Israel’s judicial crisis continues as far right bills advance in Knesset

In mid-February I wrote about Israel’s descent into judicial chaos.

Israel had gone through three elections in late 2022 to elect a new government. To regain power, the historically conservative Likud Party, headed by Benjamin Netanyahu, joined in a coalition with five right-wing and religiously conservative parties, some of which are hugely influenced, perhaps dominated, by Israel’s ultra-Orthodox community, known as the Haredim. The coalition won the third election, and Netanyahu became Prime Minister for the sixth time. Six days after the election the government filed bills in the Israeli parliament, the Knesset, to severely limit the power of the country’s Supreme Court in that:

1. A simple majority in the Knesset, 61 votes out of 120, would have the power to annul Supreme Court rulings. This would enable the government of the day to pass legislation without fear of it being struck down. It is called the “override” provision, in that the Knesset could override a Supreme Court ruling;
2. The Supreme Court’s ability to revoke administrative decisions by the government on the grounds of “reasonability” (what would a reasonable person say about this?), would end, significantly decreasing judicial oversight; and,
3. For the Supreme Court to strike down a Knesset-passed law would require 80% of the court’s 15 judges voting for such a ruling. But even if that were to happen, a simple Knesset majority could “override” the ruling.

At the time I wrote about this there was a singular complication: Benjamin Netanyahu is on trial, actually three trials, for corruption. If he is convicted of anything and appeals, the coalition government could override any Supreme Court ruling. Some might say this places Netanyahu at the mercy of his coalition partners.

Update

In order for these measure to become law requires passing three readings in Knesset committees. Last week, in a long and tense plenary session, the combined bill passed its first reading in the Knesset. Yesterday, the Knesset’s Constitution Committee advanced the bill for its second reading.

The judicial crisis was only made worse last Sunday when, in revenge for the killing of two Jewish Israeli brothers as they drove through the West Bank town of Hawara, near the city of Nablus, a mob of Jewish settlers attacked the town, torching 36 homes and 15 cars. The Palestinian Red Crescent reported one death and 98 Palestinians wounded in the attack. Three ambulances were also destroyed.

The attack was met with a public outpouring of support from settler leaders and Knesset members. Moreover, the Israeli coalition Finance Minister, Bezalel Smotrich, a firebrand of the first order, told the settlers, “Hawara must be destroyed.” It nearly was.

The U.S. condemned the violence in unusually strong terms. “Just as we condemn Palestinian incitement to violence, we condemn these provocative remarks that also amount to incitement to violence,” State Department spokesperson Ned Price said.

It does not seem too much of a stretch to conclude the new coalition government, with its uber-nationalistic sway, has emboldened the highly nationalistic settlers who continue to gobble up land and force Palestinians into ever more woeful conditions.

Israel’s other western allies, for example the UK and France, have also condemned Sunday’s violence and, along with U.S. Secretary of State Antony Blinken, have told Mr. Netanyahu—to his face—that the judicial reforms he is championing are a serious threat to the future of their relationship. So far, the Prime Minister and his coalition partners are calling their bluff.

At this point, it does not appear this situation will end well—for anyone.

Mississippi extends Medicaid postpartum coverage duration

In February, I wrote about maternal mortality in America. Bottom line: It’s the highest in the developed world. At that time, I wrote:

Federal law requires Medicaid to cover postpartum care for only 60 days following birth, which is one of the prime reasons for our lagging maternal mortality global performance. In the other OECD countries, mothers not only receive postpartum care for a year, they also average 51 weeks of paid maternity leave. (The U.S. is the only OECD country with no requirement for paid maternity leave.)

The  American Rescue Plan Act of 2021 (ARPA) created an option for states to extend postpartum coverage for Medicaid beneficiaries from 60 days to a full year. Under the Act, the option was scheduled to expire in 2027. Under the Consolidated Appropriations Act of 2023, the 12-month extended Medicaid postpartum coverage option was made permanent. Now once states take up the option to extend the postpartum period from 60 days to 12 months, federal matching funds will continue to flow. Thus far, 35 states have already taken advantage of the option and the federal cash that goes with it.

Nine other states have legislation pending to follow the 35. Mississippi is one of them.

Update

I can’t tell you how happy I am to report that yesterday the Mississippi legislature passed the postpartum permanent extension, and Governor Tate Reeves signed it into law. Reeves had been opposed to the measure, but had a change of heart when he realized that a lot more babies were about to be born in Mississippi due to the repeal of Roe v. Wade and the state’s strict (to say the least) anti-abortion laws, which meant some mothers could die without the postpartum extension, and the politically astute Reeves did not want to be the one taking incoming fire for helping that to happen. To which I say: Whatever works.

Mississippi’s joining the postpartum extension club only happened because Division of Medicaid Executive Director Drew Snyder, whose department reports to the Governor and who for months has refused to take a stance on postpartum coverage extension (how medically courageous of him, eh?), wrote a letter on 27 February to House Speaker Philip Gunn voicing his newfound support for the legislation’s passage (notably, after his boss, Governor Reeves had his change of heart). Gunn had been vehemently opposed to the measure, believing it put the state in the awful position of expanding Medicaid under the Affordable Care Act, something he has vowed would never happen. In his letter, Snyder assured Gunn that permanently extending Medicaid postpartum coverage would not equate to expanding Medicaid a la the Affordable Care Act, and he urged the Speaker to come on board for all the reasons that had swayed Governor Reeves. You know, all those babies about to be born in Mississippi. He also reminded Gunn the state has a $3.1 billion surplus, the annual cost of the extension is pegged at $7.1 million, and the feds will chip in more than $35 million. Reading Snyder’s letter is like reading George Orwell.

Whatever the reasons, Mississippi has done the right thing.

Ely Lilly to drop the cost of basic insulin to $35 per vial

I have written a number of times about what I consider the obscene price of insulin for Type 1 diabetics. See here and here for the history of the discovery and how we got to this point. Bottom line, as I wrote in 2018, the three discovers of insulin, led by Frederick Banting, who won the Nobel Prize for it:

sold the patent to the University of Toronto for the princely sum of $3.00. When asked why he didn’t cash in on his discovery, Banting said, “Insulin is my gift to mankind.” With Banting’s blessing, the University licensed insulin’s manufacturing to drug companies, royalty free. If drug companies didn’t have to pay royalties, Banting thought they would keep the price of insulin low.

And they did. For decades.

But patents expire, and capitalism being what it is, people get greedy, and greed is why we have no generic, low-cost insulin today and why, over the past 20 years, insulin prices have risen anywhere from 800% to 1,157%, depending on the variety and brand. It’s why, lacking health insurance, some Type 1 diabetics have recently been driven to ration their precious insulin. Some of them have died.

Update

Yesterday, the Ely Lilly company, the first company to license Banting’s discovery, announced price reductions of 70% for its most commonly prescribed insulins and an expansion of its Insulin Value Program that caps patient out-of-pocket costs at $35 or less per month. In its press release, the company said it is:

• Cutting the list price of its non-branded insulin, Insulin Lispro Injection…to $25 a vial. Effective May 1, 2023, it will be the lowest list-priced mealtime insulin available, and less than the price of a Humalog^® vial in 1999.
• Cutting the list price of Humalog^® …, Lilly’s most commonly prescribed insulin, and Humulin^® (insulin human) injection … by 70%, effective in Q4 2023.
• Launching Rezvoglar^TM …injection, a basal insulin that is biosimilar to, and interchangeable with, Lantus^® (insulin glargine) injection, for $92 per five pack of KwikPens^®, a 78% discount to Lantus, effective April 1, 2023.

Lilly also said:

• Effective immediately, Lilly will automatically cap out-of-pocket costs at $35 at participating retail pharmacies for people with commercial insurance using Lilly insulin.
• People who don’t have insurance can continue to go to InsulinAffordability.com and immediately download the Lilly Insulin Value Program savings card to receive Lilly insulins for $35 per month.

This, of course, is marvelous news for the 1.3 million Type 1 diabetics in the country not on Medicare, which already has a $35 cap thanks to the Inflation Reduction Act of 2022.

It is not an exaggeration to say insulin made Eli Lilly and Company and Novo Nordisk two of the top pharmaceutical companies in the world. It also hasn’t hurt the bottom line of Sanofi, the company that rounds out the insulin producing triumvirate and is the world’s fifth largest pharma by sales. I think it is a good bet these last two will quickly follow Lilly’s lead.

The greed of these three companies over the last two or three decades has hurt a lot of people, both physically and economically. Let’s hope this move by Lilly is the first step in making amends.