President Donald Trump compared America to a nation under wartime occupation that needs to be liberated from illegal immigrants during a “Make America Great Again” rally in Ohio Tuesday night. Trump said illegal immigrant gang members are like “animals” and that they’re not using guns to kill people “because it’s too fast and it’s not painful… Continue Reading →
Donald Trump has spent about a week raging about Attorney General Jeff Sessions while also targeting others in his Twitter timeline. The former reality show star has been cyberbullying his own AG because he recused himself from the probe into whether the Trump administration colluded with Russia during the 2016 presidential campaign. Sessions did that after… Continue Reading →
God, this is gorge-inducing. Alone, he could’ve stopped the process he so dislikes in its tracks. He could’ve done it in a way that echoed through the ages. But he said, “yes.”
The Obama administration and congressional Democrats shouldn’t have forced through Congress without any opposition support a social and economic change as massive as Obamacare. And we shouldn’t do the same with ours.
Alas, this is an absolute lie, and an embarrassing one, and the Straight Talk Express is in the ditch. The Affordable Care Act was the product of endless hearings and at least 100 amendments proposed by Republicans. It was scored by the CBO. The Senate debated it for almost a month, and the senators knew what was in it. Right now, the bill that John McCain facilitated likely will be one that isn’t scored by the CBO, and the Freedom Caucus crackpots in the House are trying to defund the CBO and hand the job of scoring legislation to the Heritage Foundation. I would bet a substantial number of buffalo nickels that John McCain votes for whatever bill finally comes before him, no matter how many people’s lives that bill makes miserable.
I wanted this to be different. In 2000, I thought McCain might be the person to lead his party back to marginal sanity at least. But he wanted to be president, so he became like all the rest of them. Yes, he scolded that person who said Barack Obama was a Muslim, but he chose as his running mate a nutty person who still may believe he is. Yes, he put his name on a campaign finance reform bill, but he also voted for every member of the Supreme Court who subsequently eviscerated that law, and others like it, and he’s been absent from that fight ever since. There have been very few senators as loyal to the party line as John McCain. He has been a great lost opportunity to the country. Now, he will end his career as the face of whatever wretchedness is brought on the country by whatever the bill finally is.THERE HAVE BEEN VERY FEW SENATORS AS LOYAL TO THE PARTY LINE AS JOHN MCCAIN.
By the end of the afternoon, the Democrats had taken over one of the wide marble staircases outside the Capitol. They had walked across the piazza and onto the East Lawn of the Capitol to talk to some protesters, many of whom are struggling with diseases and disabilities that would be covered under the Affordable Care Act, and certainly under the Cadillac healthcare plan enjoyed by John McCain. It was a nice gesture, and they were warmly received, but there was something of the stunt to it.
The Republicans have the votes now. Dean Heller and Rob Portman and Shelley Moore Capito have lined up with their party once, and the likelihood is their respective prices will be met again because this is not a policy issue any more, it is pure politics now, a promise made by an extremist majority to its unthinking base. That’s what the end of this ugly day looked like, a day on which the final bloody death of Barack Obama’s legacy was placed on the fast track by people who know better, and on which Susan Collins of Maine was more of a maverick than John McCain ever was. It was an ugly day in the U.S. Senate, and there was nothing but ruin everywhere you looked.
Sen. Susan Collins forgot to turn her mic off after a Senate Subcommittee hearing and her conversations with Sen. Jack Reed (D) are the stuff of legends. Sen. Reed called Trump, “crazy” and Sen. Collins responded to a duel challenge by Rep. Blake Farenthold (R-Tex.) The two Senators discussed a host of Trump administration craziness including… Continue Reading →
Being Senate majority leader isn’t easy. And Mitch McConnell is finding out that having unified government could make it harder still.
As my research shows, U.S. Senate majority leaders represent several constituencies that push and pull in multiple – and usually conflicting – directions.
First, the leader is a senator responsible for representing the interests of his state – in McConnell’s case, Kentucky.
Second, like all majority leaders, McConnell is the leader of his party in the Senate, with an obligation to get more Republicans elected to office and to push a legislative agenda that burnishes the party label.
Third, as leader of the Senate, his duty is to sustain the institutional health of that chamber in its function as a counterweight to the whims of the House of Representatives, the ambitions of the executive branch and even the rulings of the judiciary.
Balancing the demands of the office’s various constituencies is sometimes further complicated by another demand on the Senate majority leader – the president, who in times of unified government becomes a fourth constituency to which the leader must answer.
Of course, that’s the position McConnell finds himself in with Donald Trump.
To understand why McConnell must answer to the president, it helps to know some history.
It started with Wilson
Unlike the speaker of the House, the U.S. Senate majority leader is not a constitutional office. Its functions were originally assumed to be the purview of the president of the Senate, a role played by the vice president, or in his absence, a senator acting as the president pro tempore.
That arrangement proved unsatisfactory to President Woodrow Wilson. Before entering politics, Wilson was an academic – a political scientist whose research advocated for parliamentary government. He became a president interested in legislating. Separation of powers meant that Wilson needed an advocate in the Senate to advance his plans for a “New Freedom,” as he called his program of progressive reforms. Senator John W. Kern, a Democrat from Indiana, became his willing partner, having proven himself a stalwart on progressive policy in his first two years in the Senate. In 1913, Kern – with the support of Wilson and progressives in the Democratic Party – won a contested leadership election in the Senate and was the first senator to be called “majority leader.”
The relationship between president and Senate majority leader was so close that in the secrecy of night Kern would walk from the Capitol to the White House to meet with Wilson to discuss legislative strategy. As majority leader, Kern became Wilson’s man in the Senate, managing the president’s agenda in committee and on the floor. He set a precedent that has continued for his successors – particularly when the same party controls the Senate and the White House.
Crazy like a fox
From this perspective, McConnell’s actions on health care are an entirely predictable strategy to meet the demands of his party and his president.
To repeal and replace the Affordable Care Act (“Obamacare”) has been the goal of congressional Republicans since before the law was passed. Among rank-and-file members of the GOP, it was a key factor in energizing a grassroots movement – the Tea Party – that delivered divided government for the final six years of the Obama administration. In that time, the Republican-led House voted more than 60 times to overturn the law. It’s no surprise, then, that Donald Trump found opposition to Obamacare fodder on the 2016 campaign trail and adopted Republican calls to repeal and replace the program.
Unlike Wilson, however, Trump shows no appetite for the minutia of crafting policy or the legislative process. Rather than leading with a specific health policy of his own, the president left it to his congressional Republicans to fulfill his promise to repeal and replace Obamacare.
Speaker Paul Ryan used his solid, but not overwhelming, majority to deliver a House bill. The burden then fell on McConnell to deliver for the Senate. A bill designed by 13 male senators working in secret failed to pass even the motion to proceed – twice. Apparently, without a substitute plan, McConnell then proposed a vote on repeal only, reserving a replacement for a future Congress. On this, too, his party is fractured. Three senators – Shelley Moore Capito of West Virginia, Susan Collins of Maine and Lisa Murkowski of Alaska – have said they won’t support the bill. That’s enough to keep it from even being debated.
Why call the vote?
But McConnell is not caving to the numbers. He intends to call a vote on a version of the healthcare legislation anyway.
Why? McConnell is attempting to balance the multiple constituencies of his office.
Trump has pledged to repeal and replace Obamacare. Despite – or perhaps because of – his hands-off approach to policymaking, he expects his Senate majority leader to work the legislative process to fulfill that promise. In calling for a vote – even one presumably destined to fail – McConnell serves as the president’s dutiful lieutenant, following orders even with no anticipation of victory.
He’s serving his party’s interests as well. Except for the few defectors among Republicans in the Senate, the party remains unified in its aim to roll back the signature piece of legislation from the Obama presidency. “Repeal and replace” has been the mantra of the past four elections that ushered many of the current members of Congress into office. The point of calling a failed vote is to establish a record of performance for those Republicans who vote for the repeal and especially for those who do not.
Political scientist David Mayhew described position-taking by members of Congress in which voting forces them to go on record and commit to an issue position. Often this strategy is used against the opposing party. Here, McConnell’s insistence on a vote to repeal Obamacare is a coercive tactic against members of his own party. It can be viewed only, I would argue, as a precursor to a purge, an attempt to identify those Republicans who, despite years of riding the repeal bandwagon, ultimately can’t bring themselves to abolish an established and popular entitlement program. The vote stands to be an ideological purifier that likely strengthens those who vote for repeal and ensures a primary challenge for those who do not.
But McConnell no doubt has his first constituency – the state of Kentucky – in mind as well. I’ve examined those rare instances when Senate majority leaders lose their seats. Here again the origins of the office are significant to the way it works today. That is, a majority leader’s electability is strongly tied to his relationship with the president.
Consider the examples of Tom Daschle and Harry Reid. As Senate majority leader from 2001 to 2003 and thus the highest-ranking Democrat, Daschle was forced to lead the opposition against President George W. Bush, who won Daschle’s home state of South Dakota with 60 percent of the vote.
On the flip side, Harry Reid found himself in a tough race in 2010. But as Senate majority leader, he had the advantage of serving a Democratic president who was popular in his state. Barack Obama won Nevada by a 12.5 percent margin over Republican John McCain in 2008. Being the president’s man wasn’t the only reason Reid won, but it was a factor in his victory against a Tea Party wave.
Donald Trump won Kentucky in 2016 with 62.5 percent of the vote, a margin of nearly 30 percent over Hillary Clinton and an increase of 8 percent over the Democratic nominee from 2012. As long as Trump remains popular in Kentucky and among Republicans, McConnell will find it possible to balance his multiple constituencies by being the president’s man in the Senate.
- What kind of person goes through brain surgery and rushes back to D.C. to make sure other people can’t afford brain surgery? He’s already announced he’s voting to let the motion proceed.
- Obviously, he thinks of the GOP as his “real” country.
- He’s done a lot of shitty, dishonorable things that are somehow sent down the memory hole when he occasionally acts like a human.
Fuck these wealthy Republicans. Never, ever, ever forget.
After failure of Republicans to reform health care, an outside observer might think that Congress is just dysfunctional, lurching from one extreme to another in search of something that works for health care reform.
The latest development has been the inability of Republicans to even agree on their own proposal and, worse yet, what should come next if it fails. Should they repeal the Affordable Care Act and worry about a replacement later or just try to “fix” the ACA now?
But the problem is much deeper than just a policy fix. As a former health insurance CEO and professor of health finance, it seems clear to me that Republicans are making five key implicit assumptions that are inherently problematic:
1. If it’s your own money, you’ll be more careful in how you’ll spend it.
This foundational belief rests on general experience in markets for most goods, and it has led to Republican support for Health Savings Accounts (HSAs), in which people set aside their own money to pay for their health care costs.
Landmark research showed that this approach could work – but under special conditions. The RAND Health Insurance Experiment is the basis for current HSAs. It demonstrated that people could save money – with no worsening of their health – if the cost sharing (deductibles and co-pays) was completely prefunded in individual HSAs. The only major exceptions were for kids and some chronic conditions.
But current proposals have extended this logic to populations, such as those with low incomes and few assets, where these findings are not applicable. Furthermore, HSAs generally are not fully funded to the levels used in the RAND research.
Yet, the Better Care Reconciliation Act, as the current Senate bill is officially called, adds a substantial boost to HSAs, and most state-level Medicaid proposals include a modestly funded health savings account. The problem with this Republican approach is that poor people don’t have any money to begin with and typically can’t afford to buy insurance or pay deductibles.
Furthermore, even those with more money aren’t very good at using their HSA money to shop for care, due to opaque prices for services and lack of information about treatment requirements.
2. Many or most poor people (Medicaid recipients) can work and should contribute to pay for insurance.
While the Medicaid expansion enrollees are working already (by definition, they have income above the poverty line), their job prospects and history are marginal. The 30,000 Medicaid recipients in the health insurance plan that I ran as CEO, for example, had about nine months of Medicaid eligibility before they got a job and lost coverage.
But the myth persists that Medicaid is loaded with moochers who simply do not choose to work and won’t pay for coverage anyway.
The fact is that very few fall in this category. Work requirements and required premiums may be simply a way to reduce Medicaid rolls using a faulty assumption.
3. Government restrictions are holding back insurers from competition that would drive costs lower.
Both the Senate and House alternatives cut restrictions and taxes on insurers. Most important of these are the broadening of the range of premiums allowed and the elimination or weakening of required essential health benefits, such as preventive care and maternity coverage. Undoubtedly, these changes will allow premiums to drop – but primarily for the healthy population that needs insurance less while others pay more.
Cross-state competition among insurers is a big Republican talking point. The rules of Congress exclude consideration for this particular legislation, however.
What’s more, it is wishful thinking that, with less regulation, there would be a flood of out-of-state insurers entering new markets and driving health care costs down. Insurers are able to compete on premiums by obtaining favorable contracts with providers. New entrants simply won’t get rates comparable to those already in a market.
In any event, the fact is that it is recent government-induced uncertainty that is driving insurers out of the market and forcing huge increases in premiums filed for 2018 offerings.
It is more than ironic that Senate Majority Leader Mitch McConnell suggested that they may need to “shore up the individual market” when the Congress has been the main reason for the instability.
4. Physicians should be the only ones making care decisions (with the consent of their patients) since they know best.
Health and Human Services Secretary Tom Price, an orthopedic surgeon, was a vocal advocate of this view – before he accepted the Cabinet job.
Recently, however, from my observations, he seems to have discovered that payment incentives and organizational innovation actually do improve quality, satisfaction and cost.
Perhaps acknowledging this, the Senate plan sought to extend these payment incentives and other ACA innovations through a new “Medicaid Flexibility Program” under its block grant options to the states.
Unfortunately, however, the total amount of funds available to state Medicaid programs would have been cut dramatically. On the principle, however, the Republicans seem to have conceded that health care is a team sport requiring action regarding incentives, organization and knowledge, much like the Democrats, albeit with less funding.
5. Government should help people – but not too much.
The original flat premium subsidies proposed by the House are both inadequate and regressive – hurting those with lower incomes. They would have covered almost all of the premium for young people but perhaps half for older enrollees. Also, they would go to everyone regardless of income, unlike Obamacare subsidies, which were based on a defined percent of the purchaser’s income.
The Senate partially corrects this bad arithmetic – and economics – by allowing subsidies to vary somewhat by income. Unfortunately, the base level is far lower than under the ACA. Subsidies are cut substantially for the poor while giving the wealthy tax relief.
So the bottom line is that the implosion of the Obamacare exchanges that Republicans have predicted may become a self-fulfilling prophecy under continued threats to sabotage it by administrative action or inaction.
Unfortunately, even with the demise of the Senate bill, it is likely that the grand experiment of Obamacare – advancing the social objective of a fully insured population using a competitive but regulated marketplace – will fade away as insurers run away from unpredictable markets.
We may come full circle. We could end up with a dysfunctional individual market and a much smaller Medicaid population with many more uninsured people. Once again, Republicans and Democrats continue to debate specifics – rather than deal with differences in beliefs – in an evidence-free brawl.
— AM Joy w/Joy Reid (@amjoyshow) July 23, 2017
That’s right. This is much bigger than Donald Trump.
“Can we accept a president who resists any attempts to hold him in check with the law?” The question really is, how far do Republicans let him go?
The GOP enables him, every step of the way. These are dangerous times.
Would you go to war against your fellow Americans to show your support for President Donald Trump? For the last several months, that’s exactly what broadcaster Alex Jones—a favorite of the president—has been calling for.
In his radio show, on YouTube and on his Infowars website, Jones—who never met a conspiracy theory he didn’t like and who has pushed the notion that Sandy Hook was faked—has been announcing that the United States is on the verge of a bloody second civil war. Like the radio DJs in Rwanda, Jones has been egging on his conservative listeners and viewers—an estimated 2.7 million people monthly—to kill more liberal fellow citizens over their political differences.
Jones is hardly alone in promoting this scary, emerging narrative on the right. The theme gained momentum after the shooting at the congressional baseball game last month. The day before the attack, on June 13, right wing broadcaster Michael Savage, host of syndicated show The Savage Nation, warned that “there’s going to be a civil war” because of “what this left-wing is becoming in this country.” After the baseball field shooting the next day, he said that he “know[s] what’s coming, and it’s going to get worse.” Savage also said of the shooting that “this blood is on [Democrats’] hands.”
After the shooting, Newt Gingrich opined on Fox that “we are in a clear-cut cultural civil war.” Former GOP speechwriter Pat Buchanan wrote that the appointment of a special prosecutor and political street clashes presage a “deep state media coup” and that the nation is “approaching something of a civil war,” and it’s time for Trump to “burn down the Bastille.”
But few commentators can match the relentless hysteria and reach of Jones. His recent YouTube video titles telegraph the tone: “Get Ready For CIVIL WAR!” and “First Shots Fired in Second US Civil War! What Will You Do?” and “Will Trump Stop Democrats’ Plan for Violent Civil War?”
Jones’s followers have already turned broadcaster words into violent action. Last year, Edgar Maddison Welch drove from North Carolina to Washington, D.C., to fire on a pizza restaurant Jones had been saying was a front for Democratic pedophiles and Satanists. Court records indicate he had been talking to his friends about Jones’s theories before he went on his mission. In 2014, a right-wing couple, self-described Infowars fans Jerad and Amanda Miller from Indiana, killed two police officers after posting screeds on Infowars. Jones later theorized that the shooting was a false flag intended to discredit the right.
Media Matters for America (MMA), a progressive research organization, has staff assigned to track Jones Infowars shows daily. According to spokesman Nate Evans, right-wing media has been advocating violence more since Trump was elected, but Jones “has been particularly crazy about it.”
CBO lands on repeal-and-delay with a thud:
— 32 million more uninsured
— Greg Sargent (@ThePlumLineGS) July 19, 2017