Tapped: The Prospect Group Blog

Senator Cassidy’s Home State of Louisiana Gets Hit Hard by the Doctor’s Bill

The Graham-Cassidy bill is atrocious. “Shifting of responsibility” for health care to states simply means fewer federal dollars for most states—but that’s not unexpected. Many Republicans have made it clear that their main focus is to get rid of President Obama’s Affordable Care Act by any means necessary. Unfortunately, this particular proposal doesn’t just repeal the ACA (and with it, its marketplace subsidies and many protections for those with pre-existing conditions), it also includes massive cuts to Medicaid. For the thousands of people that gained health-care coverage through the Medicaid expansion, it’s going to hurt.

And it’s going to particularly hurt people in Senator Bill Cassidy’s home state of Louisiana.

The poverty in Louisiana, as it is across the South, is devastating—and Louisiana consistently ranks at the bottom in just about every measure related to economic hardship and its effects—it has the second highest poverty rate, second highest income inequality, third highest infant mortality rate, and the fourth lowest median household income. The rates are even starker for African Americans and other people of color. (The expression “Thank God for Mississippi,” is mean-spirited, but it does speak to a sad reality: If it weren’t for Mississippi, Louisiana and some other southern states would often be dead last in such rankings.)

When Louisiana voters elected Democrat John Bel Edwards as governor last year, the first thing he did was to expand Medicaid to thousands of Louisianans. Not only does Graham-Cassidy end the Medicaid expansion by 2020, but it also caps and cuts Medicaid funding for vulnerable populations like families with children, the elderly, and people with disabilities.

The proposed block grants are structured so that states that expanded Medicaid are effectively punished. Louisiana stands to lose $7.2 billion in federal funding by 2027—when the block grants dry up completely.

But Medicaid expansion was a lifeline to many in Louisiana. By June 2017, one year after coverage began for the expansion population, more than 433,000 Louisianans gained health insurance. The uninsured population, which was a staggering 21.7 percent in 2013, dropped to 12.1 percent. Thousands were able to access preventative care and screenings.

Senator Cassidy, a physician who treated poor people in the state’s charity hospital system, will not only vote to ruin the health and well-being of Louisiana residents—he helped write the prescription.

Rebekah Gee, Louisiana’s health secretary, sent a letter to Cassidy (which she shared on Twitter) decrying the proposed bill, noting that it “gravely threatens health care access and coverage for our state and its people.” She said that ending Medicaid expansion is “a detrimental step backwards for Louisiana.” The New Orleans Times-Picayune editorial board also criticized the bill, noting that a doctor like Cassidy shouldn’t be party to such “a dramatic erosion of coverage.”

In 1935, Huey Long, the legendary Louisiana governor and U.S. senator, told his critics, “All I care is what the boys at the forks of the creek think of me.” Today it seems that Senator Cassidy just wants to send his constituents down that creek without a paddle.

Graham-Cassidy: Republicans Kill Parents, Complain They’re Orphans

“Right now, 37 percent of the revenue from the Affordable Care Act goes to Americans in four states,” Louisiana Republican Senator Bill Cassidy, coauthor of the Republicans’ last-gasp effort to repeal the Affordable Care Act, said on Monday. Cassidy’s culprits—the four states at the center of this cosmic injustice—are California, New York, Massachusetts, and Maryland.

“That is frankly not fair,” Cassidy complained.

Well—whose fault is that? California, New York, Massachusetts, and Maryland are among the 31 states (32, if we count the District of Columbia) that agreed to accept federal funds made available by the ACA’s expansion of Medicaid; California and New York are by far the most populous of those 31 states, with nearly 60 million residents combined. Nineteen states, however, chose not to accept the federal funds that would expand their Medicaid rolls. In each of the 19, the decision not to accept the funds was made by the state’s Republican governor. This Republican impulse to discipline the poor, lest they loll around in the comfort of hospital emergency wards, is also reflected in the lower levels of Medicaid benefits that Republican-controlled states generally set.

Cassidy’s chutzpah isn’t confined to hailing as victims the actual perpetrators of the imbalance he describes. His bill to repeal the ACA contains provisions similar to ones in the previous Republican ACA repeal efforts, which the Congressional Budget Office concluded would deny Medicaid benefits to 15 million recipients. His plan is not to erase the gap between blue states and red by expanding Medicaid to eligible recipients in all states, but by throwing millions off the rolls and reducing expenditures to the levels in the neo-Confederacy (nine of the eleven Southern states that formed the Confederacy are among the 19 that refused to accept the Medicaid expansion funds), where the impulse to discipline the poor is made steelier yet by the impulse to discipline blacks and other people of color.

Cassidy’s vision of fairness, finally, is to have no Medicaid at all. That way, the sick and the poor in blue states won’t be able to lord it over the sick and the poor in the red ones. What could be fairer than that?

VHA Budget Cuts Threaten Veteran Safety

The Department of Veterans Affairs (VA) is considering budget cuts that could jeopardize patient safety in the nation’s largest health-care system. On the chopping block are ten VA Patient Safety Centers of Inquiry (PSCIs), facilities that have long pioneered innovations to reduce injury, addiction, and suicide that have impacted patients far beyond the VA system. While the administration claims such goals are high priorities, these facilities could be shut down by September 30.   

The potential closure of these patient safety centers is part of a broader attempt to cut costs within the nation’s largest health-care system. Surging demand for services at the Veterans Health Administration (VHA) and the high cost of paying for expensive, outsourced care in the private sector through the Veterans Choice and other Community Medical Care programs has caused a significant budget shortfall in VHA facilities across the country.

Despite this shortfall, Trump refuses to go to Congress for more money than currently budgeted for the VHA. Now VA leadership is focused on shifting pots of money from what are known as specific-purpose budgets (which includes the PSCI’s small $2.5 million budget) to general-purpose budgets. In the case of these patient safety centers, this robbing-Peter-to-pay-Paul approach will hurt veterans rather than help them. Since the VHA’s leadership in patient safety extends way beyond VHA facilities and the patients served by them, this move may also impact millions of non-veterans who also benefit from VHA research and safety practices.

In a country where more than 250,000 patients die each year due to preventable medical errors (which are America’s third leading cause of death) and more than 1.5 million are seriously injured, the VHA has become a beacon of progress in patient safety. Since the mid-1990s, the VHA has been “a bright star in the constellation of safety practice, with system-wide implementation of safe practices, training programs,” according to physicians and patient safety leaders Donald Berwick and Lucian Leape.

As patient safety leaders have long documented, turning theory into safe practice involves way more than passing around scientific journal articles, or writing patient safety policies and protocols. Motivating front-line caregivers to do everything from cleaning their hands to prescribing opioids safely involves putting what is known as evidence-based medicine and best practices into actual daily use.

Today, at the veterans hospital in White River Junction, Vermont, the Patient Safety Center of Inquiry has developed tools aimed at sharing critical information about the early warning signs of suicidal behavior among veterans. Their counterparts in Durham, North Carolina, are trying to target extremely painful surgical procedures, like the knee replacement operations so common in the aging veteran, and help surgeons manage patients’ pain without overreliance on addictive opioids. One goal of this program is to keep former members of the armed forces from adding to the grim national death toll of the opioid epidemic.

At the PSCI in Tampa, Florida, VHA researchers are designing new tools to reduce the risk that older veterans will fall and break a hip, either in their own homes or an in-patient setting. Meanwhile, the PSCI in Boston is developing ways to reduce exposure to potentially fatal hospital-acquired infections like methicillin-resistant Staphylococcus aureus.

VHA safety leaders say they are stunned by the proposed closure of their PSCIs. “VA leadership is looking for easy answers and quick solutions and are not taking the time to fully understand the consequences of their actions,” a long-time VA patient safety researcher told The American Prospect. “They are so focused on issues of access that they don’t ask questions about what kind of system patients have access to.”

Doctors like Lucian Leape share these fears. In a letter to VA leadership, Leape protested the potential closure of PSCIs, praising the centers’ “important contributions,” and said he echoed the “concern of other patient safety leaders nationwide that losing the PSCI program would terminate one of the most efficient and productive translational safety programs in the VA.” Hopefully, the Trump administration will not decide to pinch pennies at the expense of veterans’ lives.

 

 

 

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‘Tax Credit Scholarship’ Program May Soon Be Coming to Illinois

On Monday night, the Democratic-controlled Illinois House of Representatives voted in favor of an education funding plan that includes the establishment of a “tax credit scholarship” program: subsidies that support donors who help families pay for private school tuition. The Democratic-controlled Senate approved a similar bill Tuesday.

The money allocated to this voucher-like program is relatively small, just $75 million in credits, but opponents rightly note that most states that have established similar programs have increased the subsidies substantially over time. Florida’s tax-credit scholarship program launched in 2001 with a cap of $50 million but today their program tops out at $699 million. 

The circumstances that led to Democrats approving subsidies for private school tuition are complicated, but the short version of the story is that state legislators felt intense pressure to pass a school funding bill, one that would finally revamp Illinois’s notoriously inequitable school funding formula. Facing a likely veto from Bruce Rauner, the Republican governor, that Democrats wouldn’t be able to immediately override, they decided to use the tax credit scholarship measure as a bargaining chip to get the measure passed.  

Illinois lawmakers approved a separate bill to fix the state’s school funding formula in July, but Rauner vetoed parts of it earlier this month, saying too much money would be distributed to Chicago’s public school district. In mid-August, the Illinois Senate voted to override the governor’s veto, with one Republican joining the Senate’s 37 Democrats.

But on Monday, the House failed to override the governor’s veto, falling eight votes short of the necessary three-fifths majority.

Illinois school districts cannot receive state aid until the legislature approves a funding package. So with the new school year starting, House Democrats decided to accept the tax credit scholarship program, rather than prolong the negotiations.

Teacher unions were furious.

“Tonight's vote for a voucher scheme for the state of Illinois is disappointing, and the worst assault on public education since mayoral control of schools was granted in 1995,” said the Chicago Teachers Union in a statement. “We are now firmly in line with the President Donald Trump and Betsy DeVos privatization agenda. Illinois legislators have voted to ‘reform’ the worst school funding system in the country with a ticking time bomb of a voucher scheme, and the Illinois Democratic Party has crossed a line which no spin or talk of ‘compromise’ can ever erase.”

The Illinois Federation of Teachers directed its criticism at the governor: 

Tonight, state legislators moved Illinois closer to doing what we have needed to do for decades—treat our poorest students and communities fairly. Unfortunately, it came at a very disappointing cost. Governor Rauner capitalized on the crisis he created when he vetoed the original bill and used it as leverage for private school tax credits that benefit the wealthy while working families continue to struggle.

We’re on a better path toward equity and adequacy, and we must move forward in our classrooms and communities. But it’s clearer than ever that this Governor does not prioritize public schools, and we must fight for one who does in 2018.

According to the Chicago Principals and Administrators Association (CPAA), Chicago Public School officials—appointed by mayor Rahm Emanuel—helped push forward the bill, pressuring CPS principals to call and lobby in support. On Monday, CPAA referenced a piece Alexander Hertel-Fernandez published in The Prospect in 2015 about the rising threat of employer political coercion. "CPAA echoes the American Prospect and calls on CPS to immediately end their efforts to coerce their employees to support voucher legislation that many fundamentally disagree with," the organization stated.

J.B. Pritzker, a billionaire venture capitalist and the early frontrunner in the Democratic race for governor, released a statement saying that “it is disappointing that Bruce Rauner used our students as pawns in his political games to get a back-door voucher program put in place.” He promised to repeal the program if elected in 2018.

Louise Linton, Conservative Id

This week, Louise Linton, the wife of Treasury Secretary Steve Mnuchin, was forced to apologize for an "insensitive" comment she made on Instagram. While this may seem like nothing more than a silly social media spat, Linton's comment is indicative of a much larger issue present in American conservative thought and public policy.

After posting a photo of herself exiting a government plane after a #daytrip to Kentucky, Linton shot back at jennimiller29, a commenter who’d said, “Glad we could pay for your little getaway. #deplorable.” Linton’s defense invoked the theory of trickle-down economics: “Have you given more to the economy than me and my husband? Either as an individual earner in taxes OR in self sacrifice to your country? I’m pretty sure we paid more taxes toward our day ‘trip’ than you did. Pretty sure the amount we sacrifice per year is a lot more than you’d be willing to sacrifice if the choice was yours.”

According to Linton, the good folks at the top are actually burdened by their wealth, because their massive wealth provides a service to the rest of society. Not only do they “sacrifice” by the taxes they pay, but they're basically public servants of the economy. Never mind that the current tax system bolsters the wealthy through benefits that include the low capital gains tax rate, the mortgage interest deductions, and even a deduction for some expenses related to their yachts. The rich, with lifestyles so luxurious that the incautious among them will hashtag expensive brands on posts about government travel as Linton did (“#rolandmouret pants, #tomford sunnies, #hermesscarf, #valentinorockstudheels,” she wrote), need even more tax breaks because they stimulate the economy for less worthy consumers. How can jennimiller29, and all the other lowly workers, be so ungrateful?!

The American idolization of the rich is threaded throughout society's discourse and policy, birthed from the bootstrap myth that has helped define America, falsely, as a land of economic opportunity. In this storyline, hard work always equals success, and success always comes from hard work. It ignores the systemic problems that make social mobility difficult (racism, classism, inadequate policies to address these phenomena), and provides justification for a tax and welfare system that favors the wealthy. This makes it easy to villainize the poor and venerate the rich. 

Linton, in her response to jennimiller29, uses words like “adorable” and “cute”: “Your life looks cute” and “You’re adorably out of touch.” Such patronizing behavior toward someone less wealthy than her extends well past personal insults and into conservative policy proposals. Just last week, a bill was introduced in the Florida legislature to ban Supplemental Nutrition Assistance Program (SNAP, formerly Food Stamps) recipients from buying soda with their benefits.

But like many uncomfortable social realities, it's essential that this love of class hierarchy remain unspoken. Let us not forget Mitt Romney's 47 percent remark, caught on a hidden camera, in which, as he put it, there are 47 percent of Americans "who are dependent upon government, who believe that they are victims, who believe the government has a responsibility to care for them, who believe that they are entitled to health care, to food, to housing, to you name it."

Presidential candidates aren’t supposed to talk that way—something that even the otherwise uncensorable Donald Trump understood.

Linton's outburst, complete with emojis, may well have come straight from the egos and ids of the very rich, and comported with actual conservative doctrine, but it violated their rule of omerta: You’re just not supposed to, you know, talk about this stuff if there's a chance of a leaked video—or with your Instagram set to “public.”

Paul Ryan Is Lying About High Corporate Tax Rates

Republicans are taking their corporate tax-cut campaign on the road. House Speaker Paul Ryan visited airplane manufacturer Boeing on Thursday in Washington state, where he lamented how the company is quivering underneath the weight of a 35 percent tax rate. Meanwhile, Ways & Means Chair Kevin Brady sang the same song at telecom giant AT&T’s headquarters in Dallas.

There’s just one problem. Neither of these corporations pays the statutory 35 percent tax rate for corporations. Over the past eight years, Boeing has paid an effective tax rate of just 5.4 percent on its profits while AT&T has paid 8.1 percent, according to a report by the Institute on Taxation and Economic Policy. In fact, it’d be quite hard for Ryan to find a company to visit that actually does pay the full rate. Most corporations pay nowhere near the full rate thanks to a bevy of tax breaks and loopholes—the average is closer to 20 percent, though even that varies tremendously by industry.

Ryan and other GOP leaders want to shave the statutory rate down to 20 percent while President Donald Trump wants it reduced to 15 percent. Neither has given any indication as to whether their idea of corporate tax reform includes closing loopholes. They simply contend that cutting the rates will make American manufacturers more competitive with foreign companies, and will use the money they save to invest domestically in research and development, which will in turn drive economic growth and create jobs.

But through federal and state subsidies and tax breaks, corporations like Boeing and AT&T have for years benefited from a low effective tax rate. As ITEP’s Matthew Gardner explains, Boeing has received a tax refund in five of the past ten years. It saves itself $542 million a year using a special domestic manufacturing tax break, and $1.8 billion in further cuts thanks to a research and development tax credit. Boeing also benefits from the immensely favorable depreciation schedules on capital that has saved it billions of dollars over the past decade.

Boeing also entered into a $9 billion tax incentive deal with Washington state back in 2013—the largest corporate subsidy ever—to “maintain and grow its workforce within the state.” But, as Michael Hiltzik points out in the Los Angeles Times, the company has since cut nearly 13,000 jobs (about 15 percent of its Washington workforce) as it sets up shop in cheaper states that offer incentives of their own.

It still manages to enrich its shareholders though. On the same day that it announced a production slowdown in December, Hiltzik notes, Boeing also announced a 30 percent increase in its quarterly dividend and a new $14 billion share-buyback program.  

The current corporate tax system doesn’t incentivize job creation. Rather, it incentivizes the enrichment of CEOs and shareholders. Simply cutting the rate without closing loopholes or including clear economic-development requirements will only further advance shareholder capitalism, to the detriment of just about everyone else.

Ryan's and Brady’s visits to Boeing and AT&T expose the core lie behind their corporate tax-cut agenda. Corporations are already benefiting from lower rates—and they sure aren’t using the extra money to create jobs. 

Defending Their Own: Coast Guard Speaks Up After Trump Lashes Out at Transgender Soldiers

The Coast Guard has taken a leading role in efforts to push back against President Trump’s plan to ban transgender soldiers from military service. “The first thing we did was reach out to all 13 members of the Coast Guard who are transgender,” said Coast Guard Commandant Paul Zukunft in remarks at the Center for Strategic and International Studies in Washington after Trump announced the ban on Twitter. Zukunft added that the Coast Guard would not “break faith” with transgender soldiers. “We have made an investment in you and you have made an investment in the Coast Guard," he said.

The other four branches of the military have yet to comment on Trump’s plan. The chairman of the Joint Chiefs of Staff, Marine Corps General Joseph Dunford, has announced that that there would be “no modifications to the current policy until the President’s direction has been received by the Secretary of Defense and the Secretary has issued implementation guidelines.”

Trump’s proposed ban would reverse the Obama administration’s 2016 decision to allow transgender people to openly serve in the armed forces. Last year, Obama’s defense secretary Ashton Carter prohibited discharging or otherwise separating transgender people from the military solely on the basis of their gender identity.

In early June, the Army, along with the Air Force, requested a two-year delay on accepting transgender recruits; the Navy requested a one-year wait. These requests were rejected by the Pentagon in favor of a six-month delay for all branches. Although most active duty officers had little to say about the proposed ban, many transgender soldiers have been alarmed by Trump’s move.

Wendy May, a genderfluid trans woman and Army veteran who works regularly with soldiers, told The American Prospect that she and others were “appalled” by the president’s plan. She says it is little more than a discriminatory “smokescreen that the White House has used to keep us focused on other things than what we need to focus on.” More than 50 retired senior officers criticized Trump’s plan in a signed joint statement published by the Palm Center, a LGBT military advocacy center, saying that “the proposed ban would degrade readiness even more than the failed ‘Don’t ask, don’t tell’ policy” instituted in the mid-1990s.

Trump’s announcement, which he made without consulting top military leaders, came during near-constant coverage of his political and personal gaffes, including all-time low approval ratings, the Scaramucci scandal, and the failure of the Republican efforts to repeal or replace the Affordable Care Act. The ban allows Trump to engage two of his favorite ploys: targeting a controversial minority group and chipping away at Obama’s legacy.

If the announcement was designed to distract Americans from the chaos at the White House, it backfired. The ban only further antagonized Democratic and Republican members of Congress who have pushed back on the president’s plan, while a Quinnipiac University national poll released Tuesday shows that with the exception of Republicans, Americans support transgender military service 68 percent to 22 percent.

Estimates of active duty transgender soldiers range from roughly from 1,300 to 7,000 to about 15,500. Although transgender people comprise a tiny percentage of soldiers, they constitute one of the largest segments of openly transgender Americans.

Trump and others who oppose transgender people serving in the military often point to the high costs of transition-related health care. A RAND Corporation report found that the cost of gender transition-related health care in the military runs between $2.4 million and $8.4 million annually. The report also found that past integration efforts involving women and lesbians, gays, and bisexuals indicated that there would be “a minimal likely impact on force readiness.”

“A year ago, Donald said he was going to support the LGBT community more than Hillary, [but] he has done absolutely nothing but to destroy the ‘T’ part of the community,” May says. “We’ve been treated as completely disposable people by the politicians in Washington.”

New Registry Will Track Flint Residents Exposed to Lead

Nearly two years after the first reports of Flint’s contaminated water, Michigan has finally received funding to create a registry for affected residents.

The U.S. Department of Health and Human Services will award $14.4 million over four years to Michigan State University to create a registry for Flint residents exposed to lead-contaminated water. The water crisis, which began in 2014, put nearly 100,000 Flint residents at risk, and it took more than a year of resident complaints for the city government to come up with an action plan. Flint residents are still recommended to steer clear from drinking unfiltered water.

The Flint Lead Exposure Registry, directly funded by the Centers for Disease Control and Prevention (the budget of which Trump proposes to cut by more than $1 billion), will enable officials to identify and monitor residents exposed to lead-contaminated water and connect them to health services, according to Dr. Mona Hanna-Attisha, who is leading the registry effort.

“The registry will be a powerful tool to understand, measure, and improve the lives of those exposed to the contaminated water,” said Hanna-Attisha in a written statement. “The more people who participate in the registry, the more powerful this tool will be for Flint and for communities everywhere that continue to suffer from preventable lead exposure.”

President Barack Obama signed the Water Infrastructure Improvements for the Nation Act in December of 2016, almost a year after Michigan’s senators proposed an aid package for Flint. The act granted Flint $170 million in recovery funds, including $100 million in March from the Environmental Protection Agency for updating drinking-water infrastructure, and the August 1 announcement of funding for the registry.

“Though the State of Michigan has the primary responsibility to support long-term recovery efforts in Flint, the federal government should have stepped in long ago to provide emergency assistance for an American city in crisis,” said Michigan Senator Gary Peters after the act’s passage.

The crisis in Flint began in April 2014, when the city, under state emergency management, switched its water supply from Detroit’s system to the Flint River, which had not been treated for corrosion. In September 2015, Hanna-Attisha reported that, after Flint switched to the Flint River source, the number of children with elevated blood-lead levels had almost doubled—from 2.1 percent to 4 percent.

Research conducted by Virginia Tech found water in one Flint resident’s home to have lead levels between 200 and 13,200 parts per billion, far exceeding the EPA’s action threshold of 15 parts per billion. According to the EPA, “In children, low levels of exposure have been linked to damage to the central and peripheral nervous system, learning disabilities, shorter stature, impaired hearing, and impaired formation and function of blood cells.”

In January 2016, President Obama declared a state of emergency in Flint, authorizing the Federal Emergency Management Agency to cover up to $5 million in costs for water, filters, and other supplies needed by residents. Flint switched back to its original Detroit source in October, and while lead levels improved, officials still advise residents to drink filtered or bottled water.

Flint Mayor Karen Weaver and the head of Flint’s pipe-replacement program have said that Flint is still years away from having safe unfiltered water.

Heresy! Jeff Flake Attacks the President

Arizona’s senators are having a moment. Shortly after John McCain made headlines by joining with Senators Susan Collins and Lisa Murkowski to cast a Republican health-care bill into the legislative charnel house, Jeff Flake, a first-term Republican from the suburbs east of Phoenix, has put out a new book lambasting President Donald Trump.

Flake’s book, Conscience of a Conservative: A Rejection of Destructive Politics and a Return to Principle, was largely written in secret, its release something of a surprise in political circles. The title, an homage to Barry Goldwater’s 1960 manifesto, does not mention Trump directly, but Flake pulls no punches in the book’s text, citing the president as a progenitor of the country’s current political situation. Politico published an excerpt yesterday under the headline “My Party Is In Denial About Donald Trump.”

Flake acknowledges his own former complacency. Although he called for Trump to quit the presidential race after the Access Hollywood tape surfaced in October, Flake would later make a habit of saying he lacked the time to read the president’s tweets. Now, he admits his position was a cop-out. For the Republicans, Flake writes, Trump’s candidacy amounted to a “Faustian bargain”—one, he now believes, was “not worth it.”

“In this era of dysfunction and collapsed principle, our only accomplishment is painstakingly constructing the argument that we’re not to blame and hoping that we’ve gerrymandered ourselves well enough to be safe in the next election,” Flake wrote of his Republican colleagues. His main pitch is one of bipartisan cooperation and allegiance to congressional norms, coupled with his desire to return to old-school small government conservatism. That—and his folksy charm—has prompted a slew of admiring profiles and interviews in recent weeks.

The GOP has not reacted happily to Flake’s criticisms. Kelli Ward, a far-right former state senator challenging him in the Republican primary next year, called Flake a “globalist,” tweeting that America is “strong [and] unapologetic” under Trump. (“Globalist” is a term frequently used by alt-right commentators to imply that their targets are Jewish or influenced by Jews. Flake is Mormon.) Trump has pledged $10 million of his own money to beat Flake in the Republican primary, an unprecedented move by a president against an incumbent of his own party. The conservative Washington Times published an op-ed calling Flake an “elitist” and a “defector […] to the Democratic side” before blasting him for his pro-amnesty position on illegal immigration.

Although considered the second-most vulnerable Republican up for re-election in 2018 after Nevada’s Dean Heller, Flake has not yet drawn a serious Democratic challenger. Thus far, the only Democrats who have announced campaigns are two little-known attorneys and a retired judge who once served in Iowa’s state legislature. Several prominent Democrats—including astronaut Mark Kelly, the husband of former Representative Gabrielle Giffords; Phoenix Mayor Greg Stanton; and Representative Krysten Sinema—have not fully ruled out campaigns. Flake’s approval rating in his home state lags his disapproval rating by 8 percentage points, and in 2012 he defeated Democrat Richard Carmona by just 3 points.

For the Democrats to regain the Senate in 2018—a tall order, given that they are defending 23 seats while Republicans defend just eight—the most likely path goes through Arizona. Flake may well be vulnerable to Democratic attacks by virtue of his support for repealing Obamacare. But it seems unlikely that a Democratic candidate could simply run an anti-Trump campaign against Flake—after all, his 160-page tirade against the president is as strongly worded as most Democratic senators’ anti-Trump jeremiads. 

Trump’s Budget Would Eliminate Agency Tasked with Ending Homelessness

Included in President Donald Trump’s proposed $6 billion cut to the Department of Housing and Urban Development is the elimination of a small but vital program that has been a crucial force in driving down the U.S. homeless population.

The United States Interagency Council on Homelessness (USICH) has a scheduled sunset date of October 2017 and, for the first time since the Clinton administration, it may not be reauthorized.

First created in 1987, USICH’s 19 government member agencies coordinate 23 federal programs to combat homelessness. With an operating budget of $3.5 million a year, the program collaborates with both federal and local government and the private sector to help provide the nation’s homeless with food, shelter, health care, and jobs.

In 2010, the program launched “Opening Doors,” a comprehensive plan that focuses on leadership, collaboration, and civic engagement; access to stable and affordable housing; economic security; health and stability; and the homelessness crisis response system.

Five years after the plan was launched, nationwide homelessness had decreased by 14 percent, or 87,000 individuals (some 550,000 people in the United States do not have a home as of 2016). Homelessness among veterans decreased by 47 percent, chronic homelessness by 27 percent, and family homelessness by 23 percent.

The Urban Institute interviewed more than 50 national and local homelessness advocates, most of whom attributed the progress to USICH. Urban Institute research associate Sarah Gillespie told the Prospect that advocates referred to USICH’s Opening Doors plan as a “leader” in the fight to end homelessness.

“It can be hard coordinating with 19 federal agencies,” Gillespie says. “USICH helps the federal government speak as one voice, navigate as a bureaucracy, ... marshall resources together, and make sure that everyone is on the same page.”

Before Opening Doors, there was little understanding of how many veterans were homeless because the Department of Veteran Affairs only counted veterans who used VA services. Opening Doors worked with the VA and HUD to create a more accurate count, and worked with federal partners to develop a set of benchmark criteria for ending veteran homelessness. Today, 47 cities and counties and three states have announced they have met those criteria. 

Advocates also credit USICH with changing federal homelessness policy to a focus on housing first, Gillespie says. Previously, the federal government provided sobering services, and required similar preconditions before providing housing.

“Even though people will try to keep working to end homelessness,” Gillespie says,” no one could fill the role that USICH plays.”

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