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Wednesday, April 10, 2024

How Taxpayers Will Heavily Subsidize Democrat Boots on the Ground This Election

 Progressives are using legal loopholes and the power of the federal government to maximize Democrat votes in the 2024 election at taxpayers’ expense, RealClearInvestigations has found.

Heritage Foundation
Mike Howell: “There is not a ‘shadow’ campaign. There is an overt assault on President Trump and those who wish to vote for him."

The methods include voter registration and mobilization campaigns by ostensibly nonpartisan charities that target Democrats using demographic data as proxies, and the Biden administration’s unprecedented demand that every federal agency “consider ways to expand citizens’ opportunities to register to vote and to obtain information about, and participate in, the electoral process.”

A dizzying array of overwhelmingly “democracy-focused” entities with ties to the Democratic Party operating as charities and funded with hundreds of millions of dollars from major liberal “dark money” vehicles are engaged in a sprawling campaign to register the voters, deliver them the ballots, and figuratively and sometimes literally harvest the votes necessary to defeat Donald Trump.

These efforts, now buttressed by the federal government, amplify and extend what Time magazine described  as a “well-funded cabal of powerful people ranging across industries and ideologies,” who had worked behind the scenes in 2020 “to influence perceptions, change rules and laws, steer media coverage and control the flow of information” to defeat Trump and other Republicans. The “shadow campaigners,” Time declared, “were not rigging the election; they were fortifying it.”

Heading into 2024, “there is not a ‘shadow’ campaign,” said Mike Howell, executive director of the Heritage Foundation’s Oversight Project. “There is an overt assault on President Trump and those who wish to vote for him occurring at every level of government and with the support of all major institutions.”

By contrast, Republican Party stalwarts lament that no comparable effort exists on their side. The GOP’s turnout and messaging efforts seek to thread a difficult needle by encouraging early and absentee voting and ballot-harvesting – pandemic-era measures that Trump and supporters blame for his 2020 electoral defeat – while the party simultaneously fights the mainly blue-state laws that made the practices possible. The party’s position is further complicated by its standard-bearer’s warnings of a rigged election bigger than in 2020, which some speculate could turn off moderate swing voters.

Electioneering 'Super-Weapons'

The IRS permits tax-exempt nonprofit groups to engage in voter registration and get-out-the-vote drives so long as they do not “refer to any candidate or political party” nor conduct their activities “in a biased manner that favors (or opposes) one or more candidates prohibited.”

Voter Participation Center
Tom Lopach: “We do the work that state election officials typically do not do – seeking out underrepresented voting-eligible Americans."

These entities have become magnets for funds not only from wealthy donors, who can contribute without traditional campaign finance limits – and get a tax break to boot – but also abundantly endowed private foundations that are prohibited from engaging in partisan activities.

In recent years, dozens of progressive-oriented 501(c)(3)s, now pulling in upwards of $500 million annually, have engaged in purportedly neutral efforts to impact elections, according to Hayden Ludwig, director of Policy Research at the election integrity-focused advocacy group, Restoration of America.

In practice, critics like Ludwig argue, left-leaning charities flout the law by registering and mobilizing demographics that tend to vote disproportionately Democratic behind a veil of non-partisan democracy promotion.

During the 2020 election, for example, the Voter Participation Center solicited millions of ballot applications in swing states – many of them prefilled for respondents. This nonprofit, like its peers, is clear that it isn’t targeting just any voters, but what it and progressive activists have dubbed a “New American Majority” of “young people, people of color and unmarried women.”

Tom Lopach, a longtime Democratic Party operative and the center’s president and CEO, told RCI in a statement: “We do the work that state election officials typically do not do – seeking out underrepresented voting-eligible Americans Tom Lopach … This is difficult but necessary work that brings democracy to eligible Americans’ doorsteps.”

In 2020, Facebook founder Mark Zuckerberg and his wife Priscilla Chan showed how supposedly neutral efforts can have a partisan impact when they funneled some $400 million through two progressive-led but purportedly nonpartisan nonprofits into election offices across the country.

That money disproportionately went to jurisdictions that Joe Biden won in the pivotal battleground states that delivered his victory, often flowing to left-leaning nonprofits to whom election offices outsourced the administration of sometimes critical functions.

In April 2022, a primary conduit of these so-called “Zuckerbucks,” the Center for Tech and Civic Life, announced the launch of a successor to the 2020 effort – the U.S. Alliance for Election Excellence, a five-year $80 million program “to envision, support, and celebrate excellence in U.S. election administration.”

“The left has assembled an impressive ‘election-industrial’ complex of non-profit organizations that is constantly working towards goals like ‘promoting participation’ targeting ‘underrepresented minorities,’” said Jason Snead, executive director of the conservative Honest Elections Project. Such terms, Snead says, “are code for identifying and mobilizing liberal voters.”

Election experts view such activities as potentially decisive. 

“‘Nonpartisan’ and ‘charitable’ voter registration and get-out-the-vote groups” are the Democratic Party’s “electioneering super-weapon[s],” said Parker Thayer, an analyst with the conservative-oriented Capital Research Center in Washington, D.C.

'Everybody Votes' – But for Whom?

Everybody Votes Campaign
Everybody Votes gets money from charities or foundations forbidden by law from supporting “voter education or registration activities with evidence of bias.”

Of these, Thayer sees the Everybody Votes Campaign as of paramount importance.

Born of a plan “commissioned by [Hillary] Clinton campaign chairman John Podesta, funded by the Democratic Party’s biggest donors, and coordinated with cut-throat Democratic consultants,” Thayer writes in an extensive analysis of the group’s efforts, “the Everybody Votes campaign [has] used the guise of civic-minded charity to selectively register millions of ‘non-white’ swing-state voters in the hopes of getting out the Democratic vote.”

It does so by funding and training over 50 community groups to register voters to close “the voter registration gap in communities of color,” which it attributes to “modern forms of Jim Crow laws,” such as voter ID requirements, the group’s executive director, Nellie Sires, said in a January 2024 interview.

From 2016-2021, the Everybody Votes Campaign, doing business as three entities, collected over $190 million from major Democratic Party donors, unions, and environmental activists. Some of the largest donors include the League of Conservation Voters Education Fund; the New Venture and Hopewell Funds, managed by for-profit consulting firm Arabella Advisors; and the George Soros-funded Foundation to Promote Open Society – all 501(c)(3) public charities or private foundations forbidden from supporting “voter education or registration activities with evidence of bias.”

The Everybody Votes Campaign distributed the funds to a slew of left-leaning state-based voter registration organizations largely in eight pivotal states from 2016 to 2019 – Arizona, Colorado, Florida, Georgia, Ohio, North Carolina, Virginia, and Nevada – and then to Pennsylvania, Michigan, and Wisconsin in 2021.

According to Thayer’s analysis, the Everybody Votes Campaign’s voter registration push “would have provided Democrats more votes than the total margins of victory in Arizona, Georgia, Nevada, and Pennsylvania,” securing Joe Biden’s victory in the 2020 election.

'4 to 10 Times More Cost-Effective'

https://www.statevoices.org/
Images from the State Voices website, above and just below: Working together "to fight for a healthy democracy and political power for Black, Indigenous, Latinx, Asian American and Pacific Islander (AAPI), and all people of color (BIPOC).”

One notable backer of the Everybody Votes Campaign is Mind the Gap, a “Moneyball-style” Silicon Valley Democratic Super PAC founded by Stanford law professor Barbara Fried, and connected to the political activities of her convicted crypto-fraudster son, Sam Bankman-Fried.

State Voices
State Voices

The analytics-focused outfit prepared a confidential strategy memo leaked in advance of the 2020 election, noting that “501(c)(3) voter registration focused on underrepresented groups in the electorate” would be the “single most effective tactic for ensuring Democratic victories” – “4 to 10 times more cost-effective” on after-tax basis at “garnering additional Democratic votes” relative to alternatives like “broadcast media and digital buys.”

Mind the Gap recommended that donors contribute to three organizations: the Voter Participation Center and its sister organization, the Center for Voter Information for mail-based registration efforts, and Everybody Votes for site-based registration efforts.

The largest grant recipient, receiving $24 million during the 2016-21 period, was State Voices, which describes itself as a “nonpartisan network of 25 state-based coalitions … that collectively partner with over 1,200 organizations” consisting of “advocates, organizers, and activists … work[ing] together to fight for a healthy democracy and political power for Black, Indigenous, Latinx, Asian American and Pacific Islander (AAPI), and all people of color (BIPOC).”

Another top recipient, raking in over $10 million, was the Voter Participation Center.

Voter Participation Center
The Voter Participation Center: Part of an array of “democracy-focused” entities with ties to the Democratic Party.

According to the Capital Research Center, the Everybody Votes Campaign would collect and spend over $50 million in connection with the 2022 midterm elections – the most recent period for which financials are available. All told, since its founding in 2015, the Campaign says, its network has registered 5.1 million voters, of whom 76% are people of color; 56% are women; and 47% are under the age of 35.

Capital Research Center
Parker Thayer: Calls the Everybody Votes Campaign the “largest and most corrupt ‘charitable’ voter registration drive in American history.”

Last November, the news outlet Puck reported on a secret memo circulated by Mind the Gap regarding its plans for 2024. “Our strategy early in the 2024 presidential race will be to massively scale high-performing voter registration and mobilization programs,” the memo read. The PAC again specifically directed donors to the Everybody Votes Campaign, which did not respond to requests for comment.

Lopach, who has worked in Democratic Party politics his entire career, bristled at RCI’s questions regarding critics’ claims of a partisan bent to its work. “The presumptions baked into the questions … emailed to us are inaccurate and reveal the reporter’s own biases,” he responded, while emphasizing the organization’s targeting of “underrepresented voting-eligible Americans.”

Thayer has dubbed Everybody Votes the “largest and most corrupt ‘charitable’ voter registration drive in American history.”

Of such organizations’ claims of nonpartisanship, Howell told RCI: “If they were truly interested in an informed participatory constitutional Republic, they would have an even-handed approach to registering voters.”

“Call me when they show up to a NASCAR race, Daughters of the American Revolution event, or a gun show,” Howell added. “Then we can pretend for a minute that these are beyond just facial efforts to appear somewhat neutral.”

Challenges for GOP

But NASCAR races have not been hubs for GOP-led voter registration efforts either. Restoration of America’s Ludwig estimates that the right may spend as little as 1% of what the left spends on voter registration efforts.

LinkedIn
Hayden Ludwig: Conservative nonprofits may still be wary of running afoul of a hostile IRS.

A recent memo from the Sentinel Action Fund, a super PAC that aims to elect conservatives, noted that in the 2022 election cycle, while $8.9 billion was spent on federal elections, there were zero large independent expenditure organizations on the right focused on get-out-the-vote efforts or “ballot chasing.”

Republican Party vehicles and conservative outfits like grassroots-oriented Turning Point Action, a 501(c)(4), are engaged in such efforts in the 2024 cycle, but the scale and sophistication of their political counterparts’ efforts would appear unrivaled at this point.

Election experts attribute this gap to several factors beyond the GOP’s focus on other tactics to win elections, or ineffectiveness. They note that Democratic voters tend to be more concentrated in urban areas and college campuses, making it easier to run efficient registration drives. As regards early and absentee voting and ballot harvesting, it is not clear if these efforts will substantially grow the pool of Republican voters versus merely enabling the party to “bank” votes earlier.

With respect to the use of 501(c)(3)s to conduct such activities, Ludwig said some conservatives may still be fearful of running afoul of the IRS – through exploiting tax laws to pursue efforts perceived to be partisan effectively on the taxpayers’ dime – in the wake of its targeting of Tea Party groups for extreme scrutiny during the Obama years.

‘Bidenbucks’: ‘Zuckerbucks’ on Steroids

Since the 2020 election, Democrats have opened a second apparent electioneering front that Republicans could not match even if they wanted to: The rise of so-called “Bidenbucks,” which uses the “unlimited funding, resources, and reach” of the federal government and agency offices located nationwide,” to turn out favored voters, according to Stewart Whitson, legal director of the conservative Foundation for Government Accountability.

Demos
The liberal think tank believed to be behind Biden's executive order.

In March 2021, President Biden introduced Executive Order 14019. The directive on “promoting access to voting” orders every federal agency, more than 600 in all, to register and mobilize voters – particularly “people of color” and others the White House says face “challenges to exercise their fundamental right to vote.” It further directs the agencies to collaborate with ostensibly nonpartisan nonprofits in pursuit of its goals.

As RCI has previously reported, EO 14019 appears to have been designed by left-leaning think tank Demos and implemented in consultation and sometimes coordination with a slew of progressive, labor, and identity-focused groups with the goal of generating up to 3.5 million new or updated voter registrations annually.

The ACLU and Demos have reportedly helped execute the order. RCI additionally found that at least two recipients of grants under the Everybody Votes Campaign, the NAACP and UnidosUS – formerly the National Council of Raza – were also listed on an email as participants in a July 2021 listening session on the executive order convened by the White House and agency officials.

Foundation for Government Accountability
Stewart Whitson: Unlike 2020, "the threat we face in 2024 is being launched from within the government itself.”

Whitson, whose organization unearthed that email in its fight to expose details about the order, emphasized that “[U]nlike 2020 wherein the shadow campaign was conducted by private citizens seeking to influence government election operations from the outside, the threat we face in 2024 is being launched from within the government itself.”

Facing both congressional scrutiny and litigation, the administration has closely guarded the strategic plans agencies were to develop to carry out the order, how they are implementing them, to what end, and with whom.

Perfunctory press releases, reports from groups supportive of the order, and documents slowly ferreted out via FOIA requests and litigation, however, demonstrate that relevant agencies have sought to drive voter registration via public housing authorities, child nutrition programs, and voluntary tax preparation clinics.

In August 2023, U.S. Citizenship and Immigration Services issued updated guidance calling for the agency to register voters at naturalization ceremonies.

More recently, the Department of Education did the same, blessing the use of federal work-study funds to pay students for “supporting broad-based get-out-the-vote activities, voter registration,” and other activities. Scott Walter, president of the Capital Research Center, recently told the Epoch Times that the Department had previously threatened schools “that you better be registering students or you could lose your federal funds.”

When asked by RCI to respond to Walter’s claim, the Department of Education would not. Over two dozen Pennsylvania state legislators challenged the order via a lawsuit in January. Citing alleged unlawful attempts by several agencies to register Keystone state voters, the lawmakers asserted:

"By engaging in a targeted voter registration effort of this magnitude, focused specifically on these agencies and the groups of potential voters they interact with, leveraging the resources and reach of the federal government, this effort appears to be a taxpayer-funded get-out-the-vote effort designed to benefit the current President’s political party."

Echoing this view, Whitson’s Foundation for Government Accountability submitted an amicus brief noting that “all of the federal agencies FGA has identified as taking active steps to carry out EO 14019 have one thing in common: They provide government welfare benefits and other services to groups of voters the vast majority of which have historically voted Democrat.”

The plaintiffs alleged the executive order violated both Pennsylvania law limiting voter registration efforts to non-federal actors, and constitutional provisions reserving election laws to the states. On March 26, a district court dismissed the case, claiming the plaintiffs lacked standing. Whitson told RCI that others would likely lodge similar lawsuits, building on the Pennsylvania legislators’ case in the wake of the dismissal. Days later, The Federalist reported that the plaintiffs intended to appeal their case to the U.S. Supreme Court. A White House spokesperson did not reply to RCI’s inquiries regarding the executive order.

Opposition and Circumvention

Republicans have had more success opposing the use of Zuckerbucks and other private monies used to finance public elections. More than two dozen states would move to ban or restrict such grants in response to the activities observed during the 2020 election.

Most recently, Wisconsin, where some of the most controversial Zuckerbucks-related efforts took place, was added to that list when, on April 2, voters approved a constitutional amendment barring the private funding of elections.

Despite this crackdown and the feds seemingly stepping into the breach, efforts to privately finance election administration persist. The U.S. Alliance for Election Excellence bills itself as an initiative to bolster “woefully unsupported” election offices to “revitalize American democracy.”

The organization says it services jurisdictions – 11 listed on its website, ranging across states from Arizona to California and Wisconsin – with “training, mentorship, and resources.” Alliance officials did not respond to RCI’s inquiry about whether it would be terminating the relationship with the city of Madison, Wisconsin., in light of the passage of the recent ballot measure that would seem to have barred it. Nor did it respond to RCI’s other inquiries in connection with this article.

Most of these partnerships were initiated with jurisdictions in states that have not banned Zuckerbucks, though it has sought to circumvent such prohibitions in Georgia and Utah. The stated goal of the Alliance for Election Excellence is to support voters via measures like assisting participating centers in “redesigning” forms to make them more intuitive and purchasing infrastructure “to improve election security and accessibility.”

Alliance launch partners include entities such as:

  • The Center for Civic Design, which works with election offices “using research, design, accessibility, and plain language to remove barriers in the voter journey and invite participation in democracy;”
  • The Elections Group, to “implement new programs or improve processes for voters and stakeholders”; and
  • The Center for Secure and Modern Elections to “modernize the voting system, making elections more efficient and secure.”

Critics argue this seemingly more modest effort is, in reality, an ambitious Zuckerbucks rebrand.

Snead’s Honest Elections Project published a report in April 2023, based in part on documents received from FOIA requests, indicating “that the Alliance is a reinvention of CTCL’s scheme to use private funding to strongarm election policy nationwide.”

Among other takeaways, it found that:

  • The Alliance offers services that touch every aspect of election administration, ranging from “legal” and “political” consultation to public relations, guidance, and assistance with recruitment and training.
  • The Alliance is gathering detailed information on the inner workings of participating election offices and developing “improvement plans” to reshape the way they operate.

The report shows that many of the alliance’s launch partners, starting with the Center for Tech and Civic Life and the Center for Civic Design, are funded by major Democrat-tied, so-called “dark money” groups such as the Democracy Fund and Arabella Advisors’ New Venture Fund and Hopewell Fund.

The Democracy Fund is led by Democrat tech billionaire Pierre Omidyar, which has granted some $275 million to like-minded organizations from publications like Mother Jones and ProPublica to the Voter Registration Project since its founding.

The District of Columbia recently closed a criminal investigation into Arabella, whose fund network reportedly spent nearly $1.2 billion in 2020 alone, after probing it over allegations its funds were pursuing political ends in violation of their tax-exempt statuses. The Center for Secure and Modern Elections, the Honest Elections Project says, pushes “left-wing priorities like automatic voter registration” and is run by the New Venture Fund. The Elections Group’s CEO and co-founder, Jennifer Morrell, previously served as a consultant at the Democracy Fund.

The Capital Research Center’s Walter uses a football analogy to explain why he sees these efforts as untoward. He told RCI:

Capital Research Center
Scott Walter

"Election offices are the refs in elections; the parties are teams trying to score. You’d be puzzled if you heard Super Bowl refs say they’re trying to boost points scored. You’d be outraged if you learned those refs had received money and training from people who previously worked for one team’s offensive coaching staff. That’s what left-wing political operatives, using left-wing money, are doing, and it’s clearly unfair."

Non-Trump Lawfare

Democrat-aligned groups continue to engage in litigation, like that brought by chief election lawyer Marc Elias, aimed at loosening election laws to their benefit. Snead told RCI, “There are more than 70 active lawsuits right now targeting voter ID laws, anti-ballot harvesting laws, signature verification, drop box regulations, and more.”

After securing victory in a lawsuit requiring signature verification for mail voting in Pennsylvania, the RNC touted its engagement as well in 81 election integrity cases this cycle. Swing-state Wisconsin is another major battleground for such efforts.

There, Elias’ legal team has challenged witness signature requirements and bans on election clerks filling address information on mail-in ballots. It and others are also working to overturn a state Supreme Court decision finding drop boxes illegal. The Badger State’s now liberal-majority Supreme Court announced in March it would take up the case.

Cutting against these efforts are not only the state’s citizen-approved Zuckerbucks ban, but another Badger-passed April 2 ballot measure amending the state’s constitution to prohibit those other than “an election official designated by law” from carrying out election-related tasks.

Pool The News & Observer
Marc Elias, Democrat election lawyer: Accuses the other side of “voter suppression and election subversion.”

Watchdogs like Howell are concerned that left-leaning electioneers and lawfare forces collectively are pursuing an “election ‘dis-integrity’ strategy … to greatly expand the universe of ballots while limiting any ability to ensure that they are fairly cast and counted.”

“It’s a basic recipe for fraud.”

Elias says those seeking to combat such efforts are engaged in “voter suppression and election subversion.”

Democrats also have the federal government working on their side on the litigation front – and in ways extending beyond the veritable lawfare barrage the Biden Justice Department has leveled at Donald Trump.

Speaking in Selma, Ala., on the 59th anniversary of Bloody Sunday, the 1965 police assault on civil rights marchers, Attorney General Merrick Garland declared that “the right to vote is still under attack.”

Garland vowed the Department of Justice was punching back, including “challenging efforts by states and jurisdictions to implement discriminatory, burdensome, and unnecessary restrictions on access to the ballot, including those related to mail-in voting, the use of drop boxes, and voter ID requirements.”

https://www.realclearinvestigations.com/articles/2024/04/10/how_taxpayers_will_heavily_subsidize_democrat_boots_on_the_ground_this_election_1023475.html

Is There a Trump Health Care Plan?

 Although he rarely talks about it, the most significant gift Donald Trump bequeathed to economic prosperity was deregulation. And the one sector that was deregulated more than any other was health care.

Since Joe Biden has been re-regulating the economy, it’s hard to think of a starker contrast between the two leading presidential candidates this year – and it affects all aspects of health care.

I am not alone in thinking that Trump might have won the 2020 election if he had campaigned on his health care accomplishments. Let’s see if this year’s election turns out to be different.

Covid Vaccines. Even before the world had heard the term “Covid,” deregulation of vaccine production was an early Trump administration success. Because of those early steps, when Covid did arrive, we were much better prepared. University of Chicago economists estimate that that Project WARP Speed produced Covid-19 vaccines at least six months before anybody expected it. That saved an estimated 183,000 lives.

Insurance Tailored to Individual and Family Needs. Imagine combining the average premium with the average deductible for health insurance purchased by a family of four in the Obamacare exchanges. In 2020that totaled more than $25,000. In other words, a family not getting a subsidy had to spend more than $25,000 before getting any benefit from their health insurance plan! And they had to do that every year!

Not surprisingly, the unsubsidized part of the market was in a free fall. Democrats in Congress responded by creating “enhanced subsidies” – even for people who are wealthy. The government is now virtually giving health insurance away for free to average-income families.

If you are sick, things are far less rosy, however. The annual out-of-pocket maximum exposure for a family this year is $18,900. That’s the amount you may have to pay in the form of deductibles and coinsurance – over and above any premium payment. Families with ongoing, chronic conditions have to pay as much as that amount – every year!

As an alternative, President Trump used an executive order expanding people’s opportunity to buy “short-term” insurance. These plans look very much like the insurance that was popular before there was Obamacare. They often sell for as little as half the price of Obamacare insurance; they typically have lower deductibles and broader provider networks; and they offer much better protection for anyone who experiences a costly medical problem.

Congressional Democrats, with the apparent backing of the large insurance companies, have generally been quite hostile to these plans. President Obama limited them to 3 months duration. President Biden recently limited them to three months with a one-month renewal. Under Trump, they were available for one year, with renewals for two more years. A second type of insurance could bridge the gap between three-year periods – allowing a relationship with an insurer indefinitely.

Under the Trump approach, the short-term market could easily evolve into the closest thing we have ever had to free market health insurance, and that includes a free market solution to the problem of pre-existing conditions.

Note that Trump did not abolish Obamacare, or even restrict it (despite a lot of Republican rhetoric). The Trump approach was to expand people’s options. The Biden/Obama approach eliminates options.

Personal and Portable Health Insurance. Before there was Obamacare, some employers gave their employees pre-tax dollars to purchase individually owned insurance. This was insurance the employees could take with them from job to job and in and out of the labor market.

President Obama completely shut down this practice with a threat to fine any employer caught doing it as much as $100 per employee per day. This was countermanded by a Trump rule that has allowed (and even encouraged) employers to fund employee-owned health insurance since January 2020.

It is striking to observe how many significant health policy changes have been affected by presidential action alone – without any act of Congress. Yet congressional action is needed to take full advantage of the opportunities.

Under the Trump executive order, employees can only use their employer’s funds to buy “Obamacare compliant” insurance, which mainly means insurance sold in the exchanges. Moreover, the employees cannot get the subsidies other buyers get in the exchanges. Since the exchange plans are otherwise very unattractive, the take-up rate for this opportunity has been well below initial expectations. What is needed is congressional action to allow the employees to buy any kind of insurance – including the short-term plans described above.

Virtual Medicine. When Donald Trump took office, it was illegal in most cases (by act of Congress) for doctors to bill Medicare for consultations by means of phone, email, Skype, Zoom, Facebook, etc. One of the few positive aspects of Covid was the liberation of telemedicine.

Given the Covid crisis, telemedicine would probably have been liberated even if Hillary Clinton had been president. But it would likely have taken another year to accomplish that change. The reason: there are 10,000 tasks Medicare pays doctors to do. Because Medicare insists on setting the price for every one of them, in every institutional setting, and in every locality, figuring out what can and cannot be done by telemedicine and what the right price should be is an enormous challenge.

The reason telehealth emerged so quickly under a Trump presidency is that his administration believed in deregulating telehealth barriers and had been preparing for it long before Covid struck.

Chronic Illness. There is mounting evidence that patients suffering from diabetes, heart disease, and other chronic illnesses can (with training and the right support) manage a lot of their own care as well as — or better than — traditional doctor therapy can. If they are going to manage their own care, they can do an even better job if they are also managing the money that pays for that care.

HSAs are a natural vehicle. However, current law’s requirement of an across-the-board deductible makes HSAs incompatible with smart insurance design for chronic care. For example, an wise employer might want to make insulin available for free to diabetic employees in order to encourage its use. The same employer might ask noncompliant employees who show up in emergency rooms to pay for that care out of their own account.

Under guidance issued by the Trump administration, employers and insurers can now provide first-dollar coverage for the purchase of maintenance drugs for 13 chronic conditions without running afoul of HSA regulations.

More needs to be done. HSAs ought to be completely divorced from the high-deductible requirement. Let the market, rather than government, make decisions about the optimum role of cost-sharing.

Another important development in the first Trump administration was the move to encourage “focused factories” in Medicare. In contrast to the rest of the health-care system, Medicare Advantage “special needs” plans can specialize in 15 chronic conditions. These plans can exclude applicants who don’t have the condition. They can also ask health questions and request medical records.

The Obamacare exchanges would be enormously improved if they allowed the same sort of specialization and the same type of risk adjustment that we now find only in the Medicare Advantage program.

Round-the-Clock Primary Care. Concierge doctors used to be available only to the rich. Today “direct primary care” (DPC) is much more affordable. Atlas MD, in Wichita, Kan., for example, provides all primary care along with 24/7 phone and email access. They offer discounts on lab tests and generic drugs for less than what Medicaid pays. The cost: $50 a month for a middle-aged adult and $10 a month for a child.

An unfulfilled goal of the first Trump administration was to allow employers to put money into individual accounts from which the employees could make monthly payments to DPC doctors of their own choosing.

This should be a high priority in a second Trump term.

A Future Agenda. Space does not permit a discussion of other reforms, including liberating Association Health Plans, requiring hospital price transparency and expanding options under Medicare Advantage.

But I hope I have made clear that Donald Trump does not need a new health policy agenda. He merely needs to complete the agenda of the first Trump administration.

The vision behind the Trump agenda can be found in Reforming America’s Healthcare System Through Choice and Competition. This 124-page Health and Human Services document from 2018 argues that the most serious problems in health care arise because of government failure, not market failure.

It’s time to dust off that document and re-read it.

https://www.goodmaninstitute.org/2024/04/08/is-there-a-trump-health-care-plan/

After Massive CPAP Recall, Philips Ordered to Overhaul Manufacturing

 The company responsible for a global recall of sleep apnea machines

opens in a new tab or window will be barred from resuming production at U.S. facilities until it meets a number of safety requirements, under a long-awaited settlementopens in a new tab or window announced Tuesday by federal officials.

Philips will be required to overhaul its manufacturing and quality control systems and hire independent experts to vet the changes, according to a court order announced by the U.S. Department of Justice. The company must also continue to replace, repair, or provide refunds to all U.S. customers who got the defective devices, the department said.

The action is a major step toward resolving one of the biggest medical device recalls in history, which has dragged on for nearly 3 years.

Most of the devices recalled are continuous positive airway pressure (CPAPopens in a new tab or window) machines. They force air through a mask to keep mouth and nasal passageways open during sleep. Left untreated, sleep apnea can lead to dangerous drowsiness and increased risk of heart attack.

Philips has recalled more than 5 million of the machines since 2021 because their internal foam can break down over time, leading users to inhale tiny particles and fumes while they sleep. Efforts to repair or replaceopens in a new tab or window the machines have been plagued by delays that have frustrated regulators and patientsopens in a new tab or window in the U.S. and other countries.

Lawyers for the federal government allege that the company failed to comply with good manufacturing practices needed to ensure device safety. The company did not admit to the allegations, according to the court filing.

"This office, the FDA and our partner agencies are committed to holding manufacturers accountable when they violate the law and put the public at risk," U.S. Attorney Eric Olshan said in a statement.

Under the legal agreement, Philips must hire independent auditors to create a plan for fixing its manufacturing problems and for monitoring problems with the sleep devices. The plan must then be approved by the FDA. The experts must also certify that new foam selected by the company meets FDA safety standards.

Jeffrey Reed, of Marysville, Ohio, experienced persistent sinus infections and two bouts of pneumonia during the 7 years he used a Philips machine.

"I worry about my long-term health," Reed said. "I used this machine for years and no matter what money I might get out of this, what's going to happen?"

Reed received a newer Philips device after returning his old machine, but he doesn't like to use it, preferring a competitor's device.

"I don't trust the company," Reed said. "I don't want to use it."

Reed is one of more than 750 people who have filed personal injury lawsuits against the company over the devices. Those cases have been consolidated in a federal court in Pennsylvania.

Similar lawsuits are pending in Canada, Australia, Israel, and Chile, according to the company.

The Dutch manufacturer announced in January it had reached a tentative agreement with the FDA and the Department of Justice. But U.S. regulators wouldn't confirm the deal at the time because it had not yet been reviewed by a federal judge.

The FDA's website warns patients that the risks of ingesting the sound-dampening foam could include headache, asthma, allergic reactions, and more serious problems. In November, the agency issued a new warning that the machines can overheatopens in a new tab or window, in rare cases causing fires.

An FDA inspection of Philips' Pennsylvania offices in the fall of 2021 uncovered a spate of red flags, including emails suggesting the company was warned of the problem with its foam 6 years before the recall.

Between 2016 and early 2021, FDA found 14 instances where Philips was made aware of the issue or was analyzing the problem. "No further design change, corrective action, or field correction was conducted," the FDA inspectors repeatedly noted.

In 2022, the FDA took the rare step of ordering Philips to step up its outreach to customers about the recall including "clearer information about the health risks of its products." At the time, the agency estimated only about half the people in the U.S. with affected machines knew they had been recalled.

Customers trying to obtain refunds or new or refurbished devices from the company have reported long delays.

https://www.medpagetoday.com/pulmonology/sleepdisorders/109595