Posts Tagged ‘Richard Blumenthal’

How the Obama administration handled the exploding problem of opioids

March 19, 2018

Barack Obama & the Opioid Crisis

My President’s Worst Failure

President Barack Obama and Attorney General Eric Holder Jr.

In the fall of 2001, southern Virginia’s US Attorney John Brownlee launched an investigation of Purdue Pharma, a company he believed misled government officials and medical practitioners regarding the potentially addictive nature of its opiate painkiller OxyContin. Short-staffed and without much in the way of a budget, Brownlee and his investigators lumbered along, compiling evidence and building a picture of corporate negligence and wrongdoing. Finally, on October 19, 2006, they presented defense counsel a final settlement offer: a mix of plea deals, financial penalties, and modifications in the way Purdue Pharma presented Oxycontin in its marketing efforts. Take it, Brownlee advised, or Purdue Pharma and some of its key executives would face “other things.”

On October 24, the day the settlement offer was set to expire, Brownlee received permission from the Criminal Division of the Department of Justice to “accept a plea or charge the company.”

That evening he received a phone call.

On the other end of the line was Michael Elston, chief of staff to Deputy Attorney General Paul McNulty. Elston mentioned that his boss had been contacted by Purdue’s defense counsel, and he urged Brownlee to “slow down” his negotiations, a strange request to make of a litigator who led an an effort that stretched over half a decade, accumulating greater urgency with each passing year as overdose deaths mounted. After Brownlee refused, his name appeared on a list of US Attorneys to be fired by Attorney General Gonzales eight days later.

This attempt to interfere with an imminent criminal charge is recounted in Dreamland, Sam Quinones landmark book on the opioid crisis, and it also came in for extended discussion in a Senate hearing convened in 2007 to discuss the adequacy of the terms of settlement Brownlee ultimately concluded with Purdue Pharma. But omitted from all these accounts is the name of Purdue’s defense lawyer, a person who clearly enjoyed high level access to the Department of Justice, and was willing to use it to delay a settlement that entailed not just money to be used for treatment but also oversight over how Purdue Pharma marketed its product, including how it depicted the potential dangers and benefits of its blockbuster drug Oxycontin.

The person who phoned Deputy Attorney General Paul McNulty was Mary Jo White — a fact reported in only one place, as a detail in this 2007 article in The Washington Post. A former US Attorney for the Southern District, White was by the time of Brownlee’s settlement discussion a lawyer in private practice at Debevoise & Plimpton.

In 2013, President Barack Obama nominated White to serve as chair of the Securities and Exchange Commission. Her crass political intervention in the single most devastating case of corporate fraud in the modern era did nothing to deter Obama from putting her name forward to serve as a watchdog of Wall Street, nor did it strike Senate staff vetting her for confirmation as worthy of mention.

In light of her 2006 phone call to the Department of Justice, it comes as no surprise that Mary Jo White’s stewardship of the SEC was marred by controversy. Reviewing her performance for The Intercept, financial journalist David Dayen noted “persistent delays on finalizing rules mandated by the Dodd-Frank Act,” and, owing to her extensive corporate ties, frequent recusals that left the board deadlocked 2–2. Last October, citing White’s refusal to act on rules requiring corporate spending on political activities, Senator Elizabeth Warren sent President Obama a letter requesting that he fire her immediately, in what would have been an unceremonious departure with only weeks left in her term. Obama refused.

Most telling, throughout her SEC tenure, White preached a “broken windows” philosophy of enforcement against low-level infractions that she claimed would send clear signals to Wall Street. In reality, the SEC rarely extracted admissions of guilt. One recent study from a professor at Emory found that the SEC inflated its enforcement prowess by “double and triple counts” and overstated the severity of the fines it imposed.

This pattern of pursuing the low-hanging fruit, to much fanfare but no great effect, was replicated throughout the Obama administration, a kind of “performative enforcement” approach to corporate America that placated forces in the pharmaceutical industry at a time when they should have been confronted. Still, vignettes of insiders like Mary Jo White, whose work in government falls below the radar of most Americans, do not provide an adequate account of how the Obama administration handled the exploding problem of opioids. They point only to indifference — a terrain of half-measures and neglect, normally hard to discern, but when set against a drug crisis spiraling out of control, one that is difficult to defend.

Under President Obama, a small army of executive branch “slow-walkers” served as pallbearers, knowingly or not, to the grim march of overdose deaths from commonly prescribed opioids that was already underway in years before he took office. As the body count climbed, the Brownlee-led US Attorney settlement with Purdue, as well as West Virginia’s 2004 settlement against the same company, ought to have prompted scores of decisions to reign in opioid prescribing. Instead, the opposite happened: prescribing numbers continued to grow throughout Obama’s first term, reaching a peak in 2012. Despite subsequent reductions, they remain the highest in the world.

During Obama’s time in office, licit opioid prescribing increased not only in number but also in potency. Most notable was expanded use of the powerful synthetic known as fentanyl, a drug approved only for opioid-tolerant cancer patients suffering from pain beyond the reach of traditional opioids, but one that drug makers marketed in a manner of ways, including in advertisements that pictured construction workers and others employed in similar, physically demanding jobs. Although a reduction in opioid supply was desperately needed, and close scrutiny of opioid manufacturers more than warranted, the Obama administration declined to do either.

What most exacerbated the opioid crisis was the dramatic rise in overdose deaths from heroin and heroin adulterated with illicit synthetics (fentanyl and carfentanil). While Obama was president, illicit heroin underwent an industrial transformation: market expansion, innovation, and in many places, a reconfiguration of production and distribution. Yet the path of initiation to heroin via prescription pills that fueled its resurgence went substantially unchallenged by the president. In fact, it was strengthened and fortified.

Though Obama did not start the opioid crisis, it is a blunt and brutal fact that, under his administration, drug overdose became the leading cause of death for Americans under the age of 50, and the opioid crisis became the worst drug epidemic in American history. It is an irrevocable part of his legacy as president.

Does Obama shoulder the blame for this horrible turn? A statistic without a story is only a starting point for questions, not an answer. And questions must be reasonable: despite a tendency to make extravagant claims on behalf of favored candidates, most people know that what a president can control does not equate perfectly to developments for which he is credited or blamed. Some things, like drug cartels, conspire beyond a president’s reach; others, like the disappearance of work from deindustrialized communities, span decades, indicting an entire political class. It is unfair to charge Obama with responsibility for all this, and even more so to assess the shortcomings of his administration on opioids without also weighing his pertinent and hard-won achievements.

A sensible framework is available, and the issue urgent. Surprisingly, there has been very little attempt to review the record — or, as recently happened in the Washington Post, 60 Minutes” investigation, a bizarre effort to exonerate the president from the actions of his own administration. To me this suggests, among other things, an unwillingness to wrestle with hard questions while Democrats are exiled from national government.

But expulsion from power is not a moment for convenient memory and self-regard; that’s a chronicle of the lost. For the faithful, diaspora is a moment for truth-telling.

The Record

Obama’s record on opioids rests in large part on his stewardship of the parts of executive branch most involved in managing the crisis. In this regard, no institution has been more important than the Food and Drug Administration (FDA).

About 30 cents of every American dollar spent goes toward items that fall under the FDA’s purview. Despite its importance, the agency receives sustained attention only from a small corps of specialized reporters. As a result, we learn little from the news media about the FDA’s routine activities, or how these have changed over time.

For instance, most Americans would be surprised to learn that, in the two decades of the opioid crisis (commencing with the approval of Oxycontin in 1995), the agency switched its funding stream from government-only to a combination of both taxpayer dollars and money from the pharmaceutical industry. In that same period, returns on investment for pharmaceutical companies became an even more important component of the American economy, a “financialization” of Pharma that, unfortunately for investors, coincided with a time when breakthroughs in small-molecule (traditional) drugs slowed dramatically. Corporations pressed for returns looked to bio-similar, large-molecule investments for the future. To make do in the present, they launched a Hunger Games-like defense of their own patents and protected markets — and, paradoxically, they also focused on development of “me too” drugs, imitations of proven success. And in some cases, like opioids, drug companies looked to expand the clientele for existing drugs.

These changes quietly transformed the FDA. Lawmakers and special interests who regularly depict the agency as a source of obstruction worked to pressure Congress to lower the bar for drug approval and proof of clinical effectiveness. In this sense, the 1995 approval of Oxycontin, which overlooked substantial evidence against the effectiveness of Purdue’s “extended release” technology, was a harbinger of things to come, and a part of a larger culture change within the FDA itself.

As overdose deaths from prescription opioids climbed in the early aughts, the costs incurred by the quiet ascendance of a culture of lax regulation became more intolerable — and more apparent. In 2004, Connecticut Attorney General Richard Blumenthal filed a citizen petition urging the FDA to place stronger warnings on OxyContin. After it languished for four years, he sued the agency in 2008 to compel action.

Suffice it to say that by the time Obama assumed office, both he and his advisors would have been apprised of the federal government’s settlement with Purdue Pharma of 2007, as well as litigation against the same company in West Virginia and still underway in Kentucky. But they showed no great concern over it. To lead what should have been regarded as a troubled agency, the president opted, in the words of The New York Times, to “sidestep a battle” that pitted the preferred candidate of the drug industry, Dr. Robert Califf, against a well-known patient advocate, Dr. Steven Nissen. Instead Obama sent Clinton-supporter and mega-donor Dr. Margaret Peggy Hamburg to the FDA. Hamburg’s experience in managing epidemics made her more suited to run the CDC than the FDA (as the Times also noted), and her appointment fueled speculation that a long-rumored division of the agency between food and drugs was in the offing.

It never came. Instead, Hamburg retained power over the drug portfolio, and one of the first high-profile decisions under her stewardship granted Purdue Pharma approval for a tamper-resistant Oxycontin reformulation before it had been tested according to guidance the FDA had itself set out. Families of Oxycontin overdose victims filed a citizen petition to record their disbelief that the FDA would show such a lenient attitude toward a drug that was “perhaps the most abused product ever approved by the FDA.”

But the willingness to believe that tamper-resistant technology was both successful on its merits and a sufficient response to the opioid crisis was the least of the FDA’s sins on the opioid crisis. In 2012, “Physicians for Responsible Opioid Prescribing” (PROP) filed a petition urging the FDA to reconsider opioid prescribing for chronic pain. The agency resolved instead to add a risk-management strategy to extended-release opioids, and asked that opioid manufacturers undertake an analysis of the safety of their own drugs. In their petition, PROP raised the fact that no scientific evidence supported the use of opioids as an effective response to pain that lasted beyond 12 weeks; opioids had simply not been shown to work in that setting. In their reply, the FDA answered that no proof existed to the contrary — or, in other words, opioids had not been shown definitively to fail.

It’s a remarkable response — and a revealing one. Historically, ever since the landmark Kefauver-Harris Amendments of 1962, the FDA has required proof of both drug safety and effectiveness. But since that time, starting with the Reagan administration, growing pharmaceutical industry influence over the FDA weakened its commitment to this so-called “precautionary principle.” By the time of the Obama administration, the idea that the industry had an affirmative obligation to demonstrate the efficacy of their drugs — not via “surrogate endpoints” or other assumptions and extrapolations, but in actual randomized clinical trials — was on the defensive. The “21st Century Cures Act,” the last major piece of legislation signed by Obama, endangered the precautionary principle as a matter of law. Now pharmaceutical companies seeking FDA sign-off on a new use for an already-approved drug can submit “real world evidence” — observational or, as Adam Gaffney described, “really bad evidence” — in lieu of randomized clinical trials. As a result, during a year when the opioid crisis fueled an astonishing drug overdose fatality count of 63,632 lives, President Obama’s final word on the FDA was to make the scenario that unleashed the worst drug epidemic in US history more likely, not less.

There were several other decisions, specific to the opioid crisis, which baffled. Most egregious was the FDA’s 2013 approval of the opioid painkiller Zohydro, despite the agency’s own advisory committee voting 11–2 against it. That same year, a study that appeared in the journal of Drug and Alcohol Dependence found that four out of five new heroin users started their opioid consumption by misusing prescription opioids. By this point, no one could feign ignorance of the damage caused by over-prescribing and over-supply — except the FDA. After receiving criticism for its Zohydro decision, which included 28 state Attorneys General calling on the FDA to rescind approval, the agency moved to minimize future censure by refusing to convene an advisory committee for deliberations on Purdue Pharma’s tamper-resistant opioids Targiniq and Hysingla, both of which were approved.

After a long stint at the FDA, Hamburg left the agency in 2015. That was not the last she heard of her legacy, however. Hamburg is married to Peter Brown, who, alongside conservative ideologue Robert Mercer, runs Renaissance Technologies, a hedge fund that held investments in healthcare throughout Hamburg’s tenure — including, according to one lawsuit, investments in the makers of Zohydro. The suit also charges Hamburg with conspiring to shield dangerous side effects from a powerful antibiotic called Levaquin. Only after Hamburg left the agency did the FDA decide to place stronger labeling on the drug; her husband’s company also holds investments in Johnson & Johnson, makers of Levaquin.

The potential for conflicts of interest under Hamburg, once-removed and owing to the investments of her spouse, became a more direct concern when Obama put forward Dr. Robert Califf — the drug industry’s preferred initial candidate to lead the FDA — to succeed her. Califf’s financial ties to the drug and medical device industry prompted Senator Bernie Sanders to place a hold on his nomination. Massachusetts Senator Markey added an additional hold based on the agency’s “willful blindness” regarding the ever-expanding opioid crisis, and dismissed the FDA’s insistence that approval of tamper resistant opioid formulations constituted some manner of adequate response to the problem. Senator Joe Manchin of West Virginia vowed to filibuster the nomination.

After securing a promise to revamp opioid warning labels and a return to convening advisory committees, Manchin and others released their hold, but voted against Califf on the floor. “The FDA needs new leadership, new focus, and a new culture,” Manchin concluded. Richard Blumenthal, who had left the Connecticut Attorney General’s office to become a US Senator, showed the long memory of a litigator when he joined the small group of his colleagues in voting “no.” “In the face of a spiraling opioid crisis,” Blumenthal told a rally of public health and law enforcement officials gathered to oppose the Califf nomination, “the FDA has utterly, abjectly failed to protect Americans.”

Meanwhile and not surprisingly, the FDA, though possessing substantial enforcement power, declined to put it to use in the opioid crisis. The two significant cases brought against opioid manufacturers for violations of the Food and Drug Act, the agency’s core statute, came from US Attorneys (led by Brownlee) and whistleblowers who came forward in federal court, not the FDA. Even smaller enforcement tasks, some explicitly within the the agency’s purview, went unaddressed. The position of director of the FDA’s Office of Criminal Investigation (OCI) was left vacant for years, after a previous director retired in scandal. Finally, in 2014, Dr. Hamburg filled the post with a director who established a track record of going after dermatologists cutting corners by purchasing foreign versions of a popular injectable drug (field agents derisively dubbed themselves “the botox police”). But he declined to pursue more weighty cases, including investigation into counterfeit opioid painkillers sold on the street and often containing dangerous doses of fentanyl. According to reports, pop legend Prince overdosed and died from a counterfeit pain pill laced with fentanyl. Even in the wake of this shocking and high-profile event, the OCI dithered. After Republican Congressman Greg Walden requested answers regarding the office’s prosecutorial priorities, the OCI director stalled until the Trump inauguration, at which point he left the FDA to work for DLA Piper law firm. According to Reuters, he will represent drug and medical device industry clients.

It has not been difficult for Donald Trump’s nominee to the FDA, Scott Gottlieb, to improve upon the shabby opioid record of the Obama years. That’s not to suggest that his response has been adequate — only that he cuts an energetic figure compared to his predecessors. In early summer of 2017, the new director requested that the makers of Opana ER voluntarily withdraw a drug connected to HIV and Hep C outbreaks. Around the same time, Gottlieb also convened an advisory panel to discuss an expanded evaluation for tamper-resistant opioids that would incorporate public health considerations; he also extended the risk training in place for extended-release opioids to immediate-release formulations. In less than a year, he has done more than Obama’s FDA commissioners combined — although it’s imperative to note, he has shown no willingness to review the effectiveness of opioid prescribing for chronic pain, as a recent report from the National Academies recommended he do (essentially the very same recommendation PROP made back in 2012). Gottlieb has also looked to hasten drug approvals by accepting less rigorous data, citing the “real world evidence” judged to be sufficient by the Obama administration.

As poorly as the FDA performed during the Obama years, another agency compiled a record that was even worse: the Department of Justice, and specifically the Drug Enforcement Administration (DEA).

Most people are unaware of the critical role the DEA plays in regulating a large share of the country’s licit drug supply, opioids included. Like its predecessor agency the Bureau of Narcotics, tasked with essentially the same set of jobs, the DEA publicizes only its attempts to control the flow of illicit drugs to the United States, an expensive undertaking that has never met with any meaningful success.

On the other hand, the DEA’s control of licit drug supply is straightforward and effective: it sets a quota for the importation and production for all Schedule I or prohibited drugs as well as all Schedule II, or tightly monitored, drugs. (That’s right: the United States government has a production quota for prohibited substances. This allows for a small number of medical experiments that take place using these drugs — mainly with marijuana — as well as other uses the government deems appropriate.) This quota system is embedded in the global system used to regulate drugs, originally formulated by the League of Nations, and revived by the United Nations in the post World War II era. Each participating country sets its import and production quota based on its own determination of medical needs, and then submits this data to the International Narcotics Control Board, a quasi-independent body charged with implementing the latest international drug convention agreed upon by the UN. All quotas must comply with the convention, and all sanctioned imports must correspond to a sanctioned export.

That this system of regulation is rarely mentioned obscures several important facts that bear upon the current drug crisis. First, for the United States, opioids are a trade. The country does not grow its own poppies to make Oxycontin or any other drug; it never has. Legal or illegal, opioids come to the United States from elsewhere, either as a raw material or ready-for-sale (or close to it).

Second, there exists a tremendous misimpression that the opioid epidemic is the first drug crisis launched and abetted by the pharmaceutical industry. Not only does contemporaneous (and intensifying) methamphetamine abuse contradict this notion, the very structuring premise of international drug conventions — that licit drugs can be diverted to illicit channels — rests on an understanding of the role Pharma plays in all kinds of illicit drug use. In fact, the League of Nations initially developed the scheme of international conventions to deal with the diversion of one painkiller in particular: heroin. The United States ultimately persuaded the United Nations to prohibit heroin, driving all of its production and distribution channels underground. But if you go back far enough, nearly every illicit drug market can trace its roots to the pharmaceutical industry. (Even hallucinogens, a drug sector with vibrant innovation now mostly detached from industry, became of interest in the modern era as the result of a discarded compound in pharmaceutical industry experiment labeled “LSD-25”.)

The discomfiting origin story behind most illicit drug use is one reason the DEA stays silent about Aggregate Production Quotas — that is, to sustain a fiction that illicit transactions can be addressed and conceptualized separately from the pharmaceutical industry. Instead, as opioid users who turn to illicit heroin in record numbers now make plain, the patterns of licit and illicit drug use have always been deeply intertwined.

Finally, cloaking the production quotas in a veil of silence mutes an important distinction between the over-prescribing and the over-supply of licit opioids. Over-prescribing can mean either providing too many pain pills for acute care (doling out a 30-day course of pills when five or seven days would suffice), or it can mean using opioid pills in ways that science has yet to vindicate (to care for lower back pain, for instance). Some physicians would likely argue that using a maximum instead of a minimum dose of opioids is also a form over over-prescribing. Taken together, all over-prescribing starts from a prescription pad.

In contrast, over-supply starts with the Aggregate Production Quotas. Over-supply makes over-prescribing possible, and it also enables large- and small-scale diversion at any point in the chain of production, from factory to warehouse; from truck trailer to pill mill. Over-supply of dangerous drugs inevitably results in diversion and public harm. The quotas, created to define licit flows for precisely these kinds of drugs, represent a global acknowledgement of this fact: for dangerous and addictive drugs, supply will find a market, and generate its own demand.

Given that, one would assume that determinations of medical need, the ostensible guiding principle of the United States APQ, would involve medical professionals assessing need based on science and experience. One would be wrong. The DEA sets Aggregate Production Quotas by suggesting amounts, usually derived from last year’s quota and consulting the prescribing levels of their registered distributors, and publishing those suggestions in the Federal Register. Drug companies provide feedback, as is their prerogative. The DEA often incorporates that feedback, or it holds an administrative hearing to air disputes. Then the final production quota is set for the year and once again published. (See “Quotas”) In practice, the current process for setting annual APQs entails nothing more than a survey of drug companies regarding how much of any given drug they’d like to produce.

When it comes to opioids or important precursor drugs, the answer to the question has been: a lot.

Belatedly, the DEA announced in October of 2016 that it would cut APQs for 2017, citing the opioid epidemic in its announcement.

But as the chart above demonstrates, the Obama administration kept APQs extraordinarily high; even the 2017 retrenchment will mainly affect reserve stockpiles that accrued during peak APQ years of 2013–2016.

In fact the only real success the Obama administration achieved on controlled substances was the 2014 decision to bump hydrocodone from Schedule III to Schedule II (“up-scheduling”), subjecting the drug to production quotas as well as tighter controls on refills. Other than that, and notwithstanding that noteworthy change, the Obama administration kept the spigot of opioid over-exposure running at full speed. That in itself represents serious culpability in the opioid crisis. Even apart from the actual amounts, it is inexplicable why the president’s team — had they been paying any sort of attention — did not revise the process for setting APQ’s to a more public health-oriented approach.

As one part of the Drug Enforcement Administration facilitated massive exposure of the American public to opioids, other officials in their agency were hindered from pursuing opioid wholesale distributors — companies that, under the law, must report suspiciously large orders of licit opioids. In practice, distributors that claimed ignorance made money as orders swelled to staggering heights.

Only recently have drug distributors faced (minor) financial penalties for inundating local communities with narcotics. Administrative foot-dragging frustrated former DEA diversion expert Joseph Rannazzisi, who was keen to pursue criminal penalties and large fines for drug distributors while he worked at the agency.

But Eric Holder’s Department of Justice saw it differently. According to the Washington Post, Rannazzisi was called to a meeting with the Deputy Attorney General in 2012, “to chastise me for going after industry.” When the Post first reported on the resistance Rannazzisi encountered, including a congressional bill passed to stymie his efforts, reporters mentioned that the lead congressman, Republican Tom Marino, cited Eric Holder’s desire to collaborate rather than confront the drug industry during hearings on his initial bill. That detail, and the actions of the Obama administration more generally, disappeared from the Post’s latest iteration of the same story, replaced by embarrassing efforts at spin by Obama-era officials who claim to be unaware of the bill’s obvious ramifications.

Contemporaneous reportings hows that to be absurd.

US Attorneys also declined to pursue significant cases against opioid manufacturers or distributors. There was every good reason to believe that the initial settlement led by Brownlee had come up short: the damage of prescription opioids only escalated, and companies continued to misrepresent their drugs, or covertly fund ostensibly neutral nonprofits to do that work for them. In the face of corporate malfeasance, Main Justice stood still — or, as Jesse Eisinger recounts in his book The Chickenshit Club: Why the Justice Department Fails to Prosecute Executives, “timidity coursed through the Holder Justice Department.” (In fact, all second generation lawsuits on the opioid crisis have come from State Attorneys General or county and city officials.)

That the Department of Justice balked while facing the worst drug epidemic in US history is shocking, but not surprising. For most of Obama’s presidency, DOJ was led by Eric Holder, a close guardian of corporate interests — so much so that journalist David Corn once dubbed him as representative of “what’s wrong with Washington [DC]”; a “poster child” for “selling out.” While in private practice in Covington and Burling in 2004, Holder represented Purdue Pharma when defending against a West Virginia lawsuit. A settlement was reached; records were sealed (only to be revealed in the blockbuster LA Times investigation of March 2016). But all along, while serving as Attorney General of the United States, Eric Holder knew exactly what Purdue Pharma did…and he did nothing.

In fact he did worse than nothing: he remained a biddable steward of corporate America. Because of Eric Holder, Obama will go down in history as a president oblivious to or complicit in the predations of financial capitalism; and the opioid crisis, the most brutal tally of its costs.

A Record of Success

Although President Obama declined to impose a public interest principle on setting drug APQs, he crafted several of note on the provision of health insurance in the United States as part of his sweeping Affordable Care Act (ACA). Of these, none proved more important to managing the opioid crisis than the instruction that mental health services, including substance use disorder (SUD) treatment, be offered and billed on par with other kinds of care furnished to a patient. (This component built upon the Mental Health Parity Act of 2008.)

So far, this remains an unattained ideal. In their interim report, Donald Trump’s Opioid Commission singled out non-enforcement of mental health parity regulations as an area of special concern. Still, the principle of parity has been enshrined both in law — which may be repealed — and as an expectation on the part of the American people when it comes to health coverage. Though far from complete, important strides have been made.

More attention has been paid to ACA-funded access to substance use disorder treatment via health insurance expansion. As is widely noted, the ACA funded Medicaid expansion in states that opted to pursue it; the legislation also encouraged states to establish health care exchanges for individuals to purchase health care or, if they declined, made access to a federal exchange available. In Ohio alone, almost a quarter million people receive access to treatment via one of these two routes. It is difficult to make the claim that many of these people would not have received either health insurance or access treatment via other means were it not for the ACA — difficult, but sadly not impossible, given the shameful state of health insurance prior to the ACA. By facilitating access to health insurance for millions, the ACA has saved lives, and not just in the context of the opioid crisis.

Medicaid’s Section 1115 waivers have been an overlooked story in the ACA and the opioid crisis. These waivers, allowing states to bypass certain Medicaid regulations in service to a special-needs population, improve efficiency, or expand coverage, predate the ACA. But Obama’s signature reform and the attendant expansion of Medicaid have prompted several states to apply the waivers to improve SUD detection, intervention, and care, an unheralded but significant transformation in treatment delivery. If Congress or the executive branch succeeds in repealing other elements of the ACA, the legacy of Section 1115 substance use disorder-focused waivers may prove to be Obama’s most enduring success in the opioid crisis.

Obama signed other pieces of legislation designed to expand SUD treatment capacity or access. For example, in July of 2016, he signed the Comprehensive Addiction and Recovery Act — a bill with a big name that did very little, given that all the money “designated” by the act relied upon the yearly appropriations process, and that Obama had asked for $1 billion in funding and received only $181 million. “This legislation includes some modest steps to address the opioid epidemic,” Obama noted during a subdued signing ceremony.

More fanfare — and much more funding — accompanied his December 2016 approval of the “21st Century Cures Act,” which secured up to a $1 billion in grants designed to target unmet needs in outreach or care. Already the first round of funding has earmarked close to half that amount for distribution. Unfortunately, as I’ve already noted, these new resources come at a steep cost to the American people. The 21st Century Cures Act further inscribes a culture of industry deregulation into the operations of the Food and Drug Administration; in this way, President Obama’s most decisive action on the opioid crisis demonstrates his total reluctance to heed one of its most important lessons.

As a matter of fact, all of these efforts by Obama to combat on the opioid crisis can be described as “end-stage,” a point considered by public health officials to be the least effective (and most expensive) to intervene. Almost all of them will result in profits for the drug industry. Companies like Indivior, makers of Suboxone, a popular form of Medication-Assisted-Treatment (MAT), stand to reap considerable gains. A small number of companies are involved in both sides of the business, producing opioid painkillers alongside opioid maintenance drugs, allowing them to make money, and make money again, regardless of the cost to the American people.

President Obama also showed himself to be inattentive and desultory at a time when urgency was required, both in a moral and a practical sense. Although Obama occasionally devoted some stern remarks to a crisis which spiraled out of control on his watch, and he directed his bored Secretary of Agriculture to form a “taskforce” on opioids when Vilsack complained of little to do, nothing much came of either. Likewise, the White House Summit on opioids held in August 2014 was probably well thought of by earnest people willing to work within Obama’s narrow parameters of reform: leave corporate profits and power untouched.

On opioids, Obama compiled a record of success in public relations and palliative remedies, and failure in the actual practice of power.

The exception to this proves the rule: in March 2016, the Center for Disease Control released opioid prescribing guidelines, a long overdue reassessment of when and how to prescribe opioids to relieve chronic pain. Later that month, in a public forum, Obama urged “consumers and families” to use the guidelines to hold opioid manufacturers “accountable.”

He said nothing of the federal government doing the same.

The Balance Sheet

Much can be said of this impoverished notion of progressive governance — one that ameliorates the effects of exploitation, but does nothing to curb its scope, or dislodge it from power. I want to make clear that here, I have exposed it to critique on its own terms, and not from the perspective of someone who considers drug prohibition to be an unmitigated failure (as I do), or who believes late stage capitalism is beyond salvaging (as most socialists do, but as someone who is not a socialist, I do not). Both provide valid leverage for critique, but would inevitably result in assailing President Obama for failing to adopt views he never espoused. That is a harsh standard to use when considering the opioid crisis as it unfolded in real time.

Instead I have offered an account based on what a reasonable person would expect from President Obama based upon his professed vision of government; the tools he had at his disposal; and the costs of the opioid crisis itself.

Those costs have only grown since Obama left office. There is little doubt that 2017 will exceed in overdose the deaths the previously record-setting year of 2016. Neither the ACA nor the “Cures Act” will effect dramatic change in this regard, nor will the recent efforts to cut back opioid prescribing produce immediate results. Deaths once driven by the greed of the pharmaceutical industry have now graduated to the even more callous greed of drug cartels, and we must await changes beyond what we can control, or beyond what can be expected in the short-term.

This bodes ill for for Barack Obama and his legion of admirers.

What follows a presidency dictates how it is remembered. Like other components of his legacy, Obama’s deficiencies on the opioid crisis have largely endured, while his accomplishments seem provisional, vulnerable to repeal. Right now, his failure shouts, while his success whimpers. Progressives can only hope that events reverse course, or that the principles embedded in his signature reforms will survive temporary reversal, only to return as emphatic and unassailable.

Even still, the Democratic Party (or any successor to it) will not collect the voting majorities needed to revive the best components of Barack Obama’s legacy unless and until they address the worst. First and foremost, that means reckoning with the foregoing account, a story of my President’s worst failure.

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Democrats Slam Trump: Refused To Hear Call For Unity, Bipartisanship

January 31, 2018

NEW YORK (CBSNewYork) — Three in four Americans who watched President Donald Trump’s first State of the Union address approved of the speech, according to a CBS News poll.

Full Text: President Donald Trump’s 2018 State Of The Union Address

About 80 percent of those surveyed felt the president’s speech tried to unite the country rather than divide it and 65 percent said the speech made them feel proud.

The speech garnered much reaction from lawmakers and others on Twitter:

After a long and divisive year, many Americans were yearning for the President to present a unifying vision for the country. Unfortunately, his address stoked the fires of division instead of bringing us closer together.

The President paid lip service to bringing the country together tonight, but continued to push the GOP’s extremist vision of America.

After one of the most divisive years in memory—it’s up to the President to deliver. Actions speak louder than words.

President Trump in that chamber was more a Divider-in-Chief than a unifier.

After the lofty rhetoric, tonight’s speech was mostly red meat partisan applause lines. There were vacuous promises but few specifics on issues like infrastructure, opioid addiction, veterans and other key priorities.

Just like his “tax cut” really gave away millions to the world’s biggest corporations, we know @realDonaldTrump‘s performance tonight was another distraction to cover up for his divisive, hateful agenda.

After a year of erratic leadership, hateful rhetoric, and broken promises, President Trump’s actions in the days ahead will speak louder than words read from tonight’s teleprompter.

Tonight @realDonaldTrump passed up another opportunity to lay out a comprehensive strategy to combat this country’s mental health and opioid crises.

I went to the . I wanted it burned into my eyes. If there’s ever a moment when I’m too tired to keep fighting, I just have to close my eyes & see @realDonaldTrump , @mike_pence & @pryan applauding themselves for punching working families in the gut, & I’m back in this fight.

Tonight, @realDonaldTrump presented a self-congratulatory speech w/o vision. He promised unity, but sowed division. America deserves better.

.@POTUS said it right—the state of our union is strong. He laid out a clear agenda tonight with an open hand toward bipartisan cooperation. Together, we can continue making America safer and stronger for the 21st century.

President Trump clearly relishes being the Law and Order president and a strong Commander in Chief.

Just what America needs!

It was a strong speech emphasizing America is open for business and going on the offense when it comes to crime and terrorism.

I’m very pleased President Trump is empowering our military and putting our enemies on notice.

Tonight, during the , @POTUS highlighted many important accomplishments, challenges & opportunities impacting our nation. He also discussed how our great country will rise to tackle the daunting needs we still face. https://zeldin.house.gov/media-center/press-releases/rep-zeldin-president-trump-s-first-state-union-address 

Rep. Zeldin on President Trump’s First State of the Union Address

WASHINGTON- Congressman Lee Zeldin (R, NY-1) just released the following statement after the conclusion of President Trump’s first State of the Union Address:

zeldin.house.gov

.@POTUS delivered a powerful message to the American people on building a safer, stronger and prouder nation. He outlined a vision of a united people, working together to face major challenges head-on and build off the progress made in the past year. http://bit.ly/2DNluJ8 

Inspiring & powerful . @POTUS made clear the state of our Union is STRONG. In just 1 year @POTUS has cut taxes, grown our economy, and has ISIS on the run – & we’re just getting started. We are building a SAFE, STRONG & PROUD America!

Trump called for unity as he outlined his plans for the country. The president called on both parties to come together on immigration and infrastructure as he called for “our new American moment.”

“The state of our union is strong because our people are strong,” Trump said. “I am extending an open hand to work with members of both parties.”

The president also touted his accomplishments, including recent tax cuts and reforms.

Trump also used the speech as an opportunity to offer to work with both parties to get a deal on immigration, proposing a path to citizenship for Dreamers — the 1.8 million people brought to the U.S. illegally as children in exchange for billions for a border wall with Mexico.

He also called for the closure of loopholes that have allowed the MS-13 gang to make their way into the U.S.

In the audience were the parents of Kayla Cuevas and Nisa Mickens, the two teens killed by the MS-13 gang on Long Island in 2016. The president recognized the families during an emotional moment that received a standing ovation.

More than a dozen lawmakers boycotted the president’s speech. Some Democrats wore black as a nod to the movement against sexual harassment and many lawmakers, including Long Island Congressman Tom Suozzi, invited Dreamers as their guests.

The president called for both sides of the aisle to come together as he outlined his plan for the next year.

“I am asking both parties to come together to give us the safe, fast, reliable, and modern infrastructure,” Trump said, calling on Congress to produce a bill that generates $1.5 trillion for new infrastructure and improvements.

“We will build gleaming new roads, bridges, highways, railways, and waterways all across our land and we will do it with American heart, American hands, and American grit,” Trump said.

Trump also mentioned his intention to invest in job training and issued a stern warning to North Korea, but he made no mention of the Russia investigation.

On Tuesday, he signed a new executive order to keep the prison at Guantanamo Bay open — a reversal of an order by the Obama administration.

CBS New York:http://newyork.cbslocal.com/2018/01/31/state-of-the-union-reaction/

See also:

Image result for Pelosi during SOTU, photos

SARAH HUCKABEE SANDERS TOLD NANCY PELOSI TO ‘SMILE WAY MORE OFTEN,’ SUGGESTED SHE EMBODIES THE ‘BITTERNESS’ OF DEMOCRATS

http://www.newsweek.com/sarah-huckabee-sanders-told-nancy-pelosi-smile-way-more-often-796093

Uber Breach and Response Draw Global Government Scrutiny

November 23, 2017

Senator criticizes ‘inexplicable delay’ in announcing the breach, while the FTC and several countries are looking into the issue

An FTC spokesman said the agency is “closely evaluating the serious issues raised.”
An FTC spokesman said the agency is “closely evaluating the serious issues raised.” PHOTO: ERIC RISBERG/ASSOCIATED PRESS
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Government officials world-wide said they would look at Uber Technologies Inc.’s handling of a major data breach last year.

Uber said Tuesday that it paid hackers $100,000 in an effort to conceal a data breach that affected 57 million accounts. In addition to the names, emails and phone numbers of riders, about 600,000 U.S. drivers’ license numbers were accessed, Uber said.

A Federal Trade Commission spokesman said the agency is “closely evaluating the serious issues raised,” while Sen. Richard Blumenthal (D., Conn) said on Twitter that the Senate Commerce Committee should hold a hearing to “demand Uber explain their outrageous breach—and inexplicable delay in informing its consumers and drivers.”

San Francisco-based Uber said it would notify owners of the affected accounts in coming days. It fired its chief security officer and a deputy for their role in the breach and covering it up, and Chief Executive Dara Khosrowshahi apologized.

At least three European government agencies are looking into Uber’s handling of the breach, and the New York State Attorney General’s office has opened an investigation.

Uber said in a statement that “we’ve been in touch with several state attorney general offices and the FTC to discuss this issue, and we stand ready to cooperate with them going forward.”

New Mexico’s Attorney General said in a letter to Uber that the company’s reaction to the breach was “gravely concerning” and requested that the company provide more information within 10 days.

Britain’s Information Commissioner’s Office will assess what steps Uber would need to take to better comply with data-protection requirements.
Britain’s Information Commissioner’s Office will assess what steps Uber would need to take to better comply with data-protection requirements. PHOTO: SIMON DAWSON/REUTERS

Uber hasn’t disclosed a geographic breakdown of the compromised accounts. Uber said Wednesday it was in the process of notifying regulatory and government authorities about the breach. “We expect to have ongoing discussions with them,” an Uber spokesman said. “Until we complete that process we aren’t in a position to get into any more details.”

The FTC has the authority to examine Uber’s cybersecurity efforts and its response to the breach, including any communication, or lack thereof, with the public.

The commission has undertaken at least preliminary investigations, and sometimes very detailed probes, of this nature during past large-scale hacks, looking at whether a hacked company had reasonable data protection practices in place that were in line with industry best practices. The FTC also has examined how companies have responded to any known security weaknesses before a breach took place.

The FTC has pursued enforcement actions when it believed companies weren’t vigilant in following appropriate safeguards.

In September, the FTC said it was investigating a breach at Equifax Inc .

Britain’s Information Commissioner’s Office, which oversees data protection in the country, said it would assess how the breach affected people in the U.K. and what steps Uber would need to take to better comply with data-protection requirements. The office has the power to fine Uber, up to £500,000 ($665,000), for any wrongdoing.

“Deliberately concealing breaches from regulators and citizens could attract higher fines for companies,” said James Dipple-Johnstone, the British agency’s deputy commissioner, in a statement.

In addition to Britain—where Uber also faces a separate legal challenge over drivers’ compensation and a potential ban on operating in London—Italian and Dutch authorities said they also planned to evaluate how Uber handled the data breach.

“We are dismayed by the poor transparency shown towards users, which we intend to investigate,” said Antonello Soro, the Italian Data Protection Authority’s president, in a statement.

A spokesman for the data protection agency in the Netherlands, where Uber bases its European operations, said the agency would examine the reports of the data breach.

Most EU-member authorities don’t currently have the power to impose fines on companies in the case of personal data breaches. This will change under a new regulation taking effect in May 2018.

The National Privacy Commission of the Philippines said it has summoned Uber to a Nov. 23 meeting to discuss the incident and to comply with the formal breach notification procedure under the Data Privacy Act of 2012.

The coverup is another challenge for Uber, which is valued at $68 billion. Mr. Khosrowshahi has tried to bring stability after a year of controversies that took place under CEO Travis Kalanick.

Mr. Khosrowshahi has inherited several federal probes of the company over programs targeting rivals and regulators, as a well as a possible violation of the Foreign Corrupt Practices Act.

Uber is in a heated legal battle with Google parent Alphabet Inc., which filed suit in February alleging the company stole trade secrets related to self-driving cars. And it is trying to recover from claims by a former female engineer that management ignored complaints from her and other women of sexism and harassment.

The company has said it is cooperating with federal regulators in their investigations. It disputes the allegations made by Alphabet and is contesting the lawsuit.

Write to Stu Woo at Stu.Woo@wsj.com

https://www.wsj.com/articles/european-regulators-look-into-uber-handling-of-data-breach-1511378731

Related:

Trump Jr. messaged with WikiLeaks during 2016 campaign

November 14, 2017

The Associated Press

WASHINGTON (AP) — President Donald Trump’s oldest son on Monday released a series of private Twitter exchanges between himself and WikiLeaks during and after the 2016 election, including pleas from the website to publicize its leaks.

Donald Trump Jr.’s release of the messages on Twitter came hours after The Atlantic first reported them. In the exchanges — some of them around the time that the website was releasing the stolen emails from Democrat Hillary Clinton’s campaign chairman — WikiLeaks praises his father’s positive comments about WikiLeaks and asks Trump Jr. to release his father’s tax returns to the site.

The revelations are sure to increase calls in Congress to have Trump Jr. testify publicly as part of several committee probes into Russian interference in the 2016 election. And they add a new element to the investigations that have been probing for months whether Trump’s campaign colluded in any way with the Russian government.

In an intelligence assessment released last January, the NSA, CIA and FBI concluded that Russian military intelligence provided hacked information from the DNC and “senior Democratic officials” to WikiLeaks. WikiLeaks has denied that Russia was the source of emails it released, including those from Clinton’s campaign chairman, John Podesta.

The private messages released by Trump Jr. show him responding to the WikiLeaks account three times, at one point agreeing to “ask around” about a political action committee WikiLeaks had mentioned. He also asked the site about a rumor about an upcoming leak. The messages began in September 2016 and ran through July.

Trump Jr. downplayed the exchanges as he released them.

“Here is the entire chain of messages with @wikileaks (with my whopping 3 responses) which one of the congressional committees has chosen to selectively leak,” he tweeted. “How ironic!”

Trump Jr.’s lawyers had released the exchanges to three congressional committees that have been investigating Russian intervention in the 2016 election and whether there were any links to Trump’s campaign.

In a statement, Trump Jr.’s lawyer said thousands of documents had been turned over to the committees.

“Putting aside the question as to why or by whom such documents, provided to Congress under promises of confidentiality, have been selectively leaked, we can say with confidence that we have no concerns about these documents and any questions raised about them have been easily answered in the appropriate forum,” said Alan Futerfas.

Futerfas didn’t say which forum he was referring to, but Trump Jr. was interviewed behind closed doors by Senate Judiciary Committee staff in September. A person familiar with that meeting said the private Twitter messages were discussed. The person declined to be identified because the transcript of that interview hasn’t been made public.

In one message dated Oct. 3, 2016, the WikiLeaks Twitter account sent Trump Jr. an article that included critical comments Clinton had made about WikiLeaks editor Julian Assange and said “it’d be great if you guys could comment on/push this story.”

Trump Jr. replied: “Already did that earlier today. It’s amazing what she can get away with.”

Two minutes later, Trump Jr. sent another message: “What’s behind this Wednesday leak I keep reading about?”

Longtime Trump associate Roger Stone had tweeted the day before that on Wednesday, “Hillary Clinton is done,” referencing WikiLeaks.

The WikiLeaks Twitter account never responded, but days later WikiLeaks started rolling out Podesta’s stolen emails. After the emails were released, WikiLeaks sent Trump Jr. a searchable link of the emails. Trump Jr. tweeted that link two days later, on Oct. 14, 2016, The Atlantic noted.

The rest of the messages are one-sided, with WikiLeaks sending Trump Jr. messages through July 2017. They include praise for his father for mentioning them on the campaign trail, a plea to release Trump’s taxes to the site and advice on Election Day that Trump should not concede if he lost. One message suggested Trump encourage Australia to appoint Assange as U.S. ambassador.

In July, the Twitter account messaged Trump Jr. to ask him to give the site emails surrounding a meeting he and other Trump associates held with Russians during the campaign. Trump Jr. then released them himself.

Vice President Mike Pence responded quickly to the revelations, issuing a statement through his press secretary that he knew nothing about the situation.

“The vice president was never aware of anyone associated with the campaign being in contact with WikiLeaks,” said spokeswoman Alyssa Farah. “He first learned of this news from a published report earlier tonight.”

Assange tweeted after The Atlantic report that he couldn’t confirm the messages but then defended them after Trump Jr. released them.

“WikiLeaks appears to beguile some people into transparency by convincing them that it is in their interest,” Assange tweeted.

Democrats swiftly reacted to the report, saying Trump Jr. should provide more information. California Rep. Adam Schiff, the top Democrat on the House intelligence committee, says it “demonstrates once again a willingness by the highest levels of the Trump campaign to accept foreign assistance.”

Schiff also pointed to Cambridge Analytica, a data firm that worked for Trump’s campaign and reached out to WikiLeaks before the election about obtaining emails related to Clinton, according to the company’s CEO.

Democratic Sen. Richard Blumenthal, a member of the Senate Judiciary Committee, said that panel should subpoena the documents and force Trump Jr. to publicly testify.

“There seems to be no reasonable explanation for these messages,” Blumenthal said.

Senate Judiciary Committee Chairman Chuck Grassley had said he would call Trump Jr. to publicly testify after the private interview in September. But negotiations over witnesses broke down last month amid disagreements with Democrats on the panel.

The House and Senate intelligence committees are also expecting to interview Trump Jr., but those interviews are expected to be behind closed doors.

___

Associated Press writers Zeke Miller, Eric Tucker, Chad Day and Tom LoBianco contributed to this report.

Leak Reveals Ties Between Trump Administration and Russia, Implicating Commerce Secretary Wilbur Ross and Jared Kushner

November 6, 2017

Image may contain: 2 people, text

PHOTO ILLUSTRATION BY LYNE LUCIEN/THE DAILY BEAST

By 

The so-called Paradise Papers have revealed secrets of politicians worldwide, including new links between the Trump administration and Russia.

A new trove of more than 13 million leaked documents implicates top officials and associates of President Donald Trump—as well as foreign politicians—in shady business relationships tied to offshore financial accounts.

In at least two cases, the documents highlight top administration officials’ previously undisclosed connections to Russia and Kremlin-linked interests.

The so-called Paradise Papers were leaked to the German newspaper Süddeutsche Zeitung, the same publication that obtained the “Panama Papers.” Süddeutsche Zeitung shared the new documents with the International Consortium of Investigative Journalists, which led a global effort of 96 media organizations from 67 countries to pore through the records. The findings were published on Sunday.

The documents show that many of the wealthy individuals Trump brought into his administration have worked to legally store their money in offshore havens where they would be free from taxation in the United States. Trump has promised repeatedly to “drain the swamp,” in condemning the idea that well-connected individuals in Washington, D.C., preserve their own interests at the expense of the rest of the country.

Among the Trump administration officials implicated in the leaks is Commerce Secretary Wilbur Ross, who according to the documents concealed his ties to a Russian energy company that is partly owned by Russian President Vladimir Putin’s judo partner Gennady Timchenko and Putin’s son-in-law, Kirill Shamalov. Through offshore investments, Ross held a stake in Navigator Holdings, which had a close business relationship with the Russian firm. Ross did not disclose that connection during his confirmation process on Capitol Hill.

Image may contain: 3 people, people sitting

Secretary of Commerce, Wilbur Ross seated next to President Donald Trump. Photo by Pete Marovich/UPI

“In concealing his interest in these shipping companies—and his ongoing financial relationship with Russian oligarchs—Secretary Ross misled me, the Senate Commerce Committee, and the American people,” Sen. Richard Blumenthal (D-CT) said in a statement on Sunday. He characterized Ross’ financial disclosures as a “Russian nesting doll, with blatant conflicts of interest carefully hidden within seemingly innocuous companies.”

Ross has been linked to Russian interests before; in 2014, he poured hundreds of millions of dollars into the Bank of Cyprus, an institution regarded by financial watchdogs as a haven for Russian money laundering. Ross’ fellow investors included a pair of Russian oligarchs, including Dmitry Rybolovlev, the man who bought a Trump property in Palm Beach for $95 million, even though it was valued at less than $60 million. Ross became a vice chair of the bank, along with a reported former KGB officer. Former Deutsche Bank executive Josef Ackermann was installed as chairman. Deutsche Bank—one of Trump’s biggest creditors—subsequently paid hundreds of millions to settle disputes that it shipped $10 billion or more to Russia in suspect loans.

Top White House adviser Jared Kushner, Trump’s son-in-law, is also implicated. The documents reveal that Russian tech leader Yuri Milner invested $850,000 in a startup called Cadre that Kushner co-founded in 2014.

Milner has long had a reputation in Silicon Valley as a big-league investor; his firm at one point owned major chunks of both Facebook and Twitter. But Milner was never considered particularly Kremlin-connected. These new documents call that reputation into question. The investing arm of Gazprom, the state-backed energy company, financed a share of Facebook worth up to $1 billion; a Kremlin-owned bank invested $191 million into a Milner firm, and some of that money was then injected into Twitter.

Despite Milner’s investment in his startup, Kushner said in July that he told the Senate Intelligence Committee in a closed-door meeting that he never “relied on Russian funds to finance my business activities in the private sector.”

Representatives for Sens. Richard Burr (R-NC) and Mark Warner (D-VA), the chairman and vice chairman of the committee, did not immediately return requests for comment. Kushner, who still has a stake in Cadre, did not previously disclose the firm’s other business ties.

The top adviser is already ensnared in the Russia investigations as questions continue to swirl about his meeting at Trump Tower in June 2016 with a Kremlin-connected Russian lawyer, Natalia Veselnitskaya. Kushner attended the meeting alongside Donald Trump Jr. and Paul Manafort, who was indicted last week by the Justice Department’s special counsel, Robert Mueller, in connection with his lobbying work for pro-Russian interests in Ukraine.

Secretary of State Rex Tillerson, Treasury Secretary Steven Mnuchin, and top economic adviser Gary Cohn are all mentioned in the documents. But some lower-level appointees have more egregious connections to offshore interests—in some cases, directly related to industries they are tasked with regulating.

Randal Quarles, who was confirmed just last month to be vice chairman for supervision at the Federal Reserve, has financial connections to a bank based in Bermuda that is being probed by U.S. officials under suspicion of tax evasion. A Federal Reserve spokesman told The Guardian that Quarles divested from the bank when he assumed his position at the U.S. central bank.

It isn’t just American officials who are implicated in the document dump. A substantial portion of Queen Elizabeth II’s private estate—around 10 million pounds—resides in offshore accounts based in the Cayman Islands and Bermuda. Some of the money has been invested in companies with allegedly shady business practices.

A significant number of the leaked documents came from a law firm based in Bermuda called Appleby, which helps its clients set up offshore financial accounts with the goal of avoiding taxes on certain assets. Appleby has maintained that “there is no evidence of any wrongdoing, either on the part of ourselves or our clients.”

—with additional reporting by Noah Shachtman

https://www.thedailybeast.com/massive-leak-reveals-new-ties-between-trump-administration-and-russia-implicating-commerce-secretary-wilbur-ross-and-jared-kushner

Related:

See also UPI Report:

https://www.upi.com/Top_News/US/2017/11/05/Leaked-papers-show-commerce-secretary-hid-ties-to-Putin-cronies/3361509913537/?utm_source=fp&utm_campaign=ls&utm_medium=2

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Sen. Richard Blumenthal says “enough is enough” after Texas church shooting — At least 26 people killed in shooting at Texas church

November 6, 2017

Last Updated Nov 5, 2017 11:28 PM EST

CBS News

Sen. Richard Blumenthal, D-Connecticut, said he is “heartbroken” for all of those who were affected by the deadly shooting at a baptist church in Sutherland Springs, Texas, Sunday — and he called on Congress to act.

“Horror, heartbreak, shame. Prayers are important but insufficient. After another unspeakable tragedy, Congress must act — or be complicit,” Blumenthal wrote in the wake of the shooting.

“Enough is enough,” he said. “Now is the time for commonsense gun violence prevention steps. Congressional complicity must end.”

Heartbroken for victims, loved ones, and all affected by the horrific tragedy in Sutherland Springs, Texas.

Horror, heartbreak, shame. Prayers are important but insufficient. After another unspeakable tragedy, Congress must act – or be complicit.

Enough is enough. Now is the time for commonsense gun violence prevention steps. Congressional complicity must end.

Blumenthal represents the state that suffered its own tragic shooting in 2012, when a gunman opened fire at Sandy Hook Elementary School in Newtown, Connecticut, killing 20 students and six teachers.

He has since become a vocal critic of members of Congress calling for “thoughts and prayers” in the wake of similar violent shootings — most recently joining the chorus of fellow senators calling for a revision in the nation’s gun laws in the days that followed last month’s Las Vegas massacre.

Fellow Connecticut Sen. Chris Murphy, who represents the district of Newtown and is another vocal critic of gun violence, tweeted his reaction to the shooting, writing, “Oh my god.”

At least 26 people were killed in the shooting, Texas Gov. Greg Abbott said in a news conference Sunday night.

The shooting suspect has been identified as 26-year-old Devin Patrick Kelley, CBS News has learned from federal law enforcement sources.

Kelley is a former U.S. Air Force member who served from 2010 to 2014. He was dishonorably discharged and court martialed in May 2014, CBS News has learned.

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At least 26 people killed in shooting at Texas church

Story highlights

  • The shooter has been identified as Devin Patrick Kelley, according to law enforcement sources
  • Kelley was a member of the US Air Force and served at Holloman Air Force Base in New Mexico

(CNN)At least 26 people were killed in Sunday’s church shooting in Sutherland Springs, Texas, Gov. Greg Abbott said at a press conference.

About 20 others were wounded, said Freeman Martin, a regional director with the Texas Department of Public Safety, with victims ranging in age from 5 to 72 years old.
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Among the dead is the 14-year-old daughter of the First Baptist Church’s pastor, Frank Pomeroy, according to his wife, Sherri Pomeroy, the girl’s mother. The couple were traveling out of state when the shooting occurred.
Authorities have not said what may have motivated the suspected shooter, who was later found dead in his vehicle.
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The shooting has devastated the small Texas town east of San Antonio, described as a place where “everybody knows everybody.”

Here are the latest developments:

  • The suspected shooter has been identified as 26-year-old Devin Patrick Kelley, according to two law enforcement sources who have been briefed on the investigation.
  • In April 2016, Kelley purchased the Ruger AR-556 rifle he used in the shooting from an Academy Sports & Outdoors store in San Antonio, Texas, a law enforcement official said. He indicated he didn’t have a disqualifying criminal history when he filled out the background check paperwork at the store, the official said. Kelley listed a Colorado Springs, Colorado, address when he bought the gun.
  • Kelley was a member of the US Air Force and served at Holloman Air Force Base in New Mexico from 2010 until his discharge, according to Air Force spokeswoman Ann Stefanek.
  • Kelley was court-martialed in 2012 for assault on his spouse and assault on their child, according to Stefanek. Kelley served a year in prison and received a bad conduct discharge in 2014, the spokeswoman said. His rank was also reduced, she said.
  • Speaking from Japan, President Donald Trump condemned the shooting as an “act of evil” and called it “horrific.”
  • “We don’t know names of any of the victims at this time,” said Wilson County Sheriff Joe Tackitt in a press conference Sunday evening. As victims are identified, next of kin will be notified, he said.

The attack

Without naming Kelley, Martin described the shooter in Sunday’s press conference as a young white male who was dressed in all-black “tactical-type gear” and wearing a ballistic vest.
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Martin said the suspect was seen in a Valero gas station across the street from the church in Sutherland Springs at about 11:20 a.m. local time on Sunday morning.
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The suspect left the gas station, crossed the street, exited his vehicle and began firing before he entered the church, Martin said.
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As the suspected shooter left the church, a local resident used their own rifle to engage him, Martin said. The shooter then fled the church, while the citizen pursued him.
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Much more at CNN:
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US voters want Donald Trump to stop tweeting

August 9, 2017

The President says it’s his way to communicate directly

By Andrew Buncombe New York

The Independent 

donald-trump-twitter-president.jpgThe President’s tweeting has resulted in no shortage of controversies AP

Everybody knows just how much Donald Trump enjoys tweeting.

The White House has said his tweets should be considered official statements from the US President, while Mr Trump believes they are the most effective way to communicate directly to his supporters.

“The FAKE MSM is working so hard trying to get me not to use Social Media,” he tweeted in June. “They hate that I can get the honest and unfiltered message out.”

The FAKE MSM is working so hard trying to get me not to use Social Media. They hate that I can get the honest and unfiltered message out.

But Mr Trump better get ready for a surprise: a survey has suggested the majority of Americans do not actually appreciate his tweeting. And an even larger proportion of the public think it is not an appropriate way for a leader to communicate.

The poll for CNN found seven out of ten Americans believed his tweeting habits “too often seem to be in response to news he may have seen on TV” and believe Twitter is a “risky way for a President to communicate”.

More than six in ten believed that his tweets “too often turn out to be misleading” and were “easy to misunderstand”.

Mr Trump has long defended his tweeting. “My use of social media is not Presidential – it’s MODERN DAY PRESIDENTIAL,” he tweeted on July 1. “Make America Great Again!”

But his social media habits have repeatedly placed him in hot water. One of the many Twitter controversies Mr Trump sparked during the election, was an early morning attack he launched on former Miss Universe Alicia Machado.

Since he has entered the White House, Mr Trump’s tweeting has not become any more polite or measured – despite repeated calls from his advisors that he stop tweeting spontaneously.

In June, the President sparked more outcry when he attacked television anchor Mika Brzezinski, who had recently voiced mild criticism of him. He said she had a low IQ and had been “bleeding badly from a face-lift” during a social gathering at Mr Trump’s resort in Florida during the New Year.

This week, despite the appointment of John Kelly as a new Chief of Staff, a former four star general tasked with trying to bring discipline to the West Wing, he has fired off a series of tweets attacking Richard Blumenthal, a Democratic senator from Connecticut. Mr Trump called him “a phony Vietnam con artist” on Twitter after the senator appeared on television to voice support for continuing the investigation into alleged Russian meddling in the 2016 election.

The same survey found that Mr Trump has historically low approval ratings. Just 38 per cent of people said they approved of his handling of the presidency, while 56 per cent said they disapproved.

http://www.independent.co.uk/news/world/americas/us-politics/donald-trump-stop-tweeting-us-voters-approval-ratings-latest-poor-cnn-president-a7882916.html

Senate GOP Plans Health-Care Vote Next Week

June 20, 2017

McConnell tries to keep pressure on fellow Republicans

Senate Majority Leader Mitch McConnell, center, with other Republicans on Capitol Hill earlier this month.

Senate Majority Leader Mitch McConnell, center, with other Republicans on Capitol Hill earlier this month. PHOTO: TOM WILLIAMS/ZUMA PRESS
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Updated June 19, 2017 7:48 p.m. ET

WASHINGTON—Senate GOP leaders have set a timeline to vote next week on legislation to repeal large chunks of the Affordable Care Act, even though they don’t yet appear to have secured enough support to pass it.

Majority Leader Mitch McConnell (R., Ky.) is intent on keeping pressure on Senate Republicans to move quickly on the bill rolling back and replacing much of the 2010 health law, lawmakers and GOP aides said. The push for a quick vote before the weeklong July 4 recess could backfire, however, as some conservative and centrist Republicans have expressed concern about the emerging shape of the legislation.

“I expect us to vote on it next week,” Sen. Richard Burr (R., N.C.) said Monday evening of the health bill. “I believe the majority leader when he says he’s going to take it up.”

Mr. McConnell could pull back if he calculates that a little extra time could get him the votes needed to cross the finish line. He can lose no more than two GOP votes for a bill to pass. All Democrats are expected to oppose it.

Still, Mr. McConnell has reasons to try for a quick health-care vote. The pressure could force lawmakers to reach a consensus on sticking points that have divided them. And GOP leaders in both chambers want to move on to other legislative items.

Failure to take a vote before either the July 4 recess or the longer break later in the summer also could open Republican lawmakers up to pressure from constituents either concerned about losing their health coverage or expecting Republicans to follow through on pledges to repeal the law known as Obamacare. Some town-hall meetings during the spring, when the House was considering its legislation, saw lawmakers greeted by boisterous crowds.

The nonpartisan Congressional Budget Office estimated the House bill passed in May would leave 23 million fewer Americans with health coverage in 2026 versus current law.

GOP aides and others familiar with the negotiations said they anticipate the Senate bill’s text will be released later this week. The CBO is expected to release its estimate of the Senate bill’s impact on the federal budget and insurance coverage early next week, and a vote could potentially be held next Thursday, before lawmakers scatter.

Democrats and consumer groups have criticized Senate Republicans for crafting the bill in closed-door sessions without any hearings or other input. As a form of protest, Senate Democrats are planning procedural maneuvers to try to delay legislation or nominees.

Democrats are planning to “embarrass the heck out of Republicans, who are as much in the dark as we are about their own leadership’s plans on the bill,” said Sen. Richard Blumenthal (D., Conn.). “Our tools are limited, but we’re going to use every one of them.”

For their part, many Senate Republicans have said they have yet to see their bill and want to make sure they are given enough time to review it.

“There isn’t a bill yet—nobody has seen any language,” Sen. Chuck Grassley (R., Iowa) said Monday. Sen. Dan Sullivan (R., Alaska) said he wanted “significant time” to review the bill—“certainly days” rather than hours, he said.

Mr. McConnell has said all 52 Senate Republicans have been involved in the negotiations on issues the party has been talking about since the ACA passed in 2010.

Meanwhile, provisions in the GOP bill that had proved vexing , including the fate of Medicaid expansion and tax credits to consumers, appear close to being resolved, people familiar with the negotiations said.

Under an option being strongly considered, the bill would exact steeper financial cuts to Medicaid than under the House-passed legislation, the people said, a move likely to draw criticism from a number of Republican governors who want to preserve Medicaid open-entitlement funding and the ACA’s expansion of the program.

The entire funding system for the state-federal program for low-income and disabled people would be changed to a per capita cap, which would limit federal spending to states. That is the approach that also passed in the House bill, which would cut federal spending on Medicaid by $834 billion over 10 years.

Under one proposal, the Senate bill would lower Medicaid’s spending growth to a rate set in the House bill until 2025, when it would then be more sharply curtailed, according to people familiar with the discussions. The bill would slow the growth of federal spending on Medicaid by tying its growth rate to a lower price index, a change sought by Sen. Pat Toomey (R., Pa.).

That is likely to draw opposition from Republicans in states that expanded Medicaid under the ACA, including Sens. Rob Portman of Ohio, Dean Heller of Nevada and Shelley Moore Capito of West Virginia.

“Rob does not support a growth rate that is lower than the House bill,” Kevin Smith, a spokesman for Mr. Portman, said Monday.

The bill is expected to start phasing down enhanced federal funding to the 31 states that expanded Medicaid, people familiar with the deliberations said. States could get a lower amount of federal funding for new enrollees in 2020, and the amount would fully phase down by 2023.

The bill would also provide assistance to people who don’t get health insurance on the job. But unlike the House version that set up tax credits based largely on income, the Senate version could provide subsidies that are larger for people who are low-income or in areas with high health-costs, a person familiar with the proposal said.

Those tax credits are likely to be structured in ways similar to the ACA subsidies as a way to preserve restrictions on abortion funding, according to Senate GOP aides. Provisions restricting the use of the House bill’s tax credits to pay for abortion hit procedural hurdles in the Senate.

The ACA subsidies, which are advance tax credits paid to insurance companies to lower the cost of health-insurance premiums, currently can’t be used to cover the cost of abortions.

A senior White House official said they expected to have a stronger sense of how the votes were lining up by the end of the week and that they were confident the tally was heading in the right direction.

The White House is set to continue emphasizing insurance-market woes this week as a reason to get health legislation done fast, an argument that President Donald Trump has made for weeks and that is taking on additional force as state insurance deadlines pass and insurers’ rates and withdrawals from the marketplace become public. Democrats argue that Republicans are hurting the marketplaces by threatening to halt payments that are used to reduce out-of-pocket costs for lower-income patients and by raising questions about enforcement of the ACA’s coverage mandate.

Wednesday is a federal filing deadline for insurance companies to decide whether they will participate in the ACA’s exchanges and the rates they want to charge.

Write to Stephanie Armour at stephanie.armour@wsj.com and Kristina Peterson at kristina.peterson@wsj.com

Appeared in the June 20, 2017, print edition as ‘Senate Planning Health Vote.’

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U.S. Senators Likely to Vote on Iran Bill Next Week — Democrats Moving Away From Obama Iran Deal

March 19, 2015

WASHINGTON Thu Mar 19, 2015 2:30pm EDT

(Reuters) – The U.S. Senate Foreign Relations Committee will likely vote next Thursday on a closely watched bill requiring President Barack Obama to submit any nuclear agreement with Iran for Congress’ approval, the panel’s chairman, Republican Senator Bob Corker, said on Thursday.

If the committee approves the bill, as expected, it would advance legislation the Obama administration has said could endanger delicate nuclear talks with Iran, just as negotiators rush to meet a late-March deadline for a framework agreement.

Obama has threatened a veto. And he and other top administration officials have been urging Congressional Democrats not to support the measure in the committee or in the full Senate.

“We’re hoping to start marking it up next Thursday morning,” Corker, the bill’s author, told reporters outside the Senate, referring to the committee debating and considering amendments before voting on whether to recommend it to the full Senate.

After the bill is passed by the Foreign Relations panel, it would be sent for a vote in the full Senate. That would not take place before mid-April at the earliest, after lawmakers leave Washington for a two-week recess.

Lawmakers and congressional staff say there is a good chance that enough Democrats will join Republicans to give the bill the 60 votes it would need to advance in the Senate.

If it passes the Senate, the legislation would likely move quickly in the House of Representatives, where Republicans hold 245 seats, compared to just 188 Democrats.

If Obama carries through on his veto threat, the bill’s backers insist they could marshal the two-thirds of the House and Senate necessary to override the veto. Democratic leaders say it is far too early to tell.

Lawmakers had agreed to hold off on the Corker bill until after March 24, to give international negotiators time to reach a framework agreement on a nuclear deal with Iran. But many are eager to go ahead as the end of March approaches.

A senior European negotiator said on Thursday that the six world powers were unlikely to reach a framework agreement with Iran in the coming days as the sides are still far apart on key issues.

(Reporting by Patricia Zengerle; Editing by Richard Chang)

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Democrats prepared to buck White House on Iran nuclear deal

Even as the White House ramps up pressure on Congress to stay out of its negotiations with Iran on a nuclear agreement, Republicans are on the brink of veto-proof majorities for legislation that could undercut any deal.

And that support has held up even after the uproar last week over the GOP’s letter to Iranian leaders warning against an agreement.

Though several Democratic senators told POLITICO they were offended by the missive authored by Sen. Tom Cotton (R-Ark.), none of them said it would cause them to drop their support for bills to impose new sanctions on Iran or give Congress review power over a nuclear deal.

That presents another complication for the administration ahead of a rough deadline of March 24 to reach a nuclear agreement with the country.

“The letter’s incredibly unfortunate and inappropriate,” said Sen. Heidi Heitkamp of North Dakota, a centrist Democrat who voted for the sanctions bill in committee and is a sponsor of the congressional approval legislation. “That doesn’t diminish my support for the legislation that we introduced.”

The president’s challenge in Congress on the issue isn’t limited to the 47 Republican senators who signed last week’s missive arguing that a nuclear agreement could be revoked by the next U.S. president. In a letter released Saturday, White House chief of staff Denis McDonough implored Senate Foreign Relations Chairman Bob Corker (R-Tenn.) not to push for a vote on his bill that would give Congress 60 days to reject or approve of any deal.

McDonough argued that Corker’s measure, which has nearly a dozen Democratic supporters, “goes well beyond ensuring that Congress has a role to play in any deal with Iran.” And he asked Corker, who’s sought to maintain a cordial relationship with the White House, to let the administration finish its negotiations with Iran, indicating it may take until the end of June. A framework is expected by the end of this month.

Corker shrugged off the request in response. And in an interview late last week, he said he hasn’t lost the support of any Democrats despite the turbulent atmosphere surrounding Iran politics.

“Let a couple days go by. We think there’s going to be really ignited momentum,” Corker, who did not sign the Cotton letter, said on Thursday. “Nobody’s dropping out. We’ve had reaffirmed commitment” from Democrats.

Indeed, a day after the controversy over Cotton’s letter erupted, Sen. Michael Bennet of Colorado co-sponsored Corker’s congressional review bill, the 11th Democrat to signal support.

Though the White House has seized on the GOP’s “open letter to the leaders of the Islamic Republic of Iran” in an effort to shift the politics of the nuclear negotiations in its favor on Capitol Hill, there’s no evidence it’s working so far. Nearly all of the 54 Republicans and more than a dozen Democrats in the Senate remain at odds with the president on the issue.

Meanwhile, the House will hold hearings this week to grill administration officials on Iran, a potentially troubling sign for the administration, considering the chamber passed a strict Iran sanctions bill in 2013 by a vote of 400-20 — far above the veto override threshold.

…….

The administration now appears to be asking for even more time: McDonough said in his letter to Corker that if a framework is reached this month and a “final deal by the end of June, we expect a robust debate in Congress.” GOP leaders appear determined to move much sooner than that.

For a moment, Cotton’s letter appeared to shake the bipartisan foundation undergirding both of the Iran bills. Democrats warned of a backslide into partisanship on a foreign policy issue that’s united Congress for years. Capitol Hill has long pressed for additional economic penalties on Iran in hopes of forcing it to the negotiating table with global powers.

But Sen. Richard Blumenthal (D-Conn.), who backs the sanctions bill, said, “The fundamentals for bipartisan action ought still to be there.”

“This is a sad day in America when people are trying to kill negotiations that are underway,” Sen. Bill Nelson (D-Fla.) said of the Cotton letter. But would he back away from Corker’s congressional approval bill?

“No,” he answered, adding with apparent satisfaction: “I’m an original co-sponsor.”

Read more: http://www.politico.com/story/2015/03/democrats-prepared-to-buck-white-house-on-iran-nuclear-deal-116088.html#ixzz3Us9rgXR1

Related:

U.S. Energy Secretary Ernest Moniz, U.S. Secretary of State John Kerry, Iran’s Foreign Minister Mohammad Javad Zarif and the head of the Atomic Energy Organization of Iran Ali Akbar Salehi pose for a photograph before resuming talks over Iran’s nuclear programme in Lausanne on Monday.

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