Friday afternoon before a major summer holiday...relax, right?
Ha! That was then. Hold your breath for what's breaking loose right now from SCOTUS to a machiavellian Senate to anti-vax gypsies in the palace.
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Why this matters to women: From family planning to whether you or yours can get reliable, free vaccines to whether we’ll dump tens of millions more off Obamacare and Medicaid … there’s nothing boring about DC (or New York) these days. And that’s without even talking (yet) about the all-out war on higher ed being waged by a wrestling promoter, RFK-not, and a constitutionally-unencumbered DOJ.
About twice a week I miss the boring old guy who pulled our economy out of the dumpster and didn’t need to bomb someone to prove … something. But then I remind myself that way back in 1997, a couple of socio-economic researchers predicted this is exactly where we’d be by 2025: in the midst of a predictable phase of utter political chaos.1 And that, in fact, we were supposed to elect someone “perceived as a strong leader”2 in 2024 to bring on the chaos so we can decide who we are as a nation, so we can then hopefully move on to glories resembling the post-WWII decades.
I have found remembering all that plus gin and the right books3 can almost get me to a pre-holiday mood.
In case you’ve been able to pull the blanket over your head, here’s where we are on three major fronts: SCOTUS, the budget bill, and the vaccine panel uproar.
Completely in character for Trump administrations, multiple fronts are on fire; we’ll update as things change, likely over the weekend on the budget in particular.
SCOTUS
Earlier this week SCOTUS allowed states to cut Medicaid funding for Planned Parenthood, often the only place someone who is under- or uninsured can get routine Gyn care. In 2023, 96% of PP patients went for non-abortion services they couldn’t afford elsewhere. One out of three American women (including one out of five Republican women) have used PP at some time, and even more in at-risk populations.
Today was the end of the term, with key opinions now released.
Birthright citizenship: SCOTUS managed to yet again avoid a major decision, instead they focusing on the narrower issue, ruling against nationwide injunctions, still a major win for the WH. Here’s an arguably worst-case analysis of that from unapologetically-liberal Slate Magazine.
Age verification on porn sites: Ruled in favor of a Texas law requiring this. I suspect many mothers regardless of political views, are in favor of this one.
Obamacare free preventive services: Upheld in a corporate religious rights case.
Parents’ rights to opt out children of participating in public school instruction with LGBTQ+ themes: Supported parental right to opt children out — meaning that in reality those resources won’t be available for anyone. The last thing teachers and librarians have time to do is to sort out what resources may or may not be used.
Tax-subsidized internet and phone services for underserved commities: Upheld.
SCOTUS punted on another big case, a redistricting case in Louisiana alleging unconstitutional racial gerrymandering, to be reargued in the fall. (Shocker! Racial gerrymandering in Louisiana? Who could imagine that?)
BUDGET BILL (Will it never end???)
See our prior posts here, here and here with a whole lot of data.
In service of making Trump’s 2017 tax cut permanent, Congress is using the budget reconciliation process to avoid a minority filibuster. With reconciliation, only 51 votes are needed in the Senate to pass the bill, where —as in the House — Rs have only a three-vote majority.
There are three major problems: 1) The data is clear about who benefitted from Trump’s 2017 tax cut and who paid for it, and the 90% who split the half left over after the top 10% benefitted the most now know it, as do the botton 30% who paid for everyone’s else’s benefits. 2) Congress needed to find $1.3 trillion in cuts to make the tax cut permanent and it’s been clear from the start that kind of money would only be found by cutting Medicaid, Medicare, or Social Security. The poor immediately looked like a better option than noisy, donating seniors, but history has not been kind to legislators who defund healthcare. 3) The reconciliation process requires meeting requirements of Byrd Rules, and there’s not a lot of room there for the many extraneous additions these bills always accumulate. This bill in particular needed a lot of creativity to find the over a trillion dollars to pay for Trump’s tax cut.
Congress thought they were good to go with a trillion plus in Medicaid and SNAP cuts, increasing the uninsured in America by at least 62%. It turns out some of their rural (read, glowing red) district members, more dependent on Medicaid than urban districts, were massively unhappy. Things got wobbly after Musk came out threatening to primary any legislator who voted for the bill, and then more so after the Senate tacked on even more onerous cuts, courageously led by a senator worth $250M after leading a healthcare company he led to the largest ever Medicare and Medicaid fraud penalty.4 But Sen. Mitch McConnell (R-KY) told his party not to worry, because angry constituents would “get over it,” as he continues to (barely) warm the apparently lucrative Senate seat he’s held for four decades.5
Somewhat surprisingly, Americans may have figured all this out. Polls consistently show the public about 2:1 against the budget bill. Even Fox News can’t sell the budget, and another Fox poll indicated a lack of love for Trump, so they’re bad and fake again. And then the Federal Reserve forecasted higher inflation as business owners and consumers start to feel the impact of the president’s sweeping tariffs6 with Trump’s job approval underwater, particulary on deportations, trade and the economy. Vox suggests the public doesn’t like it when Trump actually does something. Apparently I’m not the only one missing boring.
Completely unrelated, of course, our laser-focused-on-governing president decided it was time to bomb someone.7 In the past, that would have yielded patriotic fervor (and positive polling), except the country as a whole is a lot more skeptical about promises and results than we were in the past. Substantial doubt remains on what the bombing may or may not have accomplished. Maybe obliterate-ish?
In the meantime, the CBO analysis of the budget bill basically said, “Guess what: The same 10% of Americans will benefit the most again, and the poor will pay even more this time.” At Trump’s request, they added in the effect of tariffs; it’s not what he’d hoped they’d say.
And then the least-known actual apparent ruler of the country, a woman you’ve probably never heard of, cast a serious pall on much of the Senate’s best laid plans, opining they are far south of the Byrd Rules for budget reconciliation, showing a distinct lack of humor over extraneous items in the bill like rural hospital-killing Medicaid cuts, a religious college tax carve-out, removing the tax on gun silencers, and selling off 3,200 square miles of a blue state. (Click for an up-to-date running list of what’s been rejected. Gifted article; no paywall.)
Naturally, that makes Senate Parliamentarian Elizabeth MacDonough a “swamp bureaucrat” — although one who somehow survived Trump the last time around. I was halfway through a post yesterday about her when I found this post from Closer to the Edge. It’s far more entertaining than anything I could offer.
So far, unlike what Sen. Lindsey Graham (R-SC) threatened in February, it appears the Senate majority leader, John Thune (R-SD), does not intend to overrule the parliamentarian, a rare but possible occurrence.
All this, according to Everyone, has cause much more significant muttering, perhaps finally even sweating, in both the Senate and the House, where they are now engaged in furious deal-cutting. Republicans aren’t doing too well in polls, either, and Congress is painfully aware of history lessons on midterm election losses after cutting healthcare.
Trump is back home from conquering NATO, where — give him credit — he did achieve the impossible: getting NATO nations to up their defense spending (never mind all the world chaos it took to get there). He now has the pedal to the metal on getting the budget bill passed in time to again flash us the jacked-up spikes8 that pass for his signature. To be signed on July 4; can’t miss the possibility of great television, you know. Stay tuned; we will update.
THE NOT-HEALTH & HUMAN SERVICES
Blowing through multiple promises he made to Congress to get approved to head HHS, RFK Jr. fired all 17 members of a key vaccine advisory panel, replacing it with peeps more to his liking, including— surprise!— vaccine skeptics. The committee’s first move was to bring in data from an anti-vax activist.
The new committee chair, Martin Kulldorff — a biostatistician who criticized pandemic-era lockdowns and said he was fired from Harvard for refusing to get a Covid vaccination — reportedly started the meeting off with a combative tone to set the stage. The panel then voted to revisit disproved theories from decades ago and rescind recommendations for some flu vaccines, but, surprising some, did recommend RSV vaccination for infants. Of course, they’re also considering getting rid of the measles vaccine.
Importantly, note the approval process influences whether a vaccine is covered by insurance, and a CDC director who could alter the committee’s recommendations has conveniently not been named.
Nothing from the ACIP meeting reassured anyone. Sen. Bill Cassidy (R-LA) — a physician and the deciding (and skeptical) vote on RFK Jr.’s nomination — called for a pause on ACIP recommendations and for hearings. The fired ACIP members aren’t media shy. The usually laid-back American Association of Pediatrics (AAP) boycotted the meeting and says it will publish its own vaccine recommendations. The American Medical Association and nearly 80 professional organizations issued a joint statement that they will continue to follow and promote evidence-based vaccine recommendations, regardless of political interference. And global biodefense is worried.
Who knows what’s next from HHS, but here are two great resources for keeping up
Internationally-recognized epidemiologist Katelynn Jetelina, PhD, is objective, a consultant to the CDC, and has taken the tiger by the tail to talk directly with MAHAs to understand where they’re coming from. Her substack is followed in more than 100 countries. Here’s her update on the ACIP meeting, during which her team fact-checked 50 fallicies and debunked them here. She also noted the lack of vaccine expertise and a basic understanding of vaccine production and policy among the new members: “This is, of course, acceptable for a curious member of the public—it is absolutely unacceptable for people determining vaccine policy for 330 million Americans.”
Zachary Rubin, MD is board certified in both pediatrics9 and allergy/immunology, with a new book out on allergies. Like Dr. Jetelina, he speaks English, not medical-ese. Here’s his update on the ACIP meeting.
If you need a break and a boost, I highly recommend this delightful (and pretty) summer G&T with rosemary, and this incredible book, particularly the audio version, read by the author herself. It’s just plain fabulous about the time you start thinking it’s never been this bad. Because it has been, and we made it then, too, with a lot of amazing women leading the way — even giving up their lives — to make change happen.
You can’t make this stuff up. Scott wanted even more draconian cuts to Medicaid, and is “frustrated” by parliamentarian blocks.
Since 1985, to be specific. Mitch, at 83, is still younger than Chuck Grassley, 92 in September; Grassley has been warming his Senate seat since 1981, with 6 years before that in the House. And we wonder why the Senate doesn’t understand the needs of younger generations. Term limits, anyone?
FWIW, I went to a mall last night with a monster Nordstrom and multiple other high end stores. The parking lot was empty; it looked like a dead mall. Seven cars at one of the largest Nordstroms I’ve ever seen, and I’ve seen a few.
For years, I’ve pictured Trump sitting on the john in the morning, on his phone, texting out these decisions as his mental and bodily Brilliant Ideas of the Second hit.
British graphologist Tracey Trussell says “Trump’s trademark signature screams narcissism, omniscience and omnipotence and transmits wild ambition and fearlessness. The soaring exaggerated pointed tips indicate big dreams and strong views, albeit frustration at an aspirational level.”
You can tell for sure he’s a Real Pediatrician because he wears bow ties. Thank goddess for the many peds who sport that wonderful light touch! When I was VP of a health system, peds were always the specialty I knew would give me straight answers uninfluenced by political pressure or other … gasses. All that matters to them is healthy, happy kids.
A well-researched piece. Thank you.