Jimmy Carter Wasn’t a Liberal by Timothy Noah

 verybody knows that Jimmy Carter was America’s last truly liberal president until Barack Obama. But everybody is wrong. Carter was the first in the conservative line of presidents more commonly associated with Ronald Reagan.

Carter’s 1980 defeat by Reagan, after serving a single term, “marked the decline and fall of the public’s faith in statist liberalism,” the late Sen. Jesse Helms (R.-N.C.) once said. A more favorable popular conceit, as described by the journalist Nicholas Lemann, is that Carter was “too much the good-hearted liberal to maintain a hold on the presidential electorate.”

 These misconceptions seem plausible today because Carter’s four-decade post-presidency was notably more left-leaning than his presidency ever was. The ex-president’s peace missions to North Korea and Cuba and his frequent criticisms of U.S. policies regarding everything from the Palestinians (whose treatment by Israel he famously likened to apartheid) to domestic surveillance (“unprecedented violations of our rights to privacy”) positioned Carter well to the left of Republican and Democratic successors alike.

 

Historical memory of Carter’s presidency is also distorted by a failure to consider his administration’s policies in their proper historical context. The creation of the Education Department, for example, or passage of the oil windfall profits tax, seem liberal only when you forget that the political spectrum drifted rightward for three decades after Carter left office. Judged outside that context, even many of Reagan’s policies today seem liberal.

 In truth, the pendulum started swinging to the right before Carter took office, and continued doing so under Carter’s presidency. Reagan didn’t change the pendulum’s direction; he just accelerated its speed.

Carter’s two Democratic predecessors in the White House, John F. Kennedy and Lyndon Johnson, spoke expansively of what government could do. Carter, a former governor in the conservative Deep South, preferred to point out that there was much government couldn’t do. “There is a limit to the role and the function of government,” Carter said in his 1978 State of the Union speech. “Government cannot solve our problems.”

Reagan would subsequently rework that statement (in his first inaugural address) into “Government is not the solution to our problem; government is the problem,” which carried the thought much further than Carter ever would. Nor would Carter have likely declared, as President Bill Clinton did in 1996, that “the era of big government is over.”

But Carter’s warning about government’s limitations, anodyne though it may seem today, shocked liberals at the time. “Can anyone imagine Franklin D. Roosevelt talking this way?” fumed the historian and political activist Arthur Schlesinger Jr. “Can anyone imagine Harry Truman, John Kennedy, Lyndon Johnson, Hubert Humphrey, or George McGovern uttering those words?” Carter, Schlesinger concluded, “is not a Democrat — at least in anything more recent than the Grover Cleveland sense of the word.”

 

Bob Shrum, the liberal Democratic operative who would later be a political consultant to Al Gore’s and John Kerry’s presidential campaigns, found Carter so hesitant to support liberal positions that he quit Carter’s 1976 campaign after 10 days. “Your strategy is largely designed to conceal your true convictions,” Shrum wrote in his resignation letter, “whatever they may be.” Four years later Shrum was a speechwriter for Sen. Ted Kennedy (D-Mass.), who in the Democratic presidential primaries challenged Carter, unsuccessfully, from the left.

If Shrum was a fish out of water with Carter, Carter was a fish out of water among Kennedy and other liberal Democrats. “I feel more at home with the conservative Democratic and Republican members of Congress than I do the others,” he confided in his White House diary, “although the liberals vote with me more often.”

The New Deal liberal ascendancy with which Carter is wrongly associated ended around 1974. It was killed off by the white backlash to the civil rights movement, which ended Democratic dominance in the South; by the Vietnam war, which ended Lyndon Johnson’s presidency and split the Democrats into warring factions; by the 1973 Arab oil embargo, which ended permanently the widely shared prosperity that undergirded liberal policies after 1945; and by the Watergate scandal that expelled Richard Nixon from the White House.

This last might seem counterintuitive, given that Nixon was a Republican much reviled by liberal Democrats. And indeed, Watergate’s immediate consequences were a Democratic congressional sweep in 1974 (the so-called “Watergate babies”) and Carter’s own narrow victory over Gerald Ford two years later. But Vietnam’s “credibility gap” and Watergate’s outright criminality undermined the public’s faith in government, a shift that over the long term mostly benefited the anti-government right.

 Watergate also put Ford, a Republican notably more conservative than Nixon, into the Oval Office. Nixon’s domestic policies, it’s often observed, were largely a continuation of New Deal liberalism (the main exception, ironic given Nixon’s own law-breaking, being the area of criminal justice). Among other actions, Nixon created the Environmental Protection Agency (the regulatory agency most hated by conservatives today); proposed what amounted to a guaranteed family income; and imposed wage and price controls. It’s difficult to imagine Ford — who would expel Henry Kissinger for being too pro-détente, deny New York City a bailout when it verged on bankruptcy, and look nervously over his shoulder at a right-flank primary challenge from Reagan — doing any of these things.

But tempting though it is to name Ford rather than Carter the first president of the conservative ascendancy, he must be denied that prize, for three reasons. First, he was in the White House only two years, barely enough time to change the drapes. Second, political circumstances required Ford to focus mainly on calming the waters after the “long national nightmare” that was Watergate. Third, Ford was temperamentally inclined, as former House minority leader in a Congress far more courteous and clubby than today’s, to work cooperatively.

Carter was a different animal altogether.

 It would be wrong to call Carter himself a conservative. He was instead a Southern liberal, which meant that from a national perspective he was a somewhat conservative Democrat. He was fiscally conservative, and bequeathed Reagan a budget deficit of about $74 billion. That was thought high at the time, but within five years Reagan had more than doubled it, after inflation. As a percentage of GDP, the deficit fell under Carter; it would rise under Reagan, who preached fiscal conservatism but did not practice it.

 The twin pillars of conservatism today are opposition to taxes and opposition to regulation. These first came to the fore during Carter’s presidency.

On taxes, Carter’s own ambitions were liberal. But he couldn’t sell his progressive tax reform to Congress because a nationwide tax revolt was spreading, sparked by passage of Proposition 13, a California initiative limiting property taxes. That revolt can be blamed, at least in part, on Carter for failing to address effectively the out-of-control inflation that was jacking up home values (and therefore property taxes). Even here, though, it should be remembered that the government official widely credited with finally curbing, in the early 1980s, the decadelong Great Inflation was Paul Volcker, chair of the Federal Reserve Board — and a Carter appointee.

With his tax reform a dead letter, Carter signed into law instead a 1978 bill initiated by Rep. Jack Kemp (R-N.Y.) and Sen. William Roth (R-Del.) that lowered substantially the capital gains tax. The rest, as they say, is history. “Emboldened by their ability to force a Democratic president and Congress to enact what was essentially a conservative tax bill,” Kemp aide Bruce Bartlett would later recall, Kemp and Roth “pressed on with more radical tax reduction efforts” that won enthusiastic support from candidate Reagan and were enacted in 1981. This second Kemp-Roth tax bill is now remembered as the signature legislative embodiment of supply-side economics, the reigning economic doctrine of the Reagan years.

 

The Carter era also saw calls for government deregulation begin to take fruit. Carter’s focus was on economic deregulation, a cause then supported even by liberals like Ted Kennedy and Ralph Nader on the theory that it would expose corporations to unwanted competition that would benefit consumers. It was under Carter that Congress passed significant bills deregulating the trucking, railroad and airline industries; these would be followed by more sweeping deregulation under Reagan, Bush and Clinton of bus travel, shipping, energy, telecommunications and banking, and by new statutory restrictions on health and safety regulations.

The conservative movement has always valued a strong military. Carter is remembered as weak on defense because his April 1980 attempt to rescue Americans held hostage in Iran ended in ignominious failure. (The New Republic labeled it “The Jimmy Carter Desert Classic.”) But, particularly for a Democrat, Carter was notably pro-defense. He had, after all, spent 10 years in the Navy — more years of military service than any president since Dwight Eisenhower. Contrary to popular wisdom, it was Carter, not Reagan, who reversed the decline in military spending (after inflation) that followed U.S. withdrawal from the Vietnam War. Reagan would merely accelerate that rate of growth.

Carter displeased conservatives by granting unconditional amnesty to Vietnam draft evaders, which infuriated hawks at the time. But Carter’s program merely expanded a clemency program Ford had instituted three years earlier. Nor was the amnesty as “unconditional” as advertised; in his 2008 book “The Age of Reagan,” the historian Sean Wilentz observed that it “sustained many of the burdens imposed by Ford” and that as a result “very few Vietnam-era military deserters and AWOLS would ever receive any form of legal relief.”

 Since the ‘80s it’s been de rigueur for presidential candidates of both parties to position themselves as Washington outsiders who will challenge the capital’s corrupt culture — a game at which Republicans bent on shrinking government enjoy a home field advantage. That competition began with Jimmy Carter.

Carter’s whole campaign was predicated on the idea that America desperately needed someone to restore honesty and decency to government. “For a long time our American citizens have been excluded, sometimes misled, sometimes have been lied to,” he said in a 1976 debate with Ford. Carter promised to be different: “I’ll never tell a lie. I’ll never make a misleading statement. I’ll never betray the confidence that any of you has in me, and I will never avoid a controversial issue.” It was a preposterous and sanctimonious pledge, one no living, breathing politician could hope ever to live up to. But it was what voters wanted to hear after Watergate and Vietnam.

 Carter was also the first president of the modern era to legitimize, for good or ill, extensive discussion by a presidential candidate of his personal faith — another arena that would prove more hospitable to conservatives than liberals.

Before Carter, U.S. presidents thought it in poor taste to go on too much about their religious beliefs. True, Eisenhower added “under God” to the Pledge of Allegiance and formalized “In God We Trust” as the national motto, and he once said “I am the most intensely religious man I know.” But Ike wasn’t even a regular churchgoer before he became president, and he was never particularly voluble about his Presbyterianism (or about anything else). Kennedy saw his Catholic religion as more liability than asset, and neither LBJ nor Nixon, despite their many photo ops with the Rev. Billy Graham, was especially devout. Ford was, but would later explain, “I didn’t think it was appropriate to advertise my religious beliefs.”

 Carter changed that. He was the first president ever to declare himself “born again,” and the first to rely on evangelicals to win the presidency. Carter’s election coincided with the politicization of evangelical Christianity, which would play a significant role in presidential politics during the 1980s and 1990s. But the movement’s conservatives quickly established political dominance with the establishment of Jerry Falwell’s Moral Majority in 1979 and the transformation of Pat Robertson’s Christian Broadcasting Network from a small regional broadcast network to a national cable network. As a result, the evangelical vote shifted from Carter to Reagan. By 2000, Carter’s own Southern Baptist church had moved so far to the right — or perhaps he to the left — that he severed his ties to it.

 The rightward shift under Carter was slight compared to the changes that would come later under Reagan, whom the smartest political thinkers, before his 1980 victory, judged way too conservative to be elected president. (So much for smart political thinkers.) Minor adjustments to the New Deal political consensus under Carter became major adjustments during what historians properly term the Reagan era, which lasted at least until 2008 and in many respects lingers today. But the first president of that era wasn’t a former Hollywood actor turned governor. It was a former Naval engineer turned peanut farmer turned governor. That’s not a laurel Carter would have been pleased to receive, but it’s his just the same.

The Walmart Effect by Rogé Karma

 New research suggests that the company makes the communities it operates in poorer—even taking into account its famous low prices

 No corporation looms as large over the American economy as Walmart. It is both the country’s biggest private employer, known for low pay, and its biggest retailer, known for low prices. In that sense, its dominance represents the triumph of an idea that has guided much of American policy making over the past half century: that cheap consumer prices are the paramount metric of economic health, more important even than low unemployment and high wages. Indeed, Walmart’s many defenders argue that the company is a boon to poor and middle-class families, who save thousands of dollars every year shopping there.

 

Two new research papers challenge that view. Using creative new methods, they find that the costs Walmart imposes in the form of not only lower earnings but also higher unemployment in the wider community outweigh the savings it provides for shoppers. On net, they conclude, Walmart makes the places it operates in poorer than they would be if it had never shown up at all. Sometimes consumer prices are an incomplete, even misleading, signal of economic well-being.

In the 1990s and early 2000s, before tech giants came to dominate the discourse about corporate power, Walmart was a hot political topic. Documentaries and books proliferated with such titles as Wal-Mart: The High Cost of Low Price and How Walmart Is Destroying America (And the World). The publicity got so bad that Walmart created a “war room” in 2005 dedicated to improving its image.

When the cavalry came, it came from the elite economics profession. In 2005, Jason Furman, who would go on to chair Barack Obama’s Council of Economic Advisers, published a paper titled “Wal-Mart: A Progressive Success Story.” In it, he argued that although Walmart pays its workers relatively low wages, “the magnitude of any potential harm is small in comparison” with how much it saved them at the grocery store. This became the prevailing view among many economists and policy makers over the next two decades.

Fully assessing the impact of an entity as dominant as Walmart, however, is a complicated task. The cost savings for consumers are simple to calculate but don’t capture the company’s total effect on a community. The arrival of a Walmart ripples through a local economy, causing consumers to change their shopping habits, workers to switch jobs, competitors to shift their strategies, and suppliers to alter their output.

 The two new working papers use novel methods to isolate Walmart’s economic impact—and what they find does not look like a progressive success story after all. The first, posted in September by the social scientists Lukas Lehner and Zachary Parolin and the economists Clemente Pignatti and Rafael Pintro Schmitt, draws on a uniquely detailed dataset that tracks a wide range of outcomes for more than 18,000 individuals across the U.S. going back to 1968. These rich data allowed Parolin and his co-authors to create the economics equivalent of a clinical trial for medicine: They matched up two demographically comparable groups of individuals within the dataset and observed what happened when one of those groups was exposed to the “treatment” (the opening of the Walmart) and the other was not.

 

Their conclusion: In the 10 years after a Walmart Supercenter opened in a given community, the average household in that community experienced a 6 percent decline in yearly income—equivalent to about $5,000 a year in 2024 dollars—compared with households that didn’t have a Walmart open near them. Low-income, young, and less-educated workers suffered the largest losses.

In theory, however, those people could still be better off if the money that they saved by shopping at Walmart was greater than the hit to their incomes. According to a 2005 study commissioned by Walmart itself, for example, the store saves households an average of $3,100 a year in 2024 dollars. Many economists think that estimate is generous (which isn’t surprising, given who funded the study), but even if it were accurate, Parolin and his co-authors find that the savings would be dwarfed by the lost income. They calculate that poverty increases by about 8 percent in places where a Walmart opens relative to places without one even when factoring in the most optimistic cost-savings scenarios.

 But their analysis has a potential weakness: It can’t account for the possibility that Walmarts are not evenly distributed. The company might, for whatever reason, choose communities according to some hard-to-detect set of factors, such as deindustrialization or de-unionization, that predispose those places to growing poverty in the first place. That’s where the second working paper, posted last December, comes in. In it, the economist Justin Wiltshire compares the economic trajectory of counties where a Walmart did open with counties where Walmart tried to open but failed because of local resistance. In other words, if Walmart is selecting locations based on certain hidden characteristics, these counties all should have them. Still, Wiltshire arrives at similar results: Workers in counties where a Walmart opened experienced a greater decline in earnings than they made up for with cost savings, leaving them worse off overall. Even more interesting, he finds that the losses weren’t limited to workers in the retail industry; they affected basically every sector from manufacturing to agriculture.

 What’s going on here? Why would Walmart have such a broadly negative effect on income and wealth? The theory is complex, and goes like this: When Walmart comes to town, it uses its low prices to undercut competitors and become the dominant player in a given area, forcing local mom-and-pop grocers and regional chains to slash their costs or go out of business altogether. As a result, the local farmers, bakers, and manufacturers that once sold their goods to those now-vanished retailers are gradually replaced by Walmart’s array of national and international suppliers. (By some estimates, the company has historically sourced 60 to 80 percent of its goods from China alone.) As a result, Wiltshire finds, five years after Walmart enters a given county, total employment falls by about 3 percent, with most of the decline concentrated in “goods-producing establishments.”

 Once Walmart has become the major employer in town, it ends up with what economists call “monopsony power” over workers. Just as monopoly describes a company that can afford to charge exorbitant prices because it lacks any real competition, monopsony describes a company that can afford to pay low wages because workers have so few alternatives. This helps explain why Walmart has consistently paid lower wages than its competitors, such as Target and Costco, as well as regional grocers such as Safeway. “So much about Walmart contradicts the perfectly competitive market model we teach in Econ 101,” Wiltshire told me. “It’s hard to think of a clearer example of an employer using its power over workers to suppress wages.”

 

Walmart’s size also gives it power over the producers who supply it with goods. As Stacy Mitchell, a co–executive director of the Institute for Local Self-Reliance, recently wrote in The Atlantic, Walmart is well known for squeezing its suppliers, who have little choice but to comply for fear of losing their largest customer. Selling to Walmart at such low prices can force local suppliers to lay off workers and pay lower wages to those who remain. They also naturally try to make up for the shortfall by charging their other customers higher prices, setting off a vicious cycle that allows Walmart to entrench its dominance even further.

The most direct upshot of the new research is that Walmart isn’t the bargain for American communities that it appears to be. (When I reached out to Furman about the new research, he said he wasn’t sure what to make of it and suggested I talk with labor economists.) More broadly, the findings call into question the legal and conceptual shift that allowed Walmart and other behemoths to get so huge in the first place. In the late 1970s, antitrust regulators and courts adopted the so-called consumer-welfare standard, which held that the proper benchmark of whether a company had gotten too big or whether a merger would undermine competition was if it would raise consumer prices or reduce sellers’ output. In other words, the purpose of competition law was redefined as the most stuff possible, as cheaply as possible. But as the new Walmart research suggests, that formula does not always guarantee the maximum welfare for the American consumer.

 

The outgoing Biden administration, with its focus on reviving antitrust, recognized this. Its most recent enforcement guidelines, for example, direct the government to take into account a merger’s effect on workers, not just consumers, and the antitrust agencies have included such claims in multiple lawsuits. The question is whether the incoming Trump administration, which has sent mixed messages on corporate consolidation, will follow the same path.

Recent history shows the political danger in threatening low consumer prices. The public’s reaction to the inflation of the past few years suggests that many Americans would rather be slightly poorer but have price stability than be richer but with more inflation. That will tempt policy makers to prioritize low prices above all else and embrace the companies that offer them. But if Walmart’s example reveals anything, it is that, in the long term, low prices can have costs of their own.

 

Facts over Fear: The price of eggs and the politics of distraction by Natalie Bencivenga

 

How does a six-week abortion ban help bring down the price of eggs? Spoiler alert: It doesn’t. Let’s talk about the art of distraction in this week’s Facts Over Fear.

This election cycle was fraught with tension, but one thing that many people agreed on was that the cost of everyday goods was just too high. So explain to me exactly – now that Donald Trump will be back in the White House come January – how reintroducing a six week abortion ban  in the Pennsylvania state House will do anything to curb inflation?

Because once again, the GOP is giving the people nothing that they’ve asked – or voted for. State Rep. Stephanie Borowicz, a Republican, has begun seeking sponsors for legislation that would ban abortion at six weeks of pregnancy, often before someone even knows they are pregnant.

And let’s not forget, she was also the one that objected to House Bill 851 which creates a grant program to provide public schools with funding to distribute menstrual hygiene products free to students. She said it would lead to communism. That bill passed, by the way.

And, interestingly enough, she objected to that bill because “A government big enough to give you everything you want is a government big enough to take everything away.”

But, isn’t a government that tells people when and if they start a family too big? And isn’t this playing out exactly as she feared —because the right to our bodies is fundamental — you take that away, you take everything away.

So what is Borowicz trying to distract us from? The fact that we still don’t have a living wage in Pennsylvania? With the Democrats holding the House, this bill will likely die — again. Perhaps she should take her own advice and do something that actually gives the people power over their own lives again like sponsoring bills that raise the minimum wage and protect the right to legal and safe abortion. And that my friends, is a fact.

U.S. homelessness jumps to another record high, amid affordable housing shortage by Jennifer Ludden

 

More than 770,000 people were living in shelters or outside in January, according to an annual federal report on homelessness by the Department of Housing and Urban Development. The number is up 18% from last year's count — which had also jumped from the year before — and is the largest number since HUD started doing this report in 2007.

HUD released its report Friday, based on the January "point-in-time" survey in cities around the country. The results punctuated a trend advocates for homeless people and affordable housing have been highlighting.

"A lot of families, a lot of households, a lot of individuals are still struggling. I think we're still in — for deeply poor people — a real recovery from the pandemic," says Jeff Olivet, who until recently was executive director of the United States Interagency Council on Homelessness.

 

He says homelessness has been rising since 2017, driven by a massive shortage of affordable housing that's pushed prices up. Research finds that where rents go up, so does homelessness. That rise stalled during the pandemic, Olivet notes, when sweeping federal aid helped keep people housed. But since that help ended, people still face higher prices for housing, food, and other everyday goods.

HUD officials say another key factor was the recent increase in asylum seekers coming to the U.S., often fleeing dangerous conditions in their home countries. In 13 communities that reported being affected by migration, family homelessness more than doubled. Overall, it was up 39%.

There was also an increase in the number of people overall living outside - that is, not in shelters; those considered chronically homeless; and unaccompanied youth. One bright spot was a decline in the number of unhoused veterans. This year that actually fell to a record low, after years of intense investment in subsidized housing and support services.

The report also says extreme weather disasters contributed to the rise, and specifically cites last year's fire in Maui that had left 5,200 people still in shelters during the January count.

The annual report is widely considered an undercount, and does not include people crowding in with family or friends because they can no longer pay rent.

 

HUD says the numbers in some places are likely down since this count was made

Despite the nearly across-the-board surge in homelessness, HUD and others say there's reason to believe the numbers in some places have come down since the count in January.

For one thing, President Biden took action in June to limit asylum claims and cap illegal border crossings. Since then, Denver, Chicago and New York — who'd been overwhelmed with asylum seekers — reported a sharp drop in migrants in shelters.

The rent spikes of recent years have also slowed, with rents nearly flat or even down in some cities. And some places that had years of rising homelessness numbers saw a turnaround this year, including Phoenix, Los Angeles and Dallas.

"What that says is that, if we keep investing the right way in getting people off the streets and into housing as quickly as possible, we really can see those numbers go down," Olivet says.

Housing costs have risen with inflation, interest rates and a tight construction labor pool. The Biden administration has nudged cities to loosen zoning rules that restrict apartments and other more affordable housing. It also boosted spending on housing vouchers and other subsidies specifically for homeless people. But there's also been growing opposition to that kind of spending, including among allies of President-elect Donald Trump.

Trump has called for a different approach to homelessness

The report comes amid growing public frustration with homelessness, and a wave of states and cities making it a crime to sleep outside in public spaces. President-elect Trump supports these bans on so-called street camping and a landmark Supreme Court decision this year allowed cities to enforce them even if people have nowhere else to go. Since then, more people are getting citations or even facing arrest.

 

Trump allies also want to shift billions in federal homelessness funding away from housing and toward requiring treatment for drug addiction or mental illness. He's also talked of putting people into "mental institutions."

Housing advocates including Olivet, worry camping bans and funding changes will only make the problem worse. But "what we need is investment in a range of solutions for people," he says. "We need all of the above. It's not an either or way of thinking that's going to solve this."

 

In shift, Trump downgrades soaring rhetoric on campaign promises by Brett Samuels

 

President-elect Trump on the campaign trail made grandiose promises to voters to bring down costs quickly, to end the war in Ukraine before he even took office and to use tariffs to bolster the U.S. economy and manufacturing.

Since winning November’s election, Trump has indicated delivering on those promises may not be as simple as advertised.

Trump in a recent “Meet the Press” interview said he could not guarantee tariffs would not lead to higher consumer prices.

He acknowledged in a Time magazine interview for his Person of the Year honor that it’s difficult to bring down the cost of groceries once they’ve gone up.

 

And in his first post-election press conference from his Mar-a-Lago estate in Palm Beach, Fla., Trump suggested ending the war in Ukraine would be more difficult than easing tensions in the Middle East.

While Democrats and critics accused Trump of lowering expectations or signaling he would not deliver on his campaign promises, the Trump transition and other allies argued it was the president-elect shifting from sweeping campaign rhetoric to the nuances and realities of governing.

“The American people re-elected President Trump by a resounding margin giving him a mandate to implement the promises he made on the campaign trail. He will deliver,” said Karoline Leavitt, a spokesperson for the transition and the incoming White House press secretary, in a statement.

One Trump ally argued the president-elect was not contradicting his promises on the trail, but he rather was shifting away from the sales pitch rhetoric that is typical of campaigns.

Trump made improving the economy, and inflation in particular, a core part of his campaign for the White House in 2024. He frequently railed against the Biden White House for the high cost of groceries specifically, and he often told supporters he would bring down costs by increasing the energy supply, which would have a ripple effect on overall prices.

 Prices will come down. You just watch. They’ll come down, and they’ll come down fast. Not only with insurance, with everything,” Trump told supporters in North Carolina in August.

At a rally in Pennsylvania on the eve of Election Day, Trump said a vote for him meant “your groceries will be cheaper.”

But in comments to Time on Nov. 25, Trump was more circumspect about his ability to bring down the cost of groceries. Asked if his presidency would be a failure if prices did not decline, Trump said he didn’t think so. “Look, they got them up. I’d like to bring them down. It’s hard to bring things down once they’re up. You know, it’s very hard,” Trump said. “But I think that they will. I think that energy is going to bring them down. I think a better supply chain is going to bring them down. You know, the supply chain is still broken.”

Democrats were quick to jump on Trump’s comments, suggesting it amounted to a broken campaign promise before he even took office.

“Candidate Trump promised to lower grocery prices, but now it seems he isn’t even going to try,” Sen. Elizabeth Warren (D-Mass.) posted on the social platform X. “While champagne corks pop at Mar-a-Lago, President-elect Trump says that he can’t really lower grocery prices because it’s ‘very hard.’ Sad. It’s the start of a broken promise.”

 

The Democratic National Committee highlighted Trump’s comments about groceries and compared them with comments he made on the floor of the New York Stock Exchange last week about trying to slash the corporate tax rate further.

The president-elect also struck a defiant tone on tariffs throughout the campaign, pushing back on anyone who suggested they would raise consumer prices, upend the economy or alienate allies hit with tariffs.

Since winning the election, Trump has largely maintained that posture, even as he has acknowledged the possibility that some companies might pass on costs to consumers.

“I can’t guarantee anything. I can’t guarantee tomorrow,” Trump told “Meet the Press” earlier this month. “But I can say that if you look at my — just pre-COVID, we had the greatest economy in the history of our country. And I had a lot of tariffs on a lot of different countries, but in particular China.”

In other areas of U.S.-foreign affairs, Trump has hearkened back to his more bombastic style — suggesting Canada become a 51st state, the Panama Canal be returned to U.S. control and again went after Greenland by suggesting U.S. ownership was “absolute necessity.” It’s possible Trump is using those warning as leverage for negotiating tactics involving tariffs and lowering the cost for American ships to cross from the Pacific to the Atlantic.

 

But Trump had also been more nuanced in recent days in speaking about the conflict between Ukraine and Russia, a war he said on the debate stage in September he would end “before even becoming president.”

The president-elect told reporters at a news conference this week he thought it would be more difficult to resolve the situation in Ukraine than it would be to lower tensions in the Middle East, a region that is rife with conflicts involving Israel, Iran, Syria and various proxy groups.

Trump told reporters Ukrainian President Volodymyr Zelensky and Russian President Vladimir Putin need to be prepared to make a deal to end the war, though he would not detail what either side should be willing to concede.

Zelensky, in an interview this week with Fox News correspondent Trey Yingst, said it would not be “simple” for Trump to influence Putin to end the war.

“But I think if to use all the issues what United States has, yes, he can. Because he is much more stronger than Putin,”  Zelensky said. “He’s stronger. United States is stronger. Economy stronger. You know, money, big money. United States has big — very big influence.”

Trump in 2016 made a slew of campaign promises he struggled to deliver on. He repeatedly vowed he would build a wall along the southern border and that Mexico would pay for it, and while there was some new construction of barriers, Mexico did not foot the bill.

He also promised to repeal and replace the Affordable Care Act, known as ObamaCare. Republicans managed to get rid of the individual mandate portion of the law, but Trump and lawmakers failed to get rid of it or pass a health care plan of their own.

When kindness becomes a habit, it improves our health by Maria Godoy

 

It's that time of year when it's customary to be a little kinder and do nice things for others. Well, here's something interesting: Research suggests that when we make acts of kindness a habit, it's also good for our health.

Whether it's volunteering at a local food bank, or taking soup to a sick neighbor, there's lots of evidence that when we help others, it can boost our own happiness and psychological well-being. But there's also growing research that it boosts our physical health too, says Tara Gruenewald, a social and health psychologist at Chapman University.

 Most of the evidence comes from observational studies of people who volunteer regularly. But there is also experimental evidence. Perhaps the most striking comes from the Baltimore Experience Corps trial, a large experiment in which adults age 60 and older were randomly assigned to either volunteer at elementary schools or be put on a waiting list. The volunteers spent at least 15 hours a week tutoring underprivileged kids. After two years, the researchers found that the volunteers had measurable changes in their brain health.

 

"They didn't experience declines in memory and executive function like we saw in our control participants," says Gruenewald, who is one of the researchers involved in the trial. "And there were even changes in brain volume in areas of the brain that support these different cognitive processes," she says.

Volunteers were also more physically active, "which is important for maintaining both cognitive and physical health as folks age," she explains.

Other research has found that people who volunteer regularly have a lower risk of mortality and have better physical function as they age. "People are able to walk longer at older ages and have better balance and so forth," says Laura Kubzansky, a professor of social and behavioral sciences at the Harvard T.H. Chan School of Public Health.

 

Kubzansky studies the interplay between physical and mental health. Her research has found that people who engage in more volunteering and charitable donations have lower levels of physical pain.

She says researchers still don't know the exact mechanisms by which volunteering and acts of kindness improve people's health, but it is likely that multiple processes are at play.

For example, stress causes a cascade of reactions in your body that can drive up blood pressure and ultimately lead to higher cholesterol levels and other changes that raise the risk of cardiovascular disease and other poor health outcomes. She says volunteering may help buffer that stress response.

"Volunteering or doing an act of kindness can distract you from some of the problems that you might be having, so you might be a little bit less reactive yourself," Kubzansky says. And "it may help to give you more perspective on what your own problems are."

And when you go out to help others, it also makes you more physically active and less lonely. Social isolation is a known risk factor for physical and mental health problems, especially as we age.

"We know that better mental health is associated with better physical health," she says.

Most of the research in this field has looked at middle-age and older adults. There's less evidence on the health benefits of helping behaviors when it comes to younger people, says Julia Boehm, an associate professor of psychology at Chapman University who studies the social and psychological factors that influence health in kids and adolescents.

But one study that really stands out involved high schoolers who were randomly assigned to volunteer for 10 weeks with elementary school kids. Compared to students in the trial who were put on a waitlist, the teen volunteers had improvements in several markers of cardiovascular health.

 

"Those students who were engaged in volunteering activities with younger students showed healthier body mass index, healthier inflammatory markers and healthier total cholesterol," Boehm says. And the students who increased the most in empathy and altruistic behaviors, and who decreased the most in negative mood, also showed the greatest decreases in cardiovascular risk over time.

Other research in adults has also linked regular participation in both volunteering and more informal acts of kindness — such as helping out a neighbor — to a lower risk of cardiovascular disease.

 

Given the findings so far, Kubzansky says she'd like to see health officials make research into the health benefits of volunteering and other acts of kindness a public health priority.

In the meantime, Gruenewald says we really can't go wrong when we engage in behaviors that aim to help others.

"At the very least, it will make the world a little bit better place for many others. And we might just make it a little bit better for ourselves," she says.

 

Greenland and the Panama Canal aren't for sale. Why is Trump threatening to take them? by Kayla Epstein

 

President-elect Donald Trump ran on a platform of isolating the US from foreign conflicts like the Ukraine war, increasing tariffs on foreign trade partners, and rebuilding domestic manufacturing.

But in recent days he has suggested a more outwardly aggressive approach for his foreign policy.

At first, he joked about Canada being an additional US state. Since, he has threatened to take back control of the Panama Canal. He also reiterated a desire from his first term to own the autonomous Danish territory of Greenland, which is not for sale.

The US is unlikely to take control of any of these regions. But these statements could indicate that Trump's "America First" vision includes flexing the superpower's muscle beyond its borders for US trade and national security interests.

On Sunday, Trump told a conservative conference in Arizona that Panama was charging US ships "ridiculous, highly unfair" fees to use its namesake canal.

After taking charge of building the canal in the early 20th century, the US turned full control over to Panama in the 1970s via a treaty. But this week, Trump said that if the "rip off" did not stop, he would demand the canal be returned to the US – though he did not specify how.

Trump added he did not want the Panama Canal "falling into the wrong hands" and specifically cited China, which has significant interests in the waterway.

"There's a real US national security interest... in controlling its neutrality," Will Freeman, a fellow on Latin American studies at the Council on Foreign Relations, said of Trump's remarks.

"Trump's statement is mostly about that."

China is the second-largest user of the Panama Canal after the US, according to data. It has major economic investments in the country as well.

In 2017, Panama cut diplomatic ties with Taiwan and recognised it as part of China, a major win for Beijing.

The Panama Canal is not only essential for US trade in the Pacific, Mr Freeman said - in the event of any military conflict with China, it would be needed to move US ships and other assets.

He also noted Trump's frequent comments about trade partners' unfair treatment of the US, as well as the president-elect's pledge to sharply increase tariffs on foreign goods, particularly those from China.

Trump's complaints about shipping fees seemed to reflect his views on trade, Mr Freeman said.

While the statements might be "coercive", said Mr Freeman, it remained to be seen "whether canal authorities lower fees on US cargo in response to the threat".

Panama's President José Raúl Mulino has released a statement saying that the canal and the surrounding area belonged to his country - and would remain so.

 

Trump eyes Greenland

Over the weekend, Trump said in a social media post that the US "feels that the ownership and control of Greenland is an absolute necessity" for reasons of national security and global freedom.

The US maintains Pituffik Space Base in Greenland. The territory is rich with natural resources, including rare earth minerals and oil, and occupies a strategic location for trade as global powers seek to expand their reach in the Arctic Circle.

Russia, in particular, sees the region as a strategic opportunity.

Trump floated the idea of purchasing Greenland in 2019, during his first term as president, and it never came to fruition.

Greenland's prime minister, Múte B Egede, responded to Trump's latest comments this week: "We are not for sale and we will not be for sale."

Still, Trump continued emphasising his public statements online.

On Truth Social, Trump's account showed an image of an American flag being planted in the middle of the Panama Canal.

His second-eldest son, Eric Trump, posted an image on X that showed the US adding Greenland, the Panama Canal and Canada to an Amazon online shopping cart.

For Trump, promises to use America's might to its advantage helped propel his two successful presidential campaigns.

It was a tactic he used during his first presidency, threatening tariffs and the deployment of "armed soldiers" to steer Mexico into beefing up enforcement along its US border.

Heading into his second term, Trump could plan to use a similar playbook once he takes office on 20 January.

While it remains to be seen what will happen, Denmark has expressed a willingness to work with his administration.

It also announced a huge boost in defence spending for Greenland, hours after Trump repeated his desire to purchase the Arctic territory.

 

Trump threatens to try to regain control of Panama Canal by Mike Wendling

 

President-elect Donald Trump has demanded Panama reduce fees on the Panama Canal or return it to US control, accusing the central American country of charging "exorbitant prices" to American shipping and naval vessels.

"The fees being charged by Panama are ridiculous, highly unfair," he told a crowd of supporters in Arizona on Sunday.

"This complete rip-off of our country will immediately stop," he said, referring to when he takes office next month.

His remarks prompted a quick rebuke from Panama's president, who said "every square metre" of the canal and surrounding area belong to his country.

 

President José Raúl Mulino added that Panama's sovereignty and independence were non-negotiable.

Trump made the comments to supporters of Turning Point USA, a conservative activist group that provided significant support to his 2024 election campaign.

It was a rare example of a US leader saying he could push a country to hand over territory - although he did not explain how he would do so - and a sign of how American foreign policy and diplomacy may shift once he enters the White House following his inauguration on 20 January.

Trump's comments followed a similar post a day earlier in which he said the Panama Canal was a "vital national asset" for the US.

If shipping rates are not lowered, Trump said on Sunday, "we will demand that the Panama Canal be returned to us, in full, quickly and without question".

The 51-mile (82km) Panama Canal cuts across the central American nation and is the main link between the Atlantic and Pacific oceans.

It was built in the early 1900s and the US maintained control over the canal zone until 1977, when treaties gradually ceded the land back to Panama. After a period of joint control, Panama took sole control in 1999.

Up to 14,000 ships cross the canal per year, including container ships carrying cars, natural gas and other goods, and military vessels.

As well as Panama, the president-elect also took aim at Canada and Mexico over what he called unfair trade practices. He accused them of allowing drugs and immigrants into the US, although he called Mexican President Claudia Sheinbaum a "wonderful woman".

Trump hits the usual themes

Trump made his remarks in front of thousands at Turning Point's annual conference, one of the country's largest gatherings of conservative activists.

Turning Point poured huge resources into get-out-the-vote efforts in swing states designed to bolster Trump and other Republicans during the election campaign.

It was his first speech since a deal passed Congress this week to keep the US government open, after several provisions were removed including one that would have increased the country's debt ceiling.

Trump had supported raising the debt ceiling, which restricts the amount of money the US government can borrow.

But his speech on Sunday avoided that issue entirely, instead recapping his election victory and hitting on themes – including immigration, crime and foreign trade – that were mainstays of his campaign.

He did, however, mention Elon Musk.

"You know, they're on a new kick," he said. "All the different hoaxes. The new one is that President Trump has ceded the presidency to Elon Musk."

"No, no, that's not happening," he said. "He's not gonna be president."

Several speakers here at the conference were critical of government spending and of politicians in both parties – however the divisions inside the Republican Party which have played out in Congress in recent days were mostly muted.

 

 

US House report finds Matt Gaetz paid thousands for sex and drugs, media reports say by Jasper Ward

 

WASHINGTON (Reuters) -The U.S. House Ethics Committee has found that former Florida Congressman Matt Gaetz paid tens of thousands of dollars to women for drugs and sex, including with a 17-year-old girl, U.S. media reported on Monday, citing a final draft of the panel's report.

Gaetz, who has denied wrongdoing, resigned from the House of Representatives last month after he was selected by President-elect Donald Trump to be attorney general. He withdrew from consideration in the face of an uphill confirmation battle in the Senate.

 

In an bid to prevent the report's release, expected on Monday, Gaetz filed a lawsuit against the Ethics panel saying damage to his reputation and professional standing would be "severe and irreversible."

Reuters was not immediately able to reach Gaetz for comment.

The report found that Gaetz paid more than $90,000 to 12 different women, payments the Ethics panel determined were likely in connection with sexual activity and drug use, CBS News reported. CNN reported similar details of the draft report. Both outlets said his actions violated Florida state laws.

The Ethics panel received testimony that Gaetz had sex twice with a 17-year-old girl, described in the report as "Victim A," at a party in 2017, CBS reported.

 

"Victim A recalled receiving $400 in cash from Representative Gaetz that evening, which she understood to be payment for sex," CBS quoted the report as saying. "Victim A said that she did not inform Representative Gaetz that she was under 18 at the time, nor did he ask her age."

Gaetz was the subject of a three-year FBI investigation into allegations of sex trafficking that produced no criminal charges.

The Ethics panel said there was not sufficient evidence that the three-term congressman violated the federal sex trafficking statute, CBS reported.

All of the women who testified said the sexual encounters with Gaetz were consensual, according to CBS.

 

However, one woman told the committee that the use of drugs at the parties and events they attended may have "impair[ed their] ability to really know what was going on or fully consent."

Another woman told the committee: "When I look back on certain moments, I feel violated."

Gaetz argued in his lawsuit filed on Monday in federal court in Washington, DC, that the panel had violated his constitutional rights to due process under the law "through the threatened release of an investigative report containing potentially defamatory allegations."

The panel's report found that Gaetz violated House rules and other standards of conduct banning prostitution, statutory rape and drug use, CBS reported.

 It also found "substantial evidence" Gaetz engaged in illicit drug use, CBS reported. It accused him of accepting gifts of luxury travel in excess of permissible limits with a 2018 trip to The Bahamas, CBS added.

Energy chief Granholm warns against ‘unfettered exports’ of liquefied natural gas by MATTHEW DALY

 The United States should proceed cautiously as officials consider new natural gas export terminals, Energy Secretary Jennifer Granholm said Tuesday, warning the incoming Trump administration that “unfettered exports” of liquefied natural gas, or LNG, could drive up domestic prices and increase planet-warming greenhouse gas emissions.

Granholm’s statement came as the Energy Department released a long-awaited study on the environmental and economic impacts of natural gas exports, which have grown exponentially in the past decade. The analysis found that U.S. LNG shipments drive up domestic wholesale prices and frequently displace renewable energy sources such as wind and solar power.

Increased LNG exports also would lead to higher global greenhouse gas emissions, even with use of newly developed equipment to capture and store carbon emissions, the report said.

 

“Unfettered exports of LNG would increase wholesale domestic natural gas prices by over 30%,’' costing American households an additional $100 a year by 2050, Granholm said

“We have recently lived through the real-world ripple effects of increased energy prices domestically and globally since the (COVID-19) pandemic, she said, adding that an “export-induced price increase” would make it harder for some families to meet basic needs.

 

“Today’s publication reinforces that a business-as-usual approach (to LNG exports) is neither sustainable nor advisable,″ Granholm said.

The Energy Department report comes after the Biden administration paused approvals of new LNG projects in January to study the effects LNG exports have on the planet. Natural gas emits methane, a potent greenhouse gas, when burned, leaked or released.

The oil and gas industry, along with Republican allies in Congress, have decried the LNG pause as unnecessary and counter-productive, and President-elect Donald Trumphas vowed to end the pause on his first day in office. The pause is on hold under a federal court order, but the Energy Department recently said it won’t decide on two major LNG export projects in Louisiana until the independent Federal Energy Regulatory Commission completes environmental reviews.

 

Trump’s transition team declined direct comment on the study, but said Trump “will make America energy dominant again” and protect U.S. energy jobs after four years of “war on American energy” under President Joe Biden.

“Voters re-elected President Trump by a resounding margin, giving him a mandate to implement the promises he made on the campaign trail, including lowering energy costs for consumers,’' said spokeswoman Karoline Leavitt.

Still, the study could hinder Trump’s plans to immediately greenlight projects to export LNG. Trump said last week that anyone making a $1 billion investment in the United States “will receive fully expedited approvals and permits, including, but in no way limited to, all Environmental approvals.”

Environmentalists have said they will use the DOE analysis in lawsuits expected over any Trump administration approvals of LNG projects. Activists decry the multi-billion dollar export terminals as “climate bombs.” 

 

LNG is especially energy intensive, since the gas must be retrieved through underground drilling, then piped to export terminals along the East and Gulf coasts. The gas is then “superchilled” into a liquid that is taken by tanker ships to import terminals in Europe and Asia, where it is then reheated into gas and distributed for business and family use.

The American Gas Association called the Biden administration’s pause a mistake that has resulted in uncertainty for the global market, investors and America’s allies around the world.

“This report is a clear and inexplicable attempt to justify their grave policy error,” said AGA president and CEO Karen Harbert. “America’s allies are suffering from the weaponization of natural gas and energy deprivation, and any limitations on supplying life essential energy is absolutely wrong-headed.”

Harbert said the industry group looks forward to working with the Trump administration “to rectify the glaring issues with this study during the public comment period,” which lasts until mid-February.

 

The DOE report came as an independent analysis found that increased LNG exports would support nearly half a million domestic jobs and contribute $1.3 trillion to U.S. gross domestic product through 2040. The study, released Tuesday by the research firm S&P Global, projects that U.S. LNG export capacity will double over the next five years, with little impact on domestic prices.

“The emergence of the U.S. LNG industry has placed the United States in the pole position with global demand for gas expected to grow through 2040, alongside the rapid growth of renewables,” said Daniel Yergin, the group’s vice chairman and a Pulitzer Prize-winning author.

 

U.S. LNG “remains a vital tool for countries looking to displace dirtier fuels” such as coal, said Charlie Riedl, executive director of the Center for LNG, a pro-industry group. U.S. gas shipments to Europe and Asia have soared since Russia’s invasion of Ukraine in 2022.

The LNG pause, announced by Biden as the 2024 election year began, aligned the Democratic administration with environmentalists who fear the huge increase in LNG exports in recent years is locking in potentially catastrophic planet-warming emissions at a time when Biden has pledged to cut U.S. climate pollution in half by 2030.

“While MAGA Republicans willfully deny the urgency of the climate crisis, condemning the American people to a dangerous future, my administration will not be complacent,″ Biden said in announcing the pause. His actions “heed the calls of young people and frontline communities who are using their voices to demand” climate action, Biden added.

Environmental groups hailed the DOE study, saying it found clear evidence of LNG’s climate, economic, national security and public health dangers.

“This study confirms that Donald Trump’s plans to supercharge LNG exports will come at the expense of consumers and the climate,” said Raena Garcia, senior energy campaigner at Friends of the Earth. She urged Biden and Granholm to reject all pending LNG projects as against the public interest.

“If Trump wants to drive up dangerous gas exports, he’s going to have to answer for causing more deadly storms, condemning the Rice’s whale to extinction and socking consumers with higher costs,” said Lauren Parker, an attorney at the Center for Biological Diversity, another environmental group.

Parker’s comment refers to an endangered whale species in the Gulf of Mexico. Environmentalists say offshore drilling for oil and gas threatens the species’ habitat.

Deny and Delay: The Practices Fueling Anger at U.S. Health Insurers by Peter Whoriskey

 

National data is hard to come by, but doctors say treatment increasingly is being delayed by demands for pre-authorization — or denied outright.

 After a UnitedHealthcare executive was gunned down on a New York City sidewalk, an eruption of bitter online commentary celebrated the killer’s presumed motive: avenging the denial and delay of health insurance coverage.

Many spoke from personal experience. Every year, health insurance companies deny tens of millions of patient claims for medical expense reimbursements, and the tide of those denials has been rising, according to surveys of doctors and other health-care providers. Insurers also have been increasingly demanding that doctors obtain approval before providing treatment, similar surveys show, causing delays in patient care that the American Medical Association says are “devastating.”

While several states have passed legislation trying to restrict such practices amid growing public anger, insurers defend the coverage denials and “pre-authorization” requirements. They say that those measures are meant to contain rising costs and that their methods comply with federal and state regulations. According to information the insurers report to regulators, there have been only small increases nationally in the frequency of denials in recent years.

Most frustrating, according to patient advocates, is that insurance companies often act without explanation, sending denial letters that offer only sparse justifications. The patient “gets a cryptic message saying ‘it’s not medically necessary,’ but without any other explanation,” said Elisabeth Benjamin, a vice president at the Community Service Society in New York, which runs a program that helps consumers appeal denials.

“People are mad because it’s all a big secret,” Benjamin said. “It’s unfair for us as a society, on something that’s so visceral, to trust giant corporations that make money when they deny care. This is why people are so, so very angry.”

Exactly why and how often claims are being denied or medical procedures are getting early scrutiny is difficult to know. Statistics regarding denials and pre-authorizations are scant, at best, and most of what is available reflects only one state or one type of insurance. Nationally since 2019, the rates of denial have been between 14 percent and 16 percent of claims, according to data from the National Association of Insurance Commissioners.

At least some state data, however, shows big increases. In Maryland, for example, regulators report that the number of claims denied by the insurers they regulate has risen nearly 40 percent since 2019.

Pointing in the same direction are large majorities of doctors and other health-care providers who report that insurers are denying more claims and imposing more pre-authorization requirements. For example, a 2024 survey conducted by Experian Health indicated that 73 percent of health-care providers said that “claim denials are increasing.” An American Medical Association survey similarly found that almost three-quarters of physicians said that denials of pre-authorization requests for treatment have increased since 2019.

“The most common feelings I see are frustration and a sense of powerlessness,” said William Bennett, an associate professor at the Indiana University School of Medicine who studies patient experiences and treats children with chronic illnesses. “Patients have a relationship with their doctor. Their doctors know them, their doctors are experts in their disease, and then, for some reason that is never explained, the recommended care is denied.”

Insurance industry representatives blame doctors for many of the denials, saying they botch the required paperwork by submitting inaccurate, incomplete or ineligible claims information. In a statement last week, UnitedHealth said the company’s insurance division pays about 90 percent of medical claims when they’re submitted. Of the remainder that undergo additional review, only 0.5 percent are “due to medical or clinical reasons,” UnitedHealth said.

AHIP, a national association of health insurers, also issued a statement regarding denials, saying that “health plans are working to protect patients from the full impact of rising costs while connecting them to care that is safe, evidence-based and coordinated.”

Health-care providers have decried the requirements for prior authorization, which oblige doctors to request the insurer’s approval before providing patients with certain medical procedures and drugs. According to an AMA survey, nearly a quarter of physicians reported that these requirements led to an adverse event for a patient, and more than 9 in 10 physicians said the practice causes treatment delays. More than a quarter said their prior-authorization requests were often or always denied.

In response to such concerns, state legislatures have passed a raft of legislation. In 2024 alone, 10 states have passed bills aiming to cut what the AMA says is the “growing volume” of such requirements, to shorten the delays they cause, or to increase public reporting of data and procedures.

Only a small minority of patients appeal health coverage decisions, according to state and federal statistics. Many are daunted by the complexity of the medical terminology and the insurance bureaucracy.

“It’s hard to fight a big insurance company,” said Larry Levitt, executive vice president of KFF, a nonprofit health policy research and polling organization. “To even begin, you need to understand the gobbledygook in the paperwork. It’s hard to make heads or tails of it.”

In the Affordable Care Act, Congress authorized the establishment of Consumer Assistance Programs in the states to help people appeal denials of insurance coverage, but it has provided no funding for them in recent years. Even so, many states have set up offices to help.

Recent cases tackled by the Maryland attorney general testify to the range of arguments patients can have with their insurers. One patient experienced 30 percent visual impairment from eyelid inflammation and loose skin, but the insurer deemed the recommended surgery “cosmetic” and refused to pay. A 12-year-old received daily injections for a growth hormone deficiency for three years, but in the fourth year, the insurer deemed the shots not medically necessary and refused to pay. A patient having surgery to repair a broken clavicle unexpectedly needed work to repair a torn vein, but the insurer refused to pay for the extra procedure.

These denials would have forced each of those patients to pay thousands of dollars more than expected for needed care. After Maryland officials intervened, each of those consumers prevailed.

Last year, consumers in Maryland filed 11,466 challenges to denials. When a denial is challenged, consumers prevail about half the time, according to statistics from the state’s attorney general’s office.

But in Maryland, as in other states with programs to aid patients, officials say few consumers know that they can appeal a coverage denial, let alone that there is a program that can help them do so.

“We would love for more people to take advantage of this program,” said Marie Grant, Maryland’s acting insurance commissioner. “Insurance is inherently complicated, and I deeply understand the frustration here. But people don’t have to be alone in this journey.”