Posts Tagged ‘healthcare’

GOP Eyes Tax Overhaul — And Lessons From Health-Care Failure

March 25, 2017

By Sahil Kapur
March 25, 2017, 5:00 AM EDT
Bloomberg News

Moments after their hopes of undoing Obamacare unraveled, President Donald Trump and top Republicans said in unison that they’re moving on to another ambitious goal — overhauling the U.S. tax code.

“We will probably start going very, very strongly for the big tax cuts and tax reform,” Trump said to reporters Friday after the House bill was pulled from a scheduled floor vote. “That will be next.”

Donald Trump speaks to members of the media on March 24.

Photographer: Olivier Douliery/Pool via Bloomberg

House Speaker Paul Ryan told reporters that Republicans will proceed with tax legislation — and said he met with Trump and Treasury Secretary Steven Mnuchin earlier on Friday to discuss taxes. Ryan sounded a note of caution: The health bill’s failure “does make tax reform more difficult,” he said, “but it doesn’t in any way make it impossible.”

Even before the health bill was withdrawn, two of the Trump administration’s top economic officials were shifting the conversation toward taxes. Mnuchin and White House Budget Director Mick Mulvaney both said Friday that the White House is at work on a plan for both individual and corporate tax changes that’s coming soon.

Still, Ryan’s frank assessment of his party’s missed opportunity on health care Friday afternoon might just as well apply to tax legislation. “Doing big things is hard,” the speaker told reporters.

That sentiment reflected the mood of some anxious and frustrated Republicans, who were unable to muster enough votes in their first major test of governing in the Trump era. Several lawmakers said a complete overhaul of the tax code — which hasn’t been done in more than 30 years — would be tougher in the wake of the American Health Care Act’s defeat, as might the rest of their agenda.

“We have to learn that we’re not just the party of no,” said Representative Steve Womack of Arkansas, a member of the House GOP’s whip team. “We have to learn how to govern.”

This month, Trump, a billionaire businessman who touted his expertise on tax-avoidance strategies during his campaign, had at times seemed wistful about letting tax issues take a back seat to health policy. On Monday, during a campaign-style rally in Louisville, he told the crowd: “We want a very big tax cut, but cannot do that until we keep our promise to repeal and replace the disaster known as Obamacare.”

Now, he and fellow Republicans will face heightened political pressure to deliver on taxes, and the president’s tactics may have to evolve, lawmakers said.

Presidential Lesson

“My guess is he has learned through this process that politics is different from business,” said Representative Bill Huizenga, a Michigan Republican, on Friday afternoon. Lawmakers answer to their constituents, not the president, he said. “There’s no ability to sit at a table and say ‘You’re fired.’”

One difference that’s already apparent: Lawmakers and administration officials seem inclined to take more time on tax legislation. The health-care bill was introduced, marked up, passed through committees and scheduled for a floor vote in just a few weeks. On taxes, House leaders have said they hope to pass a bill by August. Top Republican senators say it may take longer than that.

It’s unclear how Trump will propose to change tax laws. On Feb. 9, he promised a “phenomenal” tax plan in two or three weeks. That was six weeks ago.

His tax proposals changed over the course of his campaign — by Election Day, his plan had moved closer to the blueprint that Ryan and other House leaders prefer. Both plans would consolidate the number of individual income-tax rates to three from the existing seven; the top rate would drop to 33 percent from 39.6 percent currently.

‘Massive’ Cut

Trump has said he wants a “massive” tax cut for the middle class, but independent analyses of the House tax blueprint have concluded that it would benefit high-earners far more.

On corporate taxes, Trump and Ryan have yet to forge an agreement — particularly over the controversial issue of “border adjustments.” Ryan favors replacing the existing 35 percent corporate income tax with a 20 percent tax rate on companies’ domestic sales and imports. Exports would be excluded.

That border-adjusted approach — which opponents say would increase consumer prices — has divided Trump’s White House advisers, and the president hasn’t yet announced a position on it. Leading Republican senators have also expressed reservations. Supporters say higher prices on imported goods would be offset over time by a strengthening dollar.

For all the controversy surrounding it, though, the border-adjustment concept would raise an estimated $1.1 trillion over 10 years, giving Republican tax-cutters breathing space for reducing the corporate rate. Losing that provision will make it more difficult to achieve revenue-neutral tax legislation, complicating its chances in the Senate.

Lower Baseline

The failed health-care bill would have helped. It contained tax cuts of its own, about $999 billion worth over 10 years that would have been paid for by spending cuts — most of them in the federal Medicaid program that provides health care to the poor.  Republicans said the resulting lower revenue baseline would have made a revenue-neutral tax overhaul that much easier.

Balancing revenue and cuts in the tax bill would allow it to bypass rules requiring 60 votes in the Senate, where Republicans hold only 52 seats. Democrats — none of whom supported the GOP health-care bill in the House — will be similarly wary on tax legislation, said Senate Minority Leader Chuck Schumer of New York. If the bill winds up benefiting the wealthy and not the middle-class, “it won’t fly either,” he said.

Democrats aren’t the only potential obstacles. As Ryan learned in the health-care setback, the divide between moderate House Republicans and the conservative Freedom Caucus proved impossible to bridge. “The moderates in our conference and the Freedom Caucus are truly at opposite ends of the issues,” said Representative Chris Collins of New York, a Trump ally. “And so you get one, you lose one, you get one, you lose one.”

Mnuchin on Friday didn’t address such concerns, as he predicted a smoother glide path for tax legislation. “Health care and tax reform are two different issues,” he said during an event sponsored by the media company Axios. “Health care is complicated, tax reform is a lot simpler in some ways.”

‘Not Discouraged’

Also upbeat was House Ways and Means Committee Chairman Kevin Brady, the House’s top tax writer, who said Republicans intend to go “full steam ahead” on a tax overhaul, “and we’re gonna work with the administration to get this done.”


“Look, we fought hard for Obamacare repeal, we did fall short,” he said. “I’m not discouraged.”

Still, much depends on Trump’s leadership; his advisers signaled on Friday that he’ll take an active role. “When you see tax reform the first time, it will be the president’s plan and we’ll drive the debate on that,” Mulvaney said during an interview on ABC’s “Good Morning America.”

To drive it effectively, Trump will have to change his ways, said Brian Walsh, a former Senate Republican leadership aide.

“He needs to engage early, often, and consistently, and take his message directly to the American people on the issues he cares about,” said Walsh, who argued that Trump was unnecessarily distracted on the health-care issue. “If the President heeds the lessons from this debate that could bode well for tax reform, but if he does not we could well see a replay of this mess in the months ahead.”

House Speaker Paul Ryan Stops Planned Vote on Health Care Bill, Killing White House Ultimatum

March 24, 2017
Ryan pulls GOP health care bill following call from TrumpBy JUSTIN FISHEL, JORDYN PHELPS, MARYALICE PARKS and CECILIA VEGA

  • ABC News

House Speaker Paul D. Ryan walked in the Capitol on Friday after a vote on the rules for debating the American Health Care Act, the bill to replace the Affordable Care Act known as Obamacare. Credit Gabriella Demczuk for The New York Times

Republican leadership has decided to pull their Obamacare replacement bill at the request of President Donald Trump.

After House GOP leaders postponed a vote Thursday when it was clear they lacked the votes to ensure the bill’s passage, the White House delivered a late-night ultimatum: Vote today or the president is prepared to move on to other business.

LIVESTREAM: The debate over Obamacare replacement bill

The president has “left everything on the field when it comes to this bill,” White House press secretary Sean Spicer said today at an afternoon press briefing, adding that House Speaker Paul Ryan “has done everything he can” to collect votes but “at the end of the day, you can’t force people to vote.”

Spicer said the GOP leadership and the White House continue to pick up “yes” votes, but it remains unclear whether they will be able to persuade enough of their party’s lawmakers to vote for the bill this afternoon.

White House budget director Mick Mulvaney had earlier told Republican legislators if the House doesn’t act today, the president is prepared to leave the Affordable Care Act, known as Obamacare, in place, a GOP aide told ABC News.

It’s a move right out of the president’s own book, “The Art of the Deal.”

“Know when to walk away from the table.” The Art of the Deal

“The worst thing you can possibly do in a deal is seem desperate to make it.” – The Art of The Deal.

Trump answered questions from reporters this morning in the Oval Office on what he’ll do if the bill fails. “We’ll have to see, see what happens,” he said.

On whether he thought the bill was rushed, he replied, “no.” He also stood by Rep. Paul Ryan, R-Wis., saying “yes” when asked whether he should remain in his position as speaker of the House if the bill fails

At around 11 a.m. today, the House voted along partisan lines — with most present Republicans voting yes and all present Democrats voting no — to move the bill to the floor. Congress members will have four hours to debate the bill before voting.

For Ryan and the Trump administration, all hands are on deck today. The speaker went to the White House shortly after noon to update the president, and Vice President Mike Pence canceled a trip to Arkansas today to stay in D.C.

At around 1 p.m., Pence went to the Capitol Hill Club to join the House Freedom Caucus, the conservative group of lawmakers who oppose the bill unless amendments are made.

This bill needs no less than 215 “yes” votes to pass the House, lowering the number from 216 because one Democrat will be absent for the vote.

Trump this morning tweeted that “after seven horrible years of ObamaCare (skyrocketing premiums & deductibles, bad healthcare), this is finally your chance for a great plan!”

After seven horrible years of ObamaCare (skyrocketing premiums & deductibles, bad healthcare), this is finally your chance for a great plan!

The president also this morning called out the House Freedom Caucus, suggesting that without the GOP bill, the women’s health care and family-planning organization Planned Parenthood would not be subject to funding cuts.

The irony is that the Freedom Caucus, which is very pro-life and against Planned Parenthood, allows P.P. to continue if they stop this plan!

Asked this morning on “Good Morning America,” if the bill has enough votes to pass, Office of Management and Budget Director Mick Mulvaney could not say for certain.

“Don’t know,” Mulvaney said. “That’s up to the House to count their own votes.”

At least 32 Republicans had said they would oppose the bill, according to ABC News’ latest count. Because the GOP needs 215 votes for a simple majority to pass the bill in the House, it can afford to lose only 22 Republican votes, depending on whether all Democratic members are present, to move the legislation.

Both Democrats and Republicans shared their thoughts on the bill in several animated floor speeches this morning.

“There are only two ways you can vote for this bill,” Rep. Jim McGovern, D-Mass., said. “One is you don’t know what’s in the bill. Or two is you have to have a heart of stone. Because this bill is shameful.”

Rep. Jodey Arrington, R-Texas, echoed the sentiments of many moderate Republicans hoping to capitalize on GOP power in Congress and the White House: “Now that we’re given the opportunity to govern and keep our promises and to deliver results for the American people, we can’t let perfect be the enemy of good.”

And even if the bill passes the House, its future in the Senate is unclear.

ABC News’ Riley Beggin, Mary Bruce, John Parkinson and Alex Mallin contributed to this story.


New York Times Video:

Facing Ultimatum and Division, House Republicans Plan to Vote on Health Bill

March 24, 2017

Speaker Paul Ryan Meets With President Donald Trump

House Speaker Paul Ryan, with a staffer, walks through Statuary Hall in the U.S. Capitol Friday.

House Speaker Paul Ryan, with a staffer, walks through Statuary Hall in the U.S. Capitol Friday. PHOTO: SHAWN THEW/EUROPEAN PRESSPHOTO AGENCY

House Republicans, facing an ultimatum from President Donald Trump , are poised to vote Friday on the imperiled GOP health plan despite signs that party divisions continued to threaten its chances.

White House spokesman Sean Spicer said Friday that the vote on the bill was set for 3:30 p.m. EDT, following debate in the chamber that began this morning. House Speaker Paul Ryan was meeting Mr. Trump at the White House to “discuss a way forward” as floor debate and arm twisting on the legislation continued.

After House GOP leaders canceled a vote on the bill Thursday over fears it lacked sufficient support to pass, Republican factions met late into the night, with Mr. Trump personally calling some members to pressure them for their support. In his afternoon briefing, Mr. Spicer acknowledged the bill didn’t currently have the support needed to pass.

Because all Democrats are likely to vote against a bill that would topple key parts of their 2010 Affordable Care Act, Republicans can only afford to lose 22 votes for their bill to pass. To win the backing of the conservative House Freedom Caucus, which controls more than 20 votes, leaders have made concessions including an amendment that would repeal a requirement under the ACA that insurers provide policies that comply with federal minimum benefit standards, such as offering maternity and mental health care.

But that hardened opposition from some centrist GOP members who don’t want to move too aggressively in toppling the ACA. House leaders had started Thursday with about 30 GOP members opposing the health proposal.

As Friday wore on, more key GOP lawmakers said they wouldn’t support the bill, including Rep. Rodney Frelinghuysen (R., N.J.), chairman of the House Appropriations Committee.

“Unfortunately, the legislation before the House today is currently unacceptable as it would place significant new costs and barriers to care on my constituents in New Jersey,” Mr. Frelinghuysen said in a statement.

Another lawmaker, Rep. Dave Joyce of Ohio, who has voted for past GOP bills to repeal the ACA, tweeted his opposition, objecting to the bill’s substance and to the process followed by Republican leadership in rolling it out.

On Friday morning, the president reminded Republicans on Twitter that “this is finally your chance” to replace the ACA, widely known as Obamacare for his predecessor Barack Obama, who signed it into law.

Mr. Trump also took aim at the caucus of House conservatives, pressing them to keep to their antiabortion bona fides by supporting the bill, which would ban Medicaid funding for one year to women’s health organization Planned Parenthood Federation of America. Some of the group’s clinics provide abortion services, which aren’t funded by taxpayer dollars.

“The irony is that the Freedom Caucus, which is very pro-life and against Planned Parenthood, allows P.P. to continue if they stop this plan!” he tweeted.

Mr. Trump, briefly responding to questions on Friday at the White House, said he didn’t think he had rushed into tackling health care and that Mr. Ryan, the driving force behind the bill, should remain in his role even if the vote fails.

“We’ll have to see what happens,” he said in response to questions about the vote.

Signs of dissent have emerged over a fast vote on the bill even though a final analysis of its impact on coverage and the budget isn’t available. Rep. Kevin Brady, chairman of the House’s tax-writing committee, said in the House Rules Committee Friday it is an uncommon situation. That committee on Friday morning passed the bill, along with some last-minute amendments added Thursday night, and will be moving it to the House floor.

“It’s unusual, but it’s unusual for the right reasons,” Mr. Brady, a Texas Republican, said. Mr. Brady said the bill won’t just serve Washington. “It will serve every state in the nation about what’s right for them…They will be surveying 50 states about what plans are right for them.”

Thursday night’s amendment also would add $15 billion in funding to help states pay for mental health and maternity care. The House Freedom Caucus met Thursday night after the amendments were added but some said they were still likely to oppose the legislation.

Republicans face intensifying criticism of their health plan in the wake of a Congressional Budget Office analysis Thursday. The report showed that with the latest changes, the legislation would reduce the federal deficit by $151 billion by 2026, compared with an earlier version that delivered a $337 billion deficit cut. It showed no meaningful change to the estimate that under the new bill, the number of Americans without health insurance would grow by 24 million people in the next decade, compared with conditions if the ACA were allowed to stand.

Defeat of the health measure would be a major blow to Mr. Trump’s image as an influential negotiator because he has become heavily involved in rallying support. Mr. Spicer on Friday emphasized the president’s efforts, saying Mr. Trump had been “working the phones and having in-person meetings” since the House bill was introduced. He said more than 120 lawmakers had visited the White House or spoken with the administration by phone in recent days.

Failure of the measure would also haunt Mr. Ryan in his efforts to get through other agenda items such as tax reform.

“The bill that’s before Congress is done,” Health and Human Services Secretary Tom Price said Friday on Fox News. “I think we’re going to be able to get this bill done today and move forward.”

Dr. Price, a former orthopedic surgeon, said he would continue to use administrative steps to roll back the ACA even if the legislation craters in the House. He said he doesn’t expect a new CBO analysis before the vote.

If the measure does pass, Senate Majority Leader Mitch McConnell has vowed to take up the legislation swiftly, but it is expected to confront even greater obstacles in that chamber.

Write to Stephanie Armour at and Rebecca Ballhaus at


President Trump, Speaker Paul Ryans Fail To Unite House Republicans for Planned Healthcare Vote — Rookie president derailed on first try to make a law

March 23, 2017
What a Trump presidency will mean if the health care bill fails

NEW YORK (AP) — Hard-line House Republicans considering voting against the House GOP health bill are bracing for payback from a president who claims his favorite biblical passage is “an eye for an eye.” Many appear ready to risk it.

The scheduled roll call vote for the bill backed by President Donald Trump is a crucial first test of whether Republicans are willing to defy the White House and face the wrath of a president who has bragged about never forgetting a slight. Trump has shown he’s willing to use his megaphone and practiced counter-punch against his allies. But the vote comes as Trump’s poll numbers have slouched and his White House is consumed with damaging distractions.

A group of breakaway Republicans, including several members of the deeply conservative House Freedom Caucus, on Wednesday remain unbowed, taking comfort in the political safety they feel in their home districts.

Members are well aware they face possible primary threats if they vote against the bill the White House has cast as the only chance to make good on a GOP promise to repeal and replace President Barack Obama’s health care law.

White House chief strategist Steve Bannon told holdout lawmakers Wednesday: “You all have to vote for this. We’ve got to do this. I know you don’t like it, but you have to vote for this,” according to several representatives present. The comment came after Trump told a group Tuesday that “many of you will lose your seats in 2018” if Republicans don’t pass a health care bill.

“They know,” said Rep. Steve Stivers, of Ohio, head of the National Republican Congressional Committee, of the looming primary threats. Stivers said he’s heard Trump “say things privately” about retaliating against those who oppose the measure. “Every member has their own calculations they have to look at,” he said.

More than two dozen members of the House Freedom Caucus oppose the plan because they say it doesn’t go far enough to undo Obamacare. Some moderate GOP members, meanwhile, were turned off a recent Congressional Budget Office analysis predicting 24 million people would lose coverage in a decade.

Most of the GOP no-voters represent safely Republican seats – some drawn to ensure they stay that way – and whose grip on power would only be threatened by a primary challenger. Among them is Kentucky Rep. Thomas Massie, who was re-elected in November with 71 percent of the vote, making a stand against Trump a relatively safe bet.

“He has categorized himself as a staunch ideological conservative and can tell voters he was standing up for what he believed in,” said Stephen Voss, a political science professor at the University of Kentucky. “(The White House) could send a bunch of money to go after him but there’s no reason to think the Republican voters would buy into a fight on this.”

Massie tweeted Wednesday that he’d switched his vote from “no” to “hell no.”

Many in the Freedom Caucus also have taken a stand knowing that while Trump is popular in their districts, they are equally so. Rep. Mark Meadows, chair of the caucus, did not face a primary challenger and was re-elected to his seat last year with more than 64 percent of the vote, slightly higher than Trump’s total in his western North Carolina district.

White House Press Secretary Sean Spicer has said the White House has not considered a course of action if the lawmakers defeat the bill, insisting Wednesday that Trump is “not there to threaten them, he’s there to explain the political landscape to them.”

But the White House has previewed what could be part of its strategy to seek retribution against those who defy the president: Trump and Vice President Mike Pence have each held rallies this month in deep red Kentucky. The president just raised more than $30 million for the National Republican Congressional Committee and could threaten members’ money. And while Trump’s overall numbers have slipped, he remains popular among Republicans and could hold campaign rallies in the districts of representatives who defied hm.

The political stakes for Trump could not be much higher.

Failure to pass the bill would be a dramatic setback for Republicans core campaign promise. Rebellion among House Republicans also would undercut Trump’s self-promotion as a dealmaker and winner. The defeat would come just days after the FBI investigation confirmed it’s investigating his campaign’s contacts with Russian officials, would further damage a president with an approval rating hovering below 40 percent and weaken his ability to tackle the rest of his agenda.

Trump has long touted his ability at dishing out payback. Whether with his Twitter account or onstage at a rally, Trump lets few slights – real or imagined – go unpunished.

After Sen. Ted Cruz refused to endorse Trump at the Republican National Convention, the newly minted Republican nominee used the morning after his acceptance speech to tear into his former rival. Trump read out Sen. Lindsey Graham’s personal cell phone to get back at him. He tore into a Gold Star family after the parents of a slain solider denounced him from the stage at the Democratic National Convention. And he went after a former beauty queen – even falsely claiming she had a sex tape – after she appeared in an ad for Hillary Clinton.

Even after getting elected, Trump has showed little inclination to let bygones be bygones.

He’s warned that he would fund a Super PAC solely dedicated to defeat Ohio Gov. John Kasich, who never endorsed the president, if Kasich ever challenged him – an extraordinary threat from a sitting president. He also interjected himself into a state-level race to oust Kasich’s hand-picked Ohio state party chair.

And last week in Michigan, he turned to Republican Gov. Rick Snyder during a feel-good photo op to note that Snyder never endorsed him.

“I never forget,” Trump said.


Associated Press writer Andrew Taylor contributed reporting from Washington.

Yemen and Somalia “On The Brink” of famine, Red Cross Says — “We witness the massive suffering. Millions of people are denied the very basics to survive.”

March 23, 2017

Conflict-hit countries have only 3-4 months before millions are at risk of famine, Red Cross says.

More than 1.8 million Nigerians are facing severe food insecurity, according to the UN [EPA]

The world has as little as three months to save millions of people from famine in Yemen and Somalia, the International Committee of the Red Cross said on Wednesday.

The medical charity needs $300m to bring emergency assistance to a total of five million people in Yemen, Somalia and northeast Nigeria, as well as areas of South Sudan where famine has already been declared.

The funds will ensure that five million of the 20 million people at risk of famine and starvation receive immediate and essential aid, said Red Cross director of operations Dominik Stillhart.

“Food, water, shelter, and healthcare is required immediately,” he said.

“We are on the ground and delivering aid in all four countries. We witness the massive suffering. Millions of people are denied the very basics to survive.”

OPINION: Ending famine in Somalia, the Turkish way

Earlier this month, the United Nations announced more than 20 million people were facing famine in the four countries, and it needs to raise $4.4bn in funds by July.

In South Sudan, the UN said about 3.4 million are in need of help after being displaced by fighting between government forces and armed groups loyal to the former vice president Riek Machar.

While several districts in South Sudan are already facing famine, Stillhart said Yemen and Somalia have a three-to-four-month “window” before it sets in there.

About 300,000 people, meanwhile, face acute malnutrition in northeast Nigeria.

UN and food organisations define famine as when more than 30 percent of children under the age of five suffer from acute malnutrition and mortality rates are two or more deaths per 10,000 people each day, among other criteria.

Stillhart said that aside from addressing the immediate threat of starvation, the international community must also tackle “the root causes of the crisis”.

As a result of the conflict, an estimated seven million people are facing famine in Yemen [EPA]

Map showing scale of malnutrition

Source: Al Jazeera and news agencies



Asia markets enjoy small recovery after big losses — Investors worries grow that Trump cannot deliver on US healthcare and economy-boosting measures

March 23, 2017


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US lawmakers vote later Thursday on President Donald Trump’s proposed healthcare reform but dealers fear his struggles with the overhaul could delay his economy-boosting measures

HONG KONG (AFP) – Most Asian markets edged up and the dollar saw a small recovery on Thursday as investors tracked a bounce in New York, with focus now on a crucial congressional vote on US healthcare reform later in the day.However, the increases were marginal compared with the sharp sell-off suffered on Wednesday when equities tumbled across the board on fears Donald Trump’s economy-boosting measures could be delayed by his struggles to push through his repeal of Obamacare.

No automatic alt text available.

There is widespread belief the tycoon’s health system proposals will fall foul of lawmakers with many of his Republican counterparts opposed to numerous parts of it and raising questions about the fate of promised infrastructure spending, tax cuts and deregulation.

Greg McKenna, chief market strategist at AxiTrader, said: ?A not inconsiderable risk is that the administration gets bogged down in the repeal of Obamacare, spends its political capital, and delays the tax and infrastructure plans that so boosted the market.?

McKenna added that the head of the Office of Management and Budget had said full details of the 2018 budget would not be available until May, adding to investors worries.

But Wall Street’s three main indexes climbed Wednesday, giving some impetus to Asia, which followed suit in early trade.

Tokyo was up 0.1 percent by the break, Hong Kong added 0.3 percent, Shanghai put on 0.2 percent, Sydney also gained 0.2 percent and Seoul was 0.3 percent higher. Singapore, Manila and Jakarta also eked out small gains.

“Despite the amount of ink spilt over the healthcare vote, fundamentally the US economic landscape looks bright, and investors were quick to snap up bargains,” Stephen Innes, senior trader at OANDA, said in a note.

“With little on the economic calendar, traders remain glued to the shifting tides of the healthcare negotiations.”

The dollar enjoyed some tentative buying, edging up slightly against its major peers but it is still stuck at five-month lows against the yen.

– Key figures around 0230 GMT –

Tokyo – Nikkei 225: UP 0.1 percent at 19,068.22 (break)

Hong Kong – Hang Seng: UP 0.3 percent at 24,399.68

Shanghai – Composite: UP 0.2 percent at 3,252.39

Euro/dollar: DOWN at $1.0785 from $1.0802

Pound/dollar: DOWN at $1.2470 from $1.2486

Dollar/yen: UP at 111.50 yen from 111.13 yen

Oil – West Texas Intermediate: UP 35 cents at $48.39 per barrel

Oil – Brent North Sea: UP 33 cents at $50.97 per barrel

New York – Dow: DOWN less than 0.1 percent at 20,661.30 (close)

London – FTSE 100: DOWN 0.7 percent at 7,324.72 (close)

Most Asia markets up but dollar hit by uncertainty — Uncertainty surrounding US policy, spending, taxes, infrastructure, healthcare, trade

March 21, 2017


© AFP | Asian markets are broadly up but uncertainty over US economic policy and future rate hikes is hurting the dollar
HONG KONG (AFP) –  Most Asian markets rose Tuesday following the previous day’s retreat, but the dollar was hit by fresh uncertainty over Donald Trump’s economic policy and contradictory views on future rate hikes by two top Federal Reserve officials.Global stocks started the week with a wobble after G20 finance chiefs failed to renew a longstanding anti-protectionist pledge in the face of Trump’s “America First” push, fuelling fears about the international trade system.

But investors returned to buying in early Asian business, with Hong Kong up 0.3 percent, building on a three-day rally that has pushed it to levels not seen since the summer of 2015.

Sydney and Shanghai were flat, while Seoul jumped more than one percent and Singapore put on 0.1 percent. Taipei, Wellington and Manila were all higher.

But Tokyo ended the morning 0.3 percent lower as traders returned from a long weekend to find the yen had strengthened significantly against the dollar.

The greenback was struggling around the mid-112 zone, down from New York and well off the 113.33 yen mark seen when the Nikkei was last open Friday.

The dollar has come in for heavy selling since the Federal Reserve on Wednesday lifted borrowing costs but pointed to another two rises this year, confounding talk of a possible three or four.

On Monday Chicago Fed President Charles Evans suggested there could be more hikes this year but Minneapolis boss Neel Kashkari said the policy board should take its time.

Image result for Chicago Fed President Charles Evans, photos

Charles Evans, president of the Federal Reserve Bank of Chicago

The uncertainty surrounding US policy comes as investors are left waiting for some detail from Trump on his promise to ramp up infrastructure spending and slash taxes to fire up the economy.

World markets surged since his November election on expectations he would push the plans through but his lack of anything substantial has spooked some.

Jeffrey Halley, senior market analyst at OANDA, said in a note: “Post (Fed decision) the markets’ attention has turned again to the Trump administration’s lack of concrete policy announcements. With the new administration?s 100 days of action rapidly turning into 100 days of inaction, extended dollar reflationist long positioning has started heading for the door.”

The dollar was also struggling against most other high-yielding units, with the South Korean won up 0.3 percent and the Mexican peso 0.7 percent higher.

– Key figures around 0230 GMT –

Tokyo – Nikkei 225: DOWN 0.3 percent at 19,469.62 (break)

Hong Kong – Hang Seng: UP 0.3 percent at 24,586.66

Shanghai – Composite: FLAT at 3,250.25

Euro/dollar: UP at $1.0772 from $1.0746

Pound/dollar: DOWN at $1.2380 from $1.2392

Dollar/yen: DOWN at 112.50 from 112.71 yen

Oil – West Texas Intermediate: UP 15 cents at $48.37 per barrel

Oil – Brent North Sea: UP 22 cents at $51.84 per barrel

New York – Dow: DOWN less than 0.1 percent at 20,905.86 (close)

London – FTSE 100: UP 0.1 percent at 7,429.81 (close)

Philippines: Doctor Shortage — Why Not Pay Tuitions With Government Funds To Get More Doctors? (Editorial)

March 20, 2017

Philippines: Doctor Shortage — Why Not Pay Tuitions With Government Funds To Get More Doctors? (Editorial)

Taxpayers spend P2.5 million over four years to produce a graduate of the Philippine Military Academy. Why not make the same investment in producing surgeons and other physicians?

The proposal was made by Senate President Pro Tempore Ralph Recto, who noted that the Department of Health already has an existing scholarship program for aspiring doctors. All that’s needed is to expand the program while at the same time making compensation and benefits more attractive for physicians working for the DOH.

Unless remuneration is improved, the nation may see its shortage of doctors worsen, especially in rural areas. Recto noted that of the 946 available slots in the government’s Doctor to the Barrios program from 2015 to 2016, only 320 were filled. The program is meant to provide at least one doctor in each low-income municipality, but there were few takers. Those 626 unfilled slots meant that millions were deprived of the services of a doctor in their communities.

The medical profession can pay handsomely – but only after many years of grueling studies and substantial financial investment in schooling and specialized training. The cost of medical textbooks alone can be beyond the reach of a low-income household.

Parents who have invested their life savings to send their child to medical school would naturally be reluctant to let the new doctor volunteer for a rural assignment that pays P56,000 a month, especially in conflict zones. The medical community is still waiting for justice for a Doctor to the Barrio volunteer, Dreyfuss Perlas, who was shot dead by still unknown assailants last March 1 while serving in Lanao del Norte.

If the government shoulders the schooling expenses of deserving medical scholars, the nation may be assured of a steady supply of physicians, even if the beneficiaries leave the DOH after a mandatory four-year service. The government may then have at least one doctor for every municipality, with the scholars encouraged to serve in their hometowns.

Health experts estimate that the country currently faces a shortage of 60,000 doctors. This means six out of every 10 Filipinos die without seeing a doctor. This need not be the case. The government is recruiting more police and military personnel. Why not boost resources to produce and recruit more doctors?

Physician Shortage: Hospital postponing elective surgeries for March break — Rural areas of the U.S. brace for doctor shortage — Foreign Medical Graduates Essential to U.S. Health Care

March 19, 2017
Maureen Coulter
Charlottetown, Prince Edward Island, Canada
Published on March 17, 2017
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Queen Elizabeth Hospital in Charlottetown.

©Guardian file photo

CHARLOTTETOWN, P.E.I. – The Queen Elizabeth Hospital is postponing all of its elective operative procedures over the March break.

An internal memo was sent out this past week notifying all medical staff and department managers that there is a planned service slowdown.

Twenty-two beds are closing in surgical, rehab and critical care units until March 27, including two beds in ICU, eight beds in Unit 1, eight beds in Unit 2 and four beds in Unit 7.

The memo states “any urgent emergency cases will proceed as usual” but that “no elective operative procedures” will be booked during this time.

A statement from Health P.E.I. says it does plan scheduled slowdowns at two main hospitals during specific times of the year, including March break, summer and Christmas, when the public demand for non-urgent elective services is lower and more people are on vacation.

“A planned slowdown during this time of year is a fairly standard practice across most health-care jurisdictions,” said the statement. “It also ensures that our hard-working staff and physicians have the opportunity to take some well-deserved time off with their families.”

Rather than closing these beds, we should be helping to free up the ER and moving those patients into these acute care beds.

James Aylward, MLA for Stratford – Kinlock

However, James Aylward, MLA for Stratford – Kinlock, told The Guardian Friday evening that he heard otherwise from an “extremely” reliable source.

“They confirmed to me that the reason for these bed closures had nothing to do with shortage of staff and vacations, but it had more to do with Health P.E.I. trying to reduce costs here coming towards the end of the fiscal year.”

Aylward, who is opposition critic for health and wellness, said he found this news about service slowdown alarming.

“This is the very first time that anyone can remember bed closures during March break.”

Aylward feels this decision did not consider the pain and suffering of Islanders as they could have been having these elective operative procedures over the course of this planned service slowdown.

The other issue he has with this is that this continues the “constant backlog of patients” in the emergency room waiting for acute care beds.

“Rather than closing these beds, we should be helping to free up the ER and moving those patients into these acute care beds.”

The statement from Health P.E.I. noted that during the March break slowdown, emergency services, including emergency surgical services, will remain fully operational.

“Slowdowns at Island hospitals are planned well in advance and we work with our health-care providers to ensure patient safety and patient care standards are never compromised. We always have a contingency plan in place to ensure that we continue to provide high quality care.”

Aylward feels at the very least the public should have been informed of this service disruption.

He adds this planned service slowdown is one of many things he plans on bringing forward during the spring session of the legislature.

Health PEI is responsible for the operation and delivery of publicly funded health services in Prince Edward Island. … Health PEI is governed by a Board of Directors, which ensures that approved programs are delivered in accordance with the direction from the Minister of Health and Wellness.


Rural areas of the U.S. brace for doctor shortage

Posted: Saturday, March 18, 2017 11:00 pm

In Coudersport, Pa., a town in a mountainous region an hour’s drive from the nearest WalMart, Cole Memorial Hospital counts on two Jordanian physicians to keep its obstetrics unit open and is actively recruiting foreign specialists.

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Charles Cole Memorial Hospital, Coudersport, Pa.

In Fargo, N.D., a gastroenterologist from Lebanon — who is among thousands of foreign physicians in the state — has risen to become vice president of the North Dakota Medical Association.

In Great Falls, Mont., 60 percent of the doctors who specialize in hospital care at Benefis Health System, which serves about 230,000 people in 15 counties, are foreign doctors on work visas.


Small-town America relies on a steady flow of doctors from around the world to deliver babies, treat heart ailments and address its residents’ medical needs. But a recent, little-publicized decision by the government to alter the timetable for some visa applications is likely to delay the arrival of new foreign doctors, and is causing concern in the places that depend on them.


While the Trump administration is fighting for its temporary travel ban affecting six countries, the slowdown in the rural doctor pipeline shows how even a small, relatively uncontroversial change can ripple throughout the country.


In Montana where nine counties do not have a single physician, it means Benefis Health does not know when a Romanian doctor trained in kidney transplants will arrive. The health care company spent months recruiting the doctor and had been expecting her in July.


“Our health system already has nine months invested in her, and now we have no idea when she can start,” said Erica Martin, who recruits doctors for the company.

The doctor, Silviana Marineci, who is completing a fellowship at the University of Minnesota, said she was frazzled by being in limbo.

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“I won’t have an income, I don’t know if I will afford rent, I don’t know where I will be,” she said. “It’s insane.”


The procedural change regards temporary visas for skilled workers, known as H-1B visas. U.S. Citizenship and Immigration Services recently announced that it would temporarily suspend a “premium processing” option by which employers could pay an extra $1,225 to have H-1B applications approved in as little as two weeks, rather than several months.

Companies using that option, the government said, have effectively delayed visas for others that did not pay the extra fee.


A spokeswoman for the immigration agency, Arwen Consaul, said in a statement that the measure was necessary to “work down the existing backlogs due to the high volume of incoming petitions.”


The H-1B program has raised questions about whether it displaces American workers, particularly in computer programming and engineering jobs, for which most of the visas are issued.


H-1B recipients also include foreign physicians who practice in places shunned by American doctors for personal and professional reasons.


About 25 percent of all physicians practicing or training in the United States are foreign, but in some inner cities and most rural areas, that share is significantly higher.


There were 211,460 international medical graduates practicing in the United States in December 2015, according to the latest data available from the Educational Commission for Foreign Medical Graduates.


Sens. Amy Klobuchar, D-Minn.; Susan M. Collins, R-Maine; and Heidi Heitkamp, D-N.D., have urged the agency to continue premium processing.


“Slowing down this successful two-decade-old program and the doctors it brings to rural areas will hurt families across North Dakota and rural America,” Heitkamp wrote in an email.


The delay also could affect the roughly 400 foreign medical graduates who come each year to participate in residency programs at teaching hospitals. The doctors were matched Friday for residencies starting July 1 across the country.


“Everyone around the country will be in a mad scramble to figure out this visa situation,” said Michelle Larson-Krieg, director of international student and scholar services at the University of Colorado in Denver, which usually takes 10 or 12 residents on H-1Bs each year at its Anschutz Medical Campus.


The immigration agency said in a statement that applicants could still request an H-1B approval on an “expedited basis,” if they could prove there was an emergency or humanitarian justification.


Immigration lawyers said that it was extremely difficult to meet that standard, and that they doubted whether the agency could handle a flood of such requests.


“If they don’t have the manpower to do premium processing, I don’t see how they are going to do special requests,” said Andrea Szew, a lawyer in Los Angeles.


Foreign Doctors Assist With Physician Shortage

The challenge in Iowa, where the shortage of physicians is more pronounced, is finding qualified doctors that will stay in the area.

| March 18, 2017, at 1:02 a.m.

By DEVAN PATEL, Quad-City Times


DAVENPORT, Iowa (AP) — Dr. Nazir Kayali settled into his chair, deep in thought.

His hand stroked his chin and a smile grew into a laugh as he considered his circuitous path to the Quad-Cities.


The Syrian-born pediatrician’s first trip outside his native country was to Ohio in 1990, where his cousins were practicing medicine.

Wishing to follow in his cousins’ paths, Kayali asked what he might expect from America.

They halfheartedly told him a joke that went along with the generalization that Americans are egotistical and care only about money.

“A stranger comes to America and finds a booth that says ‘Two questions for $100,'” Kayali began, barely able to get the words past his own laughter. “He asks a woman, ‘Is that a lot of money for two questions?’ She replies ‘Yes. What’s your second question?'”


But the international medical graduate found the opposite to be true in middle America. Here, he said, he found warmth, compassion and acceptance.


Dr. Nazir Kayali has his plate dished up by daughter, Sarah, 17, as they sit down for dinner at their home in Bettendorf. Having lived in Des Moines for his residency and in the Quad-Cities previously, Kayali, a Syrian-born pediatrician, has called Bettendorf home for the past five years.


Having lived in Bettendorf for the past five years, Kayali boasts that the Quad-Cities is his third stint in Iowa, having secured his H-1B visa to complete his residency from 1993-1996 at Iowa Methodist Medical Center in Des Moines. Out of all the hospitals in the nation, his first choice was in Iowa’s capital city.


He then came to the Quad-Cities from 1999 to 2007, returning to Syria so his children could get to know their family in Aleppo.

But his Iowa memories and experiences stayed with Kayali.


When war made Syria too dangerous, the pediatrician with a soft spot for Iowa was relieved to learn of an opportunity in the safe place he had come to know more than 6,200 miles away. And it called his family back.


“I’ve had a very positive experience,” Kayali said. “The acceptance and the people, from residents, staff, colleagues and patients; it was all so incredible.”


The sentiment is the same for many of the international medical graduates who have immersed themselves in the community, including Dr. Sarojini Ratnakar, who joked that she took the easy path to practicing medicine in the United States.


The Indian-born and -trained hospitalist for Genesis Health System did not have to jump over the same hurdles that other international medical graduates did. Her husband already had a visa, so she was able to come as a spouse.


Dr. Sarojini Ratnakar talks with patient Marcia Johnson of Bettendorf in her room at Genesis Medical Center-East Rusholme Street, Davenport.


Ratnakar’s story, however, is similar in that she, too, came to the U.S. to make a better life and has settled into the void created by the country’s physician shortage.


In America’s heartland, where the shortage is more pronounced, the challenge isn’t so much in finding qualified doctors. The real test is in convincing them to stay.


Iowa ranked seventh in medical students per 100,000 population, but the state has one of the lowest physician-to-population ratios in the country. In other words, medical students are graduating in Iowa; they just aren’t practicing here.


Even more alarming is Iowa’s consistently low ranking in retaining physicians who earned their medical degrees in-state.

Since 2006, the retention percentage for in-state graduates has fluctuated between 34 percent and 36 percent for physicians, according to data from the Association of American Medical Colleges, or AAMC.


Hospitalist Dr. Sarojini Ratnakar, who was born in India, reads a chart before going to the patient’s room at Genesis Medical Center-East Rusholme Street, Davenport.


Ratnakar said she struggled when she first came to practice in Iowa in 2004.


“I moved from Atlanta, because my family was here, but at the beginning, I really wanted to go back,” she said.


As she immersed herself in the Quad-Cities, however, something changed.


“It’s the people here,” she said. “I wanted to go back, but now I won’t leave, because this place is just fantastic. I would not trade it for anything.”


Just like Ratnakar, other international medical graduates are starting to form attachments and a sense of place and are not necessarily waiting for a door to open elsewhere.


Community Health Care CEO Tom Bowman has become familiar with the doctor shortage in his 10 years at the Davenport clinic.


Bowman said Community Health Care, or CHC, tries to fill the gaps in medical treatment in the community and, in order to do so, relies heavily on sponsorship of international medical graduates through J-1 or H-1B visas.


Foreign graduates accounted for more than 50 percent of CHC recruits in the past decade, and they haven’t always been keen on staying in the area.


“Some of it, even though we’re not as rural as some parts of country, is that they tend to gravitate to more diverse and urban areas,” Bowman said. “But we’re getting better on that front.”


In the past 15 years, Community Health Care has sponsored and employed 33 international medical graduates, but only 17 have remained here. However, when narrowing the focus to the past decade the percentage of doctors sticking around increases from 50 percent to about 65 percent, the Quad-City Times ( ) reported.

Hospitalist Dr. Sarojini Ratnakar looks over the patient board for the night at Genesis Medical Center-East Rusholme Street, Davenport.


The same can be said of the percentage of active physicians who are international medical graduates, practicing in Iowa. As of 2014, their numbers increased from 17 percent to 18.6 percent, making foreign doctors second only to Iowa-educated doctors in the recruitment pool.


From 2006-14, foreign doctors accounted for almost one-third of physician growth in Iowa, according to data from AAMC. In fact, foreign graduates have become such a mainstay in American medical care, they now account for about 1 in 4 physicians.


“Foreign graduates are very hard workers, so they really don’t mind going to any place,” Ratnakar said.


The sprawling city of Kingwood, West Virginia, county seat of Preston County, was home to just more than 3,000 people when Kayali practiced there after his three-year residency in Des Moines.


“(It’s) a small town in the mountains where no one else would go,” the Bettendorf pediatrician said.


Except for his family’s social life, Kayali said, the little town produced a positive experience. But it also was the place in which he first experienced the struggles that strike a community that is medically under-served. Some of the most basic conditions were worsened, he said, by the lack of physicians in the area.


“I would see really sick kids, and I wouldn’t imagine seeing such cases in the United States,” Kayali said.

For rural areas in the U.S. like Kingwood, it’s difficult to attract physicians, which is why foreign physicians have become such a vital resource.


A study commissioned by AAMC found that the U.S. will have a shortage of 61,700 to 94,700 physicians by 2025, and rural areas can expect to suffer the most. Those regions of the country typically lack the amenities, diversity and financial incentives available in urban areas, making them less desirable to many incoming physicians.


As an incentive, foreign graduates can prolong their stay in the U.S. by serving in medically under-served areas with modest populations where other health providers are scarce.


With J-1 visas, states can sponsor physicians through the Conrad 30 waiver, which allows 30 international medical graduates to stay in the country as long as they practice their medical specialty in shortage areas for a minimum of three years.


J-1 visas typically require participants to return to their home country for two years to apply the knowledge and training they acquired in the U.S.


Over the past 10 years, more than 10,000 physicians in the U.S. stayed and served in shortage areas under Conrad 30, according to AAMC President Darrell Kirch. In the same decade, the Iowa Department of Public Health sponsored 292 foreign doctors out of the potential maximum of 300, meaning Iowa used 97 percent of its allotment of Conrad 30 doctors. In comparison, the national average is 59 percent.


From 2007 to this year, Scott County ranked eighth in the number of Conrad 30 waivers granted in the state with 18.


But the number of state-sponsored waivers has decreased since 2012, when the Department of Health and Human Services took over applications for Federally Qualified Health Centers such as CHC.

While Scott County did not receive a single Conrad 30 waiver out of the 30 recommended by the state this year, it does not mean the need isn’t there.


Information from: Quad-City Times,




Key Bloc of Conservative Lawmakers Endorse GOP Health Plan

March 17, 2017

Comments come after meeting Friday with group of 13 Republican lawmakers

President Donald Trump speaks to Vice President Mike Pence, left, and House Republicans at the White House Friday.

President Donald Trump speaks to Vice President Mike Pence, left, and House Republicans at the White House Friday. PHOTO: MIKE THEILER / POOL/EUROPEAN PRESSPHOTO AGENCY


Updated March 17, 2017 2:38 p.m. ET

The House Republican health-care plan picked up an important endorsement on Friday from leaders of a bloc of conservative lawmakers, after President Donald Trump agreed to back more stringent curbs on Medicaid funding and proposals to add work requirements for its beneficiaries.

“100% of the nos are yeses,” Mr. Trump said of the group of 13 lawmakers he hosted in the Oval Office Friday morning, who included leaders of the conservative Republican Study Committee. The president said that overnight his administration had worked to convince many of the people in the room to back the bill and that he was confident he had their support now. “Every single person sitting in this room is now a yes.”

Leaders of the Republican Study Committee, a caucus that includes most of the House GOP lawmakers, repeated their willingness to back the bill as they left the White House, citing Mr. Trump’s backing for block grants and support for states adding requirements that beneficiaries show they are working or attempting to do so.

It wasn’t clear how many rank-and-file members of the Republican Study Committee were on board and if the bill has the support of enough Republicans to pass the House, which is expected to vote on it Thursday. A smaller group of conservatives, the House Freedom Caucus, could yet torpedo the legislation if all members withhold their support.

“President Trump himself committed that he is all in, 100% in, for this bill,” House Majority Whip Steve Scalise (R., La.), who is in charge of rounding up lawmakers’ votes and a past leader in the committee.

Rep. Mark Walker (R., N.C.), the current chairman of the Republican Study Committee, said that lawmakers had held a conference call close to midnight to discuss the bill. He said that with commitments from the president to back block grants and work requirements in Medicaid, they were able to move “from undecided, or no, to a positive yes this morning.”

Reps Marsha Blackburn (R., Tenn.) and Mia Love (R., Utah) emphasized the bill’s existing restrictions on abortion funding as a reason for support.

Several of the group’s members said after they left the White House that they entered undecided, but that Mr. Trump won them over by agreeing to two changes. One would let states impose a work requirement on Medicaid recipients. The second would allow states to choose between receiving their federal Medicaid funding in the form of a block grant or as a per capita allotment.

“Those are significant steps forward from my conservative perspective that make the bill much more agreeable,” said Rep. Jim Banks (R., Ind.), who now plans to vote for the bill.

Mr. Trump said he supported the calls from House conservatives to restrict federal funding for Medicaid by giving states “block grants” in exchange for more leeway in how they run the program. He said he wanted states to continue to have federal help for their neediest but also the flexibility states have requested in managing the program.

In his comments Friday, Mr. Trump praised the visiting GOP House members, saying that they had been tough negotiators. Criticizing the 2010 health law is a point around which Republicans have been able to rally; the mechanics of undoing the law have been more divisive.

“It’s on a respirator,” Mr. Trump said. “Obamacare is not an alternative.”

Some lawmakers in the meeting had already publicly pledged support for the bill, including Mr. Scalise, the House Majority Whip. Members of the whip team, in charge of counting the votes, said they were getting closer to the 216 votes the bill will need to pass the chamber. The bill still has opposition from both conservative and centrist Republicans.

“It’s still in the works, but we’re getting closer and closer,” said Rep. Dennis Ross (R., Fla.).

Mr. Trump spoke after four Republican governors announced their opposition Thursday night to the House GOP legislation, another signal of the political challenges it faces from moderates within the Republican party as well as its right-wing.

The four GOP governors come from Ohio, Michigan, Nevada and Arkansas, states that expanded their Medicaid programs under the Affordable Care Act. In a letter to congressional leaders, they cited the potential for the bill to strip people of Medicaid coverage.

The bill is still likely to be amended in the Senate, where a dozen Republicans have already indicated they consider the more conservative direction it is going in the House as unacceptable. Some centrist GOP senators say the legislation needs to give more generous support to rural, older and low-income people to help them buy health insurance.

Mr. Scalise said he was unruffled by that prospect Friday morning, because his responsibility was simply to get a bill out of the House.

“If they want to make additional changes, that’s called the legislative process,” said Mr. Scalise. “We’re just happy to get this bill passed through the House, that’s what we’re focused on, and the Senate can take care of their business.”

Write to Louise Radnofsky at, Michelle Hackman at and Kristina Peterson at