thefiscaltimes--2020-02-12--When Your Doctor Is Also a Lobbyist: Inside the War Over Surprise Medical Bills

When Carol Pak-Teng , an emergency room doctor in New Jersey , hosted a fundraiser in December for Democratic freshman Rep. Tom Malinowski , her guests , mostly doctors , were pleased when she steered the conversation to surprise medical bills .
This was a chance to send a message to Washington that any surprise billing legislation should protect doctors ’ incomes in their battle over payments with insurers .
Lawmakers are grappling over several approaches to curtail the practice , which can leave patients on the hook for huge medical bills , even if they have insurance .
As @ @ @ @ @ @ @ there is evidence the doctors ’ message has been received : The bills with the most momentum are making more and more concessions to physicians .
As surprise medical billing has emerged as a hot-button issue for voters , doctors , hospitals and insurers have been lobbying to protect their own money flows .
All that lobbying meant nothing got passed last year .
Television and internet ads are the most visible manifestation of the battle .
But in taking their cause to politicians , doctors like Pak-Teng have waged an extraordinary on-the-ground @ @ @ @ @ @ @ Congress .
Their professional credentials give them a kind of gravitas compared with other lobbyists , who are merely hired guns .
Ending the practice of billing patients for the amount of their treatment not covered by insurance — sometimes triggered by unwittingly seeing a doctor out of network — is ultimately a fight between doctors and insurers over rate-setting and reimbursement .
But as more patients balk at surprise bills — or suffer the enormous financial strain — lawmakers are under pressure to protect patients .
In turn , powerful lobbying forces @ @ @ @ @ @ @ who don ’ t want to pay the price for a fix .
The main message physicians are using to bring lawmakers into their corner ?
“ We just want to be paid a fair amount for the services rendered , ” Pak-Teng said .
Her congressman , Malinowski , has not endorsed any surprise billing legislation .
In congressional testimony in July , he cited the “ extra $ 420 million ” in medical debt patients in New Jersey reckon with each year .
“ There are many things that Republicans and @ @ @ @ @ @ @ , ” he said .
“ I don ’ t think that this is one of them .
I don ’ t see any philosophical difference amongst us about whether people should be stuck with massive surprise medical bills.
” Doctors say they are taking the brunt of the criticism .
But little has been as powerful in shaping surprise billing legislation as the clout of hospitals and their doctors , many of whom are , in fact , employed by private equity-backed companies and armed with years of experience shaping surprise billing @ @ @ @ @ @ @ are throwing in a lot of money , too , funneling millions to lawmakers ahead of the 2020 elections .
Four physician organizations that have heavily lobbied on surprise medical bills and have private equity ties — the American College of Emergency Physicians , Envision Healthcare , US Acute Care Solutions and U.S. Anesthesia Partners — gave roughly $ 1.1 million in 2019 to members of Congress , according to a Kaiser Health News analysis of Federal Election Commission records .
The biggest recipients , from all four PACs combined , were Reps. @ @ @ @ @ @ @ Democrats who got $ 26,000 each .
Sen. Thom Tillis ( R-N.C. ) took in $ 25,500 , Senate Majority Leader Mitch McConnell got $ 25,000 , and Rep. Brett Guthrie ( R-Ky. ) received $ 22,500 .
That was in tandem with a ground game led by local doctors .
ER doctors , anesthesiologists , radiologists and other specialists who most often charge out-of-network prices — and also are among the highest-compensated practitioners — fanned out to shape legislation in a way that maintains their pay , and to voice their concern @ @ @ @ @ @ @ too much leverage to control their compensation .
“ We by necessity place a tremendous amount of trust in our physicians , ” said Zack Cooper , an assistant professor at Yale University who has extensively researched surprise medical bills .
“ Frankly , they have an easier time lobbying members [ of Congress ] than the folks who are affected by surprise billing.
” Lawmakers in both parties appear unified on the need to resolve the problem of surprise billing .
But as was clear when all the air blew out of @ @ @ @ @ @ @ ’ s end , that is largely where the agreement ends .
Fixing the problem comes down to settling on a system for deciding how much to pay for a disputed bill .
One approach is to set up an outside arbitration process , in which doctors and insurance companies would negotiate payment — this is the model preferred by doctors , who contend it puts them on better footing against insurance companies .
Another option would be to resolve surprise billing disputes by having insurance companies pay doctors based on the median @ @ @ @ @ @ @ approach known as benchmarking .
Large employers , labor unions and insurance companies prefer this .
The failure to get legislation through Congress set up a potentially explosive battle in an election year .
Republicans and Democrats who have vowed to do something about health care costs must reckon with powerful industry groups whose influence transcends party lines .
Meanwhile , physicians and hospitals have made their case in Washington and back home through in-person meetings and phone calls with lawmakers and congressional staff .
They ’ ve hosted dinners and fundraisers and @ @ @ @ @ @ @ in-person meetings .
They ’ ve even led tours of their emergency rooms .
Pak-Teng is among them , coming to Washington this month with other physicians to petition lawmakers .
She is employed by Envision , a physician staffing company backed by private equity firm KKR .
She ’ s also on the board of the American Academy of Emergency Medicine , a trade organization representing ER doctors .
“ There is a lot of anti-physician rhetoric out there , ” said Pak-Teng , who is pushing her physician colleagues to be @ @ @ @ @ @ @ sharing stories about the reality of caring for patients .
The lobbying by hospitals and physicians trying to protect their reimbursements has divided key lawmakers , compounding disagreements among senior House Democrats over the policy details of a bill and turf wars in Congress .
Three House committees have now unveiled legislation to ban surprise medical bills , each with different details .
“ We are not trying to stop legislation .
We are trying to stop bad legislation , ” said Anthony Cirillo , an emergency medicine physician who describes a “ @ @ @ @ @ @ @ insurance companies over doctors .
Cirillo is also a lobbyist for US Acute Care Solutions , a physician staffing company backed by private equity firm Welsh , Carson , Anderson & Stowe .
WCAS , which manages $ 27 billion in assets and is focused on health care and technology investments , is based in New York City and co-founded US Acute Care Solutions in 2015 .
In an interview , Cirillo said he met with lawmakers and their aides about “ 10 to 12 times ” in Washington last year .
Financial @ @ @ @ @ @ @ July and September lobbying on surprise billing on behalf of US Acute Care Solutions .
USACS ’ political committee also contributed $ 134,500 to lawmakers in 2019 , according to FEC records .
Before the private equity-fueled dark-money group Doctor Patient Unity started running ads warning of the dangers of government price controls as an argument against legislation , surprise billing legislation being drafted in one of Congress ’ most powerful health care committees was already tilting to be more favorable to doctors .
“ People on the Hill are very sympathetic to @ @ @ @ @ @ @ actually providing the care itself , ” said one Democratic aide , speaking on the condition of anonymity to candidly describe sensitive political dynamics .
“ Nobody wants to defend the insurers.
” In May , a House Energy and Commerce Committee draft proposal included no mention of outside arbitration .
The same was true for a bill the Senate Health , Education , Labor and Pensions Committee approved in June .
Instead , under those proposals , surprise billing disputes would be resolved by insurance companies paying doctors based on similar rates @ @ @ @ @ @ @ though — roughly a week before Doctor Patient Unity registered as a business in Virginia — the Energy and Commerce legislation was amended to allow doctors to appeal to an independent arbiter if their payments exceed $ 1,250 .
The revision was pushed by two physicians on the committee — Democrat Raul Ruiz of California and Republican Larry Bucshon of Indiana — and was a moment Sherif Zaafran , a Texas anesthesiologist , describes as a “ turning point ” in negotiations over the bill .
“ It ’ s all about fairness @ @ @ @ @ @ @ for private equity-backed U.S. Anesthesia Partners .
He has been involved for a decade in surprise billing fights in Texas , which enacted a new law with an arbitration process last year .
U.S. Anesthesia Partners gave $ 197,900 in campaign contributions to members of Congress last year .
Zaafran chaired another coalition of medical specialists , Physicians for Fair Coverage , in 2019 , and pressured Congress to pursue a surprise billing approach modeled on a New York law under which insurers and providers rely on arbitration .
Under that process , @ @ @ @ @ @ @ doctors and insurers , the two sides submit a proposed dollar amount to an independent mediator , who then selects one .
In New York , the mediators were told to base their decisions on the 80th percentile of the prices set by the hospital or physician .
Research has suggested that the model is broadly making health care more expensive for state residents because of higher payments to doctors , according to findings from the USC-Brookings Schaeffer Initiative for Health Policy .
Still , on Capitol Hill , doctors complained that many @ @ @ @ @ @ @ qualify for arbitration as proposed in the Energy and Commerce bill , bolstered by data ER doctors presented to lawmakers showing that prices mainly fall below $ 1,250 .
“ It ’ s largely out of reach , ” said Laura Wooster , a lobbyist with the American College of Emergency Physicians , whose political action committee contributed $ 708,000 to lawmakers in 2019 .
“ The problem with a threshold is , you just have one threshold .
It ’ s going to impact different specialties so differently.
” By December , @ @ @ @ @ @ @ Sen. Lamar Alexander , a Republican who chairs the Senate HELP Committee , agreed to lower the arbitration threshold to $ 750 as part of a bipartisan agreement on a bill .
Notably , several hospital lobbying organizations , such as the American Hospital Association and the Greater New York Hospital Association — the latter a strong financial backer of Senate Minority Leader Chuck Schumer — refused to back the deal .
Pak-Teng and other physicians also say that arbitration threshold is still too high .
The House Education and Labor Committee has @ @ @ @ @ @ @ framework .
“ I ’ m open to listening to all sides on this , ” Rep. Greg Walden of Oregon , the top Republican on the House Energy and Commerce Committee , said in an interview .
“ We want to make sure doctors are adequately compensated.
” Walden had harsh words for private equity firms that have attacked the Energy and Commerce legislation in a series of TV and internet ads , saying they were “ misleading and scaring people ” and just made lawmakers dig in deeper .
The ads @ @ @ @ @ @ @ committee Chairman Frank Pallone ( D-N.J. ) into how the companies have influenced surprise billing practices .
“ I ’ m not trying to hurtle a rock at them , but they ’ ve been throwing a few my way , ” he said .
Arvind Venkat , a Pittsburgh emergency physician employed by US Acute Care Solutions , traveled to Washington multiple times last year to meet with congressional offices representing Pennsylvania .
But he also made sure to bring up surprise bills on his home turf , giving his congressman , @ @ @ @ @ @ @ of the emergency room at Allegheny General Hospital last summer .
“ There are two issues here , ” said Venkat , who leads the Pennsylvania chapter of the American College of Emergency Physicians and has practiced at Allegheny General for 12 years .
“ Patients need to be protected , [ and ] we need to avoid anything that disrupts in-network relationships between insurers and clinicians.
” The call seems to have been heard : Legislation is likely to change further this year as the House Ways and Means Committee pushes an @ @ @ @ @ @ @ doctors .
It builds off a one-page document committee leaders issued Dec. 11 that blunted momentum for a bipartisan deal that was to be included in a December spending bill .
The latest proposal from the committee includes an arbitration process to resolve payment disputes , with no minimum dollar amount needed to trigger it , and doesn ’ t ban surprise billing from air ambulance companies — a win for yet another special-interest lobbying group .
The patient protections would not take effect until 2022 .
Richard Neal , a Massachusetts Democrat @ @ @ @ @ @ @ ally of Massachusetts hospitals .
He released the brief December surprise billing document two days after the Massachusetts Medical Society and Massachusetts Hospital Association wrote a joint op-ed in The Boston Globe arguing that benchmarking physician payments — as the Senate HELP and Energy and Commerce deal would do — would wreck the state ’ s health care system .
“ The heavy hand of government would create an unfair imbalance in the health care marketplace and insurers would have no incentive to engage physicians in building robust health care networks .
The @ @ @ @ @ @ @ been working toward in Massachusetts would immediately become fragmented and disjointed , ” the two groups wrote in The Boston Globe .
“ They weren ’ t asking for favorable treatment .
They were asking for fair treatment , and there ’ s a big difference , ” Neal said in an interview .
“ I don ’ t want to rule anything out , but I think that the momentum right now is arbitration.
” “ We need to get a little bit more balance , ” added Shalala , who endorsed @ @ @ @ @ @ @ this month .
Shalala has at least two hospitals in her Miami-area district that rely on private equity-supported physician staffing companies .
“ I ’ m worried about the hospitals , ” she said .
“ And the providers obviously include the docs .
”

When Carol Pak-Teng, an emergency room doctor in New Jersey, hosted a fundraiser in December for Democratic freshman Rep. Tom Malinowski, her guests, mostly doctors, were pleased when she steered the conversation to surprise medical bills.
This was a chance to send a message to Washington that any surprise billing legislation should protect doctors’ incomes in their battle over payments with insurers. Lawmakers are grappling over several approaches to curtail the practice, which can leave patients on the hook for huge medical bills, even if they have insurance.
As Congress begins its 2020 legislative session, there is evidence the doctors’ message has been received: The bills with the most momentum are making more and more concessions to physicians.
As surprise medical billing has emerged as a hot-button issue for voters, doctors, hospitals and insurers have been lobbying to protect their own money flows. All that lobbying meant nothing got passed last year.
Television and internet ads are the most visible manifestation of the battle. But in taking their cause to politicians, doctors like Pak-Teng have waged an extraordinary on-the-ground stealth campaign to win over members of Congress. Their professional credentials give them a kind of gravitas compared with other lobbyists, who are merely hired guns.
Ending the practice of billing patients for the amount of their treatment not covered by insurance — sometimes triggered by unwittingly seeing a doctor out of network — is ultimately a fight between doctors and insurers over rate-setting and reimbursement. But as more patients balk at surprise bills — or suffer the enormous financial strain — lawmakers are under pressure to protect patients. In turn, powerful lobbying forces have activated to protect doctors and insurers who don’t want to pay the price for a fix.
The main message physicians are using to bring lawmakers into their corner? “We just want to be paid a fair amount for the services rendered,” Pak-Teng said.
Her congressman, Malinowski, has not endorsed any surprise billing legislation. In congressional testimony in July, he cited the “extra $420 million” in medical debt patients in New Jersey reckon with each year.
“There are many things that Republicans and Democrats sincerely disagree about in this body,” he said. “I don’t think that this is one of them. I don’t see any philosophical difference amongst us about whether people should be stuck with massive surprise medical bills.”
Doctors say they are taking the brunt of the criticism.
But little has been as powerful in shaping surprise billing legislation as the clout of hospitals and their doctors, many of whom are, in fact, employed by private equity-backed companies and armed with years of experience shaping surprise billing legislation at the state level.
They are throwing in a lot of money, too, funneling millions to lawmakers ahead of the 2020 elections. Four physician organizations that have heavily lobbied on surprise medical bills and have private equity ties — the American College of Emergency Physicians, Envision Healthcare, US Acute Care Solutions and U.S. Anesthesia Partners — gave roughly $1.1 million in 2019 to members of Congress, according to a Kaiser Health News analysis of Federal Election Commission records.
The biggest recipients, from all four PACs combined, were Reps. Donna Shalala and Stephanie Murphy, Florida Democrats who got $26,000 each. Sen. Thom Tillis (R-N.C.) took in $25,500, Senate Majority Leader Mitch McConnell got $25,000, and Rep. Brett Guthrie (R-Ky.) received $22,500.
That was in tandem with a ground game led by local doctors. ER doctors, anesthesiologists, radiologists and other specialists who most often charge out-of-network prices — and also are among the highest-compensated practitioners — fanned out to shape legislation in a way that maintains their pay, and to voice their concern to lawmakers that insurance companies would have too much leverage to control their compensation.
“We by necessity place a tremendous amount of trust in our physicians,” said Zack Cooper, an assistant professor at Yale University who has extensively researched surprise medical bills. “Frankly, they have an easier time lobbying members [of Congress] than the folks who are affected by surprise billing.”
Arguing Over The Fix
Lawmakers in both parties appear unified on the need to resolve the problem of surprise billing. But as was clear when all the air blew out of legislative proposals on the table at year’s end, that is largely where the agreement ends.
Fixing the problem comes down to settling on a system for deciding how much to pay for a disputed bill. One approach is to set up an outside arbitration process, in which doctors and insurance companies would negotiate payment — this is the model preferred by doctors, who contend it puts them on better footing against insurance companies. Another option would be to resolve surprise billing disputes by having insurance companies pay doctors based on the median in-network rate for the service, an approach known as benchmarking. Large employers, labor unions and insurance companies prefer this.
The failure to get legislation through Congress set up a potentially explosive battle in an election year. Republicans and Democrats who have vowed to do something about health care costs must reckon with powerful industry groups whose influence transcends party lines.
Meanwhile, physicians and hospitals have made their case in Washington and back home through in-person meetings and phone calls with lawmakers and congressional staff. They’ve hosted dinners and fundraisers and organized fly-ins to swarm Capitol Hill with in-person meetings. They’ve even led tours of their emergency rooms.
Pak-Teng is among them, coming to Washington this month with other physicians to petition lawmakers. She is employed by Envision, a physician staffing company backed by private equity firm KKR. She’s also on the board of the American Academy of Emergency Medicine, a trade organization representing ER doctors.
“There is a lot of anti-physician rhetoric out there,” said Pak-Teng, who is pushing her physician colleagues to be more active in shaping public policy by sharing stories about the reality of caring for patients.
The lobbying by hospitals and physicians trying to protect their reimbursements has divided key lawmakers, compounding disagreements among senior House Democrats over the policy details of a bill and turf wars in Congress. Three House committees have now unveiled legislation to ban surprise medical bills, each with different details.
“We are not trying to stop legislation. We are trying to stop bad legislation,” said Anthony Cirillo, an emergency medicine physician who describes a “bad” bill as one that favors insurance companies over doctors.
Cirillo is also a lobbyist for US Acute Care Solutions, a physician staffing company backed by private equity firm Welsh, Carson, Anderson & Stowe. WCAS, which manages $27 billion in assets and is focused on health care and technology investments, is based in New York City and co-founded US Acute Care Solutions in 2015.
In an interview, Cirillo said he met with lawmakers and their aides about “10 to 12 times” in Washington last year. Financial disclosures show he spent $340,000 between July and September lobbying on surprise billing on behalf of US Acute Care Solutions. USACS’ political committee also contributed $134,500 to lawmakers in 2019, according to FEC records.
Tilt Toward Doctors
Before the private equity-fueled dark-money group Doctor Patient Unity started running ads warning of the dangers of government price controls as an argument against legislation, surprise billing legislation being drafted in one of Congress’ most powerful health care committees was already tilting to be more favorable to doctors.
“People on the Hill are very sympathetic to hospitals and physicians because they’re actually providing the care itself,” said one Democratic aide, speaking on the condition of anonymity to candidly describe sensitive political dynamics. “Nobody wants to defend the insurers.”
In May, a House Energy and Commerce Committee draft proposal included no mention of outside arbitration. The same was true for a bill the Senate Health, Education, Labor and Pensions Committee approved in June. Instead, under those proposals, surprise billing disputes would be resolved by insurance companies paying doctors based on similar rates in that area.
By mid-July, though — roughly a week before Doctor Patient Unity registered as a business in Virginia — the Energy and Commerce legislation was amended to allow doctors to appeal to an independent arbiter if their payments exceed $1,250. The revision was pushed by two physicians on the committee — Democrat Raul Ruiz of California and Republican Larry Bucshon of Indiana — and was a moment Sherif Zaafran, a Texas anesthesiologist, describes as a “turning point” in negotiations over the bill.
“It’s all about fairness,” said Zaafran, who works for private equity-backed U.S. Anesthesia Partners. He has been involved for a decade in surprise billing fights in Texas, which enacted a new law with an arbitration process last year. U.S. Anesthesia Partners gave $197,900 in campaign contributions to members of Congress last year.
Zaafran chaired another coalition of medical specialists, Physicians for Fair Coverage, in 2019, and pressured Congress to pursue a surprise billing approach modeled on a New York law under which insurers and providers rely on arbitration. Under that process, if there is a payment dispute between doctors and insurers, the two sides submit a proposed dollar amount to an independent mediator, who then selects one.
In New York, the mediators were told to base their decisions on the 80th percentile of the prices set by the hospital or physician. Research has suggested that the model is broadly making health care more expensive for state residents because of higher payments to doctors, according to findings from the USC-Brookings Schaeffer Initiative for Health Policy.
Still, on Capitol Hill, doctors complained that many procedures would fail to cost enough to qualify for arbitration as proposed in the Energy and Commerce bill, bolstered by data ER doctors presented to lawmakers showing that prices mainly fall below $1,250.
“It’s largely out of reach,” said Laura Wooster, a lobbyist with the American College of Emergency Physicians, whose political action committee contributed $708,000 to lawmakers in 2019. “The problem with a threshold is, you just have one threshold. It’s going to impact different specialties so differently.”
By December, House Energy and Commerce Committee leaders and Sen. Lamar Alexander, a Republican who chairs the Senate HELP Committee, agreed to lower the arbitration threshold to $750 as part of a bipartisan agreement on a bill. Notably, several hospital lobbying organizations, such as the American Hospital Association and the Greater New York Hospital Association — the latter a strong financial backer of Senate Minority Leader Chuck Schumer — refused to back the deal.
Pak-Teng and other physicians also say that arbitration threshold is still too high. The House Education and Labor Committee has unveiled surprise billing legislation with a similar framework.
“I’m open to listening to all sides on this,” Rep. Greg Walden of Oregon, the top Republican on the House Energy and Commerce Committee, said in an interview. “We want to make sure doctors are adequately compensated.”
Walden had harsh words for private equity firms that have attacked the Energy and Commerce legislation in a series of TV and internet ads, saying they were “misleading and scaring people” and just made lawmakers dig in deeper. The ads prompted a bipartisan probe from Walden and committee Chairman Frank Pallone (D-N.J.) into how the companies have influenced surprise billing practices.
“I’m not trying to hurtle a rock at them, but they’ve been throwing a few my way,” he said.
What’s Coming
Arvind Venkat, a Pittsburgh emergency physician employed by US Acute Care Solutions, traveled to Washington multiple times last year to meet with congressional offices representing Pennsylvania. But he also made sure to bring up surprise bills on his home turf, giving his congressman, freshman Democrat Conor Lamb, a tour of the emergency room at Allegheny General Hospital last summer.
“There are two issues here,” said Venkat, who leads the Pennsylvania chapter of the American College of Emergency Physicians and has practiced at Allegheny General for 12 years. “Patients need to be protected, [and] we need to avoid anything that disrupts in-network relationships between insurers and clinicians.”
The call seems to have been heard: Legislation is likely to change further this year as the House Ways and Means Committee pushes an approach that is friendlier to hospitals and doctors. It builds off a one-page document committee leaders issued Dec. 11 that blunted momentum for a bipartisan deal that was to be included in a December spending bill.
The latest proposal from the committee includes an arbitration process to resolve payment disputes, with no minimum dollar amount needed to trigger it, and doesn’t ban surprise billing from air ambulance companies — a win for yet another special-interest lobbying group. The patient protections would not take effect until 2022.
Richard Neal, a Massachusetts Democrat who chairs the committee, remains an ally of Massachusetts hospitals. He released the brief December surprise billing document two days after the Massachusetts Medical Society and Massachusetts Hospital Association wrote a joint op-ed in The Boston Globe arguing that benchmarking physician payments — as the Senate HELP and Energy and Commerce deal would do — would wreck the state’s health care system.
“The heavy hand of government would create an unfair imbalance in the health care marketplace and insurers would have no incentive to engage physicians in building robust health care networks. The connected system of care we have all been working toward in Massachusetts would immediately become fragmented and disjointed,” the two groups wrote in The Boston Globe.
“They weren’t asking for favorable treatment. They were asking for fair treatment, and there’s a big difference,” Neal said in an interview. “I don’t want to rule anything out, but I think that the momentum right now is arbitration.”
“We need to get a little bit more balance,” added Shalala, who endorsed the Ways and Means legislation unveiled earlier this month.
Shalala has at least two hospitals in her Miami-area district that rely on private equity-supported physician staffing companies.
“I’m worried about the hospitals,” she said. “And the providers obviously include the docs.”
Victoria Knight contributed to this story.


thefiscaltimes--2020-02-11--In Search of the ‘Disappearing Corporate Income Tax’

Lawmakers clashed on Tuesday over the performance of the 2017 Tax Cuts and Jobs Act in a House Ways and Means Committee hearing titled “ The Disappearing Corporate Income Tax , ” with Democrats arguing that the law was far too generous to big business when it slashed the top corporate tax rate from 35 % to 21 % .
“ Twenty years ago , we had a budget surplus , ” Rep. Richard Neal ( D-MA ) said in his opening remarks .
“ Corporate tax revenues were twice as high as they are today .
Now , corporations @ @ @ @ @ @ @ corporate tax revenues are at their lowest level in history outside of a major recession.
” Jason Furman , one of three Democratic witnesses at the hearing , said in his prepared remarks that corporate income tax revenues equaled 1.1 % of GDP in 2019 , a level that “ this is near the lowest since the 1930s ( outside of recessions or their immediate aftermaths ) .
U.S. corporate taxes are less than one half their historic average.
” He also noted that corporate tax revenue as a share of GDP in @ @ @ @ @ @ @ any of the top 30 developed countries – except for Latvia .
Furman , who served as President Obama ’ s chairman of the Council of Economic Advisers and is now a professor at the Harvard Kennedy School , said the low level of corporate income tax revenues were a big part of why overall tax collections relative to the size of the economy are near 50-year lows , coming to 16.3 % of GDP in 2019 , down from 17.2 % in 2017 .
And the long-term revenue losses are likely to @ @ @ @ @ @ @ said , citing a recent update to the Congressional Budget Office ’ s cost estimate for the tax cuts .
CBO ’ s original analysis put the total revenue loss from the tax package at $ 1.5 trillion over 10 years , but the most recent revision to the budget outlook now puts the cost at about $ 2 trillion , with much of the increase related to larger-than-expected revenue losses on the corporate side .
Those losses , driven by generous rule-writing and interpretations of the 2017 tax law by the U.S. @ @ @ @ @ @ @ were deemed “ tax cuts 2.0 ” by the liberal-leaning Institute on Taxation and Economic Policy .
( You can read more about the revision in a recent blog post from CBO director Phillip Swagel , and in this report on how corporate lobbying affected the interpretation of the tax law from Jesse Drucker and Jim Tankersley of The New York Times . )
For their part , Republicans rejected the entire line of inquiry , arguing that tax revenues are rising , U.S. businesses are now more competitive internationally and solid economic @ @ @ @ @ @ @ mean that the tax cuts are working just fine .
“ The whole premise of this hearing is false , ” said Rep. Kevin Brady ( R-TX ) , one of the architects of the Tax Cuts and Jobs Act .
“ Corporate taxes aren ’ t disappearing , they are growing — more than 12 % last year .
And according to CBO , corporate revenues are set to rise over the next decade both in real dollars and as a percent of GDP.
” Still , the sole Republican witness , @ @ @ @ @ @ @ now runs the conservative American Action Forum , couldn ’ t deny that the tax cuts have in fact reduced corporate tax revenues .
“ TCJA reduced corporate income tax receipts ; receipts in fiscal 2019 were $ 230 billion , down from $ 344 billion in 2015 .
This drop was to be expected , ” he said .
At the same time , Holtz-Eakin noted that the CBO projects a steady increase in corporate tax revenues in the coming years .
And he argued that it ’ s still too early @ @ @ @ @ @ @ tax package , which , while “ imperfect , ” deserves some degree of credit for recent economic performance .

Lawmakers clashed on Tuesday over the performance of the 2017 Tax Cuts and Jobs Act in a House Ways and Means Committee hearing titled “The Disappearing Corporate Income Tax,” with Democrats arguing that the law was far too generous to big business when it slashed the top corporate tax rate from 35% to 21%.
“Twenty years ago, we had a budget surplus,” Rep. Richard Neal (D-MA) said in his opening remarks. “Corporate tax revenues were twice as high as they are today. Now, corporations are paying less than ever, and corporate tax revenues are at their lowest level in history outside of a major recession.”
Jason Furman, one of three Democratic witnesses at the hearing, said in his prepared remarks that corporate income tax revenues equaled 1.1% of GDP in 2019, a level that “this is near the lowest since the 1930s (outside of recessions or their immediate aftermaths). U.S. corporate taxes are less than one half their historic average.” He also noted that corporate tax revenue as a share of GDP in the U.S. is now lower than in any of the top 30 developed countries – except for Latvia.
Furman, who served as President Obama’s chairman of the Council of Economic Advisers and is now a professor at the Harvard Kennedy School, said the low level of corporate income tax revenues were a big part of why overall tax collections relative to the size of the economy are near 50-year lows, coming to 16.3% of GDP in 2019, down from 17.2% in 2017.
And the long-term revenue losses are likely to be worse than first estimated, Furman said, citing a recent update to the Congressional Budget Office’s cost estimate for the tax cuts. CBO’s original analysis put the total revenue loss from the tax package at $1.5 trillion over 10 years, but the most recent revision to the budget outlook now puts the cost at about $2 trillion, with much of the increase related to larger-than-expected revenue losses on the corporate side.
Those losses, driven by generous rule-writing and interpretations of the 2017 tax law by the U.S. Treasury, are so substantial that they were deemed “tax cuts 2.0” by the liberal-leaning Institute on Taxation and Economic Policy. (You can read more about the revision in a recent blog post from CBO director Phillip Swagel, and in this report on how corporate lobbying affected the interpretation of the tax law from Jesse Drucker and Jim Tankersley of The New York Times.)
For their part, Republicans rejected the entire line of inquiry, arguing that tax revenues are rising, U.S. businesses are now more competitive internationally and solid economic growth over the last two years must mean that the tax cuts are working just fine. “The whole premise of this hearing is false,” said Rep. Kevin Brady (R-TX), one of the architects of the Tax Cuts and Jobs Act. “Corporate taxes aren’t disappearing, they are growing — more than 12% last year. And according to CBO, corporate revenues are set to rise over the next decade both in real dollars and as a percent of GDP.”
Still, the sole Republican witness, former CBO director Douglas Holtz-Eakin, who now runs the conservative American Action Forum, couldn’t deny that the tax cuts have in fact reduced corporate tax revenues. “TCJA reduced corporate income tax receipts; receipts in fiscal 2019 were $230 billion, down from $344 billion in 2015. This drop was to be expected,” he said. At the same time, Holtz-Eakin noted that the CBO projects a steady increase in corporate tax revenues in the coming years. And he argued that it’s still too early to make any final judgments on the tax package, which, while “imperfect,” deserves some degree of credit for recent economic performance.


thefiscaltimes--2020-02-07--Trump’s Company Charged Secret Service Hefty Rates for Stays: Report

The Secret Service paid President Trump ’ s company rates as high as $ 650 a night for rooms used by agents protecting the president , The Washington Post reports based on documents obtained under the Freedom of Information Act .
“ Those charges , compiled here for the first time , show that Trump has an unprecedented — and largely hidden — business relationship with his own government , ” the Post ’ s David A. Fahrenthold , Jonathan O'Connell , Carol D. Leonnig and Josh Dawsey write .
“ The records show more than $ 471,000 in payments @ @ @ @ @ @ @ .
But — because these records cover only a fraction of Trump ’ s travel during a fraction of his term — the actual total is likely to be higher.
” The Post notes that since taking office Trump has spent more than 342 days , or a third of his presidency , at his private clubs and hotels .
The Secret Service reportedly has failed to file some required reports detailing its spending to protect Trump at his properties , and the administration has stonewalled efforts by Democrats to get a full @ @ @ @ @ @ @ s travel .
Treasury Secretary Steven Mnuchin has sought to delay Secret Service disclosures until after the 2020 elections .
In a statement to the Post , the Secret Service said that its spending “ balances operational security with judicious allocation of resources.
” Why it matters : The records suggest that the president and his company are making significant money off taxpayers , despite assurances from the Trump Organization and the president ’ s family members that the government is only being charged minimal fees at Trump properties .
“ So everywhere @ @ @ @ @ @ @ at one of his places , the government actually spends , meaning it saves a fortune because if they were to go to a hotel across the street , they ’ d be charging them $ 500 a night , whereas , you know we charge them , like $ 50 , ” Eric Trump , the president ’ s son , said last year .
That appears to be untrue .
The Post says other recent presidents have allowed the Secret Service to use their properties for free , though former Vice @ @ @ @ @ @ @ a month in rent for a cottage on his property .
Biden was paid a total of $ 171,600 over six years .
Trump topped that total in less than three months .

The Secret Service paid President Trump’s company rates as high as $650 a night for rooms used by agents protecting the president, The Washington Post reports based on documents obtained under the Freedom of Information Act.
“Those charges, compiled here for the first time, show that Trump has an unprecedented — and largely hidden — business relationship with his own government,” the Post’s David A. Fahrenthold, Jonathan O'Connell, Carol D. Leonnig and Josh Dawsey write. “The records show more than $471,000 in payments from taxpayers to Trump’s companies. But — because these records cover only a fraction of Trump’s travel during a fraction of his term — the actual total is likely to be higher.”
The Post notes that since taking office Trump has spent more than 342 days, or a third of his presidency, at his private clubs and hotels.
The Secret Service reportedly has failed to file some required reports detailing its spending to protect Trump at his properties, and the administration has stonewalled efforts by Democrats to get a full accounting of the costs of Trump’s travel. Treasury Secretary Steven Mnuchin has sought to delay Secret Service disclosures until after the 2020 elections.
In a statement to the Post, the Secret Service said that its spending “balances operational security with judicious allocation of resources.”
Why it matters: The records suggest that the president and his company are making significant money off taxpayers, despite assurances from the Trump Organization and the president’s family members that the government is only being charged minimal fees at Trump properties. “So everywhere that he goes, if he stays at one of his places, the government actually spends, meaning it saves a fortune because if they were to go to a hotel across the street, they’d be charging them $500 a night, whereas, you know we charge them, like $50,” Eric Trump, the president’s son, said last year. That appears to be untrue.
The Post says other recent presidents have allowed the Secret Service to use their properties for free, though former Vice President Joe Biden did charge $2,200 a month in rent for a cottage on his property. Biden was paid a total of $171,600 over six years. Trump topped that total in less than three months.


thefiscaltimes--2020-02-12--Deficit Soars 25% Over First Four Months of Fiscal 2020

The federal budget deficit over the first four months of fiscal year 2020 totaled $ 389 billion , up more @ @ @ @ @ same period last year , according to data released Wednesday by the Treasury Department .
@ @ @ @ @ % while revenues have grown by 6.1 % .
The deficit over the past 12 @ @ @ @ @ .
The Treasury estimates that the deficit will top $ 1 trillion this year for @ @ @ @ @ , when the economy was still recovering from the Great Recession .

The federal budget deficit over the first four months of fiscal year 2020 totaled $389 billion, up more than 25% from the same period last year, according to data released Wednesday by the Treasury Department.
Spending has risen by 10% while revenues have grown by 6.1%.
The deficit over the past 12 months reached $1.06 trillion.
The Treasury estimates that the deficit will top $1 trillion this year for the first time since 2012, when the economy was still recovering from the Great Recession.


thefiscaltimes--2020-02-11--The $844 Billion Mystery in Trump’s Budget

Unlike in previous years , the White House budget proposal released Monday didn ’ t include a detailed plan to replace major portions of Obamacare .
It did include what Ricardo Alonso-Zaldivar of the Associated Press calls “ an $ 844 billion mystery pot.
” The dollar figure represents a target for savings over 10 years resulting from what the budget calls Trump ’ s “ health reform vision.
” And that vision remains as grand as it ’ s been since Trump was a candidate : “ The President ’ s great healthcare vision will ensure better care at @ @ @ @ @ @ @ .
“ Americans deserve affordable , personalized care that puts them in control and provides peace of mind .
The President ’ s healthcare reforms will protect the most vulnerable , especially those with pre-existing conditions , and provide the affordability , choice , and control Americans want , and the high-quality care that all Americans deserve.
” A vital campaign issue : Voters say that health care is a top issue in the 2020 elections , and it ’ s a vulnerability for Trump .
“ Despite the strong economy , the @ @ @ @ @ @ @ under Trump , and his eventual Democratic opponent is likely to have a plan to put the nation on a path to coverage for all , ” Alonso-Zaldivar writes .
“ Meanwhile , the White House is supporting a lawsuit to overturn the Obama-era Affordable Care Act , jeopardizing coverage for some 20 million people , as well as protections for those with pre-existing medical conditions.
” The $ 844 billion question : It ’ s not clear just how or whether the Trump administration proposes to achieve its promises .
But the @ @ @ @ @ @ @ in savings imply it would pursue large-scale changes .
“ Health reform always involves trade-offs , and those trade-offs become more apparent with details .
So , it 's not surprising that President Trump has avoided such details , ” Larry Levitt , executive vice president for health policy at the nonpartisan Kaiser Family Foundation , tweeted .
“ But , the level of health care spending cuts he is proposing would have severe consequences.
” As Margot Sanger-Katz of The New York Times explains : “ The deep cuts enshrined in the @ @ @ @ @ @ @ with modest tweaks .
Taken together with Medicaid changes recommended elsewhere in the budget , the proposal would strip about $ 1 trillion out of Medicaid and the Affordable Care Act ’ s premium subsidies , the two pillars of the law ’ s expansion of insurance coverage .
By 2029 , the cuts to those programs in Mr. Trump ’ s budget would represent around 85 percent of the total that the Congressional Budget Office estimates would otherwise be spent on Obamacare coverage that year.
” And Aviva Aron-Dine , the vice @ @ @ @ @ @ @ Center on Budget and Policy Priorities and a former Obama administration official , told the Times that the size of the projected cost savings don ’ t square with Trump ’ s promises to preserve existing patient protections .
“ You can ’ t cut $ 1 trillion from these programs and protect the most vulnerable , ” she said .
What Trump ’ s budget signals for health care : Trump ’ s budget proposes to reduce the growth in Medicare spending , but it does not propose cuts in Medicare benefits @ @ @ @ @ @ @ reducing program spending by around half a trillion dollars through a series of cuts to payment policies , it does not make any major changes to the benefit structure of the program or for the populations that will be eligible for coverage , ” Sanger-Katz notes .
On the other hand , the budget does signal that the administration would aim to cut Medicaid in ways that reduce coverage and benefits .
“ In Trump 's budget , Medicaid would grow somewhat , but at a rate much slower than underlying health care @ @ @ @ @ @ @ That would require cuts in the program or leave states holding the bag.
” The budget calls for Medicaid work requirements for “ able-bodied ” adults and for “ ending the financial bias that currently favors able-bodied working-age adults over the truly vulnerable ” in the program .
Alonso-Zaldivar says that jargon means that the administration would seek to repeal the generous federal matching funds for states expanding Medicaid to cover low-income adults under the Affordable Care Act .
The administration defended the Medicaid cuts to reporters .
“ The Budget protects and @ @ @ @ @ @ @ sustainable path , so it can continue to provide vital services to those who need it the most , including children , the disabled , elderly and pregnant women , ” one official told The Hill .
The bottom line : Trump ’ s budget does nothing to reduce his vulnerability on health care or counter attacks that his policies — particularly on Medicaid and the Affordable Care Act — would likely lead millions of people to lose coverage .
The cuts and savings it proposes play right into Democratic attacks , even @ @ @ @ @ @ @ his base .
“ President Trump has made clear his aim is to dramatically scale back federal health spending , ” Levitt said .
“ No matter who the Democratic nominee is , the choice will be quite stark .
”

Unlike in previous years, the White House budget proposal released Monday didn’t include a detailed plan to replace major portions of Obamacare. It did include what Ricardo Alonso-Zaldivar of the Associated Press calls “an $844 billion mystery pot.”
The dollar figure represents a target for savings over 10 years resulting from what the budget calls Trump’s “health reform vision.” And that vision remains as grand as it’s been since Trump was a candidate: “The President’s great healthcare vision will ensure better care at lower costs,” the budget says. “Americans deserve affordable, personalized care that puts them in control and provides peace of mind. The President’s healthcare reforms will protect the most vulnerable, especially those with pre-existing conditions, and provide the affordability, choice, and control Americans want, and the high-quality care that all Americans deserve.”
A vital campaign issue: Voters say that health care is a top issue in the 2020 elections, and it’s a vulnerability for Trump. “Despite the strong economy, the number of uninsured people has edged up under Trump, and his eventual Democratic opponent is likely to have a plan to put the nation on a path to coverage for all,” Alonso-Zaldivar writes. “Meanwhile, the White House is supporting a lawsuit to overturn the Obama-era Affordable Care Act, jeopardizing coverage for some 20 million people, as well as protections for those with pre-existing medical conditions.”
The $844 billion question: It’s not clear just how or whether the Trump administration proposes to achieve its promises. But the size of the projected $844 billion in savings imply it would pursue large-scale changes. “Health reform always involves trade-offs, and those trade-offs become more apparent with details. So, it's not surprising that President Trump has avoided such details,” Larry Levitt, executive vice president for health policy at the nonpartisan Kaiser Family Foundation, tweeted. “But, the level of health care spending cuts he is proposing would have severe consequences.”
As Margot Sanger-Katz of The New York Times explains:
“The deep cuts enshrined in the budget’s numbers are not consistent with modest tweaks. Taken together with Medicaid changes recommended elsewhere in the budget, the proposal would strip about $1 trillion out of Medicaid and the Affordable Care Act’s premium subsidies, the two pillars of the law’s expansion of insurance coverage. By 2029, the cuts to those programs in Mr. Trump’s budget would represent around 85 percent of the total that the Congressional Budget Office estimates would otherwise be spent on Obamacare coverage that year.”
And Aviva Aron-Dine, the vice president of health policy at the progressive Center on Budget and Policy Priorities and a former Obama administration official, told the Times that the size of the projected cost savings don’t square with Trump’s promises to preserve existing patient protections. “You can’t cut $1 trillion from these programs and protect the most vulnerable,” she said.
What Trump’s budget signals for health care: Trump’s budget proposes to reduce the growth in Medicare spending, but it does not propose cuts in Medicare benefits. “Though the budget does propose reducing program spending by around half a trillion dollars through a series of cuts to payment policies, it does not make any major changes to the benefit structure of the program or for the populations that will be eligible for coverage,” Sanger-Katz notes.
On the other hand, the budget does signal that the administration would aim to cut Medicaid in ways that reduce coverage and benefits. “In Trump's budget, Medicaid would grow somewhat, but at a rate much slower than underlying health care costs,” Levitt said. “That would require cuts in the program or leave states holding the bag.”
The budget calls for Medicaid work requirements for “able-bodied” adults and for “ending the financial bias that currently favors able-bodied working-age adults over the truly vulnerable” in the program. Alonso-Zaldivar says that jargon means that the administration would seek to repeal the generous federal matching funds for states expanding Medicaid to cover low-income adults under the Affordable Care Act.
The administration defended the Medicaid cuts to reporters. “The Budget protects and preserves Medicaid by putting it on a sustainable path, so it can continue to provide vital services to those who need it the most, including children, the disabled, elderly and pregnant women,” one official told The Hill.
The bottom line: Trump’s budget does nothing to reduce his vulnerability on health care or counter attacks that his policies — particularly on Medicaid and the Affordable Care Act — would likely lead millions of people to lose coverage. The cuts and savings it proposes play right into Democratic attacks, even as they might also hearten some in his base. “President Trump has made clear his aim is to dramatically scale back federal health spending,” Levitt said. “No matter who the Democratic nominee is, the choice will be quite stark.”


thefiscaltimes--2020-02-14--Point-Counterpoint: Bernie Sanders’ Big Spending Plans

Sen. Bernie Sanders , the current frontrunner for the Democratic presidential nomination , has proposed ambitious plans — most notably , a transition to a Medicare-for-All system — that would dramatically increase the size of the federal government .
The centrist Progressive Policy Institute estimated recently that Sanders has proposed more than $ 50 trillion in new spending , the most of any presidential candidate , and has laid out options for raising revenue to finance about half of that increase .
In a pair of newly published opinion pieces , USA Today ’ s editorial board debates such an @ @ @ @ @ @ @ research at the Economic Policy Institute , a progressive think tank .
Here ’ s a summary of the arguments : These proposals are a gift to Trump and the GOP : “ Republicans know that large segments of the electorate would be repelled by Sanders ’ vast expansion of government spending at a time when Uncle Sam is already running $ 1 trillion annual deficits and is more than $ 23 trillion in debt , ” the USA Today editorial board says .
Sanders ’ tax and spending plans aren ’ t @ @ @ @ @ @ @ them would only serve to lessen the chances of winning over suburban professionals , a critical bloc of voters .
“ For Democrats , this should pose a number of questions .
Foremost among them : Why are they spending so much time debating these costly , unrealistic plans when they should be focused on preserving Obamacare protections and the rule of law ?
” It ’ s time to tackle the problems the U.S. faces : Yes , Sanders ’ plans are ambitious .
“ The key thing people should realize , @ @ @ @ @ @ @ largely not introducing new costs on American families , ” Bivens writes .
“ Instead , they ’ re rearranging current costs already baked in , with an aim to managing them more fairly and efficiently.
” Medicare for All would replace our current premiums with taxes — and it could actually reduce the total costs of American health care , even as it gets more people covered , according to some analyses .
And not tackling climate change now will only cost us and future generations more later .
“ The United @ @ @ @ @ @ @ hugely pressing problems stemming from a past generation of rising inequality and a future of climate change .
Why would we not go for bold solutions ?
” Read the USA Today editorial here and the Bivens op-ed here .

Sen. Bernie Sanders, the current frontrunner for the Democratic presidential nomination, has proposed ambitious plans — most notably, a transition to a Medicare-for-All system — that would dramatically increase the size of the federal government. The centrist Progressive Policy Institute estimated recently that Sanders has proposed more than $50 trillion in new spending, the most of any presidential candidate, and has laid out options for raising revenue to finance about half of that increase.
In a pair of newly published opinion pieces, USA Today’s editorial board debates such an expansion with Josh Bivens, director of research at the Economic Policy Institute, a progressive think tank. Here’s a summary of the arguments:
These proposals are a gift to Trump and the GOP: “Republicans know that large segments of the electorate would be repelled by Sanders’ vast expansion of government spending at a time when Uncle Sam is already running $1 trillion annual deficits and is more than $23 trillion in debt,” the USA Today editorial board says.
Sanders’ tax and spending plans aren’t politically feasible, anyway, so embracing them would only serve to lessen the chances of winning over suburban professionals, a critical bloc of voters. “For Democrats, this should pose a number of questions. Foremost among them: Why are they spending so much time debating these costly, unrealistic plans when they should be focused on preserving Obamacare protections and the rule of law?”
It’s time to tackle the problems the U.S. faces: Yes, Sanders’ plans are ambitious. “The key thing people should realize, however, is that these plans are largely not introducing new costs on American families,” Bivens writes. “Instead, they’re rearranging current costs already baked in, with an aim to managing them more fairly and efficiently.”
Medicare for All would replace our current premiums with taxes — and it could actually reduce the total costs of American health care, even as it gets more people covered, according to some analyses. And not tackling climate change now will only cost us and future generations more later. “The United States is an enormously rich country with hugely pressing problems stemming from a past generation of rising inequality and a future of climate change. Why would we not go for bold solutions?”
Read the USA Today editorial here and the Bivens op-ed here.


thefiscaltimes--2020-02-12--Which States Rely Most on Federal Money?

About 23 % of total state revenues came from federal grants in the 2017 fiscal year , contributing to programs @ @ @ @ @ of issues including health care , education and infrastructure .
This map from the Tax @ @ @ @ @ states rank with respect to federal aid as a share of general revenue .
The @ @ @ @ @ on federal funds were Montana ( 46.1 % ) , Wyoming ( 44.5 % ) @ @ @ @ @ ) , Mississippi ( 43.3 % ) and Arizona ( 43.1 % ) .
The @ @ @ @ @ of federal funds relative to general revenue were Hawaii ( 20.7 % ) , Virginia @ @ @ @ @ Kansas ( 23.3 % ) , Utah ( 24.2 % ) and Minnesota ( 26.0 @ @ @

About 23% of total state revenues came from federal grants in the 2017 fiscal year, contributing to programs that touch on a range of issues including health care, education and infrastructure. This map from the Tax Foundation shows how the individual states rank with respect to federal aid as a share of general revenue. The states with the greatest reliance on federal funds were Montana (46.1%), Wyoming (44.5%), Louisiana (43.7%), Mississippi (43.3%) and Arizona (43.1%). The states with the smallest share of federal funds relative to general revenue were Hawaii (20.7%), Virginia (21.1%), Kansas (23.3%), Utah (24.2%) and Minnesota (26.0%).


thefiscaltimes--2020-02-12--Surprise Medical Bills Hit 1 in 5 After Surgery: Study

Even patients who plan their elective surgeries ahead of time — using in-network surgeons at in-network facilities — can receive unforeseen bills from out-of-network providers , according to a new study published Tuesday in JAMA .
Reviewing the files on nearly 350,000 patients with commercial insurance who underwent common elective surgeries such as hysterectomies and coronary artery bypass grafts , researchers found that about 20 % were hit with out-of-network charges .
The average outstanding balance on these so-called surprise medical bills was $ 2,011 .
Why the bills occur : Surprise bills came most frequently from surgical assistants and @ @ @ @ @ @ @ by the patient .
Patients with insurance plans purchased on the health insurance exchanges also had an increased risk of receiving out-of-network bills .
What it means for patients : “ The study highlights how common surprise billing is , even in a context where consumers may have an illusion of control over what they will have to pay , ” says NPR ’ s Elena Renken .
“ For elective surgeries , patients often have time to select in-network providers , but it did n't appear to make a difference.
” A @ @ @ @ @ @ @ published in JAMA Tuesday , Drs .
Karen Joynt Maddox and Edward Livingston called on doctors and lawmakers to address the problem , citing the ethical obligations of the medical profession .
“ Patients generally select surgeons because they have faith that the surgeon they choose will provide them with the best possible care , ” they wrote .
“ This crucial trust between patient and physician will be eroded if patients discover after an operation that they must pay large sums of money to other clinicians the surgeon has involved in their @ @ @ @ @ @ @ ensure that all the personnel involved in the care team that they are leading accept the same insurance plans and should consider refusing to work in facilities that allow surprise billing.
” Congress may – or may not – act : Legislation that would regulate surprise bills was under consideration last year and lawmakers from both parties say they want to do something about the problem .
But powerful lobbying groups representing the divergent interests of insurers , hospitals and physicians have pushed for different kinds of solutions , and no compromise has @ @ @ @ @ @ @ , a senior researcher at the Health Care Cost Institute , told NPR that Congress could make a deal this year .
`` It 's a rare case where both parties in Congress want to get something done , and we have examples of what a bipartisan agreement might look like , '' she said .
`` Just getting that far can often be difficult in health policy .
I 'm hopeful that they will take action . ''

Even patients who plan their elective surgeries ahead of time — using in-network surgeons at in-network facilities — can receive unforeseen bills from out-of-network providers, according to a new study published Tuesday in JAMA.
Reviewing the files on nearly 350,000 patients with commercial insurance who underwent common elective surgeries such as hysterectomies and coronary artery bypass grafts, researchers found that about 20% were hit with out-of-network charges. The average outstanding balance on these so-called surprise medical bills was $2,011.
Why the bills occur: Surprise bills came most frequently from surgical assistants and anesthesiologists, who are typically not selected by the patient. Patients with insurance plans purchased on the health insurance exchanges also had an increased risk of receiving out-of-network bills.
What it means for patients: “The study highlights how common surprise billing is, even in a context where consumers may have an illusion of control over what they will have to pay,” says NPR’s Elena Renken. “For elective surgeries, patients often have time to select in-network providers, but it didn't appear to make a difference.”
A call to act: In an editorial published in JAMA Tuesday, Drs. Karen Joynt Maddox and Edward Livingston called on doctors and lawmakers to address the problem, citing the ethical obligations of the medical profession. “Patients generally select surgeons because they have faith that the surgeon they choose will provide them with the best possible care,” they wrote. “This crucial trust between patient and physician will be eroded if patients discover after an operation that they must pay large sums of money to other clinicians the surgeon has involved in their care. When feasible, surgeons should ensure that all the personnel involved in the care team that they are leading accept the same insurance plans and should consider refusing to work in facilities that allow surprise billing.”
Congress may – or may not – act: Legislation that would regulate surprise bills was under consideration last year and lawmakers from both parties say they want to do something about the problem. But powerful lobbying groups representing the divergent interests of insurers, hospitals and physicians have pushed for different kinds of solutions, and no compromise has yet been reached.
Jean Fuglesten Biniek, a senior researcher at the Health Care Cost Institute, told NPR that Congress could make a deal this year. "It's a rare case where both parties in Congress want to get something done, and we have examples of what a bipartisan agreement might look like," she said. "Just getting that far can often be difficult in health policy. I'm hopeful that they will take action."


thefiscaltimes--2020-02-10--Trump’s $4.8 Trillion Fiscal Fantasy

Trump’s $4.8 Trillion Fiscal Fantasy

The Trump White House on Monday released a $ 4.8 trillion budget for 2021 that calls for steep reductions in spending on safety net programs including Medicaid while proposing greater outlays for the military and an extension of the 2017 Republican tax cuts .
The budget is almost certainly dead on arrival , with no chance of passing in the current Congress , but it signals the administration ’ s priorities for a possible second term while providing both Republicans and Democrats with political fodder heading into the 2020 election .
The administration ’ s budget is consistent with those @ @ @ @ @ @ @ though in ways that highlight how far the president has moved from his campaign platform in 2016 , which promised , among other things , cheaper health care for everyone , a border wall paid for by Mexico and the elimination of the national debt .
“ On immigration , health care , infrastructure and the deficit , the final budget pitch of Trump ’ s first term will look much different from the campaign platform he offered four years ago , ” Jeff Stein and Erica Werner of The Washington Post said @ @ @ @ @ @ @ trillion in spending reductions over 10 years , including $ 130 billion from changes to Medicare prescription-drug pricing ; $ 292 billion from reductions in safety net programs , some of which will adopt more stringent rules , including new work requirements for food stamps and housing assistance ; and $ 70 billion from tightening eligibility rules for disability benefits .
The cuts to Medicaid reportedly come to about $ 920 billion over 10 years .
“ A lot of these are smart , thoughtful reforms .
Many are bipartisan , and versions @ @ @ @ @ @ @ Goldwein , senior policy director at the Committee for a Responsible Federal Budget , told Bloomberg .
“ A number of them would actually reduce costs or improve the situation for beneficiaries of the programs , as well the budget.
” Other departments and agencies , meanwhile , would see increases , including a 13 % rise for the Department of Veterans Affairs , a 12 % boost for NASA and a 19 % jump for the National Nuclear Security Administration .
The budget seeks $ 2 billion in new funding for construction @ @ @ @ @ @ @ $ 5 billion the administration requested last year .
Here ’ s are some key points you need to know : Steep cuts in non-defense spending : Trump ’ s budget sticks to the $ 740.5 billion defense budget Congress agreed to as part of a two-year budget deal last summer .
But it calls for 7 % less in non-defense spending than the deal included , or $ 590 billion instead of $ 634.5 billion .
Non-defense discretionary programs would be cut by an additional 2 % each year thereafter , for @ @ @ @ @ @ @ reductions over a decade .
• A 21 % reduction in foreign aid , which would fall from $ 55.7 billion in 2020 to $ 44.1 billion in 2021 .
• A 37 % cut to Commerce Department , in part due to the completion of the 2020 census .
• A 9 % cut for the Centers for Disease Control and Prevention .
• A nearly 8 % cut to the Department of Education .
The budget is projected to balance in 15 years — even as the tax cuts are extended @ @ @ @ @ @ @ in deficit reduction over 10 years , with the bulk of that coming from the $ 4.4 trillion in spending cuts .
Even so , the gross national debt would rise to above $ 30 trillion over the next decade .
The White House says annual deficits would be eliminated in 15 years , although that projection is based on extremely optimistic assumptions about economic growth over the period .
The administration assumes a growth rate of 2.9 % over the coming decade , nearly 50 % higher than the 2 % growth @ @ @ @ @ @ @ .
And the elimination of the deficit is projected to occur even as the individual provisions in the Tax Cuts and Jobs Act , set to expire at the end of 2025 , are extended .
Allowing the tax cuts to remain in place is estimated to cost $ 1.4 trillion , though the administration also claims the new cuts will pay for themselves .
The Trump administration has also indicated that it could propose additional tax cuts later this year .
A missed opportunity ?
The president ’ s budget request won @ @ @ @ @ @ @ which has ignored or rebuffed Trump ’ s past attempts to slash domestic spending .
But Trump opted for a political messaging document rather than a more realistic effort to influence next year ’ s spending , Politico ’ s Jennifer Scholtes and Caitlin Emma suggest : “ Since Trump and congressional leaders already settled on new funding caps for the fiscal year ahead , this budget was the president ’ s big chance to give realistic feedback on how he wants Congress to divvy up that cash .
Instead , he burned @ @ @ @ @ @ @ fiscally conservative dream document lawmakers will largely disregard , though its cuts could please his base in November and get recycled should he win another four-year term.
” The political battle has already begun : The administration is portraying its budget in conventional conservative terms , saying it seeks to bring “ unsustainable ” federal spending “ under control.
” Chris Edwards of the right-libertarian Cato Institute praised the plans while calling for more aggressive spending cuts , writing Monday that , “ Most of the Trump cuts make sense , although larger @ @ @ @ @ @ @ the budget opens Trump up to plenty of attacks from the left .
Sen. Bernie Sanders , a leading contender for the Democratic presidential nomination and the ranking member of the Senate Budget Committee , excoriated the blueprint as “ an immoral document ” that shows Trump is a liar .
“ Just last week , President Trump told the American people in his State of the Union that he would ‘ always protect your Medicare ’ and ‘ always protect your Social Security .
Always , ’ ” Sanders said .
“ @ @ @ @ @ @ @ that cuts Medicare by half a trillion dollars .
It cuts Social Security by $ 24 billion , including an $ 11 billion cut in Social Security Disability benefits.
” Expect to hear much more of that no matter which Democrat gets the nomination .
Where there may be room for compromise : Administration officials reportedly acknowledge that , given the budget deal passed by Congress last year , this proposal will likely be a non-starter .
But the administration is targeting $ 135 billion in deficit reduction as a result of lower @ @ @ @ @ @ @ line with the budget score for a bipartisan drug-pricing bill from Sens .
Chuck Grassley ( R-IA ) and Ron Wyden ( D-OR ) .
The other election effect : “ Budget analysts expect lawmakers to punt final decisions on 2021 spending until after the November election , and instead fund the government with temporary spending measures for the first few months of the fiscal year , ” The Wall Street Journal ’ s Kate Davidson and Andrew Restuccia write .

The Trump White House on Monday released a $4.8 trillion budget for 2021 that calls for steep reductions in spending on safety net programs including Medicaid while proposing greater outlays for the military and an extension of the 2017 Republican tax cuts.
The budget is almost certainly dead on arrival, with no chance of passing in the current Congress, but it signals the administration’s priorities for a possible second term while providing both Republicans and Democrats with political fodder heading into the 2020 election.
The administration’s budget is consistent with those offered in the previous three years – though in ways that highlight how far the president has moved from his campaign platform in 2016, which promised, among other things, cheaper health care for everyone, a border wall paid for by Mexico and the elimination of the national debt. “On immigration, health care, infrastructure and the deficit, the final budget pitch of Trump’s first term will look much different from the campaign platform he offered four years ago,” Jeff Stein and Erica Werner of The Washington Post said Monday.
The budget proposes $4.4 trillion in spending reductions over 10 years, including $130 billion from changes to Medicare prescription-drug pricing; $292 billion from reductions in safety net programs, some of which will adopt more stringent rules, including new work requirements for food stamps and housing assistance; and $70 billion from tightening eligibility rules for disability benefits. The cuts to Medicaid reportedly come to about $920 billion over 10 years.
“A lot of these are smart, thoughtful reforms. Many are bipartisan, and versions appeared in Obama budgets,” Marc Goldwein, senior policy director at the Committee for a Responsible Federal Budget, told Bloomberg. “A number of them would actually reduce costs or improve the situation for beneficiaries of the programs, as well the budget.”
Other departments and agencies, meanwhile, would see increases, including a 13% rise for the Department of Veterans Affairs, a 12% boost for NASA and a 19% jump for the National Nuclear Security Administration. The budget seeks $2 billion in new funding for construction of border barriers, less than the $5 billion the administration requested last year.
Here’s are some key points you need to know:
Steep cuts in non-defense spending: Trump’s budget sticks to the $740.5 billion defense budget Congress agreed to as part of a two-year budget deal last summer. But it calls for 7% less in non-defense spending than the deal included, or $590 billion instead of $634.5 billion. Non-defense discretionary programs would be cut by an additional 2% each year thereafter, for a total of $1.9 trillion in reductions over a decade.
The cuts include:
A 21% reduction in foreign aid, which would fall from $55.7 billion in 2020 to $44.1 billion in 2021.
A 26.5% cut to the Environmental Protection Agency.
A 37% cut to Commerce Department, in part due to the completion of the 2020 census.
A 9% cut for the Centers for Disease Control and Prevention.
A 13.4% cut to the Interior Department.
A nearly 8% cut to the Department of Education.
The budget is projected to balance in 15 years — even as the tax cuts are extended: The budget projects $4.6 trillion in deficit reduction over 10 years, with the bulk of that coming from the $4.4 trillion in spending cuts. Even so, the gross national debt would rise to above $30 trillion over the next decade.
The White House says annual deficits would be eliminated in 15 years, although that projection is based on extremely optimistic assumptions about economic growth over the period. The administration assumes a growth rate of 2.9% over the coming decade, nearly 50% higher than the 2% growth rate or less predicted by most economists.
And the elimination of the deficit is projected to occur even as the individual provisions in the Tax Cuts and Jobs Act, set to expire at the end of 2025, are extended. Allowing the tax cuts to remain in place is estimated to cost $1.4 trillion, though the administration also claims the new cuts will pay for themselves. The Trump administration has also indicated that it could propose additional tax cuts later this year.
A missed opportunity? The president’s budget request won’t be approved by Congress, which has ignored or rebuffed Trump’s past attempts to slash domestic spending. But Trump opted for a political messaging document rather than a more realistic effort to influence next year’s spending, Politico’s Jennifer Scholtes and Caitlin Emma suggest: “Since Trump and congressional leaders already settled on new funding caps for the fiscal year ahead, this budget was the president’s big chance to give realistic feedback on how he wants Congress to divvy up that cash. Instead, he burned that opportunity in favor of penning another fiscally conservative dream document lawmakers will largely disregard, though its cuts could please his base in November and get recycled should he win another four-year term.”
The political battle has already begun: The administration is portraying its budget in conventional conservative terms, saying it seeks to bring “unsustainable” federal spending “under control.” Chris Edwards of the right-libertarian Cato Institute praised the plans while calling for more aggressive spending cuts, writing Monday that, “Most of the Trump cuts make sense, although larger entitlement reforms should be pursued.”
But the budget opens Trump up to plenty of attacks from the left. Sen. Bernie Sanders, a leading contender for the Democratic presidential nomination and the ranking member of the Senate Budget Committee, excoriated the blueprint as “an immoral document” that shows Trump is a liar. “Just last week, President Trump told the American people in his State of the Union that he would ‘always protect your Medicare’ and ‘always protect your Social Security. Always,’” Sanders said. “Today, President Trump released a budget that cuts Medicare by half a trillion dollars. It cuts Social Security by $24 billion, including an $11 billion cut in Social Security Disability benefits.” Expect to hear much more of that no matter which Democrat gets the nomination.
Where there may be room for compromise: Administration officials reportedly acknowledge that, given the budget deal passed by Congress last year, this proposal will likely be a non-starter. But the administration is targeting $135 billion in deficit reduction as a result of lower prescription drug prices — a number in line with the budget score for a bipartisan drug-pricing bill from Sens. Chuck Grassley (R-IA) and Ron Wyden (D-OR).
The other election effect: “Budget analysts expect lawmakers to punt final decisions on 2021 spending until after the November election, and instead fund the government with temporary spending measures for the first few months of the fiscal year,” The Wall Street Journal’s Kate Davidson and Andrew Restuccia write.


thefiscaltimes--2020-02-14--Would ‘Medicare For All’ Cost More Than U.S. Budget? Biden Says So. Math Says No

During the Feb. 7 Democratic presidential debate , former Vice President Joe Biden once again questioned the price tag of “ Medicare for All , ” the single-payer health care proposal championed by one of his key rivals , Sen. Bernie Sanders of Vermont .
Biden argued that the plan was fiscally irresponsible and would require raising middle-class taxes .
Specifically , he claimed , the plan “ would cost more than the entire federal budget that we spend now.
” Medicare for All ’ s price — and whether it ’ s worth it — is a subject of @ @ @ @ @ @ @ But we had never heard this figure before .
It caught our attention , so we decided to dig in .
Biden ’ s campaign directed us to the 2018 federal budget , which totaled $ 4.1 trillion .
It compared that amount with the estimated cost of Sanders ’ single-payer proposal : between $ 30 trillion and $ 40 trillion over a decade .
The math , they said , shows Medicare for All would cost more than the national budget .
But it turns out , based on the numbers and @ @ @ @ @ @ @ s comparison of Medicare for All ’ s price to total federal spending misses the mark because the calculation is flawed .
Sanders has said publicly that economists estimate Medicare for All would cost somewhere between $ 30 trillion and $ 40 trillion over 10 years .
Research by the nonpartisan Urban Institute , a Washington , D.C. , think tank , puts the figure in the $ 32 trillion to $ 34 trillion range .
We pointed out to Biden ’ s campaign that comparing 10-year spending estimates to one-year budgets is @ @ @ @ @ @ @ campaign suggested that if you take 10 times the current federal budget , you get a figure smaller than the estimated cost of Medicare for All over that 10-year window .
That calculation would lead you to multiply $ 4.1 trillion by 10 to get $ 41.1 trillion .
That result is close to the high mark Sanders set for his program ’ s cost but well above the $ 34 trillion that Urban researchers projected .
Still , that ’ s not the correct way to formulate a comparison , experts say @ @ @ @ @ @ @ math , ” said Marc Goldwein , the senior vice president and senior policy director at the Committee for a Responsible Federal Budget .
“ That ’ s taking a 2018 number and multiplying it by 10 , whereas the $ 34 trillion is a 10-year number that assumes a lot of growth.
” What you would need to do is add up the Congressional Budget Office ’ s projected budget outlays from 2020 to 2029 , and compare the sum to the Medicare for All spending figure .
So we spoke to @ @ @ @ @ @ @ Urban ’ s Health Policy Center , who arrived at the $ 34 trillion estimate .
She ran the CBO ’ s numbers : The next 10 years of on-budget outlay , the government office projects , add up to $ 44.8 trillion .
To be clear , $ 34 trillion ( 34 followed by 12 zeros ) is no small sum .
It accounts for about 75 % of that nearly $ 45 trillion budget estimate and would represent a bigger single increase to the federal budget than we ’ ve ever @ @ @ @ @ @ @ one point on which Biden may have some ground .
Goldwein argued that you would indeed need significant tax increases to finance the Sanders proposal .
But its price tag still would be less than the projected budget .
“ If he said [ Medicare for All ] was as big as the current federal budget , that would be incorrect , ” Blumberg said .
Goldwein looked at the numbers another way : Including interest , he found , the federal budget would consume about $ 55 trillion between now and 2030 @ @ @ @ @ @ @ than what Medicare for All would cost during the same period .
Big picture : No matter how you slice Biden ’ s math , his numbers are off .
“ If what he said was Medicare for All will cost as much as the entire rest of the budget , that would be fair , ” Goldwein said .
But that ’ s not the same thing .
Biden argued that Medicare for All “ would cost more than the entire federal budget that we spend now.
” This relies on faulty @ @ @ @ @ @ @ represent a substantial increase to the federal budget .
But it would neither match nor dwarf current federal spending overall .
We rate this claim False .
Kaiser Health News ( KHN ) is a national health policy news service .
It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente .

During the Feb. 7 Democratic presidential debate, former Vice President Joe Biden once again questioned the price tag of “Medicare for All,” the single-payer health care proposal championed by one of his key rivals, Sen. Bernie Sanders of Vermont.
Biden argued that the plan was fiscally irresponsible and would require raising middle-class taxes. Specifically, he claimed, the plan “would cost more than the entire federal budget that we spend now.”
Medicare for All’s price — and whether it’s worth it — is a subject of fierce discussion among Democratic presidential candidates. But we had never heard this figure before. It caught our attention, so we decided to dig in.
Biden’s campaign directed us to the 2018 federal budget, which totaled $4.1 trillion. It compared that amount with the estimated cost of Sanders’ single-payer proposal: between $30 trillion and $40 trillion over a decade. The math, they said, shows Medicare for All would cost more than the national budget.
But it turns out, based on the numbers and interviews with independent experts, Biden’s comparison of Medicare for All’s price to total federal spending misses the mark because the calculation is flawed.
The Numbers
Sanders has said publicly that economists estimate Medicare for All would cost somewhere between $30 trillion and $40 trillion over 10 years. Research by the nonpartisan Urban Institute, a Washington, D.C., think tank, puts the figure in the $32 trillion to $34 trillion range.
We pointed out to Biden’s campaign that comparing 10-year spending estimates to one-year budgets is like comparing apples to oranges. The campaign suggested that if you take 10 times the current federal budget, you get a figure smaller than the estimated cost of Medicare for All over that 10-year window.
That calculation would lead you to multiply $4.1 trillion by 10 to get $41.1 trillion. That result is close to the high mark Sanders set for his program’s cost but well above the $34 trillion that Urban researchers projected.
Still, that’s not the correct way to formulate a comparison, experts say. “That’s not good math,” said Marc Goldwein, the senior vice president and senior policy director at the Committee for a Responsible Federal Budget. “That’s taking a 2018 number and multiplying it by 10, whereas the $34 trillion is a 10-year number that assumes a lot of growth.”
What you would need to do is add up the Congressional Budget Office’s projected budget outlays from 2020 to 2029, and compare the sum to the Medicare for All spending figure.
So we spoke to Linda Blumberg, an institute fellow at Urban’s Health Policy Center, who arrived at the $34 trillion estimate. She ran the CBO’s numbers: The next 10 years of on-budget outlay, the government office projects, add up to $44.8 trillion.
To be clear, $34 trillion (34 followed by 12 zeros) is no small sum. It accounts for about 75% of that nearly $45 trillion budget estimate and would represent a bigger single increase to the federal budget than we’ve ever experienced, Blumberg said.
That raises one point on which Biden may have some ground. Goldwein argued that you would indeed need significant tax increases to finance the Sanders proposal.
But its price tag still would be less than the projected budget.
“If he said [Medicare for All] was as big as the current federal budget, that would be incorrect,” Blumberg said.
Goldwein looked at the numbers another way: Including interest, he found, the federal budget would consume about $55 trillion between now and 2030. Again, that’s more than what Medicare for All would cost during the same period.
Big picture: No matter how you slice Biden’s math, his numbers are off.
“If what he said was Medicare for All will cost as much as the entire rest of the budget, that would be fair,” Goldwein said. But that’s not the same thing.
Our Ruling
Biden argued that Medicare for All “would cost more than the entire federal budget that we spend now.”
This relies on faulty math. Medicare for All would certainly represent a substantial increase to the federal budget. But it would neither match nor dwarf current federal spending overall. We rate this claim False.
Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.


thefiscaltimes--2020-02-13--Why Pete Buttigieg’s Deficit Talk Scares the Left

Pete Buttigieg has sparked a strong backlash from the left by suggesting that Democrats should take a firm stand on the importance of the national debt .
For months now , Buttigieg has urged Democrats to embrace debt and deficit concerns .
`` I think the time has come for my party to get a lot more comfortable owning this issue , ” Buttigieg said in New Hampshire over the weekend , ahead of a strong second place finish in the state ’ s primary .
“ Because I see what 's happening under this president — a $ 1 @ @ @ @ @ @ @ Congress do not care .
So we have to do something about it.
” Buttigieg also has urged progressives in his party to focus on the issue even as they seek to enact a bold policy agenda .
“ It ’ s not fashionable in progressive circles to talk too much about the debt , largely because of the irritation to the way it ’ s been used as an excuse against investment , ” he said .
“ But if we ’ re spending more and more on debt service now , @ @ @ @ @ @ @ infrastructure and health and safety net that we need right now.
” The emphasis on the debt may be a way to differentiate himself from Sen. Bernie Sanders , the Democratic frontrunner and Buttigieg ’ s main rival in Iowa and New Hampshire voting — and it could be his way of laying claim to President Obama ’ s centrist fiscal approach .
“ Mayor Pete ’ s just showing how far he ’ s willing to go to out-centrist the rest with his deficit comments , ” blogger Allahpundit suggested at conservative @ @ @ @ @ @ @ course , by insisting on fiscal responsibility , he ’ s underlining the blowout deficits that Bernie Sanders ’ s agenda would saddle America with.
” Buttigieg is the only candidate among leading Democratic contenders to have fully offset the cost of his agenda , according to a recent study by the centrist Progressive Policy Institute ( the study didn ’ t look at Sen. Amy Klobuchar ’ s proposals ) .
The political question , though , is to what extent his emphasis on the debt will really resonate with a Democratic @ @ @ @ @ @ @ agenda , or with voters who believe — with ample evidence to back them up — that the mantra of “ fiscal responsibility ” has simply been a tool employed by hypocritical Republicans to prevent the enactment of Democratic priorities .
The pushback from some on the left to Buttigieg ’ s embrace of debt and deficit concerns has been forceful , even harsh .
• At The American Prospect , which labels Buttigieg “ Austerity Pete , ” Alexander Sammon writes : “ Buttigieg ’ s sudden pivot to deficit-hawk politics is @ @ @ @ @ @ @ of recent political and economic history .
Virtually all of the party ’ s disparate factions understand that there simply isn ’ t a deficit problem worth obsessing over at this time , and making such noises only serves to restrict progressive ambitions .
That Buttigieg is taking his cues from the worst minds in politics when it comes to the federal budget only heightens his wrongheadedness.
” • Over at New York , Eric Levitz offers a lengthy and detailed takedown , slamming both Buttigieg and the Beltway orthodoxy surrounding the idea @ @ @ @ @ @ @ now clear that the United States could have easily afforded to run higher deficits than it did during the Obama years .
Which means that our political leaders subjected the American people to years of unnecessary economic hardship for no good reason , while the Democratic Party needlessly preserved $ 1.5 trillion in fiscal space ( that could have been used to accelerate clean-energy development or eradicate child poverty ) for Obama ’ s Republican successor to fill with giveaways to the rich .
“ Any politician who does not understand that this @ @ @ @ @ @ @ s deficits — or else , who pretends not to understand in deference to popular prejudice — has no business being our next president.
” But while Buttigieg ’ s rhetoric has opened him up to such attacks from the left that he hasn ’ t grasped — or has alarmingly chosen to ignore — the fiscal lessons of the past decade , his actual proposals represent a much different approach than deficit hawks favored as recently as several years ago .
As Jordan Weissmann reports at Slate : “ Pete Buttigieg is @ @ @ @ @ @ @ But he does play one on the stump .
… Traditionally , centrist fiscal hawks tend to argue that Washington needs to raise taxes and rein in entitlement spending just to make our current suite of federal programs sustainable .
Buttigieg , in contrast , mostly just talks about raising taxes , primarily to pay for new spending.
” Buttigieg wants to expand Social Security benefits and government health care programs .
And a Buttigieg spokesperson , in answering questions from Weissmann , clarified that the candidate ’ s approach would be quite @ @ @ @ @ @ @ “ Pete would not support Bowles-Simpson or any type of agreement that would lead to any cuts to Social Security or a ‘ Grand Bargain ’ that would lead to irresponsible cuts to critical programs .
Instead , Pete ’ s proposed a bold , progressive agenda , including expanding Social Security Benefits , and he ’ s outlined sources of revenue that would fully pay for his agenda that include higher taxes on corporations and the top 2 % .
” Weissman nevertheless argues that , while the candidate might be looking @ @ @ @ @ @ @ Trump , Buttigieg “ is breathing life back into the discredited ideology of austerity ” and likely doing “ much more harm than good for the progressive cause .
”

Pete Buttigieg has sparked a strong backlash from the left by suggesting that Democrats should take a firm stand on the importance of the national debt.
For months now, Buttigieg has urged Democrats to embrace debt and deficit concerns. "I think the time has come for my party to get a lot more comfortable owning this issue,” Buttigieg said in New Hampshire over the weekend, ahead of a strong second place finish in the state’s primary. “Because I see what's happening under this president — a $1 trillion deficit — and his allies in Congress do not care. So we have to do something about it.”
Buttigieg also has urged progressives in his party to focus on the issue even as they seek to enact a bold policy agenda. “It’s not fashionable in progressive circles to talk too much about the debt, largely because of the irritation to the way it’s been used as an excuse against investment,” he said. “But if we’re spending more and more on debt service now, it makes it harder to invest in infrastructure and health and safety net that we need right now.”
The emphasis on the debt may be a way to differentiate himself from Sen. Bernie Sanders, the Democratic frontrunner and Buttigieg’s main rival in Iowa and New Hampshire voting — and it could be his way of laying claim to President Obama’s centrist fiscal approach.
“Mayor Pete’s just showing how far he’s willing to go to out-centrist the rest with his deficit comments,” blogger Allahpundit suggested at conservative site Hot Air. “And of course, by insisting on fiscal responsibility, he’s underlining the blowout deficits that Bernie Sanders’s agenda would saddle America with.”
Buttigieg is the only candidate among leading Democratic contenders to have fully offset the cost of his agenda, according to a recent study by the centrist Progressive Policy Institute (the study didn’t look at Sen. Amy Klobuchar’s proposals).
The political question, though, is to what extent his emphasis on the debt will really resonate with a Democratic electorate eager to push through a progressive agenda, or with voters who believe — with ample evidence to back them up — that the mantra of “fiscal responsibility” has simply been a tool employed by hypocritical Republicans to prevent the enactment of Democratic priorities.
The pushback from some on the left to Buttigieg’s embrace of debt and deficit concerns has been forceful, even harsh.
At The American Prospect, which labels Buttigieg “Austerity Pete,” Alexander Sammon writes: “Buttigieg’s sudden pivot to deficit-hawk politics is deeply misguided and evinces a profound misunderstanding of recent political and economic history. Virtually all of the party’s disparate factions understand that there simply isn’t a deficit problem worth obsessing over at this time, and making such noises only serves to restrict progressive ambitions. That Buttigieg is taking his cues from the worst minds in politics when it comes to the federal budget only heightens his wrongheadedness.”
Over at New York, Eric Levitz offers a lengthy and detailed takedown, slamming both Buttigieg and the Beltway orthodoxy surrounding the idea of fiscal responsibility: “It is now clear that the United States could have easily afforded to run higher deficits than it did during the Obama years. Which means that our political leaders subjected the American people to years of unnecessary economic hardship for no good reason, while the Democratic Party needlessly preserved $1.5 trillion in fiscal space (that could have been used to accelerate clean-energy development or eradicate child poverty) for Obama’s Republican successor to fill with giveaways to the rich.
“Any politician who does not understand that this is the true lesson of Trump’s deficits — or else, who pretends not to understand in deference to popular prejudice — has no business being our next president.”
But while Buttigieg’s rhetoric has opened him up to such attacks from the left that he hasn’t grasped — or has alarmingly chosen to ignore — the fiscal lessons of the past decade, his actual proposals represent a much different approach than deficit hawks favored as recently as several years ago. As Jordan Weissmann reports at Slate:
“Pete Buttigieg is not much of a deficit hawk. But he does play one on the stump. … Traditionally, centrist fiscal hawks tend to argue that Washington needs to raise taxes and rein in entitlement spending just to make our current suite of federal programs sustainable. Buttigieg, in contrast, mostly just talks about raising taxes, primarily to pay for new spending.”
Buttigieg wants to expand Social Security benefits and government health care programs. And a Buttigieg spokesperson, in answering questions from Weissmann, clarified that the candidate’s approach would be quite different than President Obama’s:
“Pete would not support Bowles-Simpson or any type of agreement that would lead to any cuts to Social Security or a ‘Grand Bargain’ that would lead to irresponsible cuts to critical programs. Instead, Pete’s proposed a bold, progressive agenda, including expanding Social Security Benefits, and he’s outlined sources of revenue that would fully pay for his agenda that include higher taxes on corporations and the top 2%.”
Weissman nevertheless argues that, while the candidate might be looking to score political points against Sanders and Trump, Buttigieg “is breathing life back into the discredited ideology of austerity” and likely doing “much more harm than good for the progressive cause.”