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Overlooked Provisions

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The climate provisions in the bill that the Senate passed this weekend are likely to be more consequential than anything else in the bill. They will lead to a sharp reduction in U.S. greenhouse gas emissions, experts say, and help address arguably the world’s most pressing crisis.

But the other main spending portion of the bill — dealing with health care — is significant in its own right, and it has received much less attention. (I virtually ignored the health provisions in a newsletter last week. And take a look, below, at yesterday’s print front page of The Times.)

Today, I want to walk through both the substance of the health care provisions and the politics of them. As my colleagues Sheryl Gay Stolberg and Rebecca Robbins have written, those provisions appear to be the most substantial changes to health policy since the passage of Obamacare in 2010.

They are all but certain to become law, too. In coming days, the House Democrats are expected to pass the same bill that the Senate did, and President Biden has made clear he will quickly sign it.

The bill sets out to reduce Americans’ medical costs in two main ways. First, it uses federal subsidies to reduce the cost of both health insurance and prescription drugs. Second, the bill gives Medicare officials the power to negotiate with pharmaceutical companies, which will likely reduce the price that the companies charge for those drugs.

For these reasons, the bill is effectively an effort to use the health care system to reduce economic inequality, much as Obamacare was. The bill’s benefits will flow overwhelmingly to poor, working-class and middle-class families. Its costs will be borne by increases in corporate taxes (which ultimately fall on shareholders, who skew wealthy) and reductions in the profits of pharmaceutical companies.

Some critics of the bill have argued that these profit reductions will lead pharmaceutical companies to spend less money developing future drugs and, in turn, to fewer promising treatments. And that’s a plausible concern. Economic incentives matter.

But most experts believe that the pharmaceutical industry will remain plenty profitable after the changes. The Congressional Budget Office — a nonpartisan body — estimates that the law will reduce the number of new drugs introduced over the next 30 years by about 1 percent. “It doesn’t seem that big a deal,” Juliette Cubanski of the Kaiser Family Foundation told me.

Here are the bill’s main provisions:

  • It allows Medicare officials to negotiate over drug costs, giving companies less freedom to set high prices. That measure will mostly reduce Medicare’s spending, rather than families’ out-of-pocket costs — and, by extension, will reduce the federal budget deficit. But there will probably be spillover into out-of-pocket costs, especially for people in Medicare.

  • The bill sets a $2,000 annual cap on the amount of money that any senior pays for drugs. After somebody hits that cap, a combination of the federal government, private insurers and drug companies will pay the remaining bills. Today, drugs for cancer, multiple sclerosis, rheumatoid arthritis and some other diseases can cost people much more than $2,000 a year. The new provision will take effect in 2025 and will save a small percentage of older Americans thousands of dollars a year.

  • The bill caps out-of-pocket insulin expenses at $35 a month for people in Medicare; many now pay more than $50 a month. The bill also makes adult vaccines free for both seniors and people in Medicaid, starting next year. The shingles vaccine, to take one example, now often costs more than $50.

  • For middle- and lower-income people who buy private health-insurance plans through the Obamacare exchanges, federal subsidies will increase for three years. This change will help about 13 million people. A typical person in this situation now pays about $80 a month in premiums, thanks to temporary funding from Biden’s Covid relief bill. The price was set nearly to double next year but now will remain roughly the same, according to Krutika Amin of Kaiser.

The political effects of the bill seem less clear.

I’ve written before about the work of Suzanne Mettler, a political scientist who has pointed out that many forms of modern government remain “submerged”: Americans often do not realize when a federal policy is helping them, because the benefits come through tax credits or other shrouded forms. Modern government tends to be more technocratic and complex than, say, Social Security.

It’s easy to imagine how these health care provisions might fit the pattern. Some of the benefits will flow through private insurance plans that people may not associate with a government program, Cubanski notes. Other provisions won’t take effect for a few years. Still others will spare people from facing a large medical bill, but they may not be aware that they would have faced such a bill if Congress had not passed a new law.

“These are meaningful changes,” Cubanski said, “but most people may not necessarily notice that things are changing for the better.”

All of which suggests that the law’s proponents will still have work to do after the House passes it and Biden signs it. “It’s always important for supporters of a policy to explain how it will benefit people,” said Sarah Lueck, a health care expert at the Center on Budget and Policy Priorities. “And that’s really hard work.”

Summer: What makes Coney Island special? The Times asked children on the boardwalk.

Check, please: Your dinner tabs have soared. This is why.

Legends: Two basketball greats are retiring. Only one is a household name.

A Times classic: Does mixing alcohol really make you sick?

Advice from Wirecutter: Fun two-player board games.

Lives Lived: Issey Miyake, the Japanese fashion designer, was famous for his innovative, origami-like designs and cult perfumes. He died at 84.

An ultimatum for the ages: N.B.A. superstar Kevin Durant and the Brooklyn Nets could be headed for a standoff after the forward asked Nets owner Joe Tsai to either trade him, or fire coach Steve Nash and general manager Sean Marks. When did the mercurial star turn on the team’s plans, anyway? Something isn’t adding up.

College football voting shenanigans: It was mostly business as usual in the college football preseason coaches poll. A suspicious first-place vote for Texas, however, is the stuff of sports radio hosts’ dreams. We have the most overrated and underrated teams. Bulletin board material!

The Yankees come up for air: New York lost five straight games before last night’s victory over the Seattle Mariners, but it sure felt like more. Aaron Judge hit his 44th home run of the season, putting him on pace for 65 this year.

To many Americans, the phrase “Mexican pizza” conjures up the Taco Bell menu item — tostadas stacked and shellacked with meat, bean and cheese. But Latino-owned pizzerias are reclaiming the name for their own creations, Regan Stephens writes.

As a new generation of Mexican chefs opened pizza restaurants around the U.S., they searched for ways to meld their cuisine with the Italian offerings. Pizzas offered a perfect canvas, with the tomato sauce replaced by tomatillo, guajillo pepper or mole sauces. Toppings can include meats — carne asada, birria, chorizo — and vegetables such as corn, roasted poblanos and avocados.

The pangram from yesterday’s Spelling Bee was gratify. Here is today’s puzzle. (Do you have questions about the Bee for its editor, Sam Ezersky? He’ll answer them in a future newsletter. Submit them here.)

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The F.D.A. Now Says It Plainly: Morning-After Pills Are Not Abortion Pills

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The F.D.A. said it made the change now because it had completed a review of a 2018 application to alter the label that was submitted by Foundation Consumer Healthcare, a company that in 2017 bought the Plan B brand from Teva Pharmaceutical Industries. Agency officials said the pandemic delayed the review process and that the timing was not motivated by political considerations.

A spokeswoman for the company, Dani Hirsch, said in an interview that for its 2018 application, the company had not conducted any new studies but had submitted “what was already out there.”

In a statement, the company’s marketing director, Tara Evans, said “the misconception that Plan B works by interfering with implantation can present barriers to broader emergency contraception access. The Plan B labeling correction will help protect continued over-the-counter emergency contraception access and reduce confusion about how Plan B works and further clarify that Plan B does not affect implantation.”

Plan B One-Step and its generic versions — including brands like Take Action, My Way and Option 2 — contain levonorgestrel, one of a class of hormones called progestins that are also found at lower doses in birth control pills and intrauterine devices. The pills are most effective in preventing pregnancy if taken within 72 hours of sexual intercourse, although they can sometimes work if taken within five days.

Another type of morning-after pill, marketed as Ella and containing a compound called ulipristal acetate, is only available by prescription and is not affected by the F.D.A.’s label change. There has been less research on this type of pill, but studies suggest that it is highly unlikely to prevent implantation of a fertilized egg. In 2009, after months of scrutiny, Ella was approved for sale in overwhelmingly Catholic Italy, where laws would have barred it if it had been considered to induce abortions.

According to data published in 2021 by the Centers for Disease Control and Prevention, nearly one-quarter of women of reproductive age who have sex with men answered yes to the question: “Have you ever used emergency contraception, also known as ‘Plan B,’ ‘Preven,’ ‘Ella,’ ‘Next Choice,’ or ‘Morning after’ pills?” The agency did not break down the data by the type of pills taken.

As far back as the 1999 approval process, the maker of Plan B — Barr Pharmaceuticals, later acquired by Teva — asked the F.D.A. not to list an implantation effect on the label, The Times reported in 2012.

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Who are Caroline Ellison’s parents? Fraudster’s mom and dad are MIT economists

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This apple fell far from the tree.

Caroline Ellison — who pleaded guilty to fraud charges related to her role in the FTX cryptocurrency scandal, which led to the extradition of Sam Bankman-Fried this week — is the daughter of high-profile economists at the Massachusetts Institute of Technology.

According to his curriculum vitae, Ellison’s father, Glenn Ellison, was educated at Harvard, Cambridge and MIT before becoming the Gregory K. Palm (1970) Professor of Economics at the latter. 

In addition to coaching youth softball and his daughters’ middle school math teams, he writes “Hard Math,” a series of textbooks and workbooks about teaching arithmetic to younger students.

Glenn Ellison is also an Elected Fellow of the Society for the Advancement of Economic Theory and American Academy of Arts & Sciences.

Caroline Ellison’s parents, Glenn and Sara Ellison, outside their Newton, Mass., home in early December.
Robert Miller

Ellison’s mother, Sara Ellison, is also an accomplished academic. Armed with an undergraduate degree from Purdue University and a mathematical statistics diploma from Cambridge University, her profile shows she completed a doctorate at MIT in 1993. 

Sara Ellison is currently a senior lecturer in the department alongside her husband.

“We were definitely exposed to a lot of economics [growing up],” Ellison, 28, once told Forbes.

Ellison, 28, plead guilty to fraud this week.
Ellison, 28, pleaded guilty to fraud this week.
Twitter / @AlamedaResearch
Caroline Ellison's sister, Anna, now lives in the West Village.
Caroline Ellison’s sister, Anna, now lives in the West Village.
BRIGITTE STELZER

Glenn and Sara Ellison were photographed by The Post outside their home in Newton, an affluent Boston suburb, earlier this month. Armed with several bags, they told reporters they were too “busy” to comment on the FTX scandal.

The eldest of three sisters — including Anna, 25, who now lives in Manhattan’s West Village — Ellison distinguished herself as a precocious math whiz at a young age. 

When she was just 8 years old, she reportedly presented her father with a paper analyzing stuffed animal prices at Toys ‘R’ Us.

Sam Bankman-Fried leaving Manhattan Federal Court on Thursday.
Sam Bankman-Fried leaving Manhattan federal court on Thursday.
Matthew McDermott
Both Glenn and Sara Ellison are economists at MIT.
Both Glenn and Sara Ellison are economists at MIT.
Robert Miller

She went on to compete in the Math Prize for Girls while at Newton North High School before studying mathematics at Stanford University, where former professor Ruth Stackman described her to Forbes as “bright, focused, [and] very mathy.”

Ellison and Bankman-Fried, 30, crossed paths at the Wall Street trading firm Jane Street. Bankman-Fried’s parents are also both university lecturers, at Stanford in California. They became good friends and she joined Alameda Research, the hedge fund arm of the FTX crypto exchange, in 2018. She then became CEO in 2021. However, the company remained owned 90% by Bankman-Fried and 10% by another member of his circle.

In addition to documenting her supposed foray into polyamory on Tumblr, Ellison once boasted about drug use on social media.

Sara Ellison completed a doctorate at MIT in 1993.
Sara Ellison completed a doctorate at MIT in 1993.
Robert Miller

“Nothing like regular amphetamine use to make you appreciate how dumb a lot of normal, non-medicated human experience is,” she tweeted in 2021.

Ellison reportedly admitted to Alameda employees that FTX had used client funds to bail out the fledgeling hedge fund during a video call in November. She was eventually terminated as CEO by insolvency professional and current FTX CEO John J. Ray III after FTX and Alameda filed for Chapter 11 bankruptcy.

She pleaded guilty to federal fraud charges on Monday, and has subsequently been released on $250,000 bail.

Ellison was spotted getting coffee in New York City on Dec. 4.
Ellison was spotted getting coffee in New York City on Dec. 4.
Twitter / @AutismCapital

Although she could be sent to jail for up to 110 years for her part in the FTX-Alameda scandal — which has been said by federal prosecutors to have lost between $1 billion and $2 billion of customers’ cash — she is thought to have struck a deal with the feds for a much lighter sentence in return for her cooperation.

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Iran condemns Zelensky’s remarks to Congress as ‘baseless.’

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Iran has condemned President Volodymyr Zelensky’s remarks to the U.S. Congress, warning the Ukrainian leader against further accusing Tehran of supplying weapons to Russia for use in the war.

Mr. Zelensky told Congress on Wednesday that Iranian-made drones “sent to Russia in hundreds” had been threatening Ukraine’s critical infrastructure, a view shared by American and European officials. In Iran, he said, Russia had found an “ally in its genocidal policy.”

A spokesman for Iran’s foreign ministry, Nasser Kanaani, called Mr. Zelensky’s comments “rude” and “baseless.”

“Mr. Zelensky had better know that Iran’s strategic patience over such unfounded accusations is not endless,” Mr. Kanaani said in a statement on Thursday.

Although Iran has officially denied supplying Russia with the weapons since Moscow’s invasion of Ukraine, U.S. officials have said that the first shipment was delivered in August.

Mr. Zelensky has said that drones used in Monday’s wave of predawn attacks on Kyiv and other Ukrainian cities were from a batch recently delivered to Russia by Iran. The strikes came after Biden administration officials said that Russia and Iran were strengthening their military ties into a “full-fledged defense partnership.”

The European Union last week condemned Iran’s military partnership with Russia as a gross violation of international law and announced new sanctions against Iranian individuals and entities over their roles in supplying the drones that Moscow has used to attack Ukrainian civilians and infrastructure. That followed a round of sanctions on Iranians over the drone deliveries in October.

Mr. Kanaani “once again emphasizes” that Iran has not supplied military equipment for use in Ukraine, the statement issued on Thursday added, and urged Mr. Zelensky to learn “the fate of some other political leaders” who were happy with U.S. support. It was not clear which other leaders the statement was referring to.

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