sources, including records from Immigrations and Customs Enforcement (which reports to DHS) and the Office of Refugee Resettlement (ORR).
Cross-referencing may not be enough, said the spokesperson. As the New York Times reported, hundreds of files have already been deleted by border patrol staff. HHS secretary Alex Azar has additionally “ordered a hand audit of the records of every single child in our care,” but that’s more than 12,000 children, only some of which came to the border with their families.
That’s right: The HHS needs to review thousands of case files by hand for clues to which children were taken from their parents—just the beginning of a process that would also require talking with case managers to verify information and then trying to locate their families. The task is so massive that the agency is asking staff to work overtime reviewing the records, according to the Times, which obtained an internal email stating that “[e]veryone here is now participating in this process, including the Secretary who personally stayed until past midnight to assist.” (D)
“How is President Donald Trump dealing with that crisis? By tweeting, of course.
Trump unleashed a trio of tweets Thursday morning — all dealing with immigration.
“Congress must pass smart, fast and reasonable Immigration Laws now,” he tweeted. “Law Enforcement at the Border is doing a great job, but the laws they are forced to work with are insane. When people, with or without children, enter our Country, they must be told to leave without our Country being forced to endure a long and costly trial. Tell the people ‘OUT,’ and they must leave, just as they would if they were standing on your front lawn. Hiring thousands of ‘judges’ does not work and is not acceptable – only Country in the World that does this!”
For good measure, Trump added: “Congress – FIX OUR INSANE IMMIGRATION LAWS NOW!”
What you may have noticed in Trump’s tweets is that there is a) no mention of the children already separated from their parents due to the Trump administration’s “zero-tolerance” policy and b) no clear directive to Congress about any sort of comprehensive immigration reform proposal aside from “FIX OUR INSANE IMMIGRATION LAWS NOW,” which is, um, sort of non-specific…
By July 26, all children separated from their parents at the border have to be reunited.” (E)
“Felicia Baez teaches English as a second language at a shelter in South Florida where anywhere from 30 to 100 migrant children in federal custody live at one time. Most stay about two months, but some leave after only a few days.
“It’s always like the first day of school,” Ms. Baez said of the turnover at the shelter, His House Children’s Home, in the suburb of Miami Gardens. And the wide range of academic ability among her students — some haven’t been in a classroom in years, while others graduated from high school in their home countries — means she is constantly making adjustments.
These are just some of the challenges of educating the thousands of migrant children now housed in youth shelters and family detention centers across the country.
Federal law requires that all children on American soil receive a free public education, regardless of their immigration status. As the Trump administration expands the number of people detained at the border, shelters and detention facilities are ramping up their roles as makeshift schools, teaching English and civics classes, offering cooking lessons and setting up field trips to art museums.
But according to lawyers and educators with firsthand knowledge of the child detention system, the education offered inside the facilities is uneven and, for some children, starkly inadequate.
Teachers at the schools are sometimes not state-certified as teachers, according to these accounts. Some shelter instructors cannot communicate effectively in Spanish, and in other cases the curriculum is so limited and classes are so wide-ranging in age groups that students seem bored and disengaged.” (F)
(A) Lawsuit: Migrant child returned to parent with lice after 85 day separation, by Morgan Gstalter, http://thehill.com/latino/395752-lawsuit-trump-dhs-returned-lice-ridden-migrant-child-after-85-days
(B) Trump Administration Wants More Time to Reunite Families Separated at the Border, http://time.com/5332091/trump-reunify-families-extension/
(C) Trump admin lost track of parents of 38 young migrant children, by Julia Ainsley, https://www.nbcnews.com/politics/immigration/trump-admin-asks-more-time-reunite-kids-parents-separated-border-n889301
(D) The scramble to reunite immigrant kids with their families is a case study in poor project management, by Annalisa Merelli & Heather Timmons, https://qz.com/1322700/how-will-hhs-and-dhs-reunite-separated-immigrant-children-with-parents/
(E) Donald Trump has no answers for the border crisis. And things are about to get worse, by Chris Cillizza, https://www.cnn.com/2018/07/05/politics/immigration-separation-border-trump/index.html
(F) In a Migrant Shelter Classroom, ‘It’s Always Like the First Day of School’, by Dana Goldstein and Manny Fernandez, https://www.nytimes.com/2018/07/06/us/immigrants-shelters-schools-order.html
Nonetheless, that was the situation during a recent court hearing for a child represented by the Immigrant Defenders Law Center in Los Angeles…
Court hearings are beginning for the 2,000 or more children who have been separated from their parents under the federal policy of “zero tolerance” for illegal border crossings, the Tribune says. And those notices are highlighting the fact that unaccompanied minors don’t get court-appointed attorneys in immigration court—meaning that most of them won’t have any lawyer at all.
That situation is not new, as the Tribune notes. By federal law, nobody gets a public defender in immigration court, because being removable from the United States is not a crime. That’s true even if the immigrant is a young child, despite immigrant advocates’ efforts to change that. As a result, minors separated from their parents must either find a lawyer on their own or represent themselves.
That’s an extraordinarily difficult task, advocates for the children say. Typically, parents seeking asylum—as the vast majority of the people subject to the “zero tolerance” policy are—are tried with any children they entered with, and therefore can explain the circumstances that led them to flee their home countries. Those facts often concern physical and sexual violence, because the Central American countries from which the immigrants come are effectively controlled by criminal gangs.
As a result, Toczylowski says, the parents often have kept the facts from children too young to understand them. This puts the children “in a disadvantageous position to defend themselves,” she told the Texas Tribune.” (A)
“Unaccompanied immigrant children face many challenges navigating the immigration system alone, including:
No right to court-appointed counsel. Unless they can afford attorneys or secure pro bono counsel, they appear in court without legal representation.
A confusing and complex court system. Deportation proceedings against children often begin in the jurisdiction where the child is placed in the custody of the Department of Health and Human Services (HHS) Office of Refugee Resettlement (ORR). Once a child is released from an ORR shelter to a sponsor or to foster care, it is the child’s responsibility – regardless of age or legal representation – to submit paperwork to inform the court that he or she has moved and to file a formal motion to change venue if the new address is under the jurisdiction of a different court. If a child does not properly update his or her address, he or she could be ordered deported in absentia for failing to appear in court.” (B)
:As many as 3,000 migrant children remain in government custody after being separated from their parents at the border, more than a week after a court ordered the Trump administration to reunite families, Health and Human Services Secretary Alex Azar said Thursday.
The Trump administration is currently in the process of reuniting families, in part by using DNA tests to confirm whether they are related. But the government has yet to return children to their parents in immigration custody, Azar said. He said the administration will meet the order to reunite families.
That means the families split up under President Donald Trump are only being reunited if the parent agrees to deportation or if the child was released to another relative in the U.S.
The Trump administration began a zero tolerance policy earlier this year to prosecute as many illegal border crossings as possible. That has included detaining parents separately from their children while they undergo brief criminal proceedings.
About 100 children under the age of 5 have been identified as potentially separated from parents, out of a total of as many as 3,000 kids, Azar said.
Azar said the administration will use “every minute of every day” to confirm the parentage of children and to make sure they have a suitable caretaker. He said the court order limits the government’s ability to do its typical screening process.” (C)
“Health and Human Services Secretary Alex Azar said Thursday that officials are racing against a federal judge’s “extreme” deadlines to reunite “under 3,000” migrant children separated from their parents at the U.S. border.
Azar did not provide a precise number of children who have been separated from their parents under the Trump administration, but he said hundreds of government employees are working to verify that information, including through DNA testing. The children are being held in shelters overseen by HHS. Their parents are in federal immigration jails.
Azar signaled that, once reunited, the families will likely remain together in the Department of Homeland Security’s custody to await asylum interviews or deportation hearings.” (D)
“Immigration advocates on Thursday criticized the Trump administration’s plan to conduct genetic testing on migrant children and parents separated as a result of its “zero tolerance” policy, saying the move is invasive and raises concerns over what the government might do with the biological data.
The federal government will be conducting the DNA tests — via a cheek swab — for every detained migrant child and then seeing if the DNA matches that of their purported parents, Cmdr. Jonathan White, assistant secretary for preparedness and response at the Department of Health and Human Services (HHS), said Thursday morning.
The move to collect DNA also raises serious concerns about consent for the children involved, said Jennifer Falcon, communications director for the immigrants rights group RAICES. “They’re essentially solving one civil rights issue with another — it’s a gross violation of human rights,” she said. “These are minors with no legal guardian to be able to advice on their legal right, not to mention they’re so young how can they consent to their personal information being used in this way?” “…
“To apply it categorically to an entire population of people who have been separated by the government — that is a new addition to what the Trump administration is doing to immigration law enforcement,” (E)
(A) Immigrant children begin appearing in court without lawyers or parents, by Lorelei Laird, https://edwardkundahlsite.wordpress.com/2018/07/02/immigrant-children-begin-appearing-in-court-without-lawyers-or-parents/
(B) Unaccompanied Immigrant Children, http://www.immigrantjustice.org/issues/unaccompanied-immigrant-children
(C) (C)As Many As 3,000 Migrant Kids Haven’t Been Reunited With Parents, Elise Foley, https://www.msn.com/en-us/news/politics/as-many-as-3000-migrant-kids-havent-been-reunited-with-parents/ar-AAzDgYJ
(D) HHS Secretary says Trump administration rushing to reunite separated migrant families, by Maria Sacchetti, https://www.sfgate.com/news/article/HHS-secretary-says-Trump-administration-rushing-13051774.php
(E) DNA tests for separated families slammed by immigration advocates, by Daniella Silva, https://www.msn.com/en-us/news/us/dna-tests-for-separated-families-slammed-by-immigration-advocates/ar-AAzDCkx
Though the HHS and DHS have bungled the reunification effort beyond comprehension, the blame ultimately lies with the Trump White House. Officials were well aware that the “zero tolerance” policy would result in family separation, but no consideration was given as to how to reunite parents with their children. Federal agencies tasked with cleaning up the mess caused by the administration’s recklessness have been overwhelmed and underprepared. The system at the border wasn’t designed to hold unaccompanied toddlers in custody, and no apparatus was put in place for reuniting scared children with parents who may have been deported, may have been released into the United States or may still be in custody.” (A)
“The government’s top health official could barely conceal his discomfort.
As Health and Human Services secretary, Alex Azar was responsible for caring for migrant children taken from their parents at the border. Now a Democratic senator was asking him at a hearing whether his agency had a role in designing the Trump administration’s “zero tolerance” policy that caused these separations.
The answer was no.
“We deal with the children once they’re given to us,” responded Azar. “So we don’t — we are not the experts on immigration.”
Separating families while sidelining the agency responsible for caring for the children was only one example of a communication breakdown in the federal government that left immigrant children in limbo, parents in the dark about their whereabouts and enraged Americans across the country.
Today, the Trump administration is still dealing with the fallout: It’s still not clear how officials will implement the policy or comply with a court order requiring that families be reunited within 30 days.
Instead, the administration is hoping Congress will fix the mess, despite its recent failure to pass immigration legislation.
“We are happy to change the policy when Congress gives us the tools to do it. That’s what we’re asking for,” Marc Short, White House director of legislative affairs, said on MSNBC.” (B)
“Federal officials are struggling to reunite migrant children with their families despite a court deadline, and agencies do not have the resources or procedures to help thousands of children detained at the border back into the arms of their parents, according to a dozen current and former officials, advocates and experts.
With a July 10 deadline looming, staffers at the Office of Refugee Resettlement, the division within HHS that oversees the care of unaccompanied children, have received no instructions on how to proceed, the sources say.
“It’s been really difficult to start the reunification process because we just don’t have a lot of direction from leadership,” said one official at the refugee office, who spoke on the condition of anonymity. “That’s been slowing things up, because there’s just been a lot of confusion.”
U.S. District Court Judge Dana Sabraw ruled last week that the Trump administration had until July 10 to reunite migrant children under 5 with their parents, and until July 26 to reunite the rest. But the refugee office is still struggling to answer basic questions such as how many children in its custody were separated from their parents.” (C)
“One thing that has been the case for many, many years that is particularly problematic as it relates to reuniting families is that ICE tends to move people in its custody frequently. In the time that a parent is in ICE custody, he or she might be in four different facilities in very, very different parts of the country, moved with no warning, without having any sort of attorney that’s tracking their whereabouts. I am familiar with an attorney who was representing an ICE detainee who couldn’t locate their own client. This has been a common practice within ICE. I am trying to facilitate communication right now between a dad and his daughter. He has already been in a couple of different facilities and doesn’t have anyone that is representing him, and therefore his daughter, who is currently across the country from where he is located, hasn’t been able to get in touch with him. She has a caseworker through the Office of Refugee Resettlement who has called ICE multiples times, left ICE multiple messages, and nobody has called back.” (D)
“Relatives of migrant children who were separated from their parents at the US-Mexico border are being forced to cover huge airfare costs in order to be reunited…
But for a migrant child to leave one of these facilities, parents and other relatives are required to pay hundreds or even thousands of dollars to cover the one-way plane ticket and a return ticket for an adult escort, according to report from The New York Times.
Marlon Parada, a construction worker in California, was told by authorities his cousin’s 14 year-old-daughter, who was separated from her mother at the border, couldn’t travel by bus and instead he had to pay the $1,800 airfares from Houston to Los Angeles. “They notified me a day before her release,” Parada told The Times. “I had no choice.”..
But the recent separation of migrant families has meant parents are often still being held in detention. It is now falling to relatives, many who earn just a few hundred dollars a week, to use their savings or rely on donations to be able to have the children released into their custody…
Aside from airfares, The Times also reported that all family members who will live in the home of a migrant child are also being forced to provide fingerprints to Immigration and Customs Enforcement (ICE).” (E)
“After a court order to reunite more than 2,000 migrant children who were separated from their parents in May and June, the Trump administration has instructed immigration agents to give those parents two options: leave the country with your kids — or leave the country without them, according to a copy of a government form obtained by NBC News.
The new instructions to agents do not allow parents who were separated from their children under President Donald Trump’s “zero tolerance” policy to reunite with their children while they await a decision on asylum, a protection sought by thousands of migrant families fleeing violence in Central America.
Advocates say that even migrants who have already passed their initial asylum screenings are being presented with the form. “We are seeing cases where people who have passed credible fear interviews and have pending asylum claims are being given this form,” said Lee Gelernt, a lawyer with the American Civil Liberties Union who is leading a class action lawsuit for family reunification.” (F)
(A) Meanwhile, at the Border, Migrant Families Are Still Separated, by Ryan Bort, https://www.rollingstone.com/politics/politics-news/family-separation-stats-
(B)Trump administration agencies confused over border separations, by Jae C. Hong,https://www.nbcnews.com/health/health-news/trump-administration-agencies-confused-over-border-separations-n888276
(C) As deadline looms, Trump officials struggle to reunite migrant families, by TED HESSON and DAN DIAMOND, https://slate.com/news-and-politics/2018/07/child-separation-now-why-its-still-so-difficult-for-immigrant-families-to-be-reunited.html
(D) “This Entire System Is Designed to Make Things Impossible for Immigrants”, by ISAAC CHOTINER, https://slate.com/news-and-politics/2018/07/child-separation-now-why-its-still-so-difficult-for-immigrant-families-to-be-reunited.html
(E) Immigrant families are being forced to pay massive airfares to reunite with children separated by the Trump administration, by Tara Francis Chan,
(F) New Trump admin order for separated parents: Leave U.S. with kids or without them, by Julia Ainsley and Jacob Soboroff, https://www.nbcnews.com/politics/immigration/new-trump-admin-order-separated-parents-leave-u-s-kids-n888631
From 1967 to 1970, during the Vietnam War, I served first as a 2nd Lieutenant and Chief Administrative Officer of the 4th Casualty Staging Flight attached to Wilford Hall USAF Medical Center, Lackland AFB in San Antonio, Texas. We received combat casualties still in battlefield bandages, often within 24 hours of injury, and either admitted them to Wilford Hall or further transported them to hospitals near home.
Here’s what hospital care looked like during the Revolutionary War period.
“When the Revolutionary War began its actual skirmishes in 1776, early attempts to prepare for the medical needs related to War were made in the City of New York. During the spring and summer of 1776, Samuel Loudon was publishing his newspaper the New York Packet, in which he included numerous articles and announcements regarding the Continental Army. On July 29, for example, came the following announcement written by Thomas Carnes, Stewart and Quartermaster to the General Hospital of King’s College, New York. Anticipating an increase demand for medically trained staff, he filed the following request for volunteers:
“GENERAL HOSPITAL New-York, July 29, 1776 Wanted immediately in the General Hospital, a number of women who can be recommended for their honesty, to act in the capacity of nurses: and a number of faithful men for the same purpose…King’s College, New York” (A)
“One of the most famous surgeons, and the first, was Cornelius Osborn. He was recruited in the Spring of 1776 and had little training even as a physician. The Continental Congress was even concerned about the well-being of the troops and the militia. They passed several ordinances and helped establish the order for the several field Hospitals during the War. The hospitals served about 20,000 men in the fight. Each hospital was required for each surgery to have at least one physician or surgeon, and one assistant, which was usually and apprentice of some sort. Each hospitals staff numbers varied on how many wounded it served and the severity of the wounds….
Most of the deaths in the Revolutionary War were from infection and illness rather than actual combat. The common practice if a limb was badly infected of fractured was amputate it. Where most amputees died of gangrene a result of not properly cleaning instruments after surgeries. Only 35% of amputees actually survived surgery. There was no pain killers quite developed back then. So at most the patient were given alcohol and a stick to bite down on while the surgeon worked. Two assistant would hold him down, a good surgeon could perform the entire process in a mere 45 seconds, after which the patient usually went into shock and fainted. This allowed the surgeon to stich up the wound, and prepare for the next amputation. Another way they decided to clean wounds, disease, or infection was by applying mercury directly to the cut of injured space, and letting it run through the blood stream which usually resulted in death.” (B)
“To seek treatment for any serious ailment, a soldier would have had to go to a hospital of sorts. Military regiments had a surgeon on staff to care for the men, so the soldier’s first stop would be with the surgeon. During battles, the surgeon could be found in a makeshift or “flying” hospital that consisted of a tent, an operating table, and some medical equipment. If the surgeon could not treat the soldier, he might be sent to a hospital. Many regimental hospitals were in nearby houses, while general hospitals for more in-depth treatment were sometimes set up in barns, churches, or other public buildings. The conditions were often cramped, which resulted in the rapid spread of contagious illnesses and infections….
Woe to the soldier who required surgery after being wounded on the battlefield! The conditions in “flying” hospitals were deplorable. Not only was the operating room simply a table in a tent, but there was little thought given to keeping the table and tools clean. In fact, wounds were sometimes cleaned using plain water from a bucket, and the used water would be saved to clean out the next soldier’s wounds as well. (C)
Hospitalization was a serious problem during the American Revolutionary War. Plans were made quite early to care for the wounded and sick, but at the best they were meager and inadequate. However on April 11, 1777 Dr. William Shippen Jr., of Philadelphia was chosen Director General of all the military hospitals for the army. Consequently the reorganization of hospital conditions took place.
Four hospital districts were created: Easter, Northern, Southern and Middle. The wage scale was as follows: Director General’s pay $6.00 a day and 9 rations; District Deputy Director $5.00 a day and 6 rations; Senior Surgeon $4.00 a day and 6 rations; Junior Surgeon $2.00 and 4 rations; Surgeon mate $1.00 and 2 rations.
After the battle of Brandywine, September 11, 1777, hospitals were established at Bethlehem, Allentown, Easton and Ephrata. After the battle of Germantown, October 4, 1777, emergency hospitals were organized at Evansburg, Trappe, Falkner Swamp and Skippack. Hospitals at Litiz and Reading were also continued. By December 1777, new hospitals were opened at Rheimstown, Warwick and Shaeferstown. Yellow Springs (now Chester Springs) an important hospital was organized under the direction of Dr. Samuel Kennedy. At Lionville, Uwchlan Quaker Meeting House was also made a hospital for a time. Apothecary General Craigie’s shop, Carlisle, was the source of hospital drugs….
It seems there was carelessness in making necessary health reports, consequently Washington ordered on January 2, 1778: “Every Monday morning regimental surgeons are to make returns to the Surgeon Gen’l. or in his absence to one of the senior surgeions, present in camp or otherwise under the immediate care of the regimental surgeons specifying the mens names Comps. Regts. and diseases.” [Weedon’s Valley Forge Orderly Book, p. 175]
January 13, 1778. “The Flying Hospitals are to be 15 feet wide and 25 feet long in the clear and the story at least 9 feet high to be covered with boards or shingles only without any dirt, windows made on each side and a chimney at one end. Two such hospitals are to be made for each brigade at or near the center and if the ground permits of it not more than 100 yards distance from the brigade.” [Weedon’s Valley Forge Orderly Book, p. 191] The Commander-in-Chief always solicitous about the comfort of his soldiers issued the following order January 15, 1778: “The Qr. Mr. Genl. is positively ordered to provide straw for the use of the troops and the surgeons to see that the sick when they are removed to huts assigned for the hospital are plentifully supplied with this article.” [Weedon’s Valley Forge Orderly Book, pp. 192-199-204-216] “ (D)