Pittsburgh Post-Gazette

Pennsylvania’s Casey exposes Trump’s written plan to dismantle ACA

Tracie Mauriello, Post-Gazette Washington Bureau    January 11, 2018

WASHINGTON — It’s no secret that President Donald Trump has been trying to dismantle the Affordable Care Act, but it took a dogged Democrat to pry the written plan from the administration and expose it.

That Democrat is Pennsylvania Sen. Bob Casey, who obtained it from the administration after blocking three of the president’s health nominees to get it.

The White House initially shared the plan with members of the conservative Freedom Caucus in March in an attempt to get them to vote for a partial Obamacare repeal. Several Freedom Caucus members were concerned that the repeal bill didn’t go far enough.

The administration was “pushing very, very hard and they were essentially buying votes” for the March repeal vote promising to sabotage other parts of the health care system, Mr. Casey said.

He learned about the document in a March 26 story in Politico, and had been trying to get his hands on it ever since, but the administration resisted until the senator blocked confirmation of three Health and Human Services nominees using a “hold,” a procedural maneuver that allows any senator to unilaterally stop a vote.

A hold is an extreme measure that Mr. Casey can’t remember using before.

He told the Department of Health and Human Services in October that he would release his holds if they turned over the document. Six weeks later the administration released it, and Mr. Casey went public with it Wednesday as part of a written report.

“It shouldn’t have required all that. This is a piece of paper, but they knew it wouldn’t read well,” Mr. Casey said. “It wasn’t for public consumption but purely to get the votes of members of Congress whose views are a lot more extreme than even a lot of Trump voters.”

HHS did not respond to a request for comment.

The document points out that the secretary of Health and Human Services has “significant authority to improve the individual and small group markets harmed by Obamacare” and suggests changes he could make in 10 areas.

The proposals, some of which have since been implemented, include reducing enrollment periods, authorizing states to interpret coverage rules for coverage of essential benefits, discourage doctors from steering patients to Obamacare marketplace plans that are more lucrative to providers than Medicaid and Medicare, and encourage states to build “skinny exchanges” that cost less and rely on private sector innovation.

Although Mr. Trump made no secret of his plan to use executive orders and other means to pull apart Obamacare, Mr. Casey said the president was never forthright with details he should have been transparent about.

“It’s horrific that government officials are taking steps to erect barriers to prevent people from getting coverage,” he said. “This secret document demonstrates how far the administration and congressional Republicans are willing to go, engaging in slimy backroom deals to further their sabotage agenda.”

He said the one-page document presents a “wrecking ball of changes” to appease far right members of Congress rather than to serve the American people. “It isn’t like Donald Trump said, ‘Hey folks, this is what I’m going to do and I want you to know about it.’ This was a backroom deal with a bunch of hard-right Freedom Caucus members.”

Mr. Casey said he became aware Thursday of documents related to 200 other health policy changes HHS is pursuing. He said he plans to try to shake loose those records next.

“That will be the next battle on this front,” he said. “It’s part of our obligation to do aggressive oversight, especially when the oversight involves something as serious and grave as to whether someone can have health insurance.”.

Washington Bureau Chief Tracie Mauriello: tmauriello@post-gazette.com; 703-996-9292 or on Twitter @pgPoliTweets.

Related:

New York Times  Editorial

Is Mr. Trump Nuts?

By The Editorial Board         January 10, 2018

Credit Jordan Awan

Is Donald Trump mentally fit to be president of the United States? It’s an understandable question, and it’s also beside the point.

Understandable because Mr. Trump’s behavior in office — impulsive, erratic, dishonest, childish, crude — is so alarming, and so far from what Americans expect in their chief executive, that it cries out for a deeper explanation.

It’s beside the point not because a president’s mental capacity doesn’t matter, nor because we should blindly accept our leaders’ declarations of their own stability, let alone genius. Rather, we don’t need a medical degree or a psychiatric diagnosis to tell us what is wrong with Mr. Trump. It’s obvious to anyone who listens to him speak, reads his tweets and sees the effects of his behavior — on the presidency, on the nation and its most important institutions, and on the integrity of the global order.

Presidents should not, for instance, taunt the leaders of hostile nations with demeaning nicknames and boasts about the size of their “nuclear button.” They should not tweet out videos depicting them violently assaulting their political opponents. They should not fire the F.B.I. director to derail an investigation into their own campaign’s possible collusion with a foreign government to swing the election. And, of course, they shouldn’t have to find themselves talking to reporters to insist that they’re mentally stable.

This behavior may be evidence of some underlying disorder, or it may not. Who knows? Mr. Trump hasn’t undergone a mental-health evaluation, at least not one made public. But even if his behavior were diagnosed as an illness, what would that tell us that we don’t already know? Plenty of people with mental disorders or disabilities function at high levels of society. Conversely, if Mr. Trump were found to have no diagnosable illness, he would be no more fit for the office he holds than he is today.

The problem lies in trying to locate the essence of Mr. Trump’s unfitness in the unknowable reaches of his mind, as opposed to where we can all openly see it and address it in political terms. As the psychiatrist Allen Frances told The Times: “You can’t say enough about how incompetent and unqualified he is to be leader of the free world. But that does not make him mentally ill.”

Unfortunately, a number of psychiatrists, politicians and others who should know better have increasingly taken up the Trump-is-crazy line. In “The Dangerous Case of Donald Trump,” released last October, more than two dozen contributors, most mental-health professionals, concluded that Mr. Trump presents a grave and immediate danger to the safety of America and the world. No argument there, but why do we need to hear it from psychiatrists relying on their professional credentials? Dr. Bandy Lee, one of the book’s editors, said the authors are “assessing dangerousness, not making a diagnosis.” Anyone with access to newspapers or Mr. Trump’s Twitter feed can do the same.

The psychiatrists say they have a duty to warn the public about what they see as a serious threat to the nation. That’s commendable, but they should consider how their comments will be taken by the vast majority of Americans, particularly in a highly politically polarized time. The language of mental health and illness is widely used yet poorly understood, and it comes loaded with unwarranted assumptions and harmful stereotypes. There’s a good reason the profession established an ethical guideline in 1973, known as the Goldwater Rule, that prohibits psychiatrists from offering professional judgment on public figures they have not personally examined.

In the future, it would be a good idea if presidential candidates voluntarily submitted to a mental-health evaluation, just as they often do a physical one — and in that case, psychiatrists would have a critical role to play. But you don’t need to put Mr. Trump on a couch now to discover who he is.

So what’s the right way to deal with Mr. Trump’s evident unfitness?

Not the 25th Amendment, despite the sudden fashion for it. Ratified in the wake of President John Kennedy’s assassination, the amendment authorizes the temporary removal of a president who is unable to do the job. Its final section, which has never been invoked, was meant to clarify what should happen if the president becomes clearly incapacitated. One of the amendment’s drafters, Jay Berman, a former congressional staff member who has said Mr. Trump “appears unhinged,” still doesn’t believe that the amendment applies to his case.

Even if invoking the amendment were the best approach, consider what would need to happen. First, the vice president, plus a majority of Mr. Trump’s cabinet, must declare to Congress that the president cannot do his job. If Mr. Trump disagreed, they would have to restate their case. Only then would both houses of Congress get involved, and each would have to agree by a two-thirds vote. The chances of any of these steps being taken in today’s political environment are less than zero.

Impeachment would be a more direct and fitting approach, if Mr. Trump’s actions rise to the level of high crimes or misdemeanors. But this path is similarly obstructed by Republicans in Congress, who are behaving less like members of a coequal branch with oversight power than like co-conspirators of a man they know is unfit to govern.

The best solution is the simplest: Vote, and organize others to register and to vote. If you believe Donald Trump represents a danger to the country and the world, you can take action to rein in his power. In November, you can help elect members of Congress who will fight Mr. Trump’s most dangerous behaviors. If that fails, there’s always 2020.

ThinkProgress

Walmart quietly lays off thousands of workers after bonus announcement

Workers across the country were not told of the closings and showed up to work to find stores shuttered.

By Jud Legum      January 11, 2018

Credit: Photo by Michael S. Williamson/The Wash. Post Via Getty Images

Thursday morning, Walmart had a flashy announcement: Thanks to corporate tax cuts, it was giving its employees bonuses of up to $1,000. Walmart and President Trump pointed to the announcement as proof that the corporate tax cuts are really a boon to working-class Americans.

This announcement, as ThinkProgress reported earlier, was much more complicated than it first sounds.

Walmart employees are eligible for the $1,000 bonus only if they’ve worked at the company for 20 years. Most Walmart employees, of course, haven’t worked there that long. Those employees will receive a smaller bonus based on seniority. Walmart didn’t explain exactly how the sliding scale will work, but said the total value of the bonuses will be $400 million. Walmart has about 2.1 million employees, which works out to be an average bonus of about $190.

The one-time bonus Walmart announced this morning amounts to just over 2 percent of the total value of the tax cut to the company.

In fiscal year 2017, Walmart had pre-tax profits of about $20.5 billion and paid an effective federal tax rate of around 30 percent. With a new corporate tax rate of 21 percent, the corporate tax cut is worth at least $1.85 billion to Walmart every year. Since this cut is permanent, the true benefits to Walmart will grow much larger over time. But it’s safe to say that, over 10 years, this corporate tax cut will be worth over $18 billion to Walmart.

But now it appears the announcement was timed carefully to cover for thousands of unannounced layoffs.

Business Insider reports that today, Walmart is abruptly closing numerous Sam’s Clubs stores across the United States. In some cases “employees were not informed of the closures prior to showing up to work on Thursday” and “learned that their store would be closing when they found the store’s doors locked and a notice announcing the closure.”

Tweets:

Jason Miles: Sam’s Club shutdown? Employees at this S Loop store tell me they showed up to work and were told store is closed effective today. Sign on door says same thing. Hearing other stores also affected. Waiting on answers from parent company, Walmart #khou11

Walmart confirmed the abrupt closings and offered an explanation of sorts on Twitter. “Closing clubs is never easy,” the company said through its verified corporate account.

YourMCAdmin: Wow, a whole lot of @SamsClub locations shut down today while giving 0 notice to workers. That sounds like the management team alright. They are heartless people. I feel terrible for the thousands of people who just lost their jobs.

Sam’s Club: After a thorough review of our existing portfolio, we’ve decided to close a series of clubs and better align our locations with our strategy. Closing clubs is never easy and we’re committed to working with impacted members and associates through this transition.

Business Insider identified at least 68 stores across the country that closed today. Three of the stores are located in Hurricane ravaged Puerto Rico. More stores are slated to be closed in the coming days.

Walmart’s behavior is part of a pattern of corporate misdirection related to the GOP tax cuts. AT&T and Comcast both announced bonuses for their employees while also laying off thousands.

While Trump talks about a “jobs boom,” job growth was slower in 2017 than in any year since 2010.

Yahoo News – Matt Bai’s Political World

He’s reckless and uninformed. But that doesn’t make Trump crazy.

Matt Bai, National Political Columnist, Yahoo News   January 11, 2018

President Trump in the Cabinet Room of the White House on Tuesday. (Photo: Evan Vucci/AP)

There’s a bunch of ignominious ways in which the grand Trump experiment could come crashing down prematurely. The special counsel’s investigation could conceivably lead to the president’s indictment, or to some public revelation that isolates him and leaves him no choice but to slink away like Richard Nixon. Or I guess the president could lose Congress to the Democrats and find himself facing impeachment for obstruction of justice.

Personally, I think the more likely scenario has President Trump drawing a credible primary challenge in 2020 and finding out that he’s actually a lot less popular than his choreographed rallies lead him to believe. I could see him standing down rather than risking humiliation, just as Lyndon Johnson did under similar circumstances.

Here’s how Trump’s presidency won’t end, though: with his Cabinet invoking the 25th Amendment and declaring him mentally unfit to serve. Because the president’s most senior subordinates won’t ever call him cognitively deficient, and near as I can tell, there’s no compelling reason they should.

This whole topic surfaced after the publication of Michael Wolff’s new insider account of the administration, “Fire and Fury.” I haven’t read the book, because life is short and too full of Trump already, but apparently Wolff suggests that some of those around the president worry openly about his aptitude and stability.

Coming just after Trump’s latest boneheaded tweet to his North Korean counterpart, Wolff’s account added a burst of oxygen to a fire that’s been dimly burning in elite faculty lounges since Trump took office. A Yale medical school professor named Bandy X. Lee, a renowned expert in mental health, has been pushing this case for many months, even publishing a series of essays by 27 clinicians who have expertly diagnosed Trump’s dangerous mental deficiencies by watching CNN.

Lee briefed Democratic senators on the president’s imminent unraveling just last month, and now Republican “Never Trump” types have joined in on the suggestion that the president may have some loose bulbs up in the penthouse.

Meanwhile, Democrats in Congress have announced plans to introduce a couple of bills that could get some traction if Democrats manage to take back the House; one, proposed by Maryland’s Jamie Raskin, would charge a new congressional commission with evaluating the president’s fitness and advising the vice president on whether to invoke the magical 25th Amendment.

That’s the amendment, added in the wake of President Kennedy’s death, that establishes specific guidelines for the transfer of power when the president is incapacitated and for the appointment of a vice president when the post is left vacant. It also empowers the vice president and Cabinet to take the keys from the president, at least temporarily, if they decide he’s in no shape to be steering the country.

Trump, as I’m sure you heard, responded to all this by trying his damnedest to confirm everyone’s worst fears. In a now famous tweet, he referred to himself as a “very stable genius,” which immediately brought to mind those old Road Runner cartoons where Wile E. Coyote was always handing his “super genius” business cards through fake doors perched on cliffs.

“Donald J. Trump, Stable Gen-i-us.”

Anyway, what’s the evidence that Trump is careening toward a breakdown? According to Lee’s research, and please note that this comes from a professional evaluation and can’t be entirely comprehended by a layman, Trump has been spreading conspiracy theories, contradicting himself a lot and tweeting crazy stuff at all hours of the night.

In other words, it’s Thursday.

Of course Trump isn’t right. Let me go out on a limb and say he’s detached, irrational, childish, narcissistic, possibly delusional, and probably deeply scarred by parents who withheld affection and left him feeling eternally unlovable. Also, his hands are small.

But we’ve known all that since the early stages of Trump’s campaign, and the voters elected him anyway, as was their right. And just by the way, if Trump’s crippling insecurity and dark countenance set him apart from other occupants of the office, then it’s mostly a question of degree.

Lyndon Johnson sometimes wouldn’t go to sleep without someone standing by, so haunted was he by loneliness. Bill Clinton raged arbitrarily and behaved in reckless, addictive ways. Richard Nixon prowled the White House mumbling about enemies and obsessing over the Kennedys. And that was just the last half-century.

Trump isn’t a fraction of the president that any of those men were, I’ll grant you. But that’s not because he’s emotionally damaged or chemically misfiring. It’s because he’s uninformed, uninterested and unserious.

Is Trump losing his mind? Rumors persist in Washington, more wishful than well sourced, that Trump is often forgetful and disoriented. Joe Scarborough, a onetime friend and current adversary of the president, aired what he said were whispers he’d been hearing for months about the president possibly suffering from early stages of dementia.

But they said the same thing about Ronald Reagan in his second term, and while that period may well have marked the beginning of his eventual decline into Alzheimer’s, which he acknowledged five years after leaving office, it may also have simply been age and stress. That line can be hard to draw.

No one’s shown me any evidence, to this point anyway, that Trump is anything other than a 71-year-old guy who never focused all that well to begin with. Or to put it another way: On the long list of reasons why America does not need another boomer president, loss of acuity and general crankiness do not rank near the top.

The larger point here is that the 25th Amendment, which has never been invoked, is a fallback reserved for cases where a president is truly incapacitated or impaired. It does not exist to negate bad decisions by the electorate. It is not there as a mechanism to remove an emotionally weak and impetuous president whom Americans elected because half of them decided they preferred emotionally weak and impetuous to the alternative.

Democracies — or republics, but let’s not get into that here — get to make bad choices and suffer the consequences. They do not get bailed out by gaggles of PhDs who know better.

And the problem with appointing some commission to pursue such an extreme course of action is that it’s likely to become just one more weapon for partisans who reflexively seek to delegitimize every election and every president. Just like articles of impeachment and special prosecutors, a remedy once considered suitable for only the most unimaginable cases is bound to become another quadrennial drama, further eroding the presidency itself.

That’s a kind of crazy we could do without.

Daily Kos

American kids are dying at much higher rates than children in other wealthy countries

By wagate     January 9, 2018

As Congress failed to refund the Children’s Health Insurance Program (CHIP), recent findings from a study in Health Affairs are especially alarming. The study compared the childhood healthcare outcomes for 20 wealthy, democratic countries. They found that the United States ranks dead last in children’s health. Vox explains:

A child born in the United States has a 70 percent greater chance of dying before adulthood than kids born into other wealthy, democratic countries, a new study has found.

The research, published in the journal Health Affairs on Monday, shows that the United States lags far behind peer countries on child health outcomes. It estimates that, since 1961, America’s poor performance accounts for more than 600,000 excess child deaths — deaths that wouldn’t have happened if these kids were born into other wealthy countries.

It turns out that while all the countries have seen a decline in childhood mortality rates, the United States has been the worst performer out of its peers for the past few decades. Yet Congress has allowed 101 days without CHIP to pass.