Democrats Slap Donald Trump On the Wrist In the Midterms

The midterms were a mixed success for the Democrats in 2018. Most notably the Democrats took control of the House, but unfortunately this probably means Nancy Peolsi returns as Speaker. They also regained about three hundred of the near one thousand seats in state legislatures they lost over the past decade, have a majority of state attorney generals in the nation, and won some key governorship battles, especially in the midwest. On the other hand, despite a Republican president as terrible as Donald Trump, their midterm gains in the House were historically not terribly impressive for the party out of power, and they did poorly in the high profile battles in the Senate. (I’m waiting to hear Rachel Maddow explain why the Russians meddled in the Senate races but not the House races this year.)

This was far more a slap on the wrist than a shallacking for Donald Trump.

The Senate map was undoubtedly very unfavorable for Democrats, but it will be so virtually every year as long as Democrats are unable to come up with a message to win in the smaller states beyond the east coast. The system of giving two Senators to each state regardless of size makes the Senate extraordinarily unrepresentative. Still, don’t be tempted to repeat the memes showing up since the election regarding winning the popular vote. They are misleading as the entire nation did not vote for Senate, and this can be tilted by which states do vote. This was especially true in 2018 as California had two Democrats running for Senate due to a system where the two leaders in the primary get on the November ballot regardless of party. This leads to a tremendous number of Democratic votes if the mythical Senate popular vote is counted, but only one Democratic Senator.

Democrats are always far quicker to list off the problems which make it more difficult to win than to change their strategy. They showed once again that moving to the right in the hopes of attracting Republican votes does not work. Nor did recruiting veterans help them do any better than expected. I would prefer to see Democrats be more consistent in supporting a reduction in  the role of government in the private lives of individuals–an attitude which might make defense of reproductive rights part of a consistent philosophy that might be accepted in the more libertarian minded portions of the country. Taking a rational anti-war line, as opposed to acting as if they are apologizing for appearing weak on national security, might also help in those areas which are hurt by perpetual warfare–and rejected Hillary Clinton in 2016.

This does note mean that the Democrats don’t have many valid complaints, including regarding voter suppression and gerrymandering. Some of the election results will help, including increasing their strength in several state governments before the next redistricting. While the high profile races in Florida did not turn out as hoped (how badly did campaigning with Hillary Clinton hurt Andrew Gillum?), but there was a victory in passing a ballot initiative to restore voting rights to convicted felons who have served their time.

While Democrats continued to struggle in Florida and Ohio, their hopes for Pennsylvania, Michigan, and Wisconsin being more blue in 2018 look favorable after Tuesday’s results, including the defeat of Scott Walker in Wisconsin. Besides possibly giving the Democrats their electoral votes again in 2020, there might be an increased number of representatives as the heavily gerrymandered system of drawing Congressional districts will be replaced by an independent redistricting commission in Michigan.

Other ballot proposals passing in Michigan will make it easier to vote and legalized marijuana for recreational use. Newly elected Governor Gretchen Whitmer is looking at legislation or issuing executive orders to free prisoners convicted for marijuana related charges which will no longer be crimes after the ballot proposal passed. I did hold my nose and vote for Whitmer, despite her reliance on dark money and financing by Blue Cross Blue Shield of Michigan. Action such as this will make me happier that I did so. A judge has already put some new marijuana cases on hold.

Medicaid expansion passed in Idaho, Nebraska, and Utah, and is also expected in Kansas due to the victory for a Democratic governor. While there is no chance of it becoming law imminently, there are also more Democratic supporters of Medicare for All in the House.

There were victories for various groups. The media has covered extensively how there are more women and people of color in the House. In addition, seven more scientists were elected to the House–all Democrats as the Republican war on science continues.

It remains to be seen how some issues will play out now that the midterms are over. Are we still supposed to be terrified by the caravan? Donald Trump quickly took advantage of having control of the Senate by firing Jeff Sessions.  I never would have guessed that I would see this as a bad thing when Sessions first became Attorney General. On the one hand, Sessions might have been the worst Attorney General in history. On the other hand, Sessions was absolutely right in his dispute with Trump in recusing himself from Mueller’s investigation, and his firing could be a sign that Trump plans to take action against Mueller. I suspect that Mueller has prepared for this by being ready to turn over evidence of financial crimes committed by Trump and his cronies to state prosecutors. Congressional Democrats will also be able to take over the investigation if needed. Hopefully they concentrate on Trump’s financial crimes and obstruction of justice, as opposed to the dubious conspiracy theories popular among many Democrats blaming Russia for Hillary Clinton’s loss.

Bernie Sanders’ Response To The State Of The Union Address (Including Full Transcript)

Last night Bernie Sanders was one of five Democratic responses to the State of the Union Address, including Joe Kennedy III’s official response. Sanders criticized Trump for promising to provide “health insurance for everybody,” with “much lower deductibles,” but instead supporting legislation that “would  thrown up to 32 million people off of the health care they had while, at the same time, substantially raising premiums for older Americans.”

Sanders noted that Trump had promised “promised not to cut Social Security, Medicare or Medicaid.” Instead, “he supported a Republican Budget Resolution that proposed slashing Medicaid by $1 trillion and cutting Medicare by $500 billion. Further, President Trump’s own budget called for cutting Social Security Disability Insurance by $64 billion.”

In addition to calling out Trump for breaking his campaign promises, Sanders noted many things which Trump failed to talk about, including climate change and voter suppression.

While overall a good speech, there were things which I wish Sanders had said, and one thing statement which was misleading. As has generally been the case with Democrats, there was nothing said about restrictions of civil liberties–passed with the cooperation of many Democrats. Nor were there protests over the never-ending war which Democrats are now accepting as the status quo. Nothing was said about the drug war, while Joe Kennedy III , among other Democrats, has been on the wrong side of this issue. This is what I want to see from a true resistance.

Sanders also stated that the Russians “interfered in our election in 2016, is interfering in democratic elections all over the world.” While technically true, this plays into the hysteria being spread by Democrats, often based upon misinformation. While true that Russia meddled in our election, this must be kept in context that Russia has meddled in elections for decades–just as the United States has frequently meddled in foreign elections. Russian meddling has also been highly exaggerated. There is also no evidence that Russia had any effect on the election results. The information obtained through the Congressional hearings has shown that claims about Russian tampering with the election have been have been of little consequence. Similarly, multiple media reports of Russian hacking were subsequently retracted as false. I would hope that Sanders would know better to play into the misleading claims of Democrats who are distorting the facts to deny the blame they deserve for losing to Donald Trump due to choosing a candidate as terrible as Hillary Clinton, along with playing into the hands of neocons who are distorting Russian electoral interference as they used false claims of WMD in Iraq to promote their goal of regime change in Russia.

The video can be seen here and the full text of Sanders’ speech is below:

(more…)

Republicans Willing To See Over 200,000 Die In Order To Give Tax Cut To The Wealthy

The Republican efforts to repeal and replace Obamacare have been stalled due to the devastating report from the Congressional Budget Office showing that 22 million people would lose health care coverage. Only 12 percent of Americans back the plan according to a USA TODAY/Suffolk University Poll. They did find considerable consensus that any health care plan include the following:

  • Pre-existing conditions: More than three-fourths, 77%, say it is “very important” that the health care system permit people with pre-existing medical conditions to buy health insurance at the same price as others. Just 6% say that protection isn’t important to them. The Senate bill requires insurers to accept those with pre-existing conditions, but it allows states to seek permission to reduce required benefits. Some patients could face dramatically higher costs or lifetime limits for treatments no longer defined as essential.
  • Medicaid expansion: Nearly two-thirds, 63%, say it is “very important” that lower-income people who became eligible for Medicaid through the Affordable Care Act continued to be covered by Medicaid. Just 10% say that isn’t important to them. The nonpartisan Congressional Budget Office estimates that the Senate plan, which would cut Medicaid spending by $772 billion over the next 10 years, would result in 15 million fewer people being covered.
  • Lower premiums: Close to six in 10, 57%, say it is “very important” that insurance premiums go down in price; 17% say that’s not important. The CBO predicts that premiums would rise for a few years under the Senate plan, then fall by about 30%. But overall health care costs would go up for most people because deductibles would be higher and some states wouldn’t require insurers to provide some benefits that are now mandated.

A growing number of Republican Senators are also opposing the plan, necessitating major changes if there is any chance for passage.

While Republicans claim that repeal of Obamacare is necessary because the program is collapsing, the CBO report on the Republican plan reaffirms statements in previous reports that these Republican claims are false. The current Congressional Budget Office report states:

Although premiums have been rising under current law, most subsidized enrollees purchasing health insurance coverage in the nongroup market are largely insulated from increases in premiums because their out-of-pocket payments for premiums are based on a percentage of their income; the government pays the difference between that percentage and the premiums for a reference plan.

It also needs to be kept in mind that premiums for plans on the individual market typically had double digit increases annually prior to the passage of the Affordable Care Act, and that this is not a new problem created by Obamacare. Unlike insurance plans sold before Obamacare became law, current plans have limits on out of pocket expenses, no lifetime maximums, and cannot be cancelled by insurance companies when people became ill. Of course there also were no subsidies to assist with paying for the plans. It was also commonplace to have limited options and to see insurance companies leave markets prior to Obamacare.

The actual problem with Obamacare is that it did not go far enough. A public option  or Medicare buy-in was necessary to provide more affordable care for those who do not obtain coverage through an employer or government plan. Expansion of Medicare to all would also have provided a more cost effective solution.

Vox looked at the likely effects on mortality should the Senate Republican plan pass, estimating that there will be 208,500 additional deaths over the next decade:

Drawing on that work, we estimate that if the Senate bill becomes law, 22,900 excess deaths will occur in 2020 — and the figure will grow over time. 26,500 extra deaths will take place in 2026. Over the next decade, we estimate that a total of 208,500 unnecessary deaths will occur if the law is passed (see Table 1).

We also calculate anticipated additional deaths, state by state, using state-level coverage losses for the year 2026 (see Table 2). The predicted excess deaths by state range from 30 in North Dakota to 2,992 in California in 2026 alone.

Some commentators have argued that it’s inappropriate — beyond the pale — to suggest that people will die as a result of this legislation. To the contrary, we contend that no debate over a health care policy can ignore evidence that it could have negative effects on health and mortality.

In making these calculations, we draw on the scientific literature demonstrating that expanding health insurance reduces deaths. We specifically apply the results of a particularly robust study of the effects of health care reform in Massachusetts on mortality. Massachusetts’ health care reform — which expanded Medicaid, offered subsidized private insurance, and included an individual mandate — famously served as a model for the ACA. The Massachusetts study looked at county-level mortality data in 2001 to 2005 (pre-reform) and 2007 to 2010 (post-reform), and compared the changes to carefully selected control groups in other states that had not enacted health reform.

Over 200,000 deaths is a high price to pay in order to provide tax cuts for the ultra-wealthy, which appears to be the major goal of the Republican plan.

Republicans Have Neither Tapes Of Trump/Comey Meetings Or A Viable Health Care Plan

Today we found that Donald Trump does not have any secretly recorded tapes of James Comey and the previously secret Senate Republican health care plan has been released. Neither was a surprise. If Trump had any tapes proving he was telling the truth, he would have already released them, and if there happened to be tapes which showed he was lying, he would never admit to having them. Also, as expected, the Senate plan includes deep cuts to Medicaid, decreases subside for lower income individuals, and increases costs for those who are older.

Barack Obama described the plan:

Simply put, if there’s a chance you might get sick, get old, or start a family – this bill will do you harm. And small tweaks over the course of the next couple weeks, under the guise of making these bills easier to stomach, cannot change the fundamental meanness at the core of this legislation.

I hope our Senators ask themselves – what will happen to the Americans grappling with opioid addiction who suddenly lose their coverage? What will happen to pregnant mothers, children with disabilities, poor adults and seniors who need long-term care once they can no longer count on Medicaid? What will happen if you have a medical emergency when insurance companies are once again allowed to exclude the benefits you need, send you unlimited bills, or set unaffordable deductibles? What impossible choices will working parents be forced to make if their child’s cancer treatment costs them more than their life savings?

To put the American people through that pain – while giving billionaires and corporations a massive tax cut in return – that’s tough to fathom. But it’s what’s at stake right now. So it remains my fervent hope that we step back and try to deliver on what the American people need.

It is far from certain that the Republicans can even pass this plan, despite using reconciliation so that they only need fifty votes. They can only afford to lose two votes, but four conservatives have already expressed reservations. From NPR:

Senate Republicans’ health care bill may already be on life support, with four key lawmakers announcing their opposition just hours after the GOP’s latest effort to repeal and replace the Affordable Care Act was released.

“Currently, for a variety of reasons, we are not ready to vote for this bill, but we are open to negotiation and obtaining more information before it is brought to the floor,” Sens. Rand Paul, R-Ky.; Ted Cruz, R-Texas; Mike Lee, R-Utah; and Ron Johnson, R-Wis., said in a statement Thursday afternoon.

They cannot easily move further to the right to appease the conservatives as some more moderate Republicans already have their own objections:

Sen. Dean Heller, R-Nev., who faces a competitive re-election race in 2018, says he has “serious concerns about the bill’s impact on the Nevadans who depend on Medicaid.”

“As I have consistently stated, if the bill is good for Nevada, I’ll vote for it and if it’s not — I won’t,” Heller said.

Annie Clark, a spokeswoman for Sen. Susan Collins, R-Maine, said the centrist has some misgivings about the bills as well.

Whether or not it passes, Republicans will now be able to tell their constituents that they have attempted to keep their promise to repeal and replace Obamacare. If their plan fails, the blame could be placed on Democrats and whichever Republicans vote against it, as opposed to the party as a whole. If that doesn’t work, McConnell could always take something from the Clinton playbook and blame Russia.

Republican Health Plan Might Be Even Meaner Than House Plan

Mitch McConnell is aiming for a vote on the Senate health care plan before July 4. The Wall Street Journal reports:

Failure to take a vote before either the July 4 recess or the longer break later in the summer also could open Republican lawmakers up to pressure from constituents either concerned about losing their health coverage or expecting Republicans to follow through on pledges to repeal the law known as Obamacare. Some town-hall meetings during the spring, when the House was considering its legislation, saw lawmakers greeted by boisterous crowds.

The nonpartisan Congressional Budget Office estimated the House bill passed in May would leave 23 million fewer Americans with health coverage in 2026 versus current law.

GOP aides and others familiar with the negotiations said they anticipate the Senate bill’s text will be released later this week. The CBO is expected to release its estimate of the Senate bill’s impact on the federal budget and insurance coverage early next week, and a vote could potentially be held next Thursday, before lawmakers scatter.

As “mean” as the House plan was (to quote the inconsistent Donald Trump), reportedly the Senate plan might cut Medicaid spending even more. The Wall Street Journal notes that this “is likely to draw opposition from Republicans in states that expanded Medicaid under the ACA, including Sens. Rob Portman of Ohio, Dean Heller of Nevada and Shelley Moore Capito of West Virginia.”

Democrats, lacking the votes to stop the bill, are planning on using stalling tactics to attempt to slow down Senate business, but this is not likely to be sufficient to stop passage if the Republicans have the votes.

Polling has shown that voters are concerned about the cuts in health care benefits and the manner in which the bill is being drafted in secrecy, with voters preferring Obamacare to the Republican plan. Hopefully this will result in pressure on  more vulnerable Republican Senators to vote against the bill.

Wednesday is also the deadline for insurance companies to decide upon whether they will participate in the exchanges under the Affordable Care Act and decide upon their rates. The uncertainty caused by the Republicans working in secrecy to change the law could scare more companies off and destabilize the plan regardless of whether Republicans succeed in repealing it.

Members of Presidential Advisory Council On HIV/AIDS Resign In Protest Over Policies Of Trump Administration

Six members of the Presidential Advisory Council on HIV/AIDS (PACHA) have resigned in protest over the lack of concern by the Trump administration for treating HIV. They have publicly announced their decision in an open letter published in Newsweek.  The letter notes that, “It is indisputable that the Affordable Care Act has benefitted people living with HIV and supported efforts to combat the HIV/AIDS epidemic.” It notes that, in contrast, provisions of the American Health Care Act which reduce access to health care “would be particularly devastating for people living with HIV.”

Following is the text of the letter:

Five of my colleagues and I resigned this week from the Presidential Advisory Council on HIV/AIDS (PACHA).

As advocates for people living with HIV, we have dedicated our lives to combating this disease and no longer feel we can do so effectively within the confines of an advisory body to a president who simply does not care.

The Trump Administration has no strategy to address the on-going HIV/AIDS epidemic, seeks zero input from experts to formulate HIV policy, and—most concerning—pushes legislation that will harm people living with HIV and halt or reverse important gains made in the fight against this disease.

Created in 1995, PACHA provides advice, information, and recommendations to the Secretary of Health and Human Services regarding programs, policies, and research to promote effective treatment, prevention, and an eventual cure for HIV.

Members, appointed by the President, currently include public health officials, researchers, health care providers, faith leaders, HIV advocates, and people living with HIV. PACHA also monitors and provides recommendations to effectively implement the National HIV/AIDS Strategy, which was created by the White House Office of National AIDS Policy in 2010 and revised in 2015.

The decision to resign from government service is not one that any of us take lightly. However, we cannot ignore the many signs that the Trump Administration does not take the on-going epidemic or the needs of people living with HIV seriously.

While many members of the public are unaware of the significant impact that HIV/AIDS continues to have in many communities— or that only 40 percent of people living with HIV in the United States are able to access the life-saving medications that have been available for more than 20 years—it is not acceptable for the U.S. President to be unaware of these realities, to set up a government that deprioritizes fighting the epidemic and its causes, or to implement policies and support legislation that will reverse the gains made in recent years.

Signs of President Trump’s lack of understanding and concern regarding this important public health issue were apparent when he was a candidate. While Secretary Clinton and Senator Sanders both met with HIV advocates during the primaries, candidate Trump refused. Whatever the politics of that decision, Mr. Trump missed an opportunity to learn—from the experts—about the contours of today’s epidemic and the most pressing issues currently affecting people living with HIV.

In keeping with candidate Trump’s lack of regard for this community, President Trump took down the Office of National AIDS Policy website the day he took office and there has been no replacement for this website 132 days into his administration.

More important, President Trump has not appointed anyone to lead the White House Office of National AIDS Policy, a post that held a seat on the Domestic Policy Council under President Obama. This means no one is tasked with regularly bringing salient issues regarding this ongoing public health crisis to the attention of the President and his closest advisers.

By comparison, President Obama appointed a director to this office just 36 days into his administration. Within 18 months, that new director and his staff crafted the first comprehensive U.S. HIV/AIDS strategy. By contrast, President Trump appears to have no plan at all…

We believe he should embrace the important work accomplished by the National HIV/AIDS Strategy. Public health is not a partisan issue, and this important document could easily be ratified by the Trump Administration. If the President is not going to engage on the subject of HIV/AIDS, he should at least continue policies that support people living with and at higher risk for HIV and have begun to curtail the epidemic.

While these actions and others are gravely worrisome to us as HIV advocates, the final straw for us—more like a two-by-four than a straw—is President Trump’s handling of health care reform.

It is indisputable that the Affordable Care Act has benefitted people living with HIV and supported efforts to combat the HIV/AIDS epidemic. Gains in the percentage of people with HIV who know their status, the percentage engaged in care, the percentage receiving successful treatment, and a decrease in new cases of HIV were seen in Massachusetts under Romneycare. We are beginning to see similar effects on a national level under Obamacare.

People living with HIV know how broken the pre-ACA system was. Those without employer-based insurance were priced out of the market because of pre-existing condition exclusions. And “high risk pools” simply segregated people living with HIV and other health conditions into expensive plans with inferior coverage and underfunded subsidies—subsidies advocates had to fight for tooth-and-nail in every budgetary session.

Because more than 40 percent of people with HIV receive care through Medicaid, proposed cuts to that program would be extremely harmful. Prior to Medicaid expansion under ACA, a person had to be both very low income and disabled to be eligible for Medicaid.

For people living with HIV, that usually meant an AIDS diagnosis—making the disease more difficult and expensive to bring under control—before becoming eligible.

Between reinstating that paradox by defunding Medicaid expansion, imposing per-person caps on benefits, and/or block granting the program, the changes to Medicaid contemplated by the American Health Care Act would be particularly devastating for people living with HIV.

And we know who the biggest losers will be if states are given the option of eliminating essential health benefits or allowing insurers to charge people with HIV substantially more than others.

It will be people—many of them people of color—across the South and in rural and underserved areas across the country, the regions and communities now at the epicenter of the U.S. HIV/AIDS epidemic.

It will be young gay and bisexual men; it will be women of color; it will be transgender women; it will be low-income people.

It will be people who become newly infected in an uncontrolled epidemic, new cases that could be prevented by appropriate care for those already living with the disease.

While we are in agreement that the ACA needs to be strengthened to lower premiums, improve competition, and increase access to care, it makes no sense to dismiss gains made under the ACA just to score political points.

Experts with real facts, grounded in science, must be in the room when healthcare policy decisions are made. Those decisions affect real people and real lives. If we do not ensure that U.S. leadership at the executive and legislative levels are informed by experience and expertise, real people will be hurt and some will even die.

Because we do not believe the Trump Administration is listening to—or cares—about the communities we serve as members of PACHA, we have decided it is time to step down.

We will be more effective from the outside, advocating for change and protesting policies that will hurt the health of the communities we serve and the country as a whole if this administration continues down the current path.

We hope the members of Congress who have the power to affect healthcare reform will engage with us and other advocates in a way that the Trump Administration apparently will not.

Scott A. Schoettes is Counsel and HIV Project Director at Lambda Legal . He resigned from the Presidential Advisory Council on HIV/AIDS on June 13, along with Lucy Bradley-Springer, Gina Brown, Ulysses W. Burley III, Michelle Ogle, and Grissel Granados.

Republicans Vote To Deny Health Care Coverage To Millions But It Is Far From Certain That Democrats Can Take Advantage Of This

The lie of the week is that the Republican-controlled Congress voted to repeal and replace Obamacare. Repeal yes, but the law they passed is too worthless to seriously be called a replacement. Republicans voted to deny health care coverage to millions, and to open the door for insurance companies to deny coverage for preexisting conditions. Doctors, insurance companies, hospitals, AARP, and many consumers groups are unified in opposing this legislation. Fortunately even some Senate Republicans realize that this is a terrible plan and want to start from scratch.

To summarize the effects of the House plan:

  • Tax cuts for the wealthy–always a Republican priority
  • Defunds Planned Parenthood for one year
  • Allows older Americans to be charged more
  • Cuts benefits to Medicaid recipients
  • Cuts school services for disabled children
  • Could weaken employer sponsored health care along with plans sold on the exchanges, including removing coverage for the essential health benefits now in Obamacare, and removing prohibition on annual limits of coverage

The House plan could return us to the days when insurance companies made their profits by taking in premiums but finding ways to avoid paying out money on claims. Only selling insurance to the healthy very well could result in lower premiums, but this defeats the purpose of having health insurance. Republicans claim to be funding high risk pools to care for those with preexisting conditions, but they are only providing funding to cover five percent of those with preexisting conditions.

Of course, this will depend upon what happens in the states, and how many red states actually do opt out of the current requirements. Scott Walker has already stated he might apply for a waiver for coverage of preexisting conditions in Wisconsin.

Democrats are excited that this will help them politically, with some saying that the GOP just doomed itself. Even those who support many of the GOP goals see this plan as being politically damaging for Republicans.

Health care should dominate politics in upcoming cycles, but Democrats cannot count on this by itself being the key to retaking control of the House. Democrats need to keep up the pressure and do a far better job of making their arguments than they did when the Affordable Care Act was initially passed. It is questionable if anything resembling the House plan will ever pass the Senate and become law. (Presumably Donald Trump will sign whatever the Republicans pass, regardless of how much it violates his campaign promises).

Democrats could have the same problem in capitalizing on this as they did in promoting Obamacare. While some might lose insurance coverage immediately, many others might feel safe, not realizing that developing a medical problem could put them at risk of losing coverage in the future. Some will even be happy as young, healthy people very likely could wind up paying less–as long as they remain young and healthy. The adverse effects of this law won’t be fully apparent in 2018.

The Democrats could also lose due to their political cowardice. During the 2016 presidential campaign, Hillary Clinton opposed Bernie Sanders’ proposal for Medicare for All. Truthout debunked Clinton’s arguments. Now Nancy Pelosi and the Democratic establishment are refusing to take this opportunity to push for a single payer plan. The Observer’s view of Pelosi and mainstream Democrats is quite close to that expressed previously by Truthout:

Their failure to support a proposal that the majority of their base wants illuminates the growing disconnect between elected officials and their constituents and the massive influence of the health insurance and pharmaceutical industries. Americans want single payer health care, and the obstacles blocking them from the system they want are special interests, which are bought and paid for Democrats in office who avoid taking principled stances on issues. Democrats like Pelosi don’t stand for anything because fighting for something like single payer health care would upset the party’s wealthy donors.

Pelosi’s and other Democrats’ arguments excuse themselves from supporting progressive policies and reaffirm the Democratic Party as a corrupt entity tied to the wealthiest 1 percent of Americans. On May 1, the Washington Post reported a poll conducted in January among Trump voters who had previously voted for Obama. When those polled were asked what the Democratic Party stands for they gave responses like, “The 1 percent,” “The status quo” and “They’re for the party. Themselves and the party.” One woman, asked whether the Democratic Party is for people like her, flatly declared, “Nope.”

As Donald Trump has learned, health care is complicated. You cannot reduce costs without reducing coverage, unless you make fundamental changes in the system. The most obvious way would be a single payer plan which both removes the huge profits of the insurance industry and places everyone in the same risk pool. In hiding from this reality, Democrats show why they tend to lose and Republicans have been winning. Republicans did not care that their ideas have been far out of the mainstream. They pushed their ideas until they won over enough people to win, even if it has been on fallacious arguments. The party which stands for something, regardless of what it stands for, has an advantage over a party which stands for nothing. Thus we have seen the Democratic losses in 2010, 2014, and now 2016.

CBO Issues Devastating Report On Effects Of GOP Obamacare Replacement

The nonpartisan Congressional Budget Office has projected that twenty-four million more Americans will wind up uninsured under the Republican health care plan (which calls into question whether this should be called a health care plan at all). The plan would provide inadequate funding for Medicaid, and risks destabilizing the individual market–unless you believe Republican predictions that the free market would respond with better products. This is rather hard to believe considering the failure of the market to handle insurance for those not receiving it through employer or government programs prior to the Affordable Care Act.

To put this in perspective, studies have projected that the loss of insurance by twenty million people (which is less than is predicted under the Republican plan) will result in 24,000 more deaths per year. This backs up the statement from Bernie Sanders that “thousands of Americans will die” if the Republican plan becomes law

Remarkably, a White House analysis projected that the plan will result in an even higher number losing insurance–26 million over the next decade. This is hardly consistent with what Donald Trump promised on the campaign trail. The plan also contradicts Trump’s promises that he would not cut Medicaid and would expand payment for treatment of opiate dependence.

The Center on Budget and Priorities notes how millions would be paying more for less coverage, along with facing higher out of pocket expenses. Aaron Blake points out:

According to the CBO, 64-year olds making $26,500 per year would see their premiums increase by an estimated 750 percent by 2026. While they are on track to pay $1,700 under the current law, the CBO projects the American Health Care Act would force them to pay $14,600. Even if you grant that inflation will allow them to make slightly more money by 2026, that’s still about half of their income going to health care.

There is additional information of significance. Despite Republican claims of a death spiral, the CBO report showed that the ACA is not “imploding.” As other studies have also found, it is stabilizing as more people obtain coverage:

Under current law, most subsidized enrollees purchasing health insurance coverage in the nongroup market are largely insulated from increases in premiums because their out-of-pocket payments for premiums are based on a percentage of their income; the government pays the difference. The subsidies to purchase coverage combined with the penalties paid by uninsured people stemming from the individual mandate are anticipated to cause sufficient demand for insurance by people with low health care expenditures for the market to be stable.

The Washington Post has fact checked White House press secretary Sean Spicer’s spin regarding the CBO report.

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.

 

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.