Month: August 2022

Ultimately, Sinema took a scalpel to the corporate minimum tax and scuttled any changes to carried interest, which Manchin called particularly “painful.” Triangulating between them through all of it: Schumer, whose job was harmonizing the views of the very public Manchin with an often-silent Sinema.

“We argue with each other on issues, but we try to respect each other,” Schumer said of Manchin on Sunday as he chomped on a celebratory meal of leftover pasta cooked by his wife. “Sinema, if she gives you her word about her, you got it. But she she’s not a schmoozer like Manchin.”

Almost exactly one year after Manchin and Sinema teamed with Republicans to pass a historic infrastructure bill, the two moderates on Sunday cast decisive votes for Democrats’ second piece of the puzzle. It was far smaller than the party’s original $3.5 trillion vision, but larger than the slim health care legislation that lawmakers were considering just two weeks ago. It’s probably the last big party-line bill Democrats will be able to deliver for years, with the House expected to flip to Republicans in the November elections.

The package delivered more than $300 billion in climate and energy investments, reformed prescription drug prices and created a new minimum tax on large corporations. Sunday’s passage of the legislation marked a triumphant moment for a party that for years has talked a big game on lowering drug prices and fighting climate change.

The yearlong drama demonstrated the difficulties Schumer faces every day in running a 50-50 Senate, corralling a caucus that includes 47 other senators with their own ideas plus Sinema and Manchin, two centrist senators with divergent priorities.

Twice in full view on the Senate floor, Manchin animatedly conversed with Sinema about his deal, including pieces of the tax legislation that Sinema felt would stymie economic growth in Arizona. Manchin observed of his relationship with Sinema and the tax dispute: “We have more in common than we do n’t. I just have a difference on this.”

“They both are pains in the neck, but pains in the neck who I respect,” said Sen. John Hickenlooper (D-Col.) admiringly. “I don’t feel they’ve ever misled me, or said something that was untrue.”

Manchin killed the $1.7 trillion Build Back Better bill back in December after failed negotiations with President Joe Biden. Two months later, Schumer and Manchin broke bread, and Manchin delivered his negotiating position: He wanted to wait until April before trying again. And when they did, he only wanted to talk to Schumer.

After Russia invaded Ukraine and Europe’s energy supplies were squeezed while US gas prices rising, Manchin then saw an opportunity to make big climate change investments while simultaneously boosting fossil fuel production this spring.

“That is the catapult that basically launched me,” Manchin said in an interview. “Iran is the greatest proliferator supportive of terrorism in the world, right? And we’re going to give them money? Over my dead body.”

By late June, he and Schumer were looking at a package that brought in more than $1 trillion in revenue and spent significantly more than the package that passed Sunday. Sinema’s team was generally clued into that package and she told leaders in mid-July she still didn’t support the carried interest provision.

But Manchin began having second thoughts after the July 4 recess, as inflation indicators continued to flash red. Then came July 14.

“I just said, ‘Chuck, I can’t do that’ … That’s when he got mad,” Manchin said. “Half-hour later, they put the dogs on me.”

Manchin says he never took it personally, yet there are two schools of thought in the Democratic caucus about whether that pressure campaign worked. Some argue that the attacks on Manchin from his own colleagues drove him back to the table. Others say a cohort of Democratic senators who quietly reassured Manchin amid the blowback proved far more effective.

After that blow up, Democrats coalesced around prescription drug reform and a short extension of Affordable Care Act subsidies, relegating energy, climate change and taxes to the dustbin. Manchin quietly summarized his talks with Schumer just four days later. When they announced their deal on July 27, the Democratic Caucus was triumphant.

There was one problem: Sinema was now in the dark.

In fact, Sinema was informed about the deal by No. 2 Republican John Thune on the Senate floor. She had huge influence on the Build Back Better bill, stripping out tax rate increases to assemble a tax package more palatable to her business-friendly state. And she and Sen. Chris Murphy (D-Conn.) laid the groundwork last year for what would become a key part of Democrats’ prescription drug proposal.

But Sinema never agreed to the carried interest provision. And she had other objections.

As Manchin and Sinema held their own conversations, they were helped along by Hickenlooper and Sen. Mark Warner (D-Va.). While Warner tried to come to a compromise on carried interest with Sinema, Hickenlooper suggested a stock buyback excise tax to compensate for Sinema’s requested changes on the corporate minimum tax.

“There’s kind of been a trust-building relationship going on,” Warner said. “It became clear that some of the changes that Sen. Sinema wanted were creating some holes.”

On Aug. 4, Warner joined Manchin on his house boat to talk about the deal Sinema would soon announce on taxes. After getting soaked in a rainstorm, Warner left with a new outfit — wearing a pair of Manchin’s shorts and a T-shirt — and a hope that Manchin, Sinema and Schumer would see eye-to-eye. (On Saturday Manchin returned Warner’s suit, fully pressed.)

But Sinema wasn’t quite done, even after scuttling language that limited business’s ability to write off some investments. When Democrats unveiled the final legislation Saturday, it imposed the 15 percent minimum tax on some businesses owned by private equity. That had been included in previous versions of the legislation but omitted from the initial draft of the deal with Manchin.

Synema opposed it, an alarming development.

“I thought we wouldn’t pass the bill,” Schumer said. “It was hard to figure out how to make it work.”

Manchin said once he agreed with Schumer the two were “hooked to the hip” at preventing changes to the bill that could jeopardize its passage, which Schumer said was a “linchpin” of the agreement. Sinema had no such deal, and when the legislation came to the floor for amendment votes she’d privately teamed with Thune to reverse the tax change.

That required Manchin and the rest of the Democrats to make yet another compromise. Schumer went around the Senate floor telling his members that while they may not like it, they had to eat the change to pass the bill.

Schumer’s members were unhappy, according to one Senate Democrat, but exhausted and resigned to doing what it took to finish the bill. Warner stepped in with a way to fill that revenue hole, too. About 15 minutes later, the bill passed after 22 hours on the Senate floor.

For Schumer, it was the capstone of a 50-50 Senate in which he passed new laws on gun safety, infrastructure, veteran health benefits and microchip manufacturing. For Sinema, the moment demonstrated that she’s simply not in lockstep with Manchin — or the rest of her caucus.

And for Manchin, the converted legislation his reputation from the guy that stopped Biden’s agenda cold in his tracks to the coal-state senator that not only cut a deal on climate, but helped sell it any way he could.

“I’ve never seen a more balanced piece of legislation coming together,” Manchin said. “We never knew this day would ever come.”

• Several states have imposed bans on abortion since the Supreme Court overturned Roe v. Wade.
• The decision has worried many medical students who are interested in becoming OBGYNs.
• Students said bans on abortion could limit their training and exposure to life-saving care.

Before the Supreme Court overturned Roe v. Wade, Lyle Suh was heavily considering becoming an obstetrician-gynecologist.

But now she’s less sure.

“This has pushed me away more for my own mental health,” Suh, who is in her third year of medical school, told Insider. “I truly can’t see myself going into a field that is governed so heavily. Like medicine already has so many things that are out of our hands – this kind of just adds another shackle to what we can do.”

Suh’s experience echoes those of other medical students who are considering specializing in reproductive care but also recognize they will enter a field where they will have to navigate confusing bureaucratic catacombs and a political minefield.

‘They’re going to have to go through all of these hurdles’

Natalie Sorias, a third-year medical student at the University of Massachusetts, told Insider that she’s passionate about women’s reproductive healthcare, and despite the challenges ahead, she’ll most likely continue to try to work in the field.

“I went into medical school trying to keep as much of an open mind as possible,” Sorias told Insider, “but the population that I really care about is women.”

Sorias, who also researches female genital mutilation in Cairo, said she noticed that the “people who were kind of neglected, were women” and that “inevitably impacts children.”

As a first-generation Egyptian-American, Sorias said she was disappointed, heartbroken, and angry at the decision to overturn Roe v. Wade.

“Being immigrants – people come to America bragging about its advancements and its incredible healthcare and all these things,” she said. “I just kind of really hoped that being in this country would mean being a part of the worldwide example of reproductive justice. It’s just kind of embarrassing that we’re not and it’s really disappointing for the people that it would affect.”

Photo by Justin Sullivan/Getty Images

She is now concerned about matching into a residency program in a state that does not offer the full range of education on reproductive health, including abortions at various stages, as well as how competitive programs may become in states where abortion is legal.

Following medical school, students continue training in a residency program, where they become resident physicians. Nearly 44% of obstetrics and gynecology residents – or 2,638 out of 6,007 – are training in programs located in states that are “certain or likely to lack access to in-state abortion training” because of statewide bans on the procedure, according to an April study published in the journal “Obstetrics & Gynecology.”

“That’s not only difficult,” Sorias said. “It also very much increases the competition for anybody trying to go into [Obstetrics]which is gatekeeping a career that needs more providers to begin with.”

Eshani Dixit, a medical student at Rutgers Robert Wood Johnson Medical School, echoed Sorias’ concern.

“It definitely is looking more and more difficult in terms of making sure I have access to education that’s not only relevant to my desire to become an abortion provider but also just relevant to the practice of obstetrics and gynecology as a field and making sure that we ‘re providing quality care to our patients,” Dixit told Insider.

She said she fears being in a state where only a medical emergency will allow her to perform an abortion legally.

“But I’m nervous about being in those types of situations and not having the exposure to adequately care for the patients that I am serving,” she said.

Morgan Levy is a third-year med student at the University of Miami in Florida, where abortions are banned after 15 weeks with a few exceptions, such as to save a pregnant patient’s life.

Levy said she will have to consider a residency rotation out of state because she worries that there is a “significant portion of the training in the field” that she “would not be able to obtain simply because the procedure would not be legal for a patient to get.”

“I think that’s a reality that a lot of students are going to face,” Levy said. “They’re going to have to go through all of these hurdles to go and find somewhere that they can actually get the training they’re looking for.”

‘We do what’s best for the patient’

ANGELA WEISS/AFP via Getty Images

The “Obstetrics & Gynecology” study recommended that programs establish “travel rotations for residents to obtain abortion training in states with protected abortion access.” However, the study noted that travel rotations may not be feasible for the large number of residents who are training in states with limited access to abortion.

The Accreditation Council for Graduate Medical Education, which accredits residency programs, submitted proposals that would require programs in states with restrictions on abortion to provide residents with alternative training in states that don’t.

“The proposed revisions help ensure obstetrics and gynecology residency programs provide residents with the knowledge, skills, and abilities necessary to practice comprehensive reproductive health care in the United States without resulting in any resident, physician educator, or residency program violating the law,” a spokesperson for the ACGME said in a statement.

The proposed revisions are still open for public comment before they are submitted to the ACGME Board for approval.

Suh said she is fearful of providers becoming too apathetic to patients’ needs as they are now placed in uncertain circumstances when seeking abortions.

“We do what’s best for the patient. We go through the best treatment, then the next,” she said. But she said if she ends up in a state abortion is restricted then the scope of her training and the care she can deliver are compromised.

She added that she thinks doctors have to do their best to do no harm and “when there’s fully set laws that prevent you from giving the best possible care to a patient, that’s just very mentally taxing.”

Suh said even if she ends up in a state where abortion isn’t heavily banned, there’s still a ripple effect.

“Even though we’re in a state that it’s very much still legal to get an abortion, we are seeing a noticeable increase in the amount of people who come in to see what options there are to permanently become infertile,” Suh ​​said.

Both Sorias and Suh said they’re concerned about the adequate training all residents in OBGYN are going to receive as a result of states having different policies.

“Every single OBGYN should be well trained and skilled at providing abortions because it is life-saving care,” Sorias said. “So it doesn’t make any sense to me that over 50% of the country’s OBGYN providers are in a place where they don’t know how to do that. I would be very disappointed and scared.”

Maureen Phipps, chief executive officer of the American College of Obstetricians and Gynecologists, said that following the overturn of Roe, “the impact on physician training will be dire, and the consequences will be long lasting.”

“Medical education should be comprehensive, and our trainees must be prepared to meet all patient needs with confidence. When 44% of OBGYN residents are trained in states that are now empowered to ban abortion, patients will have to question whether their ob-gyn has had access to the quality of training that we have all come to expect,” Phipps said in a statement.