Alice Ollstein

Alice Ollstein is a reporter at Talking Points Memo, covering national politics. She graduated from Oberlin College in 2010 and has been reporting in DC ever since, covering the Supreme Court, Congress and national elections for TV, radio, print, and online outlets. Her work has aired on Free Speech Radio News, All Things Considered, Channel News Asia, and Telesur, and her writing has been published by The Atlantic, La Opinión, and The Hill Rag. She was elected in 2016 as an at-large board member of the DC Chapter of the Society of Professional Journalists. Alice grew up in Santa Monica, California and began working for local newspapers in her early teens.

Articles by Alice

Throughout the last few months, we’ve watched a wave of states try to restrict or roll back their Medicaid expansion programs and flout the remaining pieces of the Affordable Care Act. Now, with health care costs rising and the midterm elections looming, a group of blue and purple states is moving in the opposite direction.

After years of partisan battles, Virginia could move as soon as this week to expand Medicaid to 400,000 low-income residents. A budget expanding Medicaid already passed the state House of Delegates, and a few key Republicans in the state Senate have broken ranks, making the bill’s final passage possible. In exchange for their votes, these Republicans are making a demand that Democrats are likely to agree to: Tax credits for lower-middle-income Virginians who don’t qualify for Medicaid, to help them deal with rising deductibles and co-pays. The legislature convenes for a special session on Wednesday.

Across the river in Maryland, Republican Gov. Larry Hogan (who just happens to be running for reelection in his Democratic-leaning state this fall) signed a bill to set up a reinsurance program for his ACA marketplace to subsidize care for the most expensive enrollees.

Meanwhile, New Jersey may soon become the first state to implement a replacement for the individual mandate following Congress’ vote to kill it via the tax bill. The state legislature is set to vote this Thursday on two health-care bills; one would set up a state individual mandate and the other would create a reinsurance program.

The state actions to shore up both Medicaid and Obamacare’s individual markets show that elected officials on both sides of the aisle are cognizant of the damage the Trump administration and Congress have done to health-care costs by tossing out the individual mandate, canceling cost-sharing reduction payments, defunding open enrollment outreach and allowing the sale of short-term “junk” plans. These actions are widely predicted to drive up premiums right before the pivotal 2018 midterms.

In fact, according to final Obamacare enrollment data released by HHS last week, while the number of people enrolling is much higher than expected given GOP actions to sabotage the law, the risk pool will be sicker, older, and more expensive for the federal government than in past years.

Some Republican-controlled states, however, are continuing to pursue policies that will drive insurances rates and the number of uninsured residents higher in years to come. Idaho, after its first plan to sell non-ACA compliant plans was rejected by HHS, is trying again, hoping this time to get federal approval to set up a shadow Obamacare market that may draw many young and healthy people away from their comprehensive, regulated plans.

And following the lead of Kentucky, Indiana and Arkansas, more GOP-led states are attempting to impose work requirements on their Medicaid populations. Louisiana is “studying the concept,” Ohio will submit its work requirements waiver to HHS within days, and Tennessee is pushing a bill to implement work requirements and charge the federal government for the hefty cost of implementation.

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Thanks to the GOP tax bill, the individual mandate penalty for not purchasing health insurance will be no more as of 2019. But that’s apparently not soon enough for the Trump administration. The Department of Health and Human Services released a new rule late Monday afternoon saying that people who live in counties with only one insurance company on the individual market can qualify for a “hardship exemption” and won’t be penalized on their 2018 taxes.

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EPA Administrator Scott Pruitt reassigned or demoted at least five high-ranking officials who questioned his spending and other leadership decisions — including the purchase of pricey office furniture and Pruitt’s desire to use sirens to cut through D.C. traffic — according to a New York Times report Thursday afternoon. Four of the officials were career staff and one was a political appointee.

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Dating back to his mid-1990s reign in the House of Representatives, and continuing through his failed presidential runs and unsuccessful audition to be Donald Trump’s vice president, Newt Gingrich has led a crusade for rolling back protections for federal workers and eliminating entire agencies. Today, he is pushing from the outside for that same agenda — both as a contributor to Fox News, the President’s favorite source of information, and in private communications with the administration urging officials to conduct a “cleaning” and fire career civil servants suspected of disloyalty.

Whistleblowers report that retaliation against nonpartisan federal workers is on the rise under the Trump administration, with career staffers being pushed out of many different government agencies. As investigations into these purges heat up, and as efforts on Capitol Hill to pass bills making it easier to fire career civil servants intensify, Gingrich is emerging as a key player to watch in the months to come.

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As President Trump continues to insist that the Affordable Care Act is “essentially repealed” due to the 2019 demise of the individual mandate penalty, new polling from the experts at the Kaiser Family Foundation found that 9 in 10 individual market enrollees plan to keep their health plan with or without a mandate. The poll found that the threat of paying a tax penalty is not the top deciding factor for most people on whether or not to purchase insurance, and ranks below reasons such as
protecting against high medical bills, peace of mind, or because they or a family member has an ongoing health condition.

The finding is yet another sign that the ACA is more resilient than people on both sides of the debate assumed, and may not be decimated by either the repeal of the individual mandate, the gutting of federal outreach efforts, or the termination of cost-sharing reduction payments.

But the picture is not all rosy. Monthly premiums for the minority of ACA consumers who don’t qualify for subsidies jumped about 30 percent this year, and could go up more in 2019.

Congress’ decision to throw in the towel on either stabilizing Obamacare’s individual market or fully repealing it has also pushed states to move forward aggressively with their own plans.

On Monday, Iowa’s governor signed a law allowing the Iowa Farm Bureau to team up with insurance companies to sell skimpy plans that flout Obamacare regulations (such as the ban on discriminating against people with pre-existing conditions). Under federal law, the plans cannot even be called health insurance due to how unregulated they are, and will instead be dubbed “health benefit plans.” As with the Trump administration’s move to allow the sale of bare-bones short term plans and association health plans, health care experts say Iowa’s move could drain the individual market of its younger and healthier consumers, driving up premiums for those who depend on comprehensive health plans.

Meanwhile, state efforts to slash their Medicaid rolls — potentially by hundreds of thousands of people — by imposing work requirements and other restrictions could run into both legal and political opposition. A class-action lawsuit by 15 low-income Kentuckians against the Trump administration and their Republican governor, Matt Bevin, is moving forward, and its outcome could determine what policies dozens of states pursue going forward.

And as GOP governors pitch the Medicaid restrictions as a cost-saver, evidence continues to stack up suggesting that implementing the new Medicaid rules could cost states millions instead of saving them money. Top congressional Democrats have demanded that the Government Accountability Office investigate how much the new requirements are costing both state and federal taxpayers in the three states approved so far to move forward: Kentucky, Indiana, and Arkansas.

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A full third of the senior Interior Department (DOI) career officials reassigned under Secretary Ryan Zinke in a major agency reshuffling are Native American, even though Native Americans make up less than 10 percent of the Department’s workforce, a review by TPM has found.

The finding comes days after Democratic lawmakers demanded an investigation into whether Zinke discriminated when he reassigned 33 career officials last summer, and follows on reports that Zinke has repeatedly told DOI officials he doesn’t care about diversity — which prompted one member of Congress to accuse Zinke of working to create a “lily-white department.”

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Earlier today, we published an exclusive feature story in which I reported that Capitol Hill Democrats are demanding an investigation into whether Interior Secretary Ryan Zinke disproportionately targeted senior employees of color for reassignments when he shuffled dozens of staffers around last summer. This story is the latest in my ongoing investigation into the bigger story of retaliation against career civil servants under the Trump administration, which is reportedly happening across several federal agencies.

The targeting of racial minorities in the federal workforce may also be an emerging pattern. The Interior Department probe demanded by Democrats follows reports that Trump appointees at the State Department coordinated with White House officials and outside conservative activists to sideline an Iranian-American career staffer.

For this latest scoop, I talked to one of the most prominent whistleblowers of the Trump era: climate scientist Joel Clement. Clement, who believes he was targeted because of his work on climate change and with Native American tribes who are affected by it, is challenging his reassignment at several levels. There are simultaneous investigations pending at the Office of Special Counsel, the Interior Department’s Office of the Inspector General, and the Government Accountability Office.

When I spoke with him, Clement emphasized that his case is about way more than just his own career and the careers of the few dozen of his colleagues who were also pushed out of their roles. If the various investigating bodies uphold Zinke’s move, he warned, it could give the green light for a government-wide purge.

“The concern is that if you let this one fly, they won’t hold back,” he said. “They’ll exercise their authority to move people around however they want.” 

Clement said that while many of his cohort are keeping their heads down until their cases are decided, he wanted to speak out publicly. 

“They had already taken my job, so all I had left was my voice,” he said. “The legal and political community needs to know what is is happening in terms of abuses of power. Career staff usually doesn’t have a voice, so I wanted to be that voice. Even if all the legal stuff goes sideways, I still have that.” 

TPM plans to stay on this story, and, as we do, readers’ tips will be an invaluable part of our reporting. If you are a federal worker who has experienced or witnessed politically motivated retaliation under this administration — or if you know someone who is and has — send me a tip.

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Senior Democrats are demanding that Congress’s investigative arm probe whether Interior Secretary Ryan Zinke’s mass reassignment of senior career civil servants last summer violated federal anti-discrimination laws.

In a letter sent Wednesday to the Government Accountability Office, obtained early by TPM, a group of Senate and House Democrats say they’re concerned that the controversial reassignments — already the subject of multiple investigations — are disproportionately affecting employees who “belong to a protected class.”

It’s illegal to make federal personnel decisions based on race, gender, age, religion, or disability. 

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As we predicted last week, Congress’ last-ditch effort to pass a bill to stabilize Obamacare’s struggling individual market fell apart, and the omnibus went to the President’s desk without it. This means insurance companies will likely announce major rate hikes this September, just before the midterm elections. The angry finger-pointing over this outcome has already begun, and will likely be a constant theme heading into the midterms.

The core of the proposal was the same federal reinsurance program and restoration of CSR payments that senators have been struggling to pass since last summer. But Democrats who had long campaigned for a stabilization bill revolted over GOP provisions in the version that was part of the omnibus spending package. One such provision expanded to the private insurance market a ban preventing federal funding of abortion. Another codified Trump administration guidance on cheap, short-term health insurance that Democrats call “junk plans.” The former would have meant a significant and permanent expansion of abortion restrictions, and the latter would have made it easier for companies to sell skimpy plans that charge people more or turn them away based on their age, gender and whether they have a pre-existing condition.

Congress’ failure to shore up Obamacare’s individual market means the spotlight is once again on the states, who now have just a few months to prevent the predicted double-digit rate increases.

State legislatures could vote to ask HHS for permission to set up their own reinsurance programs — something Colorado and others are currently exploring. Other states are looking into ways to contain the damage to the market expected from the Trump administration’s short-term and Association Health Plans, both of which are expected to drain younger and healthier patients out of the regulated ACA market into “junk” plans. Washington State wants to force these short-term plans to follow many of the ACA’s rules, while New Jersey wants to ban them altogether.

But many states are going in the opposite direction, taking steps to further chip away at the Obamacare market. Iowa legislators are advancing a bill to allow the sale of plans that flout ACA rules — for example, plans that do not cover maternity care or mental health treatment. Idaho, despite receiving pushback from HHS, has vowed to do the same. Many other states are petitioning for federal permission to cut their Medicaid rolls by imposing work requirements, lifetime limits, or other restrictions. Even in the one state that voted overwhelmingly to expand Medicaid by ballot initiative — Maine — outgoing Republican Gov. Paul Lepage is blocking implementation.

In petitioning for these Medicaid cut-backs, GOP-controlled states are characterizing the federally subsidized program as a heavy financial burden. But a study from Brookings published Monday found “no significant increases in spending from state funds as a result of the expansion,” even as millions more people qualify for coverage. The report finds that Arkansas, Indiana, Kentucky, LouisianaMichiganMontana, New Mexico, Ohio, and West Virginia “have actually reduced, not increased, state spending as a result of expansion.”

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