A Bishop In The Exam Room: When Faith Dictates Health Care Instead Of Science

A number of folks in Humboldt County have expressed complaints about our local hospital, but they should be thankful for the secular hospital we have available to serve our population. Given the merger-mania in corporate America, we could be facing, like so many other communities, a takeover of our hospital by Catholic Hospitals of America and the imposition of OBGYN-lite policies, restricting the availability of reproductive healthcare services to women throughout the hospital’s service area.

Here’s a post an article from ThinkProgress that will walk you through how religious institutions are imposing their religious beliefs on women through the limited care they’re willing to provide, essentially elevating their religious rights at the expense of any patient’s rights.


CREDIT: DYLAN PETROHILOS
CREDIT: DYLAN PETROHILOS

— by Erica Helerstein and Josh Israel

When Rita, a Michigan-based OB-GYN, learned that the hospital where she worked would be switching hands, she was dismayed.

The secular community hospital, Crittenton, had plans to join with Ascension Health, a prominent Catholic nonprofit hospital chain. Rita, who asked that her real name be withheld to protect her identity, knew the transition would profoundly impact her ability to do her job the way she saw fit. The OB-GYN specifically wanted to work at a place where she could practice the full scope of reproductive care, from preventing pregnancy to delivering babies. But now, with the hospital merger looming in the not-so-distant future, that possibility seemed increasingly unlikely.

Rita also understood the change in leadership meant that her patients’ medical options would be limited. That’s because Catholic hospitals follow a set of rules written by the U.S. Conference of Catholic Bishops, which often prohibit doctors from performing basic reproductive services — like contraception, sterilization, in vitro fertilization, abortion — and end-of-life care.

Although Rita knew certain services at the hospital would soon be banned, many of her patients had no idea. They also may not have known that mergers like Crittenton’s are becoming increasingly common.

As hospitals throughout the country struggle with financial woes, many have begun to merge with Catholic systems in order to stay in business. This means a growing number of patients are winding up in institutions guided by religious doctrine. Between 2001 and 2016, the number of hospitals affiliated with the Catholic Church increased by 22 percent. Today, one in six patients in the U.S. is cared for at a Catholic hospital — a troubling trend for health care providers like Rita, who worry that patients are increasingly being placed in centers that provide services based on faith rather than medical necessity.

“I do think as more places are being purchased by Catholic systems it’s going to become more of a problem,” she told ThinkProgress. “To take away the ability to provide services that people need or desire… I think it’s very upsetting both for an OB-GYN and also for a woman. Having those choices gives you the ability to participate in society.”

Rita found another job before the Catholic system moved in. Although she says her decision to leave Crittenton was based on other factors, she admits she probably would have sought employment elsewhere even if those reasons hadn’t come up. Before Rita departed from the hospital, though, she warned her patients about what was to come — and encouraged them to get their tubes tied before it was too late.

As Rita was advising her patients to move forward with their procedures, organizers with the American Civil Liberties Union of Michigan were trying to gin up support for a campaign opposing the Crittenton merger. In June, they arranged an event at a public library in a nearby town to talk about what the shift in leadership would mean for community members. But only six people showed up. “It was so hard for us to connect to anyone who cared,” said Merissa Kovach, a field organizer in charge of the campaign.

The struggle to engage people who could be directly impacted by Crittenton’s transition might not be entirely surprising given the demographic makeup of Rochester, which is predominantly white, conservative-leaning, and upper-middle class. But it suggests another problem that Kovach and others have been struggling to address: A widespread lack of awareness about a conflict that’s quietly brewing in the health care industry. It’s a trend that has managed to accelerate rapidly and yet evade public scrutiny. Because Catholic hospitals aren’t required to disclose their religious affiliation or talk about the limited medical services they may offer, many patients wind up in the dark — and don’t think about the hierarchies that govern their care until it’s too late.

In Rochester, for example, the two systems merged without much of a fuss. But just a few days after Ascension took over the hospital in October 2015, its official website changed ever so slightly. “Tubal ligations” were removed from the list of available services.

CatholicHospitalData-before-after6

The role of Catholics in health care is nothing new — indeed, throughout the Middle Ages, it was the Catholic Church that created hospitals and hospices for the old and ill in an attempt to follow Jesus’ teachings about healing the sick. Many of the earliest hospitals in America were set up by Ursuline sisters and other Catholic orders dedicated to serving the poor. About 75 Catholic hospitals had been established in the U.S. by 1875.

But there has been a particular boom in the number of Catholic hospitals since the beginning of the 21st century, according to a groundbreaking 2013 report on the growth of Catholic hospitals and health systems by MergerWatch, a patients’ rights organization that tracks hospital mergers, and the American Civil Liberties Union (ACLU). In 2001, about 8.2 percent of the nation’s acute care hospitals were Catholic nonprofits. By 2011, that number had jumped to 10.1 percent. This increase coincided with notable drops in the numbers of other nonprofit hospitals and public hospitals.

This trend is accelerating among all hospital chains, too, and not just nonprofits. A recently released 2016 update found that 14.5 percent of all acute care hospitals are now Catholic-owned or affiliated (up from 11.2 percent in 2001) and that four of the nation’s 10 largest hospital systems are Catholic-sponsored. Some of the growth is the result of new Catholic hospitals opening their doors — but many were the result of secular hospitals merging with Catholic systems, bringing them under the Catholic hospitals umbrella.

But while Lois Uttley, MergerWatch’s director, believes Catholic hospitals do deliver “excellent care” in many treatment areas, she and her group are working to shine a light on a major exception. They believe Catholic hospitals prevent many women from getting the reproductive health care they need — even procedures that are medically necessary — ultimately putting them in an untenable situation once they walk through the doors of one of these religious facilities.

Once a hospital elects to merge with the Catholic system, it agrees to obey a set of directives issued by the U.S. Conference of Catholic Bishops. Called the “Ethical and Religious Directives for Catholic Health Care Services” (ERDs), these rules include instructions that Catholic care “should distinguish itself by service to and advocacy for those people whose social condition puts them at the margins of our society and makes them particularly vulnerable to discrimination: the poor; the uninsured and the underinsured; children and the unborn; single parents; the elderly; those with incurable diseases and chemical dependencies; racial minorities; immigrants and refugees.”

Although these large Catholic hospital systems operate in accordance with religious values and doctrine, they aren’t directly funded or controlled by the Catholic Church. As Uttley put it, “they are not being funded by the envelope my mother used to put in the collection basket every Sunday.”

Instead, as tax-exempt nonprofit corporations, they are funded through a combination of private insurance reimbursement, Medicare and Medicaid payments, and sometimes government grants, according to Uttley.

By bringing many hospitals together into large Catholic health systems, they can cut costs through shared administration and joint purchasing, offering protection to hospitals in rural states where isolated health care facilities often struggle. “It’s to their credit, they’ve kept these hospitals operating in very challenging times,” she said.

CatholicHospitalData-01v4
CREDIT: DYLAN PETROHILOS

But the directives also include prohibitions on abortion, even when a woman’s health is at risk; assistance with surrogacy; egg and sperm donation; contraception; and temporary or permanent sterilization, with few — if any — exceptions. And the condoning of or participation in euthanasia or assisted suicide “in any way” is expressly verboten for all who work at a Catholic health care institution. MergerWatch, the ACLU, and the handful of other organizations that track this issue believe these directives often mean even procedures needed to mitigate serious health risk to the patient are unavailable at a Catholic hospital.

The groups also pointed to a troubling lack of transparency: Because Catholic hospitals often choose not to disclose which services are not offered, patients don’t always realize they operate any differently from a secular institution.

Proponents of the Catholic hospital system say the distinction should already be obvious to patients given the facilities’ religious presentation. As the attorney for one Catholic hospital in California that refuses to perform tubal ligation argued in a lawsuit earlier this year, “no one is lacking for understanding that this is a Catholic hospital, from the crucifix in the front entrance to everything about it.”

But that’s not necessarily how providers see it. Nancy, a physician who provided services at Rochester’s Crittenton before the merger and continues to do so today, said the now-Catholic hospital is presented to the public as a secular institution with no disclosure of its restrictions. “I think it is incredibly difficult to understand what limits we have available,” said Nancy, who asked that her real name be withheld because she is still practicing in the field, noting that the names of Catholic hospitals don’t always reveal their religious affiliation. “It’s not Saint Crittenton. It’s not Mary of Christ Crittenton. It’s just Crittenton.”

Ascension and Crittenton did not respond to a ThinkProgress inquiry about their practices. A spokesperson for the Catholic Health Association, which represents hundreds of Catholic hospitals and facilities nationwide, said his group “encourages transparency from Catholic hospitals regarding the services they do and do not offer.”

But Brigitte Amiri, senior staff attorney for the ACLU’s Reproductive Freedom Project, says in practice, that transparency is often absent — putting patients in potentially perilous situations when they’re in urgent need of care.

“The hospital closest to you might be Catholic, you might not know it, you might not think to ask these questions until [you’re facing] an emergency situation or far along in a pregnancy,” she said.

Rachel Miller found herself in that exact situation when she was a patient at Mercy hospital in Redding, California in 2015. Miller, who was pregnant with her second child, was certain she didn’t want to have more kids: In 2013, she had an emergency C-section for her first daughter, and knew she would have to repeat the procedure for the birth of her second child. After she discussed her options with her OB-GYN, she decided a tubal ligation made the most sense — she could get it right after delivering her baby and it wouldn’t require an additional hospitalization.

Miller sent a request to Mercy for the procedure, and assumed it would be approved. Instead, she received a letter back stating Mercy would be unable to accommodate her, citing the Catholic bishops’ directives.

Miller had never heard of the directives before — in fact, she had no idea that the standard of care at Mercy would be any different than what was available at a secular hospital. “I guess if someone had asked me at the time, ‘is this a Catholic hospital?’ I would have said yes, because it’s Mercy, normally a Mercy hospital is Catholic,” she told ThinkProgress. “But I had never thought about it. And as far as Catholic hospitals in general and having ERDs, I had never thought about that either.”

Miller was sure she wanted to get her tubes tied, but after Mercy’s rejection, she found that her options were limited. Redding has only one hospital with a labor and delivery department and the nearest hospital Miller could find that took her insurance was some 160 miles away. That was out of the question — Miller knew she would have to stay at the hospital for several days, and she didn’t want to be away from her toddler for that long. Mercy — the largest hospital provider in California — was her only option, and they just wouldn’t budge.

That was especially concerning to Elizabeth Gill, an attorney at the ACLU of Northern California who later took up Miller’s case. “It’s troubling that your access to health care in such a significant degree in a state like California is dictated by the moral code that corporations subscribe to, especially given that these are entities that are largely state and federally funded,” she said.

The predicament Miller found herself in is becoming increasingly common.

For many patients, Catholic hospitals are now so ubiquitous they may be the closest or only option for care. According to MergerWatch’s most recent report, more than 40 percent of the acute care beds in Alaska, Iowa, Wisconsin, Washington, and South Dakota are in Catholic-owned or affiliated hospitals, and more than 45 Catholic hospitals in the country provide the only acute care in their geographic region. Naturally, this impacts the services available to patients. As Miller experienced, the bishops’ guidelines often prevent doctors from performing tubal ligations after patients deliver, which is the safest time for the procedure.

Moreover, as the National Women’s Law Center noted in a complaint to the Centers for Medicare and Medicaid Services, many Catholic hospitals don’t follow the medical standards of care for what’s known as “miscarriage management,” often by denying services to women experiencing pregnancy complications before viability or in the middle of a miscarriage.

Tamesha Means was 18 weeks pregnant when she showed up at a Mercy hospital in Michigan in December 2010. Her water had broken prematurely. Hospital staff examined Means, but neglected to tell her that the fetus she was carrying had virtually no chance of survival — and in fact posed a risk to her health if she continued to carry it. Means was sent home, but she returned the next day as her bleeding and cramps intensified. Again, she was instructed to go home. Means returned for a third time that night — visibly in pain and showing signs of an infection. The hospital prepared to send her home once again, but stopped when she started delivering. The baby died shortly thereafter, and the hospital staff told Means to prepare funeral arrangements.

The ACLU took on the case, arguing that the directives prevented hospital staff from informing Means of the risk of the pregnancy and directly placed her in harm’s way. “Because of the Directives, MHP did not inform Ms. Means that, due to her condition, the fetus she was carrying had virtually no chance of surviving, and continuing her pregnancy would pose a serious risk to her health,” the lawsuit claimed. As a result, “Ms. Means suffered severe, unnecessary, and foreseeable physical and emotional pain.”
<

CatholicHospitalData-02v2
CREDIT: DYLAN PETROHILOS/SHUTTERSTOCK

The restrictions on care don’t present a burden for patients alone — working within the system can also weigh heavily on providers who are prevented from performing the full range of medical care they expected to practice as an OB-GYN. According to a 2012 national survey, more than 50 percent of OB-GYNs who work at Catholic hospitals said they’ve run into conflicts with their institutions over the directives. Dr. Didi Saint Louis, a physician in the Southeast who completed her medical residency at a Catholic hospital, is familiar with that tension herself. She remembered seeing a patient who fell extremely ill at an early stage in a nonviable pregnancy. Saint Louis was prohibited from terminating the pregnancy — even though the fetus would not survive — and ended up transferring the patient to another hospital.

“I remember our director riding in the ambulance with the patient, she went straight to the operating room, they terminated the pregnancy, and she was fine,” she recalled. “But it could have gone so many different ways. And while the Catholic hospitals strive to give the best standard of care, this is one area where I think they fall short.”

The impact of a hospital merger can be much more profound for people living in geographically isolated regions without easily accessible alternatives. According to MergerWatch, there are 46 hospitals nationally that provide the only short-term acute care for people in their region, leaving people who lack transportation and travel resources with few alternative options.

Nancy, the physician from Michigan who works with Ascension, says she’s fortunate to be in a region with more than one hospital. “I’m in an area in which my patients can commute or get to a different location, so people in more remote areas are stuck without that,” she said. “Which is a really disturbing trend.”

About 2,000 miles west of Rochester, a Catholic hospital merger brought a very different outcome. In Washington, a battle was waged over the fate of Vashon Island’s only health clinic. Vashon, a quirky island community near Seattle, is home to about 11,000 people, 45 miles of shoreline, and an unofficial mayor who was re-elected in 2015 over a goat named Bandit. It is a Democratic bastion: Mitt Romney received a mere 18.6 percent of the vote in the 2012 elections, to Barack Obama’s 77.6 percent.

In 2012, Mark Benedum, the CEO of the island’s health clinic, announced the board had decided that, due to financial struggles, the time had come “to explore the benefits of joining a larger system.” It reached an agreement to become an affiliate of Franciscan Health System, a chain of Catholic health facilities and part of the behemoth Catholic Health Initiatives.

Benedum initially claimed patients’ options would be unaffected by this union, insisting, “it’s not going to change a thing.”

Vashon’s residents weren’t so sure. A group of skeptics, calling itself Vashon HealthWatch, worried that the island’s sole clinic would now be forced to adhere to the bishops’ directives — and that their care would be limited as a result. After consulting with MergerWatch, they organized a massive town hall meeting where members of the community could question Franciscan and Highline leadership.

On April 25, 2013, weeks after the Franciscan’s purchase of the clinic was complete, about two hundred people packed the multipurpose room at one of the the island’s schools, according to Kate Hunter, who helped organized the event. It was a far cry from the sparsely attended event that took place in Michigan. And not only did people show up, but they’d read the directives and were prepared with specific questions.

Benedum and executives from Franciscan Health Services were peppered with two hours of anxious inquiries from community members about the merger’s impact on available reproductive health and end-of-life services.

Margaret Chen, a staff attorney with the ACLU of Washington Foundation, said this level of civic engagement is atypical. “The visibility of concerned citizens was large in the Vashon Island community, maybe in part because of the unique situation [of being so separated from other options].” This response, she suggested, might have been part of the reason the new ownership agreed to continue offering birth control, family planning, and contraception to patients on the island — though a company spokesperson said the directives are “consistently applied” across all of its facilities.

While the executives sought to assure residents that “nothing is going to change at the Vashon medical clinic,” Hunter wasn’t convinced. She recalled one particularly concerning exchange toward the end of the forum: “Does your contract with your doctors specify that they will follow the directives?” a resident asked. “Yes, they do,” the Franciscan representative answered. “Our employment contract does.”

John Jenkel, who is part of the Vashon-Maury Health Collaborative, a community group that works to improve emergency care options on the island, said the relationship between the new ownership and residents was scarred by that early tension. “[T]hose directives and the manner in which the Franciscans communicated with the community caused a rift that never really made for a comfortable working relationship on our small island,” he said. “The initial discussion that the Franciscans had with the community was a rocky one, and the relationship of the directives to the type of care the Franciscans would be providing was never too clear.”

Hunter stopped going to the Vashon clinic. “I just feel so strongly that no one’s religious beliefs should interfere with my health care and I had no confidence that that would not be the case at the clinic anymore,” she said. Instead, she travels to a secular nonprofit facility in Seattle, via ferry and bus — a 60- to 90-minute trip each way.

When ThinkProgress reached out to Franciscan for comment, spokesperson Scott Thompson said that “none of the practice’s women’s reproductive services changed at the clinic after Highline’s affiliation with CHI Franciscan Health.” However, he added that the Vashon Island clinic would be closing in August. The company attributed the decision to the cost of operating the clinic and the fact that visits had declined from about 1,000 a month when they took it over to between 750 and 850 a month today.

Kate Hunter laments that with the closing, “there will be no health care clinic on Vashon Island. We’re back to ground zero.”

The bishops’ directives were last updated in 2009 and, according to observers, are due to be revised again in the near future. Reproductive rights advocates say a revision could loosen restrictions on how hospitals that become Catholic through mergers may deal with reproductive decisions — or could put the kibosh on the limited flexibility that Catholic chains have shown in places like Vashon Island.

Sara Hutchinson Ratcliffe, domestic program director for Catholics for Choice, fears it will be the latter. “I think the upcoming regulations are going to close those avenues for alternative provision for those health care services, to make the partnership agreements even more strict on who must/must not do this or that,” she said. “I think it will make it worse.”

MergerWatch’s Lois Uttley is a bit more optimistic. “We hope that they will be realistic about the fact that, in this day and age, Catholic hospitals are serving everyone in the community, not just Catholics. And they are employing doctors and staff that come from a wide background of religious affiliation,” she said. “We hope there will be a recognition that all hospitals, including Catholic ones, are licensed to serve the whole community.”

The press office for the U.S. Conference of Catholic Bishops did not respond to a ThinkProgress inquiry about their timetable for an update. But when and if the directives are updated, they could make a huge difference in terms of whether doctors at hospitals that merge with Catholic hospital system.

In the meantime, several approaches have been contemplated for how to address the topic.

The Center for Inquiry, which advocates for a secular society, thinks that the Medicare and Medicaid funding Catholic hospitals receive could be used as leverage to force Catholic hospitals to provide a full range of reproductive health and end-of-life care. Michael De Dora, who heads the Center’s Office of Public Policy, explained that while he does not believe all individual doctors should be forced to engage in all health care services, all hospitals should. “The responsibility should be with the hospital in any case [if] they’re receiving public funds,” he said. “That is the ideal.”

The ACLU’s Brigitte Amiri noted that some — though not many — states have considered legislation that would shield doctors from punishment, should they choose to provide services forbidden under the directives. After non-discrimination laws and same-sex marriage equality were enacted, several Catholic Charities organizations shelved adoption services rather than serve same-sex couples.

Thus far, the ACLU has concentrated its efforts on the judicial system, threatening and bringing lawsuits under the federal Emergency Medical Treatment and Active Labor Act and state medical laws. Two suits were dismissed at the trial court level, though both are being appealed, and others are still working their way through the courts. In April, for the first time, the 41,000 doctors of the California Medical Association announced they would join an ACLU of Northern California case against a Catholic hospital system that bars its doctors from performing tubal ligation.

Since these and other attempts to force Catholic hospitals to provide services have not yet been met with much success, some activists have focused on making the rules more transparent.

Washington state enacted a requirement that hospitals generally disclose what services they refuse to provide to the state government — which would become public record — but MergerWatch’s advocacy coordinator, Christine Khaikin, observed even that “leaves a lot of room for interpretation to the hospital system,” and few hospitals have reported much of anything.

model-patiens
CREDIT: AMERICAN ATHEISTS

The American Atheists, a group that advocates for a strict separation of government and religion, have circulated a piece of model state legislation called the Patient’s Right to Know Act. The organization’s national legal and public policy director Amanda Knief said it would simply require that providers “inform their patients up front of all services they’re not going to provide, according to their religious, philosophical beliefs.” This “sunshine law” would not require hospitals to provide an explanation or a referral, she added, but simply a disclosure of which services are not provided there “because we’re Catholic affiliated, or we’re Pastafarian affiliated, or we don’t believe in modern medicine.”

The bill has been introduced in Arizona, and Knief is hopeful other states will soon follow. But, she acknowledges, it may have trouble gaining momentum — some progressive groups have been reluctant to back the measure because it lacks a requirement that the hospital refer the patient to a place that performs procedures prohibited by the directives.

In some communities, MergerWatch has partnered with local advocates to utilize state hospital merger laws and galvanize public actions to force accommodations or block the mergers entirely. “Frankly, totally stopping the merger is our fallback position,” Lois Uttley explained. “What we try to do, from the outset, is make sure that community access to needed reproductive health care services is preserved in some way.” She pointed to one case in which a separately funded and staffed reproductive health care center was opened on the second floor of a newly Catholic hospital that could no longer provide all services under the directives. In another, the community got a local hospital to call off its plans to affiliate with a Catholic system.

But, like with Crittenton Hospital in Michigan, these mergers often fly under the radar. Because the hospitals themselves do not highlight that they are going to begin restricting services, MergerWatch, the ACLU, and a small number of other organizations are often the only early-warning system for communities. And, as Sara Hutchison Ratcliffe of Catholics for Choice pointed out, until more people understand what these mergers mean, it can be an uphill battle for them to galvanize community resistance.

“Awareness isn’t the only solution, but it is the first step,” she said. “Until they are aware, the likelihood of something happening is small… The first step is getting those who have the power to change it involved.”

The fate that awaits Rochester, Vashon, and the numerous other communities that have recently experienced hospital mergers is uncertain. Indeed, some may choose to go the path of resistance favored by Washington’s quirky island community, organizing themselves and arranging well-attended town hall meetings. But, as Merissa Kovach and her coworkers at the ACLU of Michigan experienced while organizing their campaign, getting that community buy-in is often an uphill battle.

“One of the biggest issues with this is that it’s just not well-known at all and nobody understands what these hospitals are doing,” Kovach said. “We’re in such a public education step with this, and it’s such an unknown issue. People don’t know why they should care.”

But why did they seem to know and care in the Washington island? At least some portion of the differences between the two community responses can likely be drawn along political lines — Vashon overwhelmingly leans left, Rochester tilts right. But what took place in the Michigan city might be the more standard course of events: A merger takes place in a community that isn’t predisposed to fight it — or isn’t even aware that it might impact the care they expect to receive — and, as was the case with Rochester, a new merger quietly goes into effect. And the cumulative impact of these mergers, critics say, is an overall reduction in available reproductive services.

CatholicHospitalData-03
CREDIT: DYLAN PETROHILOS

So what are the alternatives to Catholic medical care? In some rural communities, there aren’t any — it’s a Catholic system or nothing at all. That’s a sobering reality for people on all sides of the debate, including reproductive health advocates. They recognize that a singular focus on the expansion of the Catholic health care system ignores the forces that often propelled them to step in in the first place. Public hospitals are struggling, and their Catholic counterparts can provide much-needed care. According to the most recent MergerWatch report, the number of public short-term acute care hospitals in the U.S. dropped an astonishing 34 percent between 2001 and 2016. The number of secular nonprofit hospitals, too, shrunk by 11 percent, while for-profit systems shot up by more than 50 percent. In rural areas, where it is harder to turn a profit, these trends have left tremendous disparities in health care access.

Catholic hospitals help fill some of that gap — but at what cost? The ACLU’s Brigitte Amiri worries that hospitals’ fealty to the directives over the standard of care means that for some, the delta between the services they seek and those that are available is becoming a gulf.

“We don’t want to take away health care services from a community that desperately needs them,” she acknowledged. “But I don’t think we can be so timid about our work that we don’t push them to provide health and lifesaving care to women.”

Kiley Kroh and Tara Culp-Ressler edited this piece. Cory Herro provided research assistance. Videos by Victoria Fleischer, graphics by Dylan Petrohilos, and illustrations by Laurel Raymond.


This material [the article above] was created by the Center for American Progress Action Fund. It was created for the Progress Report, the daily e-mail publication of the Center for American Progress Action Fund. Click here to subscribe. ‘Like’ CAP Action on Facebook and ‘follow’ us on Twitter

Advertisements

House GOP Budget Committee Just Passed Their FY2017 Budget Proposal

628The House GOP-dominated Budget Committee held 9 hour markup, with several lawmakers going hoarse and one losing her voice. Democrats offered up 29 amendments, involving immigration reform, prescription drug prices, and equal pay. Every amendment failed, including one proposed by Rep. Debbie Dingell [D, MI-12] that would have designated $457.5M in emergency funding for Flint and required Michigan to match the federal funds. The budget advanced 20-16, with Democrats voting against and all but one Republican voting for the measure. Here’s their summary:

Balances the Budget

  • Balances the budget within 10 years – without raising taxes – and puts the country on a path to paying off the national debt
  • This budget achieves $7 trillion in deficit reduction over ten years through a combination of $6.5 trillion in savings coupled with economic growth
  • Savings are higher than any previous House Budget Committee proposal and discretionary spending is below 2008 levels
  • Requires consideration of legislation this year to achieve at least $30 billion in automatic spending reductions and reforms over the near term
  • Advances budget process reforms to promote fiscal discipline, and calls for a vote on a Balanced Budget Amendment this year

Strengthens Our National Defense

  • Provides for greater security at home and strength abroad at funding levels above the president’s budget and with increased resources for training, equipment and compensation
  • Supports the bipartisan prohibition on closing the Guantanamo Bay detention facility and transfer of detainees to American soil
  • Identifies vulnerabilities in our nation’s refugee program and calls for oversight and rigorous screening
  • Calls for an improved and accountable Department of Veterans Affairs that can better deliver services and benefits to our veterans

Empowers Our Citizens & Communities

  • Promotes job creation and a healthier economy by calling for a fairer, simpler tax code, regulatory reform, expanded energy production, and a more efficient, effective and accountable government
  • Repeals all of Obamacare (Patient Protection and Affordable Care Act)
  • Endorses patient-centered health care solutions that improve access to quality, affordable care (but does absolutely nothing to assure access to insurance nor does it rein in health care costs)
  • Saves, strengthens, and secures Medicare for current and future retirees (read the Q&A carefully as to HOW they intend to do that)
  • Empowers states and local communities with the flexibility to innovate and make improvements to Medicaid, nutrition assistance, education and other programs
  • Strengthens the Disability Insurance program by putting an end to the “double-dipping” loophole that currently allows individuals to receive both unemployment insurance and disability insurance simultaneously
  • Puts an end to corporate welfare and dismantles the Department of Commerce [that would mean they intend to help balance the budget by issuing pink slips to 43,000+ employees and ending measuring services like: Bureau of Economic Analysis (BEA), Bureau of Industry and Security (BIS), U.S. Census Bureau (Census), Economic Development Admin (EDA), Economics and Statistics Admin (ESA), International Trade Admin (ITA), Minority Business Development Agency (MBDA), Natl Institute of Standards and Technology (NIST), Natl Oceanic and Atmospheric Administration (NOAA), Natl Technical Information Service (NTIS), Operation Natl Telecom & Information Admin (NTIA), and United States Patent and Trademark Office (USPTO).

Additional Resources

This Week’s Democratic Campaigns and GOP Agitprop

Joe Biden will Not Run for President

Swipe Right for Hillary

Bernie Sanders Explains Social Security

O’Malley on the Need for New Leadership

 

Clinton vs. Sanders vs. O’Malley On Fixing Banking
How do we fix Wall Street, a.k.a. “the banks”? How do the candidates compare? … The first place to look, of course, is CAF’s Candidate Scorecard … Clinton’s 63 percent rating is primarily based on not having a position on a financial transaction tax … as well as opposing reinstating some form of a Glass-Steagall Act and a lack of specific proposals related to the categories “Break Up Big Banks” and “Affordable Banking.” Meanwhile, Sanders rates 100 percent … O’Malley is stressing his positions on and independence from Wall Street [and] also has a 100 percent…

Blue States Make Voting Easier as Red States Add Restrictions
“In Illinois, a new provision allows voters to register electronically when they visit various state agencies. And in Delaware, some residents with criminal records will regain the right to vote … In Republican-controlled states, the story is different. North Carolina has instituted a new voter ID requirement. North Dakota has narrowed the forms of identification voters can present … Ohio’s GOP-controlled legislature has instituted … shorter early voting hours.” Meanwhile, here at home in Nevada, folks who wish to participate in the Democratic County Caucuses will enjoy the ability to “same-day” register to participate, while Republican caucus goers will need to have registered at least 10 days prior to the caucus date AND will be required to present a government issued photo ID card … no indication as to which will be allowed and which will not (e.g., will VA photo IDs be accepted?).

Ex-Gov turned Democrat Charlie Crist announced a run for U.S. House
On Tuesday, ex-Gov. Charlie Crist announced that he would run for the St. Petersburg FL-13 seat. Crist said all the way back in July that he’d run for this seat if he lived in it after redistricting, so this announcement was no surprise. However, Republican Rep. David Jolly, who is leaving this district behind to run for the Senate, unexpectedly crashed what would have otherwise been a routine campaign kickoff. Jolly told reporters that he cares too much about the seat “to lay down and let this huckster walk into office.” Republicans utterly hate Crist, who left the party in 2010, so this kind of stunt certainly won’t hurt Jolly’s chances in the GOP primary.  If Crist wins, he’ll be one of only a few ex-governors to be elected to the House. The University of Minnesota’s Smart Politics blog finds that in the last half-century, only four other ex-governors have done this, and none of them had run a state anywhere near as large as Florida.

Meanwhile in the House of Representatives, the Freedom Caucus is vowing not to play nice —all this at a crucial time when some pretty critical votes will need to be taken:

  • A vote to raise the debt limit to avoid a default on our nation’s debt. House RW budget hawks are looking again at hijacking any efforts to raise the debt limit to pay for expenses they already authorized.  Expect new attacks on medicaid, medicare, social security and planned parenthood. And then there’s Teddy Cruz, urging GOP members to take an absolute hard line against any efforts to pass a “clean” bill to raise the limit to pay for the spending they already authorized.
  • A vote will be needed to pass a fiscal budget, not yet another let’s kick the can down the road continuing resolution to extend the current (previous) budget that was passed,  and
  • A vote will be needed regarding the Iran Deal, which the US and other foreign nations have already begun to implement regardless of any approval/disapproval from our disfunctional Congress.

November should prove quite interesting. But, if all of that that is not enough agitprop for your tastes, Speaker Boehner is proposing that it’s possible that they could actually “repeal Obamacare” by the end of the year. What is he smoking, drinking or otherwise ingesting?  Apparently he thinks President Obama is just gonna roll over and sign onto their repeal efforts taking away any and all opportunities for millions of Americans to be able to purchase health care insurance.  Somebody needs to throw some ice water in his face and yell “Wake Up Bozo!”

  • Rep. Paul Ryan announces speaker bid, with conditions. NYT: “…Ryan called for … an end to the antics of ‘bomb throwers and hand wringers,’ according to members in the room … He suggested that he wanted an answer by Friday. Mr. Ryan made it clear that he would not accede to preconditions set by ‘one group,’ a clear reference to the members of the hard-line Freedom Caucus…”
  • Freedom Caucus resists. Politico: “They were dismissive of his Ryan’s request that they relinquish a procedural tactic they used to threaten to strip outgoing Speaker John Boehner of his title – one of the most potent weapons in the group’s arsenal.”
  • Paul Ryan’s Conditions for House Speaker Bid Meet Early Resistance, Bloomberg: “How does giving Paul Ryan more power solve the problem of John Boehner having had too much power?” Rep. Tim Huelskamp tells Bloomberg.

 

Clinton at the National Urban League Conference

— July 31, 2015

I’m very pleased that many presidential candidates will be here today to address you. It is a signal that the work you’ve been doing – laboring in the vineyards for decades – is getting the political attention it deserves. But the real test of a candidate’s commitment is not whether we come to speak at your national conference, as important as that is. It’s whether we’re still around after the cameras are gone and the votes are counted. It’s whether our positions live up to our rhetoric.

And too often we see a mismatch between what some candidates say in venues like this, and what they actually do when they’re elected. I don’t think you can credibly say that everyone has a “right to rise” and then say you’re for phasing out Medicare or for repealing Obamacare. People can’t rise if they can’t afford health care. They can’t rise if the minimum wage is too low to live on. They can’t rise if their governor makes it harder for them to get a college education. And you cannot seriously talk about the right to rise and support laws that deny the right to vote.

Affordable Care Act payment model saves more than $384 million in two years, meets criteria for first-ever expansion

Pioneer ACO Model advances quality and value in health care

Medicare01Today, an independent evaluation report released by the Department of Health and Human Services showed that an innovative payment model created as a pilot project by the Affordable Care Act generated substantial savings to Medicare in just two years. Additionally, the independent Office of the Actuary in the Centers for Medicare & Medicaid Services (CMS) has certified that this patient care model is the first to meet the stringent criteria for expansion to a larger population of Medicare beneficiaries.

The independent evaluation report for CMS found that the Pioneer Accountable Care Organization (ACO) Model generated over $384 million in savings to Medicare over its first two years – an average of approximately $300 per participating beneficiary per year – while continuing to deliver high-quality patient care. The Actuary’s certification that expansion of Pioneer ACOs would reduce net Medicare spending, coupled with Secretary Sylvia Mathews Burwell’s determination that expansion would maintain or improve patient care without limiting coverage or benefits, means that HHS will consider ways to scale the Pioneer ACO Model into other Medicare programs.

“This is a crucial milestone in our efforts to build a health care system that delivers better care, spends our health care dollars more wisely, and results in healthier people,” said HHS Secretary Sylvia M. Burwell. “The Affordable Care Act gave us powerful new tools to test better ways to improve patient care and keep communities healthier. The Pioneer ACO Model has demonstrated that patients can get high quality and coordinated care at the right time, and we can generate savings for Medicare and the health care system at large.”

The Pioneer ACO Model, one of the first payment models launched by CMS, gives experienced health care organizations accountability for quality and cost outcomes for their Medicare patients. Doctors and hospitals who form Pioneer ACOs can share in savings generated for Medicare if they work to coordinate patient care, keep patients healthy and meet certain quality performance standards, or they may be required to pay a share of any losses generated.

Currently, the Pioneer ACO Model is serving more than 600,000 Medicare beneficiaries. According to today’s report, compared to their counterparts in regular fee-for-service or Medicare Advantage plans, Medicare beneficiaries who are in Pioneer ACOs, on average:

  • Report more timely care and better communication with their providers.
  • Use inpatient hospital services less and have fewer tests and procedures.
  • Have more follow-up visits from their providers after hospital discharge.

Pioneer ACOs are part of the innovative framework established by the Affordable Care Act to move our health care system toward one that rewards doctors based on the quality, not quantity, of care they give patients. HHS earlier this year announced the ambitious goal of tying 30 percent of Medicare payments to quality and value through alternative payment models by 2016 and 50 percent of payments by 2018. More than 3,600 payers, providers, employers, patients, states, consumer groups, consumers and other partners have registered to participate in the Health Care Payment Learning and Action Network, which was launched to help the entire health care system reach these goals.

Pioneer ACOs generated Medicare savings of $279.7 million in 2012 and $104.5 million in 2013. To date, actuarial analyses show that ACOs in the Pioneer ACO Model and the Medicare Shared Savings Program have generated over $417 million in total program savings for Medicare. The primary analyses in the evaluation are also reported in an article published in the Journal of the American Medical Association today.

“This success demonstrates that CMS can design and test innovative payment and service delivery models that produce better outcomes for the Medicare program and beneficiaries,” added Patrick Conway, MD, the acting principal deputy administrator of CMS. “This gives CMS greater confidence in scaling elements of the model to benefit people across the nation, and we are working to determine the best strategies for embedding the lessons we have already learned from the Pioneer Model into permanent Medicare programs and our nation’s health system.”

To view the CMS Office of the Actuary Certification of Pioneer ACO Model savings, visit:http://www.cms.gov/Research-Statistics-Data-and-Systems/Research/ActuarialStudies/Downloads/Pioneer-Certification-2015-04-10.pdf.

To view the second Pioneer ACO Model evaluation report, visit:http://innovation.cms.gov/Files/reports/PioneerACOEvalRpt2.pdf.

 

HHS Presser: 9.4M Medicare Enrollees Seeing Savings Under ACA

Since 2010, 9.4 million people with Medicare have saved over $15 billion on prescription drugs

39 million Medicare beneficiaries received preventive services with no cost sharing in 2014

The Department of Health and Human Services released today new information that shows that millions of seniors and people with disabilities with Medicare continued to enjoy prescription drug savings and improved benefits in 2014 as a result of the Affordable Care Act.

medicareSince the enactment of the Affordable Care Act, 9.4 million seniors and people with disabilities have saved over $15 billion on prescription drugs, an average of $1,598 per beneficiary. In 2014 alone, nearly 5.1 million seniors and people with disabilities saved $4.8 billion or an average of $941 per beneficiary. These figures are higher than in 2013, when 4.3 million saved $3.9 billion, for an average of $911 per beneficiary.

Use of preventive services has also expanded among people with Medicare. An estimated 39 million people with Medicare (including those enrolled in Medicare Advantage) took advantage of at least one preventive service with no cost sharing in 2014. In contrast, in 2013, an estimated 37.2 million people with Medicare received one or more preventive benefits with no cost sharing. In 2014, nearly 4.8 million people with traditional Medicare took advantage of the Annual Wellness Exam, which exceeds the comparable figure from 2013, in which over 4 million took advantage of the exam.

“Thanks to the Affordable Care Act, seniors and people with disabilities have saved over $15 billion on prescription drugs, and these savings will only increase over time as we close the Medicare coverage gap known as the donut hole,” said HHS Secretary Sylvia M. Burwell. “By providing access to affordable prescription drugs and preventive services with no cost sharing, the Affordable Care Act is working for seniors to help keep them healthier.”

As part of the Department’s “better care, smarter spending, healthier people” approach to improving health delivery, providing affordable prescription drugs and certain preventive services with no-cost sharing are some of the many initiatives advanced by the Affordable Care Act. To achieve better care, smarter spending and healthier people, HHS is focused on three key areas: (1) linking payment to quality of care, (2) improving and innovating in care delivery, and (3) sharing information more broadly to providers, consumers, and others to support better decisions while maintaining privacy. Today’s news comes on the heels of Secretary Burwell’s recent announcement that HHS is setting measurable goals and a timeline to move Medicare toward paying providers based on the quality, rather than the quantity of care they give patients.

Closing the prescription drug “donut hole”

The Affordable Care Act makes Medicare prescription drug coverage more affordable by gradually closing the gap in coverage where beneficiaries had to pay the full cost of their prescriptions out of pocket, before catastrophic coverage for prescriptions took effect. The gap is known as the donut hole. The donut hole will be closed by 2020, marking 2015 as the halfway point.

Because of the health care law, in 2010, anyone with a Medicare prescription drug plan who reached the prescription drug donut hole received a $250 rebate. In 2011, beneficiaries in the donut hole began receiving discounts on covered brand-name drugs and savings on generic drugs.

People with Medicare Part D who fall into the donut hole in 2015 will receive discounts and savings of 55 percent on the cost of brand name drugs and 35 percent on the cost of generic drugs.

For state-by-state information on discounts in the donut hole, CLICK HERE.

For more information about Medicare prescription drug benefits, CLICK HERE.

Medicare preventive services

The Affordable Care Act eliminated coinsurance and the Part B deductible for recommended preventive services covered by Medicare, including many cancer screenings and other important benefits. By making certain preventive services available with no cost sharing, the Affordable Care Act is helping Americans take charge of their own health. By removing barriers to prevention, Americans and health care professionals can better prevent illness, detect problems early when treatment works best, and monitor health conditions.

For state-by-state information on utilization of preventive services at no cost to Medicare beneficiaries, CLICK HERE.


Note: All HHS press releases, fact sheets and other news materials are available at http://www.hhs.gov/news.

Like HHS on Facebook, follow HHS on Twitter @HHSgov, and sign up for HHS Email Updates.

Last revised: February 24, 2015

HHS announces important Medicare information for people in same-sex marriages

Dept. of Health & Human Services

04/03/2014

Today, the Department of Health and Human Services (HHS) announced that the Social Security Administration (SSA) is now able to process requests for Medicare Part A and Part B Special Enrollment Periods, and reductions in Part B and premium Part A late enrollment penalties for certain eligible people in same-sex marriages. This is another step HHS is taking in response to the June 26, 2013 Supreme Court ruling in U.S. v. Windsor, which held section 3 of the Defense of Marriage Act (DOMA) unconstitutional. Because of this ruling, Medicare is no longer prevented by DOMA from recognizing same-sex marriages for determining entitlement to, or eligibility, for Medicare.

Read more about today’s announcement here …

POPVOX’s Countdown of the Top Bills in 2013


I frequently use POPVOX to explore information about a bill — what’s in the text of a bill, who introduced it, what other’s are saying about, who those others are (individuals and corporations/organizations) — and to write a letter of opposition or support to my elected representatives.  My observation is that the right-wing nut jobs have more of a propensity to support/oppose legislation than do reasonable folks.  Those of us who oppose the right-wing agenda need to become more active and vocal so our elected representatives in Congress understand they need to support us too — not just the very loud and radical right wing base.

Here’s a copy of an email I received today from POPVOX itemizing the top 50 bills that garnered the most activity on POPVOX during the first half of the 113th Congress:

by RACHNA on DECEMBER 31, 2013

Members of Congress introduced more than 6,600 bills and resolutions in 2013. The Second Amendment and gun control legislation dominated the top bills list, the majority of which were introduced in the beginning of the year. Not surprisingly, the Affordable Care Act, or “Obamacare,” was also a top priority among POPVOX users, and also the House has voted to repeal some or all of it nearly 50 times.  

The Countdown of the Top 50 Bills

Together, POPVOX users from every state and Congressional district sent more than 900,000 messages to their lawmakers in Washington. These are the top 50 bills and proposals that POPVOX users weighed in on with Congress in 2013, ranked by the aggregate number of combined support and opposition.

  • HR 321
    #50 Firearm Safety and Public Health Research Act

    Would allow the Centers for Disease Control (CDC) and the National Institutes of Health (NIH) to conduct crucial scientific research into firearm safety, according to bill sponsor, Rep. Carolyn Maloney (D-NY). 

    146 Support | 3,076 Oppose

  • HR 1369
    #49 Firearm Risk Protection Act

    Would require gun buyers to have liability insurance coverage before being allowed to purchase a weapon and imposes a fine of $10,000 if an owner is found not to have the required coverage; service members and law enforcement officers are exempt from this insurance requirement, according to bill sponsor, Rep. Carolyn Maloney (D-NY).

    99 Support | 3,157 Oppose

  • HR 965
    #48 Banning Saturday Night Specials

    Would prohibit the possession or transfer of junk guns, also known as Saturday Night Specials.

    152 Support | 3,133 Oppose

  • HR 900
    #47 Cancel the Sequester Act

    A one-sentence bill that would cancel the sequester, or across-the-board federal spending cuts that were implemented in 2013.

    2,406 Support | 899 Oppose

  • HR 890
    #46 Preserving Work Requirements for Welfare Programs Act

    Extends the Temporary Assistance for Needy Families (TANF) program through December 2013 and overturns President Obama’s efforts to waive welfare work requirements, according to House Majority Leader Eric Cantor (R-VA). This bill passed in the House on March 13, 2013, and is awaiting consideration by the Senate.

    3,208 Support | 120 Oppose

  • HR 1005
    #45 Defund Obamacare Act

    To deauthorize appropriation of funds, and to rescind unobligated appropriations, to carry out the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010.

    2,905 Support | 478 Oppose

  • HR 1094
    #44 Safeguard American Food Exports Act

    To prohibit the sale or transport of equines and equine parts in interstate or foreign commerce for human consumption.

    2,727 Support | 707 Oppose

  • HR 61
    #43 Title X Abortion Provider Prohibition Act

    Would stop the Department of Health and Human Services (HHS) from providing federal family planning assistance under Title X to abortion businesses until they certify they won’t provide and refer for abortions, according to bill sponsor, Rep. Marsha Blackburn (R-TN).

    934 Support | 2,513 Oppose

  • HR 431
    #42 Gun Transparency and Accountability (Gun TRAC) Act

    Would once again allow ATF to use information on guns traced to crimes; it would remove the requirement that background checks be destroyed within 24 hours; and it would eliminate the ban on federally required inventory audits of gun dealerships, according to bill sponsor, Rep. Jackie Speier(D-CA).   

    102 Support | 3,348 Oppose

  • HR 793
    #41 Firearm Safety and Buyback Grant Act

    Would establish a grant program within the Department of Justice in which grants would be eligible to state, tribal, and local units of government and law enforcement agencies to carry out anti-violence campaigns, gun safety campaigns, and firearms buyback programs, according to bill sponsor, Rep. Linda Sanchez (D-CA).

    98 Support | 3,370 Oppose

  • HR 2959
    #40 National Right-to-Carry Reciprocity Act

    To amend title 18, United States Code, to provide a national standard in accordance with which nonresidents of a State may carry concealed firearms in the State. This bill was passed by the House in the 112th Congress, but hasn’t been voted on in this Congress.

    3,106 Support | 385 Oppose

  • HR 236
    #39 Crackdown on Deadbeat Gun Dealers Act

    Would increase the ability of the Bureau of Alcohol, Tobacco, Firearms and Explosives (ATF) to: Inspect federal firearms licensees (FFLs) for compliance with recordkeeping requirements by increasing the allowable inspections per year from one to three; Increase the penalties for knowingly misrepresenting any facts about a firearms sale; and Authorize the Attorney General to suspend a dealer’s license and assess civil penalties for firearms violations, including failure to have secure gun storage or safety devices, according to bill sponsor, Rep. Jim Langevin (D-RI).

    184 Support | 3,319 Oppose

  • Guns
    #38 Toomey-Schumer-Manchin Amendment

    A bipartisan group of senators — Sen. Pat Toomey (R-PA), Sen. Chuck Schumer (D-NY) and Sen.Joe Manchin (D-WV) — introduced a compromise proposal to expand background checks. The proposal would require states and the federal government to send all necessary records on criminals and the violently mentally ill to the National Instant Criminal Background Check System (NICS). It also extends the existing background check system to gun shows and online sales. The Senate rejected the proposal in a 54 to 46 vote on April 17, 2013 — six votes short of the 60 needed.

    197 Support | 3,343 Oppose

  • S 47
    #37 Violence Against Women Reauthorization Act

    To reauthorize the Violence Against Women Act of 1994, and includes measures on campus safety, tools to reduce domestic violence homicides, and protections for at-risk groups such as immigrants, tribal victims and members of the LGBT community, according to bill sponsors, Sen. Patrick Leahy(D-VT) and Sen. Mike Crapo (R-ID). This bill was enacted into law after being signed by the President on March 7, 2013.

    573 Support | 3,008 Oppose

  • S 374
    #36 Fix Gun Checks Act

    To ensure that all individuals who should be prohibited from buying a firearm are listed in the national instant criminal background check system and require a background check for every firearm sale.Reported by Committee on Mar 12, 2013, and is awaiting consideration by the full Senate.

    218 Support | 3,532 Oppose

  • HR 45
    #35 Repeal “Obamacare”

    To repeal the Patient Protection and Affordable Care Act and health care-related provisions in the Health Care and Education Reconciliation Act of 2010. This bill passed in the House on May 16, 2013 by a 229-195 vote, and is awaiting consideration by the Senate.

    2,970 Support | 899 Oppose

  • HR 238
    #34 Fire Sale Loophole Closing Act

    Would prohibit gun dealers whose licenses are revoked to convert their inventory to personal collections, to be sold without conducting background checks on purchasers, under current law, according to bill sponsor, Rep. David Cicilline (D-RI).

    178 Support | 3,714 Oppose

  • HR 35
    #33 Safe Schools Act

    Would repeal federal laws mandating “gun free zones” around schools, according to bill sponsor, Rep. Steve Stockman (R-TX).

    3,970 Support | 185 Oppose

  • HR 538
    #32 PLEA Act

    To protect the Nation’s law enforcement officers by banning the Five-seveN Pistol and 5.7 x 28mm SS190, SS192, SS195LF, SS196, and SS197 cartridges, testing handguns and ammunition for capability to penetrate body armor, and prohibiting the manufacture, importation, sale, or purchase of such handguns or ammunition by civilians.

    143 Support | 4,051 Oppose

  • HR 575
    #31 Second Amendment Protection Act

    Would prohibit funding to the United Nations unless the President can certify that a United Nations treaty does not infringe on individual rights protected by the Constitution, according to bill sponsor, Rep. Steve Stockman (R-TX). 

    4,083 Support | 145 Oppose

  • HR 437
    #30 Assault Weapons Ban

    Would ban the future sale, transfer, manufacture and importation of 157 specific kinds of semi-automatic guns and impose the same restrictions on ammunition magazines that contain more than 10 rounds. Excludes 2,258 legitimate hunting and sporting rifles and shotguns by specific make and model, according to bill sponsor, Rep. Carolyn McCarthy (D-NY).

    160 Support | 4,227 Oppose

  • S 815
    #29 Employment Non-Discrimination Act

    To prohibit employment discrimination on the basis of sexual orientation or gender identity. This bill passed in the Senate on November 7, 2013 by a 64 to 32 vote, and is awaiting consideration by the House.

    233 Support | 4,178 Oppose

  • HR 227
    #28 Buyback Our Safety Act

    To establish a gun buyback grant program.

    134 Support | 4,292 Oppose

  • S 2
    #27 Sandy Hook Elementary School Violence Reduction Act

    To reduce violence and protect the citizens of the United States.

    169 Support | 4,357 Oppose

  • HR 25
    #26 Fair Tax Act

    Would repeal all Federal corporate and individual income taxes, payroll taxes, self-employment taxes, capital gains taxes, the death tax, and gift taxes – and replace them with a revenue-neutral personal consumption tax, according to bill sponsor, Rep. Rob Woodall (R-GA). 

    4,219 Support | 333 Oppose

  • HR 226
    #25 Support Assault Firearms Elimination and Reduction for our Streets Act

    To amend the Internal Revenue Code of 1986 to allow a credit against tax for surrendering to authorities certain assault weapons.

    143 Support | 4,488 Oppose

  • S 174
    #24 Ammunition Background Check Act

    To appropriately restrict sales of ammunition.

    187 Support | 4,769 Oppose

  • S 336
    #23 Marketplace Fairness Act

    Would give states the option to require the collection of sales and use taxes already owed under State law by out-of-state businesses, rather than rely on consumers to remit those taxes to the States—the method of tax collection to which they are now restricted, according to bill sponsor, Sen. Mike Enzi (R-WY).

    205 Support | 4,861 Oppose

  • HR 137
    #22 Fix Gun Checks Act

    To ensure that all individuals who should be prohibited from buying a firearm are listed in the national instant criminal background check system and require a background check for every firearm sale.

    522 Support | 4,595 Oppose

  • S 147
    #21 Common Sense Concealed Firearms Permit Act

    To establish minimum standards for States that allow the carrying of concealed firearms.

    215 Support | 5,017 Oppose

  • S 34
    #20 Denying Firearms and Explosives to Dangerous Terrorists Act

    To increase public safety by permitting the Attorney General to deny the transfer of firearms or the issuance of firearms and explosives licenses to known or suspected dangerous terrorists.

    390 Support | 4,842 Oppose

  • S 22
    #19 Gun Show Background Check Act

    To establish background check procedures for gun shows.

    442 Support | 5,049 Oppose

  • S 82
    #18 Separation of Powers Restoration & Second Amendment Protection Act

    To provide that any executive action infringing on the Second Amendment has no force or effect, and to prohibit the use of funds for certain purposes.

    5,728 Support | 243 Oppose

  • HR 410
    #17 Restore the Constitution Act

    To provide that any executive action infringing on the Second Amendment has no force or effect, and to prohibit the use of funds for certain purposes.

    5,914 Support | 263 Oppose

  • HR 499
    #16 Ending Federal Marijuana Prohibition Act

    To decriminalize marijuana at the Federal level, to leave to the States a power to regulate marijuana that is similar to the power they have to regulate alcohol.

    5,824 Support | 420 Oppose

  • S 35
    #15 Stop Online Ammunition Sales Act

    To require face to face purchases of ammunition, to require licensing of ammunition dealers, and to require reporting regarding bulk purchases of ammunition.

    308 Support | 6,558 Oppose

  • S 33
    #14 Large Capacity Ammunition Feeding Device Act

    To prohibit the transfer or possession of large capacity ammunition feeding devices.

    324 Support | 6,863 Oppose

  • HR 65
    #13 Child Gun Safety and Gun Access Prevention Act

    Raising the age of legal handgun ownership to 21.

    514 Support | 7,193 Oppose

  • HR 21
    #12 NRA Members Gun Safety Act

    To provide for greater safety in the use of firearms.

    536 Support | 7,770 Oppose

  • HR 34
    #11 Blair Holt Firearm Licensing and Record of Sale Act

    To provide for the implementation of a system of licensing for purchasers of certain firearms and for a record of sale system for those firearms.

    362 Support | 8,402 Oppose

  • HR 141
    #10 Gun Show Loophole Closing Act

    To require criminal background checks on all firearms transactions occurring at gun shows.

    1,406 Support | 7,591 Oppose

  • HR 2682
    #9 Defund Obamacare Act

    To prohibit the funding of the Patient Protection and Affordable Care Act.

    9,365 Support | 307 Oppose

  • S 150
    #8 Assault Weapons Ban

    To regulate assault weapons, to ensure that the right to keep and bear arms is not unlimited.

    633 Support | 9,409 Oppose

  • HR 142
    #7 Stop Online Ammunition Sales Act

    To require face to face purchases of ammunition, to require licensing of ammunition dealers, and to require reporting regarding bulk purchases of ammunition.

    617 Support | 9,508 Oppose

  • HR 117
    #6 Handgun Licensing and Registration Act

    To provide for the mandatory licensing and registration of handguns.

    553 Support | 9,619 Oppose

  • HR 133
    #5 Citizens Protection Act

    To repeal the Gun-Free School Zones Act of 1990 and amendments to that Act.

    9,671 Support | 651 Oppose

  • HR 138
    #4 Large Capacity Ammunition Feeding Device Act

    To prohibit the transfer or possession of large capacity ammunition feeding devices.

    756 Support | 10,828 Oppose

  • S 744
    #3 Border Security, Economic Opportunity and Immigration Modernization Act

    To provide for comprehensive immigration reform. This bill passed in the Senate on June 27, 2013 and is awaiting consideration by the House.

    1,385 Support | 10,212 Oppose

  • HJRes 15
    #2 Repealing the 22nd Amendment

    Proposing an amendment to the US Constitution to repeal the twenty-second article of amendment, thereby removing the limitation on the number of terms an individual may serve as President.

    151 Support | 12,984 Oppose

  • S 649
    #1 Safe Communities, Safe Schools Act

    To ensure that all individuals who should be prohibited from buying a firearm are listed in the national instant criminal background check system and require a background check for every firearm sale.

    304 Support | 14,110 Oppose

Why Are American Health Care Costs So High?

By the incomparable John Green, who says the following about his sources: “For a much more thorough examination of health care expenses in America, I recommend this series at The Incidental Economist and The Commonwealth Fund’s Study of Health Care Prices in the U.S. Some of the stats in this video also come from this New York Times story.”