The architects of the new GOP health care plan have an amazing new perspective. "Republicans," Politicoreported this morning, "say the plan's price tag and estimates of how many people it will cover aren't really important."
Under normal circumstances, it's tempting to think these would be the first two questions Republicans would ask about any reform plan. Wondering how many Americans will have health insurance and how much the plan will cost aren't exactly obscure matters of policy minutiae, but as of this morning, GOP officials prefer to think of these metrics as trivia.
No wonder Republicans are proceeding without a score from the Congressional Budget Office. They don't know what their bill will cost or how many millions of Americans will lose their health insurance -- and they plainly don't care.
The effort to move the goalposts, ignoring meaningful metrics and making up new ones, is almost certainly a political necessity borne of the realization that the GOP's American Health Care Act isn't going to work as a matter of public policy. NBC News' Benjy Sarlin had a good piece on this earlier:
They rarely agree on much, but health care experts on the left, right and center of the political spectrum have found consensus on the House GOP's Obamacare replacement: It won't work.
While their objections vary depending on their ideological goals, the newly introduced Affordable Health Care Act (AHCA) is facing an unrelenting wave of criticism. Some experts warn that the bill is flawed in ways that could unravel the individual insurance market.
The bill, experts said, falls far short of the goals President Donald Trump laid out: Affordable coverage for everyone; lower deductibles and health care costs; better care; and zero cuts to Medicaid. Instead, the bill is almost certain to reduce overall coverage, result in deductibles increasing, and will phase out Obamacare's Medicaid expansion.
There's a reason Republican leaders are in such a rush to get their bill passed: the more time there is for scrutiny and analysis, the more "Trumpcare" looks like a cruel joke. read more
CNBC's John Harwood talked this morning to a U.S. security official who described Donald Trump's proposed cuts to the Coast Guard as "insane." The official added it'd be a good idea to take a look at what it costs the Coast Guard to help oversee security "at Mar-a-Lago every weekend."
What's this all about? The Washington Postreported on the Republican White House's approach to paying for some of its security and immigration priorities.
The Trump administration, searching for money to build the president's planned multibillion-dollar border wall and crack down on illegal immigration, is weighing significant cuts to the Coast Guard, the Transportation Security Administration and other agencies focused on national security threats, according to a draft plan.
The proposal, drawn up by the Office of Management and Budget (OMB), also would slash the budget of the Federal Emergency Management Agency, which provides disaster relief after hurricanes, tornadoes and other natural disasters. The Coast Guard's $9.1 billion budget in 2017 would be cut 14 percent to about $7.8 billion, while the TSA and FEMA budgets would be reduced about 11 percent each to $4.5 billion and $3.6 billion, respectively.
When it comes to the debate over Trump's Muslim ban and proposed border wall, much of the discussion focuses on the ideas on the merits, which certainly makes sense. But it's worth pausing to appreciate the fact that the president's priorities, in addition to being misguided, aren't cheap.
And according to the administration's budget plans, Mexico isn't paying for Trump's priorities; the Coast Guard is. read more
During the debate over the Affordable Care Act, Democrats took great care to earn support from stakeholders throughout the health care system. By the time the vote neared, they faced fierce opposition from Republicans, but reform proponents were backed by an array of key institutions, including the American Medical Association, the American Nurses Association, the American Hospital Association, the AARP, and the American Cancer Society.
Republicans are headed in a different direction. The Hillreported:
The nation's biggest doctors group on Wednesday came out in opposition to the GOP's ObamaCare replacement bill, warning that it would cause millions of people to lose coverage.
"As drafted, the AHCA would result in millions of Americans losing coverage and benefits," said Dr. Andrew Gurman, president of the American Medical Association (AMA), referring to the American Health Care Act.
The AMA statement added, "By replacing income-based premium subsidies with age-based tax credits, the AHCA will also make coverage more expensive -- if not out of reach -- for poor and sick Americans. For these reasons, the AMA cannot support the AHCA as it is currently written."
It's an increasingly common sentiment. Bloomberg Politics added, "In the last several days, other major physician groups, including the American College of Physicians, the American Academy of Family Physicians and the American Psychiatric Association, have said they have serious issues with or outright oppose the plan. Together they represent hundreds of thousands of U.S. doctors and health professionals."
The American Hospital Association has also announced its opposition to the Republican bill, which is no small detail. Hospitals tend to be major employers in practically every congressional district in the country, and they're not known for having a strong partisan or ideological bent.
In case this weren't quite enough, the AARP isn't pleased, either, probably because the Affordable Care Act restricts insurers from charging older customers more, and Republicans ease those limits.
And if GOP leaders think they're in trouble now, wait until their plan faces fierce opposition from organized seniors. read more
As recently as Friday, the Centers for Disease Control and Prevention expressed some notable concerns about a sudden surge in cases of H7N9 bird flu in China. NBC News reported that the CDC described the cases as "cause for concern," quoting CDC flu expert Dr. Tim Uyeki saying that the recent infections constitute "by far the largest epidemic wave since 2013."
The same report added, however, that CDC officials are "working on a vaccine against H7N9 just in case it's ever needed and is starting work on a second one now because it's started to mutate."
It's against this backdrop that House Republicans, just a few days later, announced some new budget cuts they intend to make.
Bird flu has started killing more people in China, and no one's sure why. Zika virus is set to come back with a vengeance as the weather warms up and mosquitoes get hungry. Yellow fever is spreading in Brazil, and antibiotic-resistant bacteria are evolving faster than doctors can keep up with them.
And the new health care replacement bill released Monday night by Republican leaders in Congress would slash a billion-dollar prevention fund designed to help protect against those and other threats.
The Prevention and Public Health Fund was created by the Affordable Care Act in 2010 as a way to help avert the spread of preventable illness. In recent years, the Fund has been used to support more routine programs, such as efforts to prevent heart disease, suicides, and diabetes, but it's also included resources to prevent the spread of infectious diseases.
This year, the Fund will account for 12% of the CDC's entire budget. read more
In the White House briefing room yesterday, a reporter asked HHS Secretary Tom Price why the Republican health care plan "includes a tax break for insurance executives that make more than $500,000. You said this is about patients. Why is that tax break important for this legislation?"
The Republican cabinet secretary was incredulous. "I'm not aware of that," Price responded.
The bill really isn't that long. How the Secretary of Health and Human Services, who presumably read the bill, could be unaware of the provision is difficult to understand.
Around the same time, House Speaker Paul Ryan (R-Wis.) was asked why his reform blueprint includes "a big, fat tax break." The Republican leader responded, simply, "Read the bill."
The Republican plan to replace Obamacare includes a tax break for insurance company executives making over $500,000 per year.
Companies can generally deduct employee salaries as a business expense but in 2013 the Affordable Care Act capped the deductions on health insurance executive salaries at $500,000.
The average compensation for top health insurance executives is in the millions. In 2014 the left-leaning Institute for Policy Studies found that this cap generated $72 million in additional tax revenue. But that cap is being eliminated in the new American Healthcare Act unveiled Monday by Republicans. That means the more health insurance companies pay their executives the less they will pay in taxes.
If you voted for Trump because you wanted to see insurance-company executives get a big tax break, this is, of course, great news. For everyone else, however, it's not quite as impressive.
And while this is a striking provision, in the GOP proposal, it's really just the start of the tax breaks in the new reform legislation. Vox explained:
To hear Donald Trump tell it, the new Republican health care plan already enjoys overwhelming public support. In brief remarks yesterday afternoon, the president said, "I'm already seeing the support... I'm seeing it from everybody. And I'm seeing it from the public."
It's not clear how Trump, who's repeatedly made up evidence he wants to believe, has seen already public support for legislation that was unveiled less than a day earlier, but even putting that aside, if the president believes "everybody" backs the Republican blueprint, he's spectacularly wrong.
[M]any Republicans balked at the details of the bill when it was released late Monday. Some called the proposal "Obamcare Lite" while others questioned whether it would provide adequate coverage, demonstrating the challenges facing GOP leadership in trying to pass the legislation.
Members of the House Freedom Caucus and two conservative Republican senators -- Rand Paul of Kentucky and Mike Lee of Utah -- held a press conference outside the Capitol Tuesday afternoon to press their case against the bill.
Yesterday afternoon, House Speaker Paul Ryan (R-Wis.), showing unusual bravado, told reporters, "We will have 218 votes. This is the beginning of the legislative process. We'll have 218 when this thing comes to the floor. I can guarantee you that."
Soon after, members of the far-right House Freedom Caucus said the exact opposite. "Right now the Speaker of the House does not have the votes to pass this bill unless he's got substantial Democratic support," Rep. Mo Brooks (R-Ala.) said after leaving a Freedom Caucus meeting. (Ryan will likely have zero Democrats votes.)
Note, there are currently five vacancies in the House, which means a bill will need 216 votes to pass. There are 237 House Republicans, which means GOP leaders can lose no more than 22 votes.
The House Freedom Caucus has roughly 40 members. read more
In the first 24 hours after House Republicans unveiled their new health care reform plan, one of the unexpected mysteries was whether Donald Trump liked it. Mixed signals from the White House raised the possibility that the Republican president might not endorse his own party's legislation.
A written statement from the White House on Monday night, for example, expressed lukewarm support and notably did not include an endorsement. The next morning, however, the president himself referred to House Speaker Paul Ryan's (R-Wis.) plan as "our wonderful new Healthcare Bill." (Trump occasionally capitalizes words he thinks are important.)
HHS Secretary Tom Price endorsed the GOP's "American Health Care Act" in a letter to Congress, but a few hours later, he hedged during a press briefing. Vice President Mike Pence backed the bill, but Press Secretary Sean Spicer was more circumspect.
It's likely much of this is the result of a dysfunctional White House, which often struggles to keep its stories straight, but it's possible Team Trump is struggling because it's aware of a broader problem: by embracing this Republican plan, the president is doing the opposite of what he told Americans he would do for them. The New Yorker's John Cassidy explained:
The bill aims to take a wrecking ball to the principle of universal coverage. If enacted, millions of Americans would end up without any coverage. For many people who purchase individual policies, especially older people, it promises fewer services for more money. And it also proposes a big tax cut for the rich, which would be financed by slashing Medicaid, the federal program that provides health care to low-income people. [...]
Back in January, Donald Trump promised that the replacement for Obamacare would provide "insurance for everybody." By endorsing the American Health Care Act, on Tuesday, Trump has broken his pledge.
That's no small development for a president who hasn't yet been in office for seven weeks. read more
Rachel Maddow notes that while the dossier of intelligence about Donald Trump ties to Russia remains unconfirmed, pieces of it have checked out upon investigation by the press, though the primary government investigators are former Trump campaign officials. watch
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.