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Image: Bill Cassidy,Lindsey Graham

Poll shows weak public support for latest Republican repeal plan

09/22/17 11:20AM

There are literally no major health care institutions in the United States that believe the latest Republican health care plan is a good idea. From doctors to nurses, hospitals to insurers, patient advocates to state officials, the entire industry has scrutinized the Graham-Cassidy legislation and called for its swift defeat.

On this, GOP policymakers are completely alone. They've convinced themselves -- and no one else.

But what about the public? There hasn't been much in the way of polling -- the legislation was only introduced last week -- but Vox this morning highlighted what I believe is the first national survey on the pending proposal.

With their deadline fast approaching, Senate Republicans' rush to repeal and replace Obamacare remains as unpopular as ever with the public.

Only 24 percent of Americans support Graham-Cassidy, the health care bill Republicans are furiously whipping to pass ahead of September 30, according to a new poll released Thursday by Public Policy Polling. The poll is the first to date of the proposed legislation, which would cripple Obamacare's exchanges and sharply cut long-term Medicaid spending while also taking billions of funding from blue states that implemented Obamacare and giving it to red ones that did not.

In case these results didn't make the repeal crusaders feel discouraged enough, let's not overlook the fact that the same PPP results found public support for the Affordable Care Act reaching 54% -- well over double the support for the latest Republican plan to repeal it.

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Sen. Dean Heller, R-Nev., during a press conference where he announced he will vote no on the proposed GOP healthcare bill at the Grant Sawyer State Office Building on Friday, June 23, 2017 in Las Vegas.

Nevada's Dean Heller is at war with himself over health care

09/22/17 10:47AM

Three months ago tomorrow, Sen. Dean Heller (R) of Nevada made a dramatic announcement. Standing alongside his home state's Republican governor, Nevada's Brian Sandoval, Heller became the first GOP senator to declare his opposition to his party's health care repeal plan.

By any fair measure, it was a bold move, which changed the trajectory of the fight. After Heller broke ranks, citing the importance of protecting Medicaid beneficiaries, other Republican senators soon followed, and the initial plan crafted by the GOP leadership failed.

But as political pressure increased, Heller wavered. When it came time to consider the Republicans' "skinny repeal" measure, for example, the Nevada senator toed the party line and voted with his party. Complicating matters, Heller soon after said he was "pleased" that the bill he voted for didn't pass.

A couple of weeks later, Heller claimed credit for having protected Medicaid from his own party, only to turn around soon after and become a leading sponsor of the Graham-Cassidy-Heller-Johnson plan that would impose deep Medicaid cuts.

CNN reported yesterday:

The shifts, Heller's Republican and Democratic opponents say, suggest he is operating out of fear -- first worried about not looking like a moderate, and then looking too much like a moderate.

I think that's right, and I think the result has pushed Heller into total incoherence. As a candidate, he endorsed ACA repeal, like nearly every other Republican. But when push came to shove, he announced his opposition to his party's repeal plan, then he supported a different repeal plan, then he was happy about the failure of the bill he voted in favor of, then he co-authored a different plan that does the one thing he said he's against.

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Nevada Governor Brian Sandoval holds a signing ceremony for Senate Bill 432, which allocates millions of dollars for low performing schools, June 3, 2015, in Las Vegas. (Photo by John Locher/AP)

Governors become important foes of Republican repeal plan

09/22/17 10:14AM

When four Republican senators unveiled the Graham-Cassidy health care plan last week -- yes, it really was just last week -- a reporter asked the quartet if they'd secured the support of governors who'd been skeptical of previous repeal plans. Sen. Dean Heller (R-Nev.) replied that it was still a "work in progress."

A week later, we can now say those efforts failed spectacularly. The Nevada Independent reported last night:

Gov. Brian Sandoval said Thursday that the flexibility fellow Republican Sen. Dean Heller promised will be good for Nevada in a health-care bill he’s sponsoring is a “false choice” because the legislation will also slash funding.

Sandoval, in a statement to The Nevada Independent, said he would not “pit seniors, children, families, the mentally ill, the critically ill, hospitals, care providers or any other Nevadan against each other” because of the steep cuts to federal funding the state would face if the Heller-sponsored measure were to pass. A state analysis, also obtained by The Nevada Independent, agrees with independent calculations from various health-care organizations estimating Nevada will lose between $600 million and $2 billion in federal funding by 2026 if the legislation passes.

Sandoval is hardly alone. Even if we put aside criticism from Democratic governors -- whom GOP senators are inclined to ignore -- the number of Republican governors who are publicly opposed to the Graham-Cassidy plan continues to grow.

We noted the other day that GOP governors representing Ohio, Nevada, Maryland, Vermont, Massachusetts, and New Hampshire have rejected the proposal. Soon after, New Jersey's Chris Christie (R) said he's against it, too. A day later, New Mexico's Susana Martinez (R) also gave the legislation a thumbs-down.

At one point this week, Sen. Bill Cassidy (R-La.) reportedly suggested his home state governor, Louisiana's John Bel Edwards (D), wasn't opposed to his repeal bill. Edwards disagreed, making clear he's against it, too.

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Image: Donald Trump

Trump aides 'aren't sure' about real-world impact of repeal bill

09/22/17 09:20AM

When House Republicans first tried to pass a far-right health care plan in the spring, it enjoyed Donald Trump's enthusiastic support. When House GOP officials tried again two months later with a slightly different proposal, the president endorsed it, too.

In the Senate, Trump quickly threw his support behind the Republican leadership's plan. When it failed, and Sen. Ben Sasse (R-Neb.) pushed an alternative approach, Trump endorsed it. When it failed to garner support, Sen. Ted Cruz (R-Texas) unveiled a related bill with several key changes, Trump endorsed it, too. When it fell short, and Republicans pursued "skinny repeal," Trump, once again, backed the plan.

The various GOP health care proposals have varied in important ways, but they've all had one thing in common: the enthusiastic support of the Republican president who appears to be hopelessly lost about even the most rudimentary details in this debate.

Now, with congressional Republicans making one last regressive push to uproot the nation's health care system, Trump has -- you guessed it -- endorsed the Graham-Cassidy plan. But as Politico noted, the White House has no idea what would happen to Americans if the proposal were actually imposed on the public.

One official said the concerns from governors have alarmed some in the White House -- and that "we really aren't sure what the impact will be" of passing the bill.

At least we've achieved some degree of unanimity on this: congressional Republicans who are eager to pass the bill have no idea what would happen if it's implemented, and the president who's eager to sign the bill is similarly clueless. None of these GOP officials has the foggiest idea how many Americans would lose coverage, how unstable the markets would become, how states would respond, or how much more consumers would pay for care -- but it might pass next week anyway.

Have I mentioned that we're talking about a life-and-death debate about one-sixth of the world's largest economy?

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Image: Tom Price

Price's private-jet travel more extensive than previously reported

09/22/17 08:40AM

We knew HHS Secretary Tom Price's private-jet travel was bad. We didn't know it was this bad.

Health and Human Services Secretary Tom Price has taken at least 24 flights on private charter planes at taxpayers' expense since early May, according to people with knowledge of his travel plans and a review of HHS documents.

The frequency of the trips underscores how private travel has become the norm -- rather than the exception -- for the Georgia Republican during his tenure atop the federal health agency, which began in February. The cost of the trips identified by POLITICO exceeds $300,000, according to a review of federal contracts and similar trip itineraries.

When Politico first broke this story earlier in the week, there was some question about who was picking up the tab for Price's charter flights. That question has now been answered: we're paying for it.

The far-right cabinet's secretary spokesperson told the New York Times the other day that Price's chartered flights were necessary to accommodate his "incredibly demanding schedule," but Politico's reporting suggests there were cheaper commercial flights available for many of these trips.

The new defense, offered yesterday pointed to Price's role in the federal response to the recent hurricanes, which might make more sense if most of his private-jet travel hadn't occurred long before the storms reached the U.S.

Indeed, the closer one looks at the details, the worse they appear. Politico's article added, "In June, Price spoke at a physicians association conference in San Diego, where he vowed to wring out wasteful spending in the government's health care programs. Getting 'value' for spending 'is incredibly important,' he said. Price took a private plane to get to the meeting, which was one stop on a five-state sprint of charter travel that cost $50,420."

Let's get a few things straight:

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Image: Senators Debate Health Care Bill On Capitol Hill

GOP eyes special side deal to buy key senator's health care vote

09/22/17 08:00AM

The future of the American health care system may rest of Sen. Lisa Murkowski's shoulders -- and with only a week remaining, no one can say with confidence what the Alaska Republican going to do.

On paper, the question seems fairly easy to answer: not only did Murkowski oppose previous GOP repeal efforts, but her home state of Alaska would be one of the nation's biggest losers if the Republican plan were approved and implemented. Common sense suggests she's a likely "no" vote.

But what if Republicans changed their plan to shield Alaska from GOP-imposed punishments? Politico had this report late yesterday, which rattled the political world quite a bit.

The Senate's Obamacare repeal bill may protect Alaska and up to four other sparsely populated states from major cuts to Medicaid through 2026, a potential boon to the home of pivotal GOP swing vote Sen. Lisa Murkowski.

The plan from Lindsey Graham (R-S.C.) and Bill Cassidy (R-La.) allows a limited number of states to opt out of its new Medicaid financing system, which would give states set sums to run their programs and do away with the open-ended entitlement that exists today.

The scheme has already received quite a few unflattering nicknames: "Alaska Purchase," "Klondike Kickback," and my personal favorite, "Polar Payoff." Whatever you're inclined to call it, the underlying idea appears to be a straightforward pitch to Murkowski: if she'll vote with her party to repeal Obamacare, Republicans will let Alaska keep Obamacare. The irony of such a move, of course, appears to be lost on the idea's proponents.

There's a lot to this development, so let's take the various elements one at a time:

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Thursday's Mini-Report, 9.21.17

09/21/17 05:30PM

Today's edition of quick hits:

* North Korea: "President Donald Trump announced Thursday that he had signed an executive order authorizing additional sanctions against North Korea by targeting individuals, companies and financial institutions that do business with what he called 'this criminal rogue regime.'"

* Puerto Rico: "Hurricane Maria, the most powerful storm to hit the U.S. territory in almost a century, ravaged the island, demolishing homes and knocking out all electricity. It could take half a year to restore power to the nearly 3.5 million people who live there."

* Florida: "The death toll from the south Florida nursing home that became a lethal sauna after Hurricane Irma knocked out the air conditioning rose to 10 on Thursday, authorities said."

* Facebook "has struck a deal with Capitol Hill investigators to release advertisements purchased by Russians to influence the 2016 campaign and some associated information with them, according to two people familiar with the matter."

* Related details: "Facebook has decided to turn over to Congress copies of more than 3,000 online political advertisements bought through Russian accounts during the 2016 U.S. presidential campaign, reversing a decision that had frustrated Capitol Hill investigators, company officials said Thursday."

* Russian officials today "raised the threat of a direct confrontation with U.S. forces in Syria, saying that it would target areas occupied by American units and U.S.-backed militias if its troops came under fire."

* Trump said he's made up his mind about the Iran nuclear deal. Secretary of State Rex Tillerson didn't appear to know that yesterday.

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Kimmel showed a 'better grasp of health policy' than GOP's Cassidy

09/21/17 04:34PM

It started in May. As regular readers know, late-night host Jimmy Kimmel spoke on the air about his young son's heart surgery, and his belief that all Americans should have access to affordable, potentially life-saving, care.

Sen. Bill Cassidy (R-La.) soon after began referencing the "Jimmy Kimmel Test": for a health care proposal to have merit, the Louisiana Republican said, it should ensure families are covered regardless of income. Cassidy even appeared on Kimmel's show, vowing to protect Americans who need protecting.

The GOP senator, however, changed quite dramatically, abandoned the "test," and partnered with Sen. Lindsey Graham (R-S.C.) on a radical, regressive proposal -- which the ABC host shredded in a brutal monologue on Tuesday night. Cassidy, Kimmel said, "lied right to my face," referencing an appearance the Republican made on “Jimmy Kimmel Live.”

The senator quickly defended himself, making a variety of television appearances in which he argued that Kimmel doesn't know what he's talking about. "I am sorry he does not understand," the senator told CNN. "More people will have coverage, and we protect those with pre-existing conditions."

So, who's right? In reality, more people won't have coverage, Cassidy isn't protecting those with pre-existing conditions, and Politico published a piece quoting health care analysts who concluded that between the host and the senator, "the late-night host has the better grasp of health policy."

[E]xperts say that Cassidy and Graham's bill can't guarantee those protections and that Kimmel's assessment was basically accurate because of the flexibility the bill gives states to set up their own health care systems. For example, health insurers could hike premiums for patients with pre-existing conditions if their states obtain waivers from Obamacare regulations -- as Kimmel said. [...]

The bill would also roll back the Affordable Care Act's Medicaid expansion and make other funding changes, like converting Obamacare funds into block grants and ending traditional Medicaid as an open-ended entitlement that would force states to choose whether to cut Medicaid enrollment, benefits or payments to providers -- or else raise taxes.

Joan Alker, the program director at Georgetown University's Center for Children and Families, told Politico, "Graham-Cassidy, like the previous Senate 'repeal and replace' proposals, takes a fiscal crowbar to Medicaid's knees.... Kimmel did not overstate the impact. If Graham-Cassidy becomes law, there is no guarantee a child born with a congenital heart defect will get the coverage they need. It would depend on where they live, but even states with good intentions would struggle to protect children with the massive cuts to Medicaid included in this bill."

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Image: Bill Cassidy,Lindsey Graham

Trump isn't the only one fibbing about the GOP's health care plan

09/21/17 12:45PM

Donald Trump declared via Twitter last night, "I would not sign Graham-Cassidy if it did not include coverage of pre-existing conditions. It does!"

It doesn't! It's probably unrealistic to think the president has spent a meaningful amount of time scrutinizing the details of the legislation he's eager to sign, but Trump's assurance is plainly untrue. In fact, there's no real ambiguity here: the Affordable Care Act guarantees protections for Americans with pre-existing conditions, and the GOP's Graham-Cassidy plan eliminates that guarantee.

Of course, the president trying to deceive the public about policies he doesn't understand is, alas, a common occurrence. What's worth appreciating, however, is that Trump isn't the only one selling the Republican plan with bogus claims. Yesterday, for example, Sen. Bill Cassidy (R-La.), one of the principal architects of the GOP legislation, said under his plan "more people will have coverage" than under the Affordable Care Act. Is that true? The Washington Post took a closer look:

Cassidy has provided little evidence to support his claim of more coverage, except that innovation would flourish and help bring down costs and expand coverage. That's certainly possible, but it would be more plausible if his proposal did not slash funding to such an extent.

Kimmel's claim that 30 million fewer Americans will have insurance may be a high-end estimate. But already, in 2019, CBO calculations suggest at least 15 million fewer Americans would have insurance once the individual and employer mandates are repealed. Much of that decline might be by choice, but Cassidy insists the gap will be filled and then exceeded in 10 years. Unlike Cassidy, no prominent health-care analyst is willing to venture a guess on coverage levels -- but the consensus is that his funding formula makes his claim all but impossible to achieve.

Vox added that there is "literally no analysis" to bolster Cassidy's claim. (The Congressional Budget Office could provide lawmakers with a more detailed analysis, but Senate Republicans aren't prepared to wait until the full CBO score is ready.)

If this were the only tall tale Cassidy and his cohorts were telling, it might seem like a manageable level of mendacity, but it's actually just the start.

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Thursday's Campaign Round-Up, 9.21.17

09/21/17 12:00PM

Today's installment of campaign-related news items from across the country.

* With eight weeks remaining in Virginia's gubernatorial race, the polls are all over the place, but nearly all of them show the Democrat with at least some kind of advantage. The latest Mason-Dixon poll, for example, show Ralph Northam (D) with the narrowest of leads over Ed Gillespie (R), 44% to 43%.

* In Alabama's Senate Republican primary, not only will Donald Trump host an event for appointed Sen. Luther Strange (R) over the weekend, but Mike Pence will also travel to Alabama on Monday to support the senator the day before the runoff election.

* Speaking of Alabama, Senate hopeful Doug Jones (D), an underdog in his ruby-red state, will get a hand from former Vice President Joe Biden, who announced yesterday he'll campaign with Jones next month.

* In New Jersey's gubernatorial race, which is also coming right up, Republicans have low expectations for Lt. Gov. Kim Guadagno's (R) candidacy, but the Republican Governors Association nevertheless launched a new attack ad this week targeting Phil Murphy (D). The ad is only 15 seconds -- television commercials are usually 30 seconds -- so I'm not sure what venue the RGA has in mind for the spot.

* Given Republicans' obsession with voting irregularities, it's a little ironic that Jeffrey Gerrish, Trump's nominee to be a deputy U.S. trade representative, has been accused of voting in Virginia in 2016, months after having moved to Maryland.

* In West Virginia, Gov. Jim Justice recently switched parties to become a Republican, but to his new party's disappointment, the governor announced this week he's supporting Sen. Joe Manchin's (D) re-election anyway.

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Image: White House Press Secretary Sean Spicer Holds Press Briefing At White House

Facing new allegations, Price's track record does him no favors

09/21/17 11:20AM

Health and Human Services Secretary Tom Price's private-jet travel is tough to defend. After initially refusing comment, the far-right cabinet's secretary spokesperson said yesterday Price's chartered flights were necessary to accommodate his “incredibly demanding schedule,” but given the circumstances, it's a tough sell.

And as Politico noted, congressional Democrats clearly aren't buying it.

House and Senate Democrats on Wednesday formally requested that the HHS inspector general investigate HHS Secretary Tom Price's use of private planes for government business.

Five Democrats asked the inspector general to review Price's adherence to federal regulations on traveling by government employees, following a POLITICO investigation that found Price used charter planes to conduct official business within the United States. The request — sent by Reps. Frank Pallone and Richard Neal and Sens. Patty Murray, Ron Wyden and Gary Peters — asks the office to probe how many times Price used government or charter aircraft, the costs of the trips and whether HHS personnel raised internal concerns about Price's use of private planes.

Rep. David Cicilline (D-R.I.) launched a related effort on Capitol Hill yesterday.

Ordinarily in a situation like this, officials might try to lean on their reputation, hoping their record and history of credibility might lead others to give them the benefit of the doubt. In Price's case, however, that really isn't an option.

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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.

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