Author: TSA Press

Sending
the
military
to
engage
in
domestic
law
enforcement
operations
is,
to
be
clear,
not
something
the
White
House
just
gets
to
do
because
Donald
Trump
hates
Chicago.
While
America
has
long
hoped
to
stop
the
scourge
of
deep
dish
pizza
from
infecting
the
nation’s
strip
malls,
the
Posse
Comitatus
Act
of
1878
protects
Pizzeria
Uno
from
federal
drone
attacks.

That
law
dictates
—
as
amended
—
“Whoever,
except
in
cases
and
under
circumstances
expressly
authorized
by
the
Constitution
or
Act
of
Congress,
willfully
uses
any
part
of
the
Army,
the
Navy,
the
Marine
Corps,
the
Air
Force,
or
the
Space
Force
as
a
posse
comitatus
or
otherwise
to
execute
the
laws
shall
be
fined
under
this
title
or
imprisoned
not
more
than
two
years,
or
both.”

Trump
v.
United
States
has,
probably,
rendered
this
law
constitutionally
unenforceable.
Since
the
conservative
justices
proactively
resolved
the
president
of
criminal
liability
for
willfully
using
Navy
SEALs
to
murder
his
political
rivals,
it’s
hard
to
believe
they’d
stop
the
military
from
being
deployed
against
average
citizens.

Still,
it
would
be
interesting
to
see
what
the
Space
Force
nerds
think
they
could
do.

But

Trump
v.
United
States
aside,
the
executive
branch
isn’t
entirely
without
legal
recourse.
The
Insurrection
Act
of
1807
provides
an
exception
to
this
restriction,
allowing
the
president
the
power
to
call
upon
the
military
under
defined,
limited
circumstances.
It’s
an
incredibly
rare
and
radical
executive
action
that
is
not
tripped
by
an
inflatable
frog
costume
twerking
outside
an
ICE
facility.
Nonetheless,
Donald
Trump
is
leaking
to
anyone
willing
to
reprint
it
that
he’s
very
“close”
to
invoking
the
Insurrection
Act.

The
media
has
an
obligation
to
the
public
to
stress
how
abnormal
and
legally
unjustified
an
Insurrection
Act
occupation
of
America’s
cities
would
be.
Unfortunately,

we
get
this
instead.

That’s
Sarah
Isgur,
the
former
spokesperson
for
the
Jeff
Sessions
DOJ,
explaining
that
invoking
the
Insurrection
Act
is
totally
normal.
Despite
the
thrust
of
the
retweeting
account,
Isgur
actually
IS
NOT
saying
that
the
Insurrection
Act
is
cool.
The
MAGA
fans
clicking
to
see
Stephanopoulos
look
“like
a
fool,”
probably
didn’t
stick
around
for
her
conclusion
that
the
Insurrection
Act
should
have
been
amended
years
ago
to
set
stricter
standards.
An
interesting
academic
question
maybe,
but
deeply
misleading.
Whether
the
Insurrection
Act
could
stand
a
rewrite
doesn’t
change
the
fact
that
Donald
Trump
sending
troops
into
Illinois
or
Oregon
over
the
objections
of
their
governors

is
illegal
right
now!

“Nearly
half
of
U.S.
presidents
have
invoked
the
Insurrection
Act
during
their
terms,”
the
Harvard
Law-educated
Isgur
explains
falsely.
In
total,
16
of
the
45
presidents
(remembering
that
Trump
47
and
Cleveland
24
were
performing
encore
acts)
have
invoked
the
Insurrection
Act,
coming
in
at
around
35
percent,
rendering
“nearly
half”
an
extreme
act
of
adverbial
violence
upon
the
both
math
and
the
English
language.

George
Stephanopolous,
interjects
to
add
“not
over
the
objection
of
governors.”
Stephanopolous,
who
recently
saw
his
network

settle
a
defamation
claim
for
$15
million
after
he
said
Trump
was
civilly
liable
for
raping
E.
Jean
Carroll
as
opposed
to
civilly
liable
for
calling
Carroll
a
liar
when
she
said
he
raped
her,
clearly
understands
the
value
of
being
hypertechnically
correct.

Isgur,
however,
pushes
back
“Absolutely!
Think
about
Eisenhower
at
Little
Rock.”
And
while
Ike
did
act
over
the
objections
of
the
Arkansas
governor,
when
she’s
arguing
that
it’s
totally
normal
to
use
the
Insurrection
Act
this
way,
“remember
they
did
it
once
70
years
ago,”
is
not
the
flex
she
thinks
it
is.
For
what
it’s
worth,
Kennedy
also
slightly
more
recently
called
upon
the
Act
over
a
state
government’s
objections.
It
has
not
happened
since.

To
put
in
perspective
how
long
ago
that
was,
when
it
last
happened
over
a
governor’s
objection,
people
heard
the
name
Kennedy
and
did
not
think
“brainworm-addled
lunatic.”

The
Eisenhower
comparison
is
also
inapposite.
The
Insurrection
Act
authorizes
three
exceptions
to
the
bar
on
deploying
an
occupying
army
within
the
United
States.
First,
as
Stephanopolous
flags,
a
request
from
state
government.
Second,
where
people
are
deprived
of
constitutionally
secured
rights
that
the
state
fails
or
refuses
to
protect
—
the
justification
Ike
and
JFK
operated
under.
And
third,
where
it
is
“impracticable
to
enforce
the
law.”

Trump
is,
at
best,
aiming
for
the
final
justification
by
claiming
that
Portland
is
on
fire,
instead
of
a
hipster
enclave
far
too
obsessed
with
Pinot
Noir.
But
it’s

still
not
sufficient
to
say,
“protesting
furries
have
made
our
ICE
officers
feel
bad.”
The

text
of
the
relevant
statute
contextualizes
“impracticable
to
enforce
the
law”
as
an
inability
to
operate
“by
the
ordinary
course
of
judicial
proceedings.”
There
is
no
claim
that
Trump
can’t
enforce
immigration
laws
and
process
the
folks
ICE
rounds
up
through
ordinary
legal
process.
The
fact
that
he’s

losing
cases
doesn’t
transform
them
from
“the
ordinary
course
of
judicial
proceedings.”

Oh,
and
if
Trump
were
to
invoke
the
Act
anyway,
the

real
culprit,
she
explains,
is

Joe
Biden
for
not
fixing
this
first.
Deferring
responsibility,
for
the
win!

Sure
it’s
been
on
the
books
as
illegal
since
the
19th
century,
but
this
isn’t
Trump’s
fault
for
doing
it,
it’s
on
the
Democrats
who
didn’t
make
it
MORE
CLEAR
that
it’s
illegal!

There
is
no
statutory
justification
for
invoking
the
Insurrection
Act
right
now.
Full
stop.

It’s
not
“a
close
question,”
or
“a
debate,”
or
“a
reason
to
revisit
the
language,”
it’s
just
not
legal
under
any
serious
reading
of
the
text.
When
historians
collect
the
receipts,
they’re
not
going
to
distinguish
the
martial
law
cheerleaders
from
the
folks
staking
out
the
“this
may
not
be
a
good
idea,
but
it’s
legal”
position.
If
anything,
the
latter
is
more
dangerous
because
the
fate
of
the
Republic
isn’t
turning
on
the
hardcore
partisans,
but
will
lean
on
the
sort
of
people
Isgur’s
telling
to
shrug
and
blame
Biden.

These
“I’m
personally
not
happy,
but…”
talking
points
might
earn
a
social
pardon
at
a
DC
cocktail
party,
but
in
the
final
equation,
it’s
still
sanewashing
the
idea
that
the
White
House
can
legally
deploy
troops
to
occupy
American
cities.

---

Joe
Patrice is
a
senior
editor
at
Above
the
Law
and
co-host
of

Thinking
Like
A
Lawyer.
Feel
free
to email
any
tips,
questions,
or
comments.
Follow
him
on Twitter or

Bluesky
if
you’re
interested
in
law,
politics,
and
a
healthy
dose
of
college
sports
news.
Joe
also
serves
as
a

Managing
Director
at
RPN
Executive
Search.

Attorneys
juggle
deadlines,
compliance,
client
demands,
and
a
mountain
of
admin
work,
often
without
clear
systems
to
support
them.
Growth,
under
those
conditions,
feels
impossible.
Workflows
are
the
step-by-step
processes
that
run
your
firm,
they
are
the
backbone
of
a
scalable,
profitable,
and
sustainable
legal
practice.
By
streamlining
how
your
firm
operates
day
to
day,
you
create
consistency,
protect
client
trust,
and
free
up
capacity
to
take
on
more
work
without
burning
out
your
staff
or
yourself.

Why
Workflows
Are
the
Hidden
Growth
Engine

In
a
law
firm,
workflows
are
everywhere:
client
intake,
case
preparation,
document
review,
billing,
court
deadlines,
closing
files,
and
more.
But
in
many
small
firms,
these
workflows
are
undocumented,
inconsistent,
or
stuck
in
one
person’s
head.
Workflows
are
your
operational
blueprint
that
reduce
mental
load,
save
time,
and
ensure
that
nothing
falls
through
the
cracks.
They
allow
your
firm
to
operate
consistently,
train
new
team
members
faster,
and
delegate
confidently. 

Many
attorneys
believe
that
growth
happens
when
you
hire
more
staff,
land
more
clients,
or
raise
your
rates.
And
while
those
things
matter,
sustainable
growth
really
comes
from
how
well
your
firm
executes
the
work
it
already
has.
When
your
processes
are
streamlined,
you
don’t
need
to
reinvent
the
wheel
every
time
a
new
case
comes
in.
You
can
handle
more
clients
without
burning
out
your
team
or
compromising
quality.
You
can
automate
small,
repetitive
tasks
and
focus
your
time
on
strategy,
service,
and
scaling.

Building
Procedures
That
Actually
Work

Start
by
identifying
your
most
common,
high-impact
processes:
client
intake,
case
initiation,
court
prep,
billing,
and
closing
files.
Then,
walk
through
each
step
as
it
currently
happens,
what’s
supposed
to
happen
vs.
what
actually
happens.

Once
your
process
is
visualized,
the
next
move
is
to
standardize
it.
That
means
creating
checklists,
SOPs
(standard
operating
procedures),
templates,
and
scripts.
This
can
include
a
checklist
for
opening
a
new
case
file,
templated
welcome
email
with
client
expectations,
uniform
process
for
how
and
when
documents
are
filed,
intake
script
or
FAQ
sheet
for
phone
staff. 

Work
gets
bottlenecked
when
no
one
knows
who
is
responsible.
Use
an
accountability
chart
to
clearly
define
roles
and
assign
ownership
to
every
major
workflow.

Look
for
the
parts
of
your
workflow
that
happen
frequently
and
predictably
and
then
find
ways
to
automate
them.
You
don’t
need
an
expensive
custom
system;
most
modern
practice
management
tools
offer
automation
built
in.

Simple
automations
with
big
impact:

● Appointment
scheduling
and
reminders
(via
Calendly
or
Acuity)

● E-signature
workflows
(DocuSign,
HelloSign,
Lawmatics)

● Client
onboarding
checklists
via
practice
management
tools
(Clio,
MyCase)

● Auto-sending
welcome
packets,
surveys,
or
review
requests

● Follow-up
emails
triggered
by
intake
forms
or
case
milestones

When
you
streamline
your
workflows,
you
don’t
just
gain
time,
you
gain
clarity,
consistency,
and
capacity.
Whether
you’re
a
solo
attorney
or
managing
a
growing
team,
workflows
allow
you
to
scale
with
stability,
delegate
with
confidence,
and
serve
clients
with
greater
professionalism
and
predictability.

The
Tech
Piece 

Modern
legal
tech
is
the
infrastructure
that
keeps
your
workflows
consistent,
measurable,
and
client-centered.
A
well-chosen
practice
management
platform
acts
as
your
firm’s
operational
command
center.
It
can
track
deadlines,
automate
reminders,
organize
communications,
and
store
client
data
in
one
accessible
place.
When
your
technology
mirrors
your
workflows,
every
team
member
knows
what
needs
to
happen
next. 

Tools
like
document
assembly
systems
can
auto-fill
forms
using
client
data,
while
AI-powered
chatbots
can
handle
routine
client
inquiries
or
status
updates.
Even
small
efficiencies
like
syncing
calendars,
automating
billing
reminders,
or
using
template-based
emails
can
reclaim
hours
each
week.

The
real
power
lies
in
connecting
these
tools
so
your
systems
“talk”
to
one
another.
Instead
of
juggling
disconnected
apps
for
intake,
billing,
and
case
management,
look
for
integrations
that
create
a
single,
unified
workflow.
This
interoperability
minimizes
data
entry
errors,
reduces
lag
time,
and
gives
you
a
full
picture
of
your
firm’s
health. 

Finally,
technology
should
be
seen
as
a
teammate,
not
a
threat.
AI-driven
tools
can
augment
your
team’s
performance
by
handling
predictable
tasks,
flagging
risks,
and
freeing
attorneys
to
focus
on
strategy
and
human
connection. 

Conclusion:
From
Chaos
to
Clarity

Streamlining
your
workflows
and
aligning
them
with
the
right
technology
builds
a
foundation
for
sustainable
growth.
It
turns
chaos
into
clarity,
ensures
consistency
across
your
practice,
and
gives
you
the
freedom
to
lead
strategically
instead
of
reacting
constantly.

By
defining
your
workflows,
adopting
tools
that
reinforce
them,
and
empowering
your
team
through
automation
and
accountability,
you’re
not
just
managing
a
law
firm,
you’re
building
a
scalable
business
designed
to
last.

Whether
you’re
a
solo
attorney
setting
up
your
first
systems
or
a
managing
partner
preparing
your
firm
for
its
next
phase
of
growth,
now
is
the
time
to
streamline
to
scale.
Because
when
your
operations
run
like
clockwork,
your
capacity
to
innovate,
serve,
and
succeed
expands
exponentially.

---

Ruby
L.
Powers is
a
Board
Certified
immigration
attorney
and
founder
of
Powers
Law
Group,
P.C.,
a
full-service
immigration
law
firm
in
Houston,
TX.
She
has
over
16
years
of
experience
in
law
practice
management.
She
is
the
author
of Power
Up
Your
Practice and
AILA’s Build
and
Manage
Your
Successful
Immigration
Law
Practice.
Through
Powers
Strategy
Group,
she
provides
consulting
and
hosts
the Power
Up
Your
Practice podcast.
She
serves
on
various
boards including
the
ABA
TECHSHOW
and
Mobile
Pathways. Ruby
empowers
attorneys
with
strategies
in
legal
innovation
and
business
growth—helping
them
build
client-focused,
efficient,
and
thriving
law
firms. 

Some
law
firms
are
handing
out

recruiting
entertainment
budgets
to
law
students.
While
we
don’t
fault
law
students
some
sweet
walking
around
money,
placing
that
power
in
the
hands
of
students
highlights
the
breakdown
in
the
law
school
recruiting
process
and
a
real
risk
of
baking
more
bias
into
hiring.
Why
has

Kirkland
memory
holes
its
incoming
partner
class?
The
decision
to
opt
out
of
its
traditional
announcement
message
seems
like
a
move
to
shield
its
high-achievers,
but
there
are
some
other
possibilities.
And
a
Senator
wants
some
answers
after
a
pair
of
federal
judges
issue
opinions
with

possible
(read:
likely)
AI
hallucinations.

Between

multiple
extrajudicial
killings
of
everyone
aboard
several
alleged
Venezuelan
drug
boats,
a
supposed
peace
deal
in
the
Middle
East,
and
a
million
other
international
stories
as
the
chaotic
daily
misinformation
vomit
of
the
Trump
administration
rains
down
upon
us,
you
can
be
forgiven
for
missing
a
tale
of
mere
economics.
Today,
though,
we
will
take
a
few
precious
moments
to
shine
a
light
upon
a
series
of
foreign
policy
decisions
that
would
have
been
a
politically
ruinous
scandal
had
they
been
made
by
any
other
presidential
administration
in
American
history
even
as
they
barely
warrant
a
footnote
today.

So,
did
you
have
any
idea
that
Donald
Trump

has
committed
$20
billion
of
U.S.
taxpayer
funds
to
bail
out
Argentina’s
central
bank?
It’s
true!
Though
the
details
are
scant,
the
idea
is
to
prop
up
Argentina’s
collapsing
currency
and
avert
a
financial
crisis
in
the
country
through
a
currency
swap.

Now,
although
rare,
it’s
not
unheard
of
for
the
U.S.
government
to
step
into
the
finances
of
a
foreign
country
under
dire
circumstances
to
safeguard
American
interests.
For
example,
30
years
ago
the
United
States
(that
time
in
conjunction
with
the
International
Monetary
Fund)
intervened

to
prevent
Mexico
from
defaulting
on
its
debt
so
as
to
protect
significant
American
investments,
prevent
a
collapse
of
global
markets,
and
avert
a
true
crisis
at
the
U.S.
southern
border.

Obviously,
Argentina
is
not
adjacent
to
the
United
States,
meaning
there
are
not
the
same
border
concerns
this
time.
There
are
indeed
American
investors
with
stakes
in
Argentina
—
the
most
heavily
invested
are
wealthy
hedge
funds
including
Fidelity,
BlackRock,
and
Pimco.

However,
the
Trump
administration
is
not
even
really
trying
to
make
a
cogent
case
for
dropping
$20
billion
into
Argentina.
Trump
likes
Argentina’s
leader
Javier
Milei
because
he
is
a
right-wing,
anti-immigrant
populist.
Sound
familiar?

“He’s
MAGA
all
the
way,”
said
Trump
at
the
start
of
his
meeting
with
Milei
on
October
14.
Trump
was
hosting
Milei
at
the
White
House,
and
has
previously
described
the
Argentine
leader
as
his
“favorite
president.”

This
bank
bailout
comes
at
what
should
be
a
more
politically
sensitive
time
for
providing
gratuitous
favors
to
Argentina:
at
this
very
moment,
American
soybeans
farmers
are
harvesting
their
crops,
often
without
any
hope
of
selling
them
because
China
has
been
instead
buying
soybeans
from
Argentine
farmers
this
year
thanks
to
Trump’s
tariffs.

Last
year,

China
purchased
more
than
half
of
American
soybean
exports
at
a
value
of
$24.5
billion.
This
year,
in
the
midst
of
Trump’s
trade
war,
export
volumes
to
China
have
fallen
by
more
than
50%.

Meanwhile,

the
Milei
government
cut
Argentina’s
export
tax
on
soybeans.
The
move
worked
as
a
means
of
courting
interest.
Chinese
buyers
have
already
reportedly
purchased
approximately
20
shiploads
of
Argentine
soybeans.

Trump
has
talked
about
using
some
of
the
tariff
revenue
to
provide
another
bailout
to
American
farmers.
Yet,
with
tariff
revenue

tied
up
in
legal
limbo
due
to
the
seemingly
facial
invalidity
of
Trump’s
tariff
regime,
and
given
that
markets
do
not
tend
to
just
spring
back
into
place
once
buyers
have
become
accustomed
to
alternative
sourcing,
it’s
an
imperfect
solution
at
best.

Let’s
review.
Without
any
oversight
from
Congress
or
the
courts,
Trump
has
committed
20
billion
American
tax
dollars
to
bail
out
the
central
bank
of
Argentina
largely
to
assist
wealthy
hedge
funds
and
a
foreign
right-wing
politician.
At
the
same
time,
Argentina
is
actively
striving
to
steal
what
was
American
soybean
farmers’
largest
market,
helped
along
by
Trump’s
erratic
tariff
regime.
Trump
is
not
doing
this
for
some
grand
strategic
reason,
but
because

Argentina’s
leader
is
aligned
with
him
ideologically.

According
to
one
report,
America’s

most
farming-dependent
counties
backed
Trump
in
last
year’s
election
by,
on
average,
an
overwhelming
77.7%.
I
guess
you
reap
what
you
sow.

---

Jonathan
Wolf
is
a
civil
litigator
and
author
of Your
Debt-Free
JD (affiliate
link).
He
has
taught
legal
writing,
written
for
a
wide
variety
of
publications,
and
made
it
both
his
business
and
his
pleasure
to
be
financially
and
scientifically
literate.
Any
views
he
expresses
are
probably
pure
gold,
but
are
nonetheless
solely
his
own
and
should
not
be
attributed
to
any
organization
with
which
he
is
affiliated.
He
wouldn’t
want
to
share
the
credit
anyway.
He
can
be
reached
at [email protected].

Biglaw
firms
are
closing
their
offices
in
China
left
and
right,
but
could
those
closures
expand
to
offices
in
other
Asian
countries?
For
one
firm,
the
answer
is
yes.

As
part
of
a
shift
in
Asia,
O’Melveny
&
Myers
will
be
stepping
away
from
its
office
in
Tokyo,
marking
an
end
to
its
presence
in
Japan
after
nearly
40
years.

An
O’Melveny
spokesperson
shared
the
following
comment
with

Law.com
International
on
its
decision
to
close
its
Tokyo
office:

“Following
a
strategic
review
of
our
Japan
operations,
we’ve
determined
that
we
will
wind
down
our
office
in
Tokyo
over
the
coming
months.
Going
forward,
we
will
continue
to
support
our
clients
in
the
region
from
our
network
of
offices
across
Asia
and
internationally.”

Yoji
Maeda,
the
O’Melveny’s
managing
partner
in
Tokyo
—
who
has
led
the
office
for
over
20
years
—
will
retire
as
part
of
the
transition.
“We
are
grateful
for
Yoji’s
friendship
and
leadership
and
wish
him
all
the
best
in
his
next
chapter,”
the
spokesperson
said
on
behalf
of
the
firm.

O’Melveny’s
exit
from
Tokyo
may
be
a
one-off
—
or
the
first
sign
of
a
regional
shift
in
Biglaw’s
long
game
across
Asia.

Which
Biglaw
firm
will
be
the
next
say
zàijiàn
to
its
offices
in
China
and
other
Asian
countries?
You
can email
us or
text
us
(646-820-8477)
if
you
have
any
intel.
Thank
you.

O’Melveny
Shutters
38-Year-Old
Tokyo
Office,
Managing
Partner
Retires
[Law.com]

---

Staci
Zaretsky is
the
managing
editor
of
Above
the
Law,
where
she’s
worked
since
2011.
She’d
love
to
hear
from
you,
so
please
feel
free
to

email
her
with
any
tips,
questions,
comments,
or
critiques.
You
can
follow
her
on Bluesky, X/Twitter,
and Threads, or
connect
with
her
on LinkedIn.

With
roughly

two
in
five
U.S.
adults
affected
by
obesity,
GLP-1
drugs
have
emerged
as
a
promising
solution
—
but
their
steep
price
remains
a
significant
hurdle.

For
instance,

GLP-1
drugs
have
a
list
price
ranging
from
$936
to
$1,349
before
insurance
coverage,
rebates
or
other
discounts
are
applied.

Given
the
expense,
several
insurers
have
decided
to
stop
covering
GLP-1s
for
weight
loss,
leading
to
outrage
among
physicians
and
advocates,
though
they
are
still
covering
the
drug
for
patients
who
have
diabetes. 

This
has
prompted
at
least
one
interviewed
for
this
story
to
say
comprehensive
coverage
in
terms
of
an
executive
order
from
the
White
House
may
be
what
is
necessary
to
make
sure
this
drug
is
available
to
those
who
need
it. 

Starting
January
1,
Blue
Cross
Blue
Shield
of
Massachusetts
(BCBSMA)
will
no
longer
cover
GLP-1s
for
weight
loss
for
employers
with
fewer
than
100
employees.
Employers
with
more
than
100
employees
can
choose
to
cover
these
drugs
at
an
additional
cost.
BCBSMA’s
policy
applies
to
self-insured
and
fully-insured
employers.

“We’ve
made
this
decision
after
careful
consideration
and
to
be
responsive
to
customers
who’ve
expressed
to
us
that
they
are
no
longer
able
to
bear
the
burden
of
paying
for
these
high-priced
medications,”
said
Kelsey
Pearse,
a
spokesperson
for
BCBSMA.

Harvard
Pilgrim
Health
Care
—
an
insurer
in
Maine,
Massachusetts,
Rhode
Island
and
New
Hampshire
—
is
also
ending
GLP-1
coverage
for
weight
loss
for
most
commercial
plans
starting
January
1.
Large
fully-insured
employers
with
more
than
100
employees
can
opt
to
pay
to
continue
coverage.
Members
of
these
plans
will
be
required
to
complete
a
six-month
behavioral
modification
program
before
accessing
the
medication,
unless
they
are
already
using
it. 

“Given
[the]
current
pipeline
of
pending
future
FDA
approvals
of
weight
loss
medications
for
alternative
indications
including
cardiovascular
conditions
and
other
comorbidities,
this
action
is
being
taken
to
ensure
affordability
of
coverage
for
all
our
members,”
a
Harvard
Pilgrim
Health
Care
spokesperson,
who
declined
to
be
named,
said.

In
other
words,
costs
are
only
expected
to
increase
with
these
additional
FDA
approvals
down
the
line.

While
no
definitive
number
is
available
to
show
how
many
insurance
companies
and
employers
are
dropping
coverage,
here
are
few
others
that
have
announced
ending
coverage
for
GLP-1s
for
obesity:
Blue
Cross
Blue
Shield
of
Michigan,
RWJBarnabas
Health
for
its
employees
and
Ascension
for
its
employees.

Medicare
also
does
not
cover
GLP-1s
for
weight
loss,
and
some
state
Medicaid
programs
are
rolling
back
coverage,
including

North
Carolina.
Former
President
Joe
Biden
proposed
a
rule
that
would
have
expanded
coverage
of
these
drugs
under
Medicare
and
Medicaid,
but
the
Trump
administration
chose

not
to
finalize
the
rule. 

When
it
comes
to
self-insured
employers,
73%
are
covering
them
for
obesity,
while
99%
are
covering
them
for
diabetes,
according
to
a
recent
survey
from
the

Business
Group
on
Health.
To
manage
costs,
some
employers
are
implementing
cost-cutting
strategies
like
a
higher
body
mass
index
threshold
for
coverage.

When
asked
about
insurers
rolling
back
coverage
of
GLP-1s
for
weight
loss,
a
spokesperson
for
AHIP
said,
“obesity
is
a
complex,
chronic
condition
that
affects
millions
and
requires
individualized
care. 

“While
GLP-1s
have
emerged
as
a
treatment
option
for
some
patients,
they
are
not
universally
appropriate
and
can
present
risks
or
challenges,”
said
Conner
Coles,
the
spokesperson.
“Health
plans
continue
to
assess
clinical
evidence
and
work
with
experts
to
support
coverage
policies
that
prioritize
safe,
effective,
and
clinically
appropriate
care
for
weight
loss.”

What
advocates
and
physicians
are
saying

While
insurers
may
be
ceasing
coverage
of
GLP-1s
for
obesity
due
to
cost
challenges,
one
obesity
medicine
physician
said
this
is
a
dangerous
game.
She
noted
that
while
obesity
often
contributes
to
numerous
other
health
conditions,
the
industry
typically
covers
treatments
for
those
conditions
—
but
not
obesity
itself.

“I
think
it’s
the
wrong
thing
to
do.
I
mean,
it’s
malpractice,
if
insurance
companies
could
be
held
to
malpractice
standards.
If
I
have
a
patient
with
obesity
today
and
I’m
seeing
them,
and
I
don’t
recommend
that
they
go
on
this
type
of
treatment,
I
think
you
could
consider
it
malpractice
today,
given
the
data
that
we
have
[on
how
well
these
drugs
work].
Especially
if
that
patient
had
multiple
other
issues
that
they
had
along
with
their
obesity,”
said
Dr.
Angela
Fitch,
co-founder
and
chief
medical
officer
of
metabolic
health
company

knownwell.
Fitch
is
also
the
former
president
of
the
Obesity
Medicine
Association.

Fitch
added
that
when
her
patients
don’t
have
coverage
for
GLP-1s,
she
has
to
advise
them
to
pay
cash
and
go
through
manufacturers’
direct-to-consumer
options
(Novo
Nordisk’s
NovoCare
or
Eli
Lilly’s
LillyDirect).
Or
she
has
to
switch
them
to
an
older
medication
that
requires
more
visits
and
potentially
more
side
effects.

A
healthcare
advocate
also
expressed
concern
over
insurers’
decisions
to
cease
coverage
of
GLP-1s
for
weight
loss.
Millicent
Gorham
is
the
CEO
of
the
Alliance
for
Women’s
Health
and
Prevention
and
leader
of
the

EveryBODY
Covered
campaign,
which
is
pushing
for
comprehensive
coverage
of
obesity
care.
She
noted
that
women
living
with
obesity
often
face
discrimination
in
the
workplace,
earn
less
money
than
their
colleagues
and
are
less
likely
to
be
promoted.

“To
see
insurers
roll
back
coverage
of
these
evidence-based
therapies
is
deeply
concerning,
as
these
decisions
reinforce
the
culture
of
stigmatization
for
women
living
with
obesity,
while
also
exacerbating
health
complications
associated
with
the
disease,”
she
said.
“We
as
a
society
need
to
break
from
the
misguided
belief
that
obesity
is
a
result
of
‘poor
lifestyle
choices.’
Obesity
management
medications
aren’t
‘vanity
drugs,’
they
are
critical
interventions
for
a
serious
chronic
disease.”

Gorham
added
that
if
insurers
care
about
cardiovascular
disease,
diabetes
and
cancer,
then
they
should
care
about
obesity
too.
Covering
these
medications
leads
to
fewer
emergency
room
visits,
fewer
surgeries
and
lower
rates
of
disability
and
absenteeism,
she
argued.

According
to
DoseSpot,
which
offers
software
to
providers
to
help
them
manage
prescription
ordering,
the
rollback
of
coverage
is
creating
a
lot
of
uncertainty
for
patients
and
providers.
That’s
why
the
company
is
using
its
platform
to
inform
providers
and
patients
of
what
financial
assistance
programs
there
are.

“We’re
bringing
more
power
into
the
patient’s
hands,
advocating
for
their
ability
to
see
pricing
of
medication
and
shop
pharmacies
that
might
have
the
medication
at
a
cheaper
price
or
more
convenient,
whether
it’s
mail
order
or
an
in-person
pharmacy
counter
experience,”
said
Josh
Weiner,
CEO
of
the
company.

What
manufacturers
are
saying

The
manufacturers
of
weight
loss
drugs
are
also
calling
out
insurance
companies
for
rolling
back
coverage
of
GLP-1s.

“We
are
disappointed
by
decisions
that
limit
access
as
it
is
contrary
to
actions
that
many
throughout
our
country
are
taking
to
expand
coverage
for
GLP-1s
for
weight
management,
recognizing
the
importance
of
these
medicines
for
people
living
with
obesity,”
said
Allison
Schneider,
director
of
media
relations
at
Novo
Nordisk.
“We
believe
that
comprehensive
coverage
through
government
and
commercial
insurance
plans
is
critical
to
providing
more
people
living
with
obesity
access
to
affordable
healthcare
and
treatment
options.”

Eli
Lilly,
which
manufactures
Zepbound
and
Mounjaro,
similarly
criticized
insurers’
actions.

A
spokesperson
who
declined
to
be
named
said
obesity
is
a
chronic
disease
and
should
have
comprehensive
coverage
like
other
diseases.

“Gaps
in
insurance
coverage
disrupt
effective
care
and
limit
access
to
safe,
evidence-based
obesity
management
medications,”
the
spokesperson
said.
“Lilly
believes
access
should
be
guided
by
clinical
evidence,
not
insurance
design.”

It’s
worth
noting,
however,
that
manufacturers
aren’t
necessarily
blameless
in
this
issue,
as
they’re
the
ones
pricing
the
medications.

Data
from
one
study
shows
that
Ozempic
can
be
manufactured
for
less
than
$5
a
month,
but
costs
about
$500
through
NovoCare.

What
needs
to
happen

While
there
were
efforts
to
expand
coverage
of
GLP-1s
under
Medicare
and
Medicaid
—
which
in
theory
would
encourage
more
employer-sponsored
coverage
—
this
wouldn’t
be
enough,
according
to
Fitch.
If
Medicare
were
to
start
covering
GLP-1s,
it
would
take
a
couple
of
years
for
that
to
take
effect,
and
then
a
few
more
years
for
commercial
insurers
to
follow
suit,
she
argued.
Instead,
there
needs
to
be
an
executive
order
from
the
White
House
that
makes
obesity
treatment
a
standard
benefit,
she
said.

“Our
health
system
is
not
designed
to
make
people
well
or
prevent
disease,”
she
declared.
“It’s
designed
to
treat
disease
after
it’s
already
happened.
But
we’re
in
a
new
era
now
where
we
can
actually
treat
the
root
cause
of
disease,
which
is
obesity,
and
prevent
all
these
other
diseases,
but
we
need
some
sort
of
urgent
public
health
action.”

So
while
Trump
could
be
the
hero,
that
doesn’t
mean
payers
should
wait
around
for
federal
action.
She
also
called
on
insurers
to
step
up.

“They
could
be
the
hero
right
now.
We
need
a
hero
in
obesity
…
because
we
have
revolutionary
treatment
in
our
hands
as
clinicians,
and
we
need
the
ability
to
get
it
out
to
people,”
Fitch
said.

Photo:
Jason
Dean,
Getty
Images

*
Supreme
Court
refuses
to
bail
out
Alex
Jones.
[NPR]

*
Musk’s
effort
to
skim
$56
billion
off
his
meme
stock’s
willing
shareholders
continues.
[Reuters]

*
Pete
Hegseth’s
personal
lawyer
—
who
represented
him
through
sexual
assault
accusation
—
behind
floundering
effort
to
make
media
organizations
promise
to
only
print
happy
Defense
Department
news.
[ed.
note:
Above
the
Law’s
sibling
publication

Breaking
Defense
has
joined
other
media
outlets
in
rejecting
the
policy]
[Washington
Post]

*
SCOTUS
considers
full
return
to
Jim
Crow
era
districting.
[Bloomberg
Law
News]

*
Ballot
measure
seeks
to
remove
state
bar
from
judge
discipline
process.
[Austin
American
Statesman]

*
Charting
the
AI-Privacy
landscape.
[Law.com]

*
What
are
the
essential
functions
of
the
Supreme
Court?
[Dorf
on
Law]

No
Evidence,
Some
Problems!:
Wasting
tax
payer
money
for
the
sake
of
Trump’s
vengeance.
Dear
Deans,
This
Is
For
You!:
Just
change
out
your
school
name
to
add
a
little
personal
flair
to
your
next
free
speech
announcement.
FASORP
Faces
Another
Public
Loss:
The
quitters
fizzled
out
before
anything
meaningful
happened.
It’s
All
Relativity:
Check
out
Joe’s
rundown
of
RelativityFest!
Make
Your
Biglaw
Predictions!:
Keep
us
informed
so
we
can
return
the
favor!

Ed.
Note:
Welcome
to
our
daily
feature

Trivia
Question
of
the
Day!

Who
was
the
only
Supreme
Court
justice
to
be
served
articles
of
impeachment
by
the
House
of
Representatives?

Hint:
He
was
acquitted
by
the
Senate
and
continued
to
serve
on
the
Court
until
his
death.

See
the
answer
on
the
next
page.