Health care – Capitol Hill Blue

Democratic debate turns in healthcare fight

July 31, 2019 by <a href="https://www.capitolhillblue.com/node/byline/steve-peoples-and-sara-burnett" rel="tag">STEVE PEOPLES and SARA BURNETT</a>

Sen. Amy Klobuchar, D-Minn., from left, South Bend Mayor Pete Buttigieg, Sen. Bernie Sanders, I-Vt., and Sen. Elizabeth Warren, D-Mass., participate in the first of two Democratic presidential primary debates hosted by CNN Tuesday, July 30, 2019, in the Fox Theatre in Detroit. (AP Photo/Paul Sancya)

The signature domestic proposal by the leading progressive candidates for the Democratic presidential nomination came under withering attack from moderates in a debate that laid bare the struggle between a call for revolutionary policies and a desperate desire to defeat President Donald Trump.

Standing side by side at center stage on Tuesday, Bernie Sanders and Elizabeth Warren slapped back against their more cautious rivals who ridiculed “Medicare for All” and warned that “wish-list economics” would jeopardize Democrats’ chances for taking the White House in 2020.

“I don’t understand why anybody goes to all the trouble of running for president of the United States just to talk about what we really can’t do and shouldn’t fight for,” said Warren, a Massachusetts senator, decrying Democratic “spinelessness.”

Sanders, a Vermont senator, agreed: “I get a little bit tired of Democrats afraid of big ideas.”

A full six months before the first votes are cast, the tug-of-war over the future of the party pits pragmatism against ideological purity as voters navigate a crowded Democratic field divided by age, race, sex and ideology. The fight with the political left was the dominant subplot on the first night of the second round of Democratic debates, which was notable as much for its tension as its substance.

Twenty candidates are spread evenly over two nights of debates Tuesday and Wednesday. The second night features early front-runner Joe Biden, the former vice president, as well as Kamala Harris, a California senator.

While much of the debate was dominated by attacks on the preferred liberal health care policy, the issue of race emerged in the second hour. The candidates, all of whom are white, were unified in turning their anger toward Trump for using race as a central theme in his reelection campaign. Sanders called Trump a racist, while others said the president’s rhetoric revived memories of the worst in the country’s history, including slavery.

“The legacy of slavery and segregation and Jim Crow and suppression is alive and well in every aspect of the economy and the country today,” said former Texas Rep. Beto O’Rourke, adding that he supported the creation of a panel to examine reparations for the descendants of slaves.

The marathon presidential primary season won’t formally end for another year, but there was an increasing sense of urgency for many candidates who are fighting for survival. More than a dozen could be blocked from the next round of debates — and effectively pushed out of the race — if they fail to reach new polling and fundraising thresholds implemented by the Democratic National Committee.

Minnesota Sen. Amy Klobuchar, who is working to keep her campaign alive, aligned herself with the pragmatic wing: “We are more worried about winning an argument than winning an election.”

Montana Gov. Steve Bullock, in his first debate appearance, took a swipe at Sanders: Working people “can’t wait for a revolution,” he charged. “Their problems are here and now.”

While he avoided any direct confrontations with his more liberal rivals, Pete Buttigieg tried several times to present himself as the more sober alternative in the race. He rejected extreme positions, quoted scripture and abstained from calling out his opponents.

The 37-year-old mayor of South Bend, Indiana, also subtly emphasized the generational difference between himself and Sanders, the candidate 40 years his senior standing to his side.

Perhaps no issue illustrates the evolving divide within the Democratic Party more than health care.

Sanders’ plan to provide free universal health care, known as Medicare for All, has become a litmus test for liberal candidates, who have embraced the plan to transform the current system despite the political and practical risks. Medicare for All would abandon the private insurance market in favor of a taxpayer-funded system that would cover all Americans.

In targeting Medicare for All, the more moderate candidates consistently sought to undermine Sanders and Warren. The moderates variously derided Medicare for All as too costly, ineffective and a near-certain way to give Republicans the evidence they needed that Democrats supported socialism.

“They’re running on telling half the country that their health care is illegal,” said former Maryland Rep. John Delaney.

“We have a choice: We can go down the road that Sen. Sanders and Sen. Warren want to take us, which is with bad policies like Medicare for All, free everything and impossible promises,” he continued. “It will turn off independent voters and get Trump reelected.”

Yet Sanders and Warren did not back down. While they are competing for the same set of liberal voters, there seemed to be no daylight between them.

“Health care is a human right, not a privilege. I believe that. I will fight for that,” Sanders said.

Buttigieg called on his party to stop the infighting.

“It is time to stop worrying about what the Republicans will say,” Buttigieg declared. “It’s true that if we embrace a far-left agenda, they’re going to say we’re a bunch of crazy socialists. If we embrace a conservative agenda, you know what they’re going to do? They’re going to say we’re a bunch of crazy socialists. So let’s just stand up for the right policy, go out there and defend it.”

A new set of candidates, none with more to lose than Biden, will face off on Wednesday.

There, Biden will fight to prove that his underwhelming performance during last month’s opening debate was little more than an aberration.

It won’t be easy.

The 76-year-old Democrat is expected to face new questions regarding his past policies and statements about women and minorities — both key constituencies he needs to claim the Democratic Party’s nomination and ultimately defeat Trump.

Meanwhile, Trump said earlier in the day that he would watch Tuesday’s prime-time affair from the White House. But his Twitter feed was uncharacteristically silent throughout the debate.

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Peoples reported from Washington. Associated Press writer Colleen Long in Washington contributed to this report.

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Copyright © 2019 Capitol Hill Blue

Health care system now covers 90% of Americans

July 28, 2019July 28, 2019 by RICARDO ALONSO-ZALDIVAR

The HealthCare.gov website main page. (HHS via AP)

America’s much-maligned health care system is covering 9 out of 10 people, a fact that hasn’t stopped the 2020 presidential candidates from refighting battles about how to provide coverage, from Bernie Sanders’ call for replacing private insurance with a government plan to President Donald Trump’s pledge to erase the Affordable Care Act and start over.

The politicians are depicting a system in meltdown. The numbers point to a different story, not as dire and more nuanced.

Government surveys show that about 90% of the population has coverage, largely preserving gains from President Barack Obama’s years. Independent experts estimate that more than one-half of the roughly 30 million uninsured people in the country are eligible for health insurance through existing programs.

Lack of coverage was a growing problem in 2010 when Democrats under Obama passed his health law. Now the bigger issue seems to be that many people with insurance are struggling to pay their deductibles and copays.

“We need to have a debate about coverage and cost, and we have seen less focus on cost than we have on coverage,” said Colorado Sen. Michael Bennet. He is among the Democratic presidential candidates who favor building on the current system, not replacing it entirely, as does Sanders. “The cost issue is a huge issue for the country and for families,” Bennet said.

A report this year by the Commonwealth Fund think tank in New York found fewer uninsured Americans than in 2010 but more who are “underinsured,” a term that describes policyholders exposed to high out-of-pocket costs, when compared with their individual incomes. The report estimated 44 million Americans were underinsured in 2018, compared with 29 million in 2010 when the law was passed. That’s about a 50% increase, with the greatest jump among people with employer coverage.

“When you have 90 percent of the American people covered and they are drowning in their health care bills, what they want to hear from politicians are plans that will address their health care costs, more than plans that will cover the remaining 10 percent,” said Drew Altman, president of the Kaiser Family Foundation, a nonpartisan research organization that tracks the health care system. “When Democrats talk about universal coverage more than health care costs, they are playing to the dreams of activists and progressives … much less to the actual concerns of the 90 percent who have coverage today.”

Sanders’ office responds that the Vermont senator’s “Medicare for All” plan would solve both the coverage and cost problems for individual Americans. Medical care would be provided with no deductibles or copays. No one would be uninsured or underinsured.

“The simple answer is that our health care system becomes more unmanageable for more and more Americans every year,” Sanders spokesman Keane Bhatt said in a statement. “This is not a system that needs a few tweaks. This is a system that needs a complete overhaul.”

But other countries that provide coverage for all and are held up by Sanders as models for the U.S. don’t offer benefits as generous as he’s proposing. If he is elected president, there’s no way of telling how his plan would emerge from Congress, or even whether something like it could pass.

Four other 2020 Democrats are co-sponsors of Sanders’ bill: Sens. Cory Booker of New Jersey, Kirsten Gillibrand of New York, Kamala Harris of California, and Elizabeth Warren of Massachusetts.

On the other side of the political spectrum, Trump is talking about big changes. His administration is seeking to have federal courts declare the entire Obama-era health care law unconstitutional, jeopardizing coverage for 20 million people, jettisoning protections for patients with preexisting conditions, and upending the rest of the 970-page statute, now nearly 10 years old.

The president says there’s nothing to worry about. Earlier this summer Trump told ABC News that he was working on a plan that would provide “phenomenal health care,” protect people with preexisting conditions, and would be “less expensive than ‘Obamacare’ by a lot.”

White House spokesman Judd Deere said in a statement that the Obama law was “sold and passed on a litany of broken promises” and now “Democrats are proposing even more radical government takeovers of our health care system.”

As president-elect, Trump promised a health plan but never offered one upon taking office. Instead he backed bills from congressional Republicans, including one he called “mean” during a private meeting.

Trump says he might come out with his new plan within months, but that passing it would hinge on his getting reelected and Republicans winning back the House in 2020 while keeping control of the Senate.

That’s a bit of political deja vu.

Republicans controlled Washington back in 2017 when Trump, then-Speaker Paul Ryan, R-Wis., and Senate Majority Leader Mitch McConnell, R-Ky., tried for months to repeal and replace the Obama law, only to fail. The repeal effort was widely seen as contributing to Republicans losing the House in 2018.

Since then, many GOP lawmakers have tried to avoid the issue altogether.

Economist Sara Collins of the Commonwealth Fund, who led the study about underinsured Americans, says cost and coverage problems are intertwined. Citing the Democrats’ debate over Medicare for All, she says what’s missing from that discussion is that “one doesn’t have to go that far in order to improve the financial situation for millions of people — you can do that with much more targeted, incremental policies.”

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Copyright © 2019 Capitol Hill Blue

Is Biden’s embrace of Obamacare risky?

July 28, 2019July 28, 2019 by BILL BARROW

Democratic presidential candidate former Vice President Joe Biden. (AP Photo/Matthew Hinton)

Joe Biden had just rolled out his health care plan when he made what could be a fateful pledge to a crowd in Iowa: “If you like your health care plan or your employer-based plan, you can keep it.”

The remark echoed assurances President Barack Obama made repeatedly as he sold the Affordable Care Act, which became known as “Obamcare.” But Obama’s promise proved an exaggeration, if not a falsehood, and it anchored early GOP attacks on the law as new regulations led private insurers to cancel certain policies, even if they had to offer replacements to consumers.

Biden’s promise on job-based coverage , which almost 160 million Americans use, underscores the risks of positioning himself as the health overhaul’s chief defender. Fully embracing the health law and pledging to expand it also means exposing Biden to attacks from all sides: from the left that wants more than what Biden is offering; from the right that loathes the law in any form; and from the middle, where voters remain skeptical about the nation’s complex and expensive health care system.

“This is one of those issues where the pendulum has swung back-and-forth since ‘Obamacare’ passed,” Democratic pollster Paul Maslin said, pointing to health care’s role in Republican victories in 2010 and Democratic wins last November. “Right now we have the advantage,” Maslin said, “but I’d be a fool to say there’s no risk here.”

Indeed, the Republican National Committee has seized on Biden’s policy rollout. “Biden has to deal with the fact that he would be the 2020 face of Barack Obama’s notorious lie that if you like your health care plan you can keep it,” said Steve Guest of the Republican National Committee.

Biden is at the center of a broader Democratic divide over the future of health care that will likely be an animating issue at this week’s primary debate in Detroit.

The former vice president is proposing to add a “public option” that would allow Americans to choose whether to buy government insurance or buy private policies. He also would boost existing subsidies that consumers use to buy policies on the law’s exchanges. That would mark a significant expansion but still be a more incremental approach than Vermont Sen. Bernie Sanders’ “Medicare for All” proposal, which would essentially replace the private market with government insurance.

Biden’s campaign says his position reflects voters’ slow embrace of the 2010 law, while acknowledging voters’ concerns about the cost and consequences of a single-payer, government health insurance system and their distrust of private insurers and the pharmaceutical industry.

“I knew the Republicans would do everything in their power to repeal ‘Obamacare,’” Biden says in an online campaign ad. “They still are. But I’m surprised that so many Democrats are running on getting rid of it … and if I’m elected president, I’m going to do everything in my power to protect it and build on it.”

An Associated Press-NORC Center for Public Affairs Research poll this spring found 57% of adults wanted the health law to remain; 42% percent said it should be kept, but with changes. Four out of 10 favored a rollback, but just half of those called for total repeal. Meanwhile, 53% favored adding a nonmandatory government insurance plan to the market; less than one-fifth opposed that course. That’s a more favorable split than on single-payer, which garnered 43% support and 31% opposition.

Which party ultimately wins on health care, Maslin and other Democrats argue, depends on who voters believe will better protect access to care, regardless of the details. “People still don’t like the way the market works,” from rising premiums to spiking drug costs, Maslin noted, but they distrust a politician “who might be taking something away.”

Republicans capitalized in 2010, when voters saw Obama’s new law — adopted but not yet in place — as the threat and rewarded the GOP’s mantra of “repeal and replace.”

By 2018, after years of GOP failures to offer an alternative, voters had grown accustomed to key provisions, chiefly the guarantee of coverage for those with existing health conditions and Medicaid expansion to cover the working poor and lower middle class. Last November, Democrats won a net 41-seat gain in the House and seven new governorships, many of the victories driven by suburban voters who’d seen a deluge of ads defending the law and hammering Republicans for attempts to gut it. Trump continues to pursue repeal, and the administration backs a pending federal lawsuit to strike down the law in its entirety.

A few months into the new Congress, the AP-NORC poll found Democrats with a 17-point advantage, 40% to 23%, on the question of which party voters trusted more on health care.

“People may have different feelings about our different approaches, but they’re more popular than Trump’s repeal that would make the problem worse,” said Jesse Ferguson, a Democratic strategist who has worked on health care messaging in recent election cycles.

Added Maslin: “Part of me says we’d be better off with no plan, let Republicans continue to screw it all up. But that’s just not responsible.”

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Associated Press Deputy Polling Director Hannah Fingerhut in Washington contributed to this report.

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Copyright © 2019 Capitol Hill Blue

Trump backs down on health care push

April 2, 2019 by AP

President Donald Trump (AP Photo/Manuel Balce Ceneta)

President Donald Trump is suggesting he will defer until after 2020 his push for a Republican health care plan to replace the Affordable Care Act.

Trump tweeted late Monday that Congress will vote on a GOP plan after the elections, “when Republicans hold the Senate & win back the House.”

Republicans were cool after Trump surprised them last week with an unexpected pivot to the issue and his claims the GOP will be the party of health care. They don’t yet have a comprehensive plan to replace the law, known as “Obamacare.”

Trump’s effort to repeal former President Barack Obama’s health care law narrowly failed in the Senate in 2017. And while Republicans gained Senate seats last fall, there’s no indication that GOP senators want another fight over repealing “Obamacare,” particularly not those up for re-election next year.

Health care, especially protections for people with pre-existing conditions, resonates with voters and helped Democrats in the November elections.

According to AP VoteCast, a survey of more than 115,000 midterm voters nationwide, nearly 4 in 10 Democratic voters identified health care as the most important among a list of key issues. A Quinnipiac University poll last week found 55% of Americans supporting the improvement and not the replacement of the nation’s health care system.

With Democrats controlling the House, any attempt to dismantle the law could not pass Congress.

Still, Trump last week appeared to commit his party to a new push for a plan to replace the health law.

“We are working very hard on that,” Trump said as he was heading out to a Michigan rally.

He said Republicans “are going to work together to come up with something that’s really spectacular.”

In his late-Monday tweets, Trump claimed Republicans are developing a plan with cheaper premiums and deductibles that “will be truly great HealthCare that will work for America.”

Challenges to the 2010 law are making their way through courts.

Last week, the Trump administration told a federal appeals court it wants the entire Affordable Care Act struck down, an outcome that could leave millions of people uninsured and reignite a winning political issue for Democrats.

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GOP scrambles to deal with Trump’s health care moves

March 30, 2019March 30, 2019 by <a href="https://www.capitolhillblue.com/node/byline/lisa-mascaro-and-catherine-lucey" rel="tag">LISA MASCARO and CATHERINE LUCEY</a>

President Donald Trump speaks at a campaign rally in Grand Rapids, Mich. (AP Photo/Manuel Balce Ceneta)

President Donald Trump’s decision to revive the fight over the Affordable Care Act has stirred a political and policy debate among Republicans on how best to approach the divisive issue heading into the 2020 election.

Failing to repeal and replace the ACA, otherwise known as Obamacare, is one of the biggest shortcomings of the president’s first term. It left Republicans with a broken campaign promise, dismal approval ratings and a narrative they haven’t been able to shake — that they don’t support protecting those with pre-existing medical conditions from high-cost care. In some races, it cost Republican seats last fall, flipping House control to Democrats.

For Trump, the reset he wants is clear. “The Republican Party will soon be known as the party of health care,” he said on Capitol Hill . “You watch!”

But among Republican senators, there’s reluctance to embrace Trump’s new priority. Usually tight-lipped Senate Majority Leader Mitch McConnell, who was given little advance notice of the president’s new push, spoke volumes when asked about it.

“I look forward to seeing what the president is proposing,” McConnell told Politico.

And in the House, it’s a mixed bag. Minority Leader Kevin McCarthy initially panned Trump’s move, questioning the timing that collided with Trump’s bounce from the end of special counsel Robert Mueller’s probe of Russian interference in the 2016 election. But the GOP leader does see value in kick-starting a health care debate, said a person granted anonymity to discuss the situation. House Republicans continue to be asked about it back home and a new GOP health care bill could improve their standing with voters, the person said.

What’s unclear is whether a Trump-Care bill will emerge from the White House or Capitol Hill to replace the Affordable Care Act or if the president’s push for a policy outcome fades to little more than a topic for the campaign trail.

Trump discussed health care at length during a rally in Michigan Thursday and again during an appearance in Florida Friday.

“We are going to have a plan that’s so much better than Obamacare,” the president promised after touring an aging dike in South Florida.

For Trump, returning to health care shows his commitment to a 2016 campaign pledge and his desire to frame the 2020 debate on his terms.

Stung by the Democratic gains in November and sparked by another ACA legal challenge that could make its way to the Supreme Court, the president dug into the issue this past week, deciding to fight. He feels that it is an important battle to take on, said two people familiar with White House thinking who were not authorized to speak publicly.

The president has been actively engaged in conversations about health care, dialing up lawmakers in the House and Senate, and the White House is expected to lay out further details on his goals in the coming days.

“We are working very hard on that,” said Trump as he was heading out to the Michigan rally, singling out Republican senators John Barrasso, Rick Scott and Bill Cassidy among those involved.

“They are going to work together to come up with something that’s really spectacular,” the president said.

But in truth, there is no grand Republican plan on Capitol Hill to replace Obamacare.

The day after Trump dropped the new priority during a private Senate GOP lunch, a top ally, Sen. Lindsey Graham, R-S.C., convened an evening meeting of senators to discuss options, according to those familiar with the talks.

Graham had helped spark the idea with Trump during a golf outing at Mar-a-Lago. The group he assembled back on Capitol Hill included two former governors well versed in health care policy — Sen. Mitt Romney of Utah, whose Romney-care in Massachusetts was a precursor to Obamacare, and Sen. Rick Scott of Florida, a former health care executive.

But McConnell has made it clear he would rather see Republicans spend their time attacking the Democratic plans to expand existing health care programs, namely the Medicare for All plans embraced by some of the Democrats running to unseat Trump. He sees it as their best option for reversing public opinion heading toward 2020 when he, too, faces re-election. McConnell derides the high cost of a government-run system as “Medicare for None.”

The thinking among McConnell and other leading Republicans is that it’s best to avoid another messy legislative battle. Republicans are loath to repeat the undertaking that consumed much of 2017. At that time, Republicans could never agree on a new health care plan and the months-long exercise ended in failure when John McCain joined others in rejecting one last-ditch effort, dooming the years-long campaign to repeal and replace Obamacare.

They would rather simply wait out the White House with an expectation that no actual legislation emerges, according to those familiar with the GOP thinking.

House Republicans, though, face a different calculus. They lost dozens of seats last fall in part because Democrats successfully attacked them over the GOP proposals to replace Obamacare. Americans have warmed to the 2010 health care law and, in particular, its provision that prevents insurers from charging more to patients pre-existing conditions.

McCarthy wants the majority back, the person said. Even though he questioned Trump’s sudden shift to health care, it has promise. The day after Trump announced his health care push, the GOP leader convened the top House Republicans from various committees to dig into the issue.

“I’ll make this promise to you — and it’s a conversation I had with the president — the Republicans will make sure pre-existing conditions are protected,” McCarthy told reporters. “The president and I have talked numerous times. We talked quite often. But this is one of the conversations we have, greatly, that we support protecting pre-existing conditions.”

But Republicans lost their chance to revise Obamacare when they controlled both chambers in Congress. Now, any bill will need Democratic backing to clear the House with Speaker Nancy Pelosi’s majority.

At most, lawmakers envision a modest package of health care bills that could lower prescription drug prices and other reforms that have wide bipartisan support.

That may or may not be enough for Trump.

And if not, he can continue advocating for more on the campaign trail.

At the rally in Michigan, he vowed, “It’s going to be far better than Obamacare.”

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Follow on Twitter at https://twitter.com/lisamascaro and https://twitter.com/catherine_lucey

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Can Dems fashion a working health care message?

July 20, 2018July 20, 2018 by AP

The Capitol in Washington at sunrise. (AP Photo/J. Scott Applewhite)

Cheered on by a handful of activists, liberal House Democrats announced outside the Capitol that they were forming a caucus to push for “Medicare for All” — shorthand for government-financed health care.

At the same time Thursday, Democratic senators were introducing a resolution aimed at putting Republicans on the defensive about Trump administration efforts to undermine former President Barack Obama’s health care law.

Neither proposal has much chance of going anywhere in the Republican-run House or Senate. But the bigger problem for Democrats is that the two messages — fundamentally reshaping the nation’s health care system versus defending Obama’s popular law — divide the party as it tries grabbing control of Congress in this fall’s elections.

All Democrats oppose President Donald Trump’s repeated efforts to scuttle Obama’s Affordable Care Act, and many have backed expanding government-paid health care, including Minority Leader Nancy Pelosi, D-Calif. But many also think drawing campaign-season attention to Democratic efforts to reinvent the country’s $3 trillion-a-year health care system, a costly and complex undertaking, is a mistake.

Promoting “Medicare for All” opens the door for Republicans to accuse Democrats of plotting tax increases, unaffordable federal costs and the loss of employer-provided coverage, these Democrats argue. They say it’s better to play offense by focusing on controlling medical costs and opposing GOP efforts to demolish the 2010 health care law.

“Every Democrat is being asked, ‘Do you support this or do you not?’ and it’s becoming a political wedge in an election year,” Rep. Kathleen Rice, D-N.Y., said of the “Medicare for All” drive. “And I think we should be focusing on the terrible things that are happening under this administration right now.”

The new caucus has more than 60 members, nearly 1-in-3 House Democrats, including many from safely blue districts where liberal voters prevail. Backing “Medicare for All” lets them tap into activists’ fervor for universal health care that helped propel Vermont independent Sen. Bernie Sanders to an unexpectedly strong challenge to Hillary Clinton for the 2016 Democratic presidential nomination.

“If you live in America, you’ve got a right to affordable quality health care, period,” said Rep. Debbie Dingell, D-Mich., a caucus founder, prompting applause from supporters watching her group’s news conference Thursday.

Rep. Pramila Jayapal, D-Wash., another leader, later said she backs a 2017 House bill providing free health care financed partly by boosting taxes on wealthy Americans. That bill has more than 120 Democratic co-sponsors. But she said her group’s goal is to build consensus for legislation it may introduce next year, with decisions remaining about costs, financing and other questions.

A similar bill by Sanders last year drew 16 Democratic co-sponsors, including at least four potential 2020 presidential contenders. Sponsors haven’t released price tags, but Sanders said a version he promoted during his 2016 campaign would have cost $1.4 trillion annually — a figure some analysts said was far too low.

“The only proposal here is a ‘Medicare for All’ caucus to figure out what the right proposal is,” Jayapal said.

That’s not stopping the GOP from getting ready to jump on the issue. By combing through candidate and newspaper websites, social media and other sources, Republicans have compiled quotes from around two dozen Democratic House challengers embracing “Medicare for All.” A Republican provided the information on condition of anonymity to disclose internal preparations.

“It would break Medicare,” said House Majority Leader Kevin McCarthy, R-Calif. “And it would end any private insurance as we know it.”

Trump and congressional Republicans tried repealing the ACA last year and failed. But they’ve taken incremental whacks at it, including cutting federal subsidies to many insurers, erasing the penalty for people who don’t buy insurance and opening the door to low-cost plans providing less coverage.

That’s exactly where many Democrats running in swing districts are concentrating their messages.

Democrat Clarke Tucker, challenging Arkansas GOP Rep. French Hill, said in an early TV ad, “I’ll stand up to anyone who tries to take your health care.” And Rep. Ami Bera, D-Calif., said in an interview, “I’d say we ought to focus on Republican efforts to undermine the ACA right now and the impact that’s had on costs going up.”

That was also the focus for Democratic senators in their resolution Thursday authorizing the Senate’s legal counsel to intervene in a lawsuit in which 20 GOP-led states allege the health care law is no longer constitutional.

The Trump administration said last month it will stop defending key parts of the law in court, including provisions protecting patients with pre-existing medical conditions. Polls show large majorities favor helping those consumers.

Democrats want the Senate counsel to defend the protections for people with pre-existing problems. There’s little chance Republicans controlling the Senate will allow such a vote, which Democrats hope would put GOP senators in an uncomfortable position.

“This is a test of the Republican Party, whether or not they are going to do the right thing,” said Sen. Bob Casey, D-Pa.

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Associated Press writer Kevin Freking contributed to this report.

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Trump asks Democrats for healthcare help

October 9, 2017October 7, 2017 by <a href="https://www.capitolhillblue.com/node/byline/ken-thomas" rel="tag">KEN THOMAS</a>

Senate Minority Leader Chuck Schumer of New York, followed by Sen. Bernie Sanders, I-Vt., look at a poster at the start of a news conference on Capitol Hill in Washington. (AP Photo/Manuel Balce Ceneta)

President Donald Trump is reaching out to Democrats to see if they “want to do a great HealthCare Bill” after Republicans have failed so far to fulfill their yearslong promise to repeal and replace the Obama health law.

Trump tweets that he called Senate Democratic leader Chuck Schumer on Friday. The president says the Obama health law “is badly broken, big premiums. Who knows!”

There’s no immediate word from Schumer about Trump’s tweets.

The president has suggested that he’d be open to negotiating with Democrats on health care.

But there’ve been no clear signs of a compromise between Republicans who’ve wanted to scrap the Affordable Care Act since it became law in 2010, and Democrats who want to protect it.
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Trump fumes as McCain says ‘nada’ on repeal

September 24, 2017September 23, 2017 by <a href="https://www.capitolhillblue.com/node/byline/erica-werner-and-alan-fram" rel="tag">ERICA WERNER and ALAN FRAM</a>

Sen. John McCain, R-Ariz. (AP Photo/Cliff Owen)

Sen. John McCain declared his opposition Friday to the GOP’s last-ditch effort to repeal and replace “Obamacare,” dealing a likely death blow to the legislation and, perhaps, to the Republican Party’s years of vows to kill the program. It was the second time in three months the 81-year-old McCain emerged as the destroyer of his party’s signature promise to voters.

“I believe we could do better working together, Republicans and Democrats, and have not yet really tried,” McCain said of the bill, co-written by Lindsey Graham of South Carolina, his best friend in the Senate, and Bill Cassidy of Louisiana. “Nor could I support it without knowing how much it will cost, how it will affect insurance premiums, and how many people will be helped or hurt by it.”

McCain, who is battling brain cancer in the twilight of a remarkable career, said he could not “in good conscience” vote for the legislation. That all but ensured a major setback for President Donald Trump and Senate Majority Leader Mitch McConnell, and appeared likely to deepen rifts between congressional Republicans and a president who has begun making deals with Democrats out of frustration with his own party’s failure to turn proposals into laws.

During the election campaign Trump had pledged to quickly kill President Barack Obama’s health care program — “It will be easy,” he contended — and he has publicly chided McConnell for not winning passage before now.

With the Arizona senator’s defection, there are now two declared GOP “no” votes on the repeal legislation, the other being Rand Paul of Kentucky. With Democrats unanimously opposed, that’s the exact number McConnell can afford to lose. But Maine GOP Sen. Susan Collins said Friday she, too, is leaning against the bill, and Lisa Murkowski of Alaska was also a possible “no,” making it highly unlikely that McConnell can prevail.

So once again, the GOP seems destined to fail on a campaign promise that every Republican agreed on — right up until the party obtained full control of Congress and the White House this year and was actually in position to follow through.

Trump, speaking at a political rally Friday night in Alabama, called McCain’s opposition “sad” and “a horrible, horrible thing” for the Republican Party. But he said he would continue the fight to repeal “Obamacare” even if it meant going back again and again.

“It’s a little tougher without McCain’s vote, I’ll be honest. But we’ve got some time. We’re going to go back,” he said and added: “You can’t quit when you have one or two votes short.”

Vice President Mike Pence also said the fight wasn’t over. “This is not going to be easy. Some have gone so far as to announce their opposition already,” he said. “President Trump and I are undeterred.”

Graham, too, vowed in a statement to “press on,” and reaffirmed his friendship with McCain.

Up until McCain’s announcement Friday, close McConnell allies were still optimistic McCain’s relationship with Graham might make the difference.

GOP leaders hoped to bring the legislation to the Senate floor next week. They face a Sept. 30 deadline, at which point special rules that prevent a Democratic filibuster will expire.

Democrats hailed McCain’s announcement and pledged to commit to the bipartisan process he sought. GOP Sen. Lamar Alexander of Tennessee and Democratic Sen. Patty Murray of Washington have been working on a package of limited legislative fixes to the “Obamacare” marketplaces.

“John McCain shows the same courage in Congress that he showed when he was a naval aviator,” said Senate Minority Leader Chuck Schumer, D-N.Y. “I have assured Sen. McCain that as soon as repeal is off the table, we Democrats are intent on resuming the bipartisan process.”

The Graham-Cassidy bill would repeal major pillars of Obama’s law, replacing them with block grants to states to design their own programs. Major medical groups are opposed, saying millions would lose insurance coverage and protections, and a bipartisan group of governors also has announced opposition.

Yet Republican congressional leaders, goaded by GOP voters and the president himself, were determined to give it one last try. Trump spent much of August needling McConnell for his failure to pass a repeal bill, and Republican lawmakers back home during Congress’ summer recess heard repeatedly from voters angered that after seven years of promises to get rid of “Obamacare,” the party had not delivered.

The House passed its own repeal bill back in May, prompting Trump to convene a Rose Garden celebration, which soon began to look premature.

After the Senate failed in several attempts in July, the legislation looked dead. But Cassidy kept at it with his state-focused approach, and the effort caught new life in recent weeks as the deadline neared. Trump pushed hard, hungry for a win.

Trump tweeted Friday morning that “Rand Paul, or whoever votes against Hcare Bill, will forever (future political campaigns) be known as ‘the Republican who saved ObamaCare.’”

On the other side, late-night TV host Jimmy Kimmel, whose son was born with a heart defect, got considerable attention when he criticized the new repeal effort at length on his show and said the Republicans were lying about what their new program would cover. In a tweet Friday, he thanked McCain “for being a hero again and again and now AGAIN.”

The bill would get rid of unpopular mandates for people to carry insurance or face penalties. It would repeal the financing for Obama’s health insurance expansion and create a big pot of money states could tap to set up their own programs, with less federal oversight. It would also limit spending for Medicaid, the federal-state program that now covers more than 70 million low-income people. Insurance rules that protect people with pre-existing conditions could be loosened through state waivers.

Over time, the legislation would significantly reduce federal health care dollars now flowing to the states. But McConnell had little margin for error in a Senate split 52-48 between Republicans and Democrats, and could lose only two votes, counting on Pence to break the tie.

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Associated Press writer Ricardo Alonso-Zaldivar contributed to this report.
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Ryan can’t escape GOP failures

August 9, 2017August 7, 2017 by <a href="https://www.capitolhillblue.com/node/byline/scott-bauer-2" rel="tag">SCOTT BAUER</a>

House Speaker Paul Ryan responds to a question from a Republican voter during an employee town hall in Mukwonago, Wis. (AP Photo/Scott Bauer)

With a dysfunctional Congress on recess, House Speaker Paul Ryan has turned his focus back home, touring flood-damaged areas and visiting local businesses in Wisconsin. But he can’t escape the questions about why Republicans in charge of Washington aren’t delivering.

And though he’s won re-election easily for years, Ryan faces the prospect of challenges from left and right and an energized Democratic base in next year’s midterm elections.

“We have a majority in the House and Senate and it feels like nothing’s getting done,” 32-year-old James Hulsey said just before Ryan recently toured his workplace.

Sensing the angst, Ryan has been much more visible in his southeast Wisconsin district as Republicans failed to deliver on their yearslong promise to scrap the health care law and new polling numbers show the speaker is less popular among Republicans in Wisconsin than President Donald Trump. Trump won Wisconsin by less than a percentage point, but he carried Ryan’s district by 10 points.

In the remaining months of the year, Ryan and the Republican-led Congress are determined to deliver major legislation, elusive so far due to GOP infighting, and the top priority is overhauling the nation’s tax code. Failure to produce could cost Republicans their House majority in the 2018 midterms and, for Ryan, his job as speaker and Republican leader.

“This is the third time in 100 years we’ve had this alignment of government that we’ve got to get it done or else I really worried our country will continue down a bad path,” Ryan said after his tour of the wire manufacturer Banker Wire, in Mukwonago, Wisconsin.

He later told the Wisconsin State Journal, “If we don’t do our job, we will depress turnout. I am frustrated as well.”

Republican Keith Ketzler, 62, worries that the GOP will pay politically next year. Democrats need to flip 24 seats to regain control.

“Everybody that voted Republican is getting very frustrated,” Ketzler said, after prodding Ryan about why Congress hasn’t achieved more. “People crossed the line last time, but they’re not going to stay crossed if they don’t get things done.”

Ryan angered some conservatives during the campaign with comments critical of then-candidate Trump. But in the first six months of Trump’s term, Ryan has been far less critical of the president than other Republican lawmakers who have challenged a number of Trump moves, including his criticism of Attorney General Jeff Sessions, a former senator.

Ryan’s Republican primary challenger last year, Paul Nehlen, initially won the backing of then-candidate Trump, who later switched to Ryan. Ryan beat Nehlen by 70 percentage points in the primary. But Nehlen, who is running again, thinks 2018 will be more difficult for Ryan, arguing that he hasn’t done enough to appease Republican Trump supporters.

“President Trump has given Paul Ryan way more opportunities to stand up and back him and what he has done is really undermine him,” Nehlen said.

Beating Ryan will not be easy.

No Democrat has represented the district since 1995. Ryan has cruised to re-election ever since he joined Congress in 1999 — winning by 35 percentage points last year. He has $11.5 million in the bank and is a familiar face in Janesville where he was born and raised and still lives with his wife and three children.

Democrats are pinning their hopes on Randy Bryce, an Army veteran and union iron worker with the nickname “Iron Stache.” He appears to have walked out of Hollywood central casting — complete with a dark mustache, thick biceps, faded blue jeans and a promise to fight for the working man. Bryce is trying to capitalize on disenchantment over Ryan’s role in the health care bill as he mounts a long-shot campaign.

Bryce generated excitement among Democrats both in Wisconsin and nationally for his announcement video in June that has now been viewed more than 550,000 times. It begins with a clip of Trump praising Ryan’s attempts to undo Democrat Barack Obama’s Affordable Care Act and then shows Bryce getting emotional as his mother details her struggle with multiple sclerosis.

“You can come work the iron,” the hardhat-wearing Bryce challenges Ryan, “and I’ll go to D.C.”

Bryce raised $430,000 in the first two weeks after the spot ran.

Ryan has tried to shift the conversation from the collapse of the GOP health care effort and toward tax reform and the news that Taiwanese iPhone manufacturer Foxconn plans to invest $10 billion on a factory in his congressional district that could employ 13,000 people. Ryan launched a series of campaign-style online ads highlighting the news that the plant was coming near abandoned automobile factories in his hometown of Janesville and nearby Kenosha.

But Ryan’s involvement doesn’t seem to be resonating quite yet with voters in his district.

“Paul Ryan? I don’t know what he’s done for it,” said Republican voter Jeff Lunde of Ryan’s role in the Foxconn deal. “They’re all working on this stupid health-care crap.”

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GOP health care bill in trouble…again

July 15, 2017July 14, 2017 by <a href="https://www.capitolhillblue.com/node/byline/erica-werner-and-alan-fram" rel="tag">ERICA WERNER and ALAN FRAM</a>

Sen. Bill Cassidy, R-La. gets in an elevator as he heads to the Senate on Capitol Hill for a meeting on the revised Republican health care bill. (AP Photo/J. Scott Applewhite)

Republican leaders unveiled a new health care bill in their increasingly desperate effort to deliver on seven years of promises to repeal and replace “Obamacare.” They immediately lost two key votes, leaving none to spare as the party’s own divisions put its top campaign pledge in serious jeopardy.

President Donald Trump declared this week that failure would make him “very angry” and that he would blame Senate Majority Leader Mitch McConnell, R-Ky.

But talking with reporters aboard Air Force One en route to France, Trump also acknowledged the challenges lawmakers face.

“I’d say the only thing more difficult than peace between Israel and the Palestinians is health care,” Trump said. “But I think we’re going to have something that’s really good and that people are going to like.”

The reworked bill McConnell presented to fellow Republicans on Thursday aims to win conservatives’ support by letting insurers sell low-cost, skimpy policies. At the same time, he seeks to placate hesitant moderates by adding billions to combat opioid abuse and help consumers with skyrocketing insurance costs.

But it was not clear whether the Republican leader has achieved the delicate balance he needs after an embarrassing setback last month when he abruptly canceled a vote in the face of widespread opposition to a bill he crafted largely in secret.

Moderate Sen. Susan Collins of Maine told reporters she had informed McConnell she would be voting against beginning debate on the bill, citing in part cuts in the Medicaid health program for the poor and disabled. Sen. Rand Paul of Kentucky, who has repeatedly complained that McConnell’s efforts don’t amount to a full-blown repeal of Obamacare, also announced he was a “no.”

That means McConnell cannot lose any other Republican senators. With Democrats unanimously opposed in a Senate split 52-48 in favor of the GOP, he needs 50 votes, with Vice President Mike Pence breaking the tie, to get past a procedural hurdle and begin debate on the bill.

The showdown vote is set for next week, though McConnell could cancel again if he’s short of support. He and other GOP leaders are urging senators to at least vote in favor of opening debate, which would open the measure up to amendments. And GOP leaders express optimism that they are getting closer to a version that could pass the Senate.

“It’s in the best shape it’s been in so far,” said Sen. Roy Blunt of Missouri. “Now that members actually have paper in their hand they can look at what is likely to be very close to the final bill we’ll be voting on and move forward.”

McConnell said the 172-page legislation is the senators’ opportunity to make good on years of promises.

“This is our chance to bring about changes we’ve been talking about since Obamacare was forced on the American people,” he said.

Many Republicans believe the party could face electoral catastrophe if it alienates GOP voters by failing get rid of former President Barack Obama’s law after taking control of both chambers of Congress and the White House.

“It could be the biggest political broken promise in many years,” said conservative former Sen. Jim DeMint, former president of the Heritage Foundation, as he passed through the Capitol.

Throughout the day McConnell huddled in his office with holdouts, including Dean Heller of Nevada, the most endangered Senate Republican in next year’s midterms, Shelley Moore Capito of West Virginia, Rob Portman of Ohio and John Hoeven of North Dakota.

The lawmakers wanted details and numbers on how the bill would affect rural and Medicaid-dependent people in their states. All had opposed McConnell’s earlier bill, but this time around several exited their meetings saying they were undecided and needed more time to evaluate the legislation.

Hoeven said of McConnell: “He’s asking everybody to work with him, and a lot of us are saying ‘yeah,’ and we’ve got more work to do.”

Like legislation earlier passed by the House after struggles of its own, the Senate bill would get rid of Obamacare’s mandates for individuals to buy insurance and for companies to offer it, repeal taxes and unwind the Medicaid expansion created by the Affordable Care Act. Analyses by the Congressional Budget Office have found the House bill and the earlier Senate version both would eliminate insurance coverage for more than 20 million people over the next decade.

The new bill contains language demanded by conservative Sen. Ted Cruz of Texas letting insurers sell plans with minimal coverage, as long as they also sell policies that meet strict coverage requirements set by Obama’s 2010 statute.

The retooled measure retains McConnell’s plan to phase out the extra money 31 states have used to expand Medicaid under Obama’s statute, and to tightly limit the overall program’s future growth.

The rewritten package would add $70 billion to the $112 billion McConnell originally sought that states could use to help insurers curb the growth of premiums and consumers’ other out-of-pocket costs. And it has an added $45 billion for states to combat the misuse of drugs like opioids.

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Associated Press writers Ricardo Alonso-Zaldivar, Mary Clare Jalonick, Julie Bykowicz, Matthew Daly and Kevin Freking contributed to this report.
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