House May Need to Vote Again on GOP Obamacare Repeal Bill

House Republicans barely managed to pass their Obamacare repeal bill earlier this month, and they now face the possibility of having to vote again on their controversial health measure.

House Speaker Paul Ryan hasn’t yet sent the bill to the Senate because there’s a chance that parts of it may need to be redone, depending on how the Congressional Budget Office estimates its effects. House leaders want to make sure the bill conforms with Senate rules for reconciliation, a mechanism that allows Senate Republicans to pass the bill with a simple majority.

Republicans had rushed to vote on the health bill so the Senate could get a quick start on it, even before the CBO had finished analyzing a series of last-minute changes. The CBO is expected to release an updated estimate next week.

“Unaware,” said Representative Jeff Denham of California, with noticeable surprise Thursday, when advised that his party leaders still hadn’t sent the bill over to the Senate. Denham was one of the House Republicans who ended up voting for the measure, after earlier in the week opposing it.

“I am on the whip team and we have a lot of conversations, but we have not had that one. So I am going to look into it,” said Denham, a member of the party’s vote-counting team.

In the Senate, the bill must hit separate $1 billion deficit reduction targets in the jurisdiction of the Finance Committee and the chamber’s health committee. Republican aides said failing to meet those numbers would force the House to fix the bill even if the legislation meets the overall cost-savings target.

If Republican leaders hold onto the bill until the CBO report is released, then Ryan and his team could still redo it if necessary. That would require at least one more House vote of some sort.

Ryan told conservative radio host Hugh Hewitt on Friday that he doesn’t think the House will need to vote again on the health law. “We just want to, out of an abundance of caution, wait to send the bill over to the Senate when we get the final score,” Ryan said.

It’s unclear what assumptions the CBO will make about what states will do with that newly created flexibility. If millions of people sign up for much cheaper, minimal insurance, that could trigger billions — and potentially even hundreds of billions — in costs over a decade because of the House bill’s health insurance tax credits.

Read the complete article on Bloomberg web site.

Republican infighting is part of being Republican


‘Working together, this unified Republican government will deliver relief and peace of mind to the millions of Americans suffering under Obamacare,’ Paul Ryan said despite health advocates’ criticism of bill. Photograph: J Scott Applewhite/AP

Trumpcare failed to pass but the real problem is that the Republican Party is plagued by partisan infighting. Mr. Trump was able to use the ideological differences between factions in the party to his advantage during the election campaign. Not only did he overthrow the party’s traditional leadership, he united many of the other competing interests in the party.

But the campaign is over now. The factions in Congress are starting to make the President’s life much more difficult. What’s the basis of Republican disunity? Aren’t Republicans, whether elites or voters, all staunch conservatives who oppose the Democrats?

Jon MacKay is an affiliate researcher of the Waterloo Institute for Complexity and Innovation. William Bendix is assistant professor of political science at Keene State College, in New Hampshire. Together they examined how several hundred interest groups have rated congressional Republicans since 2001. They found three distinct factions that were stable over time. Each represented different sets of ideological interests. The party leaders reside in what we call the corporate-establishment faction – a group that advances pro-business policies. The difficulty is that two other Republican factions also compete for power: a lunch-pail faction, whose members focus on working-class issues, and an ethno-radical faction, whose members support a mix of nativist and fiscally regressive policies. You can read their research here…. 2016 08 18 Bendix & MacKay Partisan Republican Infighting

What’s become clear is that any policy decision Donald Trump makes is now likely to produce as many losers as winners within their party’s coalition.

After the health-care defeat, Mr. Trump has said he’ll next turn to tax cuts, dramatically lowering taxes across the board. His plan, estimated to reduce federal revenues by $6-trillion (U.S.) over ten years, will provide much greater tax relief to the affluent than it will to middle- and working-class voters. This makes it, in many respects, a mainstream Republican proposal.

But that’s the problem. Massive revenue cuts need to be offset by large spending cuts, otherwise the national debt will balloon. Mr. Trump wants to boost military spending, cut taxes and slash industry oversight and entitlement programs. That likely suits the corporate establishment and the ethno-radicals of the party, but it will outrage most everyone else – including lunch-pail voters. True, Trump could cut taxes and increase spending without totally blowing up the budget by issuing 100-year bonds. But it’s hard to imagine the ethno-radicals supporting this big-government, big-debt strategy.

Trade protectionism, another pillar of Mr. Trump’s election campaign, is the most important issue for Canada. Although famously inconsistent on many issues, Trump has been unwavering on trade. He has already abandoned the Trans-Pacific Partnership and has said that he wants to reopen NAFTA, impose tariffs on individual firms, and possibly withdraw the U.S. from the World Trade Organization.

These promises are aimed at lunch-pail Republicans, who have seen manufacturing jobs disappear over the last three decades. But this anti-trade agenda is at odds with the corporate establishment of the party – which has, since at least Ronald Reagan, advocated trade liberalization.

You may read the complete article on the Globe and Mail newspaper web site.

Trump discovers politics isn’t like business

Donald Trump listens to a speaker in the East Room of the White House on Friday. Photograph: Mandel Ngan/AFP/Getty Images

Donald Trump is used to running private companies with him as President, and enjoying the Presidential power private companies provide. Now he finds being President of the United States isn’t the same as being President of Trump Organization.

Republicans, who voted more than 60 times to repeal or alter Obamacare over the past few years only to be vetoed by Obama, had got their big chance and blown it. The party’s deep ideological and factional divisions, temporarily papered over amid the euphoria of last November’s surprise win, were back with a vengeance as it struggled to go from opposition to governance.

In Trump’s rambunctious election campaign, the 70-year-old novice promised to repeal and replace the ACA “immediately”. It was a bad choice for an opening offensive. Healthcare reform is to American presidents what the Russian winter was to Napoleon.

Trump has said tax reform is next, and years of Republican planning might allow for that legislation to pass more easily. But his ability to work with Congress is in grave question. His unique selling point, as a dealmaker, has taken a huge hit.

Gwenda Blair, a Trump biographer, said of Trump’s supporters: “They voted for a guy who could fix it, the CEO, on The Apprentice for 10 years, who could make a deal with anybody.”

But the tactics that served Trump so well in business – playing the alpha male, holding one-on-one meetings – did not translate to politics, she said.

“Now he’s up against 535 other people [in the House and Senate], other people who have their own independent power base and are not really interested in rolling over. The model of taking one person in a room and beating up on them doesn’t work with 535.”

But as the health care bill negotiations gathered steam, it was clearly not going to be plain sailing. Last month, Trump admitted: “Now, I have to tell you, it’s an unbelievably complex subject. Nobody knew healthcare could be so complicated.” The bill was, in the eyes of many, rushed and deeply flawed, falling well short of Trump’s campaign pledge to provide insurance for everyone.

Grassroots protests erupted across the country, citizen activists hitting the phones and constituents berating congressmen at town hall events. Groups representing hospitals and medical professionals derided the legislation. The non-partisan Congressional Budget Office estimated that the AHCA would lead to 24 million fewer Americans having health insurance over the next 10 years. The bill achieved the rare feat of uniting the far left and far right in opposition.

Friday’s failure was a fillip for the anti-Trump “resistance” but it was hardly grounds for complacency. The president looks set to press ahead with his agenda on everything from rolling back Obama-era protections on the environment to building a wall on the Mexican border to firing off tweets that alienate allies and embolden enemies.

He may also ensure that his prediction of Obamacare’s explosion becomes a self-fulfilling prophecy. “Move fast and break things” will continue, even it if means breaking his own party.

Read the complete article on The Guardian newspaper web site.

Budget Office says Trump’s healthcare bill favors wealthy

Donald Trump: pointing the way toward … more of the same for the wealthy, actually. Photograph: Timothy A Clary/AFP/Getty Images

Effects on Health Insurance Coverage

To estimate the budgetary effects, Congressional Budget Office (CBO) and Joint Committee on Taxation (JCT) projected how the legislation would change the number of people who obtain federally subsidized health insurance through Medicaid, the nongroup market, and the employment-based market, as well as many other factors.

CBO and JCT estimate that, in 2018, 14 million more people would be uninsured under the legislation than under current law. The increase in the number of uninsured people relative to the number under current law would rise to 21 million in 2020 and then to 24 million in 2026.

The reductions in insurance coverage between 2018 and 2026 would stem in large part from changes in Medicaid enrollment—because some states would discontinue their expansion of eligibility, some states that would have expanded eligibility in the future would choose not to do so, and per-enrollee spending in the program would be capped.

In 2026, an estimated 52 million people would be uninsured, compared with 28 million who would lack insurance that year under current law.

Most of that increase would stem from repealing the penalties associated with the individual mandate. Some of those people would choose not to have insurance because they chose to be covered by insurance under current law only to avoid paying the penalties, and some people would forgo insurance in response to higher premiums.

Effects on Premiums

The legislation would tend to increase average premiums in the nongroup market prior to 2020 and lower average premiums thereafter, relative to projections under current law. In 2018 and 2019, according to CBO and JCT’s estimates, average premiums for single policyholders in the nongroup market would be 15 percent to 20 percent higher than under current law, mainly because the individual mandate penalties would be eliminated, inducing fewer comparatively healthy people to sign up.

Starting in 2020, the increase in average premiums from repealing the individual mandate penalties would be more than offset by the combination of several factors that would decrease those premiums: grants to states from the Patient and State Stability Fund (which CBO and JCT expect to largely be used by states to limit the costs to insurers of enrollees with very high claims); the elimination of the requirement for insurers to offer plans covering certain percentages of the cost of covered benefits; and a younger mix of enrollees.

By 2026, average premiums for single policyholders in the nongroup market under the legislation would be roughly 10 percent lower than under current law, CBO and JCT estimate.

Although average premiums would increase prior to 2020 and decrease starting in 2020, CBO and JCT estimate that changes in premiums relative to those under current law would differ significantly for people of different ages because of a change in age-rating rules.

Under the legislation, insurers would be allowed to generally charge five times more for older enrollees than younger ones rather than three times more as under current law, substantially reducing premiums for young adults and substantially raising premiums for older people.

Helping the richest

For many lower-income people, the new tax credits under the legislation would tend to be smaller than the premium tax credits under current law. Conversely, the tax credits under the legislation would tend to be larger than current-law premium tax credits for many people with higher income.

Read the complete CBO report in PDF….  americanhealthcareact_CBO

‘Trump lies all the time’: Bernie Sanders

has launched a withering attack on Donald Trump, accusing him of being a pathological liar who is driving America towards authoritarianism.

In an interview with the Guardian, the independent senator from Vermont, who waged a spirited campaign for the Democratic presidential nomination in 2016, gave a bleak appraisal of the new White House and its intentions.

He warned that Trump’s most contentious outbursts against the media, judiciary and other pillars of American public life amounted to a conscious assault on democracy.

“Trump lies all of the time and I think that is not an accident, there is a reason for that. He lies in order to undermine the foundations of American democracy.”

Bernie Sanders on the resistance movement in Trump’s America – video

Sanders’ warning comes 50 days into the Trump presidency at a time when the country is still reeling from the shock elevation of a real estate businessman and reality TV star to the world’s most powerful office. In that brief period, the new incumbent of the White House has launched attacks on former president Barack Obama’s signature healthcare policy; on visitors from majority-Muslim countries, refugees and undocumented immigrants; and on trade agreements and environmental protection programs.

Speaking to the Guardian in his Senate office in Washington DC, Sanders said that he was concerned about what he called Trump’s “reactionary economic program of tax breaks to billionaires and devastating cuts to programs that impact the middle class”. But he reserved his most excoriating language for what he believes are the president’s authoritarian tendencies.

He charged Trump with devising a conscious strategy of lies denigrating key public institutions, from the mainstream media to judges and even the electoral process itself, so that he could present himself as the sole savior of the nation. The aim was to put out the message that “the only person in America who stands for the American people, the only person in America who is telling the truth, the only person in America who gets it right is the president of the United States, Donald Trump”.

Trump’s fragile relationship with the truth has been one of the distinguishing features of his fledgling administration. He astonished observers by calling a judge who issued a legal ruling blocking his travel ban a “so-called judge”, accused Obama without producing any evidence of wiretapping Trump Tower, and claimed falsely that up to 5 million votes had been cast illegally in the November election.

Read the complete article in The Guardian newspaper web site.