Citizen Cartwright

Sky won't fall: Senate passes, Biden to sign debt limit bill

The Senate vote Thursday night was 63-36 on the bipartisan legislation suspending the debt limit and imposing new spending caps, sending it to President Biden for his signature and ending the possibility of a government default.

 

As in the House, Democrats provided the most votes for passage, with 44 of them and two independents joining 17 Republicans in support; 31 Republicans, four Democrats and one independent voted no.

 

Biden is to address the nation at 7 p.m. Eastern time Friday.

 

The Senate vote came after an afternoon of closed-door talks to resolve a last-minute flareup over Pentagon funding among Republicans who said the debt-limit package severely underfunded the military. Senate leaders resolved the dispute with a formal statement that the debt-limit agreement “does nothing to limit the Senate’s ability to appropriate emergency supplemental funds to ensure our military capabilities.”

 

Biden had refused for months to engage with House Speaker Kevin McCarthy but finally did so after the California Republican managed in April to pass a GOP fiscal plan, spurring negotiations with the White House that produced the compromise.

 

McCarthy defied expectations and even earned grudging respect from White House officials while defusing the debt limit time bomb he planted by insisting on concessions in return for raising the nation’s borrowing limit, says an analysis by long-time New York Times reporter Carl Hulse.

 

The bar was low for McCarthy, known more for politicking and fundraising than for policymaking, after he struggled to win his post in the first place as House Republicans took control in January, the Times says.

 

In the end, he delivered an agreement that met his goal of cutting spending from current levels. But he managed to do so only with significant help from Democrats, who rescued him on a key procedural vote and then provided the support needed for passage. McCarthy exceeded his goal of winning the support of the majority of his members with 149 backing it, but more Democrats — 165 of them — voted for the bill than members of his own party, an outcome that will fuel GOP criticism that he cut a deal that sold out his own people, the Times says.

 

That's not the way powerful speakers of the past have typically accomplished their goals, says the Times.

 

But McCarthy "has been uncommonly willing to endure political pain and even humiliation — a trait that was on ample display during his 15-round fight for the speakership in January — while focusing on extracting a few marquee concessions from Mr. Biden that could allow him to claim victory and avert a default he plainly wanted to avoid, even if many of his members did not,” says the Times.

 

His allies gave him credit for taking on the White House and Senate Democrats and emerging with a positive result when most Democrats were expecting him to fail. White House officials and congressional Democrats had privately predicted that McCarthy would be unable to corral his extraordinarily fractious troops, and would therefore have no leverage in fiscal talks, allowing them to force through an increase in the debt ceiling with few, if any, concessions to Republicans, according to the Times.

 

McCarthy’s achievement still may come at a cost, the Times says. Far-right conservative Republicans remain outraged at the agreement he struck with Biden, saying it fell woefully short of what he promised and what Republicans committed to as they pursued the majority last year.

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Debt limit bill passes House, goes to Senate

The House voted on Wednesday night to pass a painstakingly negotiated bill to suspend the debt ceiling, limit federal spending and avert a U.S. government default, securing a major win for the GOP and the White House, says The Washington Post.

The bipartisan vote was 314-117, with 71 Republicans and 46 Democrats voting no.

 

Senate Majority Leader Chuck Schumer, D-N.Y., says lawmakers may need to be in Washington through the weekend to get the legislation passed before Monday, when the Treasury Department says the United States will no longer be able to pay all its bills.

 

Nobody got everything they wanted, the Post says. Of course, that’s fundamental to compromise in a democracy. 

 

Many liberal Democrats opposed the bill, objecting to curbs on government spending and new work requirements for some recipients of federal food stamps and family welfare benefits. And far-right Republicans slammed the agreement for not securing more aggressive spending cuts. 

 

The agreement would keep nondefense spending roughly flat in the 2024 fiscal year and increase it by 1 percent the following year. It would suspend the debt limit until January 2025 — past the next presidential election.

The bill got the support of “a majority of the majority” in the final House vote, satisfying an informal GOP guideline against passing legislation mostly on the strength of Democratic support.

 

Here are details of what’s in the bill, from The Associated Press.

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NASA’s first public meeting on UFOs: 'Absolutely no convincing evidence for extraterrestrial life'

 

ProPublica: Interactive guide to rights the Supreme Court has established and could take away

 

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AP explainer of AI chips, ‘the hottest thing in technology’

 

CEOs got smaller raises, but it still would take a typical worker 2 lifetimes to make their annual pay

 

Why safe deposit boxes are getting harder to find

 

KFF: As Medicaid purge starts, ‘staggering numbers’ of Americans losing coverage

Note to readers

I’m going to extend my Memorial Day time off and will be back on Thursday, June 1. Until then, warm wishes, dear readers!

People who are making the world a better place

In 2020, Australia’s Future Crunch launched a project to identify “ordinary people answering the call to extraordinary acts of kindness.”

 

"The project was inspired by Rutger Bregman’s book 'Humankind: A Hopeful History,' which challenges the assumption of humans as inherently selfish and competitive,” Future Crunch says. "Bregman argues that this is wrong, that in truth we are hard-wired to take care of each other and solve problems, and this innate kindness and collaboration in the face of obstacles is what has led to our flourishing as a species. It's a radically different perspective from what we see in the news, which exposes the worst of us – corruption, destruction, and intolerance – on loop, 24/7.”

 

Future Crunch now has identified 100 "people who have worked tirelessly under the radar for years, sometimes decades, showcasing the best of what it means to be human, without a film crew, hashtag or sponsorship deal.” 

 

And it wants you and me to know about them.

 

For example, during the pandemic, "From the janitor in Florida who cooked a thousand meals a week for the homeless in her tiny kitchen, to the Nepalese sherpa who bought groceries for the unemployed, to the grandparents in India who created a pavement school for kids who couldn’t access online classes, we discovered that as much as the virus turned our lives upside down, it also brought out the best in us.”

 

Here are all 100 kindhearts.

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House passes bill on fentanyl-related drug penalties, on 289-133 vote

 

Biden vetoes Republican measure to block D.C.’s policing bill

 

Biden announces new strategy to combat rise in antisemitism

 

Supreme Court weakens wetlands protections in unanimous ruling that agrees on outcome, differs on legal reasoning

 

Supreme Court unanimously rules in favor of 94-year-old woman in case over compensation for condo

 

Minnesota governor signs paid family and medical leave bill to allow workers up to 20 weeks off

 

Republican-led Texas House panel issues 20 impeachment counts against state Attorney General Ken Paxton

 

Microsoft calls for AI rules, including requirement that systems used in critical infrastructure can be turned off or slowed down

 

KFF: Denials of health insurance claims are increasing — 'and getting weirder'

 

FDA grants full approval to Paxlovid to treat coronavirus

 

NIH research zeroes in on common long covid symptoms

Homeless seniors

The number of Americans 65 or older grew by more than a third from 2010 to 2020 — the fastest rate of any decade in 130 years, according to data from the 2020 census that was released Thursday.

 

And nearly a quarter of a million people 55 or older are estimated by the government to have been homeless during at least part of 2019, the most recent reliable federal count available. 

 

They represent a particularly vulnerable segment of the 70 million Americans born after World War II in the baby boom generation, the youngest of whom turn 59 this year, The Washington Post reports.

 

Advocates for the homeless in many big cities say they've seen a spike in the number of elderly homeless, who have unique health and housing needs. Some communities are racing to come up with novel solutions, including establishing senior shelters and hiring specially trained staff.

“It’s just a catastrophe. This is the fastest-growing group of people who are homeless,” says Margot Kushel, a professor of medicine and a vulnerable populations researcher at the University of California at San Francisco.

 

Dennis Culhane, a professor and social science researcher at the University of Pennsylvania, says the population of homeless seniors 65 and older will double or even triple 2017 levels in some places before peaking around 2030.

 

The largest shelter provider in Arizona, Central Arizona Shelter Services, is rushing to open an over-55 shelter in a former Phoenix hotel this summer with private rooms and medical and social services tailored for old people. The facility will open with 40 beds and eventually reach a capacity of 170, but that will barely begin to address the problem. CASS says it served 1,717 older adults in 2022, an increase of 43 percent in one year.

In Orange County, Calif., a Medicaid plan is creating a 119-bed, first-of-its-kind unit that essentially will serve as an assisted-living facility exclusively for homeless people, says Kelly Bruno-Nelson, executive director for the plan, CalOptima Health.

A combination of factors is to blame for the rising problem. People in the second half of the baby boom, who came of age during recessions in the 1970s and 1980s, face distinct economic disadvantages, Culhane says. Housing costs in many cities are soaring. The nation’s system of nursing homes and assisted-living facilities isn't equipped to handle the needs of homeless people, who suffer from high rates of substance abuse and mental illness.

And living on the street ravages the human body, street doctors and advocates say. Homeless people contract chronic diseases and other geriatric problems much earlier than average. Long waits for housing and a lack of specialized care expose them to a continued onslaught on their health.

After treatment for an acute illness, hospitals often discharge homeless patients, who wind up back in shelters or even back into their sidewalk tents and makeshift lean-tos, in what health practitioners in Phoenix call “treat-and-street.”

 

Medicaid, the health insurance program for the poor, will only pay for a long-term nursing home or assisted living bed if a person is unable to care for themselves. Many elderly homeless people aren't debilitated enough to meet that criteria.

“That’s where the gap in the system is,” says Regan Smith, long-term care ombudsman program director in Maricopa County, Ariz.

 

A pinball effect takes hold, according to health-care providers, shelter operators and advocates. Homeless people bounce from a homeless shelter to a hospital, then to a nursing home for a short-term recuperation stay. Once the short-term stay ends, nursing homes must decide if the person is infirm enough to qualify for long-term care. If the answer is no, they have to leave the nursing home, starting the cycle over again.

"Respite centers" now number about 150 around the nation, up from 80 in 2016, according to the National Health Care for the Homeless Council. They’re often funded at least in part by local hospitals that want to avoid discharging homeless people back onto the streets. They're designed to help homeless people recuperate for a few weeks after a health crisis. But with nowhere else to go, the elderly tend to stay far longer.

“Medical respite was not intended to be palliative care, hospice care, end-of-life care,” says Kushel, “yet some respite programs are starting to provide that service because there is nowhere else for these folks to go.”

 

Worrisome to Jeff Olivet, who leads the U.S. Interagency Council on Homelessness, is when the public responds to homelessness with “anger” and “vitriol” instead of seeking “thoughtful, compassionate solutions.”​

​To be part of the solution, he has four suggestions:​
1. Educate yourself on the the issue.​
2. Advocate at all government levels of government for “adequate resources to address this problem.”​
3. Donate to organizations “doing good workaround solutions to homelessness.”​
4. Volunteer for these groups.​​

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Paralyzed man walks again using implants connecting brain, spinal cord

Reining in pharmacy benefit managers (who?)

The Federal Trade Commission sued on May 16 to block the merger of drugmakers Amgen and Horizon Therapeutics, saying it would enable Amgen to leverage the monopoly power of two top Horizon drugs, reports KFF (formerly KHN).

In its suit, the FTC said if it allowed Amgen’s $27.8 billion purchase to go through, Amgen could pressure the companies that manage access to prescription drugs — pharmacy benefit managers, or PBMs — to boost the two extremely expensive Horizon products in a way that would inhibit competition.

The FTC also announced an expansion of a yearlong investigation of PBMs, saying it was looking at two giant drug-purchasing companies, Ascent Health Services and Zinc Health Services. Critics say the PBMs set up these companies to conceal profits.

The week before, the Senate Health Committee approved on May 11 bipartisan legislation sponsored by Chairman Bernie Sanders, D-Vt., and Sen. Bill Cassidy, R-La., a physician and the panel’s top Republican. The legislation (S 1339) is intended to increase transparency of PBMs, among other things.

Background
In a separate article titled "PBMs, the brokers who control drug prices, finally get Washington’s attention,” KFF discusses the role and relevance of PBMs (there’s a helpful four-minute video).

"Drug manufacturers claim that exorbitant PBM demands for rebates force them to set high list prices to earn a profit,” says KFF. "Independent pharmacists say PBMs are driving them out of business. Physicians blame them for unpredictable, clinically invalid prescribing decisions. And patients complain that PBMs’ choices drain their pocketbooks.”

"With PBMs driving prices, competition has had the opposite effect from what economic theory predicted Medicare patients would spend out-of-pocket on drugs, one large study showed. Over a five-year period, patients were paying 50 percent more for branded drugs that had competitors than for those that didn’t."

"All this makes the PBMs ripe targets for politicians of both parties," KFF says. "Yet the complexity and obscurity of their role in the drug marketplace have skeptics wondering whether legislation advancing in the House and Senate will actually help patients or lower prices at the pharmacy counter.”

The role of PBMs certainly IS complex and obscure. If you’re interested in diving deeper, I refer you to the KFF articles and to this Vox article.