Recommendations for the Fortify Maine Home Resiliency Program

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February 17, 2025

Superintendent Robert L. Carey
Bureau of Insurance
Department of Professional & Financial Regulation
#34 State House Station
Augusta, ME 04333-0034

Re: Recommendations for the Fortify Maine Home Resiliency Program

Dear Superintendent Carey,

Thank you for your efforts to establish the Fortify Maine Home Resiliency Program and encouraging the use of surplus funds from the Bureau of Insurance to fund the program. As climate change transforms the state economy and disasters increase costs for Maine households, resilience and mitigation investments are essential. To ensure the Fortify Maine Home Resiliency Program is accessible to households across the state, we encourage the Bureau to adopt the program improvements outlined in this letter.  

The increased frequency and severity of climate disasters is raising costs for state and local governments and households across the country. The U.S. spent nearly $1 trillion dollars on disaster recovery and other climate-related needs over the 12 months ending May 1, 2025, totaling three percent of GDP. These costs are increasingly falling on state and local governments. Investments in resilience provide significant cost savings—every $1 spent on climate resilience and preparedness saves communities an estimated $13 in damages, cleanup costs, and economic impact—but the more state and local budgets are strained by disaster response, the less they are able to invest in adaptation and resilience. Growing climate-related costs fall particularly hard on the 40 percent of Mainers with low incomes and limited assets, households and communities that are both overrepresented in climate vulnerable areas and have fewer resources to make the adaptation and resilience investments needed to mitigate climate damages. 

Homeowners and renters are also facing rising costs from property insurance. In response to the impacts of climate change, insurers have raised rates significantly on households and, in some cases, withdrawn from communities entirely. Between 2021 and 2024, property insurance costs increased by 24 percent, outpacing inflation by 11 percent. In Maine, insurance premiums increased by 20 percent over this period. Raising rates and withdrawing from climate-vulnerable communities has proved profitable for insurers. In 2024, property insurers took in $25.4 billion in underwriting profit and $164.3 billion in investment income. 2025 is expected to be another windfall year for the property insurance industry. S&P Global Market Intelligence estimates insurers made nearly $60 billion in underwriting profit nationwide last year. Though insurers remain profitable, the rising cost of insurance is financially straining households—driving up household debt and mortgage and credit card delinquencies. 

FORTIFIED roof upgrades work across roof types to enhance home resilience against a variety of perils, including wind, hail, and severe rain, and to protect homes from costly climate damage. A study of insurance claims and payments in Alabama following Hurricane Sally in 2020 found that homes with FORTIFIED roofs had at least 55 percent lower claim frequency and 15 percent lower claim severity than homes with standard roofs. The Fortify Maine Home Resiliency Program will help mitigate costs for households as climate-related impacts grow, but the program must extend to low-income households and communities that face the most climate risk and have the fewest resources to invest in climate resilience. Additionally, the property insurers currently boosting their own profitability by passing along costs to households and communities should assume greater responsibility for resiliency investments. Finally, the state should combine this effort on resilience with similar investments in emissions reduction to ensure resilience investments have a stronger chance of success. We recommend the following changes to the program to better accomplish these goals:

• Allow eligible recipients to use grant funding to cover all upfront costs associated with FORTIFIED roof upgrades. To incentivize program uptake, particularly for low-income households, any upfront costs associated with FORTIFIED roof upgrades, such as evaluator assessments, should be eligible for grant funding. Upgrade-related fees not covered by the grant will disincentivize participation from residents with the most financial need. 
• Extend grant eligibility to multifamily properties, with a focus on affordable housing developments. Grant eligibility under the Fortify Maine Home Resiliency Program should extend to multi-family properties, which comprise nearly 22 percent of Maine housing, with a focus on affordable housing developments. Affordable housing operators are acutely impacted by the rising costs and reduced availability of property insurance. Declining insurance access makes it more difficult to increase the supply of affordable housing or preserve existing affordable units—exacerbating housing affordability challenges in Maine. Rising insurance costs also reduce the ability of affordable housing operators to invest in needed repairs and upgrades, including investments in climate resilience and energy efficiency. The Bureau should increase per property grant eligibility for multi-family properties as appropriate for upgrades in compliance with the FORTIFIED Multifamily designation. 
• Require all insurers operating in Maine to offer a minimum premium discount for insured properties with a certified FORTIFIED roof. All Maine residents with a certified FORTIFIED roof, whether or not the roof upgrade was made with grant funding through the Maine Home Resiliency Program, should receive a premium discount from their insurer. Insurers should report to the Bureau on FORTIFIED roof discounts given to policyholders, and agents should be required to inform policyholders of their eligibility for discounts and grants. In the event of a climate disaster, insurers benefit from climate resilience investments made by the property owner. Insurance premiums should reflect the benefit a FORTIFIED roof upgrade provides to insurers.
• Collect census tract-level data on disaster impacts, insurance costs, and insurance claims to ensure resilience investments are targeted towards in-need communities. Focusing the pilot program solely on counties with high homeowner loss claims can skew the program towards communities with high property values rather than towards communities most in need of grant funding for upgrades. Collecting and publishing census tract-level data from insurers will allow the Bureau to better target grant funding towards communities most impacted by climate disasters and with the most financial need. Collecting census tract-level data will have utility for the Bureau beyond the Fortify Maine Home Resiliency Program, including by helping the Bureau track changes to insurance affordability and availability across the state. 
• Increase Bureau fees to support long-term maintenance of the resiliency program. To ensure the Fortify Maine Home Resiliency Program can meet the needs of as many eligible Maine residents as possible and to make it possible for the Bureau to offer other climate resiliency grant programs in the future, the Bureau should increase fees on property insurers operating in the state. While modest fee increases are a drop in the bucket for property insurers making record profits, they can be a meaningful source of revenue to fund climate resilience investments. 
• Address insurance and energy costs together and establish an interagency Resilience and Mitigation Council. Effectively cutting climate-related costs over the long-term requires pairing resilience investments with emissions reduction measures. We recommend the state coordinate the provision of resilience grants with measures that provide similar assistance with energy efficiency and emission reductions, such as the installation of heat pumps and rooftop solar. To coordinate these efforts, the state should establish an interagency council, following the lead of Alabama’s Fortified program. In Maine, the council should include both climate resilience and climate mitigation expertise. By convening experts on a quarterly basis, a Maine Resiliency and Mitigation Council can take advantage of existing housing and energy expertise across agencies to reduce costs for Maine residents.

Thank you for your attention to this critical matter and for your commitment to protecting Maine households and communities from climate impacts. We welcome additional opportunities for feedback or engagement with the Maine Bureau of Insurance on this program. 

 

CC:
Charles A. Mercer
Fortify Maine Homes

 

Sincerely,

Public Citizen
Americans for Financial Reform Education Fund
Consumer Federation of America
Maine Affordable Housing Coalition
Maine Conservation Voters
Natural Resources Defense Council
Union of Concerned Scientists
Sierra Club, Maine Chapter

Trump’s Deal With Argentina Marks a New Low in Big Pharma-Friendly Trade

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When Trump announced his infamous “reciprocal tariffs” in early April 2025, he waved around a report that he claimed contained other countries’ “non-tariff barriers” against the U.S. Those “non-tariff barriers” were actually laws and policies that U.S. corporations don’t like — even those that benefit the public interest such as laws that promote affordable medicines. When the more detailed annual “watch list” related to intellectual property laws, the Special 301 Report, was released later that month, Public Citizen raised alarm that this annual Big Pharma hit list of other countries’ policies could serve as a road map to Big Pharma giveaways in Trump’s secretive “reciprocal tariff” negotiations.

The recently signed Agreement on Reciprocal Trade and Investment between the U.S. and Argentina unfortunately did just that. The U.S.-Argentina deal required Argentina to make concessions explicitly listed in the Special 301 Report — representing a new low in using U.S. trade policy to bully countries into adopting intellectual property rules that expand Big Pharma’s monopoly power at the expense of access to affordable medicines.

Elevation of Big Pharma’s Special 301 Complaints

While internationally agreed trade rules at the World Trade Organization inappropriately privilege intellectual property rights, those agreements at least recognize the need to balance intellectual property rights with efforts to ensure affordable access to medicines and support the public interest.

The Special 301 report, however, has a long history of undermining these public interest considerations in favor of maximalist intellectual property provisions that expand monopoly power. Experts have questioned the legitimacy of the Special 301 process, suggesting that the Special 301 report’s practice of failing to justify its criticisms and threatening unilateral sanctions for practices which comply with the World Trade Organization’s Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) violates administrative justice norms and international rules.

Now, with the U.S.-Argentina agreement, the Trump administration has taken this bullying a step further through binding measures based on questionable Special 301 complaints, further extending inappropriate corporate influence over U.S. trade policy.

This is the first time a U.S. trade agreement explicitly mentions the 301 report and requires a country to address a litany of the Big Pharma complaints raised within.

The new agreement requires Argentina to “expeditiously take steps to fully resolve the issues identified with respect to Argentina in the most recent Special 301 Report.” The agreement includes a variety of intellectual property-related concessions, including:

• Patenting guidelines — Argentina is required to take steps to repeal its domestic regulations related to patenting standards (Joint Resolutions No. 118/2012, No. 546/2012, No. 107/2012, and No. 283/2015).

Patenting guidelines prevent the granting of poor–quality patents (such as those claiming small variations on old medicines, like extended– release versions, that companies can use to “evergreen” patents) by advising patent examiners on how to assess the patentability requirements of applications.

Argentina’s 2012 and 2015 resolutions guide the assessment of applications for pharmaceutical and biotechnological inventions. These guidelines do not modify or limit patentability criteria but aim to ensure the correct application of those standards. By repealing these guidelines, pharma corporations are more likely to be granted patents based on overly broad or non-innovative products or processes, which will further extend their monopolies and restrict access to affordable medicines.

• Data exclusivity — Argentina is required to prepare a report “analyzing the feasibility, scope, and institutional requirements for implementing a data protection regime that is consistent with Articles 20.45 and 20.48 of the United States – Mexico – Canada Agreement [USMCA].”

All countries party to the TRIPS Agreement are required to protect undisclosed data from unfair commercial use. Argentina provides such protection. The U.S. pursuit of data exclusivity goes beyond protection of data to provide an additional layer of monopoly separate from patents. The USMCA requires five years of data exclusivity, during which time generic manufacturers and regulatory authorities are prevented from using an originator company’s data to grant marketing approval for a generic drug.

• Patent extensions — Argentina is required to prepare “a report analyzing the causes of delays in the patent granting process, identifying those attributable to administrative factors, and evaluating the legal feasibility of patent term extensions for unreasonable patent delays” and to take steps to “significantly reduc[e] patent pendency, including for biotechnological and pharmaceutical inventions.”

Patent term extensions grant corporations additional years of monopoly beyond the standard 20-year term. While patent term extensions are allocated ostensibly for “delays,” variance in review periods is a normal part of each system and is not indicative of insufficient protection of intellectual property. Extending patent terms delays access to generic medications and keeps prices high.

• Enforcement — Argentina is required to establish a “coordination body for IP enforcement” and explore “having a specialized federal IP prosecutor office.”

Corporations enjoy ample avenues to pursue enforcement of their intellectual property. Expansive enforcement measures further tilt the balance of power toward industry interests, such as by providing more generous infringement remedies and broadened avenues for industry influence. These types of measures risk chilling legitimate policy actions aimed at facilitating access to medicines.

A Worrying Template

The U.S.-Argentina deal reveals the lie behind Trump’s claim that he is standing up to Big Pharma and bringing drug prices down. While he distracts the U.S. public from real action to lower prices with his vanity TrumpRx website, that actually threatens to raise drug costs for some of its users rather than lower them, he’s using secretive trade negotiations to do Big Pharma’s dirty work to expand their monopoly power globally. 

Principles for Access to Medicines and Trade

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Public Citizen, Health GAP, and 98 expert organizations from around the world are calling for an approach to global trade policy that preserves access to affordable medicines and rejects deals made under duress. The U.S.-UK Big Pharma agreement in principle, borne out of an abuse of trade power and weaponized tariffs, must not be replicated.

Experts from the public health, trade, labor, climate, and faith spaces detail six key principles to ensure affordable prices for all:

• Reject corporate bullying.

• Enable plentiful supply of medicines.

• Ensure the safety, efficacy, and quality of medicines.

• Freely determine which international treaties are beneficial.

• Adhere to transparent and accountable trade processes.

Read the full set of Principles for Access to Medicines and Trade (Spanish translation here).

Proposals to Improve Natural Gas Price Transparency

By Tyson Slocum

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Read a full pdf of the filing here NatGasReporting

In Federal Energy Regulatory Commission docket IC26–5, it seeks feedback on whether modifications are needed to the data collected in FERC Form 552 (Annual Report of Natural Gas Transactions) and FERC Form 549E (Price Index Data Providers and Developers). We offer three needed enhancements to ensure reporting of natural gas transactions adhere to the public interest, protect consumers and address America’s growing energy affordability crisis:

• Report natural gas transactions quarterly instead of annually, and disclose natural gas transactions by geographic spot market, instead of aggregated nationally as is current practice.
• Consolidate reporting of natural gas transactions by affiliate, as Form 552 often fails to reference or include affiliates that are separately reported.
• Establish an electronic natural gas transaction information system.

Section 1 of the Natural Gas Act declares “that the business of transporting and selling natural gas for ultimate distribution to the public is affected with a public interest, and that Federal regulation in matters relating to the transportation of natural gas and the sale thereof in interstate and foreign commerce is necessary in the public interest.” Congress deemed the natural gas industry to be “affected with a public interest” after exhaustive reports by the Federal Trade Commission determined that American households that were physically connected to gas service required protections as an essential utility service.

Section 23 of the Natural Gas Act directs the Commission “to facilitate price transparency in markets for the sale or transportation of physical natural gas in interstate commerce, having due regard for the public interest, the integrity of those markets, fair competition, and the protection of consumers.”

Natural gas price volatility has grown as record gas exports—primarily through Liquified Natural Gas (LNG)—have radically upended gas flows to accommodate exports at the expense of domestic use. Eight LNG export terminals now consume more natural gas than all 74 million American households with natural gas utility service. Feedgas consumption by these eight export terminals now exceed 20 billion cubic feet per day, with that number expected to rise to 21 billion cubic feet later this year as three new facilities come online. Those numbers are set to explode in the next three years, with LNG export capacity set to double by 2029. The U.S. Energy Information Administration has documented how these record gas exports have increased domestic prices and exacerbated gas price volatility. This increased price volatility requires enhanced regulation and disclosure of natural gas price reporting.

Form 552 Must Include Quarterly Reporting, And Detail Trades And Prices By Geographic Spot Trading Hub

The Commission claims compliance with the Natural Gas Act’s Section 23 mandate in part through its existing Form 552. Form 522 is a woefully inadequate tool to ensure natural gas price transparency and the protection of consumers, because it requires only reporting of purchases and sales of natural gas aggregated across the entire year. It omits any reporting by geographic spot market. As the Commission is aware, there are nearly 200 different geographic gas spot hubs where prices, volatility and liquidity of trading vary dramatically. These geographic trading hubs determine the prices that utilities, household consumers and other end-use sectors pay. Reporting that includes company-level natural gas trading by geographic hub would help ensure greater price transparency.

Clear precedent to shift Form 552 reporting from annual to quarterly, and to include all transactions by specific geographic hub exists with the Commission’s Electric Quarterly Reports, which compel quarterly reporting by specific geographic node.

Currently, such natural gas geographic reporting is done on a voluntary basis and collected by private companies who charge exorbitant fees for access. Trapping price transparency data that Congress deemed to be in the public interest behind a paywall is inconsistent with the clear statutory language of the Natural Gas Act.

Ensure That Form 552 Includes Reference to Affiliates Filing Separate Form 552 Reports

At present, there are repeated instances of affiliates filing separate Form 552 reports that present challenges to the public (and possibly the Commission) to comprehensively identify physical gas trading by affiliates.Form 552 currently provides respondents the option to “choose to either report for all its Affiliates collectively, or may choose to have each of its Affiliates report separately as their own ‘Respondent.’” So if a respondent chooses to report its affiliates separately, that reporting fails to note that there are separately filed reports of its affiliate, leaving a sizeable gap in tracking affiliate reporting. The Commission should amend Form 552 to require all respondents to clearly state the name of an affiliate that has filed a separate report, so users may easily be able to track affiliate reporting.

Establish an Electronic Natural Gas Transaction Information System

A natural gas index price is derived from trades within specific geographical boundaries that market participants voluntarily report to a price index developer. Price index developers are private, for-profit companies that classify most of the voluntarily reported data as proprietary, that the index developers then commodify and sell only to those that can afford the very expensive subscription fees.

These voluntarily-reported transactions determine the price of natural gas for millions of households and businesses across the country, as market participants reference index prices in their physical and financial transactions: natural gas pipelines and Regional Transmission Organizations feature natural gas indices in their FERC-jurisdictional tariffs for various terms and conditions of service; state utility commissions rely on natural gas indices as benchmarks when setting rates; and many natural gas financial derivative contracts used in hedging and speculation settle against the natural gas price indices. In a way, hundreds of billions of dollars of energy transactions rely upon voluntarily-reported price indexes—a 21^st century version of a smoke-filled, price-fixing establishment.

Federal law requires the Commission to ensure that spot natural gas price indices feature adequate price discovery and market transparency. Spot natural gas price indices are structurally non-competitive and the voluntary nature of reporting trades renders them susceptible to market manipulation. The rest of the world has been replacing voluntary price indices for benchmarks with far larger economic impacts that U.S. natural gas spot prices, such as replacing the London Interbank Offered Rate (LIBOR) with the Secured Overnight Financing Rate (SOFR).

The Commission should therefore establish an electronic information system, as authorized by 15 USC § 717t–2(a)(4), which states that “the Commission shall consider the degree of price transparency provided by existing price publishers and providers of trade processing services . . . The Commission may establish an electronic information system if it determines that existing price publications are not adequately providing price discovery or market transparency” [emphasis added]. Such “an electronic information system” could be based on actual transactions, and not limited to those voluntarily reported, and would be freely available to all interested parties through a platform hosted by the Commission, rather than the proprietary, commodified data model of the index publishers.

The Commission conceived of the idea of having authority to create its own electronic natural gas price reporting system. In testimony before the House Committee on Energy and Commerce on February 10, 2005, FERC’s general counsel Cynthia A. Marlette included in her prepared testimony Price Transparency in Natural Gas and Electric Markets, where she declared:

It would be helpful if the Congress clarified the Commission’s authority to require the development of an electronic price reporting system, and if the Congress gave the Commission the ability to require all electric market participants to participate in such a reporting system . . . and make it publicly available.

Connecticut Should Use Insurance Fees to Fund Risk Reduction

To fund a comprehensive home risk reduction grant program, Connecticut should look to its highly profitable insurance industry.

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Connecticut faces a fast-growing home insurance affordability crisis driven by climate change. The state needs to act now to protect homes and household budgets by lowering the risk, both by building physical resilience and addressing the root cause: fossil fuels. While proven solutions can lower costs by building resilience and clean energy, many households need upfront financial support. Connecticut should build a comprehensive home risk reduction grant program, funded by the highly profitable insurance industry, which had $1.2 trillion left over last year after paying claims. By prioritizing direct support for the most vulnerable households, Connecticut can take a proactive approach to keep communities insurable.

Climate change is driving an affordability crisis. Connecticut households are paying the price.

• Insurance costs are rising nationwide, far outpacing inflation and income. Public Citizen and the Revolving Door Project published a set of interactive maps showing these trends at a state and community level. Costs are rising fastest in climate-vulnerable areas exposed to wind and flood damage and, with dense coastal development and growing inland risks, Connecticut is particularly vulnerable. 
• Premiums in Connecticut jumped nearly 10% in 2023 and 13% again in 2024, a dramatic jump from past annual increases. Insurance in Connecticut now costs an average of $2,600 a year, on top of an average annual cost of $1590 for separate flood insurance. 
• Connecticut households are increasingly at risk of losing insurance entirely. Connecticut is in the top ten states for dropped policies and, in 2023, over 14,000 Connecticut households lost insurance, a 45% increase in one year.

Connecticut needs action now and a long-term plan to lower costs.

• Insurance is fundamental to the public interest. Without intervention, low-income households will be priced out of insurance and their homes. The state already faces tens of billions of dollars in costs from climate-driven disasters. As insurance companies retreat, vulnerable towns will struggle with a dwindling tax base that puts resilience out of reach.
• As a historically insurance-centered state facing high climate risk, Connecticut should lead in keeping coverage affordable and should not wait for the federal government to fund it. Connecticut should look to innovative sources for near-term investments, where even modest investments made early can pay off, with every $1 spent on resilience saves $13 in economic impact, damage, and cleanup costs later on.
• Connecticut cannot wait for the private market to craft a plan. Despite its sophisticated analysis of current risks, the private insurance industry has no credible, long-term plan to address climate-driven losses, other than raising premiums and retreating. Insurance companies simply do not expect to pay the price of climate change themselves, and a narrow focus on short-term profits and investments disincentivizes loss reduction.

Proven resilience programs lower losses but the state must scale them. 

• Decades of engineering research show that specific building upgrades, including fortified roofs, flood mitigation, natural habitats and home hardening for wildfires, lower losses. With sufficient oversight of insurance rates, lower losses mean lower premiums.
• Grant programs in 10 states show that targeting vulnerable homes for upgrades lowers losses and expands adoption beyond initial recipients. For example, in Alabama, homes retrofitted to the Fortified standard had 55–74% fewer insurance claims than conventional homes in the storm’s path during Hurricane Sally.
• Most households understand the risks and want to act, but many do not have sufficient savings upfront, even with the promise of a discounted premium over time. This is particularly true for communities of color harmed by decades of redlining and disinvestment, who also face disproportionate climate risk. The question now is how to scale and fund existing models with a predictable, funding stream that can meet demand. 
• The pilot program as outlined by Connecticut’s Severe Weather Mitigation & Resiliency Advisory Council is a step in the right direction. However, to scale this, the existing plan is missing two crucial pieces: carbon emissions reduction and sufficient funding.

A comprehensive risk reduction grant program should reduce carbon emissions while building resilience.

• While increasing the physical resilience of homes can lower costs, it is only part of the equation. With $30 billion a year on average of insured losses now attributed to climate change, any solution requires lowering the curve on carbon emissions.

• Currently, the Council recommends strengthening partnerships with Energize CT, but Connecticut should go further and expand grant funding to home-level energy efficiency and emissions reduction home upgrades. 
• A comprehensive approach can start stronger and reach further, by using existing agency expertise and overlapping contractor and outreach networks. By extending the program to energy efficiency and clean energy, the state can also reach a broader swath of homeowners by, for example, installing fortified roofs in areas most vulnerable to wind while installing solar in inland areas with lower risk.

Connecticut should require the insurance industry to invest in loss reduction now.

• Connecticut should look first to the industry that stands to benefit the most, the insurance industry itself. The state has the authority to raise industry fees and surcharges now. States that already use industry funding include Alabama, Oklahoma, North Carolina and Maine. 

• There is significant room to increase industry fees. The industry reached record profits and had $1.2 trillion left over after paying claims last year. This was driven by premium increases and investment gains, according to the National Association of Insurance Commissioners. Despite a looming crisis, the insurance industry also has more money than it can spend responsibly in a crisis, as evidenced by skyrocketing CEO pay, stock buyback spending sprees, billions blown on advertising wars and half a trillion dollars in reckless investments in fossil fuel projects.

• The legislature should expect a financial commitment now from its lucrative industry, when it can be meaningfully invested in loss reduction. The short-term nature of property insurance contracts means the industry has made no obligation to serve the state and vulnerable policyholders later on.
• Because insurers are not solely responsible, Connecticut could incentivize cost recovery from fossil fuel companies via a commercial policy surcharge and subrogation.

• While companies are required to set aside funds to meet capital requirements for claims and solvency, this is no longer sufficient. In the era of exponentially increasing climate-driven losses, a proactive approach is also essential to bring down the curve.

Grants should go to the most vulnerable and should be paired with additional tools.

• Full grants should be targeted to those most in need, with additional support for any evaluation fees. This should include affordable housing providers who are particularly at risk of losing insurance. To expand to homes with higher incomes, the state should provide matching grants and tax credits. 
• To target grants effectively and track the impact, the state should publish annual data on insurance premiums and claims at a census tract level and closely monitor insurance rates. 
• To ensure policyholders receive the full discount for all taxpayer-funded investments in resilience and clean energy, Connecticut should also require pricing and underwriting models to account for mitigation investments. 
• Community-level investments in resilience and clean energy provide even greater impact than home-level investments, and grants should be part of a larger approach to state and community-level upgrades. 

Connecticut’s insurance affordability crisis is not inevitable. By investing in resilience and emissions reduction, targeting support to vulnerable households, and securing sustainable funding, the state can stabilize insurance markets and protect residents from rising climate risks.

Trump’s Goal for the WTO: Stopping Taxes on Big Tech

By Melanie Foley

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At the upcoming World Trade Organization’s (WTO) 14^th Ministerial Conference (MC14) in Cameroon, trade officials from every WTO country will meet to discuss the future of a global order that has been thrown into turmoil by the Trump administration’s hostile trade policies.

One of the critical issues on the agenda at MC14 is the future of the WTO’s E-Commerce Moratorium. As we have discussed previously, the Moratorium restricts countries from imposing import taxes on business-to-consumer and business-to-business transactions that take place across borders over the internet.[1]

While ostensibly a mechanism to limit barriers to global connectivity and thereby bring a wider choice of products and services to the global market, in practice, the Moratorium prevents countries from using customs duties as a means to raise revenues needed to support development and public services, while also reducing the policy tools available to governments to boost domestic tech industry growth amongst other policy goals. As electronic transmissions become a larger portion of the global economy, maintaining the Moratorium may not be in the national interest for many countries, particularly for developing countries that are net importers of digital services and have nascent technology service industries.

The Moratorium has been controversial and was only extended at the previous WTO Ministerial Conference at the last minute following intense negotiations. A failure to agree on a renewal would mean that the Moratorium would lapse following MC14.

The Trump administration, despite its seeming hostility towards the WTO itself, is pushing hard for the WTO to make the Moratorium permanent.[2]

This is part of a broader trend of the Trump administration — to stop other countries regulating U.S.-based Big Tech companies, while actively undermining regulation and enforcement efforts at home.[3] The administration’s intent has been reiterated by several senior officials, with Vice President Vance stating that “The Trump administration is troubled by reports that some foreign governments are considering tightening the screws on U.S. tech companies with international footprints. Now America cannot and will not accept that.”[4]

The Trump administration has followed through on these threats. Not only has President Trump explicitly used his “reciprocal tariffs” to demand removal of other countries’ tech regulations, the U.S. administration has also taken extreme steps such as visa bans and politically motivated trade investigations to oppose regulations imposed by foreign countries on the digital ecosystem.[5]

The U.S. administration has been especially aggressive against efforts to tax U.S. Big Tech companies, making it clear that it will take retaliatory action against countries that it claims are ‘extorting’ U.S. companies through common taxation policies. The U.S. has already flexed its muscle to secure wins for Big Tech — for instance, the Trump administration bullied Canada into dropping its digital services tax on Big Tech companies and is attempting to do so with several other jurisdictions. At the same time, Trump withdrew the U.S. from a global effort to limit tax evasion by multinational corporations under the “Base Erosion Profit Shifting (BEPS) framework organized through the Organization for Economic Cooperation and Development (OECD), which recently announced that U.S. companies would be exempted from the multilateral arrangement.[6] The U.S. has also consistently maintained its hostility towards a nascent United Nations-led global tax convention.

In a similar vein, the Trump administration has also demanded that countries support the Moratorium as part of the numerous opaque trade deals the U.S. administration is negotiating under threat of high tariffs. Countries that have negotiated “Agreements on Reciprocal Trade” with the Trump administration — including Argentina, Bangladesh, Cambodia, El Salvador, Guatemala, and Malaysia — have committed to support a permanent moratorium at the WTO. There are similar terms in the framework deals (still under negotiation) with Ecuador, the European Union, Indonesia, Korea, Thailand, and Switzerland.[7] This is particularly noteworthy in the case of Indonesia, which was a leading opponent of the Moratorium, and in fact is the only country in the world to require reporting of digital imports (seen by some as a first step towards imposing customs duties).

By using bilateral negotiations to whittle down opposition to the Moratorium, the Trump administration is actively pushing to secure a win for Big Tech at MC14. However, the position of other developing countries is less certain — with India, Pakistan and others possibly continuing to oppose the deal. India’s position appears uncertain given that the White House recently announced in a Joint Statement, that India agreed to support the Moratorium in its bilateral trade framework with the United States. However, a revised version of the Joint Statement released subsequently excluded this language, which suggests that India did not in fact agree to such a provision.

The Trump administration appears to have two routes  through which it could push through the Moratorium — through a ministerial declaration (as has been done for the past two decades) or through WTO adoption of the Joint Statement Initiative on E-Commerce, a controversial plurilateral side agreement, which commits parties not impose customs duties on electronic transmissions.[8] The JSI route is unlikely.[9]  During the Biden administration, the U.S. withdrew support for various provisions of the JSI’s text.[10] While the Trump administration has once again embraced those pro-Big Tech provisions in bilateral deals, it is unlikely to support a JSI that does not include a national security exception (which it currently lacks). The JSI route would also provoke significant pushback due to the procedural and governance-based challenges that any joint statement initiative will face.

Countries should be wary of signing any deal to extend the Moratorium and should certainly oppose any deal to make it permanent. Doing so would jeopardize any notions of digital sovereignty and equitable distribution of the benefits of the digital economy.

A decision on the Moratorium is not a referendum about whether or not it is good policy for a country to apply customs duties to electronic transmissions.  If the benefits to all parties of a Moratorium were as overwhelming as claimed by its proponents, a global agreement would not be necessary, as no government would impose such customs duties. Instead, what is at stake is the sovereign ability of states to decide if and how to regulate the digital ecosystem, and the critical issue of preserving the policy tools available to a state to implement public and economic policy in its national and public interest.

The effort to make the Moratorium permanent should therefore be seen as what it is — one more example of the Trump administration going to bat on behalf of Big Tech to stop countries from regulating this handful of massive and powerful companies.[11] In fact, the Trump administration’s position on the substantive policy position behind the Moratorium has been laid bare by its declared intent to impose tariffs on the import of foreign films into the U.S. You can bet the Moratorium will not stop the U.S. from imposing such taxes if it so chooses, so why should others sign up to such a deal?[12]

Endnotes:

[1] Public Citizen, “WTO Moratorium on Customs Duties on Electronic Transmissions”, February 2024, https://www.citizen.org/article/fact-sheet-wto-moratorium-on-customs-duties-on-electronic-transmissions/; Public Citizen, “Understanding the Moratorium on Customs Duties on Electronic Transmissions”, February 2024, https://www.citizen.org/article/understanding-the-moratorium-on-customs-duties-on-electronic-transmissions/

[2] Washington Tariff and Trade Letter, “US Pushes for Indefinite Extension of WTO E-Commerce Moratorium”, November 2025, https://www.wttlonline.com/stories/us-pushes-for-indefinite-extension-of-wto-e-commerce-moratorium,14540; Maria Pagan, “Want to Rally the WTO? Put the E-Commerce Tariff Moratorium First”, Hinrich Foundation, December 2025, https://www.hinrichfoundation.com/research/article/wto/wto-put-e-commerce-first; Third World Network, “Defying Consensus, US Pushes to Make E-Com Moratorium permanent”, December 2025, https://twn.my/title2/wto.info/2025/ti251221.htm

[3] Public Citizen, “Trump Grants His greedy big tech buddies’ Christmas Wish With Dangerous AI Preemption EO”, December 2025, https://www.citizen.org/news/trump-grants-his-greedy-big-tech-buddies-christmas-wish-with-dangerous-ai-preemption-eo/; Rick Claypool, “Deleting tech enforcement”, Public Citizen, August 2025, https://www.citizen.org/article/deleting-enforcement-trump-big-tech-billion-report/

[4] Raf Sanchez, Mo Abbas and Nancy Ing, “Vance warns against ‘tightening the screws’ on AI in rebuff of Europe“, NBC NEWs, February 2025, https://www.nbcnews.com/politics/jd-vance/vance-ai-regulation-europe-criticizes-rcna191482

[5] Public Citizen, “Trump’s “Big Tech First” Agenda on Display with outrageous visa bans on EU Officials”, December 2025, https://www.citizen.org/news/trumps-big-tech-first-agenda-on-display-with-outrageous-visa-bans-on-eu-officials/; Public Citizen, “US and Brazilian Groups Denounce Trump’s Tariff Shakedown to benefit Big Tech”, August 2025, https://www.citizen.org/news/u-s-and-brazilian-groups-denounce-trumps-tariff-shakedown-to-benefit-big-tech/

[6] OECD, “Base Erosion and Profit Shifting (BEPS)”, https://www.oecd.org/en/topics/policy-issues/base-erosion-and-profit-shifting-beps.html

[7] Public Citizen, “Trump’s Secret Trade Deals with Malaysia and Cambodia Revealed: Imperialist Bullying on Behalf of Big Tech, Other Corporate Interests”, October 2025, https://www.citizen.org/news/trumps-secret-trade-deals-with-malaysia-and-cambodia-revealed-imperialist-bullying-on-behalf-of-big-tech-other-corporate-interests/; Public Citizen, “Trade Deals with El Salvador, Guatemala are gifts for Big Tech”, January 2026, https://www.citizen.org/news/trade-deal-with-el-salvador-is-another-gift-for-tech-ceos/

[8] Digital Trade Alliance, “Understanding the WTO Joint Statement on E-Commerce”, December 2023, https://dtalliance.org/2023/09/27/understanding-the-wto-joint-statement-initiative-on-e-commerce-2/

[9] Public Citizen, “U.S. Decision on WTO E-Commerce Talks Today Is a Welcome Step Toward Aligning U.S. Trade Policy With Big Tech Accountability Goals”, October 2023, https://www.citizen.org/news/u-s-decision-on-wto-e-commerce-talks-today-is-a-welcome-step-toward-aligning-u-s-trade-policy-with-big-tech-accountability-goals/

[10] US Trade Representative, ”USTR Statement on WTO E-Commerce Negotiations”, October 2023, https://ustr.gov/about-us/policy-offices/press-office/press-releases/2023/october/ustr-statement-wto-e-commerce-negotiations

[11] Public Citizen, ”Trump Puts Big Tech Above the Law Amid Industry’s Billion-Dollar Influence Campaign”, August 2025, https://www.citizen.org/news/trump-puts-big-tech-above-the-law-amid-industrys-billion-dollar-influence-campaign/; Public Citizen, ”Method to the Madness: How Trump’s Chaotic Trade Agenda Benefits Big Tech”, October 2025, https://www.citizen.org/article/method-to-the-madness-how-trumps-chaotic-trade-agenda-benefits-big-tech/; Public Citizen, ”Big Tech Pushes for More Giveaways in USMCA Review”, December 2025, https://www.citizen.org/article/big-tech-pushes-for-more-giveaways-in-usmca-review/; Cecilia Kang, ”From AI to Chips, Big Tech is getting what it wants from Trump”, New York Times, December 2025, https://www.nytimes.com/2025/12/28/technology/tech-trump.html

[12] PBS News, ”Trump takes tariff wars to the movies by announcing 100% tax on foreign-made films”, September 2025, https://www.pbs.org/newshour/nation/trump-takes-tariff-war-to-the-movies-by-announcing-100-tax-on-foreign-made-films

Petition to HHS: Expand Access to GLP-1s Through 28 U.S.C. § 1498

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Public Citizen filed a petition requesting that the United States Department of Health and Human Services authorize generic competition for Novo Nordisk’s semaglutide (marketed as Ozempic, Wegovy, and Rybelsus) and Eli Lilly’s tirzepatide (marketed as Mounjaro and Zepbound), overcoming the drugmakers’ patent barriers to improve access to expensive GLP-1 medications for weight loss, type 2 diabetes, and other conditions.

Read the full petition here.

Read a summary of key points here.

Public Citizen Comments to the Texas Commission on Environmental Quality Regarding the Expedited Enforcement Program

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Good morning, Commissioners.

I’m Kathryn Guerra, with Public Citizen’s Texas office. Public Citizen is a nonprofit consumer advocacy organization with over one million members and supporters that champions public interest in the halls of power.

Since the agency did not provide any other public comment opportunity on this change to its enforcement process, we want to use this opportunity to highlight our concerns about the proposal. Our concerns center around the lack of transparency and public input.

Staff conducted three engagement meetings. I attended one of those sessions with about ten other folks, and that meeting lasted just 30 minutes. Staff said they’d been working on this program change for two years, yet the agency provided what amounted to an hour and a half of public engagement. When asked whether the agency felt it had adequately engaged both communities and regulated entities on the change, staff responded that it believed it had.

The list of nearly 200 violations proposed for inclusion in this program was not made available to the public during those meetings. The list was only made publicly available as an attachment to this meeting’s agenda. The program proposes eliminating consideration of these 200 violations from the commissioners’ agenda, which also eliminates public notification and comment opportunities, as well as the penalty calculation worksheet. We take issue with any action this agency takes to lessen transparency.

We understand that this program aims to divert enforcement cases to expedite compliance, and we wholly support it. During your previous agenda, this commission adopted agreed orders ranging from 800 to 1,459 days (or 4 years) from investigation to approval. Most included ordering provisions that allowed even more compliance time after the agreed order was signed, even for the respondent, who according to staff, had been unresponsive for over a year. That means ongoing pollution for nearly 4 years. In contrast, the 60-day compliance deadline proposed for this program seems expeditious.

We hope this program also helps the agency address its extensive enforcement backlog. Between January and December of 2025, the agency cleared just 39 backlogged enforcement cases. At this rate, it’s going to take 36 years to undo the mess that the agency’s own enforcement policies, in part, have contributed to making.

Perhaps it’s also time to look at all of the agency’s enforcement policies and evaluate how to end the practice of giving polluters several years to voluntarily agree to comply before the agency takes stronger enforcement action. That alone would help expedite the resolution of environmental harms in communities across the state, while maintaining the transparency and public input opportunities currently afforded to them. Absent those opportunities, we’d like to see the number of expedited orders added to the monthly enforcement report, including a quantification of those that successfully achieve compliance and those that do not, and the amount of reduced penalties, as separate line items. 

Thank you.

Comments to the FDA on the Expert Panel on Testosterone Replacement Therapy for Men

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Public Citizen, a national nonprofit consumer advocacy organization with over one million members and supporters nationwide, submits the below comments on the Food and Drug Administration’s (FDA’s) Expert Panel on Testosterone Replacement Therapy for Men (FDA-2025-N-6743).

On December 10, 2025, the FDA convened an expert panel to explore the medical evidence and therapeutic uses of testosterone replacement therapy for men.[1] Public Citizen is concerned about the FDA’s expert panel and the unsafe medical interventions it encouraged.

The process for selecting members of the FDA panel was not transparent, and several panelists have direct ties to pharmaceutical companies that manufacture testosterone products. The Testosterone Replacement Therapy for Assessment of Long-term Vascular Events and Efficacy Response in Hypogonadal Men (TRAVERSE) trial, for example, was funded by the pharmaceutical industry, and the FDA panel co-moderator, Dr. Mohit Khera, is an author of this trial.[2]

Although an FDA advisory committee meeting would typically include a robust discussion of all of the available evidence, the expert panel appeared to be looking only at data that supported the safety of testosterone replacement therapy. Moreover, the panel did not fully consider the evidence of minimal to no benefit other than for the approved indication.

Although testosterone replacement therapy is only FDA-approved for men with low testosterone levels (hypogonadism) from specific medical conditions, such as genetic issues, chemotherapy effects, or pituitary/hypothalamic injury,[3] many panelists appeared to favor expanding the indication. Several panelists, including Dr. Khera, the panel co-moderator, called for the elimination of the FDA’s restriction on using testosterone replacement therapy for age-related low testosterone.[4] Concerningly, the expert panel did not discuss the implications of potentially expanding the indication to a large population of older men with low or declining testosterone levels, or the health risks of testosterone replacement therapy in this population.

Public Citizen urges the FDA to require further independent studies of testosterone replacement therapy before considering approval for any additional indications, particularly for age-related testosterone deficiency. Public Citizen also urges the FDA to reinstate the boxed warning about increased cardiovascular risk, which was removed based on the results of the TRAVERSE trial.[5]

The path forward is for the FDA to refer this issue to a properly convened advisory committee, such as the Drug Safety and Risk Management Advisory Committee or the Endocrinology and Metabolic Drugs Advisory Committee, operating in full compliance with the Federal Advisory Committee Act.[6] Convening an advisory committee would foster accountability, transparency, and public trust in the agency’s decision-making.

Testosterone Replacement Therapy Poses Serious Health Risks

Substantial evidence from peer-reviewed research has highlighted important concerns about the safety of testosterone replacement therapy, especially when this therapy is used by older men without clearly defined clinical indications. Well-designed studies have identified increased risks of adverse cardiovascular events (e.g. stroke, heart attack) as well as arrhythmias.

Evidence of cardiovascular harm associated with testosterone therapy has been particularly compelling. A 2013 retrospective cohort study by Vigen et al. evaluated over 8,700 men with low testosterone levels in the Department of Veterans Affairs system and found that those treated with testosterone replacement had a 29% higher risk of myocardial infarction, stroke, or death compared with untreated individuals, after adjustment for risk-related variables.[7]

Similarly, a 2014 study analyzed adverse cardiovascular events in a cohort of over 55,000 men newly starting testosterone therapy and found that men older than 65 years who received the therapy had more than a twofold increased risk of nonfatal myocardial infarction within 90 days compared with the 12 months prior to treatment.[8] These and other findings led the FDA in 2015 to mandate a boxed warning on testosterone replacement therapy products, emphasizing the potential risk for serious adverse cardiovascular events.

Studies also have found an increased risk of cardiac arrhythmias associated with testosterone replacement therapy. A 2025 meta-analysis of randomized controlled trials in men aged 40 or older with testosterone deficiency found a more than 50% increase in the risk of arrhythmia for the treatment groups compared with the placebo groups; the study, however, found no increase in cardiovascular mortality, stroke, or myocardial infarction.[9] The TRAVERSE trial found that significantly more episodes of atrial fibrillation (3.5%) and nonfatal arrhythmias requiring intervention (5.2%) occurred in the testosterone group than in the placebo group  (2.4%  and 3.3%, respectively).[10] Testosterone replacement therapy requires rigorous safety evaluation before any expansion of its approved use.

Methodological Flaws With the TRAVERSE Trial

FDA expert panel members cited the TRAVERSE trial multiple times as evidence of the safety of testosterone replacement therapy. The study, however, has important methodological flaws.[11] The trial enrolled 5,246 men between 45 to 80 years of age with symptoms of hypogonadism, two fasting testosterone levels of less than 300 ng per deciliter, and existing (or a high risk of) cardiovascular disease. Most notably, the men randomized to the treatment arm were underdosed, with a reported median on-treatment serum testosterone level of just 350 ng/dL— barely above the clinical threshold for testosterone deficiency.[12] This level is also well below the therapeutic target testosterone range of 450–600 ng/dL recommended by the American Urological Association in their most recent (2024) clinical guidelines.[13]

TRAVERSE’s protocol called for titration of study participants to the recommended therapeutic range of 350–750 ng/dL for transdermal 1.62% testosterone gel, but the observed median testosterone levels clustered at the very bottom of this therapeutic range for the four-years of the trial. As a result, the trial did not test the cardiovascular safety of full therapeutic testosterone replacement, but rather the effects of borderline or subtherapeutic dosing. This design flaw undermines the study’s conclusions about the cardiovascular safety of testosterone replacement therapy.

The TRAVERSE trial exclusively evaluated transdermal testosterone gel, in spite of the fact that injectable testosterone — a popular form of testosterone therapy in the United States — has been associated with higher risks of cardiovascular events, including myocardial infarction and stroke.[14] Moreover, about 60% of participants in both study arms discontinued treatment before the end of the trial, biasing the results toward a null finding. In a noninferiority trial, this level of attrition by study participants severely limits the ability to detect real differences in risk.

Limited Benefits of Testosterone Replacement Therapy in Men With Age-Related Low Testosterone

Although FDA panel members touted the desired effects of testosterone replacement therapy for age-related testosterone decline, evidence from high-quality studies reveals limited therapeutic benefits. A comprehensive systematic review and meta-analysis published in 2020 concluded that testosterone replacement therapy in older men with low testosterone and without medical conditions known to cause hypogonadism provided modest improvements in sexual function — about a 25% subjective reported improvement in erectile dysfunction over 58 weeks. However, there were no consistent benefits for physical function, energy, vitality, or cognitive performance.[15] These findings are consistent with a 2016 randomized trial of 790 older men with low serum testosterone, which found small to moderate gains in sexual desire and erectile function in the treatment group, but little to no benefit in walking distance or vitality after 12 months of treatment with testosterone gel or placebo.[16] The minimal clinical impact of testosterone replacement therapy on most domains—especially functional status and quality of life—raises concerns about the appropriateness of testosterone prescribing for men without clear, symptomatic hypogonadism. Furthermore, the modest benefits observed must be balanced against the significant cardiovascular risks.

Conclusion

Testosterone replacement therapy has significant and well-documented cardiovascular risks and unclear benefits for older men with age-related low testosterone. Public Citizen is concerned about the apparent endorsement of testosterone replacement therapy for age-related low testosterone by several FDA expert panel members without full consideration of the available evidence. Public Citizen is also concerned about the panel’s composition and deliberative process, which lacked transparency and appropriate vetting of panel members for conflicts of interest

Public Citizen urges the FDA to require further independent studies of testosterone replacement therapy before considering approval for any additional indications, particularly for age-related testosterone deficiency. Public Citizen also urges the FDA to reinstate the boxed warning for increased cardiovascular risks on all testosterone products.

Thank you for your consideration of our comments regarding this important issue.

Sincerely,

Gabriel Tissian, MD, MPHS
Research Fellow, Health Research Group
Public Citizen
1600 20^th St. NW
Washington, D.C. 20009

—
[1] The Food and Drug Administration. FDA expert panel on testosterone replacement therapy for men. December 10, 2025. https://www.fda.gov/patients/fda-expert-panels/fda-expert-panel-testosterone-replacement-therapy-men-12102025. Accessed February 5, 2026.

[2] Lincoff, A. M., Bhasin, S., Flevaris, P., et al. Cardiovascular safety of testosterone‑replacement therapy. New England Journal of Medicine. 2023; 389(2), 107–117. https://doi.org/10.1056/NEJMoa2215025.

[3] U.S. Food and Drug Administration. Testosterone Information. February 28, 2025. https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/testosterone-information#:~:text=FDA%20Drug%20Safety%20Communication:%20FDA,02/28/2025. Accessed February 5, 2026.

[4] The Food and Drug Administration. FDA expert panel on testosterone replacement therapy for men. December 10, 2025. https://www.youtube.com/live/BdAawJmQ9Fs. Accessed February 5, 2026. Time stamps 29:20, 1:03:30.

[5] FDA recklessly removes boxed warning for risk of cardiovascular disease from testosterone labels. Worst Pills, Best Pills News. August 2025. https://www.worstpills.org/newsletters/view/1677. Accessed February 5, 2025.

[6] The Federal Advisory Committee Act (FACA): Overview and considerations for Congress. https://www.congress.gov/crs-product/R47984. February 5, 2026.

[7] Vigen R, O’Donnell, C.I, Baron AE, Grunwald GK, et al Association of testosterone therapy with mortality, myocardial infarction, and stroke in men with low testosterone levels. JAMA. 2013; 310(17), 1829–1836. https://doi.org/10.1001/jama.2013.280386.

[8] Finkle WD, Greenland S, Ridgeway G K, Adams JL, et al. Increased risk of non-fatal myocardial infarction following testosterone therapy prescription in men. PLoS ONE. 2014; 9(1), e85805. https://doi.org/10.1371/journal.pone.0085805.

[9] Braga MA, Rivera A, Marinheiro G, Felix N, et al. Cardiovascular safety of testosterone‑replacement therapy in middle‑aged and older men: A meta‑analysis of randomized controlled trials. American Journal of Cardiovascular Drugs. 2025; 25:767–777.

[10] Lincoff AM, Bhasin S, Flevaris P, et al. Cardiovascular safety of testosterone‑replacement therapy. New England Journal of Medicine. 2023; 389(2), 107–117. https://doi.org/10.1056/NEJMoa2215025.

[11] FDA recklessly removes boxed warning for risk of cardiovascular disease from testosterone labels. Worst Pills, Best Pills News. August 2025. https://www.worstpills.org/newsletters/view/1677. Accessed February 5, 2025.

[12] Lincoff AM, Bhasin S, Flevaris P, et al. Cardiovascular safety of testosterone‑replacement therapy. New England Journal of Medicine. 2023; 389(2), 107–117. https://doi.org/10.1056/NEJMoa2215025

1³ American Urological Association Guidelines, “Evaluation and Management of Testosterone Deficiency (2024).” https://www.auanet.org/guidelines-and-quality/guidelines/testosterone-deficiency-guideline. Accessed February 7, 2026.

[14] Layton JB, Meier CR, Sharpless JL, Stürmer T, et al. Comparative safety of testosterone dosage forms. JAMA Internal Medicine. 2015; 175(7), 1187–1196.

[15] Diem SJ, Greer NL, MacDonald R, McKenzie LG, et al. Efficacy and safety of testosterone treatment in men: An evidence report for a clinical practice guideline by the American College of Physicians. Annals of Internal Medicine. 2020; 172(2), 105–118.

[16] Snyder PJ, Bhasin S, Cunningham GR, Matsumoto AM, et al. Effects of testosterone treatment in older men. The New England Journal of Medicine. 2016; 374(7), 611–624.

Polls Show Americans are Ready for Medicare for All

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Americans are sick and tired of our broken health care system and ready for reform. The recent efforts of the Trump Administration and MAGA allies in Congress have further unraveled an already tenuous system that leaves tens of millions without coverage and even more without adequate coverage. With Americans struggling to afford the care they need, it is no surprise that Medicare for All continues to grow in popularity, with recent polling finding that nearly two-thirds of Americans support such a reform. Another poll found that 56 percent of voters in battleground Congressional districts support Medicare for All. 

A number of other recent polls highlight just how unhappy Americans are with the U.S. health care system, with a record low – only 16 percent – reporting being satisfied with the total cost of our health care system. The same poll also found that 70 percent of Americans, including majorities across the political spectrum, said the health care system was in crisis or had major problems. 

Trump’s attacks on health care are increasing the desperation of everyday Americans. One poll found that around 40 percent of U.S. adults reported health care or health issues as something they want the federal government to work on in the coming year, a finding that is up around one-third from the previous year.

Even before the recent attacks on health care, Americans were struggling with the cost of care. A recent in-depth study, which explored four years of recent data found that nearly 27 percent of U.S. adults were unable to get needed care or experienced cost burdens – meaning out of pocket expenses greater than 10 percent of a family’s income or five percent for low-income families – due to needed care within the four year period. The uninsured, people with chronic conditions, lower incomes, and those who experienced at least one hospitalization were all more likely to report forgoing care or experienced cost burdens. Those in the final years of their lives were among the most likely to experience cost burdens, with over half experiencing cost burdens in the one to four years before their death.

Another recent poll found that nearly half of adults in the U.S. have had difficulties affording health care in the past year, with 36 percent reporting skipping or postponing need health care due to prohibitive costs. Of particular concern, 75% of uninsured adults under age 65 – meaning they have yet to qualify for Medicare – went without needed care because of the cost. More than one in five adults reported not filling at least one prescription for medication and a third of all adults reporting either not filling a prescription, opting for over-the-counter alternatives, cutting pills in half, or skipping doses in the past year due to the high cost of medications. Nearly 20 percent of adults and more than 40 percent of uninsured adults reported that their health got worse after postponing needed care.

With Americans struggling with health and other cost burdens, it is no wonder that 41 percent of U.S. adults reported experiencing some form of medical debt with a disproportionate share of Black and Hispanic adults, uninsured adults, low-income families, parents, and women experiencing such debts. In addition, more than six in ten adults in the U.S. report being concerned about health care costs or an unexpected medical bill. That number jumps to over 80 percent for uninsured adults under the age of 65. Over half of all adults reported that they wouldn’t even be able to afford to pay a $500 unexpected medical bill. 

These dire findings are likely a key reason that nearly 2 in 3 adults in the U.S. think the federal government should make sure all Americans have health care coverage, including nearly 90 percent of Democrats and 73 percent of independents. The same study found that over two-thirds of Democrats and a majority of independents also believed that the health care system should be run by the government, versus a system based on mostly private health insurance. Another recent poll found that two-thirds of voters said the government does “too little” in helping Americans afford health care. 

Americans understand it is private for-profit companies who are to blame for their high costs. Nearly two-thirds of Americans hold unfavorable views towards private insurers and pharmaceutical companies, while less than a quarter and one-in-five hold positive views, respectively. 

We can’t keep expecting Americans to suffer under our broken system. At the same time everyday Americans are expressing increased support for Medicare for All, we are also seeing more members of Congress sign on to sponsor Medicare for All in both the House and the Senate and more communities joining the 136 cities and counties that have already passed municipal resolutions in favor of Congress finally enacting Medicare for All. The time has come to unite around Medicare for All and build the movement that can finally make it a reality.