Senate Republicans set to release health-care bill, but divisions remain

Washington Post, Power Post

Senate Republicans set to release health-care bill, but divisions remain

By Paige Winfield Cunningham, Juliet Eilperin and Sean Sullivan, June 21, 2017

Senate Republicans on Thursday plan to release a health-care bill that would curtail federal Medicaid funding, repeal taxes on the wealthy and eliminate funding for Planned Parenthood as part of an effort to fulfill a years-long promise to undo Barack Obama’s signature health-care law.

The bill is an attempt to strike a compromise between existing law and a bill passed by the House in May as Republicans struggle to advance their vision for the country’s health-care system even though they now control both chambers of Congress and the White House.

The Senate proposal largely mirrors the House measure with significant differences, according to a discussion draft circulating Wednesday among aides and lobbyists. While the House legislation would peg federal insurance subsidies to age, the Senate bill would link them to income, as the Affordable Care Act does. The Senate proposal would cut off expanded Medicaid funding for states more gradually than the House bill but would enact deeper long-term cuts to the health-care program for low-income Americans. It also would eliminate House language aimed at prohibiting federally subsidized health plans from covering abortions, a provision that may run afoul of complex Senate budget rules.

But on the eve of the bill’s release, Senate Majority Leader Mitch McConnell (R-Ky.) faced the prospect of an open revolt from key conservative and moderate GOP senators, whose concerns he has struggled to balance in recent weeks. Republicans familiar with the effort said Senate leaders have more work to do to secure the 50 votes needed to pass the measure, with Vice President Pence set to cast the tiebreaking vote, from the pool of 52 GOP senators. No Democrats are expected to support the bill.

Republican aides stressed that the plan is likely to undergo more changes to secure the votes needed for passage, but there were major concerns Wednesday from senators on opposite ends of the GOP spectrum.

“My main concern is I promised voters that I would repeal — vote to repeal Obamacare. And everything I hear sounds like Obamacare-lite,” said Sen. Rand Paul (R-Ky.).

Sen. Shelley Moore Capito (R-W.Va.), whose state expanded Medicaid and has been pushing for a more gradual unwinding of that initiative than many conservatives prefer, said she is waiting to scrutinize what is released but has not seen anything yet that would make her drop her concerns with the proposal.

“Up to this point, I don’t have any new news — tomorrow we will see it definitively — that would cause me to change that sentiment,” she said.

Like the House bill, the Senate measure is expected to make big changes to Medicaid, the program that insures about 74 million elderly and lower-income Americans and was expanded in most states under the ACA. In effect, the revisions would reduce federal spending on the program.

The Senate measure would transform Medicaid from an open-ended entitlement to one in which federal funding would be distributed to states on a per-capita basis. The Senate measure would also seek to phase out the program’s expansion — although at a more gradual rate than the House version.

Yet the Senate bill is expected go further than the House version in its approach to cutting Medicaid funding in the future. In 2025, the measure would tie federal spending on the program to an even slower growth index than the one used in the House bill. That move could prompt states to reduce the size of their Medicaid programs.

That provision, a nod to conservative lawmakers led by Sen. Patrick J. Toomey (R-Pa.), risks alienating moderates, including Capito and Sen. Rob Portman (R-Ohio), who also represents a state that expanded Medicaid under the ACA. Some Republicans worry that such a move would force states to cut services or coverage, potentially leaving millions of low-income people without sufficient health care.

The growth rate that is applied to Medicaid spending going forward has major implications, said Sen. Susan Collins (R-Maine). “That inflater is critical, because it translates into billions of dollars over time,” she said.

Portman and Capito have also been pushing for the inclusion of a $45 billion fund to treat and prevent opioid addiction. As of early Wednesday afternoon, the opioid money was not included in McConnell’s proposal, according to a top GOP senator and Senate aide familiar with the discussions.

“I don’t think there is right now,” Senate Finance Committee Chairman Orrin G. Hatch (R-Utah) said when asked whether the legislation includes a distinct opioid fund. “It might have to be considered separately.”

But Portman and Capito, like all senators, will have a chance to introduce amendments to the bill when it heads to the Senate floor, which McConnell said is likely to happen next week. This process will allow senators to draw attention to the causes they have championed and potentially change the final bill.

Moderates who are on the fence about whether to support the Obamacare overhaul are likely to be pleased at the bill’s approach to insurance subsidies because they would be based on financial need, potentially preserving coverage for more people who got insurance under the ACA.

Subsidies are currently available to Americans earning between 100 percent and 400 percent of the federal poverty level. Starting in 2020, that threshold would be lowered to 350 percent under the Senate bill — but anyone below that line could get the subsidies if they’re not eligible for Medicaid.

That provision, said Larry Levitt, senior vice president for special initiatives at the Henry J. Kaiser Family Foundation, would be “a real benefit to poor people in states that don’t expand Medicaid.”

In a move that will please the health-care industry, the draft also proposes repealing all of the ACA taxes except for its “Cadillac tax” on high-cost health plans in language similar to the House version. Senators had previously toyed with the idea of keeping some of the ACA’s taxes.

It would also eliminate Medicaid reimbursements for Planned Parenthood for one year. Federal law already prevents taxpayer funding to pay for abortions except to save the life of the woman or in the case of rape or incest. But some Republicans want to ban all federal funding for Planned Parenthood, which also provides health services such as birth control, because their clinics provide abortion services.

Like the House measure, the Senate bill would eliminate two central requirements of the current health-care law: that individuals provide proof of insurance when filing their annual tax returns and that companies with 50 or more employees provide health coverage for their workers.

In a move that is critical to insurers, the Senate measure would continue to fund for two years cost-sharing subsidies that help 7 million Americans with ACA plans. House Republicans have challenged the legality of the $7 billion in subsidies — which help cover consumers’ deductibles and copays — in court, and insurers have warned that they will have to increase premiums dramatically next year unless the federal government commits to continuing the payments.

McConnell has told Republican senators that he wants to maintain protections for people with preexisting conditions under the law. But it was not clear to some lawmakers Wednesday what that would entail.

“I haven’t seen the draft yet. I like the idea of preexisting conditions being more firmly clarified,” Portman said.

Paul criticized GOP leaders for potentially keeping some of the ACA’s “most expensive regulations,” which he says are the primary drivers of higher premiums.

“It may well be that prices don’t come down at all,” he said.

But the Senate proposal may change rules for waivers that states can file with the Centers for Medicare and Medicaid Services that could allow them to potentially scale back some of these federal mandates.

While the details of McConnell’s proposal are expected to be made public Thursday, much of focus in recent weeks has been on the process used to draft the bill.

Democrats and even some Republicans have been critical of Senate GOP leaders for crafting the proposal behind closed doors without hearings and consideration of the legislation by the relevant committees.

Several GOP senators have expressed concern about moving quickly to a vote before they fully understand how it would impact health insurance markets and their constituents.

Sen. Ron Johnson (R-Wis.) said that in addition to reading the bill, “I’ll also want to get full input from constituencies in Wisconsin.”

Given that there may be just a week between the bill being posted and a final vote, he added, “I find it hard to believe we’ll have enough time.”

Amy Goldstein and Kelsey Snell contributed to this report.

Paige Winfield Cunningham covers health policy and authors PowerPost’s daily tipsheet The Health 202. A St. Louis native, she graduated from Wheaton College in Illinois and started her journalism career as a county board reporter at the Naperville Sun.

Juliet Eilperin is The Washington Post’s senior national affairs correspondent, covering how the new administration is transforming a range of U.S. policies and the federal government itself. She is the author of two books—one on sharks, and another on Congress, not to be confused with each other—and has worked for the Post since 1998. 

Sean Sullivan has covered national politics for The Washington Post since 2012.

We finally know what’s going to be in the Senate version of Trumpcare — and it’s not pretty

ThinkProgress

We finally know what’s going to be in the Senate version of Trumpcare — and it’s not pretty

An ugly process begets an ugly bill.

Judd Legum, Editor-in-Chief, ThinkProgress       June 21, 2017

For weeks, Senate Republicans have negotiated their version of Trumpcare in near total secrecy. There have been no public hearings — just private meetings among a select group of Republicans about a bill that could reshape one-sixth of the American economy. For many Americans, the contours of the bill could be a matter of life and death.

Text of the bill was released on Thursday, but key details began to leak Wednesday night (some from lobbyists who learned about the bill before the American people). Majority Leader Mitch McConnell (R-KY) is insisting on a vote before the July 4th holiday, which means everyone has a week to learn about this bill — including many of the senators who will be voting on it.

So let’s get started. Here are the most important things you need to know.

The bill would strip health care coverage from millions of low income Americans by rolling back the expansion of Medicaid — and then making even deeper cuts.

The core of the Senate bill, like the House version, is a massive cut to Medicaid, which millions of low income Americans rely on for health care coverage. The Senate bill will reportedly phase out the expansion of Medicaid under Obamacare, although the process won’t start until 2021. In the end, the impact is the same. The Congressional Budget Office found that rolling back Medicaid expansion would cost 14 million people their health insurance.

But the Senate bill makes even deeper, more dramatic cuts to Medicaid that, over time, would leave more low income Americans without health coverage. Instead of a program that pays for health coverage for people who need it, the House and Senate versions of the Republican health care bill place per capita caps on the program. In other words, the federal government will only send states, who administer the program, a certain amount of money no matter what the actual cost of care may be.

The Senate version, according to a report in Bloomberg, makes even deeper cuts than the House.

The House bill ties these per capita caps to the “growth rate of medical inflation (CPI-M) plus 1 percentage point.” The Senate version, however, ties caps to the general rate of inflation (CPI-U). Since medical costs consistently grow at a much faster rate than overall costs, this means states would receive a smaller and smaller percentage of the actual cost of care each year.

The bill would follow the Obamacare subsidy model, but help fewer people.

In the House version of the Republican health care bill, people receive premium subsidies based on their age. The Senate bill retains the Obamacare model where subsidies increase as incomes go down.

But while Obamacare provided subsidies to anyone making up to 400 percent of the poverty line, the Senate bill ends subsidies at 350 percent of the poverty line. This means fewer people will get help. For some people, the impact of this change could be dramatic.

The Senate bill is a massive tax cut for the rich.

At it’s heart, Trumpcare is less a health care bill than a tax cut bill. There was speculation that the Senate bill would leave more taxes in place, but it will largely mirror the House version, according to the Washington Post.

The Senate bill will repeal hundreds of million of dollars in taxes that Obamacare used to help more people afford health care providing a massive transfer of wealth to people with incomes over $200,000.

The bill will mean higher out-of-pocket medical costs for many people with insurance.

Republicans would like to reduce health care premiums. But the only mechanism to do so in the Senate bill is to allow insurers to provide fewer benefits. That means, for some people, premiums may be slightly lower. But those same people will end up with far greater costs if they do get sick.

The Senate bill will reportedly give “states more leeway in opting out of the ACA’s insurance regulations through expanding the use of so-called ‘1332’ waivers already embedded within the law.” (The House bill creates a new waiver program.) The waivers are not expected to allow states to let insurers reject or charge more to people with pre-existing conditions. But the waivers will let states allow insurers to offer skimpier plans, potentially leaving consumers with huge medical bills.

The bill also reportedly changes what percentage of costs, on average, an insurance plan must cover from 75 percent to 58 percent. This means more deductibles and out-of-pocket expenses. The Senate plan could increase these costs by 68 percent.

The bill will seek to limit the ability of insurers to provide coverage for abortions.

Senate rules may prevent the Republican health care bill from including explicit restrictions on coverage for abortion. The Senate is exploring an arcane way to limit abortion coverage anyway, according to Axios. The Senate may create a “stabilization fund” that insurance companies can tap into through the Children’s Health Insurance Program (CHIP). Most insurers will want to take advantage of this fund. But CHIP already has a restriction on abortion coverage. So insurers that take advantage of the stabilization fund will not be able to include coverage for abortion.

The bill will hit older Americans especially hard.

Across the board, older Americans who use the exchanges will be expected to pay a larger share of their income for health insurance. Those who make over 350 percent of the poverty line will now be expected pay full price.

Trumpcare’s passage is far from certain, with a number of moderate and conservative Republicans raising objections. Conservatives are likely to balk at keeping the basic Obamacare subsidy structure. Moderates are likely to object to the aggressive Medicaid cuts, particularly in states that have expanded Medicaid.

This is a developing story and will be update as we learn more details about the Senate bill.

Trump’s putdown of wind energy whips up a backlash in Iowa

Washington Post

Trump’s putdown of wind energy whips up a backlash in Iowa

By Ryan J. Foley,  AP    June 22, 2017

IOWA CITY, Iowa — President Trump’s putdown of wind energy at his Iowa rally was denounced Thursday across the state, which takes pride in its position as a national leader in wind generation.

Trump was talking up his support for coal during his speech in Cedar Rapids on Wednesday night when he said: “I don’t want to just hope the wind blows to light up your homes and your factories.” He paused before adding, “as the birds fall to the ground,” a reference to birds killed by turbines.

The remark drew some cheers and laughs inside the arena but didn’t go over well across Iowa, where the rapid growth of the state’s wind energy industry has been a bipartisan success story. Environmentalists and politicians said the president’s suggestion that wind is unreliable was outdated and off-base, and noted that bird deaths have been minimized and aren’t a source of controversy in Iowa.

Democratic gubernatorial candidate Andy McGuire called Trump’s comment “an attack on Iowa’s economy.” Iowa Environmental Council executive director Ralph Rosenberg called the president “inaccurate and misinformed.”

Iowa’s senior Republican senator, U.S. Sen. Chuck Grassley, who is considered the father of the federal wind production tax credit that has subsidized the expansion of the industry since the 1990s, again vowed to oppose any anti-wind policies Trump may pursue.

Through a spokesman, Grassley reiterated his year-old pledge that Trump would succeed in ending the production tax credit in Congress “over my dead body.” Last month, Grassley took issue with a study ordered by Energy Secretary Rick Perry into the reliability of the electric grid, saying he believed it was meant to undermine wind. Grassley argued that Iowa’s utilities have proven wind can be dependable.

In the most ever for any state, Iowa last year generated 36.6 percent of its electricity from wind. That figure is expected to keep growing, with the state’s two largest utilities having already started $4 billion in additional wind expansion projects.

Des Moines-based Mid American Energy, a leader in wind, said that using a balanced mix of traditional and renewable energy sources allows the company to deliver power to customers regardless of whether the wind blows.

MidAmerican says its adoption of wind has helped make its rates among the lowest in the nation. That has also made Iowa an attractive state for companies that use lots of power but want it to be clean. Microsoft, Facebook and Google have each built large data centers in Iowa in recent years.

A recent state report says 6,000 Iowa workers are employed in the wind energy industry, including those who manufacture and install wind turbines. Farmers also benefit from receiving payments for leasing their land to host them.

“Wind has been a great story in Iowa in every aspect,” said Josh Mandelbaum, an attorney in Des Moines for the Environmental Law and Policy Center. “For everyone else who has looked at this — policymakers across the political spectrum — all those things make supporting wind a no-brainer.”

He said the state is proving that the environmental and economic benefits of wind can be achieved without compromising the grid’s reliability. He said wind farms have been located in areas designed to avoid routes flown by migratory birds.

“There are way more bird deaths from birds striking tall buildings, like the type of towers that the president owns, than there are from birds striking wind turbines,” Mandelbaum said. “If the president’s concerned, maybe he should take a look at his own portfolio.”

The U.S. Fish and Wildlife Service estimates that between 134,000 and 327,000 birds die in wind turbine collisions annually, while at least 365 million die from window collisions.

Republican Gov. Kim Reynolds, who appeared with Trump on Wednesday, recently helped develop a state energy plan that calls for building upon the “tremendous growth of Iowa’s wind energy industry.” The plan recommends developing more energy storage infrastructure to house excess wind generated by turbines, which operate best during daylight

Trump bashes wind energy in a state that gets a third of its electricity from wind

ThinkProgress

Trump bashes wind energy in a state that gets a third of its electricity from wind

It’s like going to Georgia and talking about how peaches are terrible.

Natasha Geiling, Reporter at ThinkProgress,       June 22, 2017

On Wednesday night, President Donald Trump held a rally in Cedar Rapids, Iowa, where he praised coal and ridiculed wind energy.

“I don’t want to just hope the wind blows to light up your homes,” Trump told the crowd.

Iowa is the leading producer of wind energy in the country and generated 36.6 percent of its electricity from wind in 2016. Statewide, the wind industry employs between 8,000 and 9,000 people and has added $11.8 billion to the state’s economy through capital investments. Wind farms that are built on private land, which is leased to wind developers, collectively earn farmers and landowners an estimated $20 million annually.

The mining industry in Iowa, by contrast, employs around 2,200 people  — and is primarily made up of stone mining and quarrying jobs. Because of the way Iowa breaks down its employment data, that number also includes natural gas and petroleum extraction.

According to the Bureau of Labor Statistics, the wind industry currently employs more than 100,000 people in the United States, and wind turbine technician is the fastest growing occupation in the country. In 2016, wind capacity — the total amount of output a particular electricity generator can produce at a given time — passed hydropower to become the largest source of renewable energy capacity in the United States.

During his speech, Trump also made a reference to wind turbines killing birds, adding that “birds fall to the ground” when wind power is generated. This is not the first time Trump has claimed that wind power poses a serious threat to birds — in an interview with radio host and 2012 Republican presidential candidate Herman Cain in October, Trump said that wind power “kills all the birds” and that in areas with a lot of wind turbines, “thousands of birds are lying on the ground.”

Wind turbines do account for between 140,000 and 368,000 bird deaths annually. And while that might seem like a lot, it’s still well below the number killed each year by cell phone towers (6.8 million), collisions with glass buildings (one billion), and cats (3.7 billion).

And, as the Audubon Society notes, without wind power, birds face a much greater threat —climate change, which, by causing a shift in the habitable ranges for birds, could endanger nearly half of U.S. birds by the end of the century.

Trump has a longstanding grudge against wind power, stretching back to before his days in politics. As a developer, he fought plans to install a wind farm off the coast of one of his golf courses in Aberdeen, Scotland, which he argued would destroy the aesthetic value of his property. In 2012, he sent a letter to the then-head of the Scottish government where he called wind turbines “monsters” and described the wind farm project as “insanity.”

Donald J. Trump tweets:

“Palm Springs, Ca has been destroyed–absolutely destroyed–by the world’s ugliest wind farm at the Gateway on Interstate 10. Very very sad!

Many countries are cutting back, big time, on ugly, industrial wind turbines. The energy is very inefficient and …..

Ugly industrial wind turbines are ruining the beauty of parts of the country–and have inefficient unreliable energy to boot.

Bird killing windfarm that I oppose in Aberdeen got delayed by at least 2 years.”

Trump’s struggle against the wind farm was ultimately unsuccessful — the Scottish government approved construction of the farm in 2013, and Trump’s attempts to derail the project were rejected twice in court.

Trump has not always taken such a hard line against wind power, however. During a campaign stop in Iowa early in the 2016 presidential election, he told voters that he supports subsidies for the wind industry, like the production tax credit.

“It’s an amazing thing when you think — you know, where they can, out of nowhere, out of the wind, they make energy,” Trump said.

As president, however, Trump has been far less supportive of the “amazing” power of wind and renewable energy. He appointed Daniel Simmons, a vocal critic of renewable energy, to lead the Energy Department’s Office of Energy Efficiency and Renewable Energy (EERE) and called for deep cuts to renewable energy research in his budget.

Senate Republicans set to release health-care bill, but divisions remain

Washington Post, Power Post

Senate Republicans set to release health-care bill, but divisions remain

By Paige Winfield Cunningham, Juliet Eilperin and Sean Sullivan, June 21, 2017

Senate Republicans on Thursday plan to release a health-care bill that would curtail federal Medicaid funding, repeal taxes on the wealthy and eliminate funding for Planned Parenthood as part of an effort to fulfill a years-long promise to undo Barack Obama’s signature health-care law.

The bill is an attempt to strike a compromise between existing law and a bill passed by the House in May as Republicans struggle to advance their vision for the country’s health-care system even though they now control both chambers of Congress and the White House.

The Senate proposal largely mirrors the House measure with significant differences, according to a discussion draft circulating Wednesday among aides and lobbyists. While the House legislation would peg federal insurance subsidies to age, the Senate bill would link them to income, as the Affordable Care Act does. The Senate proposal would cut off expanded Medicaid funding for states more gradually than the House bill but would enact deeper long-term cuts to the health-care program for low-income Americans. It also would eliminate House language aimed at prohibiting federally subsidized health plans from covering abortions, a provision that may run afoul of complex Senate budget rules.

But on the eve of the bill’s release, Senate Majority Leader Mitch McConnell (R-Ky.) faced the prospect of an open revolt from key conservative and moderate GOP senators, whose concerns he has struggled to balance in recent weeks. Republicans familiar with the effort said Senate leaders have more work to do to secure the 50 votes needed to pass the measure, with Vice President Pence set to cast the tie-breaking vote, from the pool of 52 GOP senators. No Democrats are expected to support the bill.

Republican aides stressed that the plan is likely to undergo more changes to secure the votes needed for passage, but there were major concerns Wednesday from senators on opposite ends of the GOP spectrum.

“My main concern is I promised voters that I would repeal — vote to repeal Obamacare. And everything I hear sounds like Obamacare-lite,” said Sen. Rand Paul (R-Ky.).

Sen. Shelley Moore Capito (R-W.Va.), whose state expanded Medicaid and has been pushing for a more gradual unwinding of that initiative than many conservatives prefer, said she is waiting to scrutinize what is released but has not seen anything yet that would make her drop her concerns with the proposal.

“Up to this point, I don’t have any new news — tomorrow we will see it definitively — that would cause me to change that sentiment,” she said.

Like the House bill, the Senate measure is expected to make big changes to Medicaid, the program that insures about 74 million elderly and lower-income Americans and was expanded in most states under the ACA. In effect, the revisions would reduce federal spending on the program.

The Senate measure would transform Medicaid from an open-ended entitlement to one in which federal funding would be distributed to states on a per-capita basis. The Senate measure would also seek to phase out the program’s expansion — although at a more gradual rate than the House version.

Yet the Senate bill is expected go further than the House version in its approach to cutting Medicaid funding in the future. In 2025, the measure would tie federal spending on the program to an even slower growth index than the one used in the House bill. That move could prompt states to reduce the size of their Medicaid programs.

That provision, a nod to conservative lawmakers led by Sen. Patrick J. Toomey (R-Pa.), risks alienating moderates, including Capito and Sen. Rob Portman (R-Ohio), who also represents a state that expanded Medicaid under the ACA. Some Republicans worry that such a move would force states to cut services or coverage, potentially leaving millions of low-income people without sufficient health care.

The growth rate that is applied to Medicaid spending going forward has major implications, said Sen. Susan Collins (R-Maine). “That inflater is critical, because it translates into billions of dollars over time,” she said.

Portman and Capito have also been pushing for the inclusion of a $45 billion fund to treat and prevent opioid addiction. As of early Wednesday afternoon, the opioid money was not included in McConnell’s proposal, according to a top GOP senator and Senate aide familiar with the discussions.

“I don’t think there is right now,” Senate Finance Committee Chairman Orrin G. Hatch (R-Utah) said when asked whether the legislation includes a distinct opioid fund. “It might have to be considered separately.”

But Portman and Capito, like all senators, will have a chance to introduce amendments to the bill when it heads to the Senate floor, which McConnell said is likely to happen next week. This process will allow senators to draw attention to the causes they have championed and potentially change the final bill.

Moderates who are on the fence about whether to support the Obamacare overhaul are likely to be pleased at the bill’s approach to insurance subsidies because they would be based on financial need, potentially preserving coverage for more people who got insurance under the ACA.

Subsidies are currently available to Americans earning between 100 percent and 400 percent of the federal poverty level. Starting in 2020, that threshold would be lowered to 350 percent under the Senate bill — but anyone below that line could get the subsidies if they’re not eligible for Medicaid.

That provision, said Larry Levitt, senior vice president for special initiatives at the Henry J. Kaiser Family Foundation, would be “a real benefit to poor people in states that don’t expand Medicaid.”

In a move that will please the health-care industry, the draft also proposes repealing all of the ACA taxes except for its “Cadillac tax” on high-cost health plans in language similar to the House version. Senators had previously toyed with the idea of keeping some of the ACA’s taxes.

It would also eliminate Medicaid reimbursements for Planned Parenthood for one year. Federal law already prevents taxpayer funding to pay for abortions except to save the life of the woman or in the case of rape or incest. But some Republicans want to ban all federal funding for Planned Parenthood, which also provides health services such as birth control, because their clinics provide abortion services.

Like the House measure, the Senate bill would eliminate two central requirements of the current health-care law: that individuals provide proof of insurance when filing their annual tax returns and that companies with 50 or more employees provide health coverage for their workers.

In a move that is critical to insurers, the Senate measure would continue to fund for two years cost-sharing subsidies that help 7 million Americans with ACA plans. House Republicans have challenged the legality of the $7 billion in subsidies — which help cover consumers’ deductibles and co-pays — in court, and insurers have warned that they will have to increase premiums dramatically next year unless the federal government commits to continuing the payments.

McConnell has told Republican senators that he wants to maintain protections for people with preexisting conditions under the law. But it was not clear to some lawmakers Wednesday what that would entail.

“I haven’t seen the draft yet. I like the idea of preexisting conditions being more firmly clarified,” Portman said.

Paul criticized GOP leaders for potentially keeping some of the ACA’s “most expensive regulations,” which he says are the primary drivers of higher premiums.

“It may well be that prices don’t come down at all,” he said.

But the Senate proposal may change rules for waivers that states can file with the Centers for Medicare and Medicaid Services that could allow them to potentially scale back some of these federal mandates.

While the details of McConnell’s proposal are expected to be made public Thursday, much of focus in recent weeks has been on the process used to draft the bill.

Democrats and even some Republicans have been critical of Senate GOP leaders for crafting the proposal behind closed doors without hearings and consideration of the legislation by the relevant committees.

Several GOP senators have expressed concern about moving quickly to a vote before they fully understand how it would impact health insurance markets and their constituents.

Sen. Ron Johnson (R-Wis.) said that in addition to reading the bill, “I’ll also want to get full input from constituencies in Wisconsin.”

Given that there may be just a week between the bill being posted and a final vote, he added, “I find it hard to believe we’ll have enough time.”

Amy Goldstein and Kelsey Snell contributed to this report.

Paige Winfield Cunningham covers health policy and authors PowerPost’s daily tipsheet The Health 202. A St. Louis native, she graduated from Wheaton College in Illinois and started her journalism career as a county board reporter at the Naperville Sun.

Juliet Eilperin is The Washington Post’s senior national affairs correspondent, covering how the new administration is transforming a range of U.S. policies and the federal government itself. She is the author of two books—one on sharks, and another on Congress, not to be confused with each other—and has worked for the Post since 1998.

Sean Sullivan has covered national politics for The Washington Post since 2012.

Russia debacle destroys the last rationale for Trump, the myth of the genius CEO

Yahoo News

Matt Bai’s Political World

Russia debacle destroys the last rationale for Trump, the myth of the genius CEO

Matt Bai      June 22, 2017

Let’s begin this week with a question that has nothing to do with a single House election in Georgia, even though it was apparently the most critical and consequential local election in the history of elections, going all the way back to the Greeks.

What have we really learned to this point about the ties between President Trump’s campaign and the Russians, and what does it tell us?

My former colleague David Brooks, no fan of Trump’s, wrote thoughtfully on this subject a few days ago. In a column titled “Lets Not Get Carried Away,” Brooks argued that — at least as of now, which is an important caveat — all the leaks and revelations about the Trump campaign haven’t actually turned up any evidence of collusion with Russian hackers looking to influence last year’s election.

Rather, if I’m paraphrasing Brooks correctly, Trump has played right into the hands of his many critics in Washington, foolishly trying to discredit or even impede an investigation that probably leads nowhere. And in doing so, all he’s managed to do is crank up the modern machinery of scandal politics, which can whir away for years in a search for something — anything — that rises to the level of a crime.

I tend to agree with this analysis. Unless the special counsel, Robert Mueller, has unearthed something we don’t know about, there’s not much here to suggest that Trump himself had any idea of what the Russians were up to, or that any of his pro-Kremlin advisers were actively coordinating with foreign spies.

The closest thing we have to a crime right now is Trump’s sleazy attempt to influence and then destroy the FBI director, and even that feels less like obstruction of justice than like the clueless machinations of a land developer who thought he could push around the Justice Department as he would an unaccommodating city inspector.

In the end, though, if Republicans are going to argue that the whole Russia fiasco has nothing to do with Trump, and is really just a story of incompetence and greed among a few cowboy operatives working for the campaign, then they have to acknowledge something else, too.

Which is that this version of events further obliterates the entire premise of Trump’s campaign, not to mention his party’s principal rationale for having supported him in the first place.

Remember, Republicans in Washington never labored for a minute under the illusion that Trump knew anything about governance or even shared their bedrock ideology. What they settled on, when they finally embraced his candidacy, was that the country could use a CEO who knew how to run a business.

This is what Trump himself kept saying, too. “The best people” — that’s what he promised.

If I had a dime for every conservative insider and voter who told me last year that Trump would surround himself with all the sharpest minds and most experienced hands around, I’d build a garish, exorbitantly expensive hotel and stick my name in fake gold at the top.

What’s become abundantly clear, though, is that Trump didn’t run his campaign like a shrewd corporate titan with a keen eye for talent. He ran it like a sucker, easily played by anyone who knew how to stroke his ego.

OK, so maybe the party’s best and brightest weren’t exactly knocking down the door at Trump Tower last year. Maybe the Jim Bakers and Condoleezza Rices of the world wanted nothing to do with Trump at that point.

But isn’t that supposed to be Trump’s superpower — getting people to “yes”? Don’t you think he would have sought out those folks and determined the bottom-line price of their loyalty, the way a great negotiator would?

Instead, he turned to misfits and marginal characters. He hired Paul Manafort, a long-forgotten consultant who’d lately been doing shady work in Ukraine for a dubious paycheck. He turned to Michael Flynn, a former general with conspiratorial tendencies and murky relationships with foreign despots. He collected people like Carter Page, the gadfly foreign policy aide who was, in effect, if inadvertently, a Russian asset.

These guys used Trump for the purposes of their overseas friends and clients. Just four years after the last Republican nominee had called Russia the greatest threat to American security, the new nominee was praising Vladimir Putin, while Russian spies hacked his opponents.

The only thing Republicans can really argue is that Trump didn’t know. He was new to the political world. How could he have guessed that Manafort was so venal? How could he have known that Flynn wasn’t being straight?

According to the testimony of James Comey, the now deposed FBI director, Trump later said he wanted to know if any of these advisers had betrayed him (and, incidentally, their country).

Only he didn’t, really. Because even after Trump had given Flynn one of the most vital and sensitive posts in American foreign policy, and even after Trump had been personally warned by his predecessor and his Justice Department that Flynn was a blackmail risk, he did nothing.

He personally lobbied Comey to leave Flynn alone. And even now, after Flynn has been publicly disgraced and faces legal jeopardy for the conflicts he failed to disclose, Trump is said to be ruminating on a way to bring him back.

No, the president may not have been complicit in this dirty foreign intrigue. “Clueless” and “ineffectual” are the words that come to mind.

None of this should surprise us, though. Because the whole surround-yourself-with-geniuses theory was always just a wishful canard, with zero basis in reality. Trump himself, in a much-quoted interview with CNBC in 2007, offered a truer sample of his management philosophy:

“I hear so many times, ‘Oh, I want my people to be smarter than I am.’ It’s a lot of crap. You want to be smarter than your people, if possible.”

Well, he certainly is making it look possible — I’ll give him that.

Trump’s White House, like his campaign, has nothing to do with recruiting top-rate talent, and everything to do with making the president feel loved and unchallenged.

Just this week, Trump’s 36-year-old son-in-law, whose collective expertise is limited to buying a bunch of buildings in Manhattan with family money, gave a little speech about reorganizing the federal bureaucracy, just before jetting off to the Middle East in a bid to broker world peace.

(By the way, since Trump so admires the House of Saud, it’s worth pointing out that the Saudi king just ousted his crown prince in favor of his 31-year-old son. If I were Mike Pence, I might take this opportunity to spend some quality time with the boss.)

Meanwhile, Trump continues to moan privately about the dysfunction and incompetence among his own senior staff, though he seems at a loss to fix it. He still can’t seem to fill most of the critical jobs at his Cabinet agencies, assuming he even wants to.

To be clear: I’ve never been opposed to this notion of a CEO president, in theory. I agree with Republicans — and maybe some Democrats, too — who think Washington could use some leadership from another arena, especially if it involves a leader who knows what he or she doesn’t know, and who understands the powerful currents reshaping the society, and who can bring imaginative thinking and top-rate intellects into government.

But that’s not this president. What the revelations around Russia are proving is that Trump doesn’t actually run things well. His success in business comes not from being some management guru, but from being a relentless opportunist and a bit of a con man.

His only defense now is that he’s the one who got conned.

Do Not Ignore This Persistent Truth About Republicans

Do Not Ignore This Persistent Truth About Republicans

Republicans vote Republican, even when a fresh face like Jon Ossoff steals the headlines.

By Charles P. Pierce      June 21, 2017

OK, two things before we leave the leafy, tranquil suburbs of rank despair down there in Georgia and hurl ourselves into the heat and desolation of the Hot Take Caldera.

Point The First: Karen Handel, who won the congressional seat previously held by Tom (The Wolf of Wall Street) Price, was not a very strong candidate. She ran for statewide office three times and lost badly. She piled up a resounding 19 percent in the preliminary balloting. Her appeal to that mythical beast, The Independent Voter, was practically nil; on many issues judged to be critical to that critter, from good government to marriage equality, she is an extremist loon. She was nobody’s idea of an ideal Republican candidate for that seat, either.

But she won. Know why? Because there was an ‘R’ next to her name, that’s why, and because that’s all that matters to Republicans, who get out and vote for anyone with an ‘R’ next to their name, and who know how to keep their internecine knife fights largely on the down low and, in any case, even while those are going on, they know how to keep their eyes on the prize. They come out. They vote their party, even in what apparently were godawful weather conditions.

Conclusion: I would like the 2016 Democratic primary elections to be over now.

Point The Second: Now that it’s open season on Jon Ossoff, I’d like to point out that he came within a whisker of avoiding a runoff entirely in an election for a congressional seat that’s been solidly Republican since Jimmy Carter was president. That’s not a win, but it’s not nothing, either. He was a studied, cautious candidate. (His personal affect was thoughtful to the point of occasionally seeming a bit off-plumb, truth be told.) It’s very hard to make a case that a louder, more progressive candidate would have done much better than Ossoff did. (And that’s not even to mention that the Democrats ran a former Goldman Sachs executive in a deep red South Carolina district and came even closer to an upset than they did in Georgia. That would have scrambled some brains among the purity police.) It’s a fair point to say that, especially when all that Paul Ryan PAC money came flooding in at the last minute to link Ossoff to Nancy Pelosi and, most odiously, to the mass shooting in Alexandria.

(The Pelosi question is an interesting one. Already, there are cries to replace her as the minority leader in the House, almost all of which are based on election results outside the chamber. However, nobody has been better at herding the cats in the Democratic caucus than she’s been. And now that the Blue Dogs are apparently having delusions of grandeur again, I’m not sure it’s the right time to toss away that essential skill. But I do find compelling the argument that the hyper-nationalization of the Ossoff campaign did it no favors.)

Conclusion: I would like the 2016 Democratic primary elections to be over now.

Yes, it is hard for the Democrats to listen to the mad king cock-a-doodle-doo on the electric Twitter machine. And it probably is almost impossible for them to listen to the thousand voices who Know Better. Some of them will be completely a’skeered and declare themselves open for business with Camp Runamuck. Still others will insist that there is a huge reservoir out there in the boondocks for economic populism detached from the racism and xenophobia into which American economic populism almost always descends.

(Over at Lawyers, Guns, and Money, there is a thread dealing with a proposal from one of America’s most prominent Berniecrats that the key for Democratic candidates in the South is to follow the example of…Zell Miller.)

All of this will be utterly counterproductive and, worse, futile. The Republicans don’t care. They have their vicious primary battles and then, usually, everybody in the choir sings on key. Republicans are remarkably unembarrassed by jettisoning their previous deeply held beliefs for the purposes of winning elections. Ted Cruz’s fealty to the current president* is proof enough of that.

The biggest mistake the Ossoff campaign made was relying too heavily on the notion that there were Republican voters in that district that could be broken off from their party. This almost is never the case. Through decades of constant and unrelenting pressure, and through finagling with the franchise in a hundred ways in a thousand places, the Republicans have compressed the votes they need into an unmovable, diamond-hard core that will vote in robotic lockstep for whoever it is that wins a Republican primary. In American politics today, mindlessness is one of the strongest weapons you can have. Republicans vote for Republicans in Republican districts. Period.

Cops Suspect Slain Muslim Teen Nabra Hassanen Was Raped

Daily Beast

Unspeakable…..Cops Suspect Slain Muslim Teen Nabra Hassanen Was Raped

Darwin Martinez Torres is locked up for the violent attack on the girl whose death raised fears of a hate crime. ICE said he entered the U.S. illegally.

Natalia Megas     June 20, 2017 

Fairfax, Virginia — Authorities suspect Nabra Hassanen may have been raped before she was murdered on Sunday, according to two sources with knowledge of the investigation.

The killing of Hassanen, a 17-year-old Muslim girl, sent shockwaves through the country after a recent string of violent attacks on Muslims and racial minorities. Police said they are not investigating her death as a hate crime.

Hassanen’s body was found in a pond in Sterling, Virginia, hours after Darwin Martinez Torres allegedly struck her with a baseball bat, took her away, and killed her. One source said police found a woman’s pair of underwear near Hassanen’s body, and investigators are awaiting test results from vaginal swabs.

When asked if Hassanen was raped, Fairfax County Police Department Lt. Col. Deputy Chief of Police Tom Ryan said at a Monday press conference: “There was an assault that occurred in Fairfax County and we had another assault that occurred in Loudoun County.”

Torres, 22, is in Fairfax County jail custody for the attack on Hassanen. Torres, a national of El Salvador, entered the United States illegally, Immigrations and Customs Enforcement spokesperson Carissa Cutrell told The Daily Beast. Cutrell said ICE has asked to take custody of Torres after he’s released from Fairfax County jail.

“It appears that the suspect became so enraged over this traffic argument that it escalated into deadly violence,” Fairfax County police spokeswoman Julie Parker said Monday. She added the case may be potentially prosecuted in Loudoun County “due to elements of the various crimes and where they occurred.”

According to a preliminary investigation, sources said, Hassanen and a group of about 15 Muslim teenagers were walking and riding bikes back to the All Dulles Area Muslim Society (ADAMS) mosque in Sterling after leaving a nearby fast food restaurant at about 3:40 a.m. on Sunday.

One boy in the group began arguing with Torres, the sources said, before one of the teens allegedly threw a drink at Torres’ vehicle.

Torres drove his vehicle onto the curb as the teens scattered, the sources said. Witnesses told police that Torres chased part of the group, including Hassanen, with a metal baseball bat into a nearby McDonald’s parking lot.

Hassanen reportedly tripped over her abaya, which is when Torres caught up with her and struck her with the bat in the head, rendering her unconscious. Torres then allegedly dragged her body to his vehicle and drove to another location where police suspect he raped her.

A source close to the investigation said Hassanen may have regained consciousness and resisted during the sexual assault before Torres struck her again. Autopsy results showed that Hassanen suffered blunt force trauma to the upper body.

Hassanen’s body was later found in a pond.

The Washington Post reported Hassanen was the first born of four daughters, a diligent and popular student who just finished 10th grade. The Hassanen family lived in a modest apartment near Washington, D.C., usually overflowing with friends and laughter.

“It’s a family where if you’re feeling down and you need to laugh, this is where you go,” Samar Ali, 26, who grew up in the Hassanens’ apartment complex told the Post.

“Why would you kill a kid? What did my daughter do to deserve this?” her mother said to the Post.

Deny ‘Til You Die

Esquire

Deny ‘Til You Die

Scott Pruitt and Co. can talk all they want. The storms are coming.

By Charles P. Pierce    June 20, 2017

It seems that it’s too hot in Phoenix these days for airplanes to fly, or at least that’s what USA Today tells us.

Extreme heat affects a plane’s ability to take off. Hot air is less dense than cold air, and the hotter the temperature, the more speed a plane needs to lift off. A runway might not be long enough to allow a plane to achieve the necessary extra speed.

The Phoenix area is going to experience heat in excess of 115 degrees for a while. This is not merely uncomfortable; it’s damned near uninhabitable. But at least, unlike Portugal, Phoenix isn’t burning down at the moment. From the BBC:

The week’s highest temperatures of around 38C (100F) are expected on Tuesday and together with windy conditions could reignite fires already quelled. Civil protection officials say although 70% of the fire is under control, what remains is a source “of great concern”. At least 64 people have died in the fires since Saturday. The latest of the victims was identified as a 40-year-old firefighter who died in hospital. Many died inside their cars or a short distance away from them as they tried to flee. More than 130 other people have been injured.

Here is where I remind you that we have a president* committed, at least rhetorically, to reviving the dead coal industry, and who was loudly applauded by the members of his party—and quietly applauded by the CEOs who own them—for pulling the US out of the Paris climate accords, and who installed at the Environmental Protection Agency an extraction industry sublet who doesn’t even believe that Carbon dioxide and climate change have anything to do with each other. In turn, this cluck appointed a former lobbyist for various polluters to head the enforcement division of the EPA, which, in any case, is savaged in the new proposed federal budget.

Hugely anomalous and destructive weather events are going to be the new normal in no small part because a hugely anomalous and destructive political event took place last November. Some day, that whole election may be looked on as a crime against humanity.

Oh yeah, Louisiana has the first bull’s-eye of the season painted on it.

The Southwest is broiling. Are you paying attention, President Trump?

CNN

The Southwest is broiling. Are you paying attention, President Trump?

By Jill Filipovic        June 20, 2017

The opinions expressed in this commentary are solely those of the author.

Jill Filipovic: There’s plenty of reason to believe extreme heat in West is climate change portent. Yet Trump, many in GOP continue to deny reality.

She says they are mistaken to believe their base is with them on this: they will be as affected by ruined crops, rising sea level as everyone else.

(CNN) Record temperatures. Roads cracking and buckling. Planes that can’t take off. Power knocked out. Wildfires raging. These are just some of the trying conditions currently roiling America’s West Coast, which is in the midst of a record-breaking heatwave.

Nervous about how these disruptions will negatively impact the economy and even cost human life? You should be. And there’s more to come.

Changing weather patterns are the new normal, thanks to decades of trashing the environment and a refusal from many in the party currently controlling Washington, the Republicans — and their corporate patrons — to even acknowledge climate change as a reality, let alone do anything about it.

Entire nations may soon be under water. Mega-cities that are home to hundreds of millions are set to drown, leaving huge numbers of people stranded, constraining already-limited resources, fueling violence and competition over those resources, and creating a whole new category of need: climate refugees. A delayed flight out of Phoenix will soon be the least of our worries.

Yes, of course, heat waves happen, and the causes are complex. There is not a direct A to B line from “pollute the environment” and “die in a scorching June.” But there is virtually no real dissent that the Earth is getting warmer. The ice at the poles of our oceans is melting. Irregular and dangerous weather patterns are increasing. Sea levels are rising.

We have polluted, depleted and abused this planet so badly that there is much damage that can’t be undone. But there remain ways to rein in the ills we continue to reap — and ways to at least slow our progress toward a chaotic and barren global hellscape.

Even if you are a climate change skeptic and doubt human agency in this crisis — if you write off the consensus of the overwhelming majority of scientists who study this issue — now that we are regularly faced with weather extremes, why not at least entertain the idea that scientists are onto something?

And if you allow that you just might be wrong — that climate change could be real — how about reconciling to the idea that the downside of doing nothing is so immensely catastrophic that it’s our immediate obligation to act?

Let’s say the climate change skeptics get their way and we don’t act according to the pleas of environmentalists and scientists. If the doubters are right, then the upside is that we save a good deal of money on palliative measures. If they’re wrong, though, and if people who study the environment professionally are in fact better able to predict its condition than businessmen and politicians, the downside is massive — many will die.

What marginally sane person would ever take that gamble?

Our President and many in the Republican Party, it turns out.

For one example, candidate Trump made a campaign pledge to eliminate the Environmental Protection Agency, and as President has settled instead for appointing an administrator who is cozy with the oil and gas industry; who is reluctant to acknowledge the human causes of global warming; who has announced cuts that essentially gut the agency that stands between Americans and environmental disaster. For his part, the President has signed an executive order targeting regulations that had aimed to slow climate change.

For another, Trump has backed the country out of the Paris climate agreement — a move wildly opposed by Americans!

This is just a short list (there is more) of the steps this administration is taking to undo climate protections.

In all, it represents a shocking combination of greed and shortsightedness, compounded by an apparent urge to appeal to the worst impulses of the Trump base — people he and Republicans seem to assume are motivated by an urge to stick it to Prius-driving egghead liberals, even if doing so means their grandchildren might suffer or perish in a world of flooded metropolises, un-breathable air and expansive, unlivable deserts.

Surely this calculation is wrong: Republican voters whose livelihoods depend on the ability to harvest corn crops in Iowa or ship goods to their store in Arizona (or who live near the water and can’t afford flood insurance that’s more than their mortgage) can take a look around and realize this “see no evil” strategy is going to hurt them, and soon.

Indeed, that the American right has transformed climate change into a partisan issue defies all reason and rational self-interest. Climate change will have the largest and most immediate impacts on the world’s poor — not a demographic the GOP has shown much concern for. But make no mistake — rich or poor we all share the earth, and the catastrophic impacts of defiling it are coming for all of us.

If you’re stranded in Phoenix right now, or worried about an elderly acquaintance in California, or are without power in the Bay Area, or nervous about a wildfire taking your home, you can thank the long list of politicians who do the bidding of polluting corporations instead of their constituents and protect profit over the environment.

You can thank the President who tore up the Paris climate agreement. And you can show your displeasure by refusing to support candidates who don’t take climate change seriously, and don’t do whatever they can to keep the world inhabitable.

Anything less is global suicide.