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How the government shutdown might affect your health

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A government shutdown will have far-reaching effects for public health, including the nation’s response to the current, difficult flu season. It will also disrupt some federally supported health services, experts said Friday.

In all, the Department of Health and Human Services will send home — or furlough — about half of its employees, or nearly 41,000 people, according to an HHS shutdown contingency plan released Friday.

Here are some federal services and programs consumers might be wondering about:

CENTERS FOR DISEASE CONTROL AND PREVENTION
According to the HHS plan, the CDC will suspend its flu-tracking program. That’s bad timing, given the country is at the height of a particularly bad flu season, said Dr. Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine in Houston. Without the CDC’s updates, doctors could have a harder time diagnosing and treating patients quickly, he said.

Although states will still track flu cases, “they won’t be able to call CDC to verify samples or seek their expertise,” said Dr. Thomas Frieden, who was the director of the agency during the 2013 government shutdown.

A government shutdown will also affect the CDC’s involvement in key decisions about next year’s flu vaccine, which are scheduled to be made in coming weeks, said Dr. Arnold Monto, a professor of global public health at the University of Michigan.
Beyond the flu, the CDC will provide only “minimal support” to programs that investigate infectious-disease outbreaks. The Atlanta-based agency’s ability to test suspicious pathogens and maintain its 24-hour emergency operations center will be “significantly reduced,” according to the plan.

That could prevent the CDC from identifying clusters of symptoms and disease “that are the earliest indicators of outbreaks,” Frieden said.

NATIONAL INSTITUTES OF HEALTH
Although the NIH will continue to treat patients at its clinical center in Bethesda, Md., the agency will not enroll new patients in clinical trials — which many people with life-threatening illnesses see as their last hope.

Medicare
Beneficiaries will be largely unaffected by a shutdown, especially if it is short. Patients will continue to receive their insurance coverage, and Medicare will continue to process reimbursement payments to medical providers. But those checks could be delayed if the shutdown is prolonged.

MEDICAID
States already have their funding for Medicaid through the second quarter, so no shortfall in coverage for enrollees or payments to providers is expected. Enrolling new Medicaid applicants is a state function, so that process should not be affected.
States also handle much of the Children’s Health Insurance Program (CHIP), which provides coverage for lower-income children whose families earn too much to qualify for Medicaid. But federal funding for CHIP is running dry — its regular authorization expired on Oct. 1, and Congress has not agreed on a long-term funding solution. Federal officials announced Friday that the staff necessary to make payments to states running low on funds will continue to work during a shutdown.

COMMUNITY HEALTH CENTERS
According to the HHS plan, the Health Resources and Services Administration will continue to operate the nation’s 1,400 community health centers — clinics that serve about 27 million low-income people, providing preventive care, dentistry and other basic services. It will also continue the Maternal, Infant and Early Childhood Home Visiting Program, which targets low-income and at-risk families with house calls and lessons for healthy parenting. That program served about 160,000 families in fiscal year 2016.

But even those programs may not be at full speed. Funding for community health centers and the home visiting program was not renewed last fall — a casualty of Congress’ fight over the CHIP reauthorization — so, they are operating on left-over funds.

ACA PREMIUM SUBSIDIES
The shutdown will not affect some of the most politically charged health care programs, including ones created by the Affordable Care Act. Subsidies for people who get their health insurance through healthcare.gov or state marketplaces will not be affected, according to HHS.

VETERANS AFFAIRS
Staffing for the Department of Veterans Affairs will remain largely intact. “Even in the event that there is a shutdown, 95.5 percent of VA employees would come to work, and most aspects of VA’s operations would not be impacted,” said department press secretary Curtis Cashour in an email.

More than 99 percent of employees of the Veterans Health Administration, which runs the health care system, will continue working, according to the department’s contingency plan.

However, the Veterans Benefits Administration, responsible for overseeing benefits such as life insurance and disability checks, will face larger cutbacks. Over a third of its employees face furlough under a government shutdown.

FOOD AND DRUG ADMINISTRATION
In the short term, the crucial activities that protect consumers will get done, said Jill Hartzler Warner, who was the associate commissioner for special medical programs at the FDA during the 2013 shutdown.
Programs that are critical for the public safety will continue, as will positions paid for by user fees, including work under the Center for Tobacco Products, according to the HHS plan.

The hundreds of staff members who conduct sample analysis and review entry of products into the U.S. will continue to work. However, routine inspections and laboratory research will cease.

Warner, who left the agency in March 2017 and now works as an industry consultant, said grants for rare-disease drug development were determined in 2013 to not be necessary and were postponed.

NUTRITION SERVICES FOR SENIORS
The Administration for Community Living will not be able to fund federal senior nutrition programs during any shutdown, according to HHS officials. But it was not immediately clear how quickly clients would be affected.

A shutdown could delay federal reimbursements to independent Meals on Wheels programs, which serve more than 2.4 million seniors nationwide, according to Colleen Psomas, a spokeswoman for Meals on Wheels America. That could force programs to expand waiting lists for meals, reduce meals or delivery days, or suspend service, she said.

The magnitude of the effect could vary by the length of the shutdown and any final allocation. Some programs, however, could weather a shutdown, staffers said. In Portland, Ore., Meals on Wheel People spokeswoman Julie Piper Finley said meal delivery there will not be suspended. That agency receives about 35 percent of its funding through the Older Americans Act, but raises the rest of the money, ensuring that services are not disrupted.

Meanwhile, services connected to food and nutrition services for other needy populations are likely to keep operating with state partners who have funding through February and, in some cases, March, according to a Department of Agriculture spokesperson. Those programs include the Supplemental Nutrition Assistance Program, the Child Nutrition Programs and the Special Supplemental Nutrition Program for Women, Infants and Children.

FOOD SAFETY
The FDA’s food safety programs will cease, according to the HHS plan, but inspections conducted by Agriculture’s Food Safety and Inspection Service (FSIS) will continue.

Meat and poultry inspections are “such a critical, essential task, and the meat and poultry inspection acts require that inspectors be present continuously,” otherwise processing plants would have to close, said Brian Ronholm, former head of FSIS who now works for the law firm Arent Fox.

Ronholm added that many FSIS employees are “career folks” who have worked there through previous government shutdowns. “There was a lot of built-in knowledge of how to function during the [2013] shutdown,” he said, adding that this expertise would help the agency if there is another shutdown.

Source: https://www.nbcnews.com/health/health-news/how-government-shutdown-might-affect-your-health-n839516

 

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Analysis: Deval Patrick revives debate over ‘electability’

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deval patrick

Former Massachusetts Gov. Deval Patrick’s late entry into the presidential race offers Democrats a fresh — and perhaps last — chance to reassess who they think is the strongest candidate to take on President Donald Trump.

It adds to the now months-long debate within the Democratic Party over “electability” less than three months before the first votes are cast. For a party that prides itself on diversity, the answers so far have been consistent and, to some, frustrating — a top tier dominated by white candidates, only one of whom is a woman.

But Patrick’s campaign is a reminder of the divergent paths to victory for presidential hopefuls. White candidates must prove they can win over black voters. Blacks and other minority contenders, however, must show they can build white support.

That type of multiracial coalition has eluded virtually everyone in the race except Joe Biden, who — for now — has deep support among black voters in addition to working-class whites. Those who assess that backing as soft, however, see an opening for a moderate candidate like Patrick, a black governor who made history winning in a majority-white state.

That, some strategists say, differentiates Patrick from Sens. Kamala Harris of California and Cory Booker of New Jersey, the two other major black candidates whose past electoral success has come in more diverse states and who are lagging in the presidential polls.

“Kamala Harris and Cory Booker are well-funded, high-profile black candidates, but have not been able to rise during a cycle where appeals to black voters are central to who will be the eventual winner of the primary,” said Democratic strategist Joel Payne. He said the election will confront what stigma still exists with white voters toward black candidates in the post-Barack Obama era.

“We can make the assumption that Patrick will be the next black candidate to face this test, but his appeal is altogether different than Booker and Harris,” Payne said. “The Patrick candidacy is an appeal to moderation and to the center-left more than a direct appeal to black voters.”

In 2008, then-Sen. Obama was the lone black candidate in the Democratic primary field and didn’t begin to gain momentum until the final weeks before the Iowa caucuses, trailing Hillary Clinton and John Edwards for much of the contest. But Obama’s showing— winning an overwhelmingly white electorate — gave him momentum to convince black voters in South Carolina and across the Black Belt that he was viable.

Obama’s diverse coalition was a new blueprint in Democratic electoral mapmaking, earning him the party’s nomination and his history-making general election victory. Observers say it’s an electorate Democrats will have to replicate to win in 2020.

The trio of African Americans have taken different approaches in how they contend with the racial aspects of their candidacies.

Harris announced her candidacy on Martin Luther King Jr. Day and has unique status as an alumna of historically black Howard University, member of Alpha Kappa Alpha Sorority, and the lone black woman in the 2020 fray.

New Jersey Sen. Cory Booker announced during Black History Month. The former mayor of Newark touts his residency in an impoverished black neighborhood in the city but has also sought to cast himself as a bridge builder — pointing out his ties to a civil rights legacy that changed his family’s trajectory with intervention from progressive whites that helped him integrate his childhood neighborhood.

In a brief interview Friday, he encouraged voters to “pull the lens back on diversity.”

“We have women in this race, we have an openly gay person in this race, we have (a) biracial person in this race, African-Americans in this race,” he said. “It is an incredible moment in American history that our field is so diverse and that voters have such qualified folks to choose from.”

Patrick himself has made relatively few references to race since launching his campaign. But as he registered this week to appear on the ballot in the New Hampshire primary, he spoke of the “skepticism” he has experienced as a black man.

“He has demonstrated an ability to win over white voters in an overwhelmingly white state,” said Democratic strategist Doug Thornell. “The question is whether he has enough time, whether he can raise the money, and whether he can carve out a compelling narrative and identity that allows him to break through. That’s a lot to accomplish in two months, but it’s not crazy.”

His path would be a challenging one. Though Patrick is not a national name, he is fairly well-known in neighboring New Hampshire, where voters saw television ads for his gubernatorial campaigns.

A strong finish in the Granite State could provide momentum heading into South Carolina, disrupting the field and leaving no clear frontrunner heading into Super Tuesday, said Thornell.

“If you look at the African American candidates running, he might be the best positioned to pull that off,” Thornell said.

Patrick’s late entry is reminiscent of Gen. Wesley Clark’s 11th-hour bid in 2003. Clark was able to briefly break through after some among the electorate worried about then-Massachusetts Sen. John Kerry’s path to the nomination, or that former Vermont Gov. Howard Dean was too liberal.

As a prominent African American who can appeal to black and white voters, Patrick could appeal to soft Biden voters looking for an alternative to Booker or Harris, or who don’t like Sen. Elizabeth Warren or Sen. Bernie Sanders’ progressive agenda, said Democratic strategist Adrienne Elrod.

“He can create that ‘I’m more left than Biden, but not crazy like Warren/Sanders’ message,” Elrod said. “He could appeal to some of those voters who are on the fence and not satisfied with others in the field. He can say, ‘I can be your candidate.’”

— Errin Haines

 

Source www.amny.com

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White House beancounter defies Trump to tell impeachment inquiry about $400M in suspended Ukraine aid

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Ukraine Trump

A White House budget official defied President Trump and testified Saturday in the House impeachment inquiry about the controversial suspension of defense aid to Ukraine.

Mark Sandy, a career Office of Management and Budget official, told lawmakers that he raised questions about whether the decision by Trump acolytes to hold up $400 million in desperately needed military assistance violated laws mandating money allocated by Congress be spent, CNN reported.

The budget expert did not explain what reasons were given for the hold up in aid. He testified behind closed doors in a rare Saturday session as the impeachment investigation continues to deliver heavy blows to Trump.

Sandy acted on orders to put an initial hold on the aid in late July and the issue was later handed over to Trump political appointees.

The aid was already appropriated by Congress, meaning the White House would have had to offer a legally valid reason for withholding it.

It’s not known what explanation if any, was given for removing the suspension from Sandy’s purview.

Sandy’s testimony shone a harsh spotlight on Mick Mulvaney, who is both the OMB director and Trump’s acting chief of staff.

“Mulvaney not only has refused to testify, but actively worked to block others from complying with subpoenas,” said Rep. Adam Schiff (D-Cal.) in a statement. “(He also) refused to provide Congress with documents relating to Trump’s suspension of Congressionally approved military aid to Ukraine.

Mulvaney admitted that Trump imposed an improper “quid pro quo” on Ukraine at a disastrous press conference although he later sought to walk back his admission. He has refused to testify to the impeachment probe.

A key contention of impeachment advocates is that Trump suspended the aid so he could use it as leverage to force Ukraine into launching bogus investigation of Trump’s Democratic rivals.

In fact, the suspension of aid shocked Ukraine officials and reportedly led them to consider announcing the corruption probes to get the cash flowing again.

By that time, in early September, the intelligence whistleblower complaint had hit the headlines, forcing the White House to reinstate the aid without getting the investigations announcement that Trump wanted.

In a statement Saturday, Rep. Adam Schiff (D-Calif.), chair of the House Intelligence Committee, called out Mulvaney for refusing to testify.

“If Mulvaney had evidence that contradicted what we’ve already heard, he’d be eager to testify and provide documents. Instead, he’s hiding behind, and assisting in, Trump’s efforts to conceal the truth from the American people,” Schiff said.

Also on Saturday, impeachment investigators released the transcripts of depositions given by deputy assistant to the president Timothy Morrison, and Vice President Pence’s special adviser on Europe and Russia, Jennifer Williams.

In Morrison’s Oct. 31 deposition, he testified U.S. Ambassador to the E.U. Gordon Sondland told him he’d spoken with Ukrainian presidential aide Andriy Yermak about American military funding being conditioned on corruption investigations. “My concern was what Gordon was proposing about getting the Ukrainians pulled into our politics,” Morrison testified.

In Williams’ Nov. 7 deposition, she confirmed that Trump told Pence to not attend the Ukrainian President Volodymyr Zelenskiy’s inauguration in an apparent signal that he needed to pursue the corruption probes or be frozen out of the military aid.

“My understanding from my colleague—and, again, I wasn’t there for the conversation—was that the President asked the Vice President not to attend,” she testified.

Source www.nydailynews.com

By DAVE GOLDINER

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Social networks have been weaponized for the impeachment hearings

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facebook, instagram whatsapp also affected

Impeachment hearings got underway in the House of Representatives this week, as you likely noticed from the wall-to-wall coverage. The process involves the sort of high-stakes, highly partisan events that naturally dominate social feeds. What television was to impeachment in the 1970s and 1990s, Facebook and Twitter — and YouTube and maybe TikTok — will be to impeachment in 2019.

The hearings on President Donald Trump’s apparent attempted bribery of Ukraine won’t be the first time a president has had to contend with, or benefit from, a hyper-partisan media. Conservative talk radio and Fox News were in full swing when Bill Clinton was impeached in 1998, even if their rhetoric looks quaint by today’s standard. But the World Wide Web was in its infancy, and the world was then still innocent of algorithmically sorted news feeds, partisan bot armies, and state-sponsored meme warfare.

Not anymore. If the first day of hearings is any indication, social networks promise to play a powerful role in shaping the way that impeachment hearings are understood by Americans. They are also playing a powerful role in shaping the hearings themselves.

As Ryan Broderick documented at BuzzFeed, Republican lawmakers used their time during Wednesday’s hearing to promote discredited conspiracy theories that are popular on right-wing message boards:

There is one America that believes what was in former FBI director Robert Mueller’s report, that there was coordinated Russian interference in the 2016 presidential election, which helped the Trump campaign. But there is a second America that believes that in the summer of 2016, the Democratic National Committee colluded with Ukrainian nationals to frame the Trump campaign for collusion with Russia, implicating a Ukrainian American DNC contractor, Alexandra Chalupa, in the collusion and the California-based cybersecurity firm CrowdStrike in the subsequent cover-up.

This unfounded theory has been propped up by a 2017 Politico story; reporting from right-wing political commentator John Solomon published earlier this year in the Hill; Attorney General Bill Barr’s summer travels; the yearlong personal investigation into Ukraine conducted by Rudy Giuliani, a lawyer working for Trump; and coverage from Fox News and conservative news sites. All of that came into play during Wednesday’s hearing, sometimes implicitly and sometimes explicitly.

After Republican members of Congress promoted these various smokescreens, right-wing media universally dismissed the hearing — either as an absurd exercise led by clowns, or as an outrageous abuse of power. Brian Stelter described the atmosphere on cable news:

Here’s what else I heard: Wednesday’s hearing was a bust. It was all just hearsay. It was a “disaster” for the Democrats and a “great day” for the Republicans. Impeachment is “stupid.” Impeachment is “fake.” There’s nothing impeachable here. There’s no reason to hold hearings. This inquiry needs to stop right now.

The message was one-sided and overwhelming. Every host and practically every guest said the Republican tribe is winning and the Democrat tribe is losing. I’m sure the president loved watching every minute of it. That’s one of the reasons why this right-wing rhetoric matters so much — because it is reassuring and emboldening Trump.

Meanwhile, if you’re reading the New York Times or watching CNN, you’re getting the sense that the case against Trump is a slam dunk, with multiple people having heard the president directly pressure his ambassador to the European Union to pursue a bribery plot. As Ezra Klein wrote recently, this impeachment is “the easiest possible test case for can our system hold a president accountable.” And yet with something like 40 percent of the country living in an alternate media universe, the basic, actual facts of the case may never penetrate into their reality.

Of course, that fear was one of the best reasons for Democrats to initiate impeachment proceedings in the first place: Show people real witnesses answering important questions over a long enough period of time — train everyone’s eyes on the same set of facts — and maybe a greater consensus will emerge.

Time will tell if they succeed. In the meantime, impeachment has proven to be big business on Facebook — where politicians are taking out highly partisan ads consistent with their respective worldviews. Emily Stewart and Rani Molla have a thorough walkthrough of how impeachment is playing out on Facebook, with Trump and Sen. Elizabeth Warren using ads to fire up their base and build their donor rolls; Tom Steyer using impeachment as a signature issue to promote his presidential candidacy; and a spice company buying tens of thousands of dollars worth of pro-impeachment advertising because they spread farther on Facebook than non-impeachment ads, resulting in a better return on investment.

Much of the debate about whether Facebook should allow political advertising noted that it represents a small fraction of the company’s business. But as the Vox writers note, that doesn’t mean it’s an insignificant business:

Facebook itself has grown into a formidable political platform in recent years, with campaigns and outside groups spending $284 million on the platform during the midterm elections, according to a report by Tech for Campaigns, a nonprofit that helps political campaigns with digital tools. While that’s just a small share of Facebook’s overall ad revenue, it’s a growing chunk of what campaigns are spending to reach constituents.

As impeachment hearings intensify, it seems likely politicians’ spending on Facebook ads will increase. And a good number of those ads, like so much about impeachment in 2019, will seem to have been created in a parallel world. In many ways, they were.

 

 

read more theverge.com

By Casey Newton

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