Health care carried House Democrats to victory on Election Day. But what now?
In interviews this fall with half a dozen senior House Democratic aides, health care lobbyists, and progressive wonks, it became clear the party is only in the nascent stages of figuring out its next steps on health care.
The new House Democratic majority knows what it opposes. They want to stop any further efforts by Republicans or the Trump administration to roll back and undermine the Affordable Care Act or overhaul Medicaid and Medicare.
But Democrats are less certain about an affirmative health care agenda. Most Democrats campaigned on protecting preexisting conditions, but the ACA has already done that. Medicare-for-all is energizing the party’s left wing, but nobody expects a single-payer bill to start moving through the House. Drug prices offer the rare opportunity for bipartisan work with Senate Republicans and the Trump White House, but it is also a difficult problem with few easy policy solutions — certainly not any silver bullet that Democrats could pull out of the box and pass on day one, or even month one, of the next Congress.
Winning a House majority to ensure Obamacare’s safety is an important turning point after so many years in which health care hurt Democrats much more than it helped.
But the path forward for the party on their signature issue is surprisingly undefined.
The likely first item on the Democratic agenda: Obamacare stabilization
Democrats do have some ideas, of course. Democratic aides emphasized the various investigations they could launch into Trump’s health department, not only looking into any efforts by the White House to sabotage Obamacare but also focusing on more obscure issues like Medicare payment rates.
But wonky oversight inquiries probably aren’t the big-ticket item that new Democratic members and their voters are looking for, especially heading into the 2020 presidential election.
After campaigning in defense of Obamacare, warning about Republicans rolling back preexisting conditions protections and the Trump administration’s sabotage of the health care law, a bill to stabilize the Obamacare insurance markets would be the obvious first item for the new Democratic majority’s agenda.
Several sources pointed to a bill by Democratic Reps. Richard Neal (MA), Frank Pallone (NJ), and Bobby Scott (VA) — who have been serving as the top Democrats on leading health care-related committees — as the likely starting point. The plan is designed to build off Obamacare’s infrastructure to expand federal assistance while reversing the recent Republican efforts to undermine the law.
That bill would expand Obamacare’s premium subsidies, both by extending federal assistance to more people in lifting the current eligibility cutoff and by increasing the size of the tax credits people receive. It would also bolster the cost-sharing reduction subsidies that people with lower incomes receive to reduce their out-of-pocket costs, while extending eligibility for those subsidies to people with higher incomes.
The Pallone-Neal-Scott bill would reverse the Trump administration’s recent regulations intended to funnel more people to insurance plans that are not required to meet all of Obamacare’s rules for preexisting conditions. It would also pump more money back into enrollment outreach, cut by the Trump administration, and establish a new program to compensate insurers for high-cost patients, with the hope of keeping premiums down.
Two things stick out about this bill: It would be the most robust expansion of Obamacare since the law first passed, and it is just narrow enough that, with a few sweeteners for Senate Republicans, it could conceivably have a chance to pass. Democrats are waiting to see how the GOP majority in the upper chamber reacts to losing the House.
“Undoing sabotage and bringing stabilization to the ACA markets, that’s something we should really be thinking about,” one House Democratic aide told me. “It depends on what kind of mood the Republicans are in. Maybe they’ll say that actually now that the tables are turned, we should probably sit down.”
Senate Republicans and Democrats did come very close to a narrow, bipartisan deal — it wasn’t even as robust as the Pallone-Neal-Scott bill — to stabilize Obamacare in 2017. It fell apart, ostensibly after a tiff over abortion-related provisions, but that near miss would be the reason for any optimism about a bipartisan deal on the divisive health care law.
Then again Senate Republicans might have no interest in an Obamacare compromise after holding onto their majority. Republican health care lobbyists told me that they’re extremely skeptical about any big health care bill moving next year.
Nevertheless, House Democrats would still likely work on stabilization to send a message to voters on health care ahead of the 2020 presidential campaign.
Shoring up Obamacare is a good start, but what next?
In the case, the Pallone-Neal-Scott bill might be a nice starting point — no Democrat really disagrees about whether they should help the law work better in the short term — but it still lacks any truly ambitious provisions. It is just about as narrowly tailored as an Obamacare stabilization bill offered by Democrats could be, a fact that aides and activists will privately concede.
Missing are any of the bolder policy proposals animating the left. Not even a hint of Medicare-for-all single-payer health care, which is or isn’t a surprise, depending on how you look at it.
Medicare-for-all is quickly becoming orthodoxy among many in the party’s progressive grassroots, and a single-payer bill proposed this Congress in the House (similar to the one offered by Bernie Sanders over in the Senate) has 123 sponsors.
But House Democratic leaders probably don’t want to take up such a potentially explosive issue too soon after finally clawing back a modicum of power in Trump’s Washington.
Still, the current stabilization bill doesn’t even include a Medicare or Medicaid buy-in, the rebranded public option that never made it into Obamacare but would allow Americans to voluntarily join one of the major government insurance programs. It is an idea that even the more moderate Democratic members tend to support, and polls have found three-fourths of Americans think a Medicare buy-in is a good idea.
The plain truth is House Democrats haven’t reached a consensus yet about what they want to do to cover more Americans. They agree Obamacare was an important first step, and they agree the status quo is unacceptable. But the exact mechanism for achieving those goals — single-payer, a robust public option, or simply a buffed-up version of Obamacare — is still very much up for debate.
“People will want to do something, but any further action is going to be a consensus-building process,” a senior House Democratic aide told me. “Democrats have lots of different ideas on how to continue working to reduce the uninsured.”
That is all well and good, but few issues are exciting the Democratic grassroots right now like Medicare-for-all. During the midterm campaigns, Democratic candidates and even grassroots leaders were happy to let those words mean whatever voters wanted them to mean. For some people, it meant single-payer; for others; it might mean a Medicare buy-in or something more limited.
The unreservedly progressive members who were just elected to Congress will only wait so long before they start pressing Democratic leaders to take more aggressive steps to pick up one of their top campaign issues. That pressure will only intensify as the 2020 presidential campaign heats up and Democrats debate what kind of platform they should run on as they seek to take back the White House.
For now, Democrats have tried to put off a difficult debate and focus on what unites them. But the debate is still coming.
The riddle of high drug prices still needs to be solved too
Even with Obamacare and preexisting conditions mobilizing Democratic voters this year, prescription drug prices remain a top concern for many Americans. That’s another area where Democrats know they want to act but don’t know yet exactly what they can or should do.
The issue could be an opening for serious dealmaking: Trump himself has attacked big pharma since his presidential campaign. His administration has actually launched some interesting initiatives to rein in drug costs — approving a record number of generic drugs, trying to even the playing field between America and foreign countries — that have some policy wonks intrigued, even if the impact is still to be determined.
Democrats have mostly stuck to slamming Trump for feigning to act on drug prices while cozying up to the drug industry. But it’s a top priority for both parties, and there could be some room for compromise. One progressive policy wonk thought a drug prices bill might actually be the first Democratic priority. It helps that drug prices are a populist issue that the new House majority might really be able to pass a bill on.
But first, Democrats have to figure out what exactly they are for — and what would actually make a difference.
The rallying cry for Democrats on drug prices has been letting Medicare directly negotiate prices with drug manufacturers, a proposal that Trump also embraced as a candidate, though he has since softened as president. The problem is the Congressional Budget Office doesn’t think Medicare negotiations would save any money unless the government is willing to deny seniors coverage for certain medications. But adding such a provision would surely invite attacks that Democrats are depriving people’s grandparents of the medications they need.
There are a lot of levers to pull to try to reduce drug prices: the patent protections that pharma companies receive for new drugs, the mandated discounts when the government buys drugs for Medicare and Medicaid, existing hurdles to getting generic drugs approved, the tax treatment of drug research and development. Pharmacy benefits managers, the mysterious middlemen between health insurers and drugmakers, are viewed skeptically by lawmakers and the public.
But none of those are silver bullets to lower prices, and they will certainly invite pushback from the politically potent pharmaceutical lobby, focused on the concerns about how much cracking down on drug companies to discourage them from developing new drugs. Democrats also don’t know yet what specific policies could win support from Senate Republicans or the Trump White House.
“How do you take this gargantuan Chinese menu of things and figure out how things fit together in a way that stem some of the abuses?” is how one Democratic aide summarized the dilemma.
It is a problem bedeviling Democrats on more than just drug prices. Health care was a winner on election night this year, and it has always been a priority for Democrats. Now they just need to figure out what to do.
11 Exercises to Fix Rounded Shoulders and Sculpt Beautiful Posture
Modern life takes its toll on our posture when we spend hours sitting and neglect the position of our spine. Poor posture leads to an imbalance in our muscles which means that they can’t support the body properly. Luckily, this can be fixed by doing a set of effective exercises. Moreover, they can help you to reduce back pain, stop headaches, increase energy, and improve circulation and digestion.
Bright Side is ready to help our readers achieve a beautiful and healthy body, and found 11 simple exercises that can be done at home by anyone. At the end we included a small tip, as a bonus for those who enjoy massage.
1. Upper trapezius stretch
It’s better to start from your shoulders first to relax your upper muscles. An upper trapezius stretch is just perfect for this.
Initial position: For this exercise, you can stand or sit on your yoga mat, whatever you like. Keep your head straight.
What to do:
- Slowly move your right ear toward your right shoulder. When you do this, it’s normal that your left shoulder might lift as well. If it does, bring your head back to the initial position and try to relax your left shoulder.
- Put your right hand over your head and place it on your left cheekbone. Don’t push your head down with it, it should just lie there. This will stretch your upper trapezius muscles very gently.
- Calmly breathe and sit in this position for 30 seconds.
- Slowly remove your hand, come back to the initial position and repeat the same on the other side.
The Superman exercise engages your upper and lower back. It helps you fight lower back pain and prevents a curved spine.
Initial position: Lie face down on your stomach, on your yoga mat.
What to do:
- Extend your arms and legs. Keep your neck neutral.
- Keep your torso stationary and lift your arms and legs up toward the ceiling. Try forming a “U” shape with your body.
- Hold the position for 5 seconds, lower your arms and legs, and go back to the initial position.
- Repeat 10 times.
The bridge works out glutes and strengthens the lower back, which is important for good posture.
Initial position: Lie on your yoga mat, bend your knees, and place your feet hip-width apart. Place your arms by your sides.
What to do:
- Engage your buttocks and raise them up, creating a straight line with your body. Your shoulders should be on the floor.
- Hold this position for 10 seconds and slowly lower your body back to the initial position.
- Repeat 15-20 times. Give yourself a rest for 30 seconds after every 5 reps.
4. Reverse shoulder stretch
This is an effective exercise to stretch your back and shoulder muscles and remove tension and pain in them.
Initial position: Stand on a yoga mat, with your feet wider than your shoulders, place your straightened hands behind you, and lock your palms together.
What to do:
- Bring your shoulder blades together and start putting your arms up. Try to feel the tension in your spine and shoulder muscles.
- For more spine stretch bend forward and bring your locked hands up. Hold this position for 10-15 seconds.
- Slowly return back to the initial position.
- Repeat 20 times.
5. Foam roller exercise for upper back
A foam roller will help you to relieve pain in your back muscles, fix rounded shoulders, and improve your overall posture.
Initial position: Get a yoga mat and lie on it with your hips apart and your feet on the floor. Place your foam roller right under your upper middle back, in your shoulder blade area.
What to do:
- Bring your hands behind your head, this will support it. Bring your hips into a bridge pose, and hold your balance, supporting your body with your legs.
- Inhale, push your body from your heels, and roll on your spine. Stop when the roller reaches the top of your shoulder blades.
- Exhale and roll back until the roller reaches the bottom if your rib cage.
- Repeat this for 30-45 seconds.
6. Cat-cow exercise
The cat-cow exercise is perfect for stretching your back, lower spine, and core muscles.
Initial position: Stand on all fours on the yoga mat, place your hands right under your shoulders, and knees and feet hip-width apart. Keep your toes pointing toward your body. Your spine should be natural and straight, no bending or arching.
What to do:
- Cat position: exhale and engage your abdominal muscles. Arch your spine up toward the ceiling, bringing your head to your chest, aligned with your spine. Hold this for 10 seconds.
- Cow position: slowly start bringing your stomach toward the floor and try to feel the tension in your lower back. Bring your shoulder blades together. Hold this for 10 seconds and go back to the initial position.
- Repeat 15 times.
7. Kneeling hip-flexor stretch
The kneeling hip flexor stretch will help to remove tension from your pelvic and lower back muscles.
Initial position: Kneel on a yoga mat, bring your right leg in front of you, and bend it at a 90 degree angle. Your foot is flat on the ground. Support yourself by standing on your left knee that is also bent at 90 degrees.
What to do:
- Slowly start bringing your right knee forward and brace your core. Engage your glutes and keep bringing your hips forward.
- Your left knee is already bent at more than 90 degrees. Keep your spine straight, don’t bend it forward or backward.
- Hold this position for 10 seconds to feel the stretch in the muscles then slowly return to the initial position.
- Repeat 10 times for both sides.
8. Bird dog exercise
Bird dog helps to remove back pain, strengthens the core, and promotes proper posture.
Initial position: Stand on all fours on the yoga mat, your hands under your shoulders and your knees under your hips. Your spine should be straight and neutral.
What to do:
- Raise your right hand and your left leg at the same time, bringing them parallel to the floor.
- As you do this, lengthen your neck and bring your chin to your chest. Look down at the floor and remain like this for 10 seconds.
- Return to the starting position and then repeat the same exercise with your left hand and right leg.
- Repeat 10-15 times.
9. Forearm plank
Plank is not only effective at burning fat, but it also helps to strengthen the spine muscles, it prevents back pain, and it helps to improve your posture.
Initial position: Place your forearms on the yoga mat and align your elbows below your shoulders. Your arms should be parallel to your body at about shoulder-width distance.
What to do:
- You can clasp your hands together for more comfort. Correct your neck and spine by looking at one spot on the floor somewhere about 30 centimeters in front of your hands.
- Pay attention, so that your head is in line with your back.
- Hold this position for 20 seconds.
10. T-Spine windmill stretch
The t-spine windmill stretch can help you fight pain and tension in your lower back and trunk. Moreover, it works out your shoulder muscles.
Initial position: Lie on your side on a yoga mat and bend your knees and hips at 90 degrees. Extend and stack your arms together on your right side.
What to do:
- Raise your left arm up and then place it out to the left, opening your body up. Right now, your shoulder blades should be on the floor and your legs should remain in the same position.
- Hold it for a couple of seconds and return to your initial position.
- Do 30 repetitions on each side.
11. Tight shoulder massage
A simple tennis ball can help you to remove pain in your shoulders in different areas and relax them. All you need here is a tennis ball and a wall.
Initial position: Stand next to the wall and face it. Place a tennis ball on the wall and lean on it. Your chest should push the ball inside your shoulder.
What to do:
- Start making a circular movement around this muscle and try to find a trigger point.
- Hold a ball on this point until you feel that the tension and pain are gone.
- Keep doing this until you relax all of your trigger points.
- Repeat on the other shoulder.
Bonus: Thai massage is amazing for your back and shoulders.
Thai massage is an ancient form of massage that uses stretching and gentle pressure on the body to relieve muscle and joint pain, and balance your body. This massage helps to make muscles more flexible and removes chronic stiffness. For better results in achieving a healthy back and good posture, you can try this type of massage, focusing on your spine muscles.
Exercises can be effective, but it’s also important to pay attention to your posture throughout the day and strive to keep your spine straight. Do you have good posture? Maybe, you have a couple of exercises that help you relieve back and shoulder pain? Let’s share in the comments!
Illustrated by Alena Tsarkova and Marat Nugumanov for BrightSide.me
8 Top Technology Trends To Watch In China
This is a preview of 2019 Technology Trends Report in China from Business Insider Intelligence and EqualOcean. Chinese high tech firms have been leading the way in innovation for many technologies, such as 5G. These technologies are either currently undergoing or about to undergo major phases of change.
View at DailyMotion
Why Iran is attacking oil tankers in the Strait of Hormuz
The Strait of Hormuz is a narrow waterway that lies between Iran and Oman. Dozens of tankers carry oil through the 21-mile-wide passage each day. This flow of oil represents 20 percent of the world’s supply.
Most of the tankers traveling through the Strait of Hormuz are bound for Asia. But an attack on any tanker there, regardless of its destination, can affect the price of oil everywhere. That’s because oil is a globally traded product — a drop in supply from the Persian Gulf can drive up prices from other sources around the world. After two tankers were attacked in June, the price of Brent Crude — oil sourced from the North Sea — jumped by nearly $2 per barrel.
The attacks in June weren’t the only incidents in Hormuz in recent months. Several other oil tankers have been seized, attacked, and harassed. These tankers — and this narrow water passage — have become a center of conflict between the US and Iran. It’s a conflict with the potential to escalate in one of the world’s most important oil chokepoints, sending the global economy into a tailspin.
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