Category Archives: nevada health

Caveats and The Unspoken Big Lie

So, we have two sources telling us that approximately 24 to 26 million people will lose their health care insurance if the Republicans are successful in jamming through their tax shift proposal masquerading as a ‘replacement’ for the Affordable Care Act.  Therefore, it’s now time for a new ‘talking point’ from the GOP, especially since some Republicans like Rep. Mark Amodei are on record saying:

When asked what his plan for a change to Obamacare would be, Heller said, “If you like your health care, you can keep it,” a statement that echoes a promise from Obama that later ended up being false.  Amodei said he would not vote for any plan that resulted in reduced coverage for anyone.  “No, I don’t think you can say forget it, we’re going to let them be uninsured because as a practical solution, that’s not an answer and somebody ends up paying in the end anyhow,” Amodei said. [RGJ 2/22/17]

Well, now we know with some certainty that the GOP replacement bill will result in reduced coverage, and some people and families will be uninsured.  How to escape this trap? A new talking point!

“No one will lose their coverage.” 

The HHS Secretary Tom Price, whose replacement would have cost some 18 million their insurance, opined:

“Success, it’s important to look at that,” he said. “It means more people covered than are covered right now at an average cost that is less. I believe that we can firmly do that with the plan that we’ve laid out there.”  Not exactly.

Then, there was Pete Sessions, a Republican from Dallas, telling his listeners:

“Nobody is going to lose their coverage,” Sessions, chairman of the House Rules Committee, told CNN. “You’ll be able to keep your same doctor, you’ll be able to keep your same plan.”

A spokeswoman for the congressman later explained that Sessions meant Americans will have the choice whether to obtain or maintain coverage — not that the GOP bill would take coverage away. The American Health Care Act would nix the ACA mandates requiring Americans to have health insurance.” [DMN]

And, there it is, the Big Caveat, which makes taking health insurance away from working American all AOK.  You can “choose” to keep your health insurance! IF and ONLY IF you can afford it. ?

However, even IF you can afford it, the policy you can purchase may not be truly comprehensive. A young person may have to get additional insurance if he or she marries and there is a pregnancy in the plans. More cost. A plan may not cover preventative care? Or mandatory coverage for cancer screenings?  More cost.  It doesn’t take too long to add up the extras until what has been basic coverage becomes optional coverage. Then the risk pool is reduced and the premiums go up. That is how insurance works. The larger the risk pool the lower the premium costs.

Thus, “you can keep your health insurance” IF:

  • You can afford it in the first place, not likely if you are among the low wage workers in this country.
  • You can afford it and are willing to accept lower levels of coverage, and you don’t mind having to pay for additional services for additional  premiums.
  • You are willing to shop for insurance coverage every time the circumstances of your life changes; as in pregnancies, pre-natal care, caring for a special needs child, a family member needs rehabilitation or mental health care.
  • You are willing to see your local, and especially rural, hospitals see higher levels of uncompensated care.
  • You are willing to accept that your doctors and other health care professionals will see less reimbursement for services rendered.
  • You are willing to forego coverage for preventative screening and treatment for medical conditions.

Access to health insurance isn’t the same as having health care insurance.  As the now commonplace tweet has it: “I have access to a Mercedes Benz dealership — that doesn’t mean I can afford to buy something of their lot.”

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Who loses their ACA marketplace health insurance in Nevada?

Interesting numbers from the Kaiser Family Foundation on the people in Nevada’s congressional districts who have health insurance through the ACA exchange.

District 1, represented by Rep. Dina Titus (D) as of December 2016, about 19,300.

District 3, represented by Rep. Jackie Rosen (D), 19,300.

District 4, represented by Rep. Rubin Kihuen (D), 18,700

And, the District with the most people who stand to lose their marketplace coverage with the repeal of the Affordable Care Act?  District 2, represented by Rep. Mark Amodei  (R) with 22,500 who have purchased their insurance through the ACA exchange.

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And so it begins

The Senate yesterday began the process of dismantling the Affordable Care Act.  With no replacement on offer.  With no publication of a plan to make it possible for every American to purchase health care insurance.  Please write or call your Congressional Representatives.

The Trumpster said Director Clapper called him to denounce the release of information about his possible compromise by Russian agencies.  No, the Director called to say the agencies had issued no conclusions.  Another day another lie. We need a select committee investigation into Russian activities in the 2016 election. Please write or call your Congressional Representatives.

Please keep writing. Please keep calling.

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There they go again! GOP assault on Medicaid

It’s no secret the Republicans in Congress want to slash the social safety net. It’s also no secret Medicaid has been one of the favored targets for years.  The not-so-new-idea of late is to fund the program based on block grants.  There are some strong arguments against this:

(1) Block grant funding is set. Should a state have program costs exceeding the block grant funding one of two options are available – either appropriate state funds to make up the difference, or cut back on services or eligibility.

(2) The traditional match rate has been 50%, meaning that the state is insulated to some extent from unexpected cost increases and thus can ensure health insurance coverage for low income residents.

(3) When baffled by actual numbers, Republicans often return to the high-flying rhetoric about making the program more “flexible” under state control.  No. In reality the states already have that “flexibility” in terms of services covered, ways providers are paid for those services, the delivery of services, and eligibility levels.  [FUSA pdf]

Those who could see their health care access cut if Medicaid becomes a block grant program are those in Nevada who are earning $16,105 per year for an individual, or $32,913 for a family of four. (2014)  The ACA expansion of Medicaid allowed the state to add approximately 187,100 low income workers to the benefits.  Repeal of the ACA would obviously jeopardize this expansion, and cost the state approximately $1 billion in federal funds. [KFF and FUSAorg]

Consider for a moment that about 160,700 people in Nevada are employed in “accommodation and food services” jobs in which the average (mean) wages are $25,360 per year, the 10th percentile wages are approximately $16,450.   Or, we could look at health care support services with 18,860 employed at average (mean) wages of $33,900 with $22,470 at the 10th percentile and $26,500 at the 25th percentile.  [DETR]  Not to put too fine a point to it, but slashing Medicaid in Nevada would quite possibly have a negative effect on the ability of those employed in “accommodation and food services” to access health care, and these are the people who  work in one of Nevada’s major industries.  Home health care personnel wouldn’t fare much better.

When all else fails the Republicans haul out the “bankrupt system” allegations.  To the contrary, the Medicaid expansion has been a definite benefit to Nevada and other states:

    • CBO estimates show that the federal government will bear nearly 93 percent of the costs of the Medicaid expansion over its first nine years (2014-2022).  The federal government will pick up 100 percent of the cost of covering people made newly eligible for Medicaid for the first three years (2014-2016) and no less than 90 percent on a permanent basis.
    • The additional cost to the states represents a 2.8 percent increase in what they would have spent on Medicaid from 2014 to 2022 in the absence of health reform, the CBO estimates indicate.
    • This 2.8 percent figure significantly overstates the net impact on state budgets because it does not reflect the savings that state and local governments will realize in other health care spending for the uninsured.  The Urban Institute has estimated that overall state savings in these areas will total between $26 and $52 billion from 2014 through 2019.  The Lewin Group estimates state and local government savings of $101 billion in uncompensated care.  [CBPP]

A further note about uncompensated care, we need to look at the example of Pennsylvania and its latest report on the impact of expanded Medicaid and the Affordable Care Act:

“For the first time in a decade, Pennsylvania’s 170 general acute care hospitals in 2015 saw a drop in charity care spending, saving the average hospital about $200,000 over 2014, according to state data obtained by the Pittsburgh Post-Gazette.

Coupled with a nearly $300,000 drop in bad debt at the typical hospital, hospitals saved about $500,000 on uncompensated care in 2015, according to data from the Pennsylvania Health Care Cost Containment Council.

The state hospital association and patient advocates alike believe the drop in spending on charity care and bad debt is due to the impact of the Affordable Care Act, which is what experts said they believed caused a similar drop for the 24 states that adopted the ACA in 2014, as reported in the Post-Gazette series, Counting Charity Care, last year.”  [PPG]

Thus, in their ardor to repeal the Affordable Care Act and slash Medicaid support by turning the program into a block grant disaster, Representative Amodei (R-NV2) and Senator Dean Heller (R-NV) may need to explain:

(1) Why reducing support for a program which serves the least well remunerated among us – especially in one of our major industries – is a bright shining idea?

(2) Why eliminating programs which reduce uncompensated care costs to local hospitals and health care providers is also such a great notion?

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Happy New Year Nevada: Here’s what we lose if the ACA is repealed

Perhaps we should now speak of two varieties of what was formerly known as the “Fog Of War.”  The older form is often attributed to Carl von Clausewitz (but never verified), the Nebel des Krieges, or the “uncertainty in situational awareness experienced by those engaged in military combat.”  Then there seems to be a more modern form, in which the Republicans fight against “Obamacare” and promise to Repeal and Replace it without inconvenience to anyone.  Or, the uncertainty of what to do when the fight stops being strategic and starts being ever so inconveniently tactical.

One of the elements that is truly popular is the ACA provision forbidding insurance companies from denying coverage because of a person’s medical history (the pre-existing condition provisions in policies).  69% of the country favors this provision including 75% of Democrats, 65% of Republicans, and 63% of independent voters. [KKF]

Perhaps this is a popular feature of the Affordable Care Act because 25% of Nevada’s non-elderly population, or 439,000 people  could be denied health insurance coverage if the pre-2010 rules were re-established for health insurance companies. [KFF]  If a person is without health insurance the problems are well documented.

“Lack of health coverage, even for short periods of time, results in decreased access to care.  Adults with gaps in their health insurance coverage in the previous year were less likely to have a regular source of care or to be up to date with blood pressure or cholesterol checks than those with continuous coverage.16 Children who are uninsured for part of the year have more access problems than those with full-year public or private coverage.17” [KFF] (emphasis in the original)

The pattern from this point on is predictable.  No health insurance, less likelihood of consistent care, less care begets more serious health problems, and more serious health problems are more expensive, especially if treatment is deferred until the emergency room is required.    MEPS has some 2013 data which is on point:

“Average expenses for people who had one or more visits to the Emergency Room were $1423 in 2013, according to the Medical Expenditure Panel Survey (MEPS). Median, or typical, cost was $703. For people ages 45 to 64, the cost was substantially higher on average ($1840). Uninsured people under age 65 averaged $1627 in expenses ($572 median), of which they paid almost 1/3 out of pocket. While average cost for those age 65 and up was about $1500, Medicare recipients paid only about 5% out of pocket. Median charges for children under age 18 were $471 to $477.”  (Full chart here)

The standard Republican response is that people ought to have Health Savings Accounts, and/or pay more out of pocket. [PUSA]  Therefore, our 439,000 Nevadans would be on the hook for emergency room treatment of approximately in the range of $703 to $1423.  Uninsured children? The parents would be liable for costs of at least $471 for that rash, laceration, abrasion…whatever the little critter managed to do to itself.  It’s all well and good to babble on about some theoretical notion of Personal Responsibility, but …

Health Savings Accounts and High Deductible Health Plans aren’t for everyone.  For example, the median household income in Nevada is $51,847 and the average household has 2.72 people.  The average mortgage payment is $1,442, and average gross rent is $973. [Census] Those in Clark County can expect to pay out $177.22 per month on utilities, and another $352.74 on groceries (at least) per month. 

We played with some of the numbers back in 2015, and the pressure on average families in the Silver State was obvious then:

“For the sake of the argument let’s propose that the family has one car, which means  ownership costs of $517.00, and operating costs in the western region of $236.00 per month. [IRS] Subtract another $753 from the monthly budget. Now we have $1,848 left for the remaining expenses.

Basic utilities in Las Vegas run about $175.56, and in Reno about $130.00; let’s call it in the middle and estimate monthly utility bills of $150.00; now we have $1,698 in the check book.

Now for the groceries.  A family of four can just get by on about $146 per week and eat healthier on about $289 on the higher end. [USDA pdf] Let’s settle for the “moderate” plan which will cost our average family of four about $1,062 per month if the kids are over 6 years of age.  Now there’s $636.00 left.”  [DB]

Without too much more arithmetic it should be clear that High Deductible Health Plans and Health Savings Accounts are a nice idea if (1) a person is generally healthy with no family history of serious illnesses; and (2) a person is wealthy enough to afford to put aside “extra” money each month for the Health Savings Account.  Return with us now to elementary school arithmetic.

We’ve been speaking of households in terms of their Median household income. So, we know that half the households in Nevada are earning less than $51,847 per year.  We also know that 14.7% of Nevadans have incomes below the poverty line ($24,250 for a family of four in 2015).  We also know that 22.8% of Nevadans under the age of 65 and below 138% of the poverty line did not have health insurance at any time during 2015. [TP.org]  Speaking about an HSA to those whose households are trying to function with incomes below the median and barely above the poverty line seems almost cruel.  It doesn’t do to bellow “personal responsibility” when the individuals and households in question don’t have the “personal resources” to meet this exalted standard.

It’s perhaps even more cruel to imagine the days when an insurance company in this or any other state could decline coverage for previous treatment of: alcohol or drug abuse Alzheimer’s or dementia, arthritis, cancer, cerebral palsy, congestive heart failure, coronary artery disease, Crohn’s disease, pulmonary disease, diabetes, epilepsy, hemophilia, hepatitis, kidney disease or renal failure, lupus, mental illness, multiple sclerosis, muscular dystrophy, obesity, organ transplant, paraplegia, paralysis, Parkinson’s disease, pending surgery or hospitalization, pneumocystic pneumonia, pregancy, sleep apnea, or strokes. [KFF]

Yet, this is precisely what the Republican Congress has in mind … repealing the Affordable Care Act, with it’s protections for those with pre-existing conditions and replacing it with … something…. somehow … some way… in some form… when the only two definitive responses have been “using the emergency room,” and “HDHP + health savings accounts.”  In short, back to the bad old days.

No more light on the subject, just more Nebel des Krieges from the Republicans, including Representative Mark Amodei (R-NV2) and Senator Dean Heller.  It would be well for them to blow off some of the fog and illuminate precisely what they want to do.

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Physicians Could Use A Bit Of Healing in Nevada: Opioid Prescription Problems

oxycontin  The Reno Gazette Journal has done a piece of highly recommended reporting – an in-depth account of opioid prescribing in Nevada.

“…a Reno Gazette-Journal analysis of DEA data showed that for certain drugs, Nevada ranks among the highest in the country.

Take oxycodone, Nevada’s most widely prescribed opioid. In 2012, nearly 1.04 million grams was distributed via retail in the state. That’s more than double what doctors prescribed in 2006. Nevada’s distribution rate is third highest in the country.

Nevada also ranks third for its hydrocodone distribution rate. In 2012, doctors prescribed more than 799,000 grams of hydrocodone — nearly three times the rate of New Jersey, which has triple Nevada’s population.”

OC pill There are some important points to take away from the article.  One of the first is that physicians, themselves, have opposed greater oversight of opioid distribution to patients, specifically in regard to SB 459.  One physician testified to the Assembly Committee on Health and Human Services that SB 459 sections 1-12 should be adopted, but the rest of the bill including reporting and medical education requirements should be dropped because it wouldn’t prevent overdoses. [AHHS pdf] Another doctor offering testimony “went there,” comparing the regulation of opioids to Nazi Germany:

“When people come to Las Vegas and need surgery or have chronic conditions and they hear that the climate here is like Nazi Germany in terms of regulations, the tightening of prescription pain medications, and the prosecution of doctors, it has a very chilling effect on these people who need those medications. […] there are folks who have chronic pain. I am an internist and I see this every single day. I sit there arguing with them about cutting their medications down and they start crying and throwing a fit because they need it.”  [AHHS pdf]

He continued:

We pull the DEA reports now and, as a private practitioner with a two- or three-man office, it creates a lot of extra work for my staff and more
documentation. It makes me pause every time I start to write a script for any controlled substance; I should not have to feel like that. At the end of the day, the doctor and the patient have the relationship, not the government in the middle. Doctors should be the ones who decide what is best for their patients. This bill has a chilling effect on that. [AHHS pdf]

The good news is that the language requiring that a doctor check the prescription drug monitoring database before writing a prescription for a narcotic to a new patient was retained in the bill.  However, the testimony presented should cause some alarm from members of the general public.

OC pill

As the article points out, a state with one third of the population of another probably shouldn’t be prescribing three times the amount of narcotic painkillers.

The argument that the state legislature shouldn’t try to do something to mitigate the problem if the proposal won’t fix the entire problem sounds altogether too analogous to the NRA’s arguments for doing absolutely nothing to prevent guns getting into the hands of felons, fugitives, and domestic batterers.  “If it doesn’t solve the whole problem, then it shouldn’t be done.”  The second piece of testimony is, itself, chilling.

Hyperbole rarely provides productive content in a civic discussion, and Godwin’s Law applies.  Bring up Hitler, and the audience moves along assuming the argument has been abandoned.  Secondly, it’s a bit more than disturbing that a licensed physician would be argued into prescribing medication he or she knows is deleterious or even dangerous for a given patient.

OC pill

No one wants the Hot Potato.  The state pharmacy board doesn’t want to use its database to flag doctors who are over-prescribing narcotics.  Their director: “Who’s to say what’s normal or what’s OK,” Pinson said. “It might be appropriate for a physician to be prescribing a ton of narcotics according to his specialty.” [RGJ]  It might be, and then again, it might very well not be. And the Board of Medical Examiners isn’t enthusiastic about clearing out their ranks either:

“It would be inappropriate, and it’s not the intent of the (prescription monitoring program), to find cases to investigate,” said Edward Cousineau, executive director of the Board of Medical Examiners, which licenses medical doctors and investigates malpractice complaints in the state.” [RGJ]

Again, we might ask: Why isn’t it appropriate to weed out physicians who are creating a situation in which Nevada is among the top five states for opioid pushing? Perhaps the next session of Nevada’s Assembled Wisdom will find the intestinal fortitude to (1) require that the Pharmacy Board use its drug monitoring database to look for BOTH doctor shopping patients and pill pushing physicians; and (2) more thoroughly investigate drug overdose deaths. 

OC pill

Kentucky, Tennessee, Texas, and Arizona have enacted such legislation. [RGJ] Nevada should join them.

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Local Water, the EPA: Beyond Goodsprings

Water Faucet EPA

The Reno Gazette Journal reports that there are 23 local water systems in Nevada which are not in compliance with drinking water standards (there are currently 22, but more on that later).  Three local systems listed in the article have lead contamination levels exceeding the lead standard, 15 ppb (parts per billion) as the “action level.”  The public needs this information. However, the agency responsible for establishing the maximum contaminant level (MCL) standards is the whipping boy of choice for the Republican Party.  In short – it really doesn’t do to get up in arms about water or air pollution levels and then call for the abolition of the Environmental Protection Agency.

The regulatory system isn’t all that complicated. The EPA establishes the standards and then it’s up to the states to devise the implementation.  There’s a reason for this. Setting national standards means that states can’t compete in a ‘race to the bottom’ in which some states seek to attract industry by lowering standards until they are in competition to achieve the status of “Worse Than Any Pig Would Ever Consider in a Sty.”  And, potentially damaging everyone else’s air and water in the process.  However, this hasn’t stopped Over-Hyped Demagogue Donald Trump from calling for handing over environmental regulation to the individual states.  [WaPo]

Nor has this made much of an impression on Seven Mountain Dominionist Ted Cruz; “Cruz has called the EPA a “radical” agency that has imposed “illegal” limits on greenhouse gases from power plants. “I think states should press back using every tool they have available,” the Texas senator has said. “We’ve got to rein in a lawless executive that is abusing its power.” [WaPo]

Ohio Governor John Kasich has been critical of the Michigan attempts to address its man-made, GOP inspired, water quality issues in Flint, MI, but hasn’t been on top of the situation with the Sebring, OH water contamination. [TP]

The 2008 Republican national platform was exceptionally mealy-mouthed about environmental protection:

“Our national progress toward cleaner air and water has been a major accomplishment of the American people. By balancing environmental goals with economic growth and job creation, our diverse economy has made possible the investment needed to safeguard natural resources, protect endangered species, and create healthier living conditions. State and local initiatives to clean up contaminated sites — brownfields — have exceeded efforts directed by Washington. That progress can continue if grounded in sound science, long-term planning, and a multiuse approach to resources.”

It’s not likely that much more will come from a 2016 version.   Nor should we expect much in the way of support for addressing the national problems associated with our drinking water systems.  Remember the ASCE’s Report Card on American Infrastructure (2013)?

“At dawn of the 21st century, much of our drinking water infrastructure is nearing the end of its useful life. There are an estimated 240,000 water main breaks per year in the United States. Assuming every pipe would need to be replaced, the cost over the coming decades could reach more than $1 trillion, according to the American Water Works Association (AWWA). The quality of drinking water in the United States remains universally high, however. Even though pipes and mains are frequently more than 100 years old and in need of replacement, outbreaks of disease attributable to drinking water are rare.”

Not to put too fine a point to it, but as a nation we’re running on a Run-to-Ruin system in which local water distributors are functioning with outdated infrastructure while trying to maintain acceptable levels of quality.  Goodsprings Elementary School offers us an example of what can happen given a 1913 building and 21st century water quality standards. [RGJ]  If Goodsprings was an isolated example, then we could address the aging pipes and move on, but it’s not that isolated, nor that uncommon.  Current EPA estimates indicate we are having to replace between 4,000 and 5,000 miles of drinking water mains in this country on an annual basis, and that the annual replacement rate will peak sometime around 2035 with 16,000 and 20,000 miles of aging pipe needing to be replaced each year. [ASCE]

Putting The Public Back In Public Utility

I am going to start with some basic assumptions. First, that a family or person should be able to move to any part of this great land and expect to find clean water running from the faucet.  Secondly, that it is not a good idea to allow individual states to set drinking water standards, since some might find it inconvenient or inexpedient to set scientifically reliable standards in the interest of “development” or “industrialization.”  Such a piece meal approach would put paid to the first basic assumption.   So, if we’re agreed that any person in this country should have a reasonable expectation of clean drinking water then we need national standards.

Some of the standards are easier than others.  Arsenic contamination levels offer an example of a complex problem with some nuanced related issues.  The MCL (maximum contaminant level) for arsenic was lowered in 2001 from 50 ppb to 10 ppb. Public water systems were to be in compliance by January 23, 2006. [EPA] [More information at FAS pdf] The Reno Gazette Journal reports ten Nevada water systems not in compliance.  One, the McDermitt GID has recently been declared in compliance with a current projected annual running average below 10 ppb after the system put in a new central well.

Arsenic enters the drinking water systems one of two ways, either through industrial activity or as a naturally occurring contaminant.  If the system is west of the Rocky Mountains it’s a reasonably good bet that the arsenic is naturally occurring.  It’s probably not too far off the mark to say that if the standard were set at 15 ppb most Nevada water systems would be in compliance, but the standard is 10 and that’s ultimately what matters.

The smaller public water systems have more trouble meeting the standards than the larger ones, as described by the BSDW:  “The smaller systems are the ones that tend to struggle with regaining compliance because they typically have limited financial resources so we have to collectively figure out ways to help that community get back to compliance,” said Jennifer Carr, NDEP deputy administrator. “Larger systems such as TMWA also have more personnel to tackle projects whereas some of our smaller water systems are operated by one person who might be doing another side job.” [RGJ]

And, now we’re down to the gritty part: Where does the money come from to resolve contaminant problems with arsenic? Or, for that matter, other water infrastructure issues?    The State Revolving Fund provides low interest loans for water infrastructure projects in the state; and can in some circumstances offer “forgiven” loans to small public water services.  The “bottom line” is that in 2016 there will be a need for approximately $279 million for arsenic treatment, groundwater treatment, storage tank replacements, metering systems, and distribution lines in Nevada.  And, the worse news, “Not all will be funded.” [KTVN]

The Drinking Water State Revolving Fund was created in 1996 to support water systems and state safe water programs.  “The 51 DWSRF programs function like infrastructure banks by providing low interest loans to eligible recipients for drinking water infrastructure projects. As money is paid back into the state’s revolving loan fund, the state makes new loans to other recipients. These recycled repayments of loan principal and interest earnings allow the state’s DWSRF to “revolve” over time.”  [EPA]   As of 2014 this system had provided $27.9 billion to water suppliers to improve drinking water treatment, improve sources of drinking water, providing safe storage tanks, fixing leaking or aging distribution pipe, and other projects to protect public health. [EPA] The EPA estimates that small public water systems nationwide, those serving populations less than 3,330,  will need approximately $64.5 billion for infrastructure needs. [EPA 5th report pdf]

What was the Republican controlled Congress’s response? They may have avoided a shutdown, but the waters weren’t exactly flowing:

The bill provides $863.2 million for the DWSRF  well below President Obama’s request of $1.186 billion and more than $40 million below the programs FY2015 appropriation.While the figure represents the lowest DWSRF appropriation in several years, it is significantly above the FY16 funding levels originally proposed by the House and Senate Appropriations Committees, each of which would have cut DWSRF funding to below $780 million. [UIM]

What have we learned?

  • The Republican candidates for the presidency show little to no enthusiasm for infrastructure investments in general, and beyond bemoaning the state of Flint’s water system which must be someone’s fault “just not ours,” even less enthusiasm for funding local drinking water improvement projects.
  • The Republicans in Congress were only too happy to cut funding for the best source for local public water companies projects, in the name of “fiscal responsibility” – meaning, one could think, that preserving tax cuts for the rich is preferable to providing clean drinking water to everyone.
  • The infrastructure needs in this country are serious and go well beyond fixing bridges and filling pot-holes.  This, and we’ve not yet reached the peak of distribution line replacement needs coming up in the next 20 years.
  • “Austerity” is a lovely buzz word, and “We’d love to do it but we just can’t afford to” is a fine campaign trail stump speech phrase, but these won’t keep the water coming from the tap clean and safe.  We need to stop thinking of our infrastructure as an expense and begin to consider it for what it is – an investment; an investment in the capacity of our cities and towns to provide basic services so that economic activity can take place.
  • And, NO it isn’t a good idea to abolish the EPA.

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