US Senator McCain opposes Obamacare repeal bill, a possible fatal blow

Sen. John McCain. (AP)
Updated 23 September 2017

US Senator McCain opposes Obamacare repeal bill, a possible fatal blow

WASHINGTON: US Senator John McCain said on Friday he opposes the latest Republican bill to dismantle Obamacare, dealing the measure what could be a fatal blow given the party’s slim Senate majority.
With several other Republicans still undecided on the measure, Senate Majority Leader Mitch McConnell said earlier this week he intended to bring it to the Senate floor for a vote next week, though he did not promise to do so.
A vote would set the stage for another dramatic Capitol Hill decision on the 2010 law that brought health insurance to millions of Americans and became former Democratic President Barack Obama’s signature domestic achievement.
For seven years, Republicans have hammered Obamacare as an unwarranted government intrusion into American health care. President Donald Trump made repealing Obamacare one of his top campaign promises in 2016. Democrats have fiercely defended it.
The announcement by McCain, a Republican who has often been at odds with Trump and who cast a crucial “no” vote in July that helped defeat an earlier Republican repeal bill, had the potential to up-end McConnell’s plans. McConnell’s office did not immediately respond to requests for comment.
“This is not going to be easy,” Vice President Mike Pence said in a speech in Indiana after McCain’s announcement, as he made it clear that Republicans should keep their campaign promise to repeal and replace Obamacare.
“President Trump and I are undeterred.” Pence added.
Republicans have only a narrow Senate majority and cannot afford to lose many votes on the bill. They are also on a tight timetable.
McConnell has been trying to schedule a vote on the bill by Sept. 30, the last day on which the bill could pass with only a simple majority of 51 votes in the Senate. A vote taken any later than that would have to garner at least 60 votes for passage.
Weeks after the humiliating defeat in July, when the Obamacare repeal fight seemed to be over, the current bill was introduced by Republican Senators Bill Cassidy and Lindsey Graham, a close friend of McCain’s, and seemed to gain momentum.

MCCAIN SAYS DETAILS ON IMPACT NEEDED
But McCain on Friday laid out his opposition in a statement: “I cannot in good conscience vote for the Graham-Cassidy proposal.” He said he took no pleasure in announcing his opposition and noted that the bill’s authors “are my dear friends.”
McCain complained about the rushed process Republicans used to push the bill forward. He said he would consider supporting a bill like it if it had emerged from extensive hearings, debate and amendment. “But that has not been the case,” he said.
McCain, who cast his “no” vote in July just days after being diagnosed with an aggressive brain cancer, said he could not support the bill without knowing how much it would cost, how it would affect insurance premiums and “how many people will be helped or hurt by it,” information that will not be available until the non-partisan Congressional Budget Office provides a full assessment at the end of September.
The Graham-Cassidy bill would take federal money spent on the Medicaid program for the poor and disabled, as well as subsidies to help Americans buy private insurance, and divvy it up to the states in block grants. Advocates say that would give states more discretion to manage their own health care schemes.
Although the CBO has not yet fully assessed the bill’s effects, independent analyzes indicate it would fundamentally redistribute federal health care money, generally with Republican-leaning states benefiting and Democratic-leaning states losing, largely because a majority of the states that opted to expand Medicaid under Obamacare were Democratic-leaning.
An Washington Post-ABC News opinion poll said Americans prefer Obamacare to the Graham-Cassidy alternative by 56 percent to 33 percent.
Graham said in a statement he was not giving up. “We press on,” he said.
Shares of US insurers gained after news that McCain would not support the bill. Insurers had fallen over the past week as investors worried about spending cuts.
Centene Corp. gained 1.6 percent to $92.22 while Molina Healthcare rose 4.5 percent to $65.32. Both specialize in government-funded health care.

WINNERS AND LOSERS AMONG STATES
State-by-state impacts from Graham-Cassidy would vary, the Axios news website reported on Friday, citing a study by the Centers for Medicare and Medicaid Services (CMS), the unit of the Department of Health and Human Services that oversees Medicaid and the Obamacare program.
The CMS study found that by 2026, Alaska would lose 38 percent of its federal funding for insurance subsidies and Medicaid; Arizona would lose 9 percent; Maine would gain 44 percent; Ohio would lose 18 percent; and West Virginia would lose 23 percent, Axios reported.
These states are home to senators who are under pressure on health care. Both of Alaska’s Republican senators, Lisa Murkowski and Dan Sullivan, are still on the fence over Graham-Cassidy.
The CMS had no immediate comment on the Axios report.
Besides McCain, Kentucky’s Rand Paul is the only other Republican senator who has publicly said he opposes the bill.
Maine’s Susan Collins said she was leaning against the bill, the Portland Press-Herald newspaper reported on Friday. Kansas’ Jerry Moran is also undecided.
No Democrats support the bill.
To pass Graham-Cassidy, the Republicans need at least 50 votes in the 100-seat Senate, which they control 52-48, with Pence casting a potential tie-breaking vote.
The insurance industry, hospitals, medical advocacy groups such as the American Medical Association, American Heart Association and American Cancer Society, the AARP advocacy group for the elderly and consumer activists oppose the bill.
The Center on Budget and Policy Priorities, a liberal think tank in Washington, estimated the bill would cause more than 30 million people to lose insurance.


Afghan capital’s air pollution may be even deadlier than war

Updated 13 November 2019

Afghan capital’s air pollution may be even deadlier than war

  • People are dying, not from the war, but the toxic air they breathe in
  • Research group State of Global Air says more than 26,000 deaths could be attributed due to the pollution

KABUL, Afghanistan: Yousuf fled with his family from his home in eastern Afghanistan eight years ago to escape the war, but he couldn’t escape tragedy. In the capital, Kabul, five of his children died, not from violence or bombings, but from air pollution, worsened by bitter cold and poverty.
At the camp for displaced people they live in, they and other families keep warm and cook by burning the garbage that surrounds them. One by one over the years, each of the children got chest infections and other maladies from the pollution and never made it to age seven, he told The Associated Press. The 60-year-old has nine surviving children.

Yusouf, who escaped war in eastern Afghanistan to safeguard his family, speaks during an interview in Kabul, Afghanistan. In the capital, Kabul, five of his children died, not from violence or bombings, but from air pollution, worsened by bitter cold and poverty. (AP/Rahmat Gul)

“We didn’t have enough money for the doctor and medicine ... I can barely feed my children,” said Yousuf, who works as a porter in a vegetable market earning barely a dollar a day. Like many Afghans he uses only one name.
Afghanistan’s pollution may be even deadlier than its war, now 18 years long.
There are no official statistics on how many Afghans die of pollution-related illnesses, but the research group State of Global Air said more than 26,000 deaths could be attributed to it in 2017. In contrast, 3,483 civilians were killed that year in the Afghan war, according to the United Nations.
Kabul, a city of some 6 million, has become one of the most polluted cities in the world — ranking in the top of the list among other polluted capitals such as India’s New Delhi or China’s Beijing. Decades of war have wrecked the city’s infrastructure and caused waves of displaced people.
On most days, a pall of smog and smoke lies over the city. Old vehicles pump toxins into the air, as do electrical generators using poor quality fuel. Coal, garbage, plastic and rubber are burned by poor people at home, as well as at the many brick kilns, public baths and bakeries. Many apartment buildings have no proper sanitation system, and garbage is piled on roadsides and sidewalks.
The large majority of victims are poisoned by the air in their own homes, as families burn whatever they can to keep warm in Kabul’s winters, with frequent sub-zero temperatures and snow. Children and elderly are particularly vulnerable. At least 19,400 of the 2017 deaths were attributable to household pollution, which also contributed to a loss of two years and two months of life expectancy at birth, according to the State of Global Air survey.

Old vehicles are pumping poisonous fumes into the air. (AFP)

Yousuf’s camp, home to more than a hundred families, has no proper water or sanitation system and is surrounded by garbage dumps. His and other families’ children search through the garbage for paper, cloth, sticks or plastic, anything that can be burned for fuel.
“We are so poor, and we have lots of problems, we don’t have enough money for medicine, wood or coal for heating, so this is our life, my children collect garbage from dump yards and we use it for cooking and heating to keep the kids warm,” he added.
Decades of war have worsened the damage to Afghanistan’s environment and have made it a huge challenge to address them. Environmental issues are far down the list of priorities for a government struggling with basic security issues, rampant corruption and a plunging economy.
Three or four decades ago, “it was a wish for people to come to Kabul and breath this air,” said Ezatullah Sediqi, deputy director for the National Environmental Protection Agency. But in the wars since, “we lost all our urban infrastructure for water, electricity, public transportation, green areas, all these things,” he said.
Kabul’s environmental department has launched a new program to control old vehicles, one significant source of pollution.
“Fighting pollution is an important as fighting terrorism,” said Mohammad Kazim Humayoun, the department’s director.
Authorities warn that this winter is expected to be colder than usual and fear that will only increase the use of pollution-creating fuels to keep warm. The Kabul municipality has also called on residents to stop burning garbage for heat and instead use fuel.

The wife of Yousuf who fled from their home in eastern Afghanistan, burns plastic to make tea at a camp for displaced people, in Kabul, Afghanistan. (AP /Rahmat Gul)

“If everyone follows the instructions laid out by Kabul Municipality, the pollution could be controlled,” the municipality’s spokeswoman, Nargis Mohmand, said. But if not, “then we might live with this untreatable wound for years to come.”
But fuel is either too expensive or not available for many in Kabul. Electrical heaters are too pricey for most, and power outages are frequent.
Doctors at Kabul’s Indira Gandhi Children’s Hospital say they’ve seen the numbers of patients with pollution-related illnesses increase, though they could not give exact figures. In the winter, hundreds of children a day sometimes come in, suffering from respiratory illnesses, according to hospital officials.
Dr. Saifullah Abassin, a specialist trainer at the hospital, said his ward has a capacity of 10 patients but often has three times that number.
The government has launched an environmental awareness campaign. Ads on TV, programs at schools and universities and sermons at mosques talk about pollution’s harm to society and tell listeners about steps to reduce it.
But there are steps the state needs to take, like encouraging the planting of trees and creating green spaces, as well as implementing a city master plan to stop unplanned development around the capital, often a source of pollution because of their lack of services.
Sediqi, of the NEPA, said that ever since the first post-Taliban government was created in 2001, there was no planning on urban infrastructure, which left individuals to build on their own.
“Unfortunately, that led to unplanned development,” he said. “So now we have numerous urban problems and challenges and organizational challenges, which is causing the environmental pollution.”