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The purpose of the Republican health care plan remains elusive
When Democrats originally tackled health care reform in 2009, there was no great mystery surrounding their motivations. As we discussed several months ago, Dems in Congress and the White House identified some key systemic problems -- too many Americans lacked basic health coverage, and even those with insurance faced costly risks -- and then worked on a solution.
Maybe you liked what they came up, maybe you didn't, but either way, there's no question as to why Democrats created the Affordable Care Act. They had specific goals, and by and large, they've achieved them.
Eight years later, Republicans are obviously determined to overhaul the nation's health care system, but the purpose of their crusade is far less clear.
At the surface, we know GOP lawmakers are scrambling to pass their latest proposal because they hate "Obamacare," and because they made a public commitment to destroy it. But putting aside displays of raw partisan power, we can circle back to a point Peter Suderman raised in March and ask a more fundamental question: what is the substantive purpose of this endeavor? What is the policy problem Republicans are attempting to solve?
It certainly doesn't have anything to do with their criticisms of "Obamacare." Going into the debate, the ACA's Republican critics said the current system didn't cover enough people and imposed costs on consumers that were too high. Their "solution," such as it is, will cover far fewer people and likely force premiums higher.
It also doesn't have anything to do with "repeal and replace," since the bill doesn't actually create a replacement system. It's more "repeal and hope states don't hurt too many people."
And it definitely doesn't have anything to do with keeping promises. Everything Donald Trump and GOP leaders said about insuring "everybody" and protecting those with pre-existing conditions has been cast aside without explanation.
Tuesday's Campaign Round-Up, 9.19.17
Today's installment of campaign-related news items from across the country.
* With time running out in Virginia's gubernatorial race, a University of Mary Washington poll, released yesterday, shows Ralph Northam (D) with a modest lead over Ed Gillespie (R), 44% to 39%. A new Suffolk poll, however, shows the two candidates tied at 42% each.
* Roy Moore, the leading candidate in Alabama's Republican Senate primary, made some racially controversial comments yesterday, telling voters, "Now we have blacks and whites fighting, reds and yellows fighting, Democrats and Republicans fighting, men and women fighting. What's going to unite us? What's going to bring us back together? A President? A Congress? No. It's going to be God."
* Speaking of Moore, the former state Supreme Court chief justice will welcome former White House aide Sebastian Gorka and former half-term Alaska Gov. Sarah Palin to Alabama this week for a rally in support of the Moore campaign. Donald Trump, meanwhile, still supports Moore's rival, appointed Sen. Luther Strange.
* TPM got an advance look yesterday at a new ad from Save My Care, a progressive health care advocacy organization, targeting Sen. Dean Heller (R-Nev.) for his role in the regressive Republican health care crusade. The 30-second spot will reportedly target "independent voters in Nevada on Twitter, Facebook, and other platforms."
* The Trump campaign's latest fundraising pitch tells supporters, "We will BUILD A WALL (not a FENCE) along the southern border of the United States of America to help stop illegal immigration. Liberals in Congress and the Fake News media need one more reminder that building the wall is non-negotiable."
* In Michigan, the GOP's field of Senate candidates shrunk a bit yesterday when Lena Epstein announced she's dropping her statewide bid and instead running for retiring Rep. Dave Trott's (R) U.S. House seat.
Republicans take aim at their own constituents' health care
Yesterday morning, many involved in the health care debate were keeping an eye on Arizona Gov. Doug Ducey (R). The thinking was, if the Republican governor balked at the Graham-Cassidy health care plan pending in the Senate, Sen. John McCain (R-Ariz.) would use Ducey's opposition as reason to reject the bill, which would likely kill it.
Some health care advocates were cautiously optimistic: independent analyses showed that Arizona would be punished more than most states by the Republican health care overhaul, so it stood to reason that Ducey would announce his opposition to the legislation -- if for no other reason, because it would hurt the interests of his own constituents.
As it turned out, however, it didn't matter. The Arizona governor formally endorsed the plan anyway, making it a bit more likely that McCain will do the same.
It's all quite counter-intuitive. Ordinarily, explaining to policymakers that their own states would suffer as a result of a proposal is usually a powerful argument, since elected officials are supposed to be reluctant to undermine the interests of the voters who put them in office. But when it comes to health care, and the Graham-Cassidy bill in particular, this doesn't seem to matter as much as it should.
The latest Senate Obamacare repeal bill would "uniquely" and "disproportionately" hurt a key sponsor's home state, according to the Louisiana Department of Health.
Louisiana Health Secretary Rebekah Gee wrote a letter Monday to Sen. Bill Cassidy (R-LA) to share her "deep concerns" with the repeal and replace bill that he's helped to craft.... As Senate Republicans jockey to get 50 votes to support the bill, Gee warned Cassidy that his plan to cut Medicaid expansion would jeopardize coverage for 433,000 Louisiana residents, a move that would be a "detrimental step backwards for Louisiana."
What's more, Cassidy isn't alone on this front.
On health care, Republicans may regret opening this door
Sen. John Kennedy, a Republican freshman from Louisiana, said yesterday that he likes the idea of turning health care over to the states -- the core rationale behind the pending Graham-Cassidy proposal -- but he's not entirely comfortable with the direction some blue states might take,
"If you give California and New York a big chunk of money, they're gonna set up a single-payer system," the GOP senator said. "And I wanna prevent that."
It's curious. Republicans only seem to like turning over authority to states and local governments when they're confident states and local governments will govern in a conservative way.
But in this case, Kennedy's concerns probably aren't quite broad enough.
Whether congressional Republicans recognize this or not, they're in the process of creating a new governing standard. GOP leaders are telling everyone -- the public, the health care industry, even the future -- that Congress can radically overhaul the nation's health care system, ignoring the wishes of the public and stakeholders throughout the industry, without any real debate, scrutiny, or even a full Congressional Budget Office analysis. According to Republicans, this is an entirely legitimate exercise and an appropriate use of legislative power.
The funny thing about legislative power, though, is that eventually it changes hands.
Republican propaganda efforts reach a new, alarming level
Americans who pay attention to political news can probably think of plenty of conservative outlets that seem like extensions of the Republican Party. But what if there were a far-right news source that was literally an extension of the Republican Party?
The Associated Press today introduced the public to The Free Telegraph, which isn't a news outlet, but does its very best to pretend to be.
Republican governors are getting into the "news" business.
The Republican Governors Association has quietly launched an online publication that looks like a media outlet and is branded as such on social media. The Free Telegraph blares headlines about the virtues of GOP governors, while framing Democrats negatively. It asks readers to sign up for breaking news alerts. It launched in the summer bearing no acknowledgement that it was a product of an official party committee whose sole purpose is to get more Republicans elected.
If you swing by The Free Telegraph's site right now, there is a disclosure notice at the very bottom that notes the outlet is "paid for by [the] Republican Governors Association." But before anyone finds that impressive, it's worth remembering that (a) the disclosure is in a small, gray font, against a gray background; and (b) that disclosure was only added to the site after the Associated Press started asking about it.
The Free Telegraph -- not to be confused with the Daily Telegraph, which is an actual newspaper published in the U.K. -- has a Twitter feed that tells readers it's "bringing you the political news that matters outside of Washington," without mentioning its Republican ownership. The same is true of its Facebook account, which labels The Free Telegraph a "Media/News Company."
Except, of course, it's not. It's only pretending to be, and it's important to understand why that's a problem.
On health care, Republicans are prepared to govern in the dark
The series of events is familiar to anyone who cares about health care: Republicans unveil a plan to repeal the Affordable Care Act; partisans on the right get excited; health care advocates start to panic; the media notes that the bill has momentum; and then the Congressional Budget Office pours a bucket of reality on the whole endeavor.
This time, however, will be a little different. GOP senators are moving forward with Graham-Cassidy -- arguably their worst repeal proposal to date -- but data from the Congressional Budget Office won't save the day this time. The Washington Post reported:
Congress's nonpartisan budget analyst said it is working to provide a "preliminary assessment" of the latest Republican health-care bill by early next week but will not estimate how the measure would affect health insurance premiums or the number of people with medical coverage until later.
The notice Monday from the Congressional Budget Office angered Democrats, who planned to use the complete figures to hammer the Graham-Cassidy legislation, which is picking up steam in the Senate ahead of a possible vote within two weeks.
As the New York Times added, under the budget reconciliation process -- the process that allows Republicans to advance their bill with 50 votes instead of 60 -- the legislation will need some kind of cost estimate from the CBO. The budget office intends to comply "early next week," just days before the Senate's health care deadline, with some kind of data.
But unlike the other recent health care fights, this CBO "score" won't say how many Americans will lose coverage under Graham-Cassidy or how much the bill will hurt consumers trying to buy coverage.
To be sure, the CBO could provide senators with those figures, but the data won't be available before the Senate's Sept. 30 deadline. And that leaves Republican leaders with a choice between governing responsibly, with a full understanding of their bill's consequences, or legislating in the dark.
Take a wild guess which approach the GOP is prepared to embrace.
Rand Paul creates a problem for Senate GOP on health care
The arithmetic for health care advocates is pretty simple: sometime over the next 12 days, Senate Republicans are yet again going to try to pass an overhaul of the American health care system. If three or more GOP senators break ranks, the bill will fail. If not, it'll pass and probably become law.
Sen. Rand Paul (R-Ky.) keeps insisting he's one of the three "no" votes, but no one's sure whether to believe him.
The Kentucky senator first announced his opposition to the plan eight days ago, though many assumed he was just posturing. The Republican started putting his position in writing, and still, few believed he was sincere. Rand Paul went on Fox News to explain that he really does oppose the Graham-Cassidy plan, and again, much of the political world thought he didn't mean it.
So yesterday afternoon, the Kentucky Republican hosted a press briefing of sorts in order to say he's quite serious about his rejection of the legislation. Vox explained:
On Monday, Sen. Rand Paul (R-KY) voiced clear and staunch opposition to the Cassidy-Graham-Heller-Johnson proposal -- the last remaining Obamacare repeal plan that would block-grant Obamacare funding, cap federal health care spending, and send the money to the states to come up with their own health care programs.
"It keeps 90 percent of Obamacare and redistributes the proceeds," Paul said in a meeting with reporters in his office Monday. He continued: "I don't think anybody has realized the enormity of this. Obamacare took a long time to get in place. It took them a year to get their website. Can you imagine now every state has got to go through this? Start completely over with all the subsidies. Some states might want subsidies, some won't, some states might go to single-payer. I think it will be a chaotic nature for two years. It's not repeal. It's another incarnation of Republican replace. But not repeal."
Asked yesterday if anything could change his mind about the Graham-Cassidy bill, Paul replied, "Not on this bill."
And yet, even as I type this, there's a part of me that finds it hard to believe he'll follow through and keep his word. To be sure, Paul would look ridiculous if he reversed course on the bill after going out of his way to flaunt his opposition, but that doesn't mean it won't happen.
Repeal crusade puts John McCain's principles to the test
In late July, in the wake of a scary cancer diagnosis, Sen. John McCain (R-Ariz.) delivered stirring remarks on the Senate floor, making the case that his party was pursuing an overhaul of the nation's health care system the wrong way. Republican leaders blew off his concerns and assumed the Arizonan would toe the party line.
He didn't. McCain joined a bipartisan group of senators and derailed the GOP repeal crusade.
In the days and weeks that followed, when McCain wasn't receiving cancer treatment, he was laying out his legislative principles with passion and depth. The veteran lawmaker hasn't just casually expressed procedural preferences; McCain made a commitment to the kind of policymaking he wants to see in the United States.
The senator has done so repeatedly, in op-eds, in interviews, and in speeches. Just 12 days ago, McCain said in a statement that any legislative endeavor such as health care reform "must" -- not "should," not "it'd be nice," but "must" -- follow regular order.
And now we're going to find out if he meant it. The New York Times' David Leonhardt explained this morning:
The latest Trumpcare, known as Graham-Cassidy, risks the Senate's credibility again. There has been none of the regular process that McCain demanded, not even a Congressional Budget Office analysis. No major medical group -- not doctors, nurses, hospitals or advocates for the treatment of cancer, diabetes or birth defects -- supports the bill.
Passing it would violate every standard that McCain laid down.... There is reason to believe McCain will stand firm, starting with his sense of personal honor.
Health security for millions of Americans may hinge on a single question: will John McCain honor his commitment and stated principles?
Monday's Mini-Report, 9.18.17
Today's edition of quick hits:
* Another one: "Hurricane Maria was strengthening fast into a monster storm Monday as it barreled towards Martinique and Puerto Rico and the other Irma-battered Caribbean islands."
* St. Louis: "Protests in St. Louis over a former police officer's acquittal in the shooting death of a black man continued Monday after a weekend capped by the arrests of more than 80 people."
* Oh my: "On the sidelines of the United Nations General Assembly, President Donald Trump on Monday previewed a new tradition he would like to institute: a parade of military pageantry in the nation's capital in the style of the one he attended in Paris for Bastille Day this year."
* In related news: "President Donald Trump opened his first remarks at the United Nations Monday by complimenting the Trump-branded property across the street."
* Trump's latest court defeat: "A federal judge has blocked the Trump administration's attempt to use Justice Department public-safety grant programs to discourage so-called sanctuary city policies aimed at protecting undocumented immigrants."
* Russia: "A revitalized Russian military on Monday sent tanks, paratroopers, artillery, antiaircraft weapons, jets and helicopters into frigid rains to engage the forces of a mock enemy called the 'Western Coalition.' The barrage of firepower, part of war games that began last week, was an explosive show of force that Baltic leaders said was a simulation of an attack against NATO forces in Eastern Europe."
* I wonder if Elton John will mind: "President Trump is calling Kim Jong Un names -- the 'Rocket Man.'"
* Afghanistan: "Soon, American Embassy employees in Kabul will no longer need to take a Chinook helicopter ride to cross the street to a military base less than 100 yards outside the present Green Zone security district."
In Russia scandal, Trump's legal team isn't a fine-tuned machine
In recent weeks, Donald Trump's outside legal team, created to protect the president's interests as the Trump-Russia scandal moves forward, hasn't exactly been impressive. A series of bizarre incidents, including instances in which the president's lawyers got into odd email arguments with total strangers, have made some members of Trump's legal team look quite foolish.
But this New York Times report makes them look even worse. The piece is about arguments among the president's attorneys about "how much to cooperate" with Special Counsel Robert Mueller's investigation, and the challenge of balancing investigatory demands and the "prerogatives of the office of the presidency."
The debate in Mr. Trump's West Wing has pitted Donald F. McGahn II, the White House counsel, against Ty Cobb, a lawyer brought in to manage the response to the investigation. Mr. Cobb has argued for turning over as many of the emails and documents requested by the special counsel as possible in hopes of quickly ending the investigation -- or at least its focus on Mr. Trump.
Mr. McGahn supports cooperation, but has expressed worry about setting a precedent that would weaken the White House long after Mr. Trump's tenure is over. He is described as particularly concerned about whether the president will invoke executive or attorney-client privilege to limit how forthcoming Mr. McGahn could be if he himself is interviewed by the special counsel as requested.
The friction escalated in recent days after Mr. Cobb was overheard by a reporter for The New York Times discussing the dispute during a lunchtime conversation at a popular Washington steakhouse. Mr. Cobb was heard talking about a White House lawyer he deemed "a McGahn spy" and saying Mr. McGahn had "a couple documents locked in a safe" that he seemed to suggest he wanted access to. He also mentioned a colleague whom he blamed for "some of these earlier leaks," and who he said "tried to push Jared out," meaning Jared Kushner, the president's son-in-law and senior adviser, who has been a previous source of dispute for the legal team.
Some geographic context is probably in order. The head of the president's defense team went to BLT Steak, about two blocks north of the White House, sat outside, and had a loud and candid conversation about the investigation into the Russia scandal. BLT Steak is located at 1625 I Street.
The New York Times' D.C. bureau is located at 1627 I Street. In other words, Trump's top outside counsel effectively went to the New York Times' front door and started sharing his thoughts on sensitive information related to the president's legal defense in the most serious political scandal since Watergate.
That was ... unwise.
Monday's Campaign Round-Up, 9.18.17
Today's installment of campaign-related news items from across the country.
* In Alabama's Senate Republican primary, Rep. Mo Brooks (R) is no longer neutral: the far-right congressman endorsed Roy Moore over the weekend. Appointed Sen. Luther Strange (R) was hoping Brooks would stay on the sidelines.
* On a related note, following through on a promise, Donald Trump will campaign in Alabama on Saturday in support of Strange's candidacy. The GOP primary runoff is Sept. 26, which is a week from tomorrow.
* In Michigan, the president has thrown his support behind state Attorney General Bill Schuette's (R) 2018 gubernatorial campaign. (Trump tweeted his endorsement over the weekend, spelled Schuette's name wrong, then tweeted a new endorsement about 12 hours later.)
* Lawmakers in California are moving forward with state legislation that would require presidential candidates to release five years' worth of tax returns in order to qualify for the statewide ballot. The measure passed the state Assembly late last week.
* Illinois Attorney General Lisa Madigan (D), one of the highest profile politicians in the state, announced Friday that she won't seek re-election to her current post next year, setting off intense speculation about her career plans.
* In New Jersey, we don't yet know how Sen. Bob Menendez (D) will fare in his corruption trial, but many of his constituents have apparently seen enough: the latest Quinnipiac poll shows 50% of Garden State voters believe the senator does not deserve another term, while 20% believe he does.
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About The Rachel Maddow Show
Launched in 2008, “The Rachel Maddow Show” follows the machinations of policy making in America, from local political activism to international diplomacy. Rachel Maddow looks past the distractions of political theater and stunts and focuses on the legislative proposals and policies that shape American life - as well as the people making and influencing those policies and their ultimate outcome, intended or otherwise.
