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.

Country Now Evenly Divided On Impeachment Of Donald Trump

Donald Trump’s first three weeks in office have been a disaster, with Trump learning that being president is a hard job which he is not prepared for. Public Policy Polling shows that his support has dropped further from last week, with 46% both favoring and opposing impeachment:

PPP’s new national poll finds that Donald Trump’s popularity as President has declined precipitously just over the last two weeks. On our first poll of his Presidency voters were evenly divided on Trump, with 44% approving of him and 44% also disapproving. Now his approval rating is 43%, while his disapproval has gone all the way up to 53%. If voters could choose they’d rather have both Barack Obama (52/44) or Hillary Clinton (49/45) instead of Trump.

Just three weeks into his administration, voters are already evenly divided on the issue of impeaching Trump with 46% in favor and 46% opposed. Support for impeaching Trump has crept up from 35% 2 weeks ago, to 40% last week, to its 46% standing this week. While Clinton voters initially only supported Trump’s impeachment 65/14, after seeing him in office over the last few weeks that’s gone up already to 83/6.

While I don’t actually see impeachment as anything imminent, Common Dreams reports that, “On Thursday, Congressman Jerrold Nadler (D-NY) filed a ‘resolution of inquiry’ that amounts to the first legislative step toward impeachment.”

The poll looked at several issues where support for Trump is falling. This includes Obamacare:

47% of voters now say they support the Affordable Care Act to only 39% who are opposed. It just keeps getting more popular. And only 32% think the best course of action to take on health care is repealing the ACA, while 65% would like Congress to keep it and just fix parts that need fixing.

More now oppose Trump’s executive order on immigration than back it. Among those in support, a strong majority see the Bowling Green Massacre as a reason for why it is needed.

Voters think he’s over reaching to make a country safe…that they already consider to be safe. 66% of Americans consider the United States to be a safe country, to only 23% who consider it unsafe. Perhaps as an outgrowth of that sentiment only 45% of voters support Trump’s Executive Order on immigration, to 49% who are opposed to it. Among those who do support it you have to wonder how well thought out their position is- by a 51/23 margin Trump voters say that the Bowling Green Massacre shows why Trump’s immigration policy is needed.

By a 48/43 spread, voters do think that the intent of the Executive Order is to be a Muslim ban. And just 22% support a Muslim ban, to 65% who are opposed. The order has also increasingly raised issues about Trump’s competence in voters’ eyes- only 27% think the Executive Order was well executed, to 66% who think it was poorly executed. The spread on that question was 39/55 when we asked last week.

Another aspect of voters already feeling safe is that they don’t want to pay for the wall with Mexico. Just 32% support a 20% tax on items imported to the United States from Mexico, to 55% who are opposed to that concept. And in general only 37% of voters want the wall if US taxpayers have to front the cost for it, to 56% who are against that.

Betsy DeVos is also unpopular. Protesters were trying to prevent Betsy DeVos from entering a public school. While I totally sympathize with their view of her, I’m not sure this is a good idea. I don’t know if she has ever even seen the inside of a public school before. It might be a good idea for her to see what a public school is like, and that they are not threatened by grizzly bears. If they did want to keep her out they might have dressed up as grizzly bears in burkas. What could be scarier to her? (For those not familiar with her record, see this post.)

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.

Trump Executive Orders Include Expanding Global Gag Rule On Abortion & Reinstating Black Site Prisons Closed Under Obama

Donald Trump’s use of executive orders have confirmed the worst fears about what we would see from a Trump presidency. Everyone who is aware of the policy assumed Trump would reinstate the global gag rule which, since Reagan, has been in place under all Republicans and reversed when Clinton and Obama were in office. This prohibits American foreign aide to organizations involved in providing abortions. What we did not anticipate, and most did not even realize immediately, was that Trump expanded this policy considerably. Michelle Goldberg did notice this and wrote in Slate:

In the past, the global gag rule meant that foreign NGOs must disavow any involvement with abortion in order to receive U.S. family planning funding. Trump’s version of the global gag rule expands the policy to all global health funding. According to Ehlers, the new rule means that rather than impacting $600 million in U.S. foreign aid, the global gag rule will affect $9.5 billion. Organizations working on AIDS, malaria, or maternal and child health will have to make sure that none of their programs involves so much as an abortion referral. Geeta Rao Gupta, a senior fellow at the United Nations Foundation who previously served as deputy executive director of UNICEF, gives the example of HIV/AIDS clinics that get U.S. funding to provide antiretrovirals: “If they’re giving advice to women on what to do if they’re pregnant and HIV positive, giving them all the options that exist, they cannot now receive money from the U.S.”

This makes Trump significantly worse than George W. Bush regarding the gag rule. Bush at least did specifically exempt support for an AIDS program, the President’s Emergency Plan for AIDS Relief (PEPFAR) from the global gag rule:

Scott Evertz, who served as director of the White House Office of National AIDS Policy under George W. Bush, tells me, “It would have been impossible to treat HIV/AIDS in the developing world as the emergency that PEPFAR said it was if the global gag rule were to be applied to the thousands of organizations with which those of us involved in PEPFAR would be working.” Evertz offers the example of a standalone health clinic in the slums of Nairobi, Kenya. Would the U.S. have to certify that it never referred any of its patients to an abortion provider before enlisting it in the fight against AIDS?  “The notion of applying the global gag rule to them would have made it impossible to implement the program,” he says.

Other executive orders involve building the border wall and curtailing immigration, limiting Obamacare, backing the Keystone XL and Dakota Access oil pipelines, and Trump is now reportedly preparing an executive order which would reopen “black site” prisons closed under Obama. The New York Times reports on the later:

The Trump administration is preparing a sweeping executive order that would clear the way for the C.I.A. to reopen overseas “black site” prisons, like those where it detained and tortured terrorism suspects before former President Barack Obama shut them down.

President Trump’s three-page draft order, titled “Detention and Interrogation of Enemy Combatants” and obtained by The New York Times, would also undo many of the other restrictions on handling detainees that Mr. Obama put in place in response to policies of the George W. Bush administration.

If Mr. Trump signs the draft order, he would also revoke Mr. Obama’s directive to give the International Committee of the Red Cross access to all detainees in American custody. That would be another step toward reopening secret prisons outside of the normal wartime rules established by the Geneva Conventions, although statutory obstacles would remain.

Mr. Obama tried to close the prison at Guantánamo Bay, Cuba, and refused to send new detainees there, but the draft order directs the Pentagon to continue using the site “for the detention and trial of newly captured” detainees — including not just more people suspected of being members of Al Qaeda or the Taliban, like the 41 remaining detainees, but also Islamic State detainees. It does not address legal problems that might raise…

Elisa Massimino, the director of Human Rights First, denounced the draft order as “flirting with a return to the ‘enhanced interrogation program’ and the environment that gave rise to it.” She noted that numerous retired military leaders have rejected torture as “illegal, immoral and damaging to national security,” and she said that many of Mr. Trump’s cabinet nominees had seemed to share that view in their confirmation testimony.

“It would be surprising and extremely troubling if the national security cabinet officials were to acquiesce in an order like that after the assurances that they gave in their confirmation hearings,” she said.

Polls: Approval For Trump Falls; Rises For Obama & Obamacare

A new CNN poll shows the same finding as a recent Gallup poll which found that Donald Trump has record low approval for modern presidents:

Donald Trump will become president Friday with an approval rating of just 40%, according to a new CNN/ORC Poll, the lowest of any recent president and 44 points below that of President Barack Obama, the 44th president.

Following a tumultuous transition period, approval ratings for Trump’s handling of the transition are more than 20 points below those for any of his three most recent predecessors. Obama took the oath in 2009 with an 84% approval rating, 67% approved of Clinton’s transition as of late December 1992 and 61% approved of George W. Bush’s transition just before he took office in January 2001.

An ABC News/Washington Post poll had similar findings. Donald Trump has tweeted the polls are rigged.

In contrast, Barack Obama is leaving office with a 58 percent favorability rating. While the news has been dominated by Republican plans to repeal Obamacare, an NBC News/Wall Street Journal poll shows that the Affordable Care Act is more popular than ever. This poll was conducted before today’s report from the Congressional Budget Office showing that repeal of Obamacare would result in millions of people losing their insurance and in increase in premiums:

  • The number of people who are uninsured would increase by 18 million in the first new plan year following enactment of the bill. Later, after the elimination of the ACA’s expansion of Medicaid eligibility and of subsidies for insurance purchased through the ACA marketplaces, that number would increase to 27 million, and then to 32 million in 2026.
  • Premiums in the nongroup market (for individual policies purchased through the marketplaces or directly from insurers) would increase by 20 percent to 25 percent—relative to projections under current law—in the first new plan year following enactment. The increase would reach about 50 percent in the year following the elimination of the Medicaid expansion and the marketplace subsidies, and premiums would about double by 2026.

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.

Republicans Might Lack Votes In Senate To Repeal Obamacare

As I discussed earlier in the week, it was far easier for Republicans to vote to repeal Obamacare when it would be blocked by a filibuster or veto. Republicans might not have the votes in the Senate for repeal. The plan was to repeal the Affordable Care Act through budget reconciliation, where only a simple majority is necessary, with promises to replace it with something else in the future. The absurdity of that is obvious to pretty much everyone who is not a Republican.

The Republicans might not be able to achieve even a simple majority to repeal Obamacare. Now four Republicans, Rand Paul, Bob Corker, Tom Cotton, and Susan Collins are now showing skepticism towards the plan. Susan Collins also opposes the plans to defund Planned Parenthood.

Bloomberg reports that it is unclear how this will play out:

Only one of the senators — Rand Paul of Kentucky — has so far said he plans to vote against the procedural gambit that sets up Obamacare repeal, citing unrelated budget concerns. Paul and three others are concerned that Republicans haven’t said yet how they would replace the health insurance scheme after repeal, with one of them also opposing the plan to defund Planned Parenthood as part of the repeal.

The skeptics could end up yielding to pressure from their colleagues to support the plan when it reaches the Senate floor, but Republicans can only afford to lose two senators. If they lose a third, the effort would stall, and they’d be forced to return to the drawing board. Such a delay would be an embarrassing setback for Republicans, given the intense pressure from conservatives and the Trump team to speed this through.

One problem faced by the Affordable Care Act is that, with lack of Republican cooperation, it was rarely possible to pass further legislation to make adjustments, which a program this massive would normally receive. The ideal situation would be if Republicans fail to defund Obamacare and are forced to take ownership of health care policy, leading them to work in a bipartisan manner with Democrats to pass an improved plan. Unfortunately we cannot count on the Republicans acting in such a reasonable manner.

AMA Warns Of Risks Of Gutting Health Care Reform

With Republicans appearing to make abolishing Obamacare a top priority (following their failure to gut ethics oversight of Congress), the American Medical Association has weighed in with this letter (emphasis mine) stressing the importance of making coverage more affordable, providing greater choice, and increasing the number insured:

Dear Majority Leader McConnell, Leader Schumer, Speaker Ryan and Leader Pelosi:

On behalf of the physician and medical student members of the American Medical Association (AMA), I am writing regarding our ongoing commitment to reform of the health care system and potential legislative actions during the first months of the 115th Congress.

The AMA has long advocated for health insurance coverage for all Americans, as well as pluralism, freedom of choice, freedom of practice, and universal access for patients. These policy positions are guided by the actions of the AMA House of Delegates, composed of representatives of more than 190 state and national specialty medical associations, and they form the basis for AMA consideration of reforms to our health care system.

Health system reform is an ongoing quest for improvement. The AMA supported passage of the Affordable Care Act (ACA) because it was a significant improvement on the status quo at that time. We continue to embrace the primary goal of that law—to make high quality, affordable health care coverage accessible to all Americans. We also recognize that the ACA is imperfect and there a number of issues that need to be addressed. As such, we welcome proposals, consistent with the policies of our House of Delegates, to make coverage more affordable, provide greater choice, and increase the number of those insured.

In considering opportunities to make coverage more affordable and accessible to all Americans, it is essential that gains in the number of Americans with health insurance coverage be maintained.

Consistent with this core principle, we believe that before any action is taken through reconciliation or other means that would potentially alter coverage, policymakers should lay out for the American people, in reasonable detail, what will replace current policies. Patients and other stakeholders should be able to clearly compare current policy to new proposals so they can make informed decisions about whether it represents a step forward in the ongoing process of health reform.

We stand ready to work with you to continue the process of improving our health care system and ensuring that all Americans have access to high quality, affordable health care coverage.

Sincerely,
James L. Madara, MD

Medical groups and physicians have been conflicted regarding expected health care policy under Donald Trump. There was some early support for Tom Price to head Health and Human Services in the hope that he will work to reduce the regulatory burden, but many doctors have come out in opposition to him out of concern for reductions in coverage for many Americans.

While health care policy could likely a major impact of the all-Republican government, it received very little attention during the presidential campaign. This is partially due to the media’s preference to cover the horse race and scandal, Donald Trump making more noise on matters such as the Wall, and an extraordinarily poor campaign by Hillary Clinton which concentrated on stressing Trump’s negatives and avoiding issues. Democrats are now starting to speak out on health care. Chuck Schumer is trying to turn Trump’s slogan against him, warning that Republicans will “Make America Sick Again.” Hopefully they can provide a resistance beyond coming up with a slogan.

Democrats were successful in blocking George Bush when he attempted to partially privatize Social Security in his second term, and similarly have a chance of receiving public support in opposing Republican attempts to reduce health care coverage, including cuts in Medicare and Medicaid. Republicans are also getting jittery about health care legislation. They could safely please their constituents by voting to abolish Obamacare when Barack Obama was in office and they knew he would veto their efforts if it made it past a filibuster. Many now realize they will be held accountable for what happens, including if people lose coverage, and insurance costs continue to rise rapidly. The Committee For A Responsible Federal Budget, typically conservative on government  spending,  has outline the costs of repealing Obamacare, giving further reasons for Republicans to be cautious.

Donald Trump remains a huge wild care, having both promised to abolish Obamacare and to provide a plan to cover all Americans. So far he has given no meaningful specifics, talking primarily about health savings accounts and allowing insurance companies to sell insurance over state lines. Neither is a real plan. One point to Trump’s credit is that, while his major appointees have been from a very narrow group (primarily wealthy conservatives), he has spoken to a wider range of people. Zeke Emanuel, the architect of the Affordable Care Act, came out of a meeting with Trump expressing optimism, as reported by NPR. He believes Trump might seek to have a bipartisan bill after Republicans have complained about how Obamacare was passed by only Democrats. He also pointed out that some conservatives are pushing for “repeal and replace” as opposed to the currently discussed tactic of “repeal and delay” and discussed how legislation might be handled after an initial resolution (even if along party lines) to abolish the ACA utilizing budget reconciliation:

And so that you really do need to repeal and replace, and you need to do it in one bill. Otherwise, you’re really going to disrupt the individual insurance market in a very bad way, and you’ll be responsible for millions of people losing their coverage but also health insurance premiums going up. And I think that is not a scenario that a lot of Republicans really want…

So one possibility is that they pass a resolution saying that they will then come back and pass a bill that will repeal parts of the Affordable Care Act and at the same time have a replacement for those parts of the Affordable Care Act…

The resolution can be party lines, but the bill would then have to construct both the repeal part but simultaneously the replacement part. And I think if you do it that way, you could begin to negotiate with Democrats. If you just have a repeal and we’ll be back in three years and tell you how we’re going to fix it, then the Democrats are simply going to walk away. Chuck Schumer has made that clear.

And they should walk away because then it’s all – it’s the old pottery barn principle that Colin Powell made famous, which is, you break it; you have to fix it, and you take responsibility. And the Democrats will not want their fingerprints anywhere near the breaking of Obamacare and the disruption of the insurance industry in the United States…

The question is, what is the shape of that bill? Is it just a repeal bill, or is it a repeal with replacement? And that negotiation about that bill could take several months. My own estimate is if both sides come with good faith, they could probably hammer this out in about six months. It’s not a small item. I mean health care reform is big.

The question is, what are the gives and takes? I do think – again, one of the reasons I’m optimistic is that when you look at conservative and liberal health policy experts, there’s about 70 or 80 percent overlap between the two groups about the shape of the future and what you would need. And I think that’s, again, why I’m optimistic – because there aren’t that many ways of doing health care reform. They’re really limited.

Of course counting on the sanity of Republicans is a very risky bet.

The Death of Clintonism

The 2016 election had the deleterious result of electing Donald Trump president, but at least we did not wind up with another Bush or Clinton as many had predicted. While some still talk about Clinton running again in 2020, hopefully her loss this year will be the end of her political career, with 62 percent of Democrats and independents not wanting her to run again.

Todd Purdam is probably right in declaring The Death of Clintonism in his article in Politco, but he  does not seem to understand the reasons. He white washed the triangulation under Bill while ignoring most of the consequences. He repeated the conventional wisdom on how such compromise led to a victory for Bill, but ignored how much the Democrats have suffered afterwards in failing to stand for anything in a changing world. Running as a Republican-lite party lead to major Democratic defeats in 2010, 2014, and now 2016.

There is not a word on how the Clintons and the DLC were on the wrong side of the major issue to divide the country politically after Bill left office–the response to terrorism and the Iraq war. Hillary  not only supported the Iraq war, but was one of its strongest proponents, spreading false claims of ties between Saddam and an Qaeda. She made the same mistakes with support for regime change and interventionism in Libya and Syria.

Similarly Clinton was on the wrong side of the the response to 9/11 in her support for increasing the power of the surveillance state, sounding just like Donald Trump in mocking freedom of speech. Clinton has never had a very good record on civil  liberties, including introducing legislation to make flag burning a felony while in the Senate, and even after the 2016 election calling for government action against the “fake news” which harmed her in the election. Regardless of how undesirable fake news might be, there is not a requirement for accuracy in the First Amendment.

Clinton’s horrible record on First Amendment rights also included her working with The Fellowship while in the Senate to increase the role of religion in public policy. Her religious views made her further out of touch with an increasingly secular nation.

Clinton’s support for mass incarceration was wrong when Bill was president, and her continued hard line on drugs, including marijuana, made her further out of touch with current views. At least she did revise her views with the times on marriage equality, but even this change looked like a change for political expediency.

Clinton made a comeback after the 2008 election, but had a very negative influence on the Obama administration. Obama ultimately recognized that regime change in Libya, which Clinton was the primary proponent of, was the biggest mistake of his administration, while Clinton has continued to defend her failed policy. Clinton continued to push for further intervention in Syria, often for rather absurd reasons.

Not only was listening to Clinton on  Libya the biggest foreign policy mistake of his administration, the domestic policy mistake which hurt the Democrats the most politically also involved accepting a Clinton policy position. Congressional Democrats and Obama implemented the individual mandate as part of the Affordable Care Act, after Obama had campaigned against Clinton on this point. While it would be necessary to make health care reform more complicated to avoid the free-rider problem, making the program mandatory in this manner was guaranteed to create considerable public opposition to the program. Clinton has never understood the difference between providing a safety-net when necessary and nanny-state programs which intrude upon everyone’s life.

While Purdam downplayed Clinton’s Wall Street ties, this became a bigger issue with the increased concentration of wealth among the ultra-wealthy. Clinton was seen as part of this problem, not someone who would do anything serious about it. Her change in views on  trade deals was not convincing. Purdam also ignored concerns about the corrupting influence of money in politics, especially with people such as the Clintons who used their political connections to amass a large personal fortune.

Purdam was right that Hillary Clinton lacks the political skills of Bill Clinton. It was also a mistake for Clinton to run by trying to stress Donald Trump’s negatives, while failing to provide a positive argument to vote for her, when her own negatives were comparable to Trump’s. It was another variation in Democrats losing because they were afraid to stand for anything.

The death of Clintonism is not about giving up once-winning ways as Purdam put it. It is about putting aside conservative views on social issues, rejecting the damage of the warfare/surveillance state which grew tremendously after 9/11, rejecting corruption, as well as rejecting a strategy which is not working for the Democrats.