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Meet the New Health Care Bill--Same as the Old Health Care Bill

On Thursday, in a press conference that was so full of spin that it must have made reporters dizzy, Senate Majority Leader Mitch McConnell (R-KY) unveiled the secret health care plan that was pieced together by a, "working group" of 13 male GOP senators (full text here if you like reading long, boring legal documents). The 13 senators appear to have discovered the same thing that their colleagues in the House did: That crafting a bill acceptable to all wings of the party is really hard. Consequently, the Senate bill—which the authors have labeled the "Better Care Reconciliation Act" (BCRA)—bears a striking resemblance to the American Health Care Act (AHCA), albeit with some portions of the BCRA being a little more harsh than the AHCA, and some being a little less so. A rundown of the major points of comparison:

  • Employer Mandate: Both the AHCA and the BCRA would eliminate Obamacare's requirement that large companies offer affordable insurance to their employees.

  • Individual Mandate: Obamacare requires individuals to acquire insurance, or else pay a penalty. The AHCA does not require individuals to buy insurance, but does try to incentivize remaining insured by imposing a penalty on those who let their insurance lapse. The BCRA has no individual mandate of any sort.

  • Tax Credits: The AHCA reduces the Obamacare tax credits, and awards them only on the basis of age. The BCRA reduces the tax credits even further, but awards them on the basis of age, income, and geography.

  • Subsidies: Obamacare subsidizes insurance companies indefinitely, as they adapt to the new insurance market. Both the AHCA and the BCRA kill the subsidies in 2020, and allow President Trump to end them even earlier, if he wishes.

  • Pre-existing Conditions: Obamacare forbids insurers from denying coverage or increasing prices on the basis of pre-existing conditions. The AHCA allows insurers to charge higher rates for people with pre-existing conditions, while the BCRA would allow states to excuse insurers from covering certain costs associated with pre-existing conditions (for example, insurers might be allowed to deny MRIs to cancer patients). Both the AHCA and BCRA would, de facto, leave many people with pre-existing conditions uninsured or underinsured.

  • High-Risk Pools: Obamacare has no provisions for high-risk individuals, since it requires insurers to treat such individuals no differently than any other individuals. The AHCA sets aside $130 billion to help cover the costs of high-risk patients over the course of 10 years, while the BCRA sets aside $112 billion over the same period. Both allotments are meant to keep the insurance market from crashing, and are generally considered to be inadequate for doing so by a factor of two or three.

  • Costs for the Aged: Obamacare caps the price of insurance for older customers at three times the price being offered to young customers. The AHCA and BCRA would make it five times the price.

  • Medicaid: Obamacare leaves Medicaid effectively unchanged, offering open-ended amounts of funding to help states pay healthcare costs for those who qualify (poor people, handicapped people, etc.). The AHCA and BCRA would convert Medicaid into a block grant program, which means that once a state spends its annual allotment, that's it until next year. The BCRA would send less money to states, overall, than would the AHCA.

  • Essential Health Benefits: Obamacare defines a list of essential health benefits that must be covered. The AHCA and BCRA have a smaller list, and would allow states to remove items from the list as they see fit.

  • Planned Parenthood: Obamacare sends Medicaid funds to Planned Parenthood, but the funds cannot be used for abortions. The AHCA and BCRA would freeze funding for one year, which would undoubtedly be preamble to permanent de-funding.

  • Annual Caps: Obamacare does not allow benefits to be capped—a person cannot "run out" of insurance. The AHCA allows insurers to cap certain types of care, and the BCRA allows states to opt out of the ban. Both provisions lead to the same end: Some (or many) people with chronic or expensive conditions would run out of insurance.

For a slightly more thorough rundown, presented in visually appealing form, see this flow chart put together by Kim Soffen and Darla Cameron at the Washington Post.

In any case, despite the nominal differences, the basic purposes of the AHCA and the BCRA are the same. Obamacare's goal was to get as many people insured as was possible, compelling individuals to bear some of their cost of their coverage, and requiring business owners, the wealthy, and the government to pick up the rest. The AHCA and BCRA, by contrast, aim to redistribute wealth back to those who already have a lot of it. Both bills would result in about $1 trillion in tax cuts, with fully 40% of that going to the top 1% of income earners, and nearly two-thirds going to the top 20% of income earners. Warren Buffet, for example, has already announced that he would personally receive an additional $680,000 in refunds on his tax bill. He has made clear that he does not need that money; it seems fair to assume that the same is true of other billionaires and multi-millionaires. Barack Obama also weighed in on Thursday, posting an impassioned statement on Facebook in which he declared that, "The Senate bill, unveiled today, is not a health care bill. It's a massive transfer of wealth from middle-class and poor families to the richest people in America. It hands enormous tax cuts to the rich and to the drug and insurance industries, paid for by cutting health care for everybody else."

It is not only the wealthy and the corporations that the bill protects, however. Given the razor-thin margin of error that McConnell is working with, there are a few other tweaks designed to make the bill more palatable to the members of his conference. The most obvious of these appears on pages 64-66, and is already being called the "Klondike Kickback." One way in which the BCRA reins in Medicare costs is by imposing a one-year penalty on states that spend too much (25% or more above the national average on a per patient basis). However, the bill specifically exempts states with a population density of less than 15 people per square mile from the provision. Officially, the explanation for this is that health care is more expensive in sparsely-populated states because people have to travel farther. However, the provision conveniently protects exactly five deep red states—Alaska, Wyoming, Montana, and the Dakotas—while penalizing several deep blue states that also have high health care costs (most obviously, New York, Washington, and Massachusetts).

So, what happens now? Well, on the Democratic side, there is (and will continue to be) much gnashing of teeth and rending of garments, as they attempt to denigrate the bill by using the word "mean" as an adjective, noun, verb, adverb, and general reference to Mitch McConnell's parentage. On the Republican side, three very conservative senators—Ted Cruz (TX), Rand Paul (KY), and Mike Lee (UT)—joined their Wisconsin colleague Ron Johnson (who announced his views on Wednesday) in saying that they just might not be able to vote for the bill. A few others may make similar announcements today, or on the Sunday morning news shows. Meanwhile, the CBO is already at work on scoring the bill (as are several private analysts). Normally, they can work at a leisurely pace, but given the GOP's insistence on voting next week, the CBO is going to make quick work of the task. There has been some suggestion that they may announce their score as early as today. If they do not, then Monday seems the next likeliest possibility. Whenever they do announce, they will surely advise us that something like 23 million people will lose insurance under the BCRA, given how similar it is to the AHCA.

Next Monday or Tuesday will also be when the Senate begins debate on the BCRA. This will be the Democrats' only real opportunity to push back against the legislation, primarily by offering amendments to the bill. One possibility is offering amendments by the truckload, so as to gum up the works, and to keep the spotlight on the BCRA for as many days as possible. Another possibility is to offer "message" amendments. For example, the honorable senators from Vermont might propose an amendment to set aside $10 billion for funerals for all the people who will die because of the BCRA. All of this will be political theater, of course. The GOP has no interest in what the Democrats want, since those votes are lost anyhow. And the Democrats have little interest in working with the GOP, since that would enrage the base. It is also possible that, if he becomes weary of or annoyed with the Democrats' posturing, the Majority Leader could go nuclear and kill the rule that allows the proposing of amendments. This would be a pretty dramatic change of longstanding Senate tradition, something that is generally distasteful to an institutionalist like McConnell. On the other hand, he instituted a similar change to ram Neil Gorsuch's nomination to the Supreme Court through the Senate, so such a maneuver is certainly within the realm of possibility.

Meanwhile, speaking of political theater, the other thing that is likely to happen next week (or maybe the week thereafter) is that version 2.0 of the BCRA will be released. As noted above, several conservative senators have already suggested they will vote "nay" on the current iteration of the bill. The thing is, two of those individuals—Cruz and Lee—were part of the group that drafted the bill. It is a little hard to believe that they would sign off on a draft, and then immediately come out against it. Much more probable is that this is posturing that will then justify "concessions" to make the BCRA more palatable to conservatives (and, pretty much by definition, more draconian). The same thing, of course, happened with the AHCA. In fact, the odds are good that McConnell—who is about as shrewd a tactician as you will find—knows exactly what the concessions will be and has already gotten Cruz and Lee to sign off on them. Taking the speculation a bit further, it's not improbable that the bill will be amended and then voted on the next day. That would allow the Majority Leader to say, "Hey, we discussed it and we allowed amendments!" without actually subjecting the final version of the bill to scrutiny or to CBO scoring.

So, what will happen when the bill actually comes up for a vote? Well, if and when it does, it will pass, because McConnell is too shrewd to allow a vote unless he knows exactly what is going to happen. So the real question is, will McConnell be able to round up 50 solid "yes" vote? The odds are good that even he doesn't know right now. As noted above, he's likely not too worried about Cruz and Lee. Rand Paul, by contrast, is a wild card—given his libertarian sensibilities and maverick tendencies, it may be difficult to get him, either through concessions or through other forms of arm twisting. Ron Johnson also has to be a concern—he's middle-of-the-road among Senate Republicans, and represents a blue-to-purple state. His hesitation may well be for real, even if he's not up for re-election until 2022. Then there are Susan Collins (ME) and Lisa Murkowski (AK), who have already suggested they will not vote for any bill that defunds Planned Parenthood. Both women are shrewd enough to understand where a one-year "freeze" likely leads.

Johnson, Paul, Collins, and Murkowski are the four most likely defectors, but they aren't the only ones McConnell should worry about. Only 12 GOP senators have actually come out in support of the bill, while 9 have expressed concerns, and 31 have yet to make any sort of commitment. There are 20 Republican senators that come from states that expanded Medicaid under Obamacare, 14 whose home states saw the number of uninsured drop by 33% under Obamacare, and 11 who are in both groups. Not all of these people are potential defectors (McConnell is one of the 11, for example), but some of them certainly are. Most obviously, perhaps, there's Dean Heller (NV), who is in the group of 11, is up for re-election in 2018, and comes from a state won by Hillary Clinton. If he votes "yea," he could well be committing political suicide. The Post has a nice graphical breakdown of the Republican senators and the factors that might shape their vote.

In short, Obamacare took a step closer to being gutted on Thursday. However, it's just a small step at this point. Even if McConnell gets his 50 votes, the bill would have to go to a conference committee, and then the revisions that the committee made would have to be approved by both the House and the Senate. While "It's this or we're stuck with Obamacare" would be a powerful argument for many Republicans, it's also the case that the AHCA walked a thin line, and the BCRA (if it passes) would also have to walk a thin line. A compromise bill would have to walk an even thinner line—perhaps one so thin that it doesn't exist. (Z)

Trump: There Are No Recordings

On Thursday, President Donald Trump let everyone in on something we already knew: There are no recordings of his meeting with James Comey. Naturally, The Donald did so via Twitter:

There's quite a lot of spin there, as Trump tries both to equate his own deliberately misleading statements with the fact that his White House leaks like a sieve and to suggest that the recordings might exist, but he just doesn't know.

It is undoubtedly not a coincidence that Trump finally spilled the beans on the same day that the BCRA was released. Yesterday, we speculated that he might use the recordings story as a means of drowning out some other, even more damaging news item. That may indeed be what happened here, but probably not. The BCRA is such a big story that Trump would be foolish to think he could push it off the front pages. Further, he's not the one taking heat over the legislation right now, the GOP senators—particularly Mitch McConnell—are. The Donald has not historically been one to fall on his sword to save others.

No, it is more likely that the recordings themselves were the story that Trump was trying to bury with this choice of timing. Observe that his tweets were sent around 1:00 p.m. Eastern time, almost exactly the same time—within a few minutes—that the BCRA was released to the general public. Hard to believe that's just a coincidence. And if this was Trump's plan, it worked—the "no recordings" story has been knocked down the page (or off the front page entirely) on all of the major news sites and in all the major newspapers. For example, today's New York Times front page has three stories about health care (and a very unflattering picture of Mitch McConnell), and only a single refer paragraph about the recordings story, which has been buried on Page 19.

Donald Trump hasn't shown a great deal of skill at, or interest in, most aspects of his job. He doesn't seem to want to build a functioning executive branch (400+ jobs still open), or a cohesive foreign policy. So, that's "Chief Executive" and "Chief Diplomat" that are off the list. He is equally uninterested, as we have observed, in exuding the class and dignity that is expected of a Head of State. He's delegated military decision making to Secretary of Defense James Mattis, so he's no Commander in Chief, either. He lets Congress set the legislative agenda, and only gets involved on The Hill when absolutely necessary (and sometimes, not even then), so he's hardly the Chief Legislator. The only part of the entire operation that Trump seems to be really good at is managing communications, as his deft handling of today's news illustrates. For this reason, Politico's Jack Shafer argues that Trump doesn't really want to be President, what he really wants is to be White House Communications Director. "To control and edit the messages radiating out of the White House is media hound Trump's keenest ambition," writes Shafer. "He wants to conduct himself the way he did during those New York decades when he fed the tabloids items like Skittles from a fun-size bag." There is much to be said for this interpretation of things. (Z)

Karen Handel is Very Orange County

Georgia's sixth congressional district is not the only place that likes now-congresswoman Karen Handel. To the Republican leadership of Orange County, CA, she is their heroine. For years, local Republicans spoke of the OC as "America's most Republican county." That line was stowed for safekeeping last year when Hillary Clinton won the county.

Clinton's win is making some of the local Republicans nervous about 2018, since the county's demographics mirror that of GA-06. That's true, to an extent, although Handel's district is not adding new Latino voters every day, as Orange County is. On the surface, Republicans are saying Clinton's victory was simply a rejection of Donald Trump's personality, not GOP politics. Former state Republican Party executive director Jon Fleischman put it this way: "Mimi Walters isn't a jerk," referring to Rep. Mimi Walters (R-CA), who doesn't live in the CA-45 district she represents. Members of Congress are not required to live in their districts, but Republicans made hay from the fact that GA-06's losing candidate, Jon Ossoff, temporarily lives a few blocks from the district he grew up in.

Fleischman could be right, of course. Mark Petracca, a professor of political science at UC Irvine, which definitely is in the district, said: "I actually don't think the Democrats running for Congress have as good a chance as everybody thinks they do. They're closer than they were 20 years ago. But they're still not there yet." On the other hand, at least one of the four representatives whose district lies (partly) in the county is surely vulnerable. Rep. Darrell Issa (R-CA) won in 2016 by a mere 2% and will be a top Democratic target in 2018. In any event, the four Republican House members in Orange County can breathe a little easier now that Handel has shown that affluent suburban districts can still be won by Republicans. (V)

Miami Democrats Warn Daily Kos

Orange County (CA) is not the only place where Jon Ossoff's near-miss was noticed. If Democrats are to win back the House in 2018, Florida's Miami-Dade County will also be a battleground. Two must-win targets for the Democrats are the open seats left behind by retiring Rep. Ileana Ros-Lehtinen (R) and the district of Rep. Carlos Curbelo (R). Ros-Lehtinen's FL-27 district covers part of Miami, as well as West Miami, South Miami, Pinecrest, Cutler Bay, Palmetto Bay, Key Biscayne,and North Bay Village. Curbelo's FL-26 district contains southwest Miami-Dade and runs south to Key West. Both districts lean Democratic. FL-27 has a PVI of D+5; DL-26 is D+6. Both have majority Latino populations. If Democrats can't win these, they have no chance at all to capture the House.

Miami Democrats were quick to warn readers of the liberal Website Daily Kos (who poured millions into Ossoff's race) that their views might not fly in Miami-Dade County. Ben Pollara, a Democratic consultant who will work on the FL-27 race, said: "In Miami generally it is very difficult to tie national winds to what goes on in Miami-Dade County because we're such a unique little island of diversity." Christian Ulvert, another Democratic consultant in the FL-27 race, said that the since the Democrats running in the FL-27 primary have deep Miami roots, it will be difficult for the Republicans to paint the Democratic nominee as a carpetbagger in cahoots with Nancy Pelosi. Daily Kos readers were also warned that Latin American politics, which aren't on their radar, are a big deal in South Florida. (V)

Heidi Heitkamp's Love of Trump Might Be Her Secret Weapon

Sen. Heidi Heitkamp (D-ND) is not your standard Democrat. She loves fossil fuels and guns. She also likes Donald Trump a lot more than she liked Barack Obama. In a state that Trump carried by 36 points, that could come in handy.

She's not only an unusual Democrat, she's an unusual senator. It is said that every day 100 U.S. senators look in the bathroom mirror and see a future president. Not true. Not only does Heitkamp not see herself as a future president, she's not sure she even wants to be a senator any more. Despite urging from Minority Leader Chuck Schumer (D-NY), Heitkamp hasn't announced whether she will run for reelection in 2018. Friends think she will, even though she claims that she prefers living in North Dakota to living in D.C.

On the other hand, there are things she cares about, such as Native American children. She knows that a Republican replacement wouldn't, and that troubles her. She also sees herself as a kind of missionary to the Democrats on issues like oil, which is responsible for a lot of jobs in her state.

Heitkamp has a folksy demeanor that plays well in North Dakota. She also is universally known and liked in the state. Despite the Republican lean of the Roughrider state, if she decides to run, everyone—especially North Dakota's lone representative, Kevin Cramer (R)—knows the "middle-aged, kind of chubby woman" (her own description of herself) will be no pushover. Politico has a long profile on her. (V)

Hackers Changed Voter Data

According to a story in Time, hackers got into election databases and not only stole confidential data, but also changed some data. Officials think they were able to revert to the unmodified data, but the mere fact that the hackers were able to get into a database in one state and change records suggests they might have done it elsewhere undetected.

This report raises a few questions, such as:

  • Were the hackers working for the Russian government?
  • Why did the hackers change the database?
  • What did they do with the stolen data?
  • Did the Trump campaign get any of the stolen data, and if so, what did they do with it?
  • How sure are we that the data was reverted successfully?

Inquiring minds want to know. So does Sen. Richard Burr (R-NC), chairman of the Senate Intelligence Committee. Burr is worried that the attacks will be there in 2018 and 2020 and will be even more intrusive. (V)

Sanders Won't Support Wasserman Schultz's Opponent Again

After it became known that Rep. Debbie Wasserman Schultz (D-FL) supported Hillary Clinton in the 2016 Democratic primaries, Sen. Bernie Sanders (I-VT) decided he would try to defeat her in her primary by supporting her opponent, Tim Canova. Wasserman Schultz won the primary and then cruised to reelection by double digits in the general election. Canova is running against her again, but this time he will have to do without Sanders' support and the money that brings in. Recently, Sanders said: "I have no idea about Tim Canova, I honestly don't." In short, that means Wasserman Schultz is a shoo-in for her 2018 race. (V)

Steyer To Spend $7.5 Million to Mobilize Young Voters

While there are many billionaire Republicans, there are also some billionaire Democrats. One of them is California environmentalist Tom Steyer, who has announced that he plans to spend $7.5 million to turn out young voters in eight states: California, Florida, Michigan, Nevada, Ohio, Pennsylvania, Virginia, and Wisconsin. He also said that he will spend more next year, before the midterms. While it might seem odd for an environmentalist to spend money in California, a state that is already very conscious of the environment, he clearly means to target the Republican House members in places like Orange County (see above).

The program is expected to target 200 college campuses. The money will go to hire full-time field organizers whose job will be to get students and other young people engaged in politics and get them registered to vote. Steyer himself has toyed with running for governor or senator in his home state, particularly if Sen. Dianne Feinstein (D-CA) retires. Having a boatload of money doesn't mean you can win in California, though. Just ask Gov. Meg Whitman or Sen. Carly Fiorina. (V)

Congressmen Want to Ban Eating Dogs and Cats

Who says Congress can't do anything? Two Florida representatives, Alcee Hastings (D) and Vern Buchanan (R), have finally found something that has true bipartisan appeal and is almost on the tip of everyone's tongue. It is called "The Dog and Cat Meat Prohibition Act of 2017." It would, as you may have guessed, prohibit the sale and consumption of dog and cat meat. The bill would clearly bridge one of the great divides in America: dog lovers vs. cat lovers. It has 166 co-sponsors already. The new Senate health care bill may or may not make it, but even if it doesn't, if this bill passes then Congress can be proud of its achievements this session. What 15% approval rating?

The impetus for the bill is the Yulin festival in China, in which dog meat and lychees are consumed to ward off the heat of summer. Since both congressmen are from Florida, which is a mere 8,027 miles from China, the danger to canines and felines is obvious, prompting their bill. (V)

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---The Votemaster and Zenger
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