Our children deserve better – a repeated pre-pandemic clarion call

The following post was written a couple of years ago. Although the pandemic has rightfully gotten our attention, this story bears repeating.

Two time Pulitzer Prize winner Nicholas Kristof wrote an editorial earlier this week in The New York Times called “Our children deserve better.” It is a clarion call to our nation showing the plight of kids in America.

Here are a few quotes to frame the issue:

“UNICEF says America ranks No. 37 among countries in well-being of children, and Save the Children puts the United States at No. 36. European countries dominate the top places.

American infants at last count were 76 percent more likely to die in their first year than children in other advanced countries, according to an article last year in the journal Health Affairs. We would save the lives of 20,000 American children each year if we could just achieve the same child mortality rates as the rest of the rich world.”

“Half a million American kids also suffer lead poisoning each year, and the youth suicide rate is at its highest level on record….The Census Bureau reported this week that the number of uninsured children increased by 425,000 last year.”

These are different views and sources of the threats to US children that note we have a problem. Another source I read a couple of years ago noted America has a much higher maternal mortality rate at child birth than other civilized countries, which further endangers children as well as the mothers.

Yet, these issues are not being discussed in the halls of government. We have a poverty problem in our country with too many living in or just above poverty levels. We have not expanded Medicaid in fifteen states* whose numbers are worse than these national numbers per capita. We have not addressed our national water crisis which has a Flint, MI like exposure to lead in too many cities and a volume of available fresh water issue in other places. We have not invested as we should to diminish crime and provide more opportunities for jobs in disenfranchised areas. There are several pockets of success that can be emulated in more cities.

We also need to address better gun governance, especially with the number one gun death cause by far being suicide and a non-inconsequential accidental gun death rate. And, we have not dealt with the continuing and rising exposure to technology and artificial intelligence which have taken and will take even more jobs in the future. Finally, there is that climate change thing we need to deal with.

These are real problems. And, they will get worse. Data driven analysis of causes and solutions are needed. They are both multi-faceted. Investing more now, will save huge amounts later. This is not just an urban issue, it is rural one as well. The opioid crisis is rampant in these impoverished rural areas, for example.

None of the solutions will fit on a bumper sticker. And, political attempts to oversimplify issues should be questioned. Here is an easy contradiction to spot – if people believe gun deaths are a mental health issue, then why the effort to eliminate or not expand mental health benefits?

Please make your legislators aware of these issues and ask pointed questions. These questions deserve answers, not bumper sticker slogans. These concerns deserve to be talked about, studied and acted upon.

*Note: The number of states who have not expanded Medicaid is now twelve. Here is a link to a tracking of the states who have and have not. What puzzles me is this change would help people in rural areas, which tend to vote more conservatively. So, not expanding Medicaid hurts health access, but also rural hospitals and economies, with the federal government funding 90% of the cost. As former Republican governor of Ohio and presidential candidate John Kasich said, Medicaid expansion is a “no brainer.”

https://www.kff.org/medicaid/issue-brief/status-of-state-medicaid-expansion-decisions-interactive-map/

People want your money – be vigilant

Scams abound. At the dinner table when the kids were younger, we discussed with our teens that people want your money. So, you have to be vigilant and guard against them. Some want it by legitimate means – advertising to get your money for services rendered or products bought. Some want it through aggressive marketing to accelerate such purchases and some want to steal or trick it from you. The scams are the trickster part of the equation.

I had a new scam attempted on me this week which I will call the Electric Utility Scam. This scam was quite well organized with a sincere woman saying I owed money to the electric utility and they were on their way to cut off my power. I could stop them if I called Accounts/ Billing and gave me the number. I called and they asked for my last four digits on my phone and I asked what address they showed, which they correctly offered. He said I owed $500 and I said that was not possible, as my last bill showed a lesser amount due and it was not the due date. He then gave me to a supervisor who wanted me to go on my bank account and do a quick pay. I then said I do not believe you are the utility company and hung up. I called the number on my account statement and they confirmed it was a scam.

I don’t know why I went along for so long. I was skeptical from the outset, but the sincerity and the multiple people involved showed how organized it was. Yet, it was a fraud attempt. Other scams have been tried on me, my wife and my relatives. Here are a few to let others know they are indeed fraud attempts.

Grandparents Scam – This one bothers me the most as the scam preys upon the elderly by saying a grandchild has been in an automobile accident and cannot reach his parents. When the grandparent asks which one, the grandparent offers the name, which the caller seizes upon. The scam is to wire a sum such as $2,700 to an account. Usually the numbers are high, but not extreme.

Amazon Scam – This one is the most active as we have had about a half-dozen calls. An order on the account did not go through and they want us to provide credit card info to pay an odd sum like $739.45 to process the order. The first time we asked each other if we are expecting anything at all or for that amount. Since the answer was no, it must have been a scam. When other calls came in for similar odd amounts, we knew for sure.

IRS Scam – This one is scary sounding saying there is legal action being taken against you for taxes owed, but this is a scam. The IRS will send you a letter, not call you. And, they will try to resolve issues without legal action, before they ever move down that path.

Microsoft Scam – This one is a phone call saying your system has been compromised. The first time I got this one, it sounded legitimate, but when I was booting up my computer the guy asked me if this was the computer I do my banking with? I hung up. Then I realized Microsoft will not be calling me.

Insurance Scam – This one was not an effort to steal, but to sell. My mother was told her certain insurance company account had been compromised. My mother did not have such an account. This was an unscrupulous marketer trying to sell her a Medicare Advantage plan, which she already had with another provider. So, I called to cancel and told the representative how this happened. We also had to change my mother’s banking information as a result.

Bank Scam – This one often shows up on our mobile phones which is annoying. Someone representing our bank or someone else’s bank will send a text warning of a compromise on our account. It is not the bank especially when we don’t even bank with the entity being used. It is a fraud. Banks do send texts at your request, but they appear more legitimate and are for helpful reasons you checked off on – activity, overdrafts, etc.

Please share your experiences below with these and other scams. These do not even count the ID theft attempts, actual compromised credit information at various stores or services or ransomware attempts. People want your money. Be vigilant, even more so than I have been.

Shore up the ACA – letter to the editor

My local newspaper ran my following letter to the editor Sunday. I have been preaching the message of improving the Affordable Care Act for seven years offering suggestions. I will link to one of those posts below. What I have never cared for is the naysaying, sabotaging and attempts to repeal it that have been a substitute for debate in the Republican party.

The legislation Republicans almost rammed through in 2017 was ill-conceived, poorly developed and punitive to multiple millions of Americans. These were the key reasons Senator John McCain saved the GOP from itself and voted it down before he died.

“Three times now the U.S. Supreme Court has upheld the Affordable Care Act in the face of Republican attempts to rule it unconstitutional.

Per this retired actuary, benefits consultant and benefits manager, the ACA is not perfect and could use some improvements. But it is helping Americans, including provisions required in employer sponsored plans, which people tend to forget.

What has puzzled me for 10 years is that the law is somewhat based on Republican ideas, the latest being Romneycare in Massachusetts, which at least one Tea Party leader, S.C.. Sen. Jim DeMint, once supported.   

My strong advice to my former party, stop trying to screw Americans by killing the ACA and let’s find ways to shore up its deficiencies.”

Please stabilize the Affordable Care Act NOW to help Americans | musingsofanoldfart (wordpress.com)

Vaccinated – Done

Round two of the Pfizer vaccine is complete. Only side effects are a sore shot area and some body aches and tiredness. Other than that, it seems all is OK.

Today ran smoothly. It was a mass event like my first one, both through the hospital system. I got there around 3:45 pm and was on my way after a 15 minute rest by 4:15 pm.

Thirty minutes plus thirty minutes of drive time round trip. So, I only invested one hour of time, a little gas money and $5 parklng. With only a few minor side effects.

If you are waiting, please do yourself a favor and help yourself, your family and everyone else.

Internal Bleeding – Be your own Health Care Advocate

The following post was written about nine years ago. Since that time, some of the changes noted below have taken shape, but the message remains important. Be your own health care advocate.

A few years ago, two doctors looking to improve the quality of health care in the US, wrote a book called “Internal Bleeding: The Truth Behind America’s Terrifying Epidemic of Medical Mistakes.” Since Drs. Robert Wachter and Kaveh Shojania wrote their book, improvements have and continue to be made, but with the concern over the US’ 38th position in health care quality, while being the most expensive system in the world (according to the World Health Organization), I think it is appropriate to belabor a few of their key points, in particular, being your own health care advocate.

In today’s world, we must be the navigators of any customer service we receive whether it is at a bank, the driver’s license office or in a retail store. We must be diplomatically relentless in trying to gain the service we expect and need to resolve an issue. Service providers, in particular those in a Call Center, need to stay on script as much as possible. When your problems get them off script, then your navigation diplomacy skills are needed the most.  I mention this as context for what we also must do in gleaning good health care service.

A few years back there was a study conducted by a combined group called the “Leapfrog Group” to improve the quality of health care in hospitals. Leapfrog came up with three major ideas – (1) Electronic orders were a must (poorly written prescription orders were killing people), (2) Intensive Care units need to always have a doctor on site and (3) Medical procedures of import need to be done in centers of excellence, not where a hospital may have done only a handful of surgeries in this area. “Internal Bleeding” echoes many of these same issues, especially the one on electronic order taking. Yet, they also go beyond these Leapfrog issues.

They noted that often times in hospitals, fewer critical questions are asked closer to the time of the procedure. Sometimes, the critical mistake may have occurred very early in the process. They used the analogy of all of the holes in Swiss cheese aligning to allow a mistake to pass all the way through. They used the example at Duke University where a famous heart transplant for a minor child occurred. The doctors at this very fine medical center, one of the best, were so excited when a heart of a young deceased donor became available, that they assumed others had checked that the type of blood of the donor matched the patient. It did not and the patient died. Similar examples occurred when doctors operated on the wrong leg, arm, kidney, lung, etc. The doctors failed to ask the very basic of questions and assumed these issues had been resolved.

In addition to the above and related to the Rx orders, the authors advocate the patient understand fully what is being done to them in the hospital or before they get there. They recommend you introduce yourself to every care giver who comes into the room, ask questions of them relative to medications you are being given and make them fully aware of other medications you are taking. They recommend if you cannot speak for yourself or are uncomfortable in so-doing, to delegate this important role to someone you trust. In other words, they are recommending being your own health care advocate. This will help minimize mistakes.

Health care is both a science and an art. It also is a trial and error business, so the doctors may not know for certain what is wrong with you and have to figure it out. They will do their best, but they do not know you very well or at all. So, you have to play the role of information provider and advocate.  Using the authors’ recommendation supplemented by other sources of information and experience, you must be your own health care advocate and do the following to get the care you expect and need.

– Write as good a summary of your and your family medical history as possible. Make it available to others you trust who may need to speak on your behalf.

– Before you see the doctor, write down your symptoms and questions as you may get stage fright when you see the doctor’s white coat.

– Do not be scared to ask questions, especially if you do not understand the diagnosis or remedy – he or she is there to serve you. I tell my kids you show your intelligence by asking questions, not by failing to ask.

– Get a second opinion on major diagnoses. For example, it takes a lot of practice to read a mammogram correctly and a non-inconsequential percentage of misdiagnoses occur. Using this example, computers cannot take the place of human fingers in doing a self-test. If you feel a lump and the first mammogram shows negative, get a second opinion.

– Make sure you inform your doctors and pharmacists what drugs you are taking. There are a number of drugs that contraempt the drug you need (make its use less effective) and some which are toxic when taken together. I ask my pharmacist questions all the time about some over counter drugs that may be harmful when taken with the prescriptions my family is taking, including me.

– Take your medications as prescribed and through the dosage. Many people stop taking their meds when they start feeling better.

– Be truthful with the doctor about your drinking and extra-curricular drug use. Doctors tend to believe patients understate their drinking, so help them out and tell them the truth. You drink more than you say you do.

– Make sure you get treatment for a major problem at a place that does a lot of what you need – a center of excellence. This is especially true with back or spinal surgeries and surgeries on any major organs. If you are having heart surgery, do you want it done where they have done 25 in the past year or 250, e.g? I have two friends who are having major back complications after spinal surgeries were done poorly.

– Get all the information you can around procedures to make informed decisions. In some cases, living with a mild discomfort with medication may be better than invasive surgery. Ask the doctor what are the options, what are the chances for success and what are the risks. If he/ she doesn’t know, ask him/ her with whom you can speak.

– Be diplomatically relentless with Call Center personnel at insurance companies. Mistakes do occur and sometimes you may be allergic to a substituted generic prescription. So, you can appeal a claim if you feel under-served.

– This one comes courtesy of Dr. Sandra Steingraber, an ecologist, biologist and cancer survivor. Family history needs to recognize your environment as well. She was adopted, but her bladder cancer at the age of 21, also occurred in other family members who lived nearby (as well as other cancers). Bladder cancer is a bell-weather cancer. It is largely caused by environmental toxins. If your family, neighbors or community has some longevity in an area and more than one or two bladder cancers have occurred, start doing some fact-finding. It may be more than a coincidence. Since people move around, showing environmental causes is difficult as the exposure may have occurred years before.

– Finally, take care of yourself in a sustainable way. Walk more. Reduce portions. Eat more slowly and ingest more calories earlier in the day. These measures can be sustained whereas diets cannot.

These are just a few ideas, but the key message is be your own health care advocate as you are the only constant in any equation about your health. If you feel you cannot serve this role well, please take a trusted friend or family member with you. Doctors and nurses are marvelous care givers, but they are not perfect. You have to improve their service by being present in the conversations. It is only your or your children’s lives.

Conservative pundit David Brooks – How Democrats Won the War of Ideas

As an independent and former Republican (and Democrat), David Brooks is one of my favorite conservative pundits and authors. He is a regular participant on PBS Newhour’s Friday recap show with the more liberal Mark Shields. Like other key conservative pundits, MIchael Gerson, George Will, Ross Douthat, Eric Erickson and Max Boot, he is hoping that America votes out the incumbent president.

In his usual articulate and even-handed fashion, Brooks penned the following editorial last week called “How Democrats Won the War of Ideas.” The link is below, but I will highlight a few paragraphs for your review and comment.

“Over the last 100 years, Americans have engaged in a long debate about the role of markets and the welfare state. Republicans favored a limited government, fearing that a large nanny state would sap American dynamism and erode personal freedom. Democrats favored a larger state, arguing that giving people a basic economic security would enable them to take more risks and lead dignified lives.

That debate ebbed and flowed over the years, but 2020 has turned out to be a pivotal year in the struggle, and it looks now as if we can declare a winner. The Democrats won the big argument of the 20th century. It’s not that everybody has become a Democrat, but even Republicans are now embracing basic Democratic assumptions. Americans across the board fear economic and physical insecurity more than an overweening state. The era of big government is here.”

Brooks cites a few survey facts from last week’s New York Times/ Siena poll.

2/3 of Americans support allowing people to buy health insurance through the federal government

2/3 support Joe Biden’s $2 trillion plan to increase renewable energy and build efficient infrastructure

72% of likely voters and 56% of Republican voters favor another COVID-19 relief package

59% of Americans think government should do more to solve problems

2/3 think government should do more to fight climate change

60% support increasing the minimum wage and providing tax credits to low income workers

82% of voters and 70% of Republicans would like to expand requirements for paid family medical leave

Brooks also cites a study by the Mercatus Center which notes that Republicans are also moving left, just not at the pace of Democrats. This is contrary to what is believed by the media.

I have long said that more than 1/2 of the Republican voters are voting against their economic interests and do not know it. This survey indicates many do favor policies that would help them, but are sold a bill of goods packaged to woo their votes, but mask the purposeful deterioration of rights and opportunities.

A great example is the Affordable Care Act. When people are surveyed about the features of the act, the features receive high marks from all, including Republicans. The only feature that did not was eliminated – the mandate to buy coverage. Ironically, this elimination is the basis for 25 Republican Attorney Generals who have case to declare the ACA unconstitutional in front of the Supreme Court after the election, which should not occur as the case is not solid, but one never knows with these things. Sadly, the White House chose not to defend the law, which affects expanded Medicaid, exchange and employer-provided benefits.

Please read Brooks article below. It is very well done, as per usual.

Two articles speak volumes

Two articles are worth noting as we head into the election. The first is “Trump’s handling of coronavirus pandemic hits record low approval: Reuters/Ipsos poll’ by John Whitesides of Reuters. Here are a few paragraphs.

“Americans are steadily losing confidence in President Donald Trump’s handling of the coronavirus pandemic, with his net approval on the issue that has dominated the U.S. election hitting a record low in a new Reuters/Ipsos poll.

The poll taken Tuesday through Thursday, after Trump’s COVID-19 infection and weekend hospitalization, found 37% of American adults approved of the president’s handling of the pandemic and 59% disapproved.

The net approval rating of negative 22 percentage points is the lowest in the poll dating back to March 2 and has steadily declined over the last 10 days, as Trump’s illness and his return to work in the White House dominated news headlines.”

The second article was reported by Randy Tucker in the Cincinnati Enquirer is called “Mitch McConnell says White House’s lax COVID rules are why he hasn’t visited since August.”

“U.S. Senate Majority Leader Mitch McConnell Thursday said he hasn’t visited the White House in two months because of what he saw as lax coronavirus practices. “‘ haven’t actually been to the White House since Aug. 6 because my impression was their approach to how to handle this (pandemic) was different from mine and what I insisted we do in the Senate, which was to wear a mask and practice social distancing,” McConnell said during an appearance in Northern Kentucky.“

These excerpts and articles speak for themselves. To be frank, while bad, I am surprised the disapproval rating of Trump’s handling of the COVID-19 response is not higher. We are just shy of 218,000 deaths in America, yet that does not seem to be a problem or a debate question worth answering. It just shows how little news actually gets to people that need to see it. That is what this independent voter thinks.

https://www.msn.com/en-us/news/politics/trump-s-handling-of-coronavirus-pandemic-hits-record-low-approval-reuters-ipsos-poll/ar-BB19Q8zM?ocid=msedgdhp

https://www.msn.com/en-us/news/politics/mitch-mcconnell-i-havent-visited-white-house-recently-because-of-lax-covid-rules/ar-BB19PyTp?ocid=uxbndlbing

Just a quick refresher on the ACA animosity in the Republican Party

Our friend Scottie asked me why the Republican Party detests the Affordable Care Act (ACA) so much and wants to kill it. I have written many posts about this, but here is quick refresher.

The Republican party has spent about ten years nay-saying the ACA. This is in addition to actual efforts to sabotage it by Senator Marco Rubio and President Donald Trump and the fourteen states who still have not expanded Medicaid. Rubio and Trump’s actions caused premiums to increase. Blue Cross and Blue Shield of North Carolina (BCBS of NC) said it was geared to have a 0% increase in 2018, but after Trump de-funded reimbursing insurers for co-pays/ deductibles for people making less than 2 1/2 times the poverty rate, BCBS of NC said it would have a 6.6% increase. Not only did Rubio’s action cause premiums to go up, it drove some insurers out of the exchanges lessening competition which also hurt consumers. *

So, to me the Republicans are so far down the path of killing something that is working pretty good (it still needs improvements), they cannot stop. And, it is apparent that Trump has an Obama obsession that he must kill everything that Obama did regardless of its level of efficacy. As a retired benefits consultant and former actuary, what the GOP came up with in 2017 to replace the ACA was god-awful. It was throw-against-the-wall planning. The fact the Republicans did not follow due process was a key reason Senator John McCain voted it down. Mind you, I fault Obama for the terrible roll out of the exchanges in 2013, but he at least involved Republicans in the planning process in very public sessions (although they were told not to vote for it).

And, here is the rub. The reason the GOP does not have a plan is the ACA is largely based on a Republican idea set in motion by Mitt Romney for Massachusetts, when he was governor. It worked so well, that Senator Jim DeMint, the leader of the Tea Party, advocated its national use in writing to President George W. Bush. And, DeMint politicked with Romney on stage in 2008, Romney’s first run for president. I recognize the ACA is not exactly the same as Romneycare, but there are a number of similar constructs.

Everything I mention above, including the DeMint piece can be found by Googling. But, here is the major concern I have. Employers have been going to more part-time and contract work forces even before the pandemic. Why? – to avoid providing subsidized health care benefits. So, to survive in this gig and part-time employment world, the ACA is essential.

Plus, the ACA imposes requirements on employer based plans as well that may go away if SCOTUS rules unwisely with the court case. Those include pre-existing condition protection, guaranteed renewability, no deductibles on wellness visits, and limitations on insurer margins in pricing, e.g. So, a bad SCOTUS ruling could impact over 200 million Americans not just those in the exchanges and Medicaid.

* Note: The reason for the premium increases are complex, so I will mention them here. Rubio led a Republican move to defund 89% of the payments to insurers for adverse selection (pent up demand for new policy holders) for the first few years, a process used when Medicare Part D was rolled out. Insurers were forced to increase premiums and some left the market with the US owing them money that was promised. The Trump change is more complex. By stopping the reimbursement to insurers for this extra benefit for low paid policyholders, the insurers still honored their commitment to the policyholders. This drove up premiums. Trump said this would only impact insurer profits, but that was not true. The CBO said it increased the annual deficit by $10 billion because the premium subsidies went up as well. The people who ultimately got screwed were those who did not get a full subsidy.

Letter to editor – health care actions speak loudly

I have written longer posts on the actions of Donald Trump, Marco Rubio and Republicans to sabotage the Affordable Care Act. What many do not know, after the election, a court case will decide its fate, brazenly brought forward by several Republican state AGs after Congress stripped away the coverage mandate during a budget vote. The following is a brief letter I sent to my newspaper.

The truth matters. Actions matter. Four years ago, Trump said we had to wait and see his healthcare plan. None existed and still does not. Three years ago Trump cut payments to insurers to fund their payment of co-pays and deductibles for ACA members making less than 2 1/2 x the poverty rate and then lied about its impact – it actually increased premiums and the deficit per the CBO.

After the election, SCOTUS will be hearing a case to rule on the constitutionality of the ACA premium subsidy after Republicans stripped away the coverage mandate, which would severely hamper the law and may lead to its end. The White House chose not to defend the law. The ACA impacts both exchange and employer benefits, three key provisions of which are allowing pre-existing conditions, requiring guaranteed renewability and requiring wellness doctor visits not be subject to deductibles.

Sadly, beyond the nay-saying, there has been more sabotage of the ACA which increased premiums (Google Marco Rubio and risk corridors), repeal and replace efforts which were fortunately defeated, and fourteen states (including NC and SC) who still have not expanded Medicaid, a key part to help people in poverty. Health care coverage access is a major issue this coming election so says this retired benefits consultant, benefits manager and former actuary.

Eliminating the ACA which which may impact over 200 million Americans  (including the ACA requirements on employer plans) is unwise in my view, in general. But, doing so in the middle of a poorly handled pandemic by the White House with over 200,000 and growing American deaths, is plain asinine and mean-spirited.

Please feel free to adapt and use. Actions speak louder than words and my former party, the GOP, has purposefully sabotaged the right for Americans to have access to health care coverage. This is why your vote matters.

Is this what a president for the common man does?

Many of the Trump base have no idea they are voting against their economic interests. This advertised populist, common man president, fails to let folks know the following:

– in his first two hours of being president, he repealed a regulation that would have reduced homeowners insurance premiums for securing mortgages with the less than 20% down, that was scheduled to go in effect February 1, 2017. This would have helped about one million low income homeowners.

– he has hobbled the Consumer Financial Protection Bureau that was very successful, but banks and credit card companies did not like it. The CFPB penalized these companies for fraudulent and aggressive lending practices, with 95% of the fines going to cheated consumers. In short, the CFPB helps folks who are targeted.

– he eliminated a new requirement that said all investment advisors have to be fiduciaries, meaning they must put your interests ahead of their own. This was done to help investment advisors, paid by the transaction, to encourage sales that may not be in your best interests.

– he passed a tax bill that favored the elites and businesses, under the guise of helping everyone. To keep the bill down to costing only $1.5 trillion in debt, he had to have some pay higher taxes – a sneaky requirement noted that state and local tax deductions were capped at $10,000, so if you owned a house and lived in a state where income tax occurred, your tax bill may increase. Note, folks who do not itemize deductions, tended to come out ahead with the change.

– he failed to tell people (actually lying about the impact routinely) the tariffs would be paid for by consumers when importers passed along the cost. He has routinely lied saying China will pay the tariffs, but that simply is not true. Each time he said this, economists would rebut his lie.

– he also lied about an ACA change he made that increased premiums for people, saying it would only impact insurer profits. In essence, he ceased the subsidy to insurers to repay them for paying deductibles, copays, etc. for members making less than 2 1/2 times the poverty rate. Insurers honored their written commitment (Trump did not) and subsidies went up to pay for the resulting increase in premiums. BCBS of North Carolina said premiums the next year were going to increase by 0%, but with the Trump change, they went up by over 6%. The CBO said the increase in subsidies increased the deficit by $10 billion per annum and unsubsidized folk saw premium increases.

– he has advocated a COVID-19 relief bill which will prevent employees from suing employers for endangering them with COVID-19 exposure.

– finally, environmental deregulation hurts those in poverty more, as they have fewer choices as to where to live.

There is more. With his attacks on the ACA, with a pending lawsuit that would harm it, more of Trump’s base will be harmed. Plus, with his misinformation and mishandling of the COVID-19 pandemic, more people are being harmed and dying. Of all that I mentioned, his callousness and negligence in COVID-19 handling is the most prominent failure that impacts people.

So, in turn for getting protection over gun rights and attacks on abortion access, the president has largely screwed over his base and they have no idea he has.