STAT

Trump threatens insurer payments and health care enjoyed by Congress

Lev Facher, STAT News      July 29, 2017

WASHINGTON — President Trump on Saturday indicated he will make good on a months-old threat to destabilize the health insurance market if Senate Republicans cannot repeal and replace major elements of the Affordable Care Act.

Donald J. Trump @realDonaldTrump….If a new HealthCare Bill is not approved quickly, BAILOUTS for Insurance Companies and BAILOUTS for Members of Congress will end very soon!    July 29, 2017

The first part of the ultimatum likely refers to cost-sharing reduction payments made by the federal government to insurers, which in turn offer discounted plans for many low- or middle-income Americans buying plans through ACA marketplaces.

The second portion, while far narrower in scope, is significant in that it highlights an additional tool at the president’s disposal for acting unilaterally on health policy. Though ACA repeal has been in the spotlight throughout 2017, other rumblings regarding subsidies specific to Congress have been rare.

In January, Rep. Ron DeSantis (R-Fl.) introduced a bill that would end an exemption enabling members of Congress and Capitol Hill staff to obtain employer contributions from the government to pay for plans on D.C.’s small-business exchange, which the federal Office of Personnel Management in 2013 issued guidance to allow.

Read more: Get ready for the next big health care fight. This one’s all about kids

“By blowing the whistle on this special deal concocted by OPM, we will make members of Congress better understand the burdens of ObamaCare, thereby incentivizing members to get to work on a good repeal and replace plan,” DeSantis wrote then in a statement.

Heather Higgins, CEO of the conservative-leaning advocacy group Independent Women’s Voice, wrote last week in a Wall Street Journal op-ed: “Congress is essentially unaffected by the high costs of the ObamaCare exchanges because of a special exemption crafted under the Obama administration.” Some subsidies obtained via D.C.’s small-business exchange, the op-ed claimed, were worth as much as $12,000 annually.

While Trump’s meaning was not entirely clear, it is possible he could direct OPM to rescind the ruling enabling the exemption, as a coalition of right-wing groups encouraged him to do in a July 21st letter.

The president’s threat regarding cost-sharing reduction payments, however, is more broadly impactful, more familiar, and more widely understood.

It also echoes a warning made by Senate Majority Leader Mitch McConnell (R-Ky.) in the early hours of Friday, just after his chamber’s efforts to pass a narrow compromise bill fell one vote short.

“I bet I’m pretty safe in saying, for most of the people on this side of the aisle, that bailing out insurance companies — bailing out insurance companies with no thought of any kind of reform — is not something I want to be part of,” McConnell said in his speech on the Senate floor.

Trump has made the threat before, indicating he believed ending the payments would leave Democrats with no choice but to negotiate with Republicans on a broader repeal bill. But it takes on added significance in light of GOP senators’ setback.

Insurers have repeatedly indicated that ending CSR payments would throw markets into turmoil and even cause the type of “death spiral” Republicans in Congress have long warned against.

The Congressional Budget Office has estimated the payments’ value at $7 billion in 2017, $10 billion in 2018, and $11 billion in 2019.

The Kaiser Family Foundation projects that without CSR payments, the cost of “silver” insurance plans in Medicaid expansion states would increase by 15 percent, and in non-expansion states by 21 percent.

Senate Minority Leader Chuck Schumer (D-N.Y.) responded to Trump quickly via the same medium on Saturday:

Chuck Schumer @SenSchumer… If @POTUS  refuses to make CSR payments, every expert agrees that premiums will go up & #healthcare will be more expensive for millions. July 29, 2017

The New Yorker

Satire from The Borowitz Report

Trump Supporters Furious That They Still Have Health Care

By Andy Borowitz        July 28, 2017

Photograph by Sean Rayford / Getty

WASHINGTON (The Borowitz Report)—With a fury that could spell political trouble for Republicans in the midterm elections, Trump voters across the country on Friday expressed their outrage and anger that they still have health coverage.

“I went to bed Thursday night and slept like a baby, assuming that when I woke up I would have zero health insurance,” Carol Foyler, a Trump voter, said. “Instead, this nightmare.”

Harland Dorrinson, who voted for Trump “because he promised that he would take my health care away from me on Day 1,” said that he was “very upset” that he will still receive that benefit.

“I woke up this morning, and my family and I could still see a doctor,” he said. “This is a betrayal.”

Many Trump supporters said that congressional Republicans “gave up too soon” in their efforts to deprive ordinary Americans like them of their health care.

“They should not take August off,” Calvin Denoit, a Trump supporter, said. “They should stay in Washington and keep working until I totally lose my coverage.”

For Trump voters like Benoit, the abject disappointment of continuing to have health care raises fears about which other campaign promises might soon be broken.

“Now I don’t know what to believe,” he said. “Are we still going to get to pay billions of dollars in taxes for that wall?”

Andy Borowitz is the New York Times best-selling author of “The 50 Funniest American Writers,” and a comedian who has written for The New Yorker since 1998. He writes the Borowitz Report, a satirical column on the news, for newyorker.com.

The Washington Post-Wonkblog

Bosses want capitalism for themselves and feudalism for their workers

By Matt O’Brien         July 26, 2017

(HBO)

If some employers had their way, you would have to pledge eternal fealty to them just to get a paycheck.

You would bend the knee, bow your head, and swear to serve them faithfully, now and forever, even if someone else tried to hire you away for more money. And in return for this loyalty, you of course would get none. Your company could fire you whenever it wanted and wouldn’t have to take care of you when you got old. If you were really lucky, it might, just might, give you a small 401(k) match. In other words, it’d be capitalism for bosses, and feudalism for workers.

Now, as much as this might sound like a caricature, it’s actually the way things are in Idaho. Well, except maybe for the genuflecting. As the New York Time’s Conor Dougherty reports, the state’s non-compete laws are so strict that people can’t leave their jobs for a new one unless they can show that it wouldn’t “adversely affect” their current employer. That’s an impossible standard that would leave workers — and, more to the point, their wages — entirely at the mercy of their bosses.

This is not, to put it mildly, the way things are supposed to work. When unemployment is as low as it is now, companies are supposed to have to fight over workers by paying them more. If there’s one thing chief executives excel at, though, it’s cutting every cost other than their own bonuses. They’ve figured out that it’s a lot cheaper to simply tell their employees that they’re not allowed to leave than it is to pay them enough that they wouldn’t want to leave in the first place. Which is to say that Idaho isn’t the only state going medieval on workers. Many of them are. Non-competes, which started off as a way to stop a company’s top executives from revealing legitimate trade secrets to rivals, have turned into a tool for suppressing wages that now cover 14 percent of all people making $40,000 or less, according to the U.S. Treasury Department.

There’s no reason that sandwich shop makers or doggy day-care workers or summer camp counselors should have to sign non-compete agreements like some of them have recently. No reason other than that businesses know they can get away with it. Jobs were so scarce for so long in the aftermath of the Great Recession that companies realized they could put almost any condition on them and still find plenty of people willing — no, desperate — to take them. To the point that even people who were trying to get jobs at Jimmy John’s felt like they had to promise that they wouldn’t take any of the secrets they were about to learn about putting slices of meat in between pieces of bread to go work for, say, Subway instead.

It’s a reminder that economics isn’t just about supply and demand. It’s also about who has the power to make demands. Which actually has more to do with government policies than market forces. Things like how high the minimum wage is, how easy it is to form a union, and, yes, how tough non-compete laws are all affect the balance of power between capital and labor independent of the unemployment rate. So does the welfare state itself. Indeed, businesses have historically been opposed to Social Security, Medicare and, more recently, Obamacare not only because those programs cost them money, but also control over their workers. When the government helps people be able to afford to retire, companies can’t afford to hire quite as many of them — not if they want to maintain their profit margins. That’s because workers have more bargaining power when there aren’t as many of them actually looking for, well, work.

The same kind of logic, by the way, applies to stimulus spending. As economist Michal Kalecki argued back in 1943, a government that hires unemployed people is a government that doesn’t have to give business what it wants to get them to hire unemployed people. The more the government does, then, the less sway businesses have over the economy and everyone in it.

The important thing to understand is that capitalists don’t believe in capitalism. They believe in profits. There’s a difference. Capitalism is about free competition, while profitability, taken to the extreme, is about the lack of it. After all, the best way to make money is to drive everyone else out of business, and to then force your workers to accept subsistence-level wages. It’s the contradiction at the heart of capitalism, which, if it weren’t for the fact that governments can intervene to save the system from itself, could very well lead to revolution.

That’s what happens when you turn workers into vassals.

Matt O’Brien is a reporter for Wonkblog covering economic affairs. He was previously a senior associate editor at The Atlantic.

Esquire

Government by Absurdity Takes Many Forms

Watching tens of millions of Americans lose their healthcare in slow motion.

Getty

By Charles P. Pierce       July 26, 2017

WASHINGTON—A corporal’s guard of protestors remained on the South Lawn of the Capitol late Tuesday night as the U.S. Senate finished its work for the day by voting down measures that would’ve replaced the Affordable Care Act with something far worse. Half-drunk frat boys heckled them, and they heckled back, and all went quiet at the end of an ugly day.

Inside, there was a curious vote on something called the Better Care Reconciliation Act, which the Congressional Budget Office has estimated would cost 22 million Americans their health insurance. This contained an amendment from Tailgunner Ted Cruz that would allow the propagation of street-surance, cheap plans that cover nothing. It also contained an amendment from Rob Portman, Republican Senator from Ohio, that was aimed primarily at keeping Rob Portman the Republican Senator from Ohio. Because these elements of this jerry-rigged monstrosity had not been scored by the CBO, the measure needed 60 votes to pass, unless the Senate agreed to waive certain procedural requirements. The vote on the waiver failed, miserably, with nine Republicans joining a united Democratic minority to sink it, 57-43.

Getty

(Those people clinging to the notion that John McCain nobly came back to vote to begin debate in order ultimately to vote against the final passage of whatever Mitch McConnell cobbles together now have to reckon with the fact that McCain voted in favor of a bill he had said he opposed six hours earlier. Was the senator confused? He could’ve consulted his BFF Lindsey Graham, who was one of the nine Republicans who voted against it.)

After the vote, the Tailgunner gathered a brief gaggle outside the Senate chamber in which he expressed confidence that his effort to legitimize insurance fraud remained a viable option. “This is the first step in the process,” he said. “I believe it’s too soon to tell [when his amendment would re-emerge] when you’ve got unlimited amendments. I believe we will see the Consumer Freedom Amendment included in the legislation that is ultimately enacted. When in the process we will see that, the legislative path to get there, time will tell. But this is the way the legislative process works.”

Half-drunk frat boys heckled them, and they heckled back, and all went quiet at the end of an ugly day.

Clearly, what Cruz is hoping for is that something—probably the “skinny repeal,” which would eliminate only certain unpopular elements of the ACA—will come out of the Senate, whereupon the show will move into conference with the House of Representatives, where the wild things do run, and where the Freedom Caucus is running things. (At the moment, this cry of loons is trying to submarine the CBO.) The extreme and the crazy—and, it must be said, the vastly unpopular—likely will be injected there. Odds are pretty decent that the Tailgunner’s desire to free the American people from the shackles of health will be met through some bill of which very nearly 20 percent of the American people approve.

There’s more of this coming today; it’s likely that the Senate will get to roundly vote down an even less popular variation on Wednesday and then move along to something they can send into the crazy grinder at the other side of the Capitol. All this, of course, is to pass something almost universally unpopular to replace something that cracked 50 percent approval not so very long ago. Government by absurdity takes many forms.

Respond to this post on the Esquire Politics Facebook page.

Related Story

Esquire

The Price of John McCain’s Republican Loyalty

He has a terminal illness. He’s on government healthcare. But he’s a Republican.

Getty

By Charles P. Pierce      July 25, 2017

WASHINGTON—It was an ugly day in the United States Senate on Tuesday, as ugly a day as has been seen in that chamber since the death of Strom Thurmond, who used to make a day ugly simply by showing up. The Senate took up the Motion To Proceed on whatever the hell hash Mitch McConnell wants to make out of the American healthcare system. (The decision now seems to be between whether we kick 30 million, 22 million, or 18 million of our fellow citizens to the curb.) There was a loud protest in the Senate gallery, and the Capitol police, who were everywhere, went out of their way to prevent any media coverage of the ensuing arrests. (In this, they were helped immeasurably by a bunch of little omadhauns from the office of the Senate sergeant-at-arms, one of whom was so insufferable that he was even money to get thrown out a window.) That was really ugly.

The vote was 51-50, with Vice President Mike Pence breaking the tie. Back when he was becoming the very unpopular governor of Indiana, Mike Pence grabbed the Affordable Care Act’s Medicaid expansion with both hands. Now, he was the deciding vote in the first real test of whether the Republican congressional majorities will eviscerate Medicaid entirely. That was really ugly, too.

But the ugliest thing to witness on a very ugly day in the United States Senate was what John McCain did to what was left of his legacy as a national figure. He flew all the way across the country, leaving his high-end government healthcare behind in Arizona, in order to cast the deciding vote to allow debate on whatever ghastly critter emerges from what has been an utterly undemocratic process. He flew all the way across the country in order to facilitate the process of denying to millions of Americans the kind of medical treatment that is keeping him alive, and to do so at the behest of a president* who mocked McCain’s undeniable military heroism.

Getty

For longtime McCain watchers, and I count myself as one of them, this is something of a pattern. In 2000, George W. Bush’s campaign slandered him and his young daughter, and radical fundamentalist Christians joined in so eagerly that McCain delivered the best speech of his career, calling those people “agents of intolerance.” By 2006, he was on Meet The Press, which ultimately always was the constituency he cared most about, saying that the late Jerry Falwell was no longer an agent of intolerance. He was hugging Bush, and he was speaking at Liberty University. All of this seems to support the theory that the best way to win over John McCain is to treat him as badly as possible.

So he got a standing ovation when he walked into the chamber, and that was all right, and then he cast the vote to proceed. And then, having done so, he climbed onto his high horse and delivered an address every word of which was belied by the simple “yes” he had traveled so far to cast.

“Our deliberations today – not just our debates, but the exercise of all our responsibilities – authorizing government policies, appropriating the funds to implement them, exercising our advice and consent role – are often lively and interesting. They can be sincere and principled. But they are more partisan, more tribal more of the time than any other time I remember. Our deliberations can still be important and useful, but I think we’d all agree they haven’t been overburdened by greatness lately. And right now they aren’t producing much for the American people. “Both sides have let this happen. Let’s leave the history of who shot first to the historians. I suspect they’ll find we all conspired in our decline – either by deliberate actions or neglect. We’ve all played some role in it. Certainly I have. Sometimes, I’ve let my passion rule my reason. Sometimes, I made it harder to find common ground because of something harsh I said to a colleague. Sometimes, I wanted to win more for the sake of winning than to achieve a contested policy.”

His “yes” won the day for a secret process that produced a bill that nobody’s seen yet.

“Let’s trust each other. Let’s return to regular order. We’ve been spinning our wheels on too many important issues because we keep trying to find a way to win without help from across the aisle. That’s an approach that’s been employed by both sides, mandating legislation from the top down, without any support from the other side, with all the parliamentary maneuvers that requires.”

He could have struck a blow for these noble sentiments—and, most notably, for “regular order”—by voting no. It would have been the most resounding vote of his long career. But he said, “yes.”

“I voted for the motion to proceed to allow debate to continue and amendments to be offered. I will not vote for the bill as it is today. It’s a shell of a bill right now. We all know that. I have changes urged by my state’s governor that will have to be included to earn my support for final passage of any bill. I know many of you will have to see the bill changed substantially for you to support it. We’ve tried to do this by coming up with a proposal behind closed doors in consultation with the administration, then springing it on skeptical members, trying to convince them it’s better than nothing, asking us to swallow our doubts and force it past a unified opposition. I don’t think that is going to work in the end. And it probably shouldn’t.”

God, this is gorge-inducing. Alone, he could’ve stopped the process he so dislikes in its tracks. He could’ve done it in a way that echoed through the ages. But he said, “yes.”

“The Obama administration and congressional Democrats shouldn’t have forced through Congress without any opposition support a social and economic change as massive as Obamacare. And we shouldn’t do the same with ours.”

Alas, this is an absolute lie, and an embarrassing one, and the Straight Talk Express is in the ditch. The Affordable Care Act was the product of endless hearings and at least 100 amendments proposed by Republicans. It was scored by the CBO. The Senate debated it for almost a month, and the senators knew what was in it. Right now, the bill that John McCain facilitated likely will be one that isn’t scored by the CBO, and the Freedom Caucus crackpots in the House are trying to defund the CBO and hand the job of scoring legislation to the Heritage Foundation. I would bet a substantial number of buffalo nickels that John McCain votes for whatever bill finally comes before him, no matter how many people’s lives that bill makes miserable.

Getty

I wanted this to be different. In 2000, I thought McCain might be the person to lead his party back to marginal sanity at least. But he wanted to be president, so he became like all the rest of them. Yes, he scolded that person who said Barack Obama was a Muslim, but he chose as his running mate a nutty person who still may believe he is. Yes, he put his name on a campaign finance reform bill, but he also voted for every member of the Supreme Court who subsequently eviscerated that law, and others like it, and he’s been absent from that fight ever since. There have been very few senators as loyal to the party line as John McCain. He has been a great lost opportunity to the country. Now, he will end his career as the face of whatever wretchedness is brought on the country by whatever the bill finally is.

By the end of the afternoon, the Democrats had taken over one of the wide marble staircases outside the Capitol. They had walked across the piazza and onto the East Lawn of the Capitol to talk to some protesters, many of whom are struggling with diseases and disabilities that would be covered under the Affordable Care Act, and certainly under the Cadillac healthcare plan enjoyed by John McCain. It was a nice gesture, and they were warmly received, but there was something of the stunt to it.

The Republicans have the votes now. Dean Heller and Rob Portman and Shelley Moore Capito have lined up with their party once, and the likelihood is their respective prices will be met again because this is not a policy issue any more, it is pure politics now, a promise made by an extremist majority to its unthinking base. That’s what the end of this ugly day looked like, a day on which the final bloody death of Barack Obama’s legacy was placed on the fast track by people who know better, and on which Susan Collins of Maine was more of a maverick than John McCain ever was. It was an ugly day in the U.S. Senate, and there was nothing but ruin everywhere you looked.

Respond to this post on the Esquire Politics Facebook page.