Shifting Dollars From Poor To Give To the Rich Is a Key Part of the Senate Health Bill

(THIS ARTICLE IS COURTESY OF THE NEW YORK TIMES)

Senate Majority Leader Mitch McConnell at his office on Thursday, when the Republican health plan was made public. CreditDoug Mills/The New York Times

The Affordable Care Act gave health insurance to millions of Americans by shifting resources from the wealthy to the poor and by moving oversight from states to the federal government. The Senate bill introduced Thursday pushes back forcefully on both dimensions.

The bill is aligned with long-held Republican values, advancing states’ rights and paring back growing entitlement programs, while freeing individuals from requirements that they have insurance and emphasizing personal responsibility. Obamacare raised taxes on high earners and the health care industry, and essentially redistributed that income — in the form of health insurance or insurance subsidies — to many of the groups that have fared poorly over the last few decades.

The draft Senate bill, called the Better Care Reconciliation Act, would jettison those taxes while reducing federal funding for the care of low-income Americans. The bill’s largest benefits go to the wealthiest Americans, who have the most comfortable health care arrangements, and its biggest losses fall to poorer Americans who rely on government support. The bill preserves many of the structures of Obamacare, but rejects several of its central goals.

Mitch McConnell, the Senate majority leader, in the Capitol on Thursday.CreditSaul Loeb/Agence France-Presse — Getty Images

Like a House version of the legislation, the bill would fundamentally change the structure of Medicaid, which provides health insurance to 74 million disabled or poor Americans, including nearly 40 percent of all children. Instead of open-ended payments, the federal government would give states a maximum payment for nearly every individual enrolled in the program. The Senate version of the bill would increase that allotment every year by a formula that is expected to grow substantially more slowly than the average increase in medical costs.

Continue reading the main story

Avik Roy, the president of the Foundation for Research on Equal Opportunity, and a conservative health care analyst, cheered the bill on Twitter, saying, “If it passes, it’ll be the greatest policy achievement by a G.O.P. Congress in my lifetime.” The bill, he explained in an email, provides a mechanism for poor Americans to move from Medicaid coverage into the private market, a goal he has long championed as a way of equalizing insurance coverage across income groups.

High-income earners would get substantial tax cuts on payroll and investment income. Subsidies for those low-income Americans who buy their own insurance would decline compared with current law. Low-income Americans who currently buy their own insurance would also lose federal help in paying their deductibles and co-payments.

The bill does offer insurance subsidies to poor Americans who live in states that don’t offer them Medicaid coverage, a group without good insurance options under Obamacare. But the high-deductible plans that would become the norm might continue to leave care out of their financial reach even if they do buy insurance.

The battle over resources played into the public debate. Mitch McConnell, the Senate majority leader, said the bill was needed to “bring help to the families who have been struggling with Obamacare.” In a Facebook post, President Barack Obama, without mentioning the taxes that made his program possible, condemned the Senate bill as “a massive transfer of wealth from middle-class and poor families to the richest people in America.”

In another expression of Republican principles, the bill would make it much easier for states to set their own rules for insurance regulation, a return to the norm before Obamacare.

Under the bill, states would be able to apply for waivers that would let them eliminate consumer protection regulations, like rules that require all health plans to cover a basic package of benefits or that prevent insurance plans from limiting how much care they will cover in a given year.

Where Senators Stand on the Health Care Bill

Senate Republican leaders unveiled their health care bill on Thursday.

States could get rid of the online marketplaces that help consumers compare similar health plans, and make a variety of other changes to the health insurance system. The standards for approval are quite permissive. Not every state would choose to eliminate such rules, of course. But several might.

“You can eliminate all those financial protections,” said Nicholas Bagley, a law professor at the University of Michigan. “That would be huge.”

Americans with pre-existing conditions would continue to enjoy protection from discrimination: In contrast with the House health bill, insurers would not be allowed to charge higher prices to customers with a history of illness, even in states that wish to loosen insurance regulations.

But patients with serious illnesses may still face skimpier, less useful coverage. States may waive benefit requirements and allow insurers to charge customers more. Someone seriously ill who buys a plan that does not cover prescription drugs, for example, may not find it very valuable.

A protester being removed from outside the office of Mitch McConnell on Thursday.CreditSaul Loeb/Agence France-Presse — Getty Images

There are features that would tend to drive down the sticker price of insurance, a crucial concern of many Republican lawmakers, who have criticized high prices under Obamacare. Plans that cover fewer benefits and come with higher deductibles would cost less than more comprehensive coverage.

But because federal subsidies would also decline, only a fraction of people buying their own insurance would enjoy the benefits of lower prices. Many middle-income Americans would be expected to pay a larger share of their income to purchase health insurance that covers a smaller share of their care.

The bill also includes substantial funds to help protect insurers from losses caused by unusually expensive patients, a measure designed to lure into the market those insurance carriers that have grown skittish by losses in the early years of Obamacare. But it removes a policy dear to the insurance industry — if no one else. Without an individual mandate with penalties for Americans who remain uninsured, healthier customers may choose to opt out of the market until they need medical care, increasing costs for those who stay in.

The reforms are unlikely to drive down out-of-pocket spending, another perennial complaint of the bill’s authors, and a central critique by President Trump of the current system. He often likes to say that Obamacare plans come with deductibles so high that they are unusable. Subsidies under the bill would help middle-income consumers buy insurance that pays 58 percent of the average patient’s medical costs, down from 70 percent under Obamacare; it would also remove a different type of subsidy designed to lower deductibles further for Americans earning less than around $30,000 a year.

Out-of-pocket spending is the top concern of most voters. The insurance they would buy under the bill might seem cheap at first, but it wouldn’t be if they ended up paying more in deductibles.

Mr. McConnell was constrained by political considerations and the peculiar rules of the legislative mechanism that he chose to avoid a Democratic filibuster. Despite those limits, he managed to produce a bill that reflects some bedrock conservative values. But the bill also shows some jagged seams. It may not fix many of Obamacare’s problems — high premiums, high deductibles, declining competition — that he has railed against in promoting the new bill’s passage.

Shifting Dollars From Poor to Rich Is a Key Part of the Senate Health Bill

(THIS ARTICLE IS COURTESY OF THE NEW YORK TIMES)

The Affordable Care Act gave health insurance to millions of Americans by shifting resources from the wealthy to the poor and by moving oversight from states to the federal government. The Senate bill introduced Thursday pushes back forcefully on both dimensions.

The bill is aligned with long-held Republican values, advancing states’ rights and paring back growing entitlement programs, while freeing individuals from requirements that they have insurance and emphasizing personal responsibility. Obamacare raised taxes on high earners and the health care industry, and essentially redistributed that income — in the form of health insurance or insurance subsidies — to many of the groups that have fared poorly over the last few decades.

The draft Senate bill, called the Better Care Reconciliation Act, would jettison those taxes while reducing federal funding for the care of low-income Americans. The bill’s largest benefits go to the wealthiest Americans, who have the most comfortable health care arrangements, and its biggest losses fall to poorer Americans who rely on government support. The bill preserves many of the structures of Obamacare, but rejects several of its central goals.

Like a House version of the legislation, the bill would fundamentally change the structure of Medicaid, which provides health insurance to 74 million disabled or poor Americans, including nearly 40 percent of all children. Instead of open-ended payments, the federal government would give states a maximum payment for nearly every individual enrolled in the program. The Senate version of the bill would increase that allotment every year by a formula that is expected to grow substantially more slowly than the average increase in medical costs.

Continue reading the main story

Avik Roy, the president of the Foundation for Research on Equal Opportunity, and a conservative health care analyst, cheered the bill on Twitter, saying, “If it passes, it’ll be the greatest policy achievement by a G.O.P. Congress in my lifetime.” The bill, he explained in an email, provides a mechanism for poor Americans to move from Medicaid coverage into the private market, a goal he has long championed as a way of equalizing insurance coverage across income groups.

States would continue to receive extra funding for Obamacare’s expansion of Medicaid to more poor adults, but only temporarily. After several years, states wishing to cover that population would be expected to pay a much greater share of the bill, even as they adjust to leaner federal funding for other Medicaid beneficiaries — disabled children, nursing home residents — who are more vulnerable.

Mitch McConnell, the Senate majority leader, in the Capitol on Thursday.CreditSaul Loeb/Agence France-Presse — Getty Images

High-income earners would get substantial tax cuts on payroll and investment income. Subsidies for those low-income Americans who buy their own insurance would decline compared with current law. Low-income Americans who currently buy their own insurance would also lose federal help in paying their deductibles and co-payments.

The bill does offer insurance subsidies to poor Americans who live in states that don’t offer them Medicaid coverage, a group without good insurance options under Obamacare. But the high-deductible plans that would become the norm might continue to leave care out of their financial reach even if they do buy insurance.

The battle over resources played into the public debate. Mitch McConnell, the Senate majority leader, said the bill was needed to “bring help to the families who have been struggling with Obamacare.” In a Facebook post, President Barack Obama, without mentioning the taxes that made his program possible, condemned the Senate bill as “a massive transfer of wealth from middle-class and poor families to the richest people in America.”

In another expression of Republican principles, the bill would make it much easier for states to set their own rules for insurance regulation, a return to the norm before Obamacare.

Where Senators Stand on the Health Care Bill

Senate Republican leaders unveiled their health care bill on Thursday.

Under the bill, states would be able to apply for waivers that would let them eliminate consumer protection regulations, like rules that require all health plans to cover a basic package of benefits or that prevent insurance plans from limiting how much care they will cover in a given year.

States could get rid of the online marketplaces that help consumers compare similar health plans, and make a variety of other changes to the health insurance system. The standards for approval are quite permissive. Not every state would choose to eliminate such rules, of course. But several might.

“You can eliminate all those financial protections,” said Nicholas Bagley, a law professor at the University of Michigan. “That would be huge.”

Americans with pre-existing conditions would continue to enjoy protection from discrimination: In contrast with the House health bill, insurers would not be allowed to charge higher prices to customers with a history of illness, even in states that wish to loosen insurance regulations.

But patients with serious illnesses may still face skimpier, less useful coverage. States may waive benefit requirements and allow insurers to charge customers more. Someone seriously ill who buys a plan that does not cover prescription drugs, for example, may not find it very valuable.

Photo

A protester being removed from outside the office of Mitch McConnell on Thursday.CreditSaul Loeb/Agence France-Presse — Getty Images

There are features that would tend to drive down the sticker price of insurance, a crucial concern of many Republican lawmakers, who have criticized high prices under Obamacare. Plans that cover fewer benefits and come with higher deductibles would cost less than more comprehensive coverage.

But because federal subsidies would also decline, only a fraction of people buying their own insurance would enjoy the benefits of lower prices. Many middle-income Americans would be expected to pay a larger share of their income to purchase health insurance that covers a smaller share of their care.

The bill also includes substantial funds to help protect insurers from losses caused by unusually expensive patients, a measure designed to lure into the market those insurance carriers that have grown skittish by losses in the early years of Obamacare. But it removes a policy dear to the insurance industry — if no one else. Without an individual mandate with penalties for Americans who remain uninsured, healthier customers may choose to opt out of the market until they need medical care, increasing costs for those who stay in.

The reforms are unlikely to drive down out-of-pocket spending, another perennial complaint of the bill’s authors, and a central critique by President Trump of the current system. He often likes to say that Obamacare plans come with deductibles so high that they are unusable. Subsidies under the bill would help middle-income consumers buy insurance that pays 58 percent of the average patient’s medical costs, down from 70 percent under Obamacare; it would also remove a different type of subsidy designed to lower deductibles further for Americans earning less than around $30,000 a year.

Out-of-pocket spending is the top concern of most voters. The insurance they would buy under the bill might seem cheap at first, but it wouldn’t be if they ended up paying more in deductibles.

Mr. McConnell was constrained by political considerations and the peculiar rules of the legislative mechanism that he chose to avoid a Democratic filibuster. Despite those limits, he managed to produce a bill that reflects some bedrock conservative values. But the bill also shows some jagged seams. It may not fix many of Obamacare’s problems — high premiums, high deductibles, declining competition — that he has railed against in promoting the new bill’s passage.

Inside the Health Care Bill: Trump Wanted ‘Heart.’ He Didn’t Get It

(THIS ARTICLE IS COURTESY OF NBC NEWS)

JUN 22 2017, 3:47 PM ET

Inside the Health Care Bill: Trump Wanted ‘Heart.’ He Didn’t Get It

WASHINGTON — The 142-page Senate health care bill released on Thursday is easy to summarize: It cuts health care spending for low-income and middle-income Americans and uses the savings to finance large tax cuts for the wealthy and the medical industry.

How it accomplishes this is simple as well: It makes large cuts to Medicaid and to subsidies for private insurance, meaning large chunks of money that the government would have spent on helping Americans afford coverage, pay for long-term care and reduce their out-of-pocket costs would instead be paid either by states or by the customers themselves.

Related: Senate Health Care Bill Includes Deep Medicaid Cuts

In this regard, the bill, which is called the Better Care Reconciliation Act, is broadly similar to the American Health Care Act that passed the House in May. There are some significant differences within that framework, however, especially when it comes to private insurance subsidies.

Let’s go through the main planks of the Senate plan:

Medicaid cuts

Medicaid covers about 70 million Americans, including low-income residents, seniors in nursing homes (over 60 percent of whom are on Medicaid) and people with disabilities.

The Senate bill would restructure the program, cap its spending and reduce its funding significantly over time.

Play

Protester Shares Her Reasons For Opposing Health Care Bill0:57

First, the Senate GOP bill would eliminate a major expansion of Medicaid under Obamacare.

The Affordable Care Act gave states federal funding to expand Medicaid coverage to people whose incomes were between 100 percent and 138 percent of the federal poverty line (the current cap is about $34,000 for a family of four). The Supreme Court later made the funding optional, but 30 states and the District of Columbia accepted it. The Senate bill would gradually end this expansion between 2020 and 2024.

But it would go a lot further than repealing Obamacare’s changes. It would also cap the amount of funding states can get on a per-recipient basis rather than continue the current system, in which states decide how much to spend and then have the federal government match their contribution.

Starting in 2025, the plan would then grow those per-recipient caps at a rate that’s unlikely to keep pace with increasing medical costs. A similar change in the House bill was projected to reduce Medicaid spending by $839 billion over a decade and cover 14 million fewer people. The Senate bill kicks in later, but its cuts would be even deeper than the House plan.

To make up the difference, states would either have to raise taxes, cut programs elsewhere or reduce benefits and coverage for recipients. That prospect has governors, including some Republicans like Ohio Gov. John Kasich, nervous that the reduced funding will hamper their ability to respond to health crises like the current opioid epidemic. The bill provides an extra $2 billion next year for substance-abuse treatment, a small number compared to its looming cuts.

But the Medicaid cuts also have small-government conservatives nervous. Congress has a history of passing cuts to services or tax increases and then delaying them down the line. The more time before they kick in, the greater the chance that government control might change hands or public opposition could prompt a reversal.

Private insurance subsidies

When it comes to Obamacare’s subsidies to buy private insurance, the Senate bill keeps the same basic structure, but provides less money for fewer people to purchase insurance that is less generous. These changes would also raise premiums for older people.

Under the current system, people who don’t get health insurance through work or a government program can qualify for help buying a private plan on Obamacare’s exchanges. The maximum amount you’re expected to contribute is capped based on your income.

There are limits, though. If your income is higher than 400 percent of the federal poverty line — about $98,000 for a family of four — you don’t get those subsidies. This is one of the biggest gripes about Obamacare: While most people qualify for aid, those who miss the cutoff have to pay full price, which can be difficult to afford.

The Senate bill would expand this complaint to a wider group. It would cut the subsidies off at 350 percent of the federal poverty line instead, about $86,000 for the same family. On the other hand, it would also cover some lower-income people who currently fall in the “Medicaid gap” in states that didn’t take the federal expansion.

Image: Healthcare.gov site
A screen view of the healtcare.gov site is shown on May 5, 2017. File Richard B. Levine / Zuma Press

Those who qualify for subsidies could also pay higher premiums. Under current law, no Obamacare recipients are expected to contribute more than 9.5 percent of their income in premiums. But the Senate bill changes this and make the caps more generous for younger customers and less generous for older customers. A 60-year-old making $42,000 would now have to contribute as much as 16 percent of their income to premiums.

In addition, the subsidies would be pegged to less comprehensive insurance. Under the current law, they’re calculated based on a “silver plan” that covers an average of around 70 percent of medical costs. The new bill would peg them to plans that cover only 58 percent of costs. That means higher deductibles, which have also been a major complaint among Obamacare users.

Out-of-pocket expenses would actually go up even higher for many Americans. Obamacare provided “cost-sharing reduction” payments to insurers, which they used to lower expenses for customers making up to 250 percent of the federal poverty line (about $61,500 for a family of four). For those at 150 percent of the line, these payments reduced the average deductible from $3,609 to just $255, according to the Kaiser Family Foundation. But the Senate bill ends those subsidies starting in 2019.

This is still a big difference from the House bill, which would have offered only fixed tax credits. Those credits would have likely fallen far short for many people, especially older, lower-income customers in places with high health care costs, which are often rural areas. Now the subsidies will scale up to meet the costs in their area, even if they fall short of current levels.

In addition to the subsidies, the bill provides significant funding to help stabilize insurance markets in the short-term (which have been jittery, partly due to the health care debate) and a $62 billion fund over eight years to help states potentially cover more expensive patients. But the funding is temporary, making the future uncertain.

Pre-existing conditions

The Senate bill does not let insurers deny people coverage based on a pre-existing condition or charge them more based on their health, which keeps two core pieces of Obamacare in place.

However, this doesn’t mean those with pre-existing conditions won’t potentially be affected. The bill does give states flexibility to waive Obamacare’s “essential health benefits,” a list of 10 broad categories of coverage every insurance plan needs.

Image: U.S. Capitol Police remove a woman from a protest in front of the office of Senate Majority Leader Mitch McConnell
U.S. Capitol Police remove a woman from a protest in front of the office of Senate Majority Leader Mitch McConnell. Mark Wilson / Getty Images

Republicans argue states should be able to eliminate those requirements in order to lower overall premiums and provide more flexibility to insurers and customers. In the pre-Obamacare era, insurance companies often didn’t cover items like maternity care or mental health treatment, two items that are included in “essential health benefits.”

Some health experts fear that insurers will try to shepherd healthier patients into cheaper plans that cover fewer items, leaving patients with pre-existing conditions struggling to find an affordable option that covers their treatment. So even though insurers will not be able to discriminate based on pre-existing conditions, the effect could be to make their care less affordable.

Importantly, items that aren’t considered essential health benefits could be subjected to lifetime or annual limits by insurers, a practice that Obamacare eliminated.

The individual mandate

There would be no individual mandate requiring that people buy insurance, which penalized people who went without coverage.

The goal was to encourage younger and healthier people to enter the market so insurers weren’t left on the hook for only more expensive patients who were more likely to seek coverage. It didn’t work as well as intended, however, and insurers complained that the penalties were too weak and left them with a sicker crop of patients who required them to raise premiums to cover.

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Schumer, Pelosi Denounce Senate GOP’s ‘Heartless’ Health Care Bill 1:19

This bill eliminates the penalties entirely, though, and instead counts on healthier people deciding coverage is affordable enough for them to get covered. That could be a problem if they conclude that the new insurance, which could have higher deductibles, is not worth the trouble.

“I just don’t see why people would sign up,” Joe Antos, a fellow at the American Enterprise Institute, told NBC News.

If they don’t come off the sidelines, or if they drop their existing coverage, premiums could rise for everyone as markets become dominated by sicker customers. The Society of Actuaries indicated in a statement on Thursday they would be watching this issue closely.

Taxes

Unless you were paying a penalty for not carrying insurance, it’s unlikely you’ll notice any change in your taxes as a result of the Senate bill.

For rich people, though, the Senate bill is a nice income boost. It eliminates a surtax on income and investment gains for individuals making over $200,000 a year and married couples making over $250,000 a year. The bill also cuts taxes on health companies like medical device manufacturers and prescription drug companies.

Does it have ‘heart?’

President Donald Trump said recently that the Senate bill should be “something with heart.”

“Heart” is a subjective idea, but Trump laid out very specific standards as a candidate and as president. By those standards, the bill falls short.

Trump explicitly pledged he would make no cuts to Medicaid. Instead, the bill will cut Medicaid by hundreds of billions of dollars. He promised “insurance for everybody” backed by federal spending: Instead the bill will likely cover millions fewer people than current law. He repeatedly promised lower deductibles: Instead a core feature of the bill pushes customers towards higher deductible plans. He argued his dedication to providing more generous health care distinguished him from conservative Republicans who sought smaller government.

“This bottom line is that this bill will result in a very significant reduction in insurance coverage, as well as large increases in premium and out-of-pocket costs for those who manage to retain coverage,” Matthew Fiedler, a fellow at the Brookings Institute, told NBC News.

Should the bill become law, these will be unambiguous broken promises.

The U.S. Constitution Says All Are Created Equal, GOP House And Senate Say Hell No

 

Once again the GOP federal Congress and Senate show their disdain (the feeling that someone or something is unworthy of one’s consideration or respect; contempt) for the poor and the working class American people. The GOP in their healthcare bill they are pushing down the throats of the American people show how much they despise at least the bottom 90% (incomes) of the people. I live in Kentucky so Senator Mitch McConnell is one of my two Senators so I am hoping that the next time he comes up for reelection that the people of this State vote this horses behind out of office. I am a registered voting Independent, I personally can’t stand either the Republican or the Democratic Party leaderships as in my opinion neither have any interest in being honest with the American people.

 

Even though this next ‘idea’ is not one I invented I have felt this way for many years concerning health care in America. There is only one health plan that should be allowed here in our Country and that is: every single person in America should have exactly the same insurance as the Congressmen, Congresswomen, the U.S. Senators and the President have, exactly the same as theirs. They are supposed to be the servants but they have illegally made themselves into our slave masters. I do not know anything about what their plans are, I do not know if they have to pay anything out of their own pockets for the monthly costs or if they have deductibles but shouldn’t ‘We The People’ be allowed to have at least as good of healthcare as ‘our servants’? For these people to be bringing ‘other’ healthcare bills to the ‘floor’ for a vote is pure and total hypocrisy! Okay, these are just my thoughts on this issue, what are your thoughts on this issue?

Senate Health Care Bill Includes Deep Cuts to Medicaid

(THIS ARTICLE IS COURTESY OF THE NEW YORK TIMES)

The Senate majority leader, Mitch McConnell of Kentucky, is the chief author of the Senate’s health care bill.CreditDoug Mills/The New York Times

WASHINGTON — Senate Republicans, who have promised a repeal of the Affordable Care Act for seven years, took a major step on Thursday toward that goal, unveiling a bill to cut Medicaid deeply and end the health law’s mandate that most Americans have health insurance.

The 142-page bill would create a new system of federal tax credits to help people buy health insurance, while offering states the ability to drop many of the benefits required by the Affordable Care Act, like maternity care, emergency services and mental health treatment.

The Senate bill — once promised as a top-to-bottom revamp of the health bill passed by the House last month — instead maintains its structure, with modest adjustments. The Senate version is, in some respects, more moderate than the House bill, offering more financial assistance to some lower-income people to help them defray the rapidly rising cost of private health insurance.

But the Senate measure, like the House bill, would phase out the extra money that the federal government has provided to states as an incentive to expand eligibility for Medicaid. And like the House measure, it would put the entire Medicaid program on a budget, ending the open-ended entitlement that now exists.

 

Video

How the G.O.P. Health Bill Would Change Medicaid

The reporter Margot Sanger-Katz examines how the Republican health plan aims to roll back a program that insures nearly one in five Americans.

By MARGOT SANGER-KATZ, ROBIN STEIN and SARAH STEIN KERR on Publish DateJune 22, 2017. Photo by Doug Mills/The New York Times. Watch in Times Video »

It would also repeal virtually all the tax increases imposed by the Affordable Care Act to pay for itself, in effect handing a broad tax cut to the affluent, paid for by billions of dollars sliced from Medicaid, a health care program that serves one in five Americans, not only the poor but almost two-thirds of those in nursing homes. The bill, drafted in secret, is likely to come to the Senate floor next week, and could come to a vote after 20 hours of debate.

If it passes, President Trump and the Republican Congress would be on the edge of a major overhaul of the American health care system — onesixth of the nation’s economy.

The premise of the bill, repeated almost daily in some form or other by its chief author, the Senate majority leader, Mitch McConnell of Kentucky, is that “Obamacare is collapsing around us, and the American people are desperately searching for relief.”

Mr. Trump shares that view, and the Senate bill, if adopted, would move the president a great distance closer to being able to boast about final passage of a marquee piece of legislation, a feat he has so far been unable to accomplish.

Where Senators Stand on the Health Care Bill

Senate Republican leaders unveiled their health care bill on Thursday.

Democrats and some insurers blame the Republicans and Mr. Trump for sabotaging the law, in part by threatening to withhold subsidies used to help pay for deductibles and co-payments for millions of poor people covered by the law.

In the Senate, Democrats are determined to defend a law that has provided coverage to 20 million people and is a pillar of former President Barack Obama’s legacy. The debate over the repeal bill is shaping up as a titanic political clash, which could have major implications for both parties, affecting their electoral prospects for years to come.

Mr. McConnell faces a great challenge in amassing the votes to win Senate approval of the bill, which Republicans are trying to pass using special budget rules that will allow them to avoid a Democratic filibuster. But with only 52 seats, Mr. McConnell can afford to lose only two Republicans, with Vice President Mike Pence breaking the tie. He may have already lost one — Senator Rand Paul, Republican of Kentucky, has indicated repeatedly that the bill is too liberal for him.

Democrats are unified in opposing the repeal efforts, and they have already assailed Republicans for the work they have done so far, criticizing them for putting the bill together without a single public hearing or bill-drafting session.

GRAPHIC

How Senate Republicans Plan to Dismantle Obamacare

A comparison of the Senate health care with the Affordable Care Act.

OPEN GRAPHIC

In the short term, the possible electoral consequences are more muted in the Senate than in the House, as only two of the Senate Republicans who face re-election next year, Dean Heller of Nevada and Jeff Flake of Arizona, are seen as vulnerable.

But Republican leaders still must contend with internal divisions that will be difficult to overcome. Numerous Republican senators from states that expanded Medicaid are concerned about how a rollback of the program could affect their constituents, and they face pressure from governors back home.

Some senators have concerns based on other issues specific to their states, including the opioid epidemic that has battered states like West Virginia and Ohio. And some of the Senate’s most conservative members could resist a bill that they view as not going far enough in dismantling the Affordable Care Act.

Senators will not have long to sort out their differences. Mr. McConnell wants to hold a vote before lawmakers return home for the Fourth of July recess. If the repeal bill is still looming over the Senate, Republicans are certain to face intense pressure from constituents who wish to see the Affordable Care Act remain in place.

The assessment being made by senators will be shaped in part by an analysis of the bill to be released by the Congressional Budget Office, the official scorekeeper on Capitol Hill.

The budget office found that the bill passed by the House last month would leave 23 million more people without insurance in a decade. Mr. Trump recently told senators that the House bill was “mean,” though weeks earlier he had celebrated its passage.

White House to Republicans: Trump reserves the right to throw all of you under the bus

(THIS ARTICLE IS COURTESY OF THE WASHINGTON POST)

The Fix

White House to Republicans: Trump reserves the right to throw all of you under the bus

June 20 at 3:29 PM
Spicer: Trump ‘wants a bill that has heart in it’
White House press secretary Sean Spicer said President Trump wants Congress to pass a health-care bill that “has heart in it,” on June 20 at the White House. (Reuters)

Senate Republicans are confronting a potentially career-altering decision: whether to vote for a health-care bill that polls show is vastly unpopular and could backfire stupendously. And on Tuesday, White House press secretary Sean Spicer had a chance to provide them some reassurance that President Trump wasn’t going to throw them under the bus if things go sideways.

Instead, he basically shrugged his shoulders.

Reports in recent days have quoted Trump, in private settings, as both calling the House GOP’s health-care bill “mean” and saying the Senate bill needed “more heart.” Asked about that second report, from CNBC on Tuesday, Spicer practically confirmed the quote — or at least he didn’t dispute it, as the White House often does.

“The president clearly wants a bill that has heart in it,” Spicer said. “He believes health care is something that is near and dear to so many families and individuals. He made it clear from the beginning that it was one of his priorities.”

If you are a Republican who is thinking about sticking your neck out for this bill, that has to make you think twice.

Last month Trump held a Rose Garden celebration with House Republicans after they passed their version of a health-care bill. Some even thought that festivities were a little over-the-top. But the president clearly wanted to celebrate a first legislative win.

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His actions since then, however, suggest he doesn’t necessarily want his brand attached to this bill and all the sausage-making that goes with it. Recent polls have shown Americans oppose the legislation by a 2-to-1 margin or even a 3-to-1 margin, and the nonpartisan Congressional Budget Office estimates indicate it could reduce the number of insured Americans by 23 million over a decade and raise premiums for older, poorer people. And whatever the perceptions and projections are today, the law of unintended consequences certainly applies when it comes to large-scale legislation. It’s a massively difficult vote to take for any member.

The White House will almost surely come around and say all the right things when the Senate ultimately reveals its bill. And for Trump and Spicer, it’s probably smart to withhold your full endorsement to make sure that bill will reflect the things the White House feels are important. But the fact that Trump is saying these things behind closed doors about a bill he once celebrated has to make Republican senators think twice.

What if the bill they are working on does wind up causing major problems? What if it doesn’t even pass, and most all of them put themselves on the record voting for something that can still be used in a pretty brutal attack ad using those CBO numbers? There is basically nothing to suggest that Trump is going to allow himself to go down with this ship. And unlike your normal politician, he’s not going to feel bound by loyalty, his past statements or that Rose Garden celebration. When Trump feels like disowning something politically, Trump will disown it.

Perhaps the White House could be forgiven for not fighting back strongly enough against reports of Trump’s initial “mean” comment last week. But now it’s happened again; Trump and his White House have basically put the House’s bill at arms-length twice in the span of a week. And on Tuesday it suggested that it reserves the right to bash the bill at a later date if Trump feels like it.

Given the bill will need 50 of 52 Republican senators to vote for it, that’s a pretty terrible message to send right now.

Senate Leader Mitch McConnell Proving He Cares Nothing About The Voters, Only Doners

(THIS ARTICLE IS COURTESY OF THE WASHINGTON POST)

Politics

Senate leaders plan to rush a health-care bill to a vote, and there’s nothing Democrats can do about it

June 19 at 1:11 PM

When the Republican-led Senate Rules Committee briefly flirted with the idea of restricting television interviews in the hallways of the Capitol last week, it became only the most obvious manifestation of how the party’s leaders were handling the development of a bill to overhaul Obamacare: out of the public eye.

While that effort was quickly sidelined after some outcry, the Republican leadership in the Senate was otherwise unfazed in its push to craft a bill that would expose its members to as little negative public attention as possible. No repeat of the town hall meetings that drew angry constituents who yelled at House Republicans and, they clearly hope, no weeks and weeks of swamped office phone lines.

In an article for the Monkey Cage, George Washington University’s Sarah Binder explained the four ways in which the Senate effort was unusually secretive. Sure, members of Congress would always rather pass legislation without dealing with negative criticism, but rarely have they gone so dark on such a big effort.

Here’s what’s in the new CBO report on the Republican health-care bill
The Congressional Budget Office has released its score on the revised American Health Care Act. Here’s what’s in the report. (Daron Taylor/The Washington Post)

The question that arises, though, is what Democrats could actually do about it. Binder told me that the answer was probably a simple one.

Nothing.

“I have a hard time seeing a real avenue for successful obstruction by the Democrats,” Binder said. The situation is unusual enough that making hard and fast predictions is tricky, she said, but “Republicans have been so aggressive on procedure here that I’d expect them to … get this through without any heed of what the Democrats were raising.”

In particular, Binder addressed a proposal outlined in a series of tweets last week by Ezra Levin, a former deputy policy director for House Democrats. Levin suggested that the Democrats could introduce an almost infinite number of amendments that would choke the Senate calendar indefinitely until they got what they wanted.

The plan hinges on the way in which the bill is being moved through the Senate. To avoid the need for Democratic votes — which the Republican majority wouldn’t get — the Obamacare replacement is being advanced using what’s known as the reconciliation process. That process involves a special set of rules that are meant to fast-track debate over the budget, but, given that it also means legislation can avoid a filibuster in the Senate, it has also been used to pass controversial bills. (Several fixes essential to the passage of Obamacare were moved using the reconciliation process, for example.)

Those rules, defined by law, include allowing only 20 hours for debate but it also includes a process called “vote-a-rama,” in which amendments may be proposed and must be voted on before the final passage of the bill. That’s where Levin’s idea comes in: He proposed introducing tens of thousands of amendments that would need to be voted on before the Senate’s bill could be passed. In theory, Levin figured, Democrats could introduce enough amendments to shut down the Senate for a year.

Binder disagrees.

“In reality, that’s not going to happen,” she said. What was more likely, she said, is that someone would make a point of order that the Democrats were being “dilatory” — that is, slowing down the process unnecessarily. The presiding officer — the Republican senator on duty to manage floor debate — would be asked to rule on whether that was the case and would likely agree. Democrats could appeal the decision, but a majority vote would end the process.

U.S. Senate Votes Near Unanimously (98-2) For Russia, Iran Sanctions

(THIS ARTICLE IS COURTESY OF REUTERS)

U.S. Senate votes near unanimously for Russia, Iran sanctions

By Patricia Zengerle | WASHINGTON

The U.S. Senate voted nearly unanimously on Thursday for legislation to impose new sanctions on Russia and force President Donald Trump to get Congress’ approval before easing any existing sanctions on Russia.

In a move that could complicate U.S. President Donald Trump’s desire for warmer relations with Moscow, the Senate backed the measure by 98-2. Republican Senator Rand Paul and Bernie Sanders, an independent who caucuses with the Democrats, were the only two “no” votes.

The measure is intended to punish Russia for meddling in the 2016 U.S. election, its annexation of Ukraine’s Crimea region and support for Syria’s government in the six-year-long civil war.

If passed in the House of Representatives and signed into law by Trump, it would put into law sanctions previously established via former President Barack Obama’s executive orders, including some on Russian energy projects. The legislation also allows new sanctions on Russian mining, metals, shipping and railways and targets Russians guilty of conducting cyber attacks or supplying weapons to Syria’s government.

“The legislation sends a very, very strong signal to Russia, the nefarious activities they’ve been involved in,” Senator Bob Corker, the Republican chairman of the Senate Foreign Relations Committee, said as lawmakers debated the measure.

If the measure became law, it could complicate relations with some countries in Europe. Germany and Austria said the new punitive measures could expose European companies involved in projects in Russia to fines.

The legislation sets up a review process that would require Trump to get Congress’ approval before taking any action to ease, suspend or lift any sanctions on Russia.

National flags of Russia and the U.S. fly at Vnukovo International Airport in Moscow, Russia April 11, 2017.REUTERS/Maxim Shemetov
Trump was especially effusive about Russian president Vladimir Putin during the 2016 U.S. election campaign, though his openness to closer ties to Moscow has tempered somewhat, with his administration on the defensive over investigations into Russian meddling in the election.

Putin dismissed the proposed sanctions, saying they reflected an internal political struggle in the United States, and that Washington’s policy of imposing sanctions on Moscow had always been to try to contain Russia.

The bill also includes new sanctions on Iran over its ballistic missile program and other activities not related to the international nuclear agreement reached with the United States and other world powers.

UNCERTAIN PATH IN HOUSE

To become law, the legislation must pass the House of Representatives and be signed by Trump. House aides said they expected the chamber would begin to debate the measure in coming weeks.

However, they could not predict if it would come up for a final vote before lawmakers leave Washington at the end of July for their summer recess.

Senior aides told Reuters they expected some sanctions package would eventually pass, but they expected the measure would be changed in the House. The Trump administration has pushed back against the bill, and his fellow Republicans hold a commanding 238- to 193-seat majority in the chamber.

Secretary of State Rex Tillerson questioned the legislation on Wednesday, urging Congress to ensure that any sanctions package “allows the president to have the flexibility to adjust sanctions to meet the needs of what is always an evolving diplomatic situation.”

Previously, U.S. energy sanctions had only targeted Russia’s future high-tech energy projects, such as drilling for oil in the Arctic, fracking and offshore drilling. They blocked U.S. companies such as Exxon Mobil, where Tillerson was chairman, from investing in such projects.

The new bill would slap sanctions on companies in other countries looking to invest in those projects in the absence of U.S. companies, a practice known as backfilling.

Also included for the first time are discretionary measures the Trump administration could impose on investments by companies in Western countries on Russia energy export pipelines to Europe.

The Senate also voted overwhelmingly on Thursday to add provisions to the bill allowing the U.S. space agency NASA to continue using Russian-made rocket engines and the 100 senators voted unanimously for an amendment reaffirming the U.S. commitment to the NATO alliance.

(Additional reporting by Tim Gardner; Editing by Yara Bayoumy and Tom Brown)

Senate Intelligence Committee: AG Sessions Flip-Flops And Lies His Way Throughout

(THIS ARTICLE IS COURTESY OF CNN)

Attorney General Jeff Sessions tried to have his cake and eat it too when it came to his explanations during congressional testimony Tuesday for the firing of FBI Director James Comey.

On the one hand, Sessions didn’t feel like he needed to stay in the Oval Office on February 14 when President Trump said he wanted to speak privately with Comey. And he didn’t feel the need to do anything following a meeting the two men had in the days that followed in which Comey expressed his discomfort with these one-on-one conversations with the president.
Sessions’ justification in both instances was that Comey was a total pro, that he knew his stuff and that Sessions trusted him to handle his business.
“I felt (Comey), so long in the department — former deputy attorney general, as I recall — knew those policies probably a good deal better than I did,” said Sessions at one point. At another, Sessions said: “Our Department of Justice rules on proper communications between the department and the White House have been in place for years. Mr. Comey well knew them, I thought and assumed, correctly, that he complied with them.”
On the other hand, Sessions told the Senate intelligence committee that he and deputy Attorney General Rod Rosenstein had discussed removing Comey as FBI director and agreed that it was time for a “fresh start” at the bureau before either man was confirmed to their current positions.
Huh?
Either Comey was the ultimate pro who could be trusted to handle his business or he was someone who Sessions had decided months before needed to go because he had badly mismanaged his role in the 2016 election. Comey can’t simultaneously be highly competent and a bungling, bumbling fool depending on what image suits Sessions’ needs at the moment.
But, time and again, Sessions tried to hold those totally oppositional thoughts in his head — and insisted that they weren’t at all contradictory.
As Sen. Jack Reed, D-Rhode Island, noted in Tuesday’s hearing, in July and again in October — following Comey’s initial announcement that Hillary Clinton had been “extremely careless” in her handling of her private email server and his decision to re-open the case in October — Sessions praised the then FBI director.
This exchange between Reed and Sessions is telling:
REED: So, in July and November, Director Comey was doing exactly the right thing. You had no criticism of him. You felt that in fact he was a skilled professional prosecutor. You felt that his last statement in October was fully justified. So how can you go from those statements to agreeing with Mr. Rosenstein and then asking the President, or recommending he be fired?
SESSIONS: I think, in retrospect, as all of us begin to look at that clearly and talk about it, as perspectives of the Department of Justice, once the director had first got involved and embroiled in a public discussion of this investigation, which would have been better never to have been discussed publicly, and said he — it was over. Then when he found new evidence that came up, I think he probably was required to tell Congress that it wasn’t over, that new evidence had been developed.
Uh, what?
If you get what Sessions is driving at in his response to Reed, you are a better — and smarter — person than me.
(Also worth noting: Comey testified, under oath, that Trump called him several times in the first part of this year to tell him how great a job he was doing.)
Then there was the fact, revealed in Sessions’ testimony yesterday, that he had never met with Comey to discuss what he took to be his poor performance.
This back and forth with Mark Warner, D-Virginia, the vice chairman of the intelligence committee, gets at that oddity:
WARNER: So you were his — his superior, and there were some fairly harsh things said about Director Comey. You never thought it was appropriate to raise those concerns before he was actually terminated by the President?
SESSIONS: I did not do so. A memorandum was prepared by the deputy attorney general, who evaluated his performance and noted some serious problems with it.
Take one giant step back. We know, because Donald Trump told us, that the real reason he fired Comey was because of the former FBI director’s approach to the Russia investigation. Trump said that after his administration had tried to sell the same case Sessions was selling on Tuesday: That Comey was removed because of a memo from Rosenstein.
That’s the fact. Everything else — including Sessions’ attempts to spin his views on Comey and the circumstances surrounding his firing — are simply post-action spin.

Republican House whip Steve Scalise shot in Virginia shooting

(THIS ARTICLE IS COURTESY OF CNN)

Republican House whip Steve Scalise shot in Virginia shooting

Story highlights

  • The shooting appears to be a “deliberate attack,” sources tell CNN
  • Scalise is the first member of Congress to be shot since former Arizona Rep. Gabby Giffords

Washington (CNN) Rep. Steve Scalise was shot Wednesday morning in Alexandria, Virginia, a House colleague told CNN, in what sources are calling an apparent “deliberate attack.”

The shooting took place at a practice for the GOP congressional baseball team.
Scalise, a member of the House Republican leadership as the majority whip, appeared to have been shot in the hip and it appeared two Capitol Hill police agents were shot, according to Rep. Mo Brooks, who told CNN he was on deck when the shooting occurred.
According to both congressional and law enforcement sources, the shooting appears to be a “deliberate attack.”
Two law enforcement sources told CNN the shooter, who is in police custody, has been taken to a hospital.
Kentucky Sen. Rand Paul, who was at the practice, told CNN “it would have been a massacre” had Capitol Police not been present.
“Nobody would have survived without the Capitol Hill police,” Paul said on CNN. “It would have been a massacre without them.”
Arizona Sen. Jeff Flake added that he saw a member of Scalise’s security detail return fire on the gunman for what felt like 10 minutes, even though the police officer was wounded in the leg.
“50 (shots) would be an understatement, I’m quite sure,” Flake said when asked about the total amount of gunfire, including police returning fire.
Flake said two members of Scalise’s security detail were wounded, and another man was wounded in the chest.
Once they were able, Flake said he and Rep. Brad Wenstrup, who is a physician, went out to where Scalise was lying after dragging himself away from the shooting to apply pressure to the wound. Scalise was coherent the whole time, Flake said.
The President is monitoring the situation, the White House said in a statement.
“The Vice President and I are aware of the shooting incident in Virginia and are monitoring developments closely,” President Donald Trump said in a statement. “We are deeply saddened by this tragedy. Our thoughts and prayers are with the members of Congress, their staffs, Capitol Police, first responders, and all others affected.”
Trump subsequently tweeted, “Rep. Steve Scalise of Louisiana, a true friend and patriot, was badly injured but will fully recover. Our thoughts and prayers are with him.”
House Speaker Paul Ryan and Republican Majority Leader Kevin McCarthy are safe on Capitol Hill and receiving updates, aides tell CNN. Neither was at the practice.
Brooks said there were a number of congressmen and congressional staffers lying on the ground, and at least one of them was wounded. The Alabama Republican said he used his belt as a tourniquet to help one of the victims.
He said the shooter appeared to be a white male but added that “I saw him for a second or two.” He said the shooter was behind the third base dugout and didn’t say anything.
“The gun was a semiautomatic,” Brooks said, adding that he was sure it was a rifle but unsure what kind. “It continued to fire at different people. You can imagine, all the people on the field scatter.”
Scalise is the first member of Congress to be shot since former Arizona Rep. Gabby Giffords was shot in January 2011. Giffords was shot in the head by Jared Lee Loughner at a “Congress On Your Corner” event at a Tucson grocery store. Giffords, who authorities said was the main target of the shooting, survived the attack but six others were killed and an additional 12 were injured.
Loughner pleaded guilty in 2012 and was sentenced to life in prison without the possibility of parole.
This story is breaking and will be updated.

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