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The Fix Is In; Paragon’s Work on Public Health, Long-Term Care

President at Paragon Health Institute
Brian Blase, Ph.D., is the President of Paragon Health Institute. Brian was Special Assistant to the President for Economic Policy at the White House’s National Economic Council (NEC) from 2017-2019, where he coordinated the development and execution of numerous health policies and advised the President, NEC director, and senior officials. After leaving the White House, Brian founded Blase Policy Strategies and serves as its CEO.

Good morning,

In today’s newsletter, I discuss the shameful conclusion of the regulatory process around the so-called “family glitch” and highlight Paragon’s work on public health and long-term care. 
The Fix is In
In a piece published this morning in Forbes, I recount the end of the shameful regulatory process around the Internal Revenue Service’s family glitch fix rule. The White House concluded review of the final rule last week without having met with experts who raised serious concerns with the rule, as is required under Executive Order 12866. 
As numerous members of Congress and other people have pointed out, the proposed fix lacks legal basis and is poor public policy. The main effect from this illegal fix: employee dependents enrolled in employer group coverage will replace that coverage with a subsidized exchange plan. The cost of the rule will likely exceed $40 billion over a decade and the number of people with health insurance will marginally decline. 
The Forbes piece discusses both the problems with the rule as well as the process that locked out experts from providing pertinent information to the Office of Information and Regulatory Affairs (OIRA) and the Office of Management and Budget (OMB). The piece includes the statement I had intended to provide to OIRA and OMB had they not canceled two scheduled meetings with me, Tom Miller of the American Enterprise Institute, Doug Badger of The Heritage Foundation, and Grace-Marie Turner of the Galen Institute. Here is what Tom Miller planned to say. Here is what Grace-Marie Turner planned to say. And Doug Badger was going to summarize the main argument he made in his comment letter on the proposed rule.
The agencies lack the statutory authority to extend Obamacare subsidies as the rule proposes, and the proposal had numerous serious deficiencies, including a lack of a real cost-benefit analysis and the failure to adequately consider the effects on states and small businesses. 
Here is how I had intended to conclude my statement to OIRA during the meetings which were canceled: 

Given the wide range of process, policy, and legal concerns with this regulatory action, OIRA and OMB have much work to do. At a minimum, OIRA and OMB have the responsibility to do a serious vetting of regulations and ensure that they comply with various procedures regardless of any political timetable. The political staff in the White House are undoubtedly pushing for this rule to be finalized in time for open enrollment and the midterm elections, enabling them to spin this “fix” as a win for families. Those arbitrary political timetables should not dictate whether OIRA and OMB are able do a real review of the legal, policy, and process deficiencies with this proposal, and they must insist that established procedures are followed. 

Zinberg on the FDA’s Problematic Salt Guidance

Writing in City Journal on October 7, Paragon’s Public Health and Well-being initiative director Dr. Joel Zinberg recommended that the Food and Drug Administration withdraw guidance it issued a year ago on sodium and go through a better process to make sure the ultimate guidance is scientifically sound. According to Joel, “the FDA failed to conduct a peer review” or “acknowledge considerable uncertainty in the field.” From Joel’s piece:

A 2020 review of randomized controlled trials—the gold standard for scientific studies—assessing the effect on blood pressure and potential side effects of reducing salt intake by the highly respected Cochrane Library found a minuscule (0.3 percent) decrease in blood pressure in white people with normal blood pressure and a small decrease (about 3.5 percent) in people with elevated blood pressure. A few trials suggested these effects may be somewhat greater in black and Asian people. But these minimal benefits carried health costs. Sodium reduction resulted in significant increases in cholesterol and triglycerides—both associated with cardiovascular disease—which were more consistent than the blood pressure declines, especially in non-hypertensive people.
Instead of targeting sodium reduction at the hypertensive population most likely to benefit, the FDA guidance prescribes it for everyone. And the guidance fails to distinguish between people with high sodium intakes and those with normal or low sodium intakes.
Multiple studies suggest that low sodium intake can be just as detrimental as high sodium intake, leading to increased risk of cardiovascular disease and death in “those with or without hypertension.”

Long-Term Care—The Problem 
Last week, Paragon released a paper authored by long-term care (LTC) expert Steve Moses, detailing the many problems with our nation’s LTC policy. These problems include large and growing government spending on LTC, low-quality care received by many people with LTC needs, and difficulty of finding health care workers to provide LTC services. The root of these causes: the ease with which people can qualify for Medicaid to pay for their LTC needs, which discourages proper planning and crowds out private financing and alternatives. While Paragon will be releasing a solutions paper early next year, it is crucial that policymakers first understand the problems that government policy has caused in our LTC system. 

All the best,
Brian Blase
Paragon Health Institute

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