DL Open Thread: Tuesday, April 28, 2026

Containing Delaware Hospital Costs–A Process That Doesn’t Matter:

A group of state revenue analysts will vote on Wednesday to determine the level at which they predict health care costs will burden Delaware taxpayers in 2027.

A subcommittee of the Delaware Economic and Financial Advisory Council, better known as DEFAC, sets what is called the “health care spending benchmark” in an attempt to manage hospital spending that is passed down to taxpayers.

Delaware is one of eight states that set health care industry benchmarks. In 2018, then-Gov. John Carney created Delaware’s system by signing two executive orders.

Since then, Delaware has blown past its spending benchmarks almost every year they have been in effect. In December, DEFAC approved the 2026 benchmark at 4.9% after months of debate and outside litigation surrounding an oversight board meant to hold Delaware’s hospitals accountable to that spending level. 

That lawsuit, filed by ChristianaCare in 2024, challenged the authority of the board to modify and veto budgets that overshoot the health care spending benchmark. Ultimately, the lawsuit was settled after lawmakers passed a bill diminishing the board’s ability to use budget modification as an enforcement tool. 

It is unclear at what level DEFAC officials are considering setting the 2027 benchmark on Wednesday.

And after the legal settlement, there is no enforcement mechanism to restrain health care systems, insurers and pharmaceutical companies to the benchmark rate.

Making this an exercise in futility.

Vance And Hegseth Go To War With Each Other Over War:

In closed-door meetings, J. D. Vance has repeatedly questioned the Defense Department’s depiction of the war in Iran and whether the Pentagon has understated what appears to be the drastic depletion of U.S. missile stockpiles.

Two senior administration officials told us that the vice president has queried the accuracy of the information the Pentagon has provided about the war. He has also expressed his concerns about the availability of certain missile systems in discussions with President Trump, several people familiar with the situation told us. The consequences of a dramatic drawdown in munitions reserves are potentially dire: U.S. forces would need to draw from these same stockpiles to defend Taiwan against China, South Korea against North Korea, and Europe against Russia.

Pentagon leaders’ positive portrayals present an incomplete picture at best, people familiar with intelligence assessments told us. According to those internal estimates, Iran retains two-thirds of its air force, the bulk of its missile-launching capability, and most of its small, fast boats, which can lay mines and harass traffic in the Strait of Hormuz. At least in terms of resuming stalled maritime commerce, “those are the real threat,” one person told us.

Officials and outside advisers told us that the use of key weapons—including interceptors that defend against Iranian missiles, and offensive weapons such as Tomahawk and Joint Air-to-Surface Standoff missiles—has produced a serious shortage that erodes America’s ability to fight future wars, despite an effort to quickly manufacture replacements. Vance has raised concern about munitions shortages in meetings with the president and other national-security officials. Already, the United States may have gone through more than half of its prewar supply of four key munitions, the Center for Strategic and International Studies, a Washington, D.C., think tank, said this week. Even before the Iran war, stockpiles had been drained by lethargic manufacturing and munitions donations to Ukraine and Israel. Pentagon officials have warned that the deficits jeopardized the military’s ability to prevail in a hypothetical conflict against Russia or China.

There’s more inside baseball on tensions between Vance and Hegseth in this article, lest you be in the mood for a little schadenfreude with your coffee.

Trump Wants To Bail Out Shitty Airlines.  Uh, why, and with whose money?:

The Trump Administration is preparing to light $500 million on fire, handing taxpayer money to Spirit Airlines. You wouldn’t buy their tickets – but they’re going to make you give them your money anyway.

• This is a terrible precedent. Spirit is a bad investment, and government ownership (warrants in exchange for the loan) creates terrible incentives.
• It’s also blatantly illegal.

Secretary of Transportation Sean Duffy said this week that it’s a terrible idea. He’s called it ‘good money after bad.’ Once Trump has decided to do it, though, he’ll fall into line.

Spirit is a money-loser. They had no plausible business plan coming out of bankruptcy a year ago. And there’s no reason to believe that shrinking is going to make them perform better coming out of a second bankruptcy. They only need the money because private investors aren’t willing to fund their losses any longer.

The Trump administration doesn’t want to see an airline go under on its watch, especially amidst high fuel costs, since its foreign policy (Iran) will be blamed – even though Spirit’s problems have little to do with and long predated high prices of jet fuel. As we approach the election, though, they’re looking to reach into your pockets.

Ironically enough, that makes Spirit Airlines no longer a low fare airline. You’re paying more for Spirit whether you fly them or not. That’s the ultimate ancillary revenue play!

But this is simply illegal. Without new legislation from Congress, there’s just no legal authority to extend loans to private businesses like this. Appropriations can only be used for things Congress made them for. The government can’t make obligations that they don’t have appropriations for. Under the Federal Credit Reform Act, loans and loan guarantees require budget authority.

BTW, both Avelo and and Frontier have now sought a piece of this $500 mill bailout.

Guess Who Got Screwed In Purdue Oxycontin Settlement.  You don’t really have to guess, do you?:

Mary Jannotta sliced meat and cheese behind deli counters at Acme and Pathmark supermarkets in the Philadelphia suburbs for decades, developing aches that came with working on her feet. A botched back surgery in 2008 made the pain worse. Her doctor repeatedly prescribed OxyContin, Purdue Pharma’s marquee painkiller — the high-dose opioid the company later admitted it criminally marketed and distributed.

Jannotta said she soon became dependent on opioids. Cut off by her doctors, she found her way to Kensington, home of Philadelphia’s dangerous open-air drug market, to score pills. She eventually lost her car, her home — and her grandson. Tyler Cordeiro first pilfered Jannotta’s prescription pills as a teenager. He was 24 when he died of an overdose.

When Purdue filed for bankruptcy in 2019, Jannotta, along with nearly 140,000 other people, filed claims against the company for the harm they said its drugs caused. Though the money could not bring back what they lost, a financial settlement represented an opportunity to get justice from the company and its multibillionaire owners, the Sackler family.

Then they waited. The Supreme Court in 2024 rejected the first bankruptcy settlement because it shielded the Sacklers from future lawsuits. Finally, last November, a federal judge approved a new plan that would allow the payouts to start.

But this $7.4 billion bankruptcy plan — including $870 million that has been set aside for individual victims — will shut out tens of thousands of those who originally applied for a settlement, ProPublica and The Philadelphia Inquirer found. Fewer than half of those who filed claims against Purdue will get any kind of help under the new plan, despite the company touting it as “the only opioid settlement to date that meaningfully compensates individual victims.”

Court records show the new plan slashed payments for victims, imposed tougher eligibility requirements and eliminated compensation for teenagers who bought Purdue drugs on the street. Estimated settlement amounts for people whose family members fatally overdosed dropped to as little as $8,000; the previous payout for an OxyContin death had been $48,000.

Most significantly, the new plan removed a key provision that allowed victims to submit a sworn affidavit, in lieu of a prescription or other medical or legal records, to prove they purchased Purdue opioids.

Similar sworn statements have been permitted in other major bankruptcy cases — such as those driven by sexual abuse in the Boy Scouts and the Catholic Church — to account for harm done years earlier where physical evidence is scant or impossible to obtain.

Several victims told ProPublica and the Inquirer that the loss of the affidavit option meant they had no hope of receiving a settlement. Purdue sold painkillers for decades, and, while laws vary by state, generally doctors, hospitals and pharmacies must keep prescription records for only a few years.

“I can’t turn up prescriptions for my son back when he was young, years ago,” Michigan resident Ellen Isaacs said. “They’re not available anymore.”

The changes between the initial and revised settlement agreements were negotiated out of the public eye for months, with key details later scattered across thousands of pages of court filings, hearing transcripts and sworn declarations. To date, they have not received any media attention or public scrutiny. The winnowing of victims has been the result of byzantine legal procedures, strict vetting and tightened eligibility rules, which victims told ProPublica and the Inquirer took them by surprise.

This award-worthy report provides the media attention this issue deserves.  I doubt it will help make those who were screwed by attorneys behind closed doors whole, though.

What do you want to talk about?