Good news on health care

 It’s not obvious from the title, but the recently passed Inflation Reduction Act (IRA) is the biggest federal health care legislation in a dozen years, one that will directly benefit over one in four West Virginians.

For starters, the law permanently extends the Black Lung Excise Tax, which provides benefits for over 4,400 West Virginia families impacted by that terrible disease caused by breathing coal dust. Nationwide nearly 26,000 families will benefit, including over 18,000 primary beneficiaries and around 7,000 dependents. According to the Brookings Institution, Black Lung is most prevalent in central Appalachia, with 20.6 percent of miners affected. 

In the late 1960s, a historic grassroots movement spearheaded by West Virginia coal miners and supporters brought the issue to national attention and won federal legislation to establish the benefit, although its funding was in jeopardy in recent years until the bill was passed.

The IRA also extends Affordable Care Act (ACA) marketplace subsidies for three years for people who purchase insurance plans on the exchange, which will help around 23,000 West Virginians and over 14 million people nationwide.  

People who buy care through the ACA marketplace have traditionally been the hardest group to find health care since they aren’t covered by employer-based insurance and don’t qualify for public programs such as Medicare, Medicaid, Tri-Care, or VA benefits. Thanks largely to ACA subsidies and Medicaid expansion, the number of uninsured Americans reached an all time low of eight percent this summer: still too high but a big improvement.

The biggest impact of the bill will be on people receiving Medicare, which covers over 440,000 West Virginians and around 64 million Americans, although these changes will be rolled out over time. 

According to the Kaiser Family Foundation, in 2023 insulin will be capped at $35 a month on the Medicare Part D prescription drug program; drug companies have to offer rebates if prices increase above inflation; and cost sharing for adult vaccines under Part D and Medicaid will be eliminated.

The Medicare diabetes cap is a big deal, although a ruling by the senate parliamentarian blocked its application to private insurance. According to the American Academy of Family Physicians, which supported several IRA medical provisions, “More than 37 million Americans have diabetes, and an estimated one-quarter of people with diabetes in the United States ration their insulin due to costs. In 2021, U.S. diabetes deaths exceeded 100,000 for the second consecutive year.” The WV Department of Health and Human Resources estimates that 240,626 West Virginians have that disease with undiagnosed cases 65,210.

In 2024, the IRA caps Medicare premium increases to six percent a year through 2030; eliminates a part D co-pay for catastrophic coverage; and expands eligibility for the low-income Part D subsidy to 150 percent of the federal poverty level. In 2025, it caps drug costs for Medicare beneficiaries at $2,000 per year. And between 2026 and 2029, it will negotiate costs for an increasing number of expensive medicines each year.

While health care is only part of the IRA, which also addresses climate change and tax fairness, those are significant steps in the right direction and Senator Manchin was instrumental in sealing the deal. Of course, no legislation is perfect. Lots of West Virginians, myself included, worked hard on what would become the IRA for the last year or so. We didn’t get all we wanted and got some of what we didn’t, but there are still things to celebrate.

(This ran as an op-ed in the Charleston Gazette Mail last week.)

WV Climate Alliance on Inflation Reduction Act: "A good first step"

The WV Climate Alliance is composed of representatives of more than 20 state organizations (including AFSC) concerned about  the threat of climate change. The group released this statement to coincide with the signing of the bill into law.

Charleston, WV: The WV Climate Alliance has come together to release a joint statement in support of the Inflation Reduction Act as a “Good First Step”. Passage by the House Friday puts this historic legislation on president Biden’s desk for his signature. This legislation will now begin to move our nation forward in addressing our ever escalating Climate Crisis.

“We’d like to recognize Senator Manchin’s leadership for co-sponsoring this legislation,” said Gary Zuckett, Executive Director of WV Citizen Action Group, “and for his efforts to advance these reforms even in the face of total Republican opposition, outright lies broadcast 24-7 by dark money groups over social and regular media, and intense lobbying from Big Pharma, oil companies and other corporate special interests. In these tough times, West Virginians have been waiting long enough for these common-sense improvements.” 

"Once enacted, the Inflation Reduction Act of 2022 will help more West Virginians take control of where their energy comes from at a time when it’s needed most,” said Leah Barbor, West Virginia Program Director, Solar United Neighbors. “These clean energy investments will put us on track to reduce emissions, reduce energy bills, create good jobs and improve equity by expanding the opportunities to bring the benefits of solar to all West Virginians.”

“We want to thank Senator Manchin for ensuring the IRA passage. The IRA is truly a historical step forward,” said Lead West Virginia Veteran and Climate Justice Organizer Lakiesha Lloyd with Common Defense. “However, we must recognize that there is still much to do. We have a long way to go to ensure a renewable energy future where West Virginia veterans will not only survive but thrive. Thus, we’ll keep organizing–this bill is the step we need on our path to full climate justice.”  

“The Inflation Reduction Act is a once-in-a-lifetime opportunity to invest in climate solutions that will help protect West Virginia from the impacts of the climate crisis for generations to come. The WV Environmental Council (WVEC) thanks Senator Manchin for supporting this legislation. West Virginia now has a chance to fight climate change, create jobs and be a part of a clean energy future. WVEC is committed to continuing our advocacy for solutions that promote environmental protection across the state and advance environmental justice,” said Linda Frame, President of the West Virginia Environmental Council.

“We thank Senator Manchin for his support and leadership on the Inflation Reduction Act,” said Lucia Valentine, West Virginia Organizer of Moms Clean Air Force. “This historic investment in our future comes at a crucial time in Appalachia, as devastating floods remind us of the urgency to act for the safety of our children and for future generations. The Inflation Reduction Act puts us on a path to a cleaner, safer, and healthier future.”

“This legislation includes a permanent extension of the Black Lung Excise Tax – an unprecedented investment in the Black Lung Disability Trust Fund. This is a huge victory for every miner and mining family that is worried about how to pay for their bills and medication in light of the uncertainty around the Black Lung Disability Trust Fund. In West Virginia alone, 4,423 miners and their families are currently receiving federal black lung compensation. The Black Lung Disability Trust Fund provided $38 million in black lung compensation to West Virginia miners in 2021, or nearly 25% of the total funds disbursed nationally,” said Dana Kuhnline, Campaign Director for ReImagine Appalachia.

“The Inflation Reduction Act is an important measure towards ensuring the livability of our planet.  For West Virginians who have been fighting for just transitions, economic diversity, and growth, we believe this to be a giant step in the right direction”, stated Kathy Ferguson, Interim Executive Director with Our Future West Virginia. “However, we must acknowledge the trade-offs and we lament that the MVP will be bolstered at the expense of the IRA passage.  We will certainly keep pushing for Sen. Manchin to go further in ensuring that people are prioritized over profits and that all our communities are protected and environmentally sound.”

“The passage of the Inflation Reduction Act puts our nation on the pathway toward unprecedented greenhouse gas emissions reduction,” said Autumn Crowe, Program Director of the West Virginia Rivers Coalition. “While we celebrate this milestone, our work is not done. We recognize that some provisions within the IRA call for additional fossil fuel development which perpetuates the harm to frontline communities. We will continue to advocate for healthy communities and work toward 'net zero' greenhouse gas emissions.”

While the Climate Alliance is hopeful about this historic step forward in climate policy, much more is needed to be done. We will continue advocating for the advancement of climate solutions that focus on our three pillars of reform: climate justice for communities that have borne the brunt of our current fossil-fuel economy; a true transition for coal miners and other fossil fuel workers likely to be impacted by the transition to a low-carbon economy; and a significant reduction in greenhouse gasses in accordance with the findings of the UN Intergovernmental Panel on Climate Change.

________________

FOUNDED in 2020, the WEST VIRGINIA CLIMATE ALLIANCE is a broad-based coalition of almost 20 environmental organizations, faith-based, civil rights and civic organizations, and other groups with a focus on climate change. Members of the Alliance work together to provide science-based education on climate change to West Virginia citizens and policymakers. 

FOR MORE ON THE CLIMATE ALLIANCE, VISIT: WVClimateAlliance.org

A yo-yo year

 Lots of people I know, myself included, spent a lot of time over the last year trying to get something across the line in terms of a federal reconciliation bill. We started with high hopes and saw things go off the rails on more than one occasion. 

Now, a possible new bill could be voted on very soon, one largely negotiated by a certain senator from West Virginia who has been front and center throughout the process. Although there are plenty of things in the bill not to like, and some things we wanted didn't make it, this is the first major federal legislation to address climate change, while also preserving health care benefits for millions, reducing prescription drug prices, and fixing Black Lung funding.

I'm pleased and proud that this action alert in support of the legislation is at the top of the AFSC webpage.

The United Mine Workers union has also come out strong in support of the Inflation Reduction Act. The release reads in part:

“We are very pleased that Senator Joe Manchin (D-W.Va.) and Majority Leader Chuck Schumer (D-N.Y.) were able to come to an agreement on legislation that includes full and permanent funding of the excise tax that funds the Black Lung Disability Trust Fund. This will give victims of this insidious disease, their families and their survivors some peace of mind that the benefits they so desperately need will never be reduced.

“Senator Manchin never wavered in his commitment to secure the funding for this program, and he delivered. Thousands in the coalfields owe him yet another debt of gratitude, and the UMWA will never forget his dedication to getting this done.

“There is more to do regarding Black Lung, starting with the promulgation of a final rule to limit silica dust exposure in coal mines. We also must examine the entire Black Lung benefits system to make it more inclusive for victims, more efficient in the awarding of benefits, and to ensure its long-term viability in the face of a declining coal industry. The UMWA stands ready to meet with all stakeholders – victims and their families, labor, and industry – to work on solutions to these issues.

“We are also pleased to see that provisions were included in the IRA that will extend tax credits to renewable energy supply chain manufacturers that build plants in the coalfields, which will be a big step toward providing good jobs to these distressed communities. The enhanced tax credits for carbon capture and storage included in the legislation will also be a boon for coalfield jobs. We urge swift passage of this legislation by Congress.”

Now it looks like all eyes are on Senator Sinema. It's nice for once not to have to worry about someone from West Virginia breaking the deal. It would be nicer to finally get this one done.

Good news if the deal is sealed

 By now, I'm guessing most interested people have heard of the deal reportedly struck by Senators Schumer and Manchin on climate, prescription drugs, and health care. It was quite a reversal of fortune from the last two weeks.

Here's a brief statement in response penned by yours truly and AFSC DC colleague Peniel Ibe about the deal on Twitter:

Me:

Over the last year, many West Virginians worked hard to push a reconciliation bill across the line. While the outlines of the potential deal are not as bold as many hoped in addressing family economic security, we are optimistic and relieved to learn that an agreement on addressing climate change is within reach and appreciate protections for health care.  

Certain provisions in this bill will have tremendous benefits for the children and families in the Mountain State. Looking forward, we will continue to work with the Senator to ensure that components not included in the package, such as the Child Tax Credit, are enacted to provide even more support for West Virginia’s families and children.  

Peniel:

The existence of this bill is a testament to the commitment for advocates across the country to delivering much needed relief for our communities.  

The wins are hard fought, delivering on provisions to lower health care costs, reduce the deficit, tax wealthy corporations, and invest in some clean energy projects and the environment.  

But the losses are just as painful. As negotiations stalled, critical investments included in the initial package were cut, sacrificial compromises were made, and countless people lost out. The bill currently includes some counterproductive provisions that further entrench the use of fossil fuels into our society- disregarding the intensity of the climate crisis and calls from front line communities.  

Yet this plan to begin to address the needs in our communities’ wellbeing is still at risk of being cut to a point beyond meaningful impact. We call on all Senators to focus on delivering relief now as there is more to do. We have waited too long and we must no longer leave our communities needs unaddressed.  

Today, many people across the U.S. struggle to make ends meet—especially amid soaring costs of housing, groceries, and other goods. We must continue to call for massive investments in a robust care infrastructure, including monthly Child Tax Credit payments, paid family/medical leave, closing the Medicaid coverage gap and more. 

This is the only way to build vibrant communities. 

I'm still nervous and will be until the deal is actually sealed, but this was welcome news in tough times. 

 

Talking addiction

Here's the latest edition of The Front Porch podcast by way of WV Public Broadcasting. This week we talked about West Virginia's heroin/opioid/prescription drug problem and some possible solutions. 

A reluctant revolutionary

Like some of history's best revolutionaries, Charles Darwin was a reluctant one. He disliked controversy and delayed publishing his main ideas for years until he was nudged into action when the younger scientist Alfred Russel Wallace came up independently with the idea of natural selection.

Although he was ignorant of contemporary developments in the science of heredity-- such as the experiments of Gregor Mendel--and grasped for an explanation of its mechanism, his key ideas of natural selection have stood the test of time. His later work on the similarity of emotions in humans and animals was also ahead of its time and has received significant backup from studies of human and animal brains as well as behavior.

It's another discouraging sign of the times that many Americans deny evolution, which is regarded by scientists as the unifying theory of biology. These are often the same people who deny the science of climate change. I could probably think of any number of snarky Darwinian comments about that but will spare the Gentle Reader.

JUST FINES. Massey Energy led the coal industry in fines and citations in the last quarter, the Charleston Gazette reports.

WHAT DOES THIS MEAN? Progressive billionaire George Soros' hedge fund just increased its ownership of Massey stock to 2.2 million shares.

MEDICINE CABINET BLUES. It looks like El Cabrero's beloved state of West Virginia is the most medicated in the country.

OUR FAMILY TREE. Mitochondrial DNA research suggests a common mother for humanity around 200,000 years ago.

URGENT ANCIENT TURTLE UPDATE here.

GOAT ROPE ADVISORY LEVEL: ELEVATED

When the time comes

Timing is everything.

Lately the theme here is public policy and how it gets made--or doesn't. I've been bouncing off some of the research of political scientist John Kingdon's very useful book Agendas, Alternatives, and Public Policies. Although this book was written in the 1980s about federal legislation, it rings pretty true today even at the state level.

If you are interested in this kind of thing, you can get in touch with your inner policy wonk by clicking on earlier entries.

As mentioned earlier, Kingdon refers to wonks as policy entrepreneurs, who are people willing to put time and effort into developing ideas for how laws and programs could work.

Let's say a given wonk or group of wonks develops a really good policy idea. As the saying goes, that and a couple of bucks will buy you coffee in most places unless you like the fancy kind. It's important in this early stage to get the idea out there to as wide an audience as possible--and especially the audience that pays attention to such things and can help make them happen. He calls this process "softening up," a term that brings artillery barrages to mind.

As he put it,

Who are policy entrepreneurs trying to soften up? Some of the time, they speak of educating the general public. Presidential speeches, for instance, are used to "bring the public along," in the words of one bureaucrat...

A second target is a more specialized public, peculiar to a particular issue.. As with the general public, the purpose of the softening up is to insure that the relevant public is ready for a certain type of proposal when the time does come...

I think the key words are "when the time does come." I've frequently written here about the similarity of this kind of work to my martial arts hobby. As much as one might like to, you can't usually kick someone in the head (in a friendly way) just because you want to; you can only do it when an opening exists.

In my experience as in Kingdon's analysis, it takes a long period of preparation to be able to move quickly to get something done when this happens. But without an opening or a window, it probably won't happen. That's what makes it interesting.

NOTHING BUT SHAME. Here's E.J. Dionne on dirty deeds done dirt cheap (to coin a phrase) in the US Senate. And here's the way the prospects for health care reform looks now.

EASY MONEY. Economist Dean Baker calls for a tax on financial speculation here.

FREE MEDS. 270,000 West Virginians may be eligible for free prescription drugs under the WVRx program.

GOAT ROPE ADVISORY LEVEL: ELEVATED

GROWING UP BIBLICAL

Caption: This man likes to dress up for church.

This week's Goat Rope involves musing on biblical themes among many other things and was inspired in part by recent surveys that suggest many Americans--even those who claim to believe every word literally--are biblically illiterate.

But first, there is a vicious rumor out there that El Cabrero would like to put to rest.

The rumor is this: that Episcopalians don't read the Bible. That is like sooo not true. We do...in case we're ever on Jeopardy.

I actually (now) consider myself lucky to have been dragged to Episcopal services throughout my childhood by my Maternal Unit in part because it really steeps you in biblical literature. In general, Anglicans of our variety don't take it literally (as a biology, geology, or astronomy textbook, for example) but do take it seriously.

A typical service involves at least four readings, including a psalm and another reading from the Hebrew Bible (the Christian Old Testament), one from the gospels, and one from the other New Testament writings. A lot of the rest of the liturgy is also drawn from biblical texts.

As a result, I wound up as a kid involuntarily memorizing sections of psalms, canticles, and other passages. There was no way not to.

I noticed something strange in the inevitable religious discussions with other kids. While some viewed the Bible almost superstitiously as a magical oracle, they had little idea of how it went aside from a few "proof texts."

(Proof texting is a vile habit that has probably done as much as anything else to promote biblical illiteracy.)

One thing I got out of all that was the lifelong habit of reading it, regardless of how my religious opinions morphed or occasionally disappeared over time. It's some of the best time I ever spent.

When it comes to religion, El Cabrero's mind is kind of like an AM car radio driving on mountain roads; sometimes you pick up a signal and other times it's just static, although I seem to have would up pretty much where I started.

Question for you, Gentle Reader. What role has the Bible, positively or negatively/by its presence or by its absence, played in your life?

IT'S HOW THEY'RE COUNTED, as we like to say about votes in El Cabrero's beloved state of West Virginia. In this case, however, we're talking about poverty. This editorial from the New York Times is about more accurate measurements than the old federal poverty level:

According to the Census Bureau, nearly 37 million Americans — 12.6 percent of the population — were living in poverty in 2005. That means that four years into an economic expansion, the percentage of Americans defined as poor was higher than at the bottom of the last recession in late 2001, when it was 11.7 percent. But that’s not the worst of it. Recently, the bureau released 12 alternative measures of poverty, and all but one are higher than the official rate.

The alternative that hews most closely to the measurement criteria recommended by the National Academy of Sciences yields a 2005 poverty rate of 14.1 percent. That works out to 41.3 million poor Americans, 4.4 million more than were officially counted. Those higher figures indicate that millions of needy Americans are not getting government services linked to official poverty levels.

It calls for expanding the Earned Income Tax Credit and early childhood education to help combat poverty.

MEDICARE PART D. West Virginians United for Social and Economic Justice and the WV Citizen Action Group issued a statement yesterday calling for negotiated prices on the prescription drug benefit. This could save WV taxpayers $225 million per year ($30 billion at the national level.) The press release drew attention to this report by the Institute for America's Future.

GOAT ROPE ADVISORY LEVEL: ELEVATED