The Republican Health Care Plan Screws Many To Help Very Few

It looks like Republicans think that America has been demanding a new health care plan which will greatly reduce the number of people who are insured, increase costs for poor and older Americans, destabilize the individual insurance market, and cut taxes for the wealthy. While waiting for the CBO scoring, the Brookings Institute has made their calculations as to how terrible the Republican health care bill is, predicting that at least 15 million people will lose health care coverage:

There is significant uncertainty about exactly how CBO will model these provisions and how it will expect the various provisions to interact with one another. Nonetheless, we conclude that CBO’s analysis will likely estimate that at least 15 million people will lose coverage under the American Health Care Act (AHCA) by the end of the ten-year scoring window. Estimates could be higher, but it’s is unlikely they will be significantly lower.

 

Many will suffer from the cuts to Medicaid. Many of those who purchase private coverage on the exchanges will suffer because of how the subsidies are restructured, based on age as opposed to income and the actual costs of insurance. The Kaiser Family Foundation has posted projections regarding this.

Medical organizations and those representing the elderly including AARP, the American Medical Association and the American Hospital Association have objected to the Republican plan. AARP issued a statement opposing the “House plan that would make changes to our current health care system, such as shortening the life of Medicare, hiking costs for those who can least afford higher insurance premiums, risking seniors’ ability to live independently, and giving tax breaks to big drug companies and health insurance companies.”

The less affluent voters who backed Trump will be hurt by the changes. Of course some people do benefit. “Nearly everyone in the Top 1%, who earn more than $774,000 a year, would enjoy a hefty tax cut, averaging $33,000, according to the non-partisan Tax Policy Center. Those in the Top 0.1% would get an average tax cut of about $197,000.” Insurance companies also benefit:

Obamacare allowed insurance companies to deduct only $500,000 of their executives’ pay as a business expense. The GOP bill would repeal that limitation, starting in 2018.

Top insurers pay their leaders millions in compensation every year so this provision could mean a nice tax savings for the companies.

One excuse given by Republicans for repealing Obamacare is the increased cost of premiums. However, most people receive health care coverage through either government programs or employer programs, which have not had major increases in premiums. The individual market had frequent jumps in premiums, and that has continued, except under Obamacare most people receive subsidies to help cover this. As a consequence, only about three percent of the country is actually facing the increases in premiums which Republicans are using to justify their plan. In return, we receive more comprehensive coverage which cannot be denied based upon medical problems.

As one of the three percent who purchases health insurance without qualifying for subsidies, I certainly do not see the Republicans as doing me any favors. My premiums will be higher under the Republican plan than they are now, and the even bigger problem is that the plan may “threaten the stability of the individual market” per the Brookings report, possibly making it impossible to obtain coverage.

 

Discussing Obamacare Replacement With A Republican Congressman

House Republicans have finally released their plan to replace Obamacare. I have a lot of concerns about the plan, such as whether the tax credits will be sufficient for low income families to afford health insurance, and their attack on Planned Parenthood.

I am going to wait until I have a chance to look at the details of the plan to discuss it in depth, but for other reasons I have found it a good day to blog about health care. Hours prior to the release of the plan, I met with my conservative Republican Congressman, Bill Huizenga, along with a few colleagues, to discuss health care. I figured it would be futile to change the mindset of a conservative Republican, but when I received the invitation I also thought I should make the attempt to try to explain how health care really works. After all, there is zero chance of changing anyone’s mind if no attempt is made to persuade them. I was also appreciative that he was willing to meet with a group which strongly disagreed with him on the issue, while many Republicans around the country are reportedly hiding from their constituents.

The first time I spoke today I made a point of explaining how I am self-employed and have purchased health care on the individual market for my entire life. Therefore I could definitely state that high premiums and high out of pocket expenses, often cited as a failing of the Affordable Care Act by Republican, have always been a characteristic of the individual market–and are not something created by Obamacare.

Discussion got bogged down for quite a while over philosophical issues, especially when someone referred to health care as a right. Congressman Huizenga disagreed. While I managed to get out most of what I wanted to say today, in a conversation with multiple people present, sometimes the topic changed before I got a chance to speak. I didn’t get a chance until after the meeting while speaking to a colleague that I can understand a Republican’s position in not seeing health care as a Constitutional right in the same way as civil liberties specifically expressed in the First Amendment. After all, the Founding Fathers would have never conceived of health care being as expansive, and expensive, as it is now. However, regardless of whether you want to call it a right, access to affordable health care is both highly desirable, and something which is expected in a modern, advanced, industrialized society such as the United States. We should do it regardless of whether you want to label it a right.

The limited nature of assured coverage in the United States, compared to the rest of the world, was an underlying thought in many of our comments. It did come up that 1) the sick can show up to the Emergency Room and will not be turned away and 2) a significant portion of the Medicare population consists of the disabled. In typical Republican dodging of the issue, the Congressman at one point tried to claim that this does provide some form of basic health care as people can go to the Emergency Room. I pointed out that it is one thing to receive coverage in the Emergency Room, but this does not mean that people will receive necessary follow up medical care, especially for the types of chronic medical conditions I typically treat, such as diabetes, heart failure, and emphysema. Initial stabilization in an Emergency Room is both costly and not adequate health care. Plus an Emergency Room physician present pointed out that being seen does not mean patients do not receive large bills, which could be well beyond their ability to pay.

Congressman Huizenga responded that the disabled can receive coverage on Medicare, but I pointed out that people with chronic medical problems are not necessarily disabled, especially if they receive adequate medical treatment. Someone with diabetes, for example, can live and work for many years with the condition. However, without adequate care, twenty years down the road they are far more likely to develop problems such as heart attacks, strokes, and renal failure.

The Congressman’s philosophy on limited government (which, like most Republicans, is terribly selective, ignoring everything from infringements on reproductive rights to today’s revised anti-Muslim travel ban), also influenced his responses. Before his arrival I had discussed with others how market solutions have not worked well, with insurance companies having developed a business strategy based upon collecting premiums and then finding ways to deny care. Congressman Huizenga brought up irrelevant matters such as restrictions on choice present in Canada and other countries which Americans might not tolerate. The typical Republican scare stories. My response was simply that we do not have to adopt the restrictions which he mentioned, regardless of what other countries have done. One point I did not manage to get in was that in the United States, private insurance plans are often far more restrictive on the choices which patients and physicians can make than the government Medicare program is.

The physicians present generally saw Obamacare as an improvement over the previous system, but not going far enough, with Medicare for All being seen as a preferable solution. As a couple of us discussed afterwards, this is a far easier sell for physicians, who see first hand the amount of time and money wasted in having to deal with multiple different insurance companies, with  multiple different sets of rules. Plus this has the huge advantage of taking the astronomical profits received by the insurance industry, and using that money to actually provide health care. (Medicare for All was promoted by Bernie Sanders in the 2016 nomination battle, leading to politically-based opposition from Hillary Clinton.)

If Medicare for All is too hard a sell immediately, I, and others, suggested phasing it in. I also mentioned ideas such as the public option and the Medicare buy-in which were considered when the ACA was being written, but died when the two most conservative Senators voting with the Democrats (Joe Lieberman and Ben Nelson) opposed the ideas. Either would help with the high costs on the individual market.

The  higher cost for caring for older individuals, with some of that cost spread to the premiums of younger purchasers, is a major problem in health care coverage.  I doubt insurance companies even want to cover their older customers, who are responsible for the bulk of their costs. Either outright lower the Medicare age (even if gradually, such as initially to 50 or 55, and ultimately to around 40) or allow a Medicare buy-in.

After the Congressman left, his Legislative Director remained for a brief time and suggested that Americans would not go for expanding a government program such as Medicare. While a typical Republican thought, it does not hold up. I pointed out that we all do wind up on a government program, with most people going on Medicare at age 65. Not only are Americans failing to rebel at the though of going on Medicare at age 65, many look forward to the opportunity. Remember all those tea party protests with signs like “Keep Government Out Of My Medicare.”

My parting comment to Congressman Huizenga before he left was that Republicans must move beyond their anti-Obama rhetoric and actually address the problem. I related how for the past eight years I have often heard patients blame Obama for anything wrong with the health care system, even if it was over matters not even related to the Affordable Care Act. However, in early January, before Donald Trump even took office, I started to hear patients blame Trump for their healthcare problems. Republicans now “own” healthcare and must deliver.

I have my doubts as to whether the plan released today does deliver, but I do want to take a look at the details beyond what is in the initial news stories I have read.

Jeff Sessions Exposed For Lying To Senate About Meeting With Russian Ambassador

As with every other bit of news which comes out with regards to Russia and the Trump administration, the news that Jeff Sessions spoke with the Russian ambassador raises more questions. Without knowing what he spoke to him about, it is not possible to determine how much this matters. It might be no big deal if the Russians were just trying to get more information about Donald Trump, but it could be the biggest political scandal in American history if it were to turn out that the Trump campaign was actively working with Russia to attempt to rig the election.

As of now we only have evidence that Russia probably tried to influence the election, with questionable impact considering that the material released by WikiLeaks all appears to be factual. There is no evidence at this time of any conspiracy between Trump and Russia, and this needs to be investigated independent of any partisan concerns.

Having Sessions involved creates two new wrinkles to the case. First, he lied to the Senate about the matter. Secondly, as Attorney General, it is impossible to see how he could be trusted to be involved in this investigation. He has agreed to recuse himself from the investigation, which is the least he could do, but only after having been exposed for lying to the Senate.

Many are calling for more. Arn Pearson, a senior fellow at People For the American Way, wrote in USA Today that Sessions has destroyed his credibility and must go:

Not only is Sessions’ impartiality being questioned, his honesty to Congress and the American people has been thrown into doubt. Sessions must not only recuse himself from future investigations into the Russian influence scandal, which he did on Thursday, he must resign.

Lying under oath and intentionally making a false and misleading statement to Congress are crimes under federal law. In 1999, Sessions voted to convict Bill Clinton of perjury in the Monica Lewinsky scandal, having earlier said that, “I have no doubt perjury qualifies under the Constitution as a high crime.”

Whether or not Sessions did in fact commit perjury is a matter for Congress and the judicial process to decide, but there is certainly sufficient cause for investigation. What is not in doubt is that he seriously misled the Senate Judiciary Committee.

Sessions is doing his best to equivocate, saying he did not discuss the elections with Kislyak and met with him as a member of the Armed Services Committee, not the Trump campaign. But that wasn’t Sen. Al Franken’s question. Franken asked about any communications with the Russian government, and Sessions responded with his blanket statement about not having had communications with the Russians.

Sessions’ explanation doesn’t hold much water. The Washington Post reached all 26 members of the 2016 Armed Services Committee including Chairman John McCain, and Sessions was the only one who met with Kislyak that year. And Sessions’ meetings with the Russian ambassador came in the heat of the presidential campaign: first in July — the same month Sessions formally nominated Trump for president at the Republican National Convention and delegates were making pro-Russia changes to their platform; and then again in September — when concerns about Russian hacking dominated the news.

It is hard to imagine how Sessions could think those meetings were not worth mentioning during his confirmation hearing.

Richard Painter agreed in an op-ed in The New York Times. He compared this to when Richard G. Kleindienst was forced to resign as Attorney General in 1972 during the Watergate scandal:

Once again, we see an attorney general trying to explain away misleading testimony in his own confirmation hearing. A spokeswoman for Mr. Sessions says that “there was absolutely nothing misleading” about his answer because he did not communicate with the ambassador in his capacity as a Trump campaign surrogate. His contacts with the Russian ambassador, he claims, were made in his capacity as a member of the Senate Armed Services Committee.

That may or may not have been the case (individual senators ordinarily do not discuss committee business with ambassadors of other countries, particularly our adversaries). Regardless, Mr. Sessions did not truthfully and completely testify. If he had intended to say that his contacts with the Russians had been in his capacity as a member of the Senate Armed Services Committee and not for the Trump campaign, he could have said that. He then would have been open to the very relevant line of questioning about what those contacts were, and why he was unilaterally talking with the ambassador of a country that was a longstanding adversary of the United States…

President Trump has already fired his national security adviser, Michael Flynn, for misleading Vice President Pence about his conversations with the Russians. Misleading the United States Senate in testimony under oath is at least as serious. We do not yet know all the facts, but we know enough to see that Attorney General Sessions has to go as well.

Trump Reduces Nations’s Fears Of A Madman In The White House In Speech To Congress

After just over a month of Donald Trump’s presidency, Americans have very low expectations. His speech to Congress (transcript here) was received very favorably as he did not attack the media, or anybody else, and there wasn’t a single false claim about how large his election victory was. He even managed to wear a good looking tie which was not too long.

The speech boosted optimism. Hopefully that came more for a general feeling of decreased panic over fears that we might have an insane president, as opposed to any true belief in his policies. While the preliminary polls do show support for his agenda, viewers are often initially supportive of the speaker. The devil is in the details, and he gave very little detail as to how his general principles could turn into legislation. As Politico put it, Last night, Trump promised America could have all the cake it wants, and lose weight, too. What happens when he needs to deliver? Unfortunately this point seemed to be lost by many in the media who gushed over the speech, relieved that they were not attacked once again.

Brian Beutler also pointed this out, among several other failings in the speech which the media has paid too little attention to:

He alluded to courtroom convictions to create the false impression that terrorism in the U.S. is principally a consequence of weak vetting and porous borders—a false justification for his Muslim ban, which the courts have enjoined. He cited an increase in homicides in 2015 to foster the impression that violent crime is at a historic high, rather than a historic low. He outsourced to Defense Secretary James Mattis a lie about a raid he ordered in Yemen—which resulted in the death of a Navy SEAL, numerous civilians, and an eight-year-old American girl—falsely heralding it as “a highly successful raid that generated large amounts of vital intelligence.” Hours earlier, Trump had blamed his own military planners and Obama for its obvious failure. He also claimed to support NATO, which he has previously described as obsolete.

Fact checkers, including The Washington Post, PolitiFact, and Factcheck.org had their usual lists of falsehoods from Donald Trump. These might not matter with regards to public perception of the speech. The facts will matter when they try to govern based upon fantasy.

Opposition To Trump Could Cost Republicans Control Of Congress

I have said many times that the party winning the 2016 presidential election would very likely suffer for it, considering how flawed and unpopular both candidates were. If Hillary Clinton had won, most likely we would see Democrats lose further seats in Congress and the state legislatures in 2018 and 2020. Opposition to Donald Trump should help the Democrats, especially with Hillary Clinton not on the ballot. The elections will largely be a referendum on Donald Trump. Will Jordan recently showed that historically a president with an approval rating as low as Trump’s typically  loses thirty-nine House seats, with the Democrats needing twenty-four votes to retake the House. Larry Sabato had similar findings:

History is on the Democrats’ side: The president’s party has lost ground in the House in 36 of 39 midterms since the Civil War. The average loss is 33 seats, a shift in seats that would flip the House next year. Unpopular presidents can galvanize the opposition — and Democrats already seem highly engaged in battling Trump — and President Trump’s approval rating is already underwater in some polls, meaning he hasn’t had much of a honeymoon. Of course, there’s plenty of time for that to change, both positively and negatively for the president.

While it is far too early to be certain that Trump’s approval rating will remain at its currently low levels, there is considerable cause for concern among Republican House members. This is exacerbated by the complaints many are seeing from their constituents. CNN has reported on the anger at Republican town halls and  The Washington Post reports that Swarming crowds and hostile questions are the new normal at GOP town halls:

Republicans in deep-red congressional districts spent the week navigating massive crowds and hostile questions at their town hall meetings — an early indication of how progressive opposition movements are mobilizing against the agenda of the GOP and President Trump.

Angry constituents swarmed events held by Reps. Jason Chaffetz (Utah), Diane Black (Tenn.), Justin Amash (Mich.) and Tom McClintock (Calif.). They filled the rooms that had been reserved for them; in Utah and Tennessee, scores of activists were locked out. Voters pressed members of Congress on their plans to repeal the Affordable Care Act, on the still-controversial confirmation of Education Secretary Betsy DeVos and even on a low-profile vote to disband an election commission created after 2000.

House Republicans had watched footage earlier this week of McClintock’s raucous town hall in northern California and his police-assisted exit — a warning of what might come. And with Congress scheduled for a week-long recess and a raft of additional town halls starting Feb. 18, the warning may have been warranted…

Remembering how voter anger and heated town halls helped end Democratic control of Congress in 2010, Republicans have begun taking security precautions. Some have avoided in-person town halls, holding forums on Facebook or by telephone instead. Many were briefed on security recommendations for public events and their district offices at a closed-door meeting led by Rep. Dave Reichert (R-Wash.), a former county sheriff.

If the Democrats are to retake Congress, it will depend on Trump’s popularity remaining low. Pollsters such as Mark Blumenthal are looking at both whether it is likely to remain low, and how low it can go:

One striking characteristic of Trump’s initial job rating is the relative intensity of disapproval. In our most recent full week of tracking, for example, far more Americans strongly disapprove of the way Trump is handling his job (41 percent) than strongly approve (29 percent). That gap means that Trump’s overall 46 percent approval rating includes 17 percent who only “somewhat approve” of his performance…

One of the themes of new administration, as the NBC News Politics team recently noted, is how “Trump picks fights with, well, almost anyone.” Those stories help reinforce the perception of his toughness and outspokenness.

The downside of these “sprays of attack,” as CNN’s Jake Tapper called them, are the “sprays of falsehoods coming from the White House” that accompany them. These controversies help further reinforce negative perceptions about Trump’s honesty forged during the campaign.

A second theme has been the flurry of initial executive actions that helped drive the sense, especially among Republicans, that Trump can get things done. But note that relative softness in perceptions of effectiveness among Trump’s least committed supporters. As the NBC Politics team points out, executive actions aside, the Trump team has made little progress so far on his “big ticket agenda items (Obamacare repeal and replace, tax relief, paying for that border wall).”

Again, it is very early in the Trump presidency and the long term trends in his approval rating will be influenced by the direction of economy and by war, peace and scandal, or the lack thereof. However, if the initial flurry of executive action gives way to gridlock and legislative stagnation, perceptions of Trump’s ability to “get things done” may atrophy, and with it, his overall approval rating.

We don’t know where Trump’s approval rating will be in 2018 and 2020. There are many factors beyond the actual actions of the president, and if the country is doing well despite Trump’s actions, the Republicans will benefit. However, the first three weeks of Trump’s presidency give Republicans a lot to worry about.

Resistance Is Not Futile

When even John Yoo is saying that Donald Trump is abusing executive power we know both that we have a problem, and that opposition to him is becoming widespread. We have already seen major protests against Donald Trump. Matthew Yglesias argues that resistance works, and provides these examples of where Donald Trump or the Republican Congress has backed down in the face of protest:

Having people get out to protest also makes it more likely that protests will continue: “Political action can be habit-forming. Once you’ve already made a sign and taken it to a protest, it’s easier to just bring it along again in the future. Once you know which of your friends might be interested in going with you, it’s easier to reconnect and do it again.”

What will be less easy to measure, as compared to the items in the list above, are moves to the right which the Republicans might give up on out of fear of protests. Congressmen might even begin to fear that their reelection is in jeopardy, despite gerrymandering designed to make their seats safe, if enough of their constituents protest at their offices.

The most concrete example of the benefits of opposition to Trump and the Republican Congress will be if some Republicans do lose their seats in 2018. This includes not only members of Congress, but also Republicans at the state level. If Hillary Clinton had won, we would now have Democrats defending her record, even when it includes the same types of policies they protest when coming from Republicans. Most likely we would see further Republican gains in Congress and state governments. While Trump will undoubtedly do many undesirable things, Democrats must take advantage of this in 2018. Of course their chances will be far better if they actually stand for something, as opposed to continuing to run as a Republican-lite party.

Related News:

New York Times: How Attorneys General Became Democrats’ Bulwark Against Trump

Der Spiegel: Europe Must Defend Itself Against A Dangerous President

The Nation Begins To Unite In Opposition To Donald Trump–Growing Number Support Impeachment

Thanks to the incompetence of Donald Trump, opposition to his administration is far beyond what I might have hoped for a month ago. While it took five years to have massive opposition to George W. Bush, we are seeing it in the first two weeks under Trump. We are seeing demonstrations as big as, or in the case of the first weekend,  larger than, were seen during the Vietnam war. The number of people who want to see Trump impeached has reached 40 percent, up from 35 percent a week ago. Public Policy Polling provides these results:

Less than 2 weeks into Donald Trump’s tenure as President, 40% of voters already want to impeach him. That’s up from 35% of voters who wanted to impeach him a week ago. Only 48% of voters say that they would be opposed to Trump’s impeachment.

Beyond a significant percentage of voters already thinking that Trump should be removed from office, it hasn’t taken long for voters to miss the good old days of Barack Obama…52% say they’d rather Obama was President, to only 43% who are glad Trump is.

Why so much unhappiness with Trump? Voters think basically everything he’s doing is wrong:

-Overall voters are pretty evenly split on Trump’s executive order on immigration from last week, with 47% supporting it to 49% who are opposed. But when you get beyond the overall package, the pieces of the executive order become more clearly unpopular. 52% of voters think that the order was intended to be a Muslim ban, to only 41% who don’t think that was the intent. And the idea of a Muslim ban is extremely unpopular with the American people- only 26% are in favor of it, to 65% who are against it. When it comes to barring people from certain countries from entering the United States, even when those people have already secured a Visa, just 39% of voters are supportive to 53% who are against it. And just 43% of voters support the United States indefinitely suspending accepting Syrian refugees, with 48% opposed to that. Finally voters see a basic competence issue with Trump’s handling of the executive order- only 39% of voters think it was well executed, to 55% who believe it was poorly executed…

In addition, Steve Bannon is highly unpopular: “19% of voters see Bannon favorably, to 40% who have a negative opinion of him.” Few believe his claims of vote fraud. A majority opposes the wall, which was the centerpiece of his campaign: “Only 40% of voters are in support of building the wall if American taxpayers have to front the cost for it, to 54% who are opposed.”

Even his campaign promise to repeal Obamacare has become unpopular: “46% of voters now say they support it to just 41% who are opposed. And only 33% of voters think the best course of action is for Congress to repeal the Affordable Care Act and start over, to 62% who think it would be better to keep it and fix the parts that need fixing.” Congressional Republicans are also finding it to be difficult to abolish the Affordable Care Act, and are now talking about fixing Obamacare rather than repealing it.

Trump is also losing his battles, including with the media. Despite his attacks on CNN, “By a 50/42 spread voters say CNN has more credibility than Trump.” Similarly, The Washington Post and The New York Times have more credibility than Trump in this poll.

While Donald Trump is highly unpopular and his policies are failing, he may have unintentionally succeeded at one thing. He has brought the country together, even if in opposition to him, as is seen in the highly publicized photo above.

Trump Screws Up Obamacare So He Can Falsely Call It A Failure

The White House has pulled ads to promote signing up for coverage under Obamacare, including ads already paid for. If the goal is to provide more affordable coverage, this is counterproductive. Younger, healthier people tend to put off signing up, and are among the last to enroll each year. Having more healthy people sign up for coverage leads to lower insurance premiums.

Of course if the goal is to call Obamacare a failure, then this was a smart move by Trump. The higher premiums are, the easier it is to criticize the plan.

What Donald Trump might not even understand is that the Affordable Care Act did not bring about insurance with high premiums, along with high deductibles and copays. Insurance on the individual market has always been like this for those of use who purchase our own insurance, as opposed to receiving insurance through employers or government plans. The difference is that, prior to Obamacare, people could purchase expensive, high deductible plans and then lose their coverage if they got sick. If they already had preexisting medical conditions, they would often be denied coverage, or have the reasons they need health care coverage be excluded from the plan. These problems no longer exist under the Affordable Care Act.

Republicans are meeting to discuss health care, with a goal of introducing legislation by late March for an alternative program. While President Trump and Republican Congressional leaders are talking about a quick repeal of Obamacare, The Washington Post reports that, behind closed doors, many Republicans are expressing concerns:

Republican lawmakers aired sharp concerns about their party’s quick push to repeal the Affordable Care Act inside a closed-door meeting Thursday, according to a recording of the session obtained by The Washington Post.

The recording reveals a GOP that appears to be filled with doubts about how to make good on a long-standing promise to get rid of Obamacare without explicit guidance from President Trump or his administration.

Senators and House members expressed a range of concerns about the task ahead: how to prepare a replacement plan that can be ready to launch at the time of repeal; how to avoid deep damage to the health insurance market; how to keep premiums affordable for middle-class families; even how to avoid the political consequences of defunding Planned Parenthood, the women’s health-care organization, as many Republicans hope to do with the repeal of the ACA.

In a survey conducted by The New England Journal of Medicine, most primary care physicians preferred making improvements to the Affordable Care Act and opposed repeal. Improvements supported by physicians included creating a public option similar to Medicare to compete with private plans, providing tax credits to people eligible for Medicaid to purchase private plans, and increasing the use of health savings accounts. There was less support for some good ideas such as expanding Medicare coverage to those 55 to 64 years of age. There was also less support for two of the ideas promoted by Republicans, shifting even more costs to consumers and reducing regulations on insurance companies by allowing them to sell insurance over state lines. (From or dealings with insurance companies, doctors know that they cannot be trusted, and regulation is needed.) From the report:

We found that in response to the question, “What would you like to see the federal policy makers do with the Affordable Care Act?,” 15.1% of PCPs indicated that they wanted the ACA to be repealed in its entirety. Responses varied according to the physicians’ self-reported political party affiliation; no Democrats wanted to see the ACA repealed, whereas 32.4% of Republicans did. Among physicians who reported voting for Trump, only 37.9% wanted the ACA repealed in its entirety. PCPs were less likely than the general public to want the law repealed. A Kaiser Family Foundation poll conducted after the election that used a question and response options similar to those in our survey showed that 26% of the general public wants the law repealed in its entirety

When asked about aspects of the ACA as it currently exists, the physicians we surveyed almost universally supported the insurance-market regulations that prohibit insurance companies from denying coverage or charging higher prices on the basis of preexisting conditions (95.1% stated that the prohibition was “very important” or “somewhat important” for improving the health of the U.S. population). There was also strong support for other key provisions of the law, including allowing young adults to remain on their parents’ insurance plan until 26 years of age (87.6%), providing tax credits to small businesses (90.8%) and tax subsidies to individuals (75.2%), and expanding Medicaid (72.9%). A lower proportion — just under half — favored the tax penalty for individuals who do not purchase insurance (49.5%)…

Although only 15% of PCPs want the ACA repealed, nearly three quarters (73.8%) favor making changes to the law. Physicians responded most favorably to policy proposals that might increase choice for consumers, such as creating a public option resembling Medicare to compete with private plans, providing tax credits to allow people who are eligible for Medicaid to purchase private health insurance, and increasing the use of health savings accounts. PCP Survey Responses Regarding Potential Health Reform.). Physicians responded most negatively to policies that would shift more costs to consumers through high-deductible health plans. Less than half were in favor of proposals to decrease insurance-market regulations (by allowing insurance companies to sell across state lines), require states to expand Medicaid, or expand Medicare to adults 55 to 64 years of age.

Senate To Investigate Alleged Ties Between Trump And Putin

The Hill  and Politco report that the Senate Intelligence Committee is going to probe the alleged connections between Donald Trump and Russia. As long as it is a real investigation, and not a coverup or witch hunt depending upon party affiliation, I’m all for investigating. I’ll go with whatever the facts show. I could be wrong, but at the moment I question if the Russia claims are the new Benghazi.

There is a tendency of people to believe negative things they hear about politicians they do not like. Sometimes they are true, and sometimes they are not. While I do not like Hillary Clinton, and have discussed at length many of the valid criticisms of her, I never bought into many of the claims ranging from Vince Foster to Benghazi. Turning on Fox (which I can only handle in brief spurts) demonstrates that many on the right still believe these things. Despite all the conspiracy theories, multiple investigations have shown that most of what conservatives claimed about Benghazi was false. All that is left is the possibility that Clinton might have involved in spinning the explanation for the attack after the fact based upon what sounded best politically, and it is also possible we were just seeing confusion from the fog of war as opposed to intentional deceit.

I don’t like Trump any more than I like Clinton, and there is also considerable valid criticism of him, but the material recently released regarding Trump’s alleged Russian ties has the same smell of bullshit as that which surrounded Benghazi. Claims of Russian attempts to influence our election are probably valid, just as the United States (including Hillary Clinton) often tries to influence elections in other nations. Circumstantial evidence such as business ties between Trump and associates is insufficient to prove a wider conspiracy.

This all needs to be investigated, but any conclusions ultimately need to be based upon the facts, not whether you dislike Trump for other valid reasons. On the other hand, if there is valid evidence against Trump, this should not be ignored just because you dislike Hillary Clinton, also for multiple other reasons. If the claims are false, they should be demonstrated to be false, as opposed to hiding behind the vastly over-used term fake news.

Whatever the investigation finds, Russian interference is not the main reason Hillary Clinton lost. There are no credible allegations that Russia actually hacked the voting machines, or even faked email. The Wikileaks email was one of many factors which was damaging to the Clinton campaign, but ultimately this just provided evidence of dishonesty on the part of Clinton, and unfair intervention in the campaign by the DNC, which was already known. Similarly, it is foolish to blame James Comey for Clinton’s loss when it was Clinton who both violated the rules regarding handling of email (as documented in the State Department Inspector General report) and who handled classified information in a careless manner, placing her campaign in this situation. Hillary Clinton was the wrong candidate for Democrats to nominate, and she went on to run an inept campaign.

One negative to a two party election system is that some people come out of it seeing one side as good and the other side as bad. Both sides can be bad, and if we are unusually fortunate, perhaps some year we will have an election when both sides are good. Your enemy’s enemy is not necessarily your friend. Disliking Clinton is no reason to like either Trump or Putin, and all of Trump and Putin’s flaws do not make Hillary Clinton acceptable.

Republican Attempts To End Obamacare May Have Died

As I’ve discussed previously, Republican plans to repeal Obamacare are not going well for them. Donald Trump is still talking about immediate repeal, while having no idea what is actually going on. Repeal might not be possible as more Senators, in addition to those mentioned in the previous post, are jumping ship.  Jonathan Chait writes that their plans to destroy Obamacare may have died, reporting that additional Republican Senators are now pushing to include a replacement plan with legislation to repeal Obamacare.

Over in the House, Paul Ryan is also talking vaguely about including portions of a new plan in the repeal legislation.

Including a replacement plan could very well kill off any Republican plans to repeal Obamacare. From a public relations stand point, they will have difficulty obtaining public support for a health plan which does not include popular components of the Affordable Care Act. Politico confirmed this in a new poll:

Voters want — and expect — President-elect Donald Trump and the GOP-controlled Congress to repeal the 2010 health care law, according to a new POLITICO/Morning Consult poll released Tuesday, but they are skeptical of repeal without a plan to replace Obamacare and some of its most popular elements…

Testing eight separate elements of the law, more voters want to keep each of the eight provisions than want to repeal them, in some cases by overwhelming margins.

Nearly two-thirds of voters, 66 percent, favor keeping a provision that prohibits insurance companies from denying coverage to patients with pre-existing conditions. Sixty-three percent of voters want to keep the requirement that insurance companies allow policyholders to keep their children on their plans until age 26. Fifty-six percent think subsidies for low-income Americans to buy insurance should stay, and the same percentage wants to keep federal funding for states to expand their Medicaid programs.

A 55-percent majority also wants to keep the requirement that businesses and companies with more than 50 full-time employees offer health insurance to those employees, while only 27 percent want that provision repealed. Many Republicans say that requirement has led businesses to slash jobs and hours to avoid hitting that threshold.

And 53 percent of voters want to keep requiring insurance companies to cover prescription birth control, while just three-in-10 want that requirement repealed. (The Supreme Court ruled in 2014 that employers may exclude contraceptive coverage for their employees if it violates the employers’ religious beliefs.)

Pluralities of voters also want to keep two other provisions of the law, though by narrower margins: 46 percent want to keep the elimination of lifetime and annual limits on health reimbursement to individuals, while 32 percent want that repealed. And 33 percent of voters want to repeal the long-derided medical-device tax, compared to 37 percent who want to keep it.

The most-popular elements of the law are also well-regarded by Republicans. Sixty-three percent of Republicans want Trump and Congress to keep the prohibition on denying coverage to those with pre-existing conditions, and 56 percent want to retain requiring insurance companies to allow the children of policyholders to stay on their plans until age 26.

In other words, as has been the case all along, the public opposes Obamacare by name but supports its components when asked.

Besides the public relations issues, the repeal of Obamacare might be dead due to Senate rules. The Senate can repeal Obamacare as part of a budget resolution with a simple majority, but a bill which repeals Obamacare and establishes a replacement program can be blocked with a filibuster if it lacks sixty votes. If Republicans cannot get a simple majority for repeal now, they could wind up with a choice of continuing Obamacare or only replacing it with a plan which can obtain bipartisan support. Such a plan will very likely be much like Obamacare, even if under a different name.