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Monday's Mini-Report, 6.26.17
Today's edition of quick hits:
* The right call: "The U.S. Supreme Court ruled Monday that Arkansas authorities must list the names of both same-sex parents on their child's birth certificate."
* The wrong call: "The U.S. Supreme Court reduced the wall of separation between church and state Monday in one of the most important rulings on religious rights in decades. The decision could doom provisions in 39 states that prohibit spending tax dollars to support churches. The states defended the limits as necessary to keep the government from meddling in religious affairs."
* This will be interesting: "The U.S. Supreme Court agreed Monday to hear an appeal from a Colorado bakery that refused to make wedding cakes for same-sex couples."
* Moscow has pushed back against this report, for what it's worth: "Ending one the most turbulent tenures of a Washington-based ambassador in recent memory, the Kremlin has decided to recall Ambassador to the United States Sergey Kislyak, three individuals familiar with the decision told BuzzFeed News."
* Look for more on this on tonight's show: "One month before Election Day, Jared Kushner's real estate company finalized a $285 million loan as part of a refinancing package for its property near Times Square in Manhattan."
* Read this whole story out of St. Louis: "An off-duty officer was wounded by 'friendly fire' as police looked for suspects after a stolen vehicle fled police and crashed late Wednesday."
* This relationship isn't working: "The White House is becoming increasingly frustrated with Secretary of State Rex Tillerson and a close-knit circle of aides over the slow pace of hiring and a chokehold on information and access to Tillerson, according to senior Trump administration officials and others familiar with the rift."
CBO: Senate Republican plan would take coverage from 22 million
During the debate over the House Republican plan, Sen. Susan Collins (R-Maine) made clear she was unimpressed with the GOP proposal. Any bill resulting "in 23 million people losing coverage is not a bill that I can support," the Maine Republican said in March.
OK, how about 22 million?
The Senate health care bill would insure 22 million fewer people after a decade than current law, according to an analysis by the non-partisan Congressional Budget Office.
It would save $321 billion in the same period overall by spending $1 trillion less on health care and using the savings to repeal the Affordable Care Act's taxes, which primarily affect wealthy individuals and medical companies.
The CBO's full report is online here. Note that the impact imposed on the nation would be felt almost immediately -- there would be 15 million more uninsured Americans next year, which happens to be an election year, according to the non-partisan office's estimate -- before getting worse in the years that follow.
Complicating matters, the CBO score added, "By 2026, among people under age 65, enrollment in Medicaid would fall by about 16 percent and an estimated 49 million people would be uninsured, compared with 28 million who would lack insurance that year under current law."
I should concede that this report is quite a bit worse than I thought it'd be. Senate Republican leaders worked fairly closely with CBO officials while writing their secret legislation, getting periodic updates. Indeed, it's one of the reasons the CBO score, which would ordinarily take two weeks, was turned around so quickly.
With this in mind, I figured Senate Majority Leader Mitch McConnell's (R-Ky.) office would carefully game the system, and tweak his blueprint in such a way that the numbers would look less awful. But if that was the plan, it failed spectacularly: the CBO's findings are, or at least should be, a punch to the gut of proponents of Senate Republicans' legislation.
Donald Trump has gone out of his way lately to say he wants to see a health care bill "with heart." By any sensible standard, it's now painfully obvious that the GOP legislation fails this simple test.
Supreme Court opens the door to Trump's troubled Muslim ban
Donald Trump's Muslim ban has struggled badly in the face of multiple legal challenges, and has already run into trouble in two separate appellate courts. But the Republican White House has some allies at the U.S. Supreme Court, who appear to be approaching the controversy from a different perspective.
The U.S. Supreme Court agreed Monday to reinstate much of President Donald Trump's travel ban before hearing the case this fall, dealing a partial victory to the administration in one of the most divisive policy battles of his presidency.
The Supreme Court said the ban cannot be enforced for people from six nations -- Iran, Sudan, Syria, Libya, Somalia and Yemen -- who have relatives in the U.S. and want to travel to America.
However, the ban can be enforced for refugees and those who do not have that personal relationship.
Note, this wasn't a ruling on the constitutionality of the administration's policy on the merits. Rather, the Supreme Court agreed this morning to hear the White House's appeal, and in the interim, the justices said parts of Trump's policy can be implemented. That's a break from the status quo: previous courts that have heard challenges to the policy did not allow the administration's ban to go into effect.
Justices Clarence Thomas, Samuel Alito, and Neil Gorsuch -- by most measures, the high court's three most conservative members -- said they wanted to go further, allowing all of Trump's policy to go into effect immediately.
Oral arguments in this case will be heard in the fall, but in the meantime, this policy will get a little tricky.
The poor would be crushed by GOP health plan, but they're not alone
One of the core cruelties to the Republican health care plan is the burdens it would impose on low-income families. As many have noted many times in recent days, at the heart of the GOP legislation is the belief that the poor should pay more for worse coverage in order to finance tax breaks that would disproportionately benefit the wealthy.
For those concerned with economic and social justice, such circumstances are obviously obscene. It's also true, however, that few groups in America have less political capital than the poor.
For health care advocates, trying to find the most compelling arguments to sway Republican lawmakers, pointing to the impact on the low-income communities may not do the trick. Many on the right, after all, agree with Ben Carson's recent assessment that poverty is really just "a state of mind."
So what's more persuasive? Maybe by focusing on the impact on nursing homes?
Under federal law, state Medicaid programs are required to cover nursing home care. But state officials decide how much to pay facilities, and states under budgetary pressure could decrease the amount they are willing to pay or restrict eligibility for coverage.
"The states are going to make it harder to qualify medically for needing nursing home care," predicted Toby S. Edelman, a senior policy attorney at the Center for Medicare Advocacy.
Or how about the impact on hospitals?
Eager for branding credit, Trump undercuts the GOP on health care
Barack Obama had quite a bit to say last week about the latest Republican health care plan, but the former president specifically made the case that "if there's a chance you might get sick, get old, or start a family," the GOP legislation "will do you harm." Minor tweaks, he added, "cannot change the fundamental meanness at the core of this legislation."
The written statement brought to mind Donald Trump's reported comments to senators, to whom the president described the House-passed health care overhaul as "mean," "cold-hearted," and a "son of a bitch" in a recent private meeting.
But did Trump really call the legislation he publicly celebrated "mean"? Whether Obama intended to bait his successor or not, the president admitted in yet another Fox News interview that the reports were true.
"Well, [Obama] used my term, 'mean.' That was my term because I want to see -- and I speak from the heart -- that's what I want to see. I want to see a bill with heart."
Trump was so eager to claim branding credit for himself, he ended up publicly confirming an assessment that made his own House allies look bad. The president also didn't do himself any favors: Trump initially described the House GOP bill as a "great plan" that he backed with enthusiasm. Now we know he didn't like the legislation after all.
There's a substantive angle to this that's worth watching: Trump is now saying all kinds of nice things about the Senate Republicans' bill, but if it passes and it's poorly received, the president is making clear right now that he'll turn around and condemn it later, separating himself from a policy the American mainstream may perceive as cruel.
In other words, if you're an on-the-fence Senate Republican weighing your options, Trump is making clear that he'll sell you out in a heartbeat in the hopes of saving his own skin.
How Republicans justify ignoring public attitudes on health care
In theory, polling on issues and legislation matters because it offers policymakers a guide to public attitudes. Elected officials in the United States have traditionally cared what the American people like and care about -- especially on life-or-death matters -- and the system was designed to make it difficult for woefully unpopular legislation to pass.
It should therefore matter -- again, in theory -- that the Republican health care plan is widely detested by much of the country, including many GOP voters, while the popularity of the Affordable Care Act reaches all-time highs.
Indeed, it's not just independent surveys. Sen. Chris Murphy (D-Conn.) noted the other day that his office received nearly 400 phone calls opposed to the GOP health care plan -- and literally zero in support of the proposal. The senator said he's "never seen anything like this." In my casual conversations with Hill staffers in recent days, I've heard nearly identical assessments: the GOP proposal is generating intense opposition, but it's inspired effectively zero activism from its supporters, who apparently exist in small numbers.
Unless someone is prepared to argue that Americans don't much count in the American political system, how exactly does someone justify ignoring public attitudes on an issue as important as health care?
Vox's Sarah Kliff attended an event last week and heard a candid remark from an unnamed Republican member of Congress.
"The way I look at is there is no question we're getting inundated with calls and emails and protests. There is all this energy and anger on the left. The people who lost are the ones who are angry. We won the entire elected government. So I remind my staff after a long day of hostile calls, it was less than six months we got more votes than a person on the other side in [my state]. The people who voted for me are still out there."
And in this American lawmaker's mind, those who didn't vote for him or her just aren't especially important.
Why some on the right see the GOP plan as 'Obamacare Lite'
Senate Majority Whip John Cornyn (R-Texas), reviving an old, awful argument, said over the weekend that the Republican health care plan must be better than the Affordable Care Act -- because it has far fewer pages. Politico's Blake Hounshell noted in response, "It's short because it leaves the basic structure of Obamacare in place."
This may seem counter-intuitive, but it's important to understand why Hounshell's response is accurate.
I've heard from a few readers who've expressed confusion about the competing messages. Opponents of the Republican plan from the left condemn it as a needlessly vicious monstrosity that will hurt millions. Critics of the plan from the right dismiss it as "Obamacare Lite." Clearly, they can't both be right.
Or can they?
The answer has to do with the structure of the system in the broadest possible sense. Imagine looking at the models from 20,000 feet, where relevant details are harder to see. The core of the ACA model is a system that provides tax credits to consumers to purchase health insurance. At the core of the Republican alternative is a system that provides tax credits to consumers to purchase health insurance.
The profound differences matter, obviously, and in many cases, would quite literally be a matter of life or death. But when you hear someone like Rand Paul or Mike Lee say the bill reminds them too much of the Affordable Care Act, the comments aren't entirely ridiculous. Their perspective is incomplete in a way that paints a misleading picture, but they're saying they prefer an entirely different model -- as opposed to an ungenerous version of the status quo.
Indeed, the Senate Republicans' bill maintains the ACA's model even more than the House bill, since it relies on income-based tax credits -- as opposed to age-based tax credits -- just as "Obamacare" does.
With time running out, health care advocates look for GOP 'no' votes
Sen. Dean Heller (R-Nev.) didn't just announce his intention to vote against his party's health care plan late last week; he also torched the legislation itself. For all intents and purposes, the Nevada Republican's argument against the GOP bill wasn't much different from the Senate Democrats' case.
But one "no" vote among Senate Republicans won't be enough to rescue the American system from the proposal. Health care advocates will need two more GOP senators to break ranks.
Sen. Susan Collins (R-Maine) hasn't formally made an announcement, but her comments to ABC News' George Stephanopoulos yesterday suggested she isn't exactly ready to partner with her far-right colleagues.
"For my part, I'm very concerned about the cost of insurance for older people with serious chronic illnesses, and the impact of the Medicaid cuts on our state governments, the most vulnerable people in our society, and health care providers such as our rural hospitals and nursing home, most of whom are very dependent on the Medicaid program. So threading that needle is going to be extremely difficult. [...]
"I'm also very concerned about the Medicaid cuts, what it means to our most vulnerable citizens. And I'm very concerned about the cost of insurance premiums and deductibles, particularly for that very vulnerable group between the age of 50 and 64. They are particularly at risk, based on my initial analysis."
Of particular interest, the Maine Republican, widely seen as the most moderate GOP senator, added that the Senate bill "is going to have more impact on the Medicaid program than even the House bill" -- and given that Collins opposed the House bill, this wasn't a compliment. Asked about the timeline her party's leaders have in mind, Collins added, "It's hard for me to see the bill passing this week."
Republican insiders continue to work from the assumption that "moderates always cave." Whether Collins will take this opportunity to prove them wrong remains to be seen, but let's not forget that the senator is rumored to be interested in a gubernatorial campaign next year. Voting for a wildly unpopular health care bill wouldn't exactly serve as a springboard for a statewide race.
But even if Collins joins Heller among the bill's opponents, that's still not enough to stop the regressive legislation. Who else is worth watching?
An inconvenient truth in the health care debate: 'People will die'
On Friday, Sen. Bernie Sanders (I-Vt.) raised an important argument against the Republican health care plan: "Let us be clear and this is not trying to be overly dramatic: Thousands of people will die if the Republican health care bill becomes law." Soon after, Hillary Clinton added, "Forget death panels. If Republicans pass this bill, they're the death party."
Such talk didn't impress Sen. Orrin Hatch (R-Utah). "The brief time when we were not accusing those we disagree with of murder was nice while it lasted," the Republican senator wrote.
The idea that the GOP's legislation may lead to preventable American deaths appears to be a touchy subject for some on the right. Republicans no doubt expect pushback on their regressive health care proposal, but to argue that people will quite literally die as a consequence of GOP senators' actions is apparently a talking point some on the right consider offensive and inappropriate.
The trouble is, whether the truth hurts Republicans' feelings or not, there's ample reason to believe Sanders' and Clinton's point is true. The Washington Post ran this striking quote over the weekend:
"There has never been a rollback of basic services to Americans like this ever in U.S. history," said Bruce Siegel, president of America's Essential Hospitals, a coalition of about 300 hospitals that treat a large share of low-income patients. "Let's not mince words. This bill will close hospitals. It will hammer rural hospitals, it will close nursing homes. It will lead to disabled children not getting services.... People will die."
Atul Gawande also spoke to Vox about the available evidence. "The bottom line," the surgeon and scholar said, "is that if you're passing a bill that cuts $1.2 trillion in taxes that have paid for health care coverage, there's almost no way that does not end up terminating insurance for large numbers of people. If you are doing that, then there's clear evidence that you will be harming people. You will be hurting their access to care. You will be harming their health -- their physical health and mental health. There will be deaths. As a doctor, I find this unconscionable."
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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.
