WASHINGTON — In his State of the Union address, President Trump announced a bold plan to end the scourge of H.I.V. by 2030, a promise that seemed to fly in the face of two years of policies and proposals that go in the opposite direction and could undermine progress against the virus that causes AIDS.
In November, the Trump administration proposed a rule change that would make it more difficult for Medicare beneficiaries to get the medicines that treat H.I.V. infection and prevent the virus from spreading.
Mr. Trump has repeatedly urged Congress to repeal the expansion of Medicaid under the Affordable Care Act, even though Medicaid is the largest source of coverage for people with H.I.V. And he has promoted the sale of short-term health plans that skirt the Affordable Care Act, even though such plans usually exclude people with H.I.V.
To end the spread of the virus, federal health officials say they must reduce the stigma attached to gay men and transgender people who are at high risk so they will seek testing and treatment. But for two years the administration has tried to roll back legal protections for people in those groups.
Those opposing moves by the administration have AIDS activists baffled.
“The president’s announcement comes as a surprise, albeit a welcome surprise,” said Jennifer C. Pizer, the law and policy director at Lambda Legal, a gay rights group. “It represents an about-face on H.I.V. policy.”
The administration describes the plan to end the spread of H.I.V. as one of the most important public health initiatives in history. But the record shows a rather large gap between the administration’s words and deeds.
A Trump proposal would limit Medicare drug coverage.
Since Medicare’s outpatient drug benefit began in 2006, the government has required prescription drug plans to cover “all or substantially all drugs” in six therapeutic classes, including antiretroviral medicines to treat H.I.V.
In November, the Trump administration proposed a new policy to cut costs for Medicare by reducing the number of drugs that must be made available to people with H.I.V.
The proposal would allow certain exceptions to the requirement for Medicare drug plans to cover all drugs in the six “protected classes.”
Insurers could require Medicare beneficiaries to get advance approval, or “prior authorization,” for H.I.V. drugs and could require them to try less expensive medications before using more costly ones, a practice known as step therapy.
People with H.I.V. and doctors have condemned the proposals.
Bruce Packett, the executive director of the American Academy of H.I.V. Medicine, representing doctors who care for H.I.V. patients, said the administration’s proposals “could be catastrophic” for Medicare patients with the virus, as well as for the president’s campaign to end the epidemic.
“At least 25 percent of all people living with H.I.V. who are in care in the United States rely on Medicare as their insurer,” Mr. Packett said.
Those patients are 65 or older or have disabilities and often have other chronic diseases or conditions, so doctors need access to the “full arsenal” of medicines to treat H.I.V., Mr. Packett said.
Many of the Medicare patients with H.I.V. are taking medicines for their other conditions, so doctors have to worry about drug interactions, Mr. Packett said. In addition, he said, some have drug-resistant strains of H.I.V., and different patients often respond to the same drug in different ways.
“It’s important that providers have access to all the available options” among drugs to treat H.I.V., he said.
Requirements for prior authorization and similar restrictions can delay the start of treatment. Studies show that a rapid start to therapy, within a week or even a day of diagnosis, produces better results for patients and reduces the likelihood that they will infect others while waiting for treatment.
President Trump appeared in front of a joint session of Congress for the annual address. Here is how his remarks stacked up against the facts.
President Trump leaned hard on the strength of the American economy during his second State of the Union address on Tuesday, but with a blend of precise statistics and gauzy superlatives that are much more difficult to measure.
He also returned to a theme
that dominated the second year of his presidency — a quest for a border
wall with Mexico to cope with what he said is a crisis of crime and
drugs in the United States caused by illegal immigration.
The
two issues dominated his address, which in tone was more measured than
his biting Twitter feed, but in substance contained numerous claims that
were false or misleading.
Here is what Mr. Trump said and how it stacked up against the facts.
The economy
“The U.S. economy is growing almost twice as fast today as when I took office, and we are considered far and away the hottest economy anywhere in the world.”
This is false.
The
American economy expanded at an annual rate of 3.5 percent in the third
quarter of 2018. Growth in Latvia and Poland was almost twice as fast.
Same for China and India. Even the troubled Greek economy posted
stronger growth. And a wide range of economic analysts estimate that the
growth of the American economy slowed in the fourth quarter, and slowed
even further in the first month of 2019.
“We
recently imposed tariffs on $250 billion of Chinese goods — and now our
Treasury is receiving billions and billions of dollars.”
This is true.
Since
Mr. Trump imposed tariffs on certain imports from China — and imported
steel and aluminum from around the world — federal tariff revenues have
increased. Revenues from customs duties, which include tariffs, rose by
$13 billion in the third quarter of 2018 compared with a year earlier,
the Commerce Department reported. Technically, that money is paid by
Americans who bring the goods across the border, and it is often passed
on to American consumers in the form of higher prices.
“My administration has cut more regulations in a short period of time than any other administration during its entire tenure.”
This is false.
The Trump administration has slowed the pace of adopting new rules, and it has moved to roll back some existing or proposed federal regulations, particularly in the area of environmental protection. The White House claimed that as of October, a total of $33 billion worth of future regulator costs had been eliminated. But experts say the scale of the rollbacks in the Trump era still does not exceed extensive cuts in federal rules during the Carter and Reagan administrations, when rules governing airline, truck and rail transportation were wiped off the books, among other changes.
“We
have created 5.3 million new jobs and importantly added 600,000 new
manufacturing jobs — something which almost everyone said was impossible
to do, but the fact is, we are just getting started.”
This is false.
The
Bureau of Labor Statistics reports that since January 2017, when Mr.
Trump took office, the economy has added 4.9 million jobs, including
454,000 jobs manufacturing jobs. Far from being “impossible,” that is
closely comparable to the pace of job creation during some two-year
periods during the Obama administration, and significantly slower than
the pace of job creation in manufacturing in the 1990s.
Wages were “growing for blue-collar workers, who I promised to fight for. They are growing faster than anyone thought possible.”
This is true.
Wages
are rising faster for construction and manufacturing workers than
workers in service occupations, according to the Labor Department.
“More people are working now than at any time in our history.”
This is misleading.
While the total number of people working in the United States is higher than ever, it is not because of the president’s policies. It is because more people than ever live in the United States.
Immigration
“The
border city of El Paso, Tex., used to have extremely high rates of
violent crime — one of the highest in the entire country, and considered
one of our nation’s most dangerous cities. Now, immediately upon its
building, with a powerful barrier in place, El Paso is one of the safest
cities in our country.”
This is false.
El Paso was never one of the most dangerous cities in the United States, and crime has been declining in cities across the country — not just El Paso — for reasons that have nothing to do with border fencing. In 2008, before border barriers had been completed in El Paso, the city had the second-lowest violent crime rate among more than 20 similarly sized cities. In 2010, after the fencing went up, it held that place.
“San
Diego used to have the most illegal border crossings in our country. In
response, a strong security wall was put in place. This powerful
barrier almost completely ended illegal crossings.”
This is misleading.
Border
apprehensions decreased by 91 percent in the San Diego sector between
the 1994 fiscal year, right after the original border fencing was
completed, to the 2018 fiscal year. But, according to the Congressional
Research Service, that fence alone “did not have a discernible impact”
on the number of immigrants crossing the border into the United States
illegally.
“As we speak, large, organized caravans are on the march to the United States.”
This is exaggerated.
At the end of January, a new caravan
of thousands of migrants from Central America was headed north, and
some of the travelers said they intended to try to cross into the United
States. But many in the caravan have said they plan to remain in
Mexico, thanks in part to policies put in place by the new Mexican
government. President Andrés Manuel López Obrador has made it easier for
Central Americans to get visas and work in Mexico. President Trump’s
warnings of an imminent invasion from new caravans is overstated.
“I
hope you can pass the U.S.M.C.A. into law, so we can bring back our
manufacturing jobs in even greater numbers, expanding American
agriculture, protecting intellectual property, and ensuring that more
cars are proudly stamped with the four beautiful words: Made in the
U.S.A.”
This is exaggerated.
The
revised trade deal with Canada and Mexico, known as the United
States-Mexico-Canada Agreement, does include provisions that are
intended to bring manufacturing jobs back to the United States — like
minimum wage provisions for some auto manufacturing. But some economists
have said those provisions could ultimately push more manufacturing —
and jobs — outside North America. The deal does allow American farmers
to sell more dairy products to Canada. But the trade pact has yet to be
approved by Congress, and both Democrats and Republicans say that is
unlikely to happen without significant changes.
Foreign policy
“When
I took office, ISIS controlled more than 20,000 square miles in Iraq
and Syria. Just two years ago. Today, we have liberated virtually all of
the territory from the grip of these bloodthirsty monsters.”
This is true.
The Defense Department reports that the Islamic State now controls only around 20 square miles of territory in Syria, down from 34,000 in 2014. But many of the gains against the Sunni extremist caliphate began under President Barack Obama, with the Trump administration continuing Obama administration policy. And the top American military commander in the Middle East told a Senate hearing on Tuesday that the Islamic State could return if the United States and its allies abandoned the fight. In December, Mr. Trump announced he was withdrawing American troops from Syria.
“We
condemn the brutality of the Maduro regime, whose socialist policies
have turned that nation from being the wealthiest in South America into a
state of abject poverty and despair.”
This is misleading.
This
has become a popular talking point among American conservatives. It is
true that the rule of President Nicolás Maduro of Venezuela has brought
that country to economic ruin. Inflation is at astronomical rates, and
ordinary people are struggling to get basic food and health supplies.
Three million citizens have fled. Some of the collapse can be traced to
Mr. Maduro’s economic policies, which do fall under the broad label of
socialism. But analysts say that corruption, the lack of rule of law and
the absence of democracy — all the hallmarks of a dictatorship — have played just as big or larger roles.
“If
I had not been elected president of the United States, we would right
now, in my opinion, be in a major war with North Korea.”
There is no evidence.
In
2016, at the end of the Obama administration, there was no sign that
the United States and North Korea were about to go to war, though
Pyongyang had been conducting nuclear tests and Mr. Obama had continued
economic sanctions. In Mr. Trump’s first year in office, he increased
tensions with North Korea by attacking its leader, Kim Jong-un, in a
series of Twitter posts, which prompted hostile statements from
Pyongyang. Mr. Trump wrote that North Korea’s actions would be met with
“fire and fury” and called Mr. Kim “Little Rocket Man.” Analysts said at the time that the chances of war between the two nations had grown because of these exchanges.
Abortion
“Lawmakers
in New York cheered with delight upon the passage of legislation that
would allow a baby to be ripped from the mother’s womb moments from
birth.”
This is misleading.
On
Jan. 22, the 46th anniversary of the Supreme Court’s landmark decision
Roe v. Wade, Gov. Andrew M. Cuomo, Democrat of New York, signed the
Reproductive Health Act. The new law ensures a woman’s right to an
abortion in New York if Roe v. Wade were to be overturned. It does not
broadly allow abortions until shortly before birth, as Mr. Trump
suggested. Instead, it will allow for an abortion after 24 weeks to
protect the mother’s health or if the fetus is not viable. Under the
prior law, abortions were allowed after 24 weeks only if the woman’s
life was in jeopardy.
“We had the case of the governor of Virginia where he stated he would execute a baby after birth.”
This is false.
In an interview last month, Gov. Ralph Northam said that he supported a late-term abortion bill that would loosen restrictions on the procedure, and allow women to consult with a doctor on an abortion up to, but not including, the time of birth.
The governor, a pediatric neurologist,
also talked about some of the dangerous medical emergencies that
pregnant women could face, such as carrying a nonviable fetus. He said
that in such a case, the mother would deliver the infant and then, “the
infant would be resuscitated if that’s what the mother and the family
desired, and then a discussion would ensue between the physicians and
the mother.” While Mr. Northam was talking about an end-of-life care
discussion in the case of a child that would not live, Republicans
seized on his remarks as evidence that Mr. Northam supported killing
babies after their birth.
Reporting
was contributed by Eileen Sullivan, Michael Tackett, Linda Qiu, Edward
Wong, Eric Lipton, Eric Schmitt, Adam Liptak, Binyamin Appelbaum,
Caitlin Dickerson, Charlie Savage, Coral Davenport, Glenn Thrush, Helene
Cooper, Jim Tankersley, Julian E. Barnes, Katie Benner, Matt Phillips,
Robert Pear and Thomas Gibbons-Neff.
WASHINGTON — America will get its first taste of divided government under President Trump this week when a Democratic House tries to wrest control of the political agenda from Mr. Trump, who appears determined to keep the focus on border security, immigration and his “big, beautiful” wall.
After the midterm elections ushered in the most diverse freshman class in history, House Democrats intend to put a spotlight on the issues that worked well for them during the campaign: diminishing the influence of the wealthy and connected, expanding voting rights, lowering prescription drug costs and passing a bipartisan infrastructure bill.
Mr. Trump, on the defensive and presiding over a federal government that remains partially closed, is trying to stomp on that message. On Tuesday, as the government shutdown was in its 11th day, Mr. Trump invited congressional leaders of both parties to a briefing on border security Wednesday afternoon. White House officials did not say whether Mr. Trump would attend.
WASHINGTON — The
Trump administration announced on Thursday that it would seek to put in
place more stringent work requirements for adults who rely on food
stamps, even as the president signed a sweeping farm bill in which
lawmakers had rejected stricter rules.
By moving to limit the ability of states to issue waivers
to people who say they cannot make ends meet under the requirements for
the Supplemental Nutrition Assistance Program, the Agriculture
Department found another route to create restrictions, bypassing
Congress and drawing immediate criticism that the proposed rule was sure
to harm Americans below the poverty line.
The
administration, which along with conservatives had fought to include
stricter work requirements in the farm bill, continued to argue that
food stamps were never meant to be a way of life and that able-bodied
adults should be able to find jobs in a healthy economy.
“Long-term reliance on government assistance has never been part of the American dream,” Sonny Perdue, the agriculture secretary, said in a statement. “Moving people to work is common-sense policy, particularly at a time when the unemployment rate is at a generational low.”
The $867 billion
farm bill, a huge piece of legislation intended to provide relief for
farmers and the poor, encountered a number of obstacles this year as it
faced scrutiny from conservative lawmakers who pushed for an overhaul in how the food program’s participants would be evaluated.
In the end, Republican and Democratic negotiators decided to drop two proposals introduced by conservatives and publicly championed by President Trump:
one that would have imposed further work requirements on adults using
SNAP, and another that would have closed a loophole allowing states to
waive the requirements in areas with high unemployment rates.
The
proposed rule drew ire from Democrats, who accused the Trump
administration of steamrollering a rare bipartisan compromise and
ignoring Congress’s mandate to leave the program and its 40 million
recipients untouched.
“After a very
rough back and forth on that particular issue, basically we left the
program alone without restricting people from being able to get it,”
said Representative Raúl M. Grijalva, Democrat of Arizona, one of the
negotiators on the bill’s bicameral committee. “Now you have Secretary
Perdue doing essentially what was, in a bipartisan way, agreed not to
do. He needs to know what the intent of Congress is and follow it.”
Senator Debbie Stabenow of Michigan, the top Democrat on the Senate Agriculture Committee, accused Mr. Perdue in a bluntly worded statement of “blatantly” ignoring the bipartisan farm bill and disregarding “over 20 years of history giving states flexibility to request waivers based on local job conditions.” READ MORE:https://www.nytimes.com/2018/12/20/us/politics/food-stamps-trump-administration-snap.html
The defense secretary could no longer serve a president who no longer thinks he needs to listen to anybody. James Mattis is not an imposing man. At five-foot-nine, with a slight build, he doesn’t have the physical presence you might expect from someone whose nickname is “Mad Dog.” He doesn’t have, say, H.R. McMaster’s bull neck or booming voice. Yet Mattis loomed large over U.S. national security policy, such as it is, under this presidency—so much so that his long-expected but still-sudden resignation Thursday had Washington reporters competing to see who could dial up the most hair raising quotes warning of catastrophe ahead.
(My contribution: One former top official who speaks regularly to the White House offered only a one-word reaction over email: “Alarming.”) When I met Mattis for the first time, at Stanford University’s Hoover Institution, the retired Marine general was still fuming over his treatment by the Barack Obama administration—he was fired as Central Command chief, basically, for urging a more aggressive Iran policy—and though our conversation wasn’t on the record, it was clear he was somebody who wasn’t to be trifled with.
Now, he’s aiming his considerable capacity for outrage at a different occupant of the Oval Office, with the stakes far higher given that the president today is, well, Donald Trump. Every journalist in Washington knew Mattis opposed Trump on the biggest foreign policy issues of the day, be it pushing back against a revanchist Russia, managing the messy conflicts in the broader Middle East, or handling a surging China. He made it known around town that he was only running the Pentagon to protect it, if not the world, from the president, and for nearly two years he was more or less able to prevent an outright crisis. The question was always when Mattis would reach his breaking point—when the president’s isolationist instincts, impulsive decision-making and attempts to use the military as a political weapon would push him over the edge.
It wasn’t, apparently, Trump’s deployment of U.S. troops to the Mexican border in a transparent effort to swing the November midterms that did it; Mattis went along with that. It wasn’t the president’s repeated snipes at NATO, the transatlantic alliance that has underpinned American national security for seven decades; nor was it his assiduous adoption of Kremlin talking points or his periodic eruptions at U.S. allies—it was basically all of that, Mattis made clear in his extraordinary resignation letter, which contains not a scintilla of praise for his boss and outlines several major points of disagreement.
“Because you have the right to have a Secretary of Defense whose views are better aligned with yours,” Mattis wrote, “I believe it is right for me to step down from my position.” Obviously, Mattis couldn’t abide Trump’s sudden and apparently unilateral decision to pull U.S. troops out of Syria, where they were supporting predominantly Kurdish forces in fighting against ISIS and keeping an eye on an encroaching Iran. Word soon leaked out, too, that Trump plans to yank a big chunk of U.S. forces from Afghanistan, a flailing war effort the president has long questioned as pointless. It’s not that these moves are indefensible—one can easily imagine a President Hillary Clinton determining that the juice wasn’t worth the squeeze and ordering U.S. forces home.
But in a normal administration, a big move like that would have taken place only after endless rounds of discussions at multiple levels of governments, arguments between agencies, and consultations with allies. There would be plans for every possible contingency, and a carefully coordinated PR rollout. Trump seems to have just ordered it done at the speed of a tweet, and it’s clear his administration hasn’t worked through the dangers that accompany any withdrawal of troops from a war zone. On Wednesday, the administration hastily announced a conference call to brief the press on the president’s Syria decision, then struggled to explain what it was and when or how it would happen. The Pentagon pointed reporters to the White House; the White House told reporters to talk to the Pentagon. It was a level of chaos I hadn’t seen in a decade of covering U.S. foreign policy.
So it isn’t surprising that Mattis left—with his advice so conspicuously spurned, he might have realized he could no longer be effective. For years, he had ignored or slow-walked Trump’s wilder ideas, such as his reported order to assassinate Syrian President Bashar al-Assad, but this time the president doesn’t appear to have consulted him at all—and reportedly rejected his desperate final attempt to change his mind over Syria. Any Cabinet secretary would have resigned. So what now?
Each occupant of the Oval Office claims ever-vaster powers in foreign policy, and Congress has steadily ceded its oversight powers as the complexity of conflicts, and the speed and might of the U.S. military, has increased. So those looking to Capitol Hill for a public intervention may end up disappointed. After all, Republican senators have wished away their differences with Trump on foreign policy for many months, occasionally rebuking him but generally doing little to rein him in.
More than 100 years ago, black domestic workers in Georgia organized for better pay. Now they’re getting out the vote for Stacey Abrams.
All across Atlanta, hundreds of domestic workers have been knocking on doors for Stacey Abrams, the Democratic candidate for Georgia governor, hoping to turn her into first black woman in that role.
These domestic workers, mostly black women affiliated with Care in Action, the political arm of the National Domestic Workers Alliance, are using new technologies, like a smartphone app to identify the homes of voters of color.
But they’re also carrying on an 140-year-old tradition of domestic workers fighting for economic empowerment. Despite their marginalized positions and the many obstacles in their way, they insist on making their voices heard.
In July 1881, washerwomen in Atlanta, toiling outside in the hot summer as they lugged buckets of well water and scrubbed their white patrons’ laundry, finally had enough. They decided to go on strike to demand increased wages and respect for their work.
They and a few male allies mobilized supporters by going door to door in black neighborhoods, despite threats of being arrested for “disorderly conduct.” The women held meetings in churches, hundreds packing the pews. They formed the Washing Society, a cross between a labor union and a mutual aid organization, with subsidiaries in the city’s five wards.
And in the beginning of the Jim Crow era, domestic work was more than a system of labor. It also symbolized an ordering of society by race in which black people were always considered subservient.
When the strike broke out in July, the women faced a chorus of boos and laughs from employers, city officials, businessmen and reporters from the The Atlanta Constitution newspaper. The women were called “Washing Amazons.”
But the nickname soon proved to be apt. “I tell you, this strike is a big thing,” the police chief admitted after the first week when it was clear that there was no end in sight. Unlike other domestic workers, who labored in isolation in their employers’ homes, the laundresses shared work sites and were thus able to build solidarity.
In Southern cities, black domestic workers, including maids, nurses, cooks and laundresses, performed the most intimate and the most undesirable jobs for white families. They were paid substandard wages, expected to work long hours and were subjected to insults and sometimes even physical assaults.
LOS ANGELES — From pulpits across Los Angeles, Pastor Kelvin Sauls has spent the past few months delivering sermons on the spiritual benefits of fasting. The food in the sermon is rent, and landlords need less of it. “My role is to bring a moral perspective to what we are dealing with around the housing crisis,” Pastor Sauls explained.
In addition to a Sunday lesson, this is an Election Day pitch. Pastor Sauls is part of the campaign for Proposition 10, a ballot initiative that would loosen state restraints on local rent control laws. The effort has stoked a battle that has already consumed close to $60 million in political spending, a sizable figure even in a state known for heavily funded campaigns.
Depending on which side is talking, Proposition 10 is either a much-needed tool to help cities solve a housing crisis or a radically misguided idea that will only make things worse. Specifically, it would repeal the Costa-Hawkins Rental Housing Act, which prevents cities from applying rent control laws to single-family homes and apartments built after 1995.
The initiative drive builds on the growing momentum of local efforts to expand tenant protections. “In the midst of the worst housing and homeless crisis that our country has ever seen, how does a bill that restricts local government’s ability to address it go untouched?” asked Damien Goodmon, director of the Yes on 10 campaign, which is primarily funded by the AIDS Healthcare Foundation in Los Angeles.
Proposition 10 has won prominent endorsements from backers including the California Democratic Party and The Los Angeles Times. But opponents have also amassed editorials and broad support, mainly from a coalition of construction unions, nonprofit housing developers and local chambers of commerce.
Among those fighting the initiative is a relatively recent class of landlords — private equity firms like Blackstone Group, which accumulated a vast residential real estate portfolio after the housing market collapse a decade ago. Landlords warn that repealing the Costa-Hawkins law would create deep uncertainty among developers, making California’s housing shortage worse by discouraging construction.
“This is a serious problem, but the solution to that problem should not land solely on the rental housing industry,” said Tom Bannon, president of the California Apartment Association, a landlords’ group.
The California fight reflects a renters’ rights movement that is bubbling up in churches and community centers across the country, a semi-coordinated stand of low-income tenants against the gentrifying American city. Last month in the Roxbury section of Boston, about 300 people gathered for an afternoon assembly on how to blunt evictions and economic displacement. The event offered free child care and had organizers speaking English, Spanish and Cantonese.
