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Senate Majority Leader Mitch McConnell speaks to reporters in the U.S. Capitol in Washington, May 17, 2016. (Photo by Kevin Lamarque/Reuters)

Republicans describe health care secrecy as 'transparent and open'

06/23/17 10:09AM

Now that the Senate Republicans' health care plan has been released, the debate is now shifting away from process and towards the merits of the bill and its legislative process. But before the political world moves on, several GOP senators see one last opportunity for some gaslighting.

One of the most striking -- and historically unusual -- aspects of the Senate Republicans' approach to health care has been their willingness to operate in total secrecy. GOP leaders appointed members to a "working group," which negotiated behind doors, and kept every detail hidden -- from the public, from stakeholders in the health care industry, from much of the Senate -- until yesterday.

As Rachel noted on the show the other day, even a Republican member of the "working group" conceded earlier this week that he hadn't seen the legislation he was ostensibly helping write.

Compounding the secrecy, GOP senators have refused to hold legislative hearings in any committee, preferring to keep the health care overhaul in total darkness and away from scrutiny.

And yet, consider these quotes from Senate Republicans yesterday:

Sen. Pat Roberts (R-Kan.): "There's no lack of transparency.... You shouldn't even ask that question."

Senate Majority Whip John Cornyn (R-Texas): "I can't imagine a more transparent and open process."

Senate Republican Conference Chairman John Thune (R-S.D.), asked by Fox Business why his party relied on a secretive process: "There hasn't been any secrecy."

None of these members was kidding. They may have been shamelessly lying, but they actually expect people to believe the rhetoric.

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Trump and health care: Promises made, promises broken

06/23/17 09:22AM

At a campaign rally in Iowa this week, Donald Trump boasted, "One by one we are keeping the promises we made to the people of Iowa and the people all over our country." That's hopelessly bonkers on a wide variety of fronts, but it's especially striking when it comes to health care.

The president promised the American public, "We're going to have insurance for everybody.... Everybody's going to be taken care of." He vowed his health care policy would offer "lower premiums" with "much lower deductibles." And perhaps most importantly, Trump swore, over and over again, in writing and in public remarks, that he would never cut Medicaid.

And yet, there was the Republican president yesterday, throwing his support behind a Senate GOP bill that won't cover everybody, would increase consumer costs, and cuts Medicaid by hundreds of billions of dollars. As NBC News' Benjy Sarlin explained:

The Affordable Care Act gave states federal funding to expand Medicaid coverage to people whose incomes were between 100 percent and 138 percent of the federal poverty line.... But [the Senate Republicans' plan] would go a lot further than repealing Obamacare's changes. It would also cap the amount of funding states can get on a per-recipient basis rather than continue the current system, in which states decide how much to spend and then have the federal government match their contribution.

Starting in 2025, the plan would then grow those per-recipient caps at a rate that's unlikely to keep pace with increasing medical costs. A similar change in the House bill was projected to reduce Medicaid spending by $839 billion over a decade and cover 14 million fewer people. The Senate bill kicks in later, but its cuts would be even deeper than the House plan.

This is a profound betrayal to those Americans who actually believed Trump's assurances, and voted for him because they expected the Republican to honor his word.

What's the White House's explanation for the presidential perfidy? Trump's budget director recently questioned the importance of the Medicaid promise, which probably won't offer much comfort to families poised to suffer.

What's more, it's not just Trump.

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Two men stand on the plaza of the U.S. Capitol Building as storm clouds fill the sky, June 13, 2013 in Washington, DC.

The window of opportunity to stop the GOP health plan is closing

06/23/17 08:44AM

When the Republican's far-right health care plan passed the House last month, several lawmakers who voted in the majority conceded they did so grudgingly. Rep. Mario Diaz-Balart (R-Fla.) gave an especially memorable quote to the Washington Post.

"Is this bill good? No, I don't like it," Diaz-Balart said. But he suggested that voting for the bill would allow him to be part of future negotiations: "So my decision was, how do I stay involved?"

Even at the time, this seemed more like wishful thinking than a credible legislative strategy. Diaz-Balart voted for a bill he admittedly didn't like, and in the weeks that have followed, there's no evidence that he's been "involved" in shaping his party's approach in any meaningful way.

That said, the Miami Republican probably wasn't the only one thinking along these lines. Policymakers, the argument goes, should just keep the process moving forward, incrementally making changes along the way, giving various players an opportunity to tweak, change, and hopefully improve the legislation before it's too late.

For opponents of the GOP plan, this offers related opportunities: at every choke point, health care advocates have a chance to stop the far-right package from advancing.

What became clear yesterday, however, is that everyone's window of opportunity is closing in ways that aren't fully appreciated.

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GOP health plan is like trying to put out a fire with a flamethrower

06/23/17 08:00AM

It's not exactly a secret that Republicans hate the Affordable Care Act with every fiber of being -- or at least they claim to. It's never been altogether clear why GOP officials are so disgusted with the reform law, but when asked, Republicans tend to have some key complaints at the ready.

"Obamacare," they argue, doesn't cover enough people and it costs consumers too much. With this in mind, Republican officeholders and candidates have spent years pleading with the American electorate: give the GOP power and they'll make the health care system better. How? They've been reluctant to say for the last seven years.

It's now painfully clear why. The new proposal from Senate Republicans is stunning in a wide variety of ways, but perhaps the most striking takeaway is the degree to which it's a substantive non-sequitur. The Republicans' purported goals and their proposed legislation have almost nothing in common. Vox's Ezra Klein explained yesterday:

The Senate GOP's health care bill is a strange document. It doesn't fix what conservatives dislike most about Obamacare. But it takes what everyone else hates about Obamacare and makes it much, much worse. [...]

The new world created by the Senate health care bill will be based around higher-deductible plans that cover fewer health benefits and cost people more. The plan degrades Obamacare's insurance regulations, and cuts insurance subsidies so that Americans won't be able to afford plans as generous as the ones they purchase now. If the Medicaid expansion really does die out in 2024, then the poorest of the poor will be pushed from comprehensive, low-cost health insurance to extremely high-deductible plans.

Obviously, the scope and scale of the damage this legislation would impose on the nation is what matters most, but it's also worth pausing to appreciate the pernicious dishonesty that serves as the bill's foundation.

There's no meaningful connection between what Republicans say is wrong with the health care system and what they're proposing. GOP officials said the Affordable Care Act doesn't cover enough people, so they're pushing a plan that covers fewer people. Republicans said the costs for consumers under "Obamacare" are too high, so they're advocating a new system that would force consumers to pay more.

In other words, their questions and their answers don't match. Republicans, concerned about a simmering fire, are trying to put it out with a flamethrower.

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Thursday's Mini-Report, 6.22.17

06/22/17 05:30PM

Today's edition of quick hits:

* Quite a sight: "Capitol Police forcibly removed protesters gathered outside Senate Majority Leader Mitch McConnell's office on Thursday, with at least one photo showing drops of blood on the hallway floor."

* Missile defense: "An American attempt to gauge the military's ability to shoot down medium- and intermediate-range ballistic missiles and counter potential threats from North Korea failed Wednesday night, according to the U.S. Missile Defense Agency and the Japan Ministry of Defense."

* Quite a swamp: "More than 100 former federal lobbyists have found jobs in the Trump administration, despite President Trump's campaign pledge to restrict the power of special interests in Washington, according to a tally provided to USA TODAY by a Democratic group."

* On a related note: "One of President Donald Trump's newest appointees is a registered agent of Saudi Arabia earning hundreds of thousands of dollars to lobby on the kingdom's behalf, according to U.S. Department of Justice records reviewed by the Center for Public Integrity."

* This really was weird: "President Trump blasted wind power during a rally in Iowa Wednesday night despite the fact that the state gets nearly a third of its power from the alternative energy source."

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With the health care system threatened, Obama speaks up

06/22/17 04:49PM

In the American tradition, former presidents tend to say very little about their successors. And with this in mind, while Barack Obama has no doubt been tempted in recent months to condemn Donald Trump and his actions, Obama has been restrained, giving the new president a wide berth.

But just a couple of days before Trump's inauguration, Obama acknowledged that while the White House and Congress would make their own determinations about the nation's direction in the coming years, and he intended to stay out of it, that principle is not absolute.

"There's a difference," Obama said, "between that normal functioning of politics and certain issues or certain moments where I think our core values may be at stake."

Less than two weeks after leaving office, this led Obama to issue a statement responding to the Trump White House's proposed Muslim ban. This afternoon, with the American health care system in peril, the former president spoke up again, this time via social media.

The Democrat's 1,000-word statement is worth reading in its entirety, and it clearly has more than one audience in mind. Part of Obama's message clearly intends to encourage health care advocates and their allies to remain engaged and fight to prevent the nation from falling backwards.

But the other part of the message appears to be a challenge to Republican policymakers to do the right thing:

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Republican U.S. presidential candidate Sen. Ted Cruz attends a Penn. campaign kickoff event held on N.Y. presidential primary night at the National Constitution Center in Philadelphia, Penn. on April 19, 2016. (Photo by Charles Mostoller/Reuters)

Four far-right senators balk at GOP health plan, for now

06/22/17 04:15PM

The arithmetic for Senate Republicans is pretty straightforward: they have 52 members in the chamber, and their far-right health care overhaul will need 51 votes to pass.

If one or two GOP senators break ranks and decide they can't support the bill, that won't be enough to change the outcome: Vice President Mike Pence would break the tie and advance the legislation. If three or more Republicans oppose the plan, it dies.

And that, in turn, gives a group of four GOP senators a fair amount of influence.

Four Republican senators have announced that they will not vote for the GOP health care bill unless changes are made, putting passage of the bill at risk just hours after it was unveiled. [...]

The four conservative GOP senators -- Rand Paul of Kentucky, Mike Lee of Utah, Ron Johnson of Wisconsin and Ted Cruz of Texas -- released a joint statement outlining their concerns:

"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," the four conservatives said in a written statement. "There are provisions in this draft that represent an improvement to our current healthcare system but it does not appear this draft as written will accomplish the most important promise that we made to Americans: to repeal Obamacare and lower their healthcare costs."

This isn't exactly a hard-hitting threat. On the contrary, it's a lukewarm, almost mealy-mouthed statement. It's one thing for a group of senators to announce their opposition; it's something else when senators say in the first sentence of their statement that they're "open to negotiation and obtaining more information."

Still, it's a warning shot of sorts: Senate Republican leaders are apparently going to have to move the bill  even further to the right, at least in some tangible ways, to pick up these four far-right members.

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Image: Donald Trump

Donald Trump comes clean, admits he doesn't have tapes

06/22/17 02:25PM

Six weeks ago, Donald Trump had one of the more consequential Twitter tantrums of his career. The president, for reasons that have never been explained, wrote in a warning to the former director of the FBI, "James Comey better hope that there are no 'tapes' of our conversations before he starts leaking to the press!"

This 19-word missive, which came shortly before Comey's scheduled testimony on Capitol Hill, sparked a chain reaction that included, among other things, the appointment of a special counsel to investigate Trump's Russia scandal.

But against the dramatic background, there's been an open question as to whether or not the "tapes" Trump referred to exist in reality. Asked at a press conference two weeks ago, the president said, cryptically, "Well I'll tell you about that sometime in the very near future." Evidently, he decided to come clean this afternoon.

President Donald Trump on Thursday tweeted that he did not record his conversations with then-FBI Director James Comey, putting to rest one of the biggest lingering mysteries surrounding the drama between the president and the FBI head he later dismissed.

Specifically, the president wrote in another pair of tweets, "With all of the recently reported electronic surveillance, intercepts, unmasking and illegal leaking of information, I have no idea whether there are 'tapes' or recordings of my conversations with James Comey, but I did not make, and do not have, any such recordings."

Note, the first half of this message seems designed to suggest some nefarious forces may have recordings of Trump, while the second half is his carefully worded -- no doubt lawyer approved -- denial.

Why it took the president six weeks to bring clarity to this simple question is something the White House has not yet explained.

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New Republican health care plan focuses on tax cuts, Medicaid cuts

06/22/17 01:12PM

The Senate is expected to vote in a week on a massive overhaul of the American health care system. After weeks of secretive deliberations, we can finally read what Republicans have in mind.

Senate Republicans have unveiled a draft of their legislation to revamp the government's role in the nation's health care system, a proposal that includes big reductions to Medicaid, eliminates the Obamacare mandate requiring individuals to purchase insurance and offers tax credits to help people afford insurance while slashing taxes for the wealthy.

The major change to health care comes in the form of Medicaid. The bill winds down the expanded Medicaid program under Obamacare after 2020 -- a longer timeline than the House health care bill that was passed in May. But it also makes deeper cuts to the program in the long run, by 2025, through changing the federal funding allocation formula for states to receive fewer federal dollars for Medicaid recipients.

The 142-page bill, which is being described as a "discussion draft," is online in its entirety here. (It is, fortunately, searchable.)

Scrutinizing any health care bill should always start with the same question: what is the problem the proposal intends to solve? In this case, GOP senators appear to be working from the premise that the nation needs a big tax cut.

And so, at its core, this new Republican legislation is effectively an income-redistribution plan: it intends to cut Medicaid deeply, and apply the bulk of those saving to tax breaks.

As for the details, we'll have a better sense of the projected impact of the bill -- which GOP senators have ironically called the "Better Care Reconciliation Act of 2017" -- after the Congressional Budget Office releases a score, which is expected early next week, just a few days before the scheduled vote. But in the meantime, here are some tidbits to keep in mind:

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Image: Senate Republicans Address The Press After Their Weekly Policy Luncheon

The GOP's political incentives on health care are a mess

06/22/17 11:26AM

The Senate Republicans' secret health care bill is, as of this morning, no longer a secret. Though the website GOP senators created for the proposal doesn't appear to be working perfectly, the bill is now available for public scrutiny -- with only a week to go before a scheduled floor vote.

But as we start digging in on the blueprint, and await a report from the Congressional Budget Office on its impact, it's worth taking a moment to think about the strange political incentives surrounding the entire initiative.

Because, frankly, I find them baffling.

Senate Republicans have kept the bill-writing process secret, in large part because they recognize how deeply controversial and unpopular their efforts are. GOP leaders have been reluctant to even talk about their own policy ideas, effectively telling their own members, "We better pass this now before anyone realizes how horrible the plan is."

But then what? What exactly do Republicans expect to happen once their regressive ideas are imposed on the nation?

In 2009 and 2010, Democrats wanted the public to know as much about their health care proposal as possible. Dems were desperate for Americans to learn the details, in part because Democratic officials believed people would like what they saw, but also because Dems wanted the facts to counteract the nonsensical rumors and brazen lies touted by the ACA's opponents. What's more, once "Obamacare" was law, Dems were confident that the law's popularity would eventually grow -- which is largely what's happened.

In 2017, however, all of this is reversed. Republicans plainly don't want Americans to get too close a look at their unpopular legislation, and have no real confidence that the public will actually like what GOP officials came up with behind closed doors.

All of which leads to a question that isn't asked often enough: why in the world are they doing this? Or more to the point, why aren't they concerned about a political backlash? As Vox's Ezra Klein put it the other day, "If their plan is so unpopular they can't defend it in theory, how will they defend it in practice? Each day this goes on, it seems less like a legislative process and more like a form of madness."

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