“Jeff Bezos, Warren Buffett and Jamie Dimon did not hire a big-thinking industry outsider to set up a conventional insurance system or haggle with doctors and hospitals over prices. Dr. Gawande was selected to fundamentally change how healthcare is structured, paid for and provided. He was hired to disrupt the industry, to make traditional health plans obsolete, and to create a bold new future for American healthcare…
So, what will the future of Dr. Gawande’s high-profile healthcare venture look like?..
Taking out the trash. It’s estimated that 25 percent of all U.S. healthcare spending (about $765 billion each year) is wasted…
Creating a checklist. Gawande earned national acclaim with his 2009 bestseller, The Checklist Manifesto, inspiring an entire industry to double down on evidence-based medicine…
Being human. In Being Mortal, Dr. Gawande shines an unflattering light on end-of-life care in America, revealing that treatment for our nation’s elderly is often expensive, ineffective and inhumane.
I predict the Bezos-Buffett-Dimon cooperative will become a for-profit company that sells its expertise to dozens, possibly hundreds, of large corporations, each of them eager to offer their employees better healthcare at a lower cost. And once smaller companies see 30 percent improvements in both quality and cost, they too will prefer the new model to the old. And when that happens, the traditional health insurers, hospitals and independent physicians who refuse to change will become obsolete. If you have any doubt, just ask the former CEOs of Kodak or Borders, or the current executives at Yellow Cab, or anyone who has faced the business end of disruptive innovation.
The good news for healthcare’s incumbents is that the change process will likely take five to 10 years to solidify. The bad news is that the clock just started ticking.” (A)

“Dr. Atul Gawande is best known as a surgeon and a writer, but it’s his experience running a Boston-based health research program that may be most relevant to his new role as chief executive of the health care venture spun out of Amazon, Berkshire Hathaway, and JPMorgan Chase.
Ariadne Labs, a partnership between a major Boston hospital and Harvard University, has since 2012 served as a testing ground for projects to improve the quality of health care around the world. The project’s track record, and how Gawande has run it, may be indicative of what’s in store for the company he’ll be heading up starting July 9.
A STAT examination of Ariadne’s work shows that Gawande and his team are willing to push ahead with bold ideas that have the potential to save patients’ lives but don’t always end up working as well as intended in the complex world of health care. It paints a picture of Gawande as a big thinker, ready to empower others and reluctant to micromanage.
“Our tools do work to improve the quality of care, but, in some cases, don’t achieve the result hoped for,” said Deborah O’Neil, director of communications for Ariadne. “We recognize there is more to do.”..
Many of Ariadne’s projects focus on checklists — chief among them, the “safe surgery” checklist, which has its roots in research that Gawande began before Ariadne’s official founding. He developed the checklist along with Berry, and in 2007 and 2008 they tested it in eight hospitals around the world.
The goals of the checklist are twofold, Berry said. “[It was] a conscious attempt to combine both process checks and prompts for team communication.”
At Aspen, Gawande said that checklists are a first step in moving health care from an individual to a team exercise.
Added Tsai, “You need to learn from both the successes and the failures … [and] I think it’s that level of nuance and transparency, which, I think, makes him unique.” (B)

“After interviews with leaders across the world of health care, STAT has identified five challenges Gawande will take on in his new role. Each one carries substantial risks and complications that range from the political, to the personal, to the professional and ethical:
1. Challenge: Controlling costs while improving quality
How: Leverage technology to inform patients, demand lower prices
Risk: Coming off as a corporate stooge, rather than a steward of better health
2. Challenge: Lowering hospital prices
How: Shift care to lower-cost settings, get more employers to join the effort
Risk: Alienating academic centers that dominate some markets
3. Challenge: Cutting out the middlemen
How: Create innovative business solutions that streamline health care’s supply chain
Risk: Alienating key stakeholders needed to access or serve customers
4. Challenge: Attacking chronic disease; and variations in care
How: Leverage technology to improve patient knowledge, contract with select providers
Risk: Changing patient behavior is the hardest thing to do in health care, and may prove costly
5. Challenge: Writing for the New Yorker while leading a national effort to reform health care
How: Carefully selecting subjects and avoiding conflicts
Risk: Compromising the progress of the new venture, or undermining his credibility as a journalist” (C)

“These accomplishments, while esteemed, are merely scratching the surface. Here are nine lesser known things about Dr. Gawande.
6. He tried (and failed) as a rock & roller. Dr. Gawande had a rock band that had many names, one of which was “Thousands of Breaded Shrimp,” he told Boston Magazine. Despite the “terrible” songs he wrote, his girlfriend Kathleen Hobson stayed with him. The two met at Stanford and married in 1992. Dr.
8. He is a recognized genius. Dr. Gawande was named a MacArthur genius in 2006, receiving a “no-strings attached” grant from the John D. and Catherine T. MacArthur Foundation for “extraordinary originality and dedication in their creative pursuits and a marked capacity for self-direction.”” (D)

“In one of his first actions as a CEO, Gawande is planning to travel across the country to meet with the employees he will serve through the health care venture being formed by Amazon, JPMorgan Chase, and Berkshire Hathaway.
Gawande intends to hold one-on-one meetings with a variety of employees who work for the sprawling companies, with the goal of understanding the breadth of their needs and the challenges they face in getting care, according to a person familiar with the plan. The expedition is set to take place in coming weeks and will be done without the involvement of the high-profile leaders of the three companies: Jeff Bezos, Jamie Dimon, and Warren Buffett.
The listening tour will put Gawande face to face with the enormity of his task: lowering costs and improving care for 1.2 million people whose incomes and health struggles are as diverse as their geography. The group includes fulfillment center workers and bank tellers, software engineers and store clerks. Berkshire Hathaway owns companies ranging from Duracell to GEICO to Acme Brick, with a workforce spread through factories, office towers, and shopping malls in rural and urban areas nationwide.” (E)

(A) Why Atul Gawande Will Soon Be The Most Feared CEO In Healthcare, by Robert Pearl, https://www.forbes.com/sites/robertpearl/2018/06/25/atul-gawande-ceo/#3a68e210369b
(B) Ariadne Labs: Atul Gawande’s testing ground for new ideas in health care, by Ike Swetlitz, https://www.statnews.com/2018/06/27/inside-ariadne-labs-atul-gawande-testing-ground/?utm_source=Sailthru&utm_medium=email&utm_campaign=Newsletter%20Weekly%20Roundup:%20Healthcare%20Dive%2006-30-2018&utm_term=Healthcare%20Dive%20Weekender
(C) As Atul Gawande steps into a risky health CEO role, here are five challenges he faces, by CASEY ROSS, https://www.statnews.com/2018/07/09/atul-gawande-health-ceo-risks/
(D) 9 lesser known things about Dr. Atul Gawande, by Emily Rappleye, https://www.beckershospitalreview.com/hospital-management-administration/9-lesser-known-things-about-atul-gawande.html
(E) CEO Gawande’s first task: a road trip to hear firsthand about workers’ health challenges, By CASEY ROSS, https://www.statnews.com/2018/07/19/atul-gawande-ceo-listening-tour/

“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

Prequels
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)

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