There’s an $18 billion hole in President Trump’s “skinny” budget: it calls on Congress to cut this year’s funding for non-defense discretionary programs by $18 billion but gives no hint about which programs the President wants to cut.
President Trump’s new budget would push huge additional costs to states at a time when most of them lack the revenue to pay for current services. Low-income families would be particularly hard hit, as the budget eliminates or deeply cuts funding for a wide array of state programs and services that help these families overcome hard times and rise into the middle class.
Running for President, President Trump asked African Americans, “What do you have to lose by trying something new like Trump?” As it turns out, one answer is health insurance.
The Indigenous Law Portal, launched on the Law Library’s website in June 2014, provides an open access platform to legal materials regarding how indigenous peoples govern themselves. Currently featuring North America (Canada, the United States, and Mexico), the work continues!
The Policy and Standards Division released the classification schedule for subclass KI this past February. It describes global agreements, such as the United Nations’ Declaration on the Rights of Indigenous Peoples, as well as relevant organizations.
In the summer of 2016, the information for Mexico was updated with dozens of indigenous advocacy organizations, both national and regional. There is also a list of resources covering topics from forms of government to food sovereignty. The Portal doesn’t just link to written sources; a national government webpage provides recorded translations of the General Law on Linguistic Rights of Indigenous Peoples into 65 languages.
The next region to be added will be Central America, with digital resources and classification schedules for each of the seven nations in that region. Users will be able to access information about the resident indigenous peoples, their governments or councils, advocacy organizations, and use a bibliography that divides resources by legal subject.
Here are some highlights of what is coming:
In 2009, CANEK published Políticas culturales para un Estado Plural: Construcción del Estado Plural desde la interpretación comunitaria de la cultura los derechos colectivos, el territorio y el poder (Cultural policies for a pluralistic state: construction of a pluralistic state from the community perspective of the culture of collective rights, territory, and power). This resource examines historical processes from the colonial period to the present, compares the collective rights of indigenous peoples in other Hispanic countries, and considers two case studies of the Xinka and K’iche peoples.
An undated report from the Movimiento Indígena Lenca de Honduras (MILH) and the Foro Internacional de Mujeres Indígenas (FIMI) titled Diagnóstico participativo en el pueblo indígena Pech Honduras C.A. (Participatory diagnosis of the Pech indigenous community Honduras C.A. [Central America]) tackles the issue of gender violence.
In 2014, the national legislature passed a constitutional amendment recognizing indigenous peoples. While not indigenous law, this historic change is worthy of documentation on the Portal.
Mayagna (Sumo) Community of Awas Tingni v. Nicaragua was a landmark decision issued by the Inter-American Court of Human Rights in 2001. It obligated the state to secure land titles not only for Awas Tingni but all of its indigenous peoples. This decision, together with Nicaragua’s Law 28 about regional autonomy and Law 445 about communal land ownership, are changing the map and how indigenous people govern. The Portal will track these changes via digital resources like the 2011 Plan de Manejo, Conservación y Desarrollo Territorial Indígena (Management, conservation and indigenous territorial development plan) by the Territorial Government Mayangna Sauni Bas, the Environmental and Natural Resources Ministry, and the German Technical Cooperation (Gesellschaft für Technische Zusammenarbeit or GTZ).
These digital resources about Central America are just a few of the hundreds that will be available. The work is ongoing so stay tuned for new content on the Indigenous Law Portal later this year!
WASHINGTON — For the first time, research shows that a pricey new medication called Repatha not only dramatically lowers LDL cholesterol, the “bad cholesterol,” it also reduces patients’ risk of dying or being hospitalized.
Repatha, a man-made antibody also known as evolocumab, cut the combined risk of heart attack, stroke and cardiovascular-related death in patients with heart disease by 20 percent, a finding that could lead more people to take the drug, according to a study presented Friday at a meeting of the American College of Cardiology.
Some doctors hailed the results as major progress against heart disease. In an editorial in The New England Journal of Medicine, Dr. Robin Dullaart, a researcher at the University of Groningen in the Netherlands, called it a landmark study.
Others said they expected more from the $14,000-a-year drug. It was approved in 2015 without evidence that it prevents heart attacks, simply because its cholesterol reductions were so dramatic and promising.
Doctors often recommend that people keep their LDL levels under 100 milligrams per deciliter, and that people at very high risk reduce their LDL under 70.Use Our ContentThis KHN story can be republished for free (details).
In the new study, patients with heart disease who combined Repatha with a statin, the most commonly used cholesterol medication, decreased their LDL from 92 milligrams per deciliter to 30. Doctors have rarely seen cholesterol levels that low. Many doctors wondered if such low levels would be dangerous, causing memory problems or dementia due to a lack of cholesterol, said Dr. Steven Nissen, chair of cardiovascular medicine at the Cleveland Clinic, who was not involved in the new research but has led clinical trials of PCSK9 inhibitors in the past.
The new study, which followed 27,000 patients for two years, found no safety risks.
While doctors said they were relieved that Repatha is safe, doctors such as David Rind said they had hoped the study would show that the injectable medication reduces heart attacks and other serious complications by 30 percent or more, given its success in early studies.
“This [result] is probably a little less than we had been hoping for,” said Rind, chief medical officer at the Boston-based Institute for Clinical and Economic Review, which evaluates drugs’ cost effectiveness. Rind also was not involved in the study.
The study’s author, Dr. Marc Sabatine, said the “compelling reductions” in heart attacks, strokes and death suggest doctors should treat cholesterol much more aggressively, aiming to lower LDL levels as much as possible. His study focused on patients with underlying heart disease, most of whom had already had a heart attack.
The standard treatment for cholesterol, other than diet and exercise, is a generic statin, which costs $250 a year. Statins can cut LDL levels by up to half and reduce heart attack risk by 25 percent, Nissen said.
Some doctors are less impressed with the new study, which was funded by Amgen, Repatha’s manufacturer.
In the study, also published in The New England Journal of Medicine, 5.9 percent of patients who combined Repatha with a statin had a heart attack, stroke or died, compared with 7.4 percent of patients who took a statin plus a placebo.
“It’s a small reduction for a super expensive drug,” said Dr. John Mandrola, a cardiologist at Baptist Health in Louisville, Ky., and chief cardiology correspondent for Medscape, who wasn’t involved in the study.
Yet Repatha’s high cost could burden the U.S. health system, said Dr. Steve Miller, senior vice president and chief medical officer at Express Scripts, a pharmacy benefit manager. A similar drug to Repatha, called Praluent, costs about as much. Doctors don’t know whether Praluent would also prevent heart attacks, Rind said.
Repatha and Praluent, which belong to a class called PCSK9 inhibitors, are especially expensive because they would be taken for such a long time. Unlike an antibiotic, which patients take for a few days or weeks, those prescribed Repatha would take it for the rest of their lives.
Given its price, doctors aren’t likely to give Repatha to everyone with high cholesterol, said cardiologist Cam Patterson, chief operating officer at NewYork-Presbyterian Hospital/Weill Cornell Medical Center, who wasn’t involved in the study.
About 11 million Americans could be eligible for Repatha, according to Amgen. Repatha was approved for people with an inherited condition that causes high LDL levels or who have underlying heart disease but haven’t been able to adequately lower their LDL with statins alone. About 70 million Americans have high cholesterol and 25 million take statins, Nissen said.
Repatha could be an important drug for some high-risk patients, in spite of the cost, he said.
“It would be hard for me to look a patient in the eye, if they’ve had a couple of heart attacks and is scared to death, and say it’s not worth you taking this medication,” Nissen said.
KHN’s coverage of prescription drug development, costs and pricing is supported in part by the Laura and John Arnold Foundation.
Republicans in Washington working to overhaul the Affordable Care Act say their strategy consists of “three buckets.” But it appears that all three may be leaking.
The plan to dismantle and replace Obamacare emerged after the Republican congressional retreat in late January. The first bucket is a fast-track budget bill that needs only a simple majority to pass the Senate. Because of congressional rules, however, it can only address parts of the health law that have immediate impact on federal spending.
The second consists of changes to regulations and other policies put in place by the Obama administration that could theoretically be undone by new Health and Human Services Secretary Tom Price. And the third is separate legislation that would do things Republicans have been advocating for many years, such as imposing caps on medical malpractice damages and selling health insurance across state lines.
All three are proving problematic at this point — among Republicans.Use Our ContentThis KHN story can be republished for free (details).
“There is no three-phase process, there is no three-step plan,” Sen. Tom Cotton (R-Ark.) told radio host Hugh Hewitt Tuesday. “That is just political talk. It’s just politicians engaging in spin.”
“Anyone who believes in the three-step process is believing in a fantasy,” said Rep. Raul Labrador (R-Idaho) at a press conference Thursday.
The first part, the so-called budget “reconciliation” bill, is already drawing fire within the GOP, not to mention among Democrats. Conservatives, like Sen. Rand Paul (R-Ky.), derisively refer to it as “Obamacare Lite” and oppose the bill’s tax credits to help people buy insurance as a new entitlement. Moderates have been shaken by the estimate from the Congressional Budget Office that 24 million people could lose their health coverage if the bill passes.
The bill has passed through several committees, but members of the conservative House Freedom Caucus say they might be able to stop the bill from passing the House, in spite of heavy pressure from Republican leaders and the Trump administration.
“The question is: ‘Am I OK losing my election because I did the thing I promised I would do?’” said Freedom Caucus co-founder Labrador, referring to his promise to repeal the entire law. He said the answer to that question is yes: “I can live with myself if I do the things I promised I would do.”
Complaints about the bill from a several Republican senators suggest that there are more than enough GOP “no” votes in that chamber to block its passage.
Conservatives also question exactly how much of the law the administration can dismantle.
Price said at a CNN Town Hall Wednesday that he is ready to plunge into the “hundreds” of regulations and “thousands” of guidance letters issued by the Obama administration to implement the health law.
“If they hurt patients, they need to go away,” he said. “If they drive up costs, then they need to go away.”
But undoing all those rules comes with its own set of dangers.
“Step two requires us to believe that Tom Price is going to go outside the law,” Labrador said. He noted that conservatives often complain when an administration takes on authority not granted in legislation when devising rules.
“And we think the courts are not going to stop him from doing that?” Labrador asked. Reversing policy on existing law can open up new rules and regulations to lawsuits.
Cotton, in his radio interview, noted that whatever changes Price proposes are “going to be subject to court challenge, and therefore, perhaps the whims of the most liberal judge in America.”
Finally, while Republicans tend to agree on step three, the legislation that would implement their preferred policies for the nation’s health care system, there is one big hurdle: It would need 60 votes to pass a filibuster in the Senate, and getting eight Democrats to join seems highly unlikely.
“It’s not going to happen if you need 60 votes in the Senate,” said Sen. Lindsey Graham (R-S.C.) on MSNBC Wednesday.
Cotton agreed. “If we had those Democratic votes, we wouldn’t need three steps,” he said. “We would just be doing that right now on this legislation.”
President Donald Trump and many congressional Republicans campaigned on repealing the Affordable Care Act and replacing it with their own plan to overhaul the nation’s health care system. As the GOP develops its offering, its representatives are tossing around wonky health policy terms to describe their core strategies.
Want to know what it all means? See below for a tipsheet, then click on the thought bubbles above for easy-to-understand translations.
MEDICAID BLOCK GRANTS AND PER-CAPITA CAPS: The federal government gives states a set amount of money to pay for coverage for Medicaid recipients. This would be a shift from the current Medicaid program, where the federal government matches state Medicaid spending on a percentage basis. Learn more.
HEALTH SAVINGS ACCOUNTS: Also known as HSAs, these allow consumers to put money away on a tax-free basis as long as they use it for medical expenses. Learn more.
BUDGET RECONCILIATION: Legislative process that allows measures to pass with a simple majority in Congress. Budget reconciliation bills can’t be filibustered but must focus on provisions that have a budgetary impact. Learn more.
ESSENTIAL HEALTH BENEFITS: ACA-mandated categories of benefits that health plans must cover. They include emergency services, hospitalization and maternity care. Learn more.
INDIVIDUAL MARKET: Where people who do not have health coverage through the government or their employer purchase a plan directly from an insurer. It is sometimes called the non-group market. Learn more.
TAX CREDITS/SUBSIDIES: Financial assistance to help consumers purchase health insurance. Learn more.
HIGH-RISK POOLS: Insurance groups that cover individuals with high health insurance costs, such as people who have a past serious illness or a chronic condition. Learn more.
Visit Repeal & Replace Watch for more KHN coverage of the health law debate.