White House Invited Muslim Brotherhood Policy



A ROUND TABLE DISCUSSION WITH “THE STOP QATAR NOW COALITION”

Who Are the Muslim Brotherhood-Linked Leaders Obama Met?


The Stop Qatar Now Coalition of good Patriots have spent weeks gathering evidence, documents and performed interviews to bring to publication the facts on the Muslim Brotherhood penetration into the American culture against the will and knowledge of Americans and the U.S. Constitution…

BROADTCAST LIVE WORLDWIDE:  THURSDAYS – 9:00PM (eastern) / 6:00pm (pacific) on WDFP – Restoring America Radio , Red State Talk Radio, American Agenda, Nightside Radio Studios, and on Freedom In America Radio

Uncovering the AUMF Against Islamic State

There is zero strategy in the Authorization of Military Force the White House sent electronically to Congress today. At the core of this feeble document is all deference to Iran and the building issues with Russia. Yet the most unspoken issue is Barack Obama taking a swipe at GW Bush.

Ralph Peters told Fox News this morning that Obama’s war authorization reads as if it were written by a nervous lawyer, not a bold Commander in Chief. He said there are so many caveats in it that you’d think it was a Hollywood contract negotiation.

As far as the ‘no enduring troops’ phrase, Peters says that’s simply a swipe at George W. Bush. He says this White House can’t get over the fact that Bush ever existed and it’s a dig at the occupation of Iraq.

The AUMF notably allows Obama to employ U.S. ground troops against ISIS, but with the proviso that such operations not be “enduring.” The three-year limitation comes alongside the repeal of the 2002 authorization to use force in Iraq, but the AUMF notably leaves intact the 2001 authorization to use military force against al Qaeda — the resolution the Obama administration is relying on to conduct its war on ISIS now.

The Obama administration’s draft language and transmittal letter, obtained from congressional sources, appears below:

 

TO THE CONGRESS OF THE UNITED STATES:

The so-called Islamic State of Iraq and the Levant (ISIL) poses a threat to the people and stability of Iraq, Syria, and the broader Middle East, and to U.S. national security. It threatens American personnel and facilities located in the region and is responsible for the deaths of U.S. citizens James Foley, Steven Sotloff, Abdul-Rahman Peter Kassig, and Kayla Mueller. If left unchecked, ISIL will pose a threat beyond the Middle East, including to the United States homeland.

I have directed a comprehensive and sustained strategy to degrade and defeat ISIL. As part of this strategy, U.S. military forces are conducting a systematic campaign of airstrikes against ISIL in Iraq and Syria. Although existing statutes provide me with the authority I need to take these actions, I have repeatedly expressed my commitment to working with the Congress to pass a bipartisan authorization for the use of military force (AUMF) against ISIL. Consistent with this commitment, I am submitting a draft AUMF that would authorize the continued use of military force to degrade and defeat ISIL.

My Administration’s draft AUMF would not authorize long-term, large-scale ground combat operations like those our Nation conducted in Iraq and Afghanistan. Local forces, rather than U.S. military forces, should be deployed to conduct such operations. The authorization I propose would provide the flexibility to conduct ground combat operations in other, more limited circumstances, such as rescue operations involving

U.S. or coalition personnel or the use of special operations forces to take military action against ISIL leadership. It would also authorize the use of U.S. forces in situations where ground combat operations are not expected or intended, such as intelligence collection and sharing, missions to enable kinetic strikes, or the provision of operational planning and other forms of advice and assistance to partner forces.

Although my proposed AUMF does not address the 2001 AUMF, I remain committed to working with the Congress and the American people to refine, and ultimately repeal, the 2001 AUMF.

Enacting an AUMF that is specific to the threat posed by ISIL could serve as a model for how we can work together to tailor the authorities granted by the 2001 AUMF.

I can think of no better way for the Congress to join me in supporting our Nation’s security than by enacting this legislation, which would show the world we are united in our resolve to counter the threat posed by ISIL.

The White House,

JOINT RESOLUTION

To authorize the limited use of the United States Armed Forces against the Islamic State of Iraq and the Levant.

***

Whereas the terrorist organization that has referred to itself as the Islamic State of Iraq and the Levant and various other names (in this resolution referred to as ‘”ISIL’”) poses a grave threat to the people and territorial integrity of Iraq and Syria, regional stability, and the national security interests of the United States and its allies and partners;

Whereas ISIL holds significant territory in Iraq and Syria and has stated its intention to seize more territory and demonstrated the capability to do so;

Whereas ISIL leaders have stated that they intend to conduct terrorist attacks internationally, including against the United States, its citizens, and interests;

Whereas ISIL has committed despicable acts of violence and mass executions against Muslims, regardless of sect, who do not subscribe to ISIL’s depraved, violent, and oppressive ideology;

Whereas ISIL has threatened genocide and committed vicious acts of violence against religious and ethnic minority groups, including Iraqi Christian, Yezidi, and Turkmen populations;

Whereas ISIL has targeted innocent women and girls with horrific acts of violence, including abduction, enslavement, torture, rape, and forced marriage; Whereas ISIL is responsible for the deaths of innocent United States citizens, including James Foley, Steven Sotloff, Abdul-Rahman Peter Kassig, and Kayla Mueller;

Whereas the United States is working with regional and global allies and partners to degrade and defeat ISIL, to cut off its funding, to stop the flow of foreign fighters to its ranks, and to support local communities as they reject ISIL;

Whereas the announcement of the anti-ISIL Coalition on September 5, 2014, during the NATO Summit in Wales, stated that ISIL poses a serious threat and should be countered by a broad international coalition;

Whereas the United States calls on its allies and partners, particularly in the Middle East and North Africa that have not already done so to join and participate in the anti-ISIL Coalition;

Whereas the United States has taken military action against ISIL in accordance with its inherent right of individual and collective self-defense;

Whereas President Obama has repeatedly expressed his commitment to working with Congress to pass a bipartisan authorization for the use of military force for the anti-ISIL military campaign;

and Whereas President Obama has made clear that in this campaign it is more effective to use our unique capabilities in support of partners on the ground instead of large-scale deployments of U.S. ground forces:

Now, therefore, be it Resolved by the Senate and House of Representatives of the United States of America in Congress assembled, That

SECTION 1. SHORT TITLE.

This joint resolution may be cited as the “Authorization for Use of Military Force against the Islamic State of Iraq and the Levant.”

SEC. 2. AUTHORIZATION FOR USE OF UNITED STATES ARMED FORCES.

(a) AUTHORIZATION.—The President is authorized, subject to the limitations in subsection (c), to use the Armed Forces of the United States as the President determines to be necessary and appropriate against ISIL or associated persons or forces as defined in section 5.

(b) WAR POWERS RESOLUTION REQUIREMENTS.— (1) SPECIFIC STATUTORY AUTHORIZATION.—Consistent with section 8(a)(1) of the War Powers Resolution (50 U.S.C. 1547(a)(1)), Congress declares that this section is intended to constitute specific statutory authorization within the meaning of section 5(b) of the War Powers Resolution (50 U.S.C. 1544(b)). (2) APPLICABILITY OF OTHER REQUIREMENTS.—Nothing in this resolution supersedes any requirement of the War Powers Resolution (50 U.S.C. 1541 et seq.).

(c) LIMITATIONS.— The authority granted in subsection (a) does not authorize the use of the United States Armed Forces in enduring offensive ground combat operations.

SEC. 3. DURATION OF THIS AUTHORIZATION. This authorization for the use of military force shall terminate three years after the date of the enactment of this joint resolution, unless reauthorized.

SEC. 4. REPORTS.

The President shall report to Congress at least once every six months on specific actions taken pursuant to this authorization.

SEC. 5. ASSOCIATED PERSONS OR FORCES DEFINED.

In this joint resolution, the term ‘‘associated persons or forces’’ means individuals and organizations fighting for, on behalf of, or alongside ISIL or any closely-related successor entity in hostilities against the United States or its coalition partners.

SEC. 6. REPEAL OF AUTHORIZATION FOR USE OF MILITARY FORCE AGAINST IRAQ. The Authorization for Use of Military Force Against Iraq Resolution of 2002 (Public Law 107– 243; 116 Stat. 1498; 50 U.S.C. 1541 note) is hereby repealed.

But what about Libya, Afghanistan or Pakistan?

The Islamic State has expanded its presence in the failed state of Libya, and if not confronted, the terror group may be able to gain strategic territory in its quest to form an Islamic Caliphate, according to the Washington Institute’s Andrew Engel. While the United States and its allies are focused on Syria and Iraq, IS (commonly referred to as ISIL or ISIS) has its eyes beyond that fight.

The report, titled The Islamic State’s Expansion in Libya, says Libya’s ex-ambassador to the Emirates Aref Ali Nayed is worried that if Washington does not act, IS will use Libya to threaten Europe. The IS has increased its physical and media presence in the last three months. A local terrorist organization, the Islamic Youth Shura Council (IYSC), has pledged its loyalty to IS.

“ISIS leader Abu Bakr al-Baghdadi recognized the Libyan ‘provinces’ of Barqa (Cyrenaica), Tripolitania, and Fezzan as belonging to his self-styled ‘caliphate,’” Engel said.

Adding to concerns, IS is winning the battle to be the dominant terrorist group in the region, just as it is in Iraq and Syria. Al-Barqawi has said that the terrorist organization would like to remove the borders of North African countries Tunisia, Libya, and Egypt to form a province similar to the one they are building in Syria and Iraq, which they call the “Euphrates Province.”

Have You Met Christiana?

  • She is a member of the Carbon Finance Advisory Panel
  • She is an Advisory Committee Member of Green Cross International, founded by Pres. Gorbachev
  • She is an invited member of the Clinton Global Initiative
  • She is a member of the Global Roundtable on Climate Change led by Jeffrey Sachs at Columbia University
  • She is a technical advisor to the Prototype Carbon Fund at the World Bank
  • She was personally trained by Al Gore to deliver his presentation of ‘An Inconvenient Truth’
  • She is the Executive Secretary of the United Nations Framework Convention on Climate Change
  • She even blogs at the UNFCCC

Are you beginning to see a crusader here because there is notoriety and money and power involved? Wonder how many times she has visited the White House…

UN Climate Chief: We Are Remaking The World Economy

The United Nation’s climate chief says that reordering the global economy to fight climate change is the “most difficult” task the international body has ever undertaken.

“This is probably the most difficult task we have ever given ourselves, which is to intentionally transform the economic development model, for the first time in human history,” Christiana Figueres, who heads up the U.N.’s Framework Convention on Climate Change, told reporters.

“This is the first time in the history of mankind that we are setting ourselves the task of intentionally, within a defined period of time, to change the economic development model that has been reigning for the, at least, 150 years, since the industrial revolution,” Figueres said.

Figueres’s remarks come ahead of a meeting in Geneva next week where delegates will pour over draft treaty texts that the U.N. hopes countries will agree to in December. She doesn’t expect global warming to be solved by one treaty, but was optimistic in will be solved in the coming years. “That will not happen overnight and it will not happen at a single conference on climate change, be it COP 15, 21, 40 – you choose the number,” she said. “It just does not occur like that. It is a process, because of the depth of the transformation.”

The climate chief even held up President Obama as a shining example of steps countries can take to tackle global warming.

“The international community is quite grateful for the fact that in his second term, President Obama has turned his attention quite clearly and quite decisively to climate change,” Figueres told reporters.

“He has not only spoken about his commitment both to his national agenda on climate change, but also to the international process, and has been quite clear in his political leadership,” Figueres said, touting the EPA’s success cutting carbon dioxide emissions from power plants.

The EPA will finalize rules to cut carbon emissions from new and existing power plants this summer. Critics of these rules say they will hurt the economy through job losses and higher energy prices. Supporters, however, say it will spur green energy development and set an example for other countries to follow.

Obama’s 2016 budget proposal boosts EPA funding to help it finalize emissions rules for power plants. The budget would also give the EPA $4 billion to reward states that reduce emissions even more than federal mandates require.

Figueres also cheered Obama’s agreement with China to reduce carbon emissions by 2030 and to give the U.N.’s climate fund a $3 billion boost.

“So for all of these reasons, certainly a very welcome leadership from the United States as a single nation,” Figueres said. “Countries can attain a certain level of emission reductions on their own, but they can do much more if they collaborate with each other, in particular with certain specific sectors.”

But while Figueres seems rosy about a deal, there are already signs of countries backing away from a tough international climate treaty.

France’s foreign minister, Laurent Fabius, told an audience at an event in New Delhi, India that a climate treaty should not hurt national economic growth. “An agreement that would leave some countries to consider their growth hampered by its provisions will not be accepted,” Fabius said. *** If you can stand this nonsense and fleecing of policy and global threats, you can read more here about Christiana. One more thing, controlling climate change brings gender equality….really?

 

What Would Loretta Lynch Do on IRS Targeting?

The Obama administration is refusing to publicly release more than 500 documents on the IRS’s targeting of Tea Party groups.

Twenty months after the IRS scandal broke, there are still many unanswered questions about who was spearheading the agency’s scrutiny of conservative-leaning organizations. The Hill sought access to government documents that might provide a glimpse of the decision-making through a Freedom of Information Act (FOIA) request.

The Hill asked for 2013 emails and other correspondence between the IRS and the Treasury Inspector General for Tax Administration (TIGTA). The request specifically sought emails from former IRS official Lois Lerner and Treasury officials, including Secretary Jack Lew, while the inspector general was working on its explosive May 2013 report that the IRS used “inappropriate criteria” to review the political activities of tax-exempt groups.

TIGTA opted not to release any of the 512 documents covered by the request, citing various exemptions in the law. The Hill recently appealed the FOIA decision, but TIGTA denied the appeal. TIGTA also declined to comment for this article.

Will anyone be charged?

In its written response to The Hill, TIGTA cited FOIA exemptions ranging from interagency communication to personal privacy. It also claimed it cannot release relevant documents “when interference with the law enforcement proceedings can be reasonably expected.”

Yet, congressional Republicans say there is no evidence of any prosecution in the works, and media outlets have indicated that the Department of Justice and the FBI have already determined that no charges will be filed.

Rep. Jim Jordan (R-Ohio) notes that eight months after Lerner was held in contempt of Congress for not testifying at two hearings, the matter has not yet been referred to a grand jury. The contempt citation is in the hands of Ronald Machen, the U.S. attorney for the District of Columbia who was appointed by President Obama.

Asked for comment on the administration’s FOIA response to The Hill, Jordan said, “It’s par for the course. We’ve had a difficult time getting information from the IRS and the Department of Justice.” Jordan, a senior member of the House Oversight and Government Reform Committee, has held numerous hearings on the IRS scandal.

Last week, Senate Finance Committee Chairman Orrin Hatch (R-Utah) said the IRS recently delivered 86,000 pages of new documents to the panel. Hatch added, “These documents … were given to us without notice or explanation roughly twenty months after we made our initial document request [on the targeting].”

Republicans in both the House and Senate are stepping up their investigations of the IRS. They have criticized the IRS and TIGTA for not informing Congress about the Tea Party targeting before the 2012 presidential election. GOP lawmakers say the administration has largely stonewalled them, while Democrats have called the probes “a witch hunt.”

 

Who knew what when?

The crux of the GOP’s IRS targeting investigations is: Who knew what when?

On Friday, May 10, 2013, Lerner famously planted a question at an American Bar Association (ABA) conference where she acknowledged “inappropriate” handling of tax-exempt applications in 2012. Lerner, who has since said she did nothing wrong, released the news before the TIGTA report came out the following week.

The Obama administration considered several other options on how to release the information, including an April conference at Georgetown University and an April 25, 2013, Ways and Means subcommittee hearing. Then-Treasury chief of staff Mark Patterson told Republican investigators that he informed the White House about the IRS plan to disclose the targeting “so that the White House wouldn’t be surprised by the news.”

Soon after Lerner’s comments attracted national attention, White House officials acknowledged they knew about the report but didn’t tell Obama about it.

Lew told Congress he first heard about the IRS matter at a “getting to know you” meeting with TIGTA chief J. Russell George in March 2013. But he said he didn’t learn the full extent of the findings until the media reported Lerner’s remarks at the ABA meeting.

Lew served as White House chief of staff before succeeding Treasury Secretary Timothy Geithner in 2013. Republicans on Capitol Hill are considering asking Geithner questions later this year on what he knew about the IRS’s targeting.

 

Weekly activity reports

TIGTA sends the Treasury secretary “weekly activity reports” on what it is working on. These reports, which are common in the executive branch and obtained through a FOIA request, serve as a “heads up” to Cabinet heads from inspectors general. They include categories such as “potential or expected press stories,” “upcoming hearings” and TIGTA reports that are awaiting public release.

From January through early May 2013, TIGTA referenced 25 reports that were subsequently issued in the weekly activity reports to Lew. But the agency’s most explosive report was not included in any of these weekly memos. It is unclear why, though a government official pointed out that Lerner spoke about the targeting at the ABA conference before TIGTA released its report. Her comments likely accelerated the Treasury Department’s clearance process.

Regardless, TIGTA officials briefed IRS and Treasury officials in 2012 and 2013, according to TIGTA memos provided to Congress. On May 30, 2012, TIGTA informed then-IRS Commissioner Doug Shulman and his deputies that criteria targeting Tea Party groups “were being used. …”

Jordan said neither the IRS nor TIGTA informed the Congress at that time — less than six months before the 2012 elections. He also pointed out Shulman didn’t correct his March 22, 2012, testimony to the Ways and Means oversight subcommittee where he said “there is absolutely no targeting” of Tea Party groups.

TIGTA’s FOIA practices have come under criticism before. In the fall of last year, the U.S. District Court for the District of Columbia admonished the agency for its use of FOIA exemptions. Cause of Action, a nonprofit group that has sued TIGTA, announced in December that the agency declined to fork over more than 2,000 documents related to a FOIA request.

Judicial Watch, another group that has sued the Obama administration on FOIA, said in December that the DOJ withheld 832 documents pertaining to meetings between the IRS and the Justice Department’s Public Integrity Section and Election Crimes Division.

Some of the documents that The Hill requested were released to Judicial Watch last year after a judge ruled in favor of the conservative group’s lawsuit.

Attorney General Eric Holder said last week that the DOJ will soon release a report on the IRS targeting that will include “some final recommendations.”

Lerner, who pleaded the Fifth Amendment before Congress, has given a lengthy interview to DOJ officials.

*** Let’s go deeper. DOJ Emails Suggest IRS Counsel’s Office Slowed Investigation

WASHINGTON, DC, Feb 05, 2015 (Marketwired via COMTEX) — Judicial Watch today released new internal Department of Justice (DOJ) documents revealing that the Internal Revenue Service Office of Chief Counsel’s office delayed approval of an IRS employee’s meeting with DOJ and FBI investigators into the Obama IRS targeting scandal. The emails also detail the involvement the Public Integrity Section of the Justice Department’s Criminal Division with the investigation. The documents show the Public Integrity Section was investigating the IRS scandal only a month after it reached out to Lois Lerner about prosecuting targeted tax-exempt entities. This is the first window into the criminal investigation of the alleged IRS abuses.

The Public Integrity Section previously has been tied to an effort to work with the Obama IRS in an effort to prosecute the very groups and individuals critical of the Obama administration and the president’s reelection that the IRS has admitted to illicitly targeting.

The new documents were released by the DOJ as result of a court order in Judicial Watch Freedom of Information Act (FOIA) lawsuit (Judicial Watch v. U.S. Department of Justice (No. 14-cv-01239)). The lawsuit was filed after the DOJ failed to respond to a FOIA request seeking:

Any and all records concerning meetings and/or communications between the Department of Justice Criminal Division Public Integrity Section and the Internal Revenue Service Tax Exempt and Government Entities Division, the White House, Members of Congress and/or congressional staff, and any non-government entity, regarding 501(c)(4) or other tax-exempt organizations.

The emails show that, on June 12, 2013, the lawyer for a cooperating IRS employee in Cincinnati complained to a DOJ prosecutor about the IRS Counsel’s office delaying approval of a meeting between the IRS employee and Justice Department prosecutors: “[W]e find it amazing that they didn’t immediately respond giving us the green light to meet with you.”

The DOJ prosecutor wanted to know who the contact in the IRS Counsel’s office was and wrote back: “Let’s talk in am if they don’t get back to you. Thanks.” The new emails suggest that investigators had wanted to meet quickly but it was nearly a month before the unnamed IRS employee met to proffer evidence to two Justice Department prosecutors, two FBI officials, and an investigator from the Treasury Inspector General for Tax Administration. The proffer session seems to have taken place in the IRS’ Cincinnati office on July 11, 2013, and included the IRS employee’s attorney, who the documents suggest works at the Cincinnati area law firm Adams, Stepner, Woltermann & Dusing PLLC. The documents detail that the proffer took place after a Garrity immunity waiver was secured for the IRS witness. Garrity immunity assures the right of public employees not to be compelled to incriminate themselves.

The email exchanges show that a trial attorney from the Public Integrity Section was partnered with an unnamed attorney from the Civil Rights Division of the Justice Department.

Barbara Bosserman, an attorney at the Civil Rights Division, has been reported to be leading the IRS investigation at Justice. The DOJ, in court filings in another Judicial Watch lawsuit about Bosserman’s role in the case, confirmed that she is one of the attorneys investigating the IRS matter. According to Federal Election Commission records, Bosserman contributed $6,750 to Obama’s campaigns and the DNC from 2004 to 2012, including 12 separate contributions to Obama for America between 2008 and 2012.

William J. Wilkins, the Chief Counsel for the IRS, is a political appointee of President Obama’s. Wilkins was a former Democratic staffer the U.S Senate, a donor to Democratic candidates and committees, and was a lobbyist for several years. The May 14, 2013, Treasury Inspector General report that revealed that the IRS had singled out groups with conservative-sounding terms such as “patriot” and “Tea Party” in their titles when applying for tax-exempt status details that the “Chief Counsel” was involved in the IRS’s Tea Party and conservative targeting.

In this second “rolling production,” the Justice Department released 34 pages of heavily redacted emails, while admitting that it had reviewed 938 pages of responsive records related to its contacts with the IRS concerning the criminal prosecution of targeted tax exempt entities. As of today’s date, the DOJ has reviewed 1,772 pages of records in this case, but only produced 36 heavily redacted pages. Held in their entirety are 1,736 pages.

The new documents also provide detail on what the investigators were examining and the nature of the documents it wanted from the IRS witness. On July 12, 2013, the DOJ attorney (whose name is blacked out) emails:

First, we would appreciate receiving the time line related to the “TAG spreadsheet” and “BOLO” that [REDACTED] prepared. As we stated, that timeline will be covered by the proffer agreement she executed yesterday. Second, we would also appreciate obtaining the email communications that you obtained from [REDACTED-BLACKED OUT] pertaining to the 501(c)-application issues we discussed yesterday, i.e., the public allegations that the IRS “targeted” certain groups based on their political viewpoints, in particular groups associated with the ‘Tea Party.” As I explained yesterday, due to the filter procedures we have in place, could you please divide the communications into two groups, those dated before and those dated on or after March 1, 2012? To the extent practical, the emails dated on or after March 1, 2012, should be placed in a sealed envelope or otherwise clearly separated from the first batch (i.e., if they are scanned and emailed, please do so in separate files). To the extent any of these applications contain taxpayer information, return information, and/or taxpayer return information, the Department of Justice and the FBI have referral authority under 18 U.S.C. 6103(h) to view this information by virtue of our participation in a joint investigation with TIGTA.

The documents do not detail why the emails needed to be “filtered” according to the March 1, 2012, date, though there is a reference to Justice Department “filter team” elsewhere in the material.

“The IRS scandal is getting worse. These documents show that the Obama IRS Counsel’s office, run by an Obama political appointee, was stonewalling a federal criminal investigation. And only in the Holder Justice Department would it be deemed appropriate that the offices implicated in the IRS abuses should investigate the IRS abuses,” said Judicial Watch President Tom Fitton. “And one might wonder why the Justice Department was so quick to offer an immunity deal to an IRS employee. This is an ugly mess and it is no surprise that, after nearly two years, the criminal investigation of the Obama IRS by its co-conspirators at the Obama Justice Department is widely acknowledged as a farce.”

In early December 2014, Judicial Watch released the first batch of internal DOJ documents revealing that former IRS official Lois Lerner had been in contact with DOJ officials about the possible criminal prosecution of tax-exempt entities two full years before what the IRS conceded was its “absolutely inappropriate” 2012 targeting of the organizations. According to the documents, Lerner met with top Obama DOJ Criminal Division officials as early as October 2010.

In April 2014, Judicial Watch forced, through a federal court order, the release of IRS documents revealing that the Department of Justice’s Public Integrity Section reached out to former IRS official Lois Lerner on May 8, 2013, about whether it was possible to criminally prosecute targeted tax-exempt entities. The documents were obtained as a result of an October 2013 Judicial Watch FOIA lawsuit filed against the IRS.

Even the NYT’s Admits Obamacare Purgatory

Ah, Sylvia Burwell if you received the memo, would you please call the White House for comment? The next step is beyond repealing Obamacare, if all else fails, at least rename it from ‘Affordable’ to Hell on Earthcare. Then last week while Burwell was providing testimony to Congress, the exchange did not go too well. During a hearing on the Health and Human Services (HHS) department budget, Secretary Sylvia Burwell had a contentious exchange with Sen. John Cornyn, R-Texas, over whether the administration has a contingency plan should it lose the Supreme Court case that will be argued this session over the fate of the health care law.

The case, King v. Burwell, deals with whether the federal government can give subsidies to Obamacare recipients in states with federally-run health care exchanges.

Cornyn asked Burwell, “If the administration loses in the King vs. Burwell case, do you believe you already have the authority to make an administrative fix, or will you come to congress to ask for additional legislation?

Insured, but Not Covered

WHEN Karen Pineman of Manhattan received notice that her longtime health insurance policy didn’t comply with the Affordable Care Act’s requirements, she gamely set about shopping for a new policy through the public marketplace. After all, she’d supported President Obama and the act as a matter of principle.

Ms. Pineman, who is self-employed, accepted that she’d have to pay higher premiums for a plan with a narrower provider network and no out-of-network coverage. She accepted that she’d have to pay out of pocket to see her primary care physician, who didn’t participate. She even accepted having co-pays of nearly $1,800 to have a cast put on her ankle in an emergency room after she broke it while playing tennis.

But her frustration bubbled over when she tried to arrange a follow-up visit with an orthopedist in her Empire Blue Cross/Blue Shield network: The nearest doctor available who treated ankle problems was in Stamford, Conn. When she called to protest, her insurer said that Stamford was 14 miles from her home and 15 was considered a reasonable travel distance. “It was ridiculous — didn’t they notice it was in another state?” said Ms. Pineman, 46, who was on crutches.

She instead paid $350 to see a nearby orthopedist and bought a boot on Amazon as he suggested. She has since forked over hundreds of dollars more for a physical therapist that insurance didn’t cover, even though that provider was in-network.

                                           

The Affordable Care Act has ushered in an era of complex new health insurance products featuring legions of out-of-pocket coinsurance fees, high deductibles and narrow provider networks. Though commercial insurers had already begun to shift toward such policies, the health care law gave them added legitimacy and has vastly accelerated the trend, experts say.

The theory behind the policies is that patients should bear more financial risk so they will be more conscious and cautious about health care spending. But some experts say the new policies have also left many Americans scrambling to track expenses from a multitude of sources — such as separate deductibles for network and non-network care, or payments for drugs on an insurer’s ever-changing list of drugs that require high co-pays or are not covered at all. For some, like Ms. Pineman, narrow networks can necessitate footing bills privately. For others, the constant changes in policy guidelines — annual shifts in what’s covered and what’s not, monthly shifts in which doctors are in and out of network — can produce surprise bills for services they assumed would be covered. For still others, the new fees are so confusing and unsupportable that they just avoid seeing doctors.

It is true that the Affordable Care Act has erased some of the more egregious practices of the American health insurance system that left patients bankrupt or losing homes to pay bills. Insurers can no longer deny coverage to those with pre-existing conditions, for example. And the new policies cap out-of-pocket spending so long as the patient receives care within the plan. Most important, the act has offered health insurance to an estimated 10 million Americans who did not have any, often by expanding Medicaid or providing subsidies.

But by endorsing and expanding the complex new policies promoted by the health care industry, the law may in some ways be undermining its signature promise: health care that is accessible and affordable for all.

“I’m always curious when I read this ‘good news’ that health costs are moderating, because my health care costs go up significantly each year, and I think that’s a common experience,” said Mark Rukavina, president of Community Health Advisors in Massachusetts.

While much of the focus in the past has been on keeping premiums manageable, “premiums now tell only a part of the story,” Mr. Rukavina said, adding: “A big part of the way they’ve kept premiums down is to shift costs to patients in the form of co-pays and deductibles and other types of out-of-pocket expenses. And that can leave patients very vulnerable.”

Such policies desperately need improvement, patients and professionals like Mr. Rukavina say. But with the Republicans attacking the Affordable Care Act at all turns, even political supporters seem reluctant to acknowledge that it has some flaws. The narrative has been cast in black or white: It’s working, or it’s a failure. The reality, of course, is gray.

AT this point, we don’t have a good definition of “affordable” — or how to measure it fully and fairly. Many studies show that national health costs, while still rising, are not growing as fast as they once were. But what does that mean for individual patients? So far the research has yielded mixed results.

A study by the Commonwealth Fund this month found that the rise in health insurance premiums in employer-based plans had slowed in 31 states since the passage of the Affordable Care Act (good news, right?). But premiums were still rising faster than median incomes (hmm). More important, perhaps, the researchers found that patients were paying more in health care expenses than ever before, during a time of stagnant wages (not so great). In fact, nearly 10 percent of median household income now goes to pay premiums and deductibles, the study found. And that does not include other kinds of health payments that patients now encounter, such as co-pays and uncovered drugs or services.

A recent New York Times/CBS poll found that 46 percent of Americans said they had trouble affording health care, up 10 percentage points in just one year. Some of the cost problems may ease as patients — now known as health care consumers — learn what to expect and how to choose and navigate their plans.

But other problems may be related to the process by which the plans are created. Under the Affordable Care Act each state was asked to select a benchmark plan as its standard. It had to cover certain “essential health benefits” like maternity care and prescription drugs; it had to have a defined actuarial value depending on the level of plan. Silver plans, for example, had to cover 70 percent of charges, leaving consumers with 30 percent. But within those parameters, competing insurers had leeway to set premiums, co-payments and deductibles, and to create networks by negotiating with doctors and hospitals. Naturally, they created policies that met the core criteria while minimizing their financial risk.

Suddenly there were hundreds of new insurance products that had never been tested in real time. Their shortcomings are now playing out in various ways.

Alison Chavez, 36, who is self-employed, signed up for a marketplace plan in October 2013 that she hoped would be an improvement on her previous plan. She had recently been given a diagnosis of breast cancer and was just beginning therapy, so she was careful to choose a policy on the Covered California marketplace that included her physicians.

But in March, while in the middle of treatment, she was notified that several of her doctors and the hospital were leaving the plan’s network. She was forced to postpone a surgery as she scrambled to buy a new commercial policy that included her doctors. “I’ve been through hell and back, but I came out alive and kicking (just broke),” she wrote in an email.

Dr. Alexis Gersten, a dentist in East Quogue, N.Y., switched her family and 11 employees to a new Blue Cross/Blue Shield plan for 2014, after a previous small-business group plan was canceled. She bought the plan through a broker, and says she was unaware that it was an Affordable Care Act plan. When her son needed an ear, nose and throat specialist, the nearest was in Albany, five hours away. Though her cardiologist was on the network list, he said he did not take the plan. She ended up driving an hour to see a new one. A dispute with the insurer about how to count deductibles left her with a $457 pediatrician’s bill. This year she has chosen a new policy.

“People may have a checklist when they buy insurance: First, premiums, then the deductible — and those are pretty easy to understand because they’re set dollar amounts,” said Lynn Quincy, associate director of health reform policy at Consumers Union. But new policies demand different and more difficult kinds of calculations, she said: “The terms are unfamiliar, and figuring out networks is especially murky.”

Compounding the problem is the lack of basic information to shop effectively. When Andrea Greenberg, a New York lawyer, called the help line of Health Republic to clarify the difference between two plans, she found herself speaking to someone reading off a script in the Philippines. “I was really outraged,” she said. “This is an important decision with potentially dire consequences. It’s not like you’re choosing a sweater.”

Likewise, it took many phone calls for Aviva Starkman Williams, a California computer engineer with insurance through her employer, to determine whether the pediatrician doing her son’s 2-year-old checkup was in-network for 2015. Only three of the pediatricians in her doctor’s six-person group were listed in her plan’s online directory, and since her deductible had tripled from the previous year’s, she wanted to limit her out-of-pocket payments.

The practice’s office manager couldn’t tell her for sure. The insurer’s representative said he didn’t know because doctors came in and out of network all the time, likening the situation to players’ switching teams in the National Basketball Association. “If you don’t have updated information, who does?” she asked. “Isn’t it your job to know?”

Ms. Quincy said regulators needed to do a much better job setting requirements and policing plan practices and offerings, particularly provider networks. Few states have clear standards and many rely on consumer complaints to ferret out problems.

Last month, the California insurance commissioner, Dave Jones, announced new emergency regulations concerning networks, noting: “Health insurers’ medical provider directories have been inaccurate, misleading consumers into signing up with a health insurer for access to a doctor, specialist or hospital, only to learn that these medical providers are not actually a part of the health insurer’s network.”

But for now, patients are most often left to fend for themselves. When Amy Moses, a tech entrepreneur in New York City, went online to select a plan, she paid a relatively pricey $650 per month for a United Healthcare plan to make sure her network included a longtime physician. One month into the year, the doctor’s practice was bought by a hospital, which then dropped the plan, so her doctor did as well. (A year later the doctor was still listed in the network directory.)

She discovered the change only when she contacted the physician for a referral for an urgent outpatient procedure costing thousands of dollars that had been recommended by an in-network surgeon. (Both the referring doctor and the surgeon had to be in-network for coverage.) “I literally had three days to find a new in-network internist and score an appointment to get a referral, or cancel my procedure,” she said. “I was stuck in insurance purgatory.”