<Some businesses deserve sympathy when they land in bankruptcy. Then there's Envision.

The Tennessee company prospered as a provider of medical staff to hospitals around the country. It concentrated on emergency physicians, anesthesiologists and radiologists for a simple reason: Their patients typically had no ability to pick and choose among these doctors when they need care.

Waiting to be seen at the emergency room or already laid out on an operating table, the patients weren't in a position to ask whether the doctor was in their insurance plan's network.

These higher payment rates [are] caused not by supply or demand, but rather by the ability to "ambush" the patient."

They might not even know they were seen by out-of-network doctors until they received a bill for their services — a surprise invoice for hundreds or even thousands of dollars.

Envision's "secret sauce was to pile medical debt on people with emergencies," says Eileen Appelbaum, co-director of the Center for Economic and Policy Research, a nonprofit Washington think tank. "That was purely taking advantage of people at their most vulnerable time."

Envision stands as a case study in the destructive incursion of the profit motive — actually, the profiteering motive — in American healthcare.

Doctors themselves aren't the problem — they're disadvantaged themselves by financial pressures imposed by profit-seeking firms, which often require them to see more patients in a day and work without the best equipment.

Surprise billing — sometimes known as "balance billing" — by Envision and other firms like it elicited so much public outrage that Congress was finally moved to do something about the practice. In 2020 it enacted the No Surprises Act, which went into effect on Jan. 1, 2022.

Envision wasn't alone in sticking patients with unexpected bills; another staffing firm, TeamHealth, is also struggling with the ramifications of the No Surprises Act.

The act prohibited out-of-network providers who were not chosen by a patient from charging the patient more than the in-network reimbursement fee set by the patient's health plan. It forbade insurers to reject outright a patient's claim for service from an out-of-network doctor.

Federal officials estimated that the law would apply to about 10 million unexpected bills a year. That figure didn't include beneficiaries of another provision, which outlawed the very sleazy practice by some big insurers of rejecting an emergency-room claim because a patient's condition didn't turn out to be a true emergency.

The No Surprises Act blew a sizable hole in Envision's profit-and-loss statement — part of "a whiplash-inducing onslaught of obstacles and complications" facing the firm's management, its bankruptcy filing stated.

Among other elements of the "onslaught" the firm cited was the COVID pandemic, which reduced non-emergency hospital visits by as much as 70% because patients deferred elective surgeries; an increase in salaries for professionals as the pandemic prompted older clinicians to retire; and a billing backlash by its largest payer, UnitedHealth Group.

Envision, which provides staff for more than 500 facilities in 45 states, said in its bankruptcy filing that the pandemic cost it some $795 million in operating revenue (technically, earnings before interest, taxes, depreciation and amortization, or EBITDA) in 2020 and 2021....>

<....UnitedHealth's "uniquely aggressive" pushback on reimbursements, Envision said, cost it more than $400 million in EBITDA over the last five years. Envision says that if UnitedHealth merely paid what Envision claims it owes, it would not have had to file for bankruptcy. Overall, the company's EBITDA went from about $1 billion before the pandemic to about $250 million last year.

In any case, the No Surprises Act was the factor that hit Envision's business model below the water line.

It's worthwhile, then, to take a closer look at what this firm and its owner, the private equity firm Kohlberg Kravis Roberts & Co., have been up to, and why we should celebrate the modest change in the American healthcare system represented by the act. (TeamHealth is owned by another private equity firm, Blackstone.)

Private equity firms acquire businesses typically through leveraged buyouts, in which the acquisition is financed largely through borrowings to be paid back out of the acquired business' revenues. Generally, their goal is to cash out by selling the business or taking it public within about five years.

The firms first showed interest in healthcare businesses in the 1990s, initially focusing on nursing homes and hospitals because of their reliable cash flows, as a Brookings Institution study outlined in 2021. By 2010, the private equity firms had moved on to urgent care clinics, ambulance services, and emergency departments and hospital services such as anesthesiology and radiology "that could utilize surprise out-of-network billing," Brookings found.

According to a 2018 Yale University study that heavily influenced the legislative movement in Congress, it wasn't unusual for emergency doctors to end their network contract with insurers. On average, the Yale researchers reported, out-of-network physicians charged more than twice the going in-network insurance reimbursements and more than six times the standard reimbursements from Medicare.

The study in effect pointed the finger at the physician staffing firms, Envision (known at the time as EmHealth) and TeamHealth. "Both firms profit from the fact that out-of-network physicians working in in-network hospitals cannot be avoided by patients." The runup in charges, the researchers wrote, "undercuts the functioning of healthcare labor markets, exposes patients to significant financial risk, and reduces social welfare."

"These higher payment rates" charged by out-of-network physicians, the Yale study said, are "caused not by supply or demand, but rather by the ability to 'ambush' the patient." The practice raised the cost of healthcare generally.

The Yale researchers made passing mention of another player in this process: the health insurance industry, which has an interest in paying providers as little as it can get away with. (UnitedHealth, as it happens, provided the researchers with the data they used for their study, leading to accusations that the study favored the health plans' point of view; the researchers said UnitedHealth had no influence on their findings.)

Insurers reacted to the charges from out-of-network doctors by paying only a portion of their bills. That prompted doctors to try to obtain the balance by billing the patients. The surprise billing scandal was born.

Envision says it started to phase out surprise or balance billing in 2020, even before the No Surprises Act was passed and signed — though congressional action against the practice was in the wind long before that.

It says its real problem is that regulations implementing the act have put health insurers in the driver's seat in setting reimbursements. Provider firms have to go to arbitration to settle their differences, but that's resulted in a logjam of arbitration cases and a backup of unpaid claims.

Private equity investors had long had their eyes on Envision, which was founded in 1992. The firm oscillated between private and public ownership, as a succession of investors sought to squeeze it for profits.

The process started in 2005, when Onyx Capital acquired it through a leveraged buyout and took it public the same year. The investment firm Clayton, Dubilier & Rice acquired it in 2011 for $3.2 billion and staged an initial public offering two years later....>

<....Soon after that, EmHealth merged with Amsurg, a physician staffing service for ambulatory surgical centers — that is, those unaffiliated with hospitals. The result was Envision, which became the largest physician staffing firm in the country.

Kohlberg Kravis Roberts entered the scene in 2018 with a $9.9-billion leveraged buyout, in which the firm and its partners invested $3.5 billion. That stake was wiped out in the bankruptcy, which followed lengthy and extremely complex negotiations with creditors that included Newport Beach-based Pimco.

The prearranged bankruptcy will allow both Amsurg and Envision to continue operating under the ownership of their creditors, who will take over once the latter emerges from bankruptcy in the fall. Among the new owners will be Blackstone, giving the big private equity firm a foothold in the two biggest staffing companies, Envision and TeamHealth.

The No Surprises Act did little to remedy the dysfunction of American healthcare. If anything, it underscored the insanity of a system that locks providers and payers in never-ending conflict over who owes what to whom and for which services.

Envision and UnitedHealth waged this war for years. The two parties let their last network contract expire in January 2021, after which they continued to snipe at each other over reimbursements until last September, when they served each other with lawsuits.

Envision says UnitedHealth has consistently low-balled its reimbursements ever since the contract expiration — in fact, it says Envision allowed the contract to lapse because it wouldn't accept UnitedHealth's "unconscionable take-it-or-leave-it reimbursement offer."

The insurer, for its part, says Envision has "systematically" upcoded its reimbursement claims. The allegation is that Envision has submitted claims for more elaborate patient treatments — which warrant higher reimbursements — than the patients needed or received at the ER.

(Envision won a $91-million arbitation award from UnitedHealth in March, but that dispute concerned reimbursements owed in 2017 and 2018, while the firms' network contract was in effect.)

It's tempting to declare a plague on both their houses, to quote "Romeo and Juliet," but the problem is systemic. It's grounded in "the tension between profit maximization by firms that own health care providers, and the best care possible for patients that providers are obligated to provide," Appelbaum has observed.

The No Surprises Act addressed one symptom of that tension, the practice of sticking unwary patients with unexpected bills. But it didn't lay a finger on the underlying disease. Americans spend vastly more on medical care than residents of any other developed country, and have worse health outcomes.

One reason is the endless, costly dickering among middlemen like Envision and UnitedHealth to make sure they get their share of the bucks sloshing around in the system. Every segment of the healthcare industry also spends heavily on lobbyists in Washington to ensure they don't get shut out of the party.

Who doesn't have lobbyists? The patients. The No Surprises Act is one of the very few victories they've ever notched in this battle, and they shouldn't expect to see many more.>

<Former President Donald Trump on Tuesday claimed that a judge "violated" his First Amendment rights by explaining the terms of a protective order restricting Trump's use of evidence in his hush-money case.

Trump appeared virtually for a Tuesday hearing that Judge Juan Manuel Merchan, who is overseeing Manhattan District Attorney Alvin Bragg's 34-count indictment against Trump over his role in wired payments made to adult film actress Stormy Daniels during the 2016 presidential campaign, scheduled earlier this month after establishing rules preventing the former president from using case evidence to attack witnesses or make a public spectacle.

"It's certainly not a gag order. It's certainly not my intention in any way to impede Mr. Trump's ability to campaign … he's certainly free to deny the charges … he's free to do just about anything that doesn't violate the specific terms of this protective order," the judge said, according to The Daily Beast.

However, Merchan did advise the ex-president that dismissing the protective order could create a slew of legal issues, including fines or jail time.

"Violation of a court order or a court mandate could result in sanctions. There are a wide range of sanctions, but it could include up to a finding of contempt, and that is punishable," he said.

Judge orders Trump to attend lecture on how not to use evidence to attack witnesses: report NPR reported that Trump, who was tuning in from his Mar-a-Lago resort in West Palm Beach, Florida, spoke only once during the hearing, saying "I do" when asked if he had a copy of the order.

However, not long after the hearing had concluded, Trump took to Truth Social to bemoan what he felt had been a violation of his First Amendment rights.

"Just had New York County Supreme Court hearing where I believe my First Amendment Rights, 'Freedom of Speech,' have been violated, and they forced upon us a trial date of March 25th, right in the middle of Primary season," Trump wrote. "Very unfair, but this is exactly what the Radical Left Democrats wanted. It's called ELECTION INTERFERENCE, and nothing like this has ever happened in our Country before!!!"

During the hearing, Trump's lead defense lawyer Todd Blanche prodded Merchan's protective order, arguing that "because President Trump is running for president of the United States and is the current leading contender... he's very much concerned that his First Amendment rights are being violated by this order."

The order, which was signed by the judge on May 8, stipulates that any evidence shared by the DA "shall be used solely for the purposes of preparing a defense," barring Trump from sharing the case materials online in any capacity. Additionally, Merchan wrote that Trump is only permitted to "review the limited dissemination materials only in the presence of defense counsel."

Former U.S. Attorney Harry Litman observed that Mechan "is treating Trump like a truant child."

"Sounds as if Merchan was really tough on Trump in the hearing today — letting him and counsel know that if there's any violation of the discovery order, it's for him (Merchan) to handle, including possible criminal contempt," he wrote on Twitter.

CNN legal analyst Norm Eisen warned that Trump faces a "grave risk" after being "lectured by judge" because he's so "undisciplined."

"If he violates the order, he'll now face serious consequences," he tweeted.

Ever since Bragg's probe began to gain significant traction, the former president had unleashed a torrent of vitriol and personal attacks online. In March, he floated "death and destruction" in an early morning Truth Social rant before being indicted, calling Bragg a "degenerate psychopath that truly hates the USA." Last month, Trump targeted Merchan in another Truth Social tirade, calling him "highly partisan" and claiming his family "are well known Trump haters."

In March, Trump referred to the case as a "witch hunt," alleging that Merchan hated him.

"The Judge 'assigned' to my Witch Hunt Case, a 'Case' that has NEVER BEEN CHARGED BEFORE, HATES ME," Trump wrote. "His name is Juan Manuel Marchan, was hand picked by Bragg & the Prosecutors, & is the same person who 'railroaded' my 75 year old former CFO, Allen Weisselberg, to take a 'plea' deal (Plead GUILTY, even if you are not, 90 DAYS, fight us in Court, 10 years (life!) in jail. He strong armed Allen, which a judge is not allowed to do, & treated my companies, which didn't 'plead,' VICIOUSLY.">

What a f***ing joke.

<Republicans in Ohio are trying to increase the vote percentage needed for voters to successfully pass ballot initiatives in their state – and the Cleveland Plain Dealer editorial board is accusing the party of trying to conceal this effort from voters.

In an editorial published Wednesday, the Plain Dealer editors accused Republican members of the Ohio Ballot Board of using deceptive language in an upcoming ballot initiative that dramatically raise the threshold for future ballot initiatives to pass.

"The wording that the board’s Republicans approved claims in its title that the proposal is aimed at, 'Elevating the standards to qualify for and to pass any constitutional amendment,'" the editors argue. "In fact, the amendment increases the requirements for getting an issue on the ballot. LaRose told reporters a dictionary indicates that “‘elevating’ means to raise or increase.” But voting booths aren’t stocked with dictionaries. Ordinary Ohioans don’t say, 'the bank elevated my credit-card interest rate' or 'the Browns elevated the score.'"

In addition to this, the wording fails to describe the existing law about ballot initiatives that would be changed, which they argue gives voters an incomplete picture of the proposal, which would enact a 60 percent supermajority threshold for successful initiatives.

The goal of the initiative, note the editors, is to make getting an amendment that protects abortion rights in the state far harder to pass than would otherwise be the case.

The editorial urges the Ohio State Supreme Court to step in and "stop the Ballot Board’s brazen partisanship," which it says has gone so far as to be "patently unconstitutional.">

<Former Donald Trump lawyer John Eastman has asked the Supreme Court to reverse lower court rulings that allowed for the now-defunct House January 6 committee to access emails he sought to shield under attorney-client privilege.

The committee obtained the handful of emails questions after a federal judge, in a notable March 2022 ruling, concluded that the emails fell under the so-called “crime-fraud” exemption to the privilege because the emails showed that Trump and Eastman may have been plotting a crime in their efforts to disrupt Congress’ January 6, 2021, election certification vote.

“Based on the evidence, the Court finds it more likely than not that President Trump corruptly attempted to obstruct the Joint Session of Congress on January 6, 2021,” Judge David Carter wrote at the time.

Eastman, when he was Trump’s attorney during the 2020 election, spearheaded efforts to convince Vice President Mike Pence to delay Congress’ counting of the Electoral College votes on January 6. Pence ultimately resisted the pressure from Trump and his allies to interrupt the congressional ceremony.

“The illegality of the plan was obvious,” Carter added. “Our nation was founded on the peaceful transition of power, epitomized by George Washington laying down his sword to make way for democratic elections. Ignoring this history, President Trump vigorously campaigned for the Vice President to single-handedly determine the results of the 2020 election … Every American – and certainly the President of the United States – knows that in a democracy, leaders are elected, not installed.”

In Eastman’s new petition with the Supreme Court, which was initially filed in late April but only publicly posted on the high court’s online docket this week, Eastman argues that Carter’s ruling “created a stigma for both Petitioner and his client, the former President of the United States and current candidate for the presidency.”

Eastman is asking the Supreme Court to reverse the ruling, even though the case became moot when the emails were handed over to the committee and then inadvertently made public with a live link that was left unredacted in a court filing submitted by the committee’s lawyers.

“Respondent committee’s action of accessing disputed documents while a motion to stay was pending, and then publishing in a public filing a live link to the confidential documents that were the subject of the appeal, deprived Petitioner of the opportunity to show that the ‘crime-fraud’ conclusions of the District Court were clearly erroneous, thus clearing his name and that of his former client, former President Trump,” the petition said.

Eastman is a former clerk to Justice Clarence Thomas. Thomas has been scrutinized for his participation in cases involving the January 6 committee’s investigation, after it was revealed that Thomas’s wife was in communication with key players to the election reversal schemes, including Eastman.

During an interview with the House January 6 committee last year, Ginni Thomas said she did not speak to her husband about her post-2020 election political work.>

<From Bud Light’s standpoint, the move was clever, if not somewhat optimistic. It customized cans of beer depicting influencer Dylan Mulvaney and sent them along, an eye on expanding its appeal to a new demographic in the face of declining sales.

What happened next is called “context collapse.” The beer manufacturer was targeting Mulvaney’s not-small audience, an audience that was interested in the story of her emergence as a trans woman. But the video Mulvaney made hyping the beer was plucked out of the context of that audience and shared widely by prominent voices on the political right. A narrow effort to engage Mulvaney’s audience — like Bud Light’s similar “Brewed in Texas” campaign — was presented as though Bud Light was deeply or primarily focused on shifting its brand to focus on transgender people. A firestorm resulted. Bud Light publicly apologized.

What happened with Target is different. This week, the retailer announced that it was “making adjustments to our plans” for marketing products centered on Pride Month, “including removing items that have been at the center of the most significant confrontational behavior.”

“Confrontational behavior” is a relatively gentle framing for the company’s concern that anti-LGBTQ activists who opposed Target’s Pride displays were (according to the company) threatening store staff. There’s no reason to think that such threats are exaggerated, given the escalation of anti-LGBTQ rhetoric over the past 24 months. A movement that appeals to the Proud Boys, a far-right group with a history of violence, is one that carries with it some inherent danger.

Again, though, this isn’t exactly what Bud Light experienced. Bud Light was trying to expand its audience. Target was trying to engage its existing one. Pride Month has been a part of American capitalism for years now, one that’s been viewed as cynical by many LGBTQ Americans. There was little reason, then, for Target to think that its 2023 Pride displays would invoke a sharper, more aggressive backlash than its 2022 or 2021 ones.

But 2023 is, in fact, different.

For one thing, the LGBTQ community — and, in particular, the “T” in that abbreviation — has become a political target on the right. This is not entirely organic; the New York Times reported in April that message-testing determined that isolating transgender Americans might be an effective political wedge for the right.

For another thing, the tactics that emerged online a decade ago as part of what came to be known as “GamerGate” have become pervasive in political attacks. Social media accounts such as Libs of TikTok or Gays Against Groomers — which contributed to the focus on Target — have generated audiences by plucking LGBTQ-related content and outreach from their intended context and presenting them to the political right as targets. Sometimes, the attacks extend offline. The big accounts inspire smaller efforts, with people jockeying for online attention by directing their ire in the same direction.

Online actors are heavily influential in right-wing and Republican politics. Florida Gov. Ron DeSantis (R), who is expected to announce his candidacy for president Wednesday, has expended an enormous amount of political energy in the past year targeting LGBTQ identity in his state. It’s generated a lot of approval from prominent right-wing voices, something he clearly sees as valuable for the 2024 nominating process despite the outcry. Or, perhaps, because of the outcry.

Matt Walsh, a right-wing, anti-trans commentator whose attacks on Target have included false claims about the products that the retailer was selling, outlined his desired outcome Wednesday morning on Twitter.

“The goal is to make ‘pride’ toxic for brands,” he wrote. “If they decide to shove this garbage in our face, they should know that they’ll pay a price. It won’t be worth whatever they think they’ll gain. First Bud Light and now Target. Our campaign is making progress. Let’s keep it going.”

The progression there is unintentionally revealing, since it elevates the difference between what the beer brand and the retailer were doing....>

Rest right behind....

<....One out of every 14 adults in the country identifies as LGBTQ. By having a display of Pride-themed products, Target is trying to wring cash out of that market. We’re asked to believe that Target’s displays of rainbow flip-flops or T-shirts with messages of support for trans people are somehow influencing kids — it’s always framed as being about kids — to embrace an LGBTQ identity. It’s as silly as suggesting that Target having a display of NASCAR-themed shirts is getting kids to drive at excess speeds; the obvious intent is to appeal to an existing audience, not create a new one.

Right-wing voices have suggested that businesses engage in this sort of outreach because they’re being graded on how “woke” they are by nonprofits. This patently ridiculous idea is more palatable to them than the reality: There’s a market for Pride gear — and far more Americans support businesses welcoming LGBTQ customers than oppose the idea.

Polling shows that businesses, even small ones, see value in reaching out to the LGBTQ community. Employees are more likely to want to work for companies that support LGBTQ people. While a plurality of Americans indicated in polling released last year that a company’s support for LGBTQ customers didn’t influence their decision to give the company their patronage, more than a third said that LGBTQ support increased the likelihood they’d buy from that brand. By contrast, less than a fifth said it decreased the likelihood.

That’s the irony here. The attacks on Pride are often framed as efforts to curtail the small LGBTQ community from forcing its worldview upon others. But those attacks themselves fit that description: a subset of right-wing voices finding community and influence online seeking to force Target and other brands to adhere to their boundaries of acceptability.

For Target, the decision isn’t easy. There’s no question that their staff are, in fact, being put in situations that are at a minimum uncomfortable. Acquiescing to the pressure, though, increases the likelihood that pressure will be applied by small groups in similar ways in the future.

Former South Carolina governor Nikki Haley, herself a candidate for the 2024 Republican presidential nomination, was in New Hampshire on Wednesday, where she sought to toss some red meat to the Republican audience.

“Everybody know about Dylan Mulvaney? Bud Light?” she said, according to reporter David Weigel. “That is a guy, dressed as a girl, making fun of women.”

<A hate preacher told his church’s congregation that parents who allow their children to have “a transgender surgery” should be shot in the back of the head and hung from a bridge as an example to the public. However, gender-affirming genital surgeries aren’t conducted on children.

These comments came from Jason Graber — a New Independent Fundamental Baptist (New IFB) preacher at Sure Foundation Baptist Church in Spokane, Washington.

Hate preacher says he’d rather eat his own vomit than be gay in unhinged sermon

He then pretended to eat his own vomit in front of his congregation to show how serious he was.

“Any parent that would have their child, would have a transgender surgery done on them, any parent that would do that, they just need to be shot in the back of the head,” Graber said. “They need to be convicted in trial and immediately shot in the back of the head. Okay, and then we can string them up above a bridge so that the public can see the consequences of that kind of wickedness.”

“And so there should be no excuse to not put these people to death, no excuse whatsoever,” he added.

He then said that “there are very, very few people out there in the world today that are actually fighting the spiritual fight.” He told his congregation that he doubts other preachers are willing to say that “these child molesters, that these child butchers, that these fa***ts, all the LGBTQ people, people that desire strange flesh, that they should all be put to death in a public execution by the government.”

It’s worth noting that in the TV series The Handmaid’s Tale, the bodies of LGBTQ+ people are hung in public by a dystopian Christian Nationalist government.

These comments aren’t surprising coming from Graber. He has referred to gay people as “AIDS dispensers,” has previously called for the execution of gay people, and said that teachers want to turn kids transgender to teach them to hate God. In April 2022, he called for LGBTQ+-accepting teachers to be shot in the head or beheaded on live TV because, he claimed, they’re “grooming” kids for sexual abuse. The grooming claim has been repeated by mainstream Republican politicians as a reason to ban LGBTQ+ content from public schools.

He has also said that LGBTQ stands for “Let God Burn Them Quickly.”

New IFB isn’t affiliated with any mainstream Baptist denomination, although both Baptist and New IFB teachings exhibit anti-LGBTQ+ bigotry, antisemitism, and misogyny. But while Baptists merely condemn queer people to hell, New IFB goes a step further, calling for the execution of LGBTQ+ people.

In March 2023, Graber’s church tweeted from its account that it is getting death threats after calling for the death of LGBTQ+ people so many times.

“When someone actually follows through with one of the MANY threats to rape and kill me, my family, and blow up and kill everyone in my church, including women and children and many other vile and filthy things threatened. What will you say?” the church tweeted.>

<Donald Trump welcomed Florida Gov. Ron DeSantis to the Republican presidential race with a series of increasingly bizarre posts on his various social media channels.

The former president posted a video attacking DeSantis as an ingrate who owes his career to Trump. He posted another of what appears to be a SpaceX rocket falling over and exploding with “Ron! 2024” over it.

And he shared a weird video mocking DeSantis’ entry via a glitchy Twitter event hosted by Elon Musk.

In Trump’s version, the participants include not just Musk and DeSantis but also Adolf Hitler, the devil, a coughing Dick Cheney, billionaire George Soros, World Economic Forum founder Klaus Schwab and an FBI agent openly plotting to “take out” Trump.

The video concludes with a fake ― perhaps AI ― Trump voice unleashing insults.

“The devil, I’m gonna kick your ass very soon. Hitler, you’re already dead. Dick Cheney, sounds like you’ll be joining Hitler very soon,” the Trump voice says. “Ron DeSanctimonious can kiss my big, beautiful 2024 presidential ass.”

The bizarre video was posted on Trump’s official Instagram and Truth Social pages but widely shared by others on Twitter:

Trump also fired off a series on insults aimed at DeSantis on his Truth Social website, including one in which he compared sizes.

That’s a reference to a 2018 tweet by Trump warning that his nuclear launch button “is a much bigger & more powerful one than his, and my Button works!”

DeSantis at one point appeared to be a legitimate threat to Trump’s third run for the presidency, with polls showing him catching up the former president.

One poll in January even had DeSantis with a lead over Trump.

His star has since faded, with more recent polls showing the Florida governor behind by double digits ― including a recent Quinnipiac poll that has the Florida governor down by nearly 30 percentage points.

“His whole campaign will be a disaster,” Trump predicted Wednesday on Truth Social. “WATCH!” >

Does this cretin imagine they are back in third grade? Really?

<For weeks, a mystery has surrounded Manhattan District Attorney Alvin Bragg's business fraud charges against former President Donald Trump. To enhance the charges from misdemeanors to felonies, Bragg has to establish that the fraud was done to conceal another, underlying crime.

But he hasn't revealed what that crime actually is, and has declined to provide a "bill of particulars" on request of Trump's legal team — something that Trump's allies have been quick to claim is proof the whole case is illegitimate.

But now, as several legal experts including Paula Junghans, Norm Eisen, Siven Watt, Joshua Stanton, and Fred Wertheimer write for Just Security, there are clear hints of what Bragg's legal basis is — and they say it's strong.

"The main facts of the case have been known for some time," they wrote. "DA Bragg alleges that, in October 2016, Trump had attorney Michael Cohen pay adult film actress Stormy Daniels (whose real name is Stephanie Clifford) a $130,000 payment to prevent her from publicizing an alleged sexual encounter she had with Trump.

"To conceal the hush money payment, it was agreed that Cohen would make the payment to Daniels via a shell company (Essential Consultants), on the agreement that Trump would later reimburse Cohen."

What ties this all together, they wrote – and what likely allows for the felony enhancement – is violations of tax law. And there are not just state statutes that apply here, but federal ones.

"Because Bragg’s response to the request for a bill of particulars leaves open the door that other offenses than those listed might also serve as the 'bump-up' predicates to the falsifying business records charges, in addition to New York state tax statutes, we also consider the possibility that prosecutors will attempt to leverage federal tax offenses for this purpose," they wrote.

"Two statutes appear most relevant: Declaration under Penalties of Perjury (26 U.S.C. 7206(1)), and Willful Assistance in Preparation of False or Fraudulent Tax Documents (26 U.S.C. 7206(2))."

In essence, these crimes involve deliberately misrepresenting finances on tax documents with intent to defraud the state. Some of these tax crimes are misdemeanors — but that doesn't matter, because business fraud to cover up a misdemeanor is still a felony.

"Whatever the effectiveness of such a bump-up based on the alleged primary campaign finance violations, pursuing an approach based upon state tax violations is wise and well grounded," they concluded.

"The strongest case involves statements to tax authorities falsely characterizing the payments to Michael Cohen as “legal fees,” rather than their true nature (reimbursements for a hush money payment). A strong case could also involve other variations on state criminal tax violations, as well as possible federal ones.">

<It’s the second flat white that does it. I would barely be awake without the first, which I pick up on the way into the office. But the second – which always seems like a good idea at the time – all too often leaves me jittery and overstimulated. This is the strong stuff: unlike weaker instant coffee, or tea, which contain roughly 100mg and 75mg of caffeine respectively, a high-street flat white can contain over 250mg.

We are a nation of fully-fledged coffee addicts, consuming approximately 98 million cups per day, according to the British Coffee Association. But we forget that, fundamentally, caffeine is a fairly powerful stimulant: it makes you feel more awake and focused, but too much can potentially leave you in an anxious spiral. As my colleague Bryony Gordon has written, “coffee is essentially panic juice”. Which goes to show that, clearly, if you are prone to anxiety, coffee is not the drink you should turn to calm down.

Why does this happen? “Caffeine blocks adenosine receptors (which promote sleep), which increases the production of dopamine, noradrenaline and glutamate [neurotransmitters that play a role in cognitive function],” explains Clare Thornton-Wood, a dietician and British Dietetics Association (BDA) spokesperson. “That makes you more alert and increases your blood pressure and heart rate. In many cases, this is beneficial.” That’s why coffee boosts your mood and helps you concentrate.

But there’s a tipping point. “The negative impacts of caffeine are caused when this effect goes too far and promotes anxiety,” she says. There is no clear reason why drinking two cups of coffee seems to tip some of us over the edge, while others can easily tolerate four or five cups. Genetics play a role, and generally your caffeine tolerance is greater if you are heavier, says Thornton-Wood. “Only some people are susceptible to the effects of caffeine; if you are more anxious in any case, you’re probably more susceptible.”

Too much caffeine leaves you “feeling restless, nervous, not being able to sleep, feeling nauseous, having a headache and general anxiety”, says Thornton-Wood. The formal classification for this group of symptoms is “caffeine-induced anxiety”, which is actually “a recognised disorder in the DSM-5 – the Diagnostic and Statistical Manual of Mental Disorders,” she says.

The good news is that research shows a coffee habit can have significant benefits for physical health. A 2021 study published in the journal PLOS Medicine found that moderate caffeine intake cuts the risk of a stroke by almost a third and that of dementia by a quarter. Another major study from scientists at the Universities of Southampton and Edinburgh found that two cups of coffee per day reduces the risk of liver cancer by a third. That’s not all: a 2014 meta-analysis revealed that drinking up to four cups of caffeinated coffee a day was associated with a 25 per cent lower risk of developing diabetes.....>

<....Other studies show that it boosts athletic performance: in 2017, researchers from the University of São Paulo put 40 cyclists through a series of time trials and found that a caffeine supplement boosted performance by an average of 2.5 per cent compared to a placebo. These benefits are all associated with a “moderate” caffeine intake of roughly one to four coffees per day – drinking five or more can have adverse health effects. And yet, for some, drinking more than one cup (or in some cases, any at all) can wreak havoc.

There is no golden rule for when you should drink coffee in order to enjoy the buzz and skip the jitters. “It all depends on the dose of caffeine in your coffee and how close together you’re having them,” says Thornton-Wood. “It’s personal to you. I can drink coffee all day and after dinner and it doesn’t make any difference to me. I know the rest of my family won’t drink coffee after mid-afternoon. Everybody’s different.”

How much you should drink is a more complicated question. While 400mg of caffeine per day is the recommended limit (200mg for pregnant women), the amount of caffeine in various high-street coffees varies wildly, which can make it difficult to keep track of your consumption.

According to data from Which?, a single cappuccino from Costa would put you close to the maximum recommended intake, with 325mg of caffeine (more than double that of a Starbucks one, and almost as much as four cans of Red Bull). However, you could drink three cappuccinos from Café Nero, at 120mg of caffeine each, and still be under the limit.

The variations are not only down to how many shots of coffee each chain uses, but also on the coffee beans themselves: of the two most commonly used, Robusta beans contain roughly double the caffeine of Arabica beans. So you may find you feel the negative effects of too much caffeine after two flat whites from a coffee shop, but not after four weaker instant coffees, or after a latte from one chain but not from another.

How can you beat the two-coffee tipping point? Know your limits: if you often find yourself in a cappuccino-induced spiral, cut down and stick to one caffeinated coffee, one decaf, which has some of the health benefits of caffeinated coffee with none of the stimulating effect.>

<House Democratic lawmakers are voicing frustration over President Biden’s approach to negotiating a debt ceiling deal with Republicans, worrying that their priorities are not being championed aggressively enough and that Biden hasn’t more forcefully pushed back publicly against Republican demands.

In a previously unreported interaction, Rep. Sheila Jackson Lee (D-Tex.), who has served in the House for almost 30 years, encouraged Minority Leader Hakeem Jeffries (D-N.Y.) during Democrats’ weekly caucus meeting Tuesday to ask the president to immediately address the nation, detailing how Republicans are toying with the economy and explaining that a default would catastrophically affect their lives.

Jeffries acknowledged Jackson Lee’s request and assured lawmakers that he and his leadership team would take a more aggressive approach to messaging while the White House adheres to a strategy of keeping negotiations behind closed doors. Jeffries has not yet raised the request with the president, according to a person familiar with the situation, who, like others who spoke to The Washington Post, did so on the condition of anonymity to discuss sensitive conversations. But White House officials and leadership staff have remained in contact in recent days.

“It’s my expectation that if Republicans continue to play games with the American economy, threaten default, and drive us into a very dangerous situation, that we’ll begin to hear from the administration, if not the president himself,” Jeffries said in a news conference Wednesday afternoon.

House Democrats across ideological factions are frustrated at what they say is a lack of communication by the White House at a time when they should be preparing to defend their party’s president, who has frequently commented on his willingness to find compromise in hopes of striking a deal. Democrats have publicly and privately said the president isn’t responding forcefully enough to Republicans’ framing of the negotiations, and that their lack of insight into the process could jeopardize Democrats’ ability to whip votes in support once a bipartisan deal eventually hits the House floor.

The approach is a stark contrast to that of House Speaker Kevin McCarthy (R-Calif.) and his lieutenants, who have held court with the press at length, multiple times per day, effectively shaping a narrative and — at least publicly — the parameters of the negotiations.

“It’s frustrating,” said Rep. Daniel Kildee (D-Mich.), who represents a swing district. McCarthy “feels free to negotiate in public, and that’s not really a productive way to try to come to a conclusion.”

After McCarthy and his team met with Biden at the White House on Monday, the speaker and Rep. Patrick T. McHenry (R-N.C.) spoke to the press twice — once at the White House and once at the Capitol, totaling nearly an hour of taking questions.

Biden, who gave brief remarks before the meeting, did not speak to the press after but instead released a statement. Jeffries, Minority Whip Katherine M. Clark (D-Mass.), and Democratic Caucus Chair Pete Aguilar (D-Calif.) took that opportunity to walk down the Capitol steps to hold an impromptu news conference.

“Thankfully, we have a good messenger in Leader Jeffries, who has been forcefully pushing back and holding Republicans accountable,” Aguilar said after another news conference Wednesday.

Biden has not held a public event regarding the negotiations since returning from Japan late Sunday. He did comment on the state of negotiations while in Japan, but not enough to assuage House Democrats’ nerves.

White House press secretary Karine Jean-Pierre rejected the notion that Biden has not spoken on the debt limit clearly and forcefully.

“You’ve heard from the president multiple times over the weekend,” she told reporters Tuesday. “You’ve heard from the president multiple times during the last five months. He’s been very clear. You’ve heard from me; you’ve heard from others. We’ve had our economic team out there talking about this on [television] networks.”....>

<....Even so, Democrats have seethed in private over what they view as the White House’s 20th century approach to high-stakes negotiations — all done behind closed doors, with an occasional designated leak of information designed to shame the other side. Biden is adhering to the notion of not negotiating through the press, while McCarthy has frequently engaged the media.

The House speaker has been a whirling-dervish of communication with the press, engaging roughly a dozen times in hallway interviews since the House gaveled into session on Monday. His top lieutenants in the negotiations, Reps. Garret Graves (R-La.) and McHenry, did a short televised news conference Tuesday morning before their talks with top Biden officials. Later that day, after the 2 ½-hour negotiation session ended, they gave reporters a nearly 50-minute readout of their side of the talks.

All the while, Biden remained mostly silent, which Democrats say has helped Republicans appear reasonable.

Democrats on Capitol Hill want the president to frame Republicans as extreme hostage takers of the debt limit, which requires an act of Congress to lift. The frustration among Democrats spread throughout the caucus Friday after negotiations fell apart and Republicans took hold of the messaging while the White House did not explain what went wrong from their perspective.

The White House argues that the president has been touting the Democratic position in short interactions with the press and that inside the negotiating room, Biden and his team — which includes Director of the Office of Management and Budget Shalanda Young, White House Counselor Steve Ricchetti and Director of Legislative Affairs Louisa Terrell — are working to save the president’s student loan relief program and green energy tax credits and investment, while resisting work requirements on social programs.

In a sign that advisers want to escalate the debate, the White House on Wednesday afternoon accused Republicans of trying to “actively harm their own constituents.”

“House Republicans need to be called out for the vicious threat they are making to sabotage America, and to put down the gun they’re holding to the head of middle class jobs,” deputy White House press secretary Andrew Bates wrote in a memo. “Then they need to face reality and work across the aisle on a reasonable budget agreement.”

Meanwhile, House Democratic leaders have been placed in the delicate position of trying to act on the feedback from their irritated caucus without stepping on the White House’s toes. After soliciting member feedback, an approach unique to this new generation of leaders, Jeffries, Clark and Aguilar decided on the Monday evening news conference to push back on the GOP’s claims and another Wednesday. They have shown equal willingness to stop in the hallways and hold court in recent days.

“Jeffries’s messaging has been clear and strong and consistent, but the problem is, he’s not even in the room right now,” liberal Rep. Jared Huffman (D-Calif.) said. “We need more people echoing and amplifying Leader Jeffries’s message because he’s spot on.”....>

<....Democratic lawmakers have also lamented that the White House has not aggressively demanded that increases to revenue, including tax hikes on the wealthy, be on the table. Instead, lawmakers said, the parameters of the negotiations center on the Republican priorities of deep cuts to nondefense government programs and work requirements for social safety net programs — both anathema to Democrats.

Sitting next to McCarthy on Monday, Biden did stress that be believes negotiators “should be looking at tax loopholes” for the wealthy and that “revenue matters as well as — as long as you’re not taxing anybody under 400,000 bucks.”

But some swing-district Democrats who ran on fiscal reform say their party also is missing an opportunity to frame themselves as the party of fiscal responsibility by arguing they would never allow the country to default, while remaining cognizant that some voters feel the government is spending too much. One Democratic lawmaker said voters are “pulling their hair out at the Democrats [sic] lack of understanding” that voters do not view their party as one that can responsibly govern the economy.

Liberals are pushing for Biden not to budge at all, defending what they have spent over the last two years as critical for Americans and imperative to Biden’s agenda.

“Democrats are not going to vote for a bill that screws poor people, while protecting rich people,” said Rep. Jim McGovern (D-Mass.). “End of story.”

Democrats first grew skeptical of Biden’s handling of the talks when he told reporters in Rehoboth Beach, Del., earlier this month that some work requirements for some entitlement programs are a potential area of compromise — infuriating the more liberal wing of the caucus. Biden later clarified his comments that “not anything of consequence” would be affected by work requirements undermining what House Democratic leaders were telegraphing: that work requirements were a “nonstarter.”

Republicans involved in the negotiations have acknowledged that they would need the help of Democrats to pass any bill through the House because it is likely they will lose a majority, if not all, of the roughly three-dozen conservatives in the House Freedom Caucus. McCarthy knows he needs “a majority of the majority” of his conference to put any bill on the floor, which means that as many as 100 Democrats would need to sign off on the legislation.

“I think the backlash will be significant if somehow we were to get bullied into a bad deal,” said Rep. Pramila Jayapal (D-Wash.), the Congressional Progressive Caucus’s chairwoman. “I think it’s very bad for the people of America. I also think it’s a terrible dynamic for negotiations going forward.”

Democratic leaders haven’t been able to whip support for a bill that lacks legislative text. Knowing more about where the negotiations stand could help the effort, especially because the new generation of leaders are trying to avoid the model former speaker Nancy Pelosi (D-Calif.) perfected of making her caucus deliver on tough votes without much pushback.

The new Democratic trio of leaders has worked to be more receptive to rank-and-file concerns after lawmakers spent last Congress privately expressing how fed up they were about having to fall in line and take bad votes in exchange for Democratic unity. Their philosophy, according to multiple lawmakers and aides, is to maintain that unity ahead of a vote — a challenging exercise as Biden has stepped away from forcefully using the bully pulpit....>

<....Democrats also worry that the lack of White House communication could undercut Jeffries when he is tasked with delivering votes on a deal many in the caucus may not like. In roughly two dozen interviews, lawmakers insisted that they are not upset at their leadership, instead remaining united as a caucus in defending them.

During the White House Oval Office meeting Monday, Biden told reporters that he and McCarthy “both talked about the need for a bipartisan agreement” and understood that the final product is one “where we can sell it to our constituencies.”

During their weekly whip meeting Wednesday morning, Rep. Joe Neguse (D-Colo.), who chairs Democrats’ policy arm, played a clip of McCarthy saying Tuesday that the only concession Republicans would make in the negotiations is raising the debt ceiling.

In response, Jeffries said it was reasonable to conclude that Republicans are bringing Americans to the edge of a default, which could possibly trigger a painful recession that kills jobs. Their task now was to explain those dangers until the message breaks through, and they flirted with the idea that if Republicans were willing to leave the Capitol for their scheduled recess that begins Thursday, Democrats would seize the opportunity to shape public debate.

Hours later, Jeffries began a news conference standing between Clark and Aguilar by stating that Republicans were on the brink of bringing “catastrophic” consequences “for everyday Americans.”

“The more House Republicans talk, the more information and insight the American people have in their true motives, which is that they are involved in a hostage-taking situation,” he said. “The hostage is the economy and everyday Americans.”>

<Hurled from a road-paving machine, Michael Sheldon tumbled 50 feet down a Colorado slope and struck a mound of boulders headfirst on a summer day in 2006. After eight surgeries to his head, neck and spinal cord, his debilitating headaches, chronic pain and post-traumatic stress have made it impossible to return to his work preparing roads for new subdivisions.

Yet for more than a decade, the Social Security Administration repeatedly denied Sheldon’s full claim for disability benefits that would pay him $1,415 a month.

Even after three federal judges found significant errors with how his case was handled and sent it back to Social Security for new hearings, the agency continued to reject Sheldon, court documents show.

“They’ve done everything to prolong this to get me to quit,” he said after testifying in March at his fifth hearing. Now 59, he lives with his wife in a trailer in Cortez, Colo., and depends on food stamps and state benefits for the indigent. “I can’t replace the battery on a vehicle. Why has this taken 14 years?”

Like Sheldon, thousands of other disabled Americans battle for years for benefits, even after federal courts rule in their favor.

In the last two fiscal years, federal judges considering appeals for denied benefits found fault with almost 6 in every 10 cases and sent them back to administrative law judges at Social Security for a new hearing — the highest rate of rejections in years, agency statistics show. Court remands are on pace to reach similar levels this year.

Federal judges have complained of legal errors, inaccurate assessments of whether claimants can work, failures to consider medical evidence and factual mistakes, according to court rulings and Social Security’s own data. The scathing opinions have come from trial and appellate judges across the political spectrum, from conservatives appointed by President Ronald Reagan to liberal appointees of President Barack Obama.

Northern California District Court Judge Susan Illston, appointed by President Bill Clinton, wrote in January that a claim denied by Social Security that ignored key physician records was “so vague as to be essentially unreviewable.” The judge reversed the decision and ordered the agency to pay benefits to the claimant, a woman who suffers from delusions, depressive disorder and schizophrenia.

Approval rates for benefits are down at every level of review, Social Security data show, even as the number of disabled people applying dwindled during the coronavirus pandemic. Fewer than 20 percent of those who lose their appeal at Social Security take their claim to federal court, as most lack the time or resources to keep fighting.

“The system has become one of ‘how do we deny this claim’ rather than ‘what is the right answer in this person’s case?’” said Ann Atkinson, Sheldon’s attorney outside Denver. “And the federal court is agreeing with us: ‘You have to do a better job.’”

The high rate of rejections for cases handled by administrative law judges and the attorneys who write their decisions is driven by stringent monthly quotas set by Social Security officials and growing pressure to deny more cases, according to current and former officials, audits and attorneys who represent the disabled. The agency’s policies have been reshaped to give less deference to the expertise of doctors who, in some cases, have treated claimants for years, and its policies routinely depart from federal appellate court rulings.

The result has been an unmistakable shift to an adversarial disability system, advocates for the disabled claim: rather than calling the case down the middle, they say, Social Security has stacked the cards against the approximately 2 million people each year who apply for help when they can no longer work.

Yet federal judges rarely order the agency to approve claims in deference to the government, but instead must typically refer the cases back to the administrative law judges — often the very ones responsible for the errors in the first place, a common practice in administrative law that avoids asking a new judge to rehear a complicated case. Only about half of the agency judges assigned to rehear cases they initially denied reverse those rulings, prolonging the cycle of appeals and new remands for disabled claimants, few of whom have means to support themselves, a Washington Post analysis found....>

<....“Some of them just dig in and say, ‘I’m going to find a way to deny this claim again,’” said Steven Weiss, regional managing attorney at Bay Area Legal Aid in Oakland, Calif.

Nicole Tiggemann, a Social Security spokeswoman, disputed that the system has overly tilted against claimants.

“The agency evaluates the totality of the evidence and decides cases based upon the issues and evidence in the particular case,” she wrote in an email. “The process has always been and continues to be non-adversarial.”

Yet the rate of cases remanded to the agency from federal judges has long been a source of alarm inside Social Security, current and former officials said. For the last decade, roughly half of all appealed cases have been sent back. Under a federal law known as the Equal Access to Justice Act, the government paid attorneys of claimants who prevailed in federal court $68 million in fiscal 2022, the largest number of awards of any federal agency and more than triple the sum a decade ago, internal agency data shows.

“It’s absolutely much higher than it should be,” said Asheesh Agarwal, Social Security’s chief lawyer during the first two years of the Trump administration. Given the stakes for disabled people and taxpayers, he argued, administrative law judges must do a better job deciding cases. “There’s a lot of money at stake when you think of a grant of lifetime benefits.”

Social Security spokesman Mark Hinkle in an email defended the system, noting that disability decisions appealed to federal court “constitute a very small fraction of the overall decisions issued by the agency.”

Hinkle acknowledged that “despite our consistent efforts to ensure quality decisions, the federal courts may remand decisions for further action.” He said that since courts rarely reverse the decisions of Social Security judges outright, “the agency is not directed to issue a decision in favor of the claimant” but must only “consider” new evidence — circumstances like a claimant’s age, a changed medical condition “and any specific action or analysis directed by the court.”

While Social Security officials defend the rate of court remands, current and former officials said that the agency’s own lawyers are increasingly admitting error before proceedings begin in federal court. Government attorneys frequently ask district courts to remand an appeal before the claimant’s attorney submits a written brief, a practice that spiked during the pandemic as the agency fell behind.

“They recognize right away that some of these cases aren’t defensible,” said Cody Marvin, a Chicago-based disability attorney who frequently takes cases to federal court. He estimated that 40 percent of the claims his firm appeals to trial judges are returned to Social Security in what is known as voluntary remands. The numbers vary by state, but Social Security acknowledges some degree of error in at least 15 percent of cases, officials said.

Administrative law judges and their representatives also acknowledge that the system is flawed. Som Ramrup, president of the organization that represents 1,084 Social Security judges not in management, cited the sustained imposition of monthly case quotas as the “number one reason” behind the high rate of remands. Each judge schedules up to 600 cases a year, according to Ramrup and other administrative law judges.

“The judges strive to issue quality decisions, but they certainly are encouraged to rush,” Ramrup said. “When you’re rushing, it’s not going to be perfect. It’s a business decision [by the agency] to say, ‘that’s an acceptable remand rate to us.’”

Disabled claimants, meanwhile, can spend years battling for benefits, only to see victories in federal court rejected by Social Security after follow-up administrative proceedings. After a Colorado district court found in 2020 that an administrative law judge had erred in denying benefits to Heather Fowler, her claim was returned to the same judge — who reached the same conclusion after a second hearing.

“It should not be this hard to help people get what they need,” said Fowler, 47, of Yuma, Colo., who has been unable to work after a diagnosis of dissociative identity disorder that she said arose from years of physical abuse as a child.

A system on the edge

The disability system has relied since the 1950s on administrative law judges, who were meant to serve as impartial fact-finders in disputes over decisions on claims for benefits. These judges adjudicate disputes in government programs, operating outside the federal judiciary as they work directly for more than two dozen agencies. Their triallike hearings are supposed to be free from agency coercion or influence. A law degree is required for the job.....>

<....The largest share work at Social Security, which has 1,200 judges, including managers, with salaries ranging from $146,000 to $195,000. Unlike in standard courts, their hearings are closed to the public.

Administrative law judges must hear and make complex decisions in disability cases in less than three hours on average, Ramrup said. The role is complicated by the relatively subjective rules used to award benefits. While the judges ultimately answer to Social Security and do not enjoy the independence of the federal judiciary, they have chafed for years at a system that subjects them to scrutiny over how many claims they approve.

Two decades ago, Social Security judges were relatively generous, approving 70 percent of appeals in 2001 — a high point. But that changed after an explosive corruption case broke open in 2012, when a Kentucky lawyer was found to have defrauded taxpayers in a $600 million disability benefits scheme. The crime led to new congressional oversight and pressure to deny more claims, according to federal audits, attorneys and current and former Social Security employees.

Approval rates plummeted to 45 percent for several years, rising to 51 percent last year, agency data shows. Some administrative law judges who approved high numbers of cases found themselves under new scrutiny, a practice that accelerated during the Trump administration as political appointees took a hard line against paying claims, current and former judges and other officials said.

Jonathan Baird, an administrative law judge in the Lawrence, Mass., hearing office, said an agency review in 2020 warned that his pay rate of about 70 percent — which had never before caused concern — was “a huge red flag” and was told to rely less on medical opinions from claimants’ treating doctors about whether they are disabled and more on treatment notes. These reviews had a chilling effect on his colleagues, Baird said. “They were out to get high-paying judges,” he said, referring to colleagues with high approval rates.....>

<....Other Social Security judges with similar rulings have been forced out. Michael Blanton, 63, a Seattle-based judge who approved between 89 and 93 percent of his cases from 2016 through 2020, was placed on administrative leave in 2021, then told he was being fired over alleged performance shortfalls. Before his dismissal, “I was never informed of any these issues,” said Blanton, who is challenging his firing, calling the reasons cited a pretext to attack his record of approving benefits.

Social Security officials declined to comment on specific judges or how widespread these reviews are today. The agency “monitors performance to ensure that decisions are consistent with [Social Security] policy, including regulations and rulings,” Hinkle wrote. “We provide feedback to [administrative law judges] regarding the quality of their decisions.”

More than a decade ago, Social Security also imposed production quotas on judges to help address a historic backlog of appeals prompted by the Great Recession and a wave of baby boomers applying for benefits. But even after the logjam cleared, management continued to demand that judges hear and decide about 50 cases a month, said Ramrup. The bottleneck shifted to initial claims during the coronavirus pandemic, leaving fewer cases in the pipeline of appeals.

Given these caseloads, administrative law judges rely heavily on mid-level attorneys to draft their decisions. Known as decision writers, they face production quotas, too. It’s a high-turnover job that requires years to become proficient. Training suffered during the pandemic, said Spencer Bishins, who left in 2021 after a decade as a decision writer, then wrote a book about why it is so hard to win disability benefits.

“I’ve read a lot of very bad decisions,” Bishins recalled, “because the agency squeezes the [decision writers] so much.”

“The decisions are getting worse with fewer cases,” Bishins added. “Shouldn’t they be getting better?”

Claims for disability benefits have declined from almost 3 million at the peak of the recession to 1.8 million last year, dropping during the pandemic when Social Security’s in-person operations ceased, its phones jammed and many claimants could not get help on its website.

The Government Accountability Office found in 2021 that the expectation that administrative law judges would hear and decide hundreds of appeals a year did not balance “timely case processing while maintaining high-quality work and employee morale.”

In response, Social Security hired a contractor to review the workloads, GAO reported, but told auditors in March that “Its long-standing expectations [of its judges] are reasonable.” Hinkle said production demands are necessary to “quality public service” and “effective docket management and time management skills in a high-volume environment.”

In recent years, the demands on administrative law judges have become more onerous as claimants have been required to submit more medical evidence, with records that can now run as large as 3,000 pages. The volume can result in more scrutiny when a case reaches the trial court, whose staff has more time to review if the Social Security judge paid attention to the evidence, officials said.

Administrative law judges must often weigh medical evidence to determine if someone can still work despite their limitations, and if there are jobs they can still do. Their decisions fall into gray areas that require judgment calls rare in other safety-net programs, experts said.

But Social Security has also tilted the scales in recent years away from key medical evidence, critics say, in another sign of the shift toward granting fewer claims. While administrative law judges once based much of their decision on evidence from primary care doctors or psychiatrists who best understood their patients’ medical issues, that policy changed in 2017. Now judges are free to disregard the opinions of these treating physicians and rely heavily instead on contracted doctors who examine claimants for as little as 15 minutes, according to claimants, their attorneys and former Social Security employees. This often leads to shoddy records and poor decisions, federal courts have found.

Social Security officials said they changed the rules “to focus more on the content the reliability of medical opinions and less on who the treatment source is,” a system that helps courts “better assess whether substantial evidence supports the decision” to grant benefits. The agency’s regulations also emphasize that “sufficient time be provided to thoroughly examine the claimant” for an outside medical exam, “including development of the claimant’s case history,” officials said....>

<....In recent years, other agency rules have also made it harder on applicants to prove their cases. Less weight is given to certain musculoskeletal conditions, for example. IQ tests that show mental impairments do not automatically grant benefits. Evidence can be excluded if a claimant submits it too close to a hearing. If someone applying for benefits cannot communicate in English, that language barrier is no longer a factor considered in granting benefits under a rule change enacted in 2020. Critics of the agency contend that its administrative decisions are often at odds with precedents set by federal appeals courts, citing, for instance, its refusal to be bound by a 2017 ruling giving substantial weight to Veterans Affairs disability ratings.

The Supreme Court has allowed vocational experts to refuse to disclose how they come up with jobs a claimant could still do or how many exist in the economy. An internal panel that must consider appeals before they go to federal court sent just 18 percent back to administrative law judges last year.

These policies have exasperated federal judges.

“Social Security has attempted by regulation to authorize its judges’ decisions to be of lower quality in the eyes of a federal court,” said David Camp, president of the National Organization of Social Security Claimants’ Representatives.

But the agency cannot totally disregard the testimony of physicians who know claimants the best. That’s what happened to a 55-year-old South Carolina woman with severe depression who was denied benefits despite her suicidal ideations, anxiety and other mental impairments. In February, the U.S. Court of Appeals for the 4th Circuit ordered the agency to pay benefits outright after finding that Social Security had improperly accorded “little weight” to the testimony of the woman’s longtime treating psychiatrist — among other mistakes.

“Given the ALJ’s duty to balance the record’s evidence, to disregard a 20-year treatment relationship … is a disproportionate response,” the judges wrote.

In another South Carolina case, Shanette Rogers, an Army veteran from Myrtle Beach, who was raped twice in the military, waited five years for a ruling from the 4th Circuit in March that her post traumatic stress syndrome justified an award of disability benefits. The appeals court found that Social Security had ignored evidence from her psychiatrist that her symptoms were tied to her menstrual cycle, chronically restricting her ability to work.

“I just feel like I’ve been really passed along a lot,” Rogers, 53, said. “My cycle is a trigger for me. It brings out the demons I’m battling.”

Advocates say change is needed at every level of review to shift a culture that encourages Social Security judges to deny claims at the expense of the law.

“Claims must be properly reviewed at the initial application,” said George Piemonte, a disability attorney in Charlotte who represents Rogers. “This can be a matter of life or death for a huge proportion of disabled people. Social Security needs to focus its efforts on getting things right in the first instance.”

For many claimants, it’s easier to walk away than to keep battling.

Sheldon only carried on because, he said, he was entitled to benefits he paid for through payroll taxes during decades as a laborer before his accident. “It’s just almost like they’re against you from the get go,” he said.

At his hearing in March, a new Social Security judge considered the rulings by three federal judges who found that the agency failed to properly consider the severity of his headaches, nerve damage and other impairments by ignoring treatment notes from his doctors. An outside doctor Social Security hired to examine him also described severe “pain and anxiety” from his injuries.

He prepared to wait for months for another rejection.

Instead, the written decision came just two weeks later: Sheldon had been awarded the monthly benefits — along with $205,000 in back pay. His first check landed in his bank account this month.>

<Jamie Dimon predicts more banking pain from real estate … growing problems with multifamily commercial real estate … are lenders beginning to repeat the same problems from 2007?

The commercial real estate market is deteriorating.

Regular Digest readers know that for months, we’ve been running a “commercial real estate watch” segment to monitor this critically-important sector of the U.S. economy.

The same factors that resulted in a handful of banking failures this spring are creating cracks in the foundation of the $20-trillion commercial real estate sector. If defaults snowball, it will have an enormous impact on the U.S. economy.

Well, the stories are coming faster and faster.

Let’s begin with Monday’s CNBC article featuring commentary from JPMorgan’s CEO, Jamie Dimon

Here’s CNBC:

Deposit runs have led to the collapse of three U.S. banks this year, but another concern is building on the horizon.

Commercial real estate is the area most likely to cause problems for lenders, JPMorgan Chase CEO Jamie Dimon told analysts Monday.

“There’s always an off-sides,” Dimon said in a question-and-answer session during his bank’s investor conference.

“The off-sides in this case will probably be real estate. It’ll be certain locations, certain office properties, certain construction loans. It could be very isolated; it won’t be every bank.”

Sure, it won’t be “every” bank, but my money is on it being less “isolated” than Dimon says.

After all, regional banks are responsible for the overwhelming majority of loans to the commercial real estate sector. Bank of America puts the number at roughly 68%. So, let’s size-up just how big this issue might be.

This comes from Dimon’s own analysts at JPMorgan:

We expect about 21% of commercial mortgage-backed securities outstanding office loans to default eventually, with a loss severity assumption of 41% and forward cumulative losses of 8.6%…

Applying the 8.6% loss rate to office exposure, it would imply about $38 billion in losses for the banking sector…

Does that sound isolated?

We’re already seeing some troubled banks reducing their exposure to real estate Take PacWest, which we’ve highlighted here in the Digest in recent weeks.

The bank’s stock has come under enormous pressure since March as banking contagion has spread. As you can see below, investors are down nearly 75% since March 1st.

Well, Monday brought word that PacWest is unloading dozens of properties to Kennedy-Wilson Holdings, which is a large real estate investment trust (REIT).

From CNBC:

Regional lender PacWest Bancorp said on Monday it agreed to sell a portfolio of 74 real estate construction loans with an aggregate principal outstanding balance of around $2.6 billion to a unit of Kennedy-Wilson Holdings.

PacWest said in a filing it will also sell an additional six real estate construction loans with an aggregate principal balance of around $363 million to Kennedy-Wilson…

PacWest is one of several U.S. regional lenders whose shares have been hit by investor concerns over the health of the banking sector following the collapse of three banks since March…

Digest readers are familiar with this “office/regional bank” trouble, the ripple effects are now spreading

So far, our analysis has focused on the “office” part of commercial real estate. But the sector is far larger than just office.

Broadly speaking, commercial real estate refers to any property used for business-related purposes. So, that could be a single storefront, a big shopping center, a warehouse, or even residential properties with five or more units paying rent.

Let’s zero in on these multifamily residential properties for our next story.

Yesterday, The Wall Street Journal ran a piece highlighting Jay Gajavelli, a real estate investor who built a rental apartment empire in Houston consisting of more than 7,000 buildings.

You might even know Gajavelli since he pitches his “double-your-money” real estate strategy on YouTube. From one of Gajavelli’s pitches:

I never worry about [the] economy now. Even if [the] economy goes down, still I make money.

Well, Mr. Gajavelli, I’d like to introduce you to reality.

From the WSJ:

In April, Gajavelli’s company lost more than 3,000 apartments at four rental complexes taken in foreclosure, one of the biggest commercial real estate blowups since the financial crisis.

Investors lost millions. Gajavelli didn’t respond to requests for comment.

His company had taken out commercial real-estate loans that carried floating interest rates and were adjusted each month. Those types of loans in 2021 offered initial rates as low as 3.5%.

Everything changed when the Federal Reserve began raising rates last year, driving up monthly loan payments.…>

<....Inflation contributed to higher expenses, and [Gajavelli’s company] couldn’t raise rents fast enough to keep pace. After bills went unpaid, company properties went into foreclosure.

Think Gajavelli was alone in taking out variable-rate loans?

Not so much.

From a different WSJ article earlier this month:

…Property buyers loaded up on unusually large amounts of variable debt during the pandemic.

In 2021 and 2022, the share of floating-rate loans in total CMBS issuance was around 60%, according to Trepp data.

Back in 2005 and 2006, when interest rates were also rising, the share was below 15%.

There’s no way around it – more defaults are coming.

To illustrate, let’s return to our original WSJ article:

Gajavelli is one of thousands of real estate entrepreneurs in the U.S. known as syndicators. Many have come under similar financial pressures and hold properties they can no longer afford.

From 2020 through 2022, real estate syndicators reported raising at least $115 billion from investors, according to a Wall Street Journal analysis of Securities and Exchange Commission filings.

So far, defaults have been rare. But real-estate analysts and property investors anticipate a wave of foreclosures ahead…

Many syndicators are racing to either raise funds or sell properties before tipping into foreclosure.

Most hold balloon-payment loans that require repayment when they come due this year or next. Those syndicators face large payouts at a time when getting new, more affordable property loans will be difficult.

Even firms with multibillion-dollar portfolios have used syndication to buy apartment buildings that no longer make enough money to cover debt payments, bond documents show.

But don’t worry – I’m sure the problems will be “isolated,” just like Dimon says they’ll be for banks.

Speaking of banks and real estate, idiocy is repeating itself

Remember the whole housing crisis of 2007 that nearly took down the U.S. banking system? Do you recall what caused that?

In large part, it was banks extending risky loans to subprime borrowers.

But we’ve learned, right? There’s no way our lending institutions would repeat that same mistake again…

Well, feast your eyes on this delightful MarketWatch headline from Tuesday:

Home buyers will now be able to put down as little as 1% on their home, Rocket Mortgage says

Rocket Mortgage is allowing low- and moderate-income would-be homeowners to buy homes with just 1% down on their purchase price.

And I know this makes you nervous, but don’t worry! This is in no way, shape, or form like the “no down payment” mortgages in the subprime crisis. After all, this is an enormous “1%” down payment. See? It’s miles above 0%!

Rocket Mortgage’s CEO Bob Walters assures us that borrowers will have to meet “stringent” credit standards. In fact, Walters is so certain that nothing could go wrong here, that this new 1%-down loan doesn’t even require the borrowers to pay mortgage insurance. Rocket Mortgage will pay it for you!

(Is it relevant that Rocket Mortgage reported a net loss of $411 million in Q1?)

I hope this works out, but I’m wary. Whatever the specific outcome, looking broader, there’s more fallout coming. Unfortunately, real estate is so large and intertwined with complementary sectors that there will be collateral damage – we just don’t know exactly how much, or where.

Please be careful.

Have a good evening,

Jeff Remsburg>

<Big corporations usually choose their bottom line when it comes to hard choices over profit versus the environment. Amazon is no different.

The ecommerce giant recently backed out of a commitment to make 50% of its shipments net-zero carbon by 2030.

Amazon said in a statement that it would roll this goal into a broader Climate Pledge to reach net-zero carbon across all its operations by 2040 — A decade later than the 50% goal, which was called "Shipment Zero" at the time.

"As we examined our work toward The Climate Pledge, we realized that it no longer made sense to have a separate and more narrow Shipment Zero goal that applied to only one part of our business, so we've decided to eliminate it," Amazon wrote in the statement.

The investigative reporter Will Evans squeezed this information from Amazon and tweeted about it Thursday. Last year, Evans uncovered a study that said the company had drastically undercounted its carbon footprint. At the time, an Amazon spokesman reiterated the company's commitment to cutting emissions, including ordering a fleet of electric delivery vans and buying renewable energy for its electricity needs.

Dropping the specific shipment pledge is noteworthy because Amazon's ecommerce operation relies on vast fleets of vehicles and aircraft to deliver packages to consumers quickly. Most of this activity chews up vast quantities of fossil fuels and spews out greenhouse gases. However, fast delivery is a key selling point for shoppers and the main reason millions subscribe to the company's Prime program.

Amazon announced the Shipment Zero initiative in a blog a few years ago. The company has since deleted the post. However, through the magic of the Internet Archive's Wayback Machine, large corporations cannot rewrite online history. Here's a version of the blog.

Some choice phrases from the announcement, so you can see what Amazon is backing out of now:

"We can now see a path to net zero carbon delivery of shipments to customers, and we are setting an ambitious goal for ourselves to reach 50% of all Amazon shipments with net zero carbon by 2030."

"We believe that lower costs include lowering the costs to the environment we all live and work in every day. We'll keep you posted as we work towards achieving Shipment Zero."

"It won't be easy to achieve this goal, but it's worth being focused and stubborn on this vision and we're committed to seeing it through.">