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This horrific event on July 29 led immediately to dueling accusations as Ukraine and Russia blamed each other. With each passing day, however, evidence — direct and circumstantial — mounts that this was, indeed, a premeditated massacre by Russia. As such, it would rank as one of the worst war crimes yet, in a war marked by the atrocity with which Russian President Vladimir Putin’s troops have waged it. There must be an investigation, followed by full accountability for the perpetrators, lest international law on treatment of prisoners of war become another casualty of Mr. Putin’s aggression.
Most of the soldiers held at the Olenivka prison site are members of the Ukrainian Azov Regiment who surrendered after fighting for weeks from a last redoubt in the city of Mariupol. Their status as ex-combatants entitles them to all the protections of the 1949 Geneva Convention. Arguably, the mere fact that Russian-backed Ukrainian separatists were holding them at Olenivka, just about 12 miles from the front line, violates the provision which reads: “Prisoners of war shall be evacuated, as soon as possible after their capture, to camps situated in an area far enough from the combat zone for them to be out of danger.” Thus, Russia and its allies would be at fault even if one believes their version of events: Ukraine targeted the prison with rocket fire from a U.S.-provided HIMARS (High Mobility Artillery Rocket System) system, supposedly to keep the POWs from disclosing secret information or Ukrainian war crimes.
And the Russian story is highly dubious: It does not explain how Ukraine’s army could know the Azov soldiers would have been in the particular building when they purportedly fired at it. Nor does it square with the analysis of experts, consulted by The Post, who noted that damage depicted in photos of the site is inconsistent with a rocket attack.
Far more plausible is Ukraine’s allegation that Russia targeted the POWs for annihilation, for two reasons: to take revenge on the Azov unit for waging ferocious resistance at Mariupol and to prevent POWs from reporting the torture to which they have been subjected at Olenivka, also in violation of the Geneva Conventions. Prisoners had been newly moved to the targeted barracks; satellite photos show fresh excavations on nearby grounds shortly before the explosion, as though those in charge were preparing mass graves. Within hours of the incident, the Russian Embassy in London tweeted a supposed quotation from purported Mariupol residents: “Azov militants deserve execution, but death not by firing squad but by hanging, because they’re not real soldiers. They deserve a humiliating death.”
Small wonder that the International Committee of the Red Cross, the neutral body that monitors compliance with the Geneva Conventions, has not had access to Olenivka since May 20, despite requesting a visit and offering aid immediately after news of the July 29 explosion broke. The secretary-general of the United Nations has announced a fact-finding mission. The truth must come out. Russia has already shredded key post-World War II rules against instigating aggressive war. It cannot be allowed to destroy restraints on the conduct of war, too.
If the judge rules in favor of the plaintiffs, access to free birth control, cancer screenings, vaccines, PrEP (HIV pre-exposure prophylaxis), counseling for alcohol misuse, diet counseling for people at higher risk of chronic disease, and many more preventive services would be in jeopardy, according to the nation's leading doctors' groups, which have sounded the alarm.
"The lawsuit could cause millions of Americans, probably more than 150 million, to lose guaranteed access to preventive services," Dr. Jack Resneck, president of the American Medical Association, told NPR. "There's really a great deal at stake," he said.
The doctors' group points to research showing that expanded access to preventive care and coverage, ushered in by the ACA, has led to an increase in colon cancer screenings, vaccinations, use of contraception and chronic disease screenings. There's also data to show that expanded coverage has reduced racial and ethnic disparities in preventive care.
Resneck warns that if the preventive care mandate is rolled back in court, it threatens to reverse this progress. Some plans may decide to limit or deny coverage for certain services. Others would tack on copays.
"Having copays and deductibles brought back for these services would actually keep many patients from getting them," Resnick says. He says for people on a tight budget, a copay for a mammogram or colonoscopy could be enough of a disincentive to skip the screening.
Americans have saved billions of dollars in out-of-pocket spending on contraceptives since the ACA's preventive services and birth control coverage took effect. And since the overturning of Roe v. Wade, the Biden administration has taken steps to clarify the benefits. "Under the ACA, most private health plans are required to provide birth control and family planning counseling at no additional cost," according to an HHS release. (A small percentage of American workers are covered by grandfathered insurance plans that are not required to follow the ACA's preventive care coverage rules.)
Plaintiffs in the Texas case argue that the preventive care mandates violate the Religious Freedom Restoration Act. Some object to paying for health insurance plans that cover contraceptives, PrEP drugs, or other preventive care services that may violate their religious beliefs. Plaintiffs also object for economic reasons, arguing that the mandate to cover preventive services raises the price of insurance coverage.
Plaintiff John Kelley, an orthodontist who lives in Tarrant County, Texas, "has no desire to purchase health insurance that includes contraceptive coverage because his wife is past her child-bearing years," according to the complaint. "He does not want or need health insurance that covers Truvada or PrEP drugs because neither he nor any of his family members is engaged in behavior that transmits HIV," the complaint continues. "Mr. Kelley is also a Christian," and is unwilling to purchase health insurance plans that subsidize certain types of contraception or PrEP drugs "that encourage homosexual behavior and intravenous drug use."
The plaintiffs are represented by attorney Jonathan Mitchell, who is known as a key strategist behind the Texas abortion law passed in 2021 that bans abortions after 6 weeks of pregnancy. America First Legal Foundation, launched by former Trump administration official Stephen Miller, is also providing counsel.
"The plaintiffs seem perhaps extra motivated by the contraceptive requirement and coverage of services like PrEP," says Katie Keith, director of the Health Policy and the Law Initiative at the O'Neill Institute at Georgetown University. But she says the lawsuit is broad in its reach: "This is very clearly a threat to the entire preventive services requirement under the Affordable Care Act."
One of the plaintiffs' legal arguments rests on the nondelegation doctrine, the principle that Congress may not delegate its legislative power to other entities, explains Andrew Twinamatsiko of the O'Neill Institute for National and Global Health at Georgetown University.
When the ACA was written, Congress empowered several groups to use their expertise to identify evidence-based preventive services. The Advisory Committee on Immunization Practices helped identify the appropriate vaccines, the Preventive Services Task Force reviewed evidence to recommend which procedures and services could be covered, and the Health Resources and Services Administration determined services and screenings for maternal and child health coverage.
"The plaintiffs argue that this structure delegates too much decision-making power to the groups without providing sufficient guidance – or what they call 'intelligible principle' – to exercise their discretion," Twinamatsiko explains.
Some legal scholars say that the argument that Congress has not provided enough specific guidance on what counts as preventive care could hold up in court.
"I've argued for years that the phrase preventive care is very open-ended," says Josh Blackman, a constitutional law professor at South Texas College and a scholar at the Cato Institute. "The courts might react to this position by saying, 'Congress: If you want something like birth control covered, you have to be more precise," Blackman says.
The case was argued in late July before Judge Reed O'Connor of the U.S. District Court, Northern District of Texas — the same judge who ruled in 2018 that the Affordable Care Act was unconstitutional. A decision is expected in the coming weeks.
"I'm expecting a pretty sweeping decision that is likely to invalidate all the preventive care requirements," Keith says. Legal experts expect the case will be appealed to the U.S. Court of Appeals for the Fifth Circuit and ultimately end up before the U.S. Supreme Court.
Though the Supreme Court has upheld the Affordable Care Act in prior cases, there's now a new make-up of justices. Scholars point to the recent EPA v. West Virginia decision, in which justices challenged the EPA's authority to act without specific direction from Congress. Georgetown's Twinamatsiko points to another case, Little Sisters of the Poor v. Pennsylvania, that also centered on the Affordable Care Act's preventive services provision requiring employers to include cost-free birth control in their health plans in accordance with the Health Resources and Services Administration guidelines. In that case, "Justice Clarence Thomas specifically said that the ACA's preventive services requirement seems to give HRSA virtually unlimited power to determine what counts as preventive care," tipping his hand at what his opinion would be if Kelley v. Becerra comes before the Supreme Court.
State attorneys general in 20 states filed a friend of the court brief defending access to free, preventive care. And public health experts have weighed in too. "It's really difficult to take away something that people already have," says A. Mark Fendrick, a doctor who directs the University of Michigan Center for Value-Based Insurance Design. "If the preventive mandate were to be struck down, I believe lots of people will not get the preventive care they need."
Abortion-rights and anti-abortion activists confront one another in front of the U.S. Supreme Court Building in Washington, D.C. (photo: Win McNamee/Getty Images)
Historically, the Court has tended to align with popular sentiment. But what happens when US elections do not produce democratic results?
A Gallup poll taken shortly before the Court overruled Roe v. Wade found that only a quarter of US adults have either a “great deal” or “quite a lot” of confidence in the Court — the lowest ever measured by Gallup. A Marquette poll, which most recently looked at public approval of the Court a few weeks after Roe was overruled, found that public approval of the Court has fallen an astonishing 28 points since Justice Amy Coney Barrett’s confirmation gave Republican appointees a 6-3 supermajority.
Shortly before Justice Ruth Bader Ginsburg’s death in September 2020 allowed former President Donald Trump to elevate Barrett, the Court’s approval rating stood at 66 percent in the Marquette poll. As of mid-July, it is at 38 percent.
While a new Gallup poll released last week shows the Court with a somewhat healthier 43 percent approval rating, it also shows that public perception of the justices has almost completely polarized along partisan lines. Republican approval of the Court spiked to 74 percent since the Court abolished the constitutional right to an abortion, and Democratic approval collapsed to 13 percent.
Scholarly research confirms that the Court is wildly out of step with the median American. Political researchers Stephen Jessee, Neil Malhotra, and Maya Sen conducted surveys in 2010, 2020, and 2021 of how members of the public believed the most politically salient cases heard by the Court in those years should have come down. They found that the Court’s views largely aligned with the public’s during the two surveys conducted before President Donald Trump appointed Barrett.
After Barrett’s confirmation gave Republican appointees a supermajority, however, the picture changed dramatically. The three scholars found that “the court is now near the typical Republican and to the ideological right of roughly three quarters of all Americans.” Notably, they reached this conclusion even before the Court’s 2022 decision in Dobbs v. Jackson Women’s Health Organization overruled Roe.
Most of this data precedes the Court’s decision in Dobbs, but there is also early evidence that the Court’s anti-abortion decision triggered a significant political backlash — one that could potentially change the outcome of the upcoming midterm elections. In Kansas, which Trump won by nearly 15 points in 2020, a ballot initiative that would have overturned the state constitution’s right to an abortion failed by almost 18 percentage points, according to the most recent vote tallies.
For most of 2022, polls predicted a crushing defeat for Democrats in the upcoming midterms. In the wake of Dobbs, however, Democrats now have a slight lead over the GOP in the generic ballot. The election forecasting site FiveThirtyEight now finds that Democrats are slightly favored to hold on to the Senate, despite the fact that the Senate is malapportioned to favor Republicans. And this shift toward the pro-abortion-rights Democratic Party appears to have begun right after Dobbs was handed down.
It’s obviously too soon for Democrats to declare victory and start itemizing the bills they will pass in the latter half of President Joe Biden’s first term — plenty could happen between now and November to shift the electorate back to the party of Dobbs. But if the Court’s polls remain in the toilet, and if Democrats do overperform in the upcoming midterms, a great deal hinges on whether the Court continues to act as though it has a mandate to govern.
Three questions raised by the Court’s dismal polls
All of this data raises three important questions. One is whether the Court’s unpopular decision in Dobbs will affect the outcome of the midterms and potentially give Democrats large enough majorities in Congress to re-legalize abortion nationwide. At least some members of the Democratic caucus predict that they can pass such legislation if they gain two more Senate seats.
At the moment, Sen. Joe Manchin (D-WV) is the only Democrat who publicly opposes the Women’s Health Protection Act (WHPA), the primary bill Democrats are pushing to codify a national right to an abortion. But Manchin and Sen. Kyrsten Sinema (D-AZ) both oppose changing the Senate’s filibuster rule, which allows a minority of only 41 senators to block most legislation.
The Senate can change its rules to abolish the filibuster by a simple majority vote, but that means Democrats need at least two more votes to accomplish this goal, assuming that all 48 Democrats who’ve supported filibuster reform in the past vote to prevent the WHPA from being filibustered.
Picking up at least two seats is far from guaranteed — FiveThirtyEight currently gives it less than a 30 percent chance of happening. But if they do, that raises a second question: whether the Court will react to its grim poll numbers and quickly moderate. Democrats could pass the WHPA, but the Supreme Court still has an anti-abortion majority that could strike that law down. So, absent Supreme Court reforms that either strip the Court of much of its power or change its membership, there is a high risk that this Court would sabotage any effort by Congress to protect abortion rights — unless it chooses to rein itself in.
In his Dobbs opinion, Justice Samuel Alito declared that his Court would defiantly ignore whether it is hated by the people it governs — “we cannot allow our decisions to be affected by any extraneous influences such as concern about the public’s reaction to our work” — but there is at least one very famous example of a key justice retreating from an unpopular policy agenda after it was repudiated by voters.
Beginning in the late 19th century, the Supreme Court started reading the Constitution to permit it to veto economic legislation that it disapproved of on ideological grounds. And the Court used this self-given power fairly aggressively to strike down New Deal policies favored by President Franklin Roosevelt.
Then Roosevelt won the 1936 presidential election in one of the most overwhelming landslides in American history, a result that appears to have spooked conservative Justice Owen Roberts into flipping his vote and giving liberals the majority they needed to overrule many of the Court’s decisions that hampered the New Deal.
Many observers attribute Roberts’s flip to Roosevelt’s proposal to add additional seats to the Court, in order to dilute the votes of its anti-New Deal majority. But it is unlikely that the court-packing proposal swayed Roberts’s vote. Roosevelt announced that plan in February 1937, weeks after Roberts would have voted during the justices’ private conference to overrule a seminal conservative decision in West Coast Hotel v. Parrish (1937).
In any event, I wouldn’t bet that one of the five justices who’ve formed much of their political identity around opposition to Roe will back away simply because their political party loses an election. It’s possible that a surprising victory for Democratic abortion rights supporters could spook some of the justices in much the same way that Roberts was spooked in 1937 — especially if Democrats celebrate such a victory with a credible threat to add seats to the Court. But these five justices have already signed on to an opinion claiming to be unmoved by the “public’s reaction to our work.”
And that brings us to the third question posed by the Court’s unpopularity: whether sustained opposition to the Court and its political stances could shift the Court back to the middle — not by the justices changing their opinions, but by Americans changing the justices.
The Court’s present majority is entrenched by an anti-democratic constitution
In a seminal 1957 article, political scientist Robert Dahl argued that the Supreme Court will tend to align itself with the nation’s dominant political coalition.
Dahl’s argument is fairly straightforward. From the Court’s creation in 1789, until when his article was published in the 1950s, Dahl found that “on the average one new justice has been appointed every twenty-two months.” This meant that a president would typically get to replace two justices for every term they spent in office, and so a president who was determined to remake the Court’s ideology “is almost certain to succeed in two terms.”
Thus, even if incumbent justices insist on pushing an agenda that is wildly out of step with the public, Dahl argued that they won’t be able to maintain that resistance for long if their political coalition falls out of favor. “Except for short-lived transitional periods when the old alliance is disintegrating and the new one is struggling to take control of political institutions,” he wrote, “the Supreme Court is inevitably a part of the dominant national alliance.”
There are two reasons, however, to doubt whether Dahl’s analysis means that the Supreme Court will have a pro-abortion rights majority anytime soon, even if a majority of the electorate consistently votes for Democrats over Republicans.
The first reason is very basic: A majority of the electorate already votes consistently for Democrats over Republicans in national elections, and has done so for about three decades. Democratic presidential candidates won the popular vote in seven of the last eight presidential elections. The only reason why Republicans have held the White House so often in recent decades is that the Electoral College effectively gives them extra, unearned power.
In fairness, the Democratic Party’s run of bad luck in recent presidential elections may be just that — bad luck. Republican Presidents George W. Bush and Donald Trump would have never seen the inner workings of the White House if their coalitions were not optimized for the Electoral College (Bush also got a big boost from the Supreme Court). But President Barack Obama at least arguably built a Democratic coalition that gave him an advantage in the Electoral College — although if Obama did build a “blue wall” it crumbled very quickly after he was no longer on the ballot.
The problem, however, is even worse in the Senate, where federal judges are confirmed. In the current Senate, the 50 Democratic senators represent about 43 million more people than the 50 Republican senators. Republicans owe their parity with Democrats to the fact that the Senate is malapportioned to effectively give them extra seats. The 25 most populous states contain about 84 percent of the population, and Democratic senators have a 29-21 majority in these states. Meanwhile, Republicans have an identical 29-21 majority in the 25 least populous states — the ones that make up only about 16 percent of the nation.
That advantage stems from the persistent fact that voters in less populous states tend to prefer conservative candidates and have done so for several decades. If senators were chosen in a system where every vote counts equally — rather than one that effectively gives extra Senate seats to sparsely populated states — Democrats would have controlled the Senate since the late 1990s.
The Republican advantage in the Senate was not a factor when Dahl published his paper in 1957. One reason why is that, in the Jim Crow era, the South only had one major party — the Democratic Party — and that gave Democrats a structural advantage in the fight to control the Senate.
But the Republican Party’s structural advantage in the Senate is one of the central features of modern-day American politics. As Stanford political scientist Jonathan Rodden explains, “as you go from the center of cities out through the suburbs and into rural areas, you traverse in a linear fashion from Democratic to Republican places.” So long as this urban/rural divide endures, Republicans will remain favored to control the Senate. And, without control of the Senate, Democrats cannot confirm a justice unless at least some Republicans consent.
All of which is a long way of saying that Democrats cannot regain control of the Court by continuing to win the popular vote by the same margins that they have won by it in the last several decades. To take back the Court, they will need to grow their majority — although the Kansas abortion result suggests that such an outcome is, at least, possible.
The second problem facing Democrats, and pro-abortion-rights Americans more generally, is that justices are now replaced much less often than they were during the period studied by Dahl.
The longest-serving member of the Court, Justice Clarence Thomas, joined the Court in 1991. Since then, 10 justices have left the Court and been replaced. That means that justices are now being replaced less often than once every three years, rather than every 22 months, as Dahl found.
An unexpected vacancy could arrive at any time. But if this pattern holds, it would mean Democrats could have to win several presidential races in a row in order to remake the Court — and that’s assuming that they also control the malapportioned Senate.
The bottom line, in other words, is that — barring a solution such as adding additional seats to the Supreme Court — the Court’s current majority can probably hold out for a fairly long time, regardless of what the voters prefer.
Anti-death penalty activists rally outside the U.S. Supreme Court in an attempt to prevent Oklahoma's planned execution of Richard Glossip. (photo: Larry French/Getty Images)
Bipartisan group calls for new hearing over lack of evidence in case of Richard Glossip, 59, as state rushes to speed up executions
Forty-four Republican and 17 Democratic legislators, amounting to more than a third of the state assembly, have written to John O’Connor pleading for the new hearing.
The outpouring of concern is an indication of the intense unease surrounding the Glossip case, and the mounting fear that Oklahoma is preparing to kill an innocent man.
Glossip, 59, is due to be killed on 22 September as part of a sudden speeding up of capital punishment activity in Oklahoma. He was sentenced to death for the 1997 murder of Barry Van Treese, the owner of a Best Budget motel in Oklahoma City, where Glossip was manager.
Justin Sneed, the motel’s maintenance worker, admitted that he had beaten Van Treese to death with a baseball bat. But Sneed later turned state’s witness on Glossip, accusing the manager of having ordered the murder.
As a result, Sneed, the killer, avoided the death penalty and was given a life sentence. Glossip was put on death row almost entirely on the basis of Sneed’s testimony against him, with no other forensic or corroborating evidence.
In their letter, the 61 legislators ask the attorney general to call for a hearing to consider new evidence that has been uncovered in the case. Last year a global law firm, Reed Smith, was asked by state lawmakers to carry out an independent investigation.
Their 343-page report found that the state had intentionally destroyed key evidence before the trial. The review concluded that “no reasonable juror hearing the complete record would have convicted Richard Glossip of first-degree murder”.
Glossip’s scheduled execution forms part of an extraordinary glut of death warrants that have been issued by Oklahoma in recent weeks. In July, the state received court permission to go ahead with 25 executions at a rate of almost one a month between now and December 2024.
Should all those executions be carried out, Oklahoma’s current death row would shrink by almost 60% from its current occupancy of 43 prisoners.
The first scheduled execution of the 25 is that of James Coddington, 50, on 25 August. Coddington’s fate is now in the hands of Kevin Stitt, Oklahoma’s Republican governor, after the state’s parole board recommended that he commute the prisoner’s sentence to life without parole.
The clemency petition pointed out that Coddington had been impaired by alcohol and drug abuse starting when he was a baby. It said he had shown full remorse for having murdered Albert Hale, a friend who had refused to lend him $50 to buy cocaine.
Glossip is the second of the 25 death row inmates to be booked for execution.
The Republican-controlled state is rushing to kill so many prisoners over the next two years as it rebounds from a six-year capital punishment moratorium that was forced upon it following a spate of gruesomely botched executions. In April 2014 Clayton Lockett writhed and groaned on the gurney after lethal injection drugs were administered into his flesh rather than a vein – he took 43 minutes to die.
In January, 2015 Charles Warner was heard to say: “My body is on fire” as he was being killed. It was later discovered that the state had used an unauthorized drug in the procedure.
Glossip was set to be the next one to die in September 2015 but the execution was postponed after it emerged that the same mistaken drug was about to be used. Oklahoma halted executions for six years before the practice was cranked up again last October.
Remarkably, the first execution carried out after the hiatus in October 2021 was also botched. Witnesses saw John Grant displaying full-body convulsions and vomiting for 15 minutes.
Ambulance paramedics. (photo: Philadelphia Inquirer)
For the 17 years that the Josephs have lived in Wake County, North Carolina, they’ve been patrons of the local EMS subscription program. They pay an annual household fee of $60, and in exchange, Wake County EMS promises to waive any costs of 911 ambulance services not covered by insurance. When the Josephs needed to call an ambulance once before, their subscription covered them as planned.
Yet this time, a $236 insurance bill landed in the Josephs’s mailbox. Because an ambulance from neighboring Johnston County had been dispatched to their home, the ride was not covered under the Wake County plan. Johnston County EMS has its own subscription program, but the counties don’t offer reciprocal coverage.
“I wasn’t even aware at the time what ambulance it was,” said Bobbie. “I didn’t care at that moment, because the main thing I knew was that I needed attention immediately, and I was not able to move.”
The Intercept found at least 24 states, from California to Pennsylvania, where public, non-profit, or for-profit EMS agencies have adopted similar models. Almost all of them trumpet the central benefit of relieving consumers from the pitfalls of surprise ambulance bills, while also providing the departments with supplemental funding. Change Healthcare, an EMS billing and health care technology company, states on its website that subscription programs present “new revenue opportunities” for EMS agencies and that they’re gaining traction nationwide.
When half of emergency ground ambulance rides result in often exorbitant out-of-network charges, paying a flat yearly or monthly fee for blanket protection might seem like a no-brainer. But it wouldn’t be unreasonable to wonder why it’s necessary for these programs to exist at all.
In a nation that deprioritizes health care for the sake of profit, emergency ambulance rides are not uniformly funded or operated as a public service. A network of regulatory failures have plagued the United States’ fragmented and underfunded EMS system for decades; in the absence of federal legislation, vulnerable patients are forced to bear the brunt of the economic burden.
Some Surprises Act
“No more surprise billing. No more,” President Joe Biden declared in February. His promise referred to the newly implemented No Surprises Act, but it was only partially true. While the bipartisan law offers a broad set of protections to safeguard patients from surprise medical bills, ground ambulance services are one glaring omission.
Citing insufficient data and the unique difficulties of federally regulating a complex world of local providers, the act instead required that the government convene the Ground Ambulance and Patient Billing, or GAPB, Advisory Committee. In November 2021, nearly one year after the No Surprises Act was signed into law, the Biden administration finally announced that it would be soliciting committee nominations. An accompanying press release from the Department of Health and Human Services stated that the committee would be required to submit a report recommending ways to protect patients from surprise ground ambulance bills within 180 days of its first meeting.
More than eight months later, it’s not clear if the committee has ever met. The administration has not shared any updates on the status of the GAPB Advisory Committee’s members, dockets, meetings, or promised report — or any reason as to why the committee appears to have stalled. The Department of Health and Human Services did not respond to The Intercept’s requests for comment.
As long as this bureaucratic impasse endures, patients could continue to be saddled with an aggregate $129 million in surprise ground ambulance bills every year. The New York Times previously noted that the rate of out-of-network bills for ground ambulance rides is “substantially higher” than many of the medical specialities actually covered under the No Surprises Act.
Air ambulance rides — in which a medical helicopter is dispatched due to the patient’s remote location or urgent condition — are covered under the act, after garnering attention in recent years for their own staggering out-of-network bills. According to Erin Fuse Brown, a law professor and director of the Center for Law, Health & Society at Georgia State University, similar market failures contribute to both air and ground ambulance surprise billing. Patients will always need to use emergency services, regardless of whether a provider is in their insurance network.
“They’re going to get called no matter what, “ said Brown, who has researched out-of-network air ambulance billing and legislation. “So then they might as well just stay out-of-network, and not expend the resources to negotiate the discount.”
Like EMS agencies, air ambulance companies also frequently offer subscription programs to purportedly protect subscribers against surprise bills. Despite their similarities, there’s one fundamental difference: The majority of air ambulance companies are owned by private equity firms, but nearly two-thirds of emergency ground ambulance rides are performed by government-based organizations.
Whether the service is public or private, a patient can’t control which service shows up when 911 is called — rendering the value proposition of these programs dubious. Bobbie Joseph learned this firsthand when she received her surprise bill, but other ground ambulance subscription programs have similar caveats. Unless an EMS agency’s website clarifies outright, it can be difficult for the person in need to know whether there are other ambulance services in their region that could potentially be dispatched.
“YOU PAY NOTHING!”
Some ground ambulance membership programs reviewed by The Intercept marketed themselves directly to Medicare beneficiaries — who cannot receive surprise bills, because Medicare is prohibited from “balance billing,” or charging patients for what their insurance didn’t cover, for emergency ambulance rides under federal law.
If an ambulance provider picks up a Medicare patient, they must accept Medicare’s reimbursement rate as their full payment, so a Medicare recipient’s bill would only reflect their deductible and copay.
“One of the things that was dubious about the practices of air ambulances is that they seemed to be indiscriminately marketing these membership programs, even to people who couldn’t be balance billed under law, because they were Medicare beneficiaries,” said Brown. “So if the ground ambulance providers are being very careful to screen out individuals and households who may have Medicare or Medicaid coverage, I think that’s a step in the right direction.”
But this isn’t always the case. “John Doe is billed $1512 for EMS transport to a hospital. He is a Medicare recipient,” states the brochure for New Haven, Indiana’s EMS subscription program. “YOU Pay $250.00 WITHOUT New Haven Subscription EMS. WITH New Haven Subscription EMS, YOU PAY NOTHING!”
Similarly, a FAQ sheet for an EMS subscription program in Caroline County, Maryland, asks why someone should subscribe if they already have “Medicare or other insurance.” The response states, “Medicare and most insurance plans will not cover 100% of the bills incurred for ambulance service. … If your insurance reimburses EMS any portion of the bill, we accept it as payment in full. However, if the insurance company denies the claim, you will NOT be charged anything further.”
Brown noted that the terms of these ground ambulance subscription programs are not immediately obvious. If they’re agreeing to waive balance billing for Medicare patients, she said, then they’re misleading, because Medicare does not balance bill. If they’re waiving cost-sharing altogether, like copays or deductibles, then Brown is concerned that they may violate federal fraud and abuse laws, such as the Anti-Kickback Statute, which makes it illegal for a health care provider to advertise financial incentives to attract potential patients if the provider bills its services to a federal health care program.
In 2003, the Department of Health and Human Services Office of Inspector General ruled that one ambulance subscription program was legal as long as it collected more subscription revenue than it wrote off in copays and deductibles, but the advisory opinion only applied to the nonprofit emergency ambulance service that requested it.
Since then, while some state and federal courts have examined air ambulance subscription programs, their ground ambulance equivalents have largely avoided federal scrutiny. A 2012 report from the U.S. Fire Administration cites subscription programs as a potential funding alternative for EMS services but advises that departments “seek legal advice when setting up a subscription program so that requirements of Medicare and Medicaid are met by the approach taken.”
“The majority of states have simply not addressed it one way or the other, so it’s not expressly prohibited or expressly permitted,” said Douglas Wolfberg, founding partner of EMS law firm Page, Wolfberg & Wirth.
Ambulance subscription programs might also run into legality issues under certain states’ insurance laws. In all New England states except Vermont, for example, ambulance subscriptions are considered to be insurance businesses and must be licensed as such. In other states, some membership programs explicitly clarify that they are not insurance policies — despite essentially operating in the same way.
Overall, ground ambulance subscription programs appear to operate in a legal gray zone, and without much regulation or oversight, the door remains open for potential consumer abuse.
Pointing Fingers
The growing adoption of EMS subscription programs nationwide underscores the financial issues that many public departments have faced for decades. The EMS Systems Act of 1973 provided over $300 million in funding for the development of a nationwide EMS system, but in 1981, the Reagan administration effectively dismantled the program by moving the principle funding from the federal government to the states. States were then given broad discretion over how to use the funds, and many did not allocate them toward EMS services.
“Some of these publicly operated ambulance services might be facing financial sustainability issues, and somewhere along the lines may have decided to directly bill as a way to finance themselves,” said Krutika Amin, Kaiser Family Foundation’s associate director for the program on the Affordable Care Act. “Contracting with insurance companies might require a level of administrative work that they might not have resources for.”
“If you’re working with a public fire department, the people who work there aren’t trained in network negotiation,” said Madeline O’Brien, a research fellow at Georgetown University’s Center on Health Insurance Reforms. “It’s very difficult for them to come to the table, and to know the rate that they should be charging, or how to even start with negotiations.”
Insurance companies often place the blame on ambulance providers, arguing that their billed rate is far too high. Indeed, uncovering the true cost of ambulance transportation is a difficult task. Wake County EMS Assistant Chief of Community Outreach Brian Brooks told The Intercept that a ride with basic life support is $600; Palo Alto, California, Fire Chief Geo Blackshire put the average cost of an ambulance ride at around $2,000. A recent investigation by Kaiser Health News and NPR reported that three nearly identical ambulance rides, each performed by a different Illinois public fire department, resulted in bills ranging from $1,250 to $3,606.
Conversely, emergency services professionals argue that federal Medicare and Medicaid reimbursement rates are too low, which leads them to increase prices and bill patients directly. The website for the Morgan County, Colorado, EMS states outright that “declining reimbursements by Medicare/Medicaid and commercial carriers” have caused the ambulance service to only be able to collect 35 to 45 percent of the amount billed, which “inherently impacts the fee for services.”
In April, Palo Alto launched a new EMS subscription program called Palo Alto FireMed, after receiving feedback that it could benefit the community. According to Blackshire, a significant amount of the city’s transports are provided to patients with Medicare or Medicaid, and in those cases, the EMS doesn’t fully recoup their costs. “Palo Alto FireMed is just another means for us to try and break even on what it costs to run this program,” said Blackshire.
Palo Alto FireMed was inspired by the Huntington Beach Fire Department’s subscription program, which launched in 1990. Long before surprise billing debates reached a national fever pitch, the goal of the program was primarily revenue generation: to increase response times for medical emergencies and improve equipment and supplies.
But in today’s expensive health care landscape, subscription programs might not be all that beneficial for some cash-strapped EMS departments.
“I would venture to say that we are not breaking even,” said Brooks. “There’s no benefit for us whatsoever. It’s completely just a way to ease the financial burden for somebody who has to be transported.”
Today, responsibility for EMS oversight is split among various federal agencies. The structure and funding of departments varies greatly, and while some are taxpayer-supported, others might rely fully on patient billing for their income or be volunteer-run. Given the high overhead costs of maintaining a 24-hour EMS program, some municipalities have outsourced their services to private ambulance companies entirely.
“I still don’t entirely understand how they managed to not be regulated by legislation,” said Caitlin Donovan, senior director of public relations at the National Patient Advocate Foundation. “To me, the more obvious solution is to bring back a public service that’s paid for in tax dollars.”
Other legislative solutions can be found by looking at states that have passed their own laws to remedy surprise ground ambulance bills, including by setting standard ambulance rates that must be reimbursed by out-of-network providers.
But until the federal government enacts across-the-board legislation, many Americans in unprotected states might have to turn to imperfect supplemental programs for peace of mind against surprise bills.
“I think that there’s really a frustration with the movement of ground ambulance legislation at the federal level,” said O’Brien, of Georgetown’s Center on Health Insurance Reforms. “Until you can bring those experts together and start having that conversation, this is kind of at a standstill.”
Government soldiers look at the scene of a suicide bomb attack in Mogadishu, Somalia. (photo: AFP/Getty Images)
Joe Biden has announced the return of US ground troops to Somalia. Far from helping Somalis, the long, destructive history of US intervention since the 1970s has merely worsened their country’s deep crisis and fueled the rise of the terrorist group al-Shabaab.
Much of this coverage gives readers the impression that Somalia’s problems are self-generated and that the rest of the world has been trying to save it. In reality, there is a protracted history of outside interference in Somali affairs that has worsened its long crisis. From the Cold War to the “war on terror,” the United States has used Somalia as a battleground for its geopolitical schemes, with profoundly destructive consequences for Somalis.
From Independence to Siad Barre’s Rule
A union of British and Italian colonies that were joined at independence in 1960, Somalia is strategically located on the Horn of Africa, which oversees Middle Eastern natural gas and oil routes. Although most of the country’s inhabitants are ethnic Somalis who share a language, culture, and religion, they have been divided by clan rivalry. Ethnic minorities have suffered from political, economic, and social discrimination.
Somalia’s internal conflicts have been mirrored in regional tensions. Colonial boundaries, retained at independence, placed millions of ethnic Somalis in neighboring Ethiopia, Kenya, and Djibouti. Campaigns to unite all ethnic Somalis in one nation have led to multiple border conflicts and regional wars.
Somalia’s early attempts at democracy ended in 1969, when its second president was assassinated and Major General Mohamed Siad Barre seized power. The next year, he announced that Somalia would pursue a scientific socialist agenda, beginning with a massive public works program.
In the early 1970s, Somalia made significant strides in mass literacy, primary education, public health, and economic development, particularly in the rural areas. However, Siad Barre also suspended the constitution, banned political parties, and assassinated rivals. Like its predecessors, his government was rife with clan patronage.
A Cold War Battleground
Wary of Somalia’s socialist orientation, the United States had suspended economic aid, and the Soviet Union became the country’s main source of military and economic assistance. By 1976, Somalia boasted a 22,000-strong army, one of the largest in sub-Saharan Africa. Cuban technicians trained Somali troops, while Soviet and East German agents strengthened Somalia’s repressive National Security Service.
However, by 1977, the relationship with the Eastern Bloc had begun to fray. Moscow pursued another alliance on the Horn with a new military regime in Ethiopia after the revolution that ousted Haile Selassie. The Kremlin claimed that this government had stronger Marxist credentials than the Somali one.
Hoping to promote socialist unity throughout the Horn, Moscow urged Somalia to relinquish its claims to Ethiopian territory. Instead, Somalia invaded Ethiopia, and the Soviet Union threw its full support behind the latter.
The United States, meanwhile, hoped to use Somalia to thwart Soviet encroachment in the Horn. But it worried that open support would damage its relations with other African countries, which viewed Somalia as the aggressor nation in the conflict. Washington therefore offered little overt assistance. Instead, the CIA hired an arms dealer that supplied US-made weapons, and other agencies coordinated a flow of weapons through third parties.
This support proved to be insufficient. Without a significant source of external aid, Mogadishu was unable to sustain the war. In March 1978, it was forced to withdraw from Ethiopian territory. After Somalia’s departure, the United States reverted to a stance of public support for Siad Barre’s regime. By 1986, Mogadishu was one of the largest recipients of US military aid in sub-Saharan Africa.
US aid notwithstanding, Somalia was in dire straits by the mid-1980s. The cost of the Ethiopian war had combined with corruption and mismanagement to run the economy into the ground, dissipating the developmental achievements of the previous decade. Onerous taxes stimulated rural unrest, which was brutally suppressed.
Siad Barre imprisoned or killed his critics or drafted them into the Somali army, while collectively punishing their clan members and encouraging clan rivalry to disrupt his opponents. Members of Siad Barre’s own clan and their allies increasingly dominated his regime. By 1989, clans that had suffered from harassment or discrimination had united in their opposition to Siad Barre’s rule, as had Islamists, whom the dictatorship had also repressed.
Insurgency
In the north, the government had resettled a large number of war refugees on Isaaq clan land, and its policies threatened Isaaq economic interests. The Ethiopian-backed Somali National Movement instigated an insurgency in the region. In response, Somali military planes, piloted by white South African and former Rhodesian mercenaries, bombed the northern city of Hargeisa. Tens of thousands of Isaaq clan members were killed.
In the south, a Salafist study group, al-Itihaad al-Islamiya (Islamic Union), spearheaded Islamist opposition to Siad Barre. Most of the group’s members were students or faculty from Somali secondary schools and colleges or from the Somali National University. The massacre of 450 Islamist protesters in Mogadishu in July 1989 sparked the transformation of al-Itihaad from a nonviolent association calling people to the faith into a jihadist organization whose goal was to establish a single Islamic state, including populations in Somalia, Ethiopia, Kenya, and Djibouti.
By this time, the Soviet Union was entering a deep crisis. With Moscow weakening politically and economically, the United States no longer needed a regional policeman in the Horn, and the alliance with Somalia faltered. After the 1989 Mogadishu massacre, Washington expressed newfound concern for Siad Barre’s human rights abuses and suspended its economic and military aid.
Without US support, the Siad Barre government was an easy target. In January 1991, warlords and their clan-based militias overthrew his regime. Conflict between competing warlords destroyed much of Mogadishu in 1991–92. The central government collapsed, and Somalia lapsed into chaos.
Southern Somalia fractured into fiefdoms ruled by rival warlords who clashed with a resurgent Islamist movement. State institutions disintegrated, and nongovernmental actors had to supply basic services, if they were provided at all. Islamist organizations in particular played critical roles in restoring order and reestablishing social services.
After the Cold War
As the fighting intensified in 1991, war-induced famine, compounded by drought, threatened much of the population. Massive population displacement, the theft of food and livestock by marauding soldiers and militia members, and crop failure rendered 4.5 million people at risk of starvation. Warlords confiscated food aid and manipulated food supplies to reward their supporters, punish their opponents, and finance the purchase of weapons. By late 1992, some 300,000 Somalis had died from starvation and war-related disease and violence, while two million people had fled their homes.
Concerned about instability in this strategic region, the United States, backed by the United Nations, launched a multinational military intervention in 1992. Its mission was to ensure the delivery of humanitarian relief. The following year, another UN mission permitted US-led forces to disarm and arrest Somali warlords and militia members.
Both the UN and Washington took actions that favored warlord Mohamed Farah Aidid over his opponents. Civilians were caught in the crossfire. Many were killed in US airstrikes, including elders, clan and religious leaders, intellectuals, and businessmen, who were meeting to consider a UN peace initiative.
The massacres elicited a furious backlash from the population. Violent retaliation was directed against all foreigners, causing numerous relief organizations to withdraw from Somalia. US troops, in turn, increasingly regarded Somali civilians as hostile actors.
Although the delivery of food aid had been the priority of the US military in early 1993, it was not the objective eight months later. From late August to early October, the US armed forces were bent on capturing or killing Aidid and his top lieutenants. The final raid took place in October 1993, when US Army Rangers and Delta Force troops attempted to capture key leaders of Aidid’s militia in Mogadishu.
Aidid’s forces shot down two Black Hawk helicopters, which crashed into children in the streets below. Angry crowds attacked the surviving soldiers and their rescuers. Eighteen American soldiers and hundreds of Somali men, women, and children were killed in the ensuing violence.
Somalia’s “War on Terror”
In 1994, having stirred up a hornets’ nest, the United States hastily withdrew from Somalia. However, the emergence of al-Qaeda elsewhere in East Africa sparked new US concerns. The bombing of US embassies in Kenya and Tanzania in 1998, followed by the 9/11 attacks in 2001, led to increased US collaboration with Ethiopia, Somalia’s longtime nemesis.
Meanwhile, Somali Islamist groups had gained significant popular support by providing essential social services, including schools, medical care, and courts that brought some semblance of order to the war zone. Ignoring the reasons for the appeal of Islamism, Washington set out on a violent campaign to stamp it out.
In pursuit of this end, the United States banded together with Somali warlords and the Ethiopian government in 2004, helping outsiders impose a new government on the country — the fourteenth attempt to do so since Siad Barre’s ouster. A corrupt regime dominated by the clan of one warlord, it marginalized rival clans that controlled Mogadishu and purged the Parliament of opposition members. Surviving only with the protection of Ethiopian troops, the new government was unable to enter Mogadishu and controlled little territory outside its makeshift capital in Baidoa.
In 2006, Washington backed yet another warlord coalition to counter Islamist power and supported an Ethiopian invasion and occupation that lasted until 2009. Foreign intervention precipitated a domestic insurgency led by al-Shabaab, originally a youth militia organized to defend the Islamic courts, which quickly transformed into a violent jihadist organization that gained the support of al-Qaeda. By 2007, al-Shabaab had taken control of large swaths of central and southern Somalia, prompting the UN, the African Union, and neighboring countries to intervene.
The United States worked in the shadows, launching low-intensity warfare against al-Shabaab operatives, deploying both private contractors and Special Operations Forces to train and accompany Somali and African Union troops in combat operations. US drones and airstrikes killed key al-Shabaab leaders, who were rapidly replaced by others. As a result, al-Shabaab increasingly focused its attention on the West, targeting aid workers, journalists, and Somalis who worked with them.
Al-Shabaab’s Mutation and Survival
In 2012, outside forces once again imposed a new political dispensation, complete with constitution, parliament, and president. It was mediated by the UN, backed by the international community, and disavowed by large segments of Somali civil society, which had had little input into the process. Al-Shabaab was diminished but not defeated.
As it lost territory and revenues, the organization changed tactics, focusing increasingly on unprotected soft targets, including government offices, schools, hotels, and restaurants. When it was ousted from towns and cities and pushed to Somalia’s southern border, al-Shabaab attacked rural populations in Kenya’s North Eastern Province. Meanwhile, the presence of foreign troops battling al-Shabaab on Somali soil continued.
Today, al-Shabaab maintains its powerful foothold in Somalia in the absence of any functioning state apparatus. Although a new president was elected in May 2022 after a protracted political crisis during which the previous president had refused to hold elections, the central government still cannot provide basic services in the territories it holds.
There is no coherent national army, and the security forces, like the civilian government, are riven by clan-based factions who fight each other rather than al-Shabaab. Few Somalis believe that the new government will behave differently from its predecessors. They expect it to go on catering to corrupt elites rather than the majority of citizens and ignoring the grievances that ignited the insurgency
Meanwhile, the United States continues to wage a shadow war. In recent years, the nature of the US war has changed. The number of American feet on the ground has decreased. Instead of troops, the Barack Obama administration escalated the use of drones and airstrikes to kill al-Shabaab insurgents.
While this method diminished the number of US deaths, it slaughtered hundreds of Somali civilians. In 2013, Obama introduced restrictions intended to reduce civilian casualties, yet their impact was minimized by get-out-of-jail-free exemptions for cases of “self-defense.” The Donald Trump administration reversed this policy, reinstating more lenient guidelines for civilian deaths and intensifying attacks. Eventually, it withdrew most US forces in order to deploy them elsewhere.
A Persistent Presence
President Joe Biden’s May 2022 decision to increase the number of US Special Operations Forces has brought Washington’s policy full circle. The president announced that some five hundred US ground troops would return to Somalia to establish a “persistent presence.” The soldiers would train and assist Somali forces in counterterrorism operations, with the aim of killing a dozen extremist leaders deemed a direct threat to the United States, its interests, and its allies.
Justifying the move, Biden’s top general for Africa, Stephen Townsend, attested that al-Qaeda’s affiliate in the country had grown “bigger, stronger, and bolder” since the US departure in January 2021. After a decade and a half of US and African Union training, the Somali National Army was still unable to defend its territory.
How has foreign meddling shaped the Somalia of today? It has internationalized what had been a local conflict, strengthening violent extremist factions and precipitating al-Qaeda involvement. Far from containing the bloodshed, external intervention increased it, expanding the war to the extent that, by 2016, it included new players associated with the Islamic State.
Likewise, peace initiatives brokered by outside actors have repeatedly foundered. Large segments of Somali civil society — agricultural cooperatives, trade unions, women’s and youth groups — have been excluded from the bargaining table. Grassroots peacemaking and nation-building efforts have been ignored, and the interests of foreign governments and Somali elites have prevailed over those of ordinary citizens.
As a result, no negotiated settlement to the conflict has been able to garner popular support, and a succession of weak Somali governments have failed to provide services and security to its citizens. Refusing to address the grievances at the root of the conflict, the Biden administration, like every Democratic and Republican administration over the past century, has defaulted to the failed military policy of endless war. Somali civilians are paying the consequences.
Tara Houska. (image: Ayse Gürsöz/Education Images/Getty Images)
This Is Not a Climate Solution: Indigenous Land Defender Warns Senate Bill Will Aid Fossil Fuel Firms
Democracy Now!
Excerpt: "Mother Nature does not deal in U.S. dollars. That's my response."
We look at the Democrats’ sweeping $739 billion bill just passed by the Senate in part to address the climate crisis. Democrats in the Senate passed the Inflation Reduction Act on Sunday with votes from West Virginia’s Joe Manchin and Arizona’s Kyrsten Sinema, and the House will vote on the package Friday. The reason the bill exists at all is due to Senator Bernie Sanders and grassroots organizing to demand action on climate change, says Robert Weissman, president of Public Citizen. Indigenous lawyer Tara Houska says the bill’s climate provisions cede too much to Big Oil companies in pursuit of renewable energy. “Black and Brown people continue to disparately experience the effects of extractive industry,” she adds. Bishop William Barber, co-chair of the Poor People’s Campaign, says the bill contains too much compromise. “Part of the bill was putting a pipeline that Black and white and Brown and poor people in frontline communities are fighting right now,” he says.
MAJORITY LEADER CHUCK SCHUMER: The Senate has now passed the most significant bill to fight the climate crisis ever, and it’s going to make a difference to my grandkids. The world will be a better place for my grandchildren because of what we did today, and that makes me feel very, very good.
AMY GOODMAN: Many climate groups praised the Senate for taking action but said far bolder steps are needed to address the climate emergency. Varshini Prakash, the founder of the Sunrise Movement, tweeted, “This isn’t the bill my generation deserves but it is the one we can get. It must pass to give us a fighting chance at a livable world.” She went to write, “Youth leaders to Congress–Pass this bill, then get back to work.”
The Senate bill aims to cut U.S. carbon emissions by 40% by the end of the decade. But it also includes controversial provisions added to win support from West Virginia Senator Joe Manchin and Arizona’s Kyrsten Sinema. At Manchin’s request, the bill will make it easier for the pipeline industry to win approval of new projects, including the proposed Mountain Valley Pipeline in West Virginia. The bill could also lead to more drilling on public lands and waters and expand tax credit for fossil coal and gas-burning plants. The Center for Biological Diversity has described the bill as a “climate suicide pact.”
Still with us, Rob Weissman, president of Public Citizen. We’re also joined by Tara Houska, Indigenous lawyer and land defender, founder of the Giniw Collective. She is Ojibwe from Couchiching First Nation.
Tara Houska, can you respond to this bill, that many of the more mainstream environmental groups are declaring a great victory? You have the Sunrise Movement saying it’s not what they would have done, but it’s a beginning. Your response?
TARA HOUSKA: You’ve got a bill that in order to get access to renewable energy dollars and investments, upfront, the fossil fuel industry has handed off millions and millions of acres of public lands, of waters, side project deals where you see the rolling back of bedrock environmental law, all of this just to get investment into renewable energy. I mean, that is not a climate solution. Mother Nature does not deal in U.S. dollars. That’s my response.
JUAN GONZÁLEZ: And I wanted to ask you, Tara — the two main crafters of this bill, Senators Manchin and Majority Leader Chuck Schumer, both of them have received significant contributions from — according to The New York Times, from NextEra Energy, a utility giant that’s a stakeholder in the Mountain Valley Pipeline. Schumer alone has received more than $281,000 from NextEra just this election cycle. What does this tell us about the continuing role of the fossil fuel industry in crafting federal legislation?
TARA HOUSKA: It, to me, says you’ve got a project that has not passed environmental review. It’s a project that funders and investors are very concerned about. It’s a project that’s bad all the way around and just cannot get momentum and get it going. And here you see Congress just deciding, “Oh, you know what? We’re going to give it a pass,” and specifically this project, so, setting this precedent of, well, even if your project doesn’t meet environmental reviews, even if it’s not fiscally responsible, even if it’s not going to meet any standard of economic development, you still might get it through. That’s what this precedent is saying.
AMY GOODMAN: Let me play what West Virginia Senator Manchin had to say about this.
SEN. JOE MANCHIN: It has nothing to do with me, and it has everything to do not only with West Virginia but our country and the security and energy that we need. And that’s the bottom line. There’s not another project in America today that will bring this much energy within four to five months, within a half-year. There’s nothing that we can go to that will bring 2 billion cubic feet back into the marketplace.
AMY GOODMAN: The New York Times reports contributions to Manchin from natural gas pipeline companies dramatically increased, quote, from the “$20,000 in 2020 to more than $331,000 so far this election cycle.” Tara?
TARA HOUSKA: I mean, it’s doubling down on fossil fuels to get to renewables. And even the renewables, we have to acknowledge the fact that renewables themselves, it’s still going to be extraction. It’s still going to be the model that the fossil fuel and extractive industry wants, which is new mines in new places, which means our people, Indigenous people, which means Black and Brown people continue to disparately experience the effects of extractive industry. It means that mining companies are showing up in our backyard, taking out lithium, which is already happening in Thacker Pass. It’s already happening in other places. I mean, it’s — to get to the place that these folks are saying is a solution requires a lot of damage, according to them. That’s their climate crisis decision-making process, and it is sorely lacking.
JUAN GONZÁLEZ: Rob Weissman, I’d like to bring you back into the conversation. If you could talk — respond to some of the negative aspects in terms of climate on this bill, but also talk about the positive aspects? Clearly, there are all kinds of subsidies and enticements for renewable energy, but there’s also questions as to whether the industry already, especially the automobile industry, is not profiting from these rebates for electric cars by hiking the prices of cars.
ROBERT WEISSMAN: Yeah, there’s a lot in it. Look, I mean, there’s a lot that’s bad in it on the climate side and the energy side. Everything Tara said is absolutely right. I wouldn’t disagree with a word that she said.
There are a lot of good things in it. And, you know, the top line is it will reduce overall emissions, you know, from this 2005 baseline, from about 30% to 40%. That’s not nearly enough, but it’s consequential. And it’s consequential as opposed to the choice of doing nothing, which was unfortunately our alternative. There are a lot of good programs in here. There’s a lot of environmental justice-specific investments, billions of dollars for that, including, for example, money to decarbonize ports to reduce the diesel pollution that so badly affects communities around ports. There’s a lot of resilience money targeted for low-income coastal communities. And there’s big money to try to facilitate a rapid transition to renewables. So, there’s just a ton in there, and a lot of it’s really good.
But it’s absolutely right that the overall deal, because of Senator Manchin and, on this part, to a lesser extent, Senator Sinema, includes outrageous things that are completely counterproductive to the objective of reducing the climate crisis and absolutely will worsen both the problem of emissions and really focused harm on communities that have to deal with oil and gas extraction, with pipelines and, as Tara was saying, in mining. And those overwhelmingly are almost definitionally poor communities, communities of color, and often Native American communities, for sure.
AMY GOODMAN: Let me ask you, Rob, about what Senator Sinema extracted in order to get her support, Democrats agreeing to drop a proposal to raise taxes on private equity and hedge fund firms. You know, both of these senators, they feared, could torpedo this deal. But what about Senator Sanders torpedoing it from another direction, or threatening to, unless he, too, got concessions around the issues — well, everything from what Tara is raising to this issue of what Senator Sinema was demanding? If you could respond? I wanted to get Senator Bernie Sanders in here, his voice, speaking on the Senate floor this weekend.
SEN. BERNIE SANDERS: Mr. President, under this legislation, the fossil fuel industry will receive billions of dollars in new tax breaks and subsidies over the next 10 years, on top of the $15 billion in tax breaks and corporate welfare that they already receive every year. And interestingly enough, Mr. President, that may well be the reason why BP, one of the largest oil companies in the world, supports this bill. It may be the reason why Shell, another huge oil company, supports this bill. And it is the reason, I suspect, why the CEO of ExxonMobil is pleased by many of the provisions included in this bill. So we’ve got to think a little bit about what it means when major oil companies who are in the process of destroying the planet support this legislation.
AMY GOODMAN: So, if you could respond to what Sanders said? The difference between Sanders and Sinema and Manchin is he doesn’t hold the bill hostage, and unless he gets what he wants, support it. And if you could respond to that, everything from the fossil fuel companies he’s talking about to what Sinema got? Sinema has received more than half a million dollars in campaign donations from private equity group executives in this election cycle alone, representing about 10% of her fundraising from individual donors. This includes — I’m reading from the Financial Times — “donations totalling $54,900 from executives at KKR, $35,000 from Carlyle, [more than $27,000] from Apollo, [more than $24,000] from Crow Holdings Capital and [more than $23,000] from Riverside Partners.”
ROBERT WEISSMAN: Yeah, well, for the first part of the question, Bernie doesn’t have the leverage that Manchin and Sinema do, because they won’t go along with what he might have demanded. Any additional thing, they would have said, “Fine. No bill.” We know that for certain, because we thought there was going to be no bill just a few days before there was a bill. So, I don’t hold — I have no criticism for Bernie. I think he did everything he did. And I think if we step back, the reason this bill exists at all is because of the Sanders campaign for president and how he framed things at the get-go, at the start of the Biden administration. So, I think that the existence of all the positive things, the single — the person who has the most single credit for that is Bernie Sanders. I think those positive things are the reflection of grassroots movements across the country. And that’s why we got them. He did not have the leverage to get more than is in the bill.
On the part about Senator Sinema, you’re absolutely right. You’re referring to a special loophole in the tax system that makes it possible for some of the richest Wall Street actors, the people who run private equity firms and hedge funds, to pay a lower tax rate. It’s slightly complicated why, but that’s just what it — that’s what the loophole does. It’s called the carried interest rate. The industry itself knows there’s no conceivable policy justification for it. But they prefer paying less in taxes, so they do everything they can to keep it going. And it’s not — this is not for the companies; this is for the rich people at the top. They got Senator Sinema to carry water for them. And her price of agreeing to the bill was to take out a provision that would have partially closed this loophole. It was only partial, so giving it up is actually not as bad as it might seem. In exchange, it turns out, Schumer was able to extract something that was also important, very progressive, and raises more money, which is a 1% tax on share buybacks. So, at the end of the day, Sinema took care of her donors — a complete outrage — but that netted out for the American people something that’s more progressive in terms of the tax system, and, I guess, a net positive. But no excuse for what Senator Sinema did. Sinema — Manchin at least told the —
JUAN GONZÁLEZ: Rob — Rob, if we can —
ROBERT WEISSMAN: — [inaudible] about why [inaudible] harmful. She can’t say that about what she did.
JUAN GONZÁLEZ: Rob, if we can, I’d like to bring in Tara Houska, as well. The Inflation Reduction Act provides over $60 billion in funding for environmental justice priorities, something Rob Weissman mentioned earlier. Tara, was anyone in the environmental justice movement that you know involved in helping to craft this provision?
TARA HOUSKA: No. There’s been some pretty serious pushback regarding the lack of representation in the drafting of this bill, specifically on the pieces that affect our communities directly. You know, from my perspective, it doesn’t really work to throw money at us if we don’t have habitable places to live. So, if our communities are underwater or if our air is poisoned and we’ve got pipelines and mines and all the things that are destroying our lands actively, how is some investments in block grants supposed to help us? You know, those are really serious questions that this bill is lacking.
And to that one piece that was just said, too, about, like, where we’re at in terms of blocking the bill, you know, there is this side deal that Manchin has mentioned and that they promised him, right? Like, this is a handshake agreement about the permitting provisions, the rolling back of NEPA, the, quote-unquote, “streamlining” of bedrock environmental processes and designation of 25 different projects to avoid these reviews. That’s going back to the House, and they’re going to try to attach it to appropriations. So there still is something that can be done at the congressional level.
AMY GOODMAN: I want to bring into this conversation Bishop Dr. William Barber, co-chair of the Poor People’s Campaign and president of Repairers of the Breach. You tweeted on Monday about the reconciliation package, “While many politicians are applauding this compromise & it does some good things, it falls short of its promise & very short of addressing America’s most pressing economic problems.” If you can elaborate on that? And also, the Mountain Valley Pipeline, that Senator Manchin got revived and funded in this bill, goes from West Virginia through North Carolina, where you are.
BISHOP WILLIAM BARBER II: Thank you so much, Amy.
And yeah, one of the concerns I have, and many of us have, is how we keep applauding so much compromise. You know, compromise historically has been very problematic once you read the details. You know, it was compromise that made people three-fifths of a person and gave us an Electoral College. It was compromise on the 1964 civil rights bill that actually John Lewis and many others criticized, and he said it wasn’t doing what it actually said it was going to do to — necessitated the ’65 Voting Rights Act. And I could go through history. So, history has taught us that when politicians get in a compromise, we must really look at what was put in, what was put out.
It is very possible to celebrate the good things in this bill, the historic investment in climate issues and the green bank and economic environmental justice. But you have to at least say, “Wait a minute. Part of bill was putting a pipeline that Black and white and Brown and especially poor people in frontline communities are fighting right now, from West Virginia through Virginia and North Carolina.” We’ve already beat two of those from coming in communities, one in Tennessee and one in North Carolina. And what do those pipelines do? How dangerous are they? Who is it really going to help? Is it going to benefit everyday people and working-class people and poor people? Is it going to benefit corporate interests?
We also, Amy, have to say, “Wait a minute. While we can celebrate some things, we have to honestly say what’s not a part of this bill, so that we don’t act as though this is an end, this is like a dunk, if we’re in basketball, game over.” No, we have to wrestle with what is wrong with our politics when, in order to get something good, you’ve got to give up universal pre-K, you’ve got to cut child care, you have to cut elder care, you have to cut child tax credit from the bill, and money for public housing, affordable housing from the bill, you have to cut the expansion of earned income tax credit from the bill, you have to cut closing the Medicaid gap from the bill, you have to cut the millionaire surtax from the bill.
And then we saw all of this work — 20 hours one day, 20 hours another day — but we only get one vote on restoring the Voting Rights Act, one vote on the John Lewis bill, which Manchin actually said, while John Lewis was living, that he would sign off on, that he agreed on, that he told people when he was running that he supported. We haven’t had — we haven’t gotten a living wage. Manchin said he was for a living wage when he ran. So did Sinema. All of these things had to be pushed away and pushed down in order to get this.
So, we have to honestly say what is historic, but we also have to say what is problematic. That is our constitutional right. That is our moral right. And because 90% of the things that were cut out will hurt poor people, low-wage people and low-wealth people, who represent 140 million people in this country, 30% of the electorate overall and 45% in some battleground states, we have to address this. And it is a real — it is a problem that has always been in the midst of American politics.
You know, Dr. King got talked about a lot when he said that moderates were the worst enemy of the civil rights movement, because they were more interested in compromise and order than they were in reordering the society. And we still have to have that critique today. Some don’t like it, Amy, when you say it.
But, you know, Amy, I come out of a sports background. And when I played football and when I watch basketball, if you win a championship seven-game series, you didn’t win one game and then say, “Series over.” You did not really jump and applaud until you won all four games. Democrats should say, “Look, this is what we were able to do with 50 votes in the Senate and two renegade senators. Give us 54 votes or 55 votes, and we will get the rest of it done.” But you can’t just celebrate what was done and leave, no conversation about all of these other things that matter so much in the life of poor, low-wealth people in this country, because to do so is morally inconsistent, constitutionally inconsistent and economically insane.
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