Trump to halt subsidies to health insurers

US President Donald Trump plans to halt payments to insurers under the Obama-era health care law. (AFP)
Updated 13 October 2017
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Trump to halt subsidies to health insurers

WASHINGTON: In a brash move likely to roil insurance markets, President Donald Trump plans to halt payments to insurers under the Obama-era health care law that he has been trying to unravel for months.
Two people familiar with the decision described the plan late Thursday night, seeking anonymity because they were not authorized to speak publicly.
The White House said in a statement that the government cannot legally continue to pay the so-called cost sharing subsidies because they lack a formal authorization by Congress. The administration has been making the payments from month to month, even as Trump threated to cut them off to force Democrats to negotiate over health care.
The president’s action is likely to trigger a lawsuit from state attorneys general, who contend the subsidies to insurers are fully authorized by federal law, and the president’s position is reckless.
Word of Trump’s plan came on a day when the president had signed an executive order directing government agencies to design insurance plans that would offer lower premiums outside the requirements of President Barack Obama’s Affordable Care Act.
Frustrated over setbacks in Congress, Trump is wielding his executive to bring the “repeal and replace” debate to a head. He appears to be following through on his vow to punish Democrats and insurers after the failure of GOP health care legislation.
On Twitter, Trump has termed the payments to insurers a “bailout,” and administration officials have questioned their legal authorization. It’s unclear if the president will get Democrats to negotiate by stopping payment.
Experts have warned that cutting off the money would lead to a double-digit spike in premiums, on top of increases insurers already planned for next year. That would deliver another blow to markets around the country already fragile from insurers exiting and costs rising. Insurers, hospitals, doctors’ groups, state officials and the US Chamber of Commerce have urged the administration to keep paying.
Leading GOP lawmakers have also called for continuing the payments to insurers, at least temporarily, so constituents maintain access to health insurance. Senate Health, Education, Labor and Pensions Committee Chairman Lamar Alexander, R-Tennessee, is working on such legislation.
The so-called “cost-sharing” subsidies defray out-of-pocket expenses for people with low-to-modest incomes, and can reduce a deductible of $3,500 to a few hundred dollars. Assistance is available to consumers buying individual policies; people with employer coverage are unaffected by the dispute.
Nearly 3 in 5 HealthCare.gov customers qualify for help, an estimated 6 million people or more. The annual cost to the government is currently about $7 billion.
But the subsidies have been under a legal cloud because of a dispute over whether the Obama health care law properly approved the payments to insurers. Adding to the confusion, other parts of the Affordable Care Act clearly direct the government to reimburse the carriers.
For example, the ACA requires insurers to help low-income consumers with their copays and deductibles.
And the law also specifies that the government shall reimburse insurers for the cost-sharing assistance that they provide.
But there’s disagreement over whether the law properly provided a congressional “appropriation,” similar to an instruction to pay. The Constitution says the government shall not spend money unless Congress appropriates it.
House Republicans trying to thwart the ACA sued the Obama administration in federal court in Washington, arguing that the law lacked specific language appropriating the cost-sharing subsidies.
A district court judge agreed with House Republicans, and the case has been on hold before the US appeals court in Washington. Up to this point the Trump administration continued making the payments, as the Obama administration had done.
A panel of appellate judges recently ruled that a group of states can defend the legality of the subsidies if the Trump administration decides to stop paying.
While the legal issue seems arcane, the impact on consumers would be real.
Independent experts estimate that premiums for a standard “silver” plan will increase by about 19 percent without the subsidies. Insurers can recover the cost-sharing money by raising premiums, since those are also subsidized by the ACA, and there’s no legal question about their appropriation.
Consumers who receive tax credits under the ACA to pay their premiums would be shielded from those premium increases.
But millions of others buy individual health care policies without any financial assistance from the government and could face prohibitive increases. It’s also estimated that taxpayers would end up spending more.


Former UN chief and Nobel Peace Prize Laureate Kofi Annan has died

Updated 4 min 28 sec ago
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Former UN chief and Nobel Peace Prize Laureate Kofi Annan has died

  • His family said he died after a short unspecified illness
  • During his tenure, Annan presided over some of the worst failures and scandals at the world body

GENEVA: Kofi Annan, one of the world’s most celebrated diplomats and a charismatic symbol of the United Nations who rose through its ranks to become the first black African secretary-general, has died. He was 80.
His foundation announced his death in Switzerland on Saturday in a tweet , saying that he died after a short unspecified illness.
“Wherever there was suffering or need, he reached out and touched many people with his deep compassion and empathy,” the foundation said in a statement.
Annan spent virtually his entire career as an administrator in the United Nations. His aristocratic style, cool-tempered elegance and political savvy helped guide his ascent to become its seventh secretary-general, and the first hired from within. He served two terms from Jan. 1, 1997, to Dec. 31, 2006, capped nearly mid-way when he and the UN were jointly awarded the Nobel Peace Prize in 2001.
During his tenure, Annan presided over some of the worst failures and scandals at the world body, one of its most turbulent periods since its founding in 1945. Challenges from the outset forced him to spend much of his time struggling to restore its tarnished reputation.
His enduring moral prestige remained largely undented, however, both through charisma and by virtue of having negotiated with most of the powers in the world.
When he departed from the United Nations, he left behind a global organization far more aggressively engaged in peacekeeping and fighting poverty, setting the framework for the UN’s 21st-century response to mass atrocities and its emphasis on human rights and development.
“Kofi Annan was a guiding force for good,” current UN Secretary-General Antonio Guterres said. “It is with profound sadness that I learned of his passing. In many ways, Kofi Annan was the United Nations. He rose through the ranks to lead the organization into the new millennium with matchless dignity and determination.”
Even out of office, Annan never completely left the UN orbit. He returned in special roles, including as the UN-Arab League’s special envoy to Syria in 2012. He remained a powerful advocate for global causes through his eponymous foundation.
Annan took on the top UN post six years after the collapse of the Soviet Union and presided during a decade when the world united against terrorism after the Sept. 11 attacks — then divided deeply over the US-led war against Iraq. The US relationship tested him as a world diplomatic leader.
“I think that my darkest moment was the Iraq war, and the fact that we could not stop it,” Annan said in a February 2013 interview with TIME magazine to mark the publication of his memoir, “Interventions: A Life in War and Peace.”
“I worked very hard — I was working the phone, talking to leaders around the world. The US did not have the support in the Security Council,” Annan recalled in the videotaped interview posted on The Kofi Annan Foundation’s website.
“So they decided to go without the council. But I think the council was right in not sanctioning the war,” he said. “Could you imagine if the UN had endorsed the war in Iraq, what our reputation would be like? Although at that point, President (George W.) Bush said the UN was headed toward irrelevance, because we had not supported the war. But now we know better.”
Despite his well-honed diplomatic skills, Annan was never afraid to speak candidly. That didn’t always win him fans, particularly in the case of Bush’s administration, with whom Annan’s camp spent much time bickering. Much of his second term was spent at odds with the United States, the UN’s biggest contributor, as he tried to lean on the nation to pay almost $2 billion in arrears.
Kofi Atta Annan was born April 8, 1938, into an elite family in Kumasi, Ghana, the son of a provincial governor and grandson of two tribal chiefs.
He shared his middle name Atta — “twin” in Ghana’s Akan language — with a twin sister, Efua. He became fluent in English, French and several African languages, attending an elite boarding school and the University of Science and Technology in Kumasi. He finished his undergraduate work in economics at Macalester College in St. Paul, Minnesota, in 1961. From there he went to Geneva, where he began his graduate studies in international affairs and launched his UN career.
Annan married Titi Alakija, a Nigerian woman, in 1965, and they had a daughter, Ama, and a son, Kojo. He returned to the US in 1971 and earned a master’s degree at the Massachusetts Institute of Technology’s Sloan School of Management. The couple separated during the 1970s and, while working in Geneva, Annan met his second wife, Swedish lawyer Nane Lagergren. They married in 1984.
Annan worked for the UN Economic Commission for Africa in Ethiopia, its Emergency Force in Egypt, and the office of the High Commissioner for Refugees in Geneva, before taking a series of senior posts at UN headquarters in New York dealing with human resources, budget, finance, and staff security.
He also had special assignments. After Iraq invaded Kuwait in 1990, he facilitated the repatriation from Iraq of more than 900 international staff and other non-Iraqi nationals, and the release of western hostages in Iraq. He led the initial negotiations with Iraq for the sale of oil in exchange for humanitarian relief.
Just before becoming secretary-general, Annan served as UN peacekeeping chief and as special envoy to the former Yugoslavia, where he oversaw a transition in Bosnia from UN protective forces to NATO-led troops.
The UN peacekeeping operation faced two of its greatest failures during his tenure: the Rwanda genocide in 1994, and the massacre in the Bosnian town of Srebrenica in July 1995.
In both cases, the UN had deployed troops under Annan’s command, but they failed to save the lives of the civilians they were mandated to protect. Annan offered apologies, but ignored calls to resign by US Republican lawmakers. After became secretary-general, he called for UN reports on those two debacles — and they were highly critical of his management.
As secretary-general, Annan forged his experiences into a doctrine called the “Responsibility to Protect,” that countries accepted — at least in principle — to head off genocide, crimes against humanity, ethnic cleansing and war crimes.
Annan sought to strengthen the UN’s management, coherence and accountability, efforts that required huge investments in training and technology, a new whistleblower policy and financial disclosure requirements.
In 1998, he helped ease a transition to civilian rule in Nigeria and visited Iraq to try to resolve its impasse with the Security Council over compliance with weapons inspections and other matters. The effort helped avoid an outbreak of hostilities that seemed imminent at the time.
In 1999, he was deeply involved in the process by which East Timor gained independence from Indonesia, and started the “Global Compact” initiative that has grown into the world’s largest effort to promote corporate social responsibility.
Annan was chief architect of what became known as the Millennium Development Goals, and played a central role in creating the Global Fund to Fight AIDS, Tuberculosis and Malaria and the UN’s first counter-terrorism strategy.
Annan’s uncontested election to a second term was unprecedented, reflecting the overwhelming support he enjoyed from both rich and poor countries. Timothy Wirth, president of the United Nations Foundation, which disburses Ted Turner’s $1 billion pledge to UN causes, hailed “a saint-like sense about him.”
In 2005, Annan succeeded in establishing the Peacebuilding Commission and the Human Rights Council. But that year, the UN was facing almost daily attacks over allegations about corruption in the UN oil-for-food program in Iraq, bribery by UN purchasing officials and widespread sex abuse by UN peacekeepers — an issue that would only balloon in importance after he left office.
It emerged that Annan’s son, Kojo, had not disclosed payments he received from his employer, which had a $10 million-a-year contract to monitor humanitarian aid under the oil-for-food program. The company paid at least $300,000 to Kojo so he would not work for competitors after he left.
An independent report criticized the secretary-general for being too complacent, saying he should have done more to investigate matters even if he was not involved with the awarding of the contract.
World leaders agreed to create an internal UN ethics office, but a major overhaul of the UN’s outdated management practices and operating procedures was left to Annan’s successor, Ban Ki-moon.
Before leaving office, Annan helped secure a truce between Israel and Hezbollah in 2006, and mediated a settlement of a dispute between Cameroon and Nigeria over the Bakassi peninsula.
At a farewell news conference, Annan listed as top achievements the promotion of human rights, the fighting to close the gap between extreme poverty and immense wealth, and the UN campaign to fight infectious diseases like AIDS.
He never took disappointments and setbacks personally. And he kept his view that diplomacy should take place in private and not in the public forum.
In his memoir, Annan recognized the costs of taking on the world’s top diplomatic job, joking that “SG,” for secretary-general, also signified “scapegoat” around UN headquarters.
Former US ambassador to the United Nations Richard Holbrooke called Annan “an international rock star of diplomacy.”
After leaving his high-profile UN perch, Annan didn’t let up. In 2007, his Geneva-based foundation was created. That year he helped broker peace in Kenya, where election violence had killed over 1,000 people.
He also joined “The Elders,” an elite group of former leaders founded by Nelson Mandela, eventually succeeding Desmond Tutu as its chairman after a failed interlude trying to resolve Syria’s rising civil war.
As special envoy to Syria in 2012, Annan won international backing for a six-point plan for peace. The UN deployed a 300-member observer force to monitor a cease-fire, but peace never took hold and Annan was unable to surmount the bitter stalemate among Security Council powers. He resigned in frustration seven months into the job, as the civil war raged on.
Annan continued to crisscross the globe. In 2017, his foundation’s biggest projects included promotion of fair, peaceful elections; work with Myanmar’s government to improve life in troubled Rakhine state; and battling violent extremism by enlisting young people to help.
He also remained a vocal commentator on troubles like the refugee crisis; promoted good governance, anti-corruption measures and sustainable agriculture in Africa; and pushed efforts in the fight against illegal drug trafficking.
Annan retained connections to many international organizations. He was chancellor of the University of Ghana, a fellow at New York’s Columbia University, and professor at the Lee Kuan Yew School of Public Policy in Singapore.
In his memoir, Annan recognized the costs of taking on the world’s top diplomatic job, joking that “SG,” for secretary-general, also signified “scapegoat” around UN headquarters.
Annan is survived by his wife and three children. Funeral arrangement weren’t immediately announced.