Category Archives: Republicans

FACT CHECK: Trump’s False Claims On ‘Medicare For All’ and Yes the Senate defeats a ​measure to overturn Trump expansion of non-ObamaCare plans, but now back to Pre-Existing Conditions

19657154_1241634215966235_4531903697739664365_nI think that I mentioned that an important issue for the Mid-Term elections was going to be healthcare and last week look how health care was treated. Peter Sullivan wrote that the Senate on last Wednesday defeated a Democratic measure to overrule President Trump’s expansion of non-ObamaCare insurance plans as Democrats seek to highlight health care ahead of the midterm elections.

The Democratic measure would have overruled Trump’s expansion of short-term health insurance plans, which do not have to cover people with pre-existing conditions or cover a range of health services like mental health or prescription drugs.

It was defeated on an extremely narrow, mostly party-line 50-50 vote, with Sen. Susan Collins (R-Maine) voting with Democrats in favor of overturning the short-term plans.

Republicans argue the short-term plans simply provide a cheaper option alongside more comprehensive ObamaCare plans.

Democrats forced the vote ahead of the midterms in an attempt to put health care front and center in the campaign. Democrats said Republicans voting to keep in place these “junk” insurance plans that do not have to cover pre-existing conditions was another example they can use to paint the GOP as wrong on health care.

“In a few short weeks the American people will head to the polls where they can vote for another two years of Republican attempts to gut our health-care system, or they can vote for Democratic candidates who will safeguard the protections now in place and work to make health care more affordable,” Senate Democratic Leader Charles Schumer (N.Y.) said on the Senate floor Wednesday.

Sen. Lamar Alexander (R-Tenn.), the chairman of the Senate Health Committee, forcefully pushed back, saying short-term plans provide a cheaper option than ObamaCare and if people want full ObamaCare plans with all the protections, they can still have them.

With short-term plans, Alexander said the message is “you can pay less with less coverage and at least you will have some insurance.”

“But our Democratic friends will say, ‘Oh no, we don’t want to do anything that will lower the cost of insurance,’” Alexander added.

Health-care experts say the short-term plans pose a risk of siphoning healthy people away from ObamaCare plans, leading to an increase in premiums for those remaining in the ObamaCare plans.

“The rule threatens to split and weaken the individual insurance market, which has provided millions of previously uninsured people with access to quality coverage since the health care law went into effect,” a range of patient groups, including the American Cancer Society and American Heart Association, said in a joint statement this week opposing the Trump administration’s short-term plans rule.

The rules that Democrats seek to overturn, which the Trump administration finalized in August, lifted a three-month restriction on short-term plans, allowing them to last up to a year. Critics say this makes the plans not really “short-term” at all.

“Our constituents deserve more options, not fewer,” Senate Majority Leader Mitch McConnell (R-Ky.) said Wednesday. “The last thing we should do is destroy one of the options that are still actually working for American families.”

Scott Horsley mentioned that USA Today published an opinion column by President Trump Wednesday in which the president falsely accused Democrats of trying to “eviscerate” Medicare while defending his own record of protecting health care coverage for seniors and others.

The column — published just weeks ahead of the midterm elections — underscores the political power of health care to energize voters. But it makes a number of unsubstantiated claims.

Here are 5 points to know

1. The political context: Healthcare has emerged as a dominant issue on the campaign trail in the run-up to the November elections. According to the Wesleyan Media Project, which tracks congressional advertising, health care was the focus of 41 percent of all campaign ads in September, outpacing taxes (20 percent), jobs (13 percent) and immigration (9 percent). Democrats are particularly focused on health care, devoting 50 percent of their ads to the issue, but health care is also a leading issue in Republican commercials (28 percent), second only to taxes (32 percent).

Perhaps sensing that Democrats are gaining traction, Trump has decided to go on the attack, targeting the Democratic proposal known as “Medicare for All.”

2. Cost of the plan: Trump claims that expanding the federal government’s Medicare program would cost$32.6 trillion over a decade. But as Business Insider reports, that would actually be a discount compared with the nation’s current health care bill.

Trump’s figure was calculated by the libertarian Mercatus Center, but he fails to note that total health care spending under Medicare for All would be about $2 trillion less over the decade than currently projected. The federal government would pay more, but Americans, on the whole, would pay less.

Remember that the U.S. already spends far more per person on health care than does any other country. And when you count the tax break for employer-provided insurance, the federal government already pays about two-thirds of this bill. But because of the fragmented private insurance system, the government gets none of the efficiency or buying power that a single-payer system would provide.

3. Health care rationing: Trump claims — with no supporting evidence — that “the Democratic plan would inevitably lead to the massive rationing of health care Doctors and hospitals would be put out of business. Seniors would lose access to their favorite doctors. There would be long wait lines for appointments and procedures. Previously covered care would effectively be denied.”

The detailed implementation of any single-payer plan would, of course, be subject to substantial negotiation. But the Medicare for All bill drafted by Sen. Bernie Sanders, I-Vt., states explicitly that “Nothing in this Act shall prohibit an institutional or individual provider from entering into a private contract with an enrolled individual for any item or service” outside the plan.

4. Pre-existing conditions: Trump notes that as a candidate, he “promised that we would protect coverage for patients with pre-existing conditions.” In fact, Trump and his fellow Republicans tried — unsuccessfully — to repeal the Affordable Care Act, which guarantees insurance coverage for people with pre-existing conditions. GOP plans would leave it up to the states to craft alternative protections. In addition, Republican attorneys general have sued to overturn Obamacare’s protections, and the Trump administration has declined to defend them.

America’s Health Insurance Plans, the trade group for the insurance industry, warns that ending the Obamacare guarantee could result in hardship for the estimated 130 million Americans under 65 with pre-existing conditions.

“Removing those provisions will result in renewed uncertainty in the individual market, create a patchwork of requirements in the states, cause rates to go even higher for older Americans and sicker patients, and make it challenging to introduce products and rates for 2019,” AHIP said in a statement in June.

5. The strength of Medicare: Trump wrote that “Democrats have already harmed seniors by slashing Medicare by more than $800 billion over 10 years to pay for Obamacare. Likewise, Democrats would gut Medicare with their planned government takeover of American health care.”

He is repeating a claim that was widely debunked during the 2012 election. The Affordable Care Act actually strengthened the solvency of Medicare, but it has since been weakened again by the GOP tax cut.

The president is trying to play on the fears of seniors — who vote in large numbers — with the claim that any effort to improve health security for younger Americans must come at their expense. But that is a false choice.

Donald Trump: Democrats ‘Medicare for All’ plan will demolish promises to seniors

Our dear President recently stated “the Democrats want to outlaw private health care plans, taking away freedom to choose plans while letting anyone cross our border. We must win this.”

Throughout the year, we have seen Democrats across the country uniting around a new legislative proposal that would end Medicare as we know it and take away benefits that seniors have paid for their entire lives.

Dishonestly called “Medicare for All,” the Democratic proposal would establish a government-run, single-payer health care system that eliminates all private and employer-based health care plans and would cost an astonishing $32.6 trillion during its first 10 years.

As a candidate, I promised that we would protect coverage for patients with pre-existing conditions and create new health care insurance options that would lower premiums. I have kept that promise, and we are now seeing health insurance premiums coming down.

I also made a solemn promise to our great seniors to protect Medicare. That is why I am fighting so hard against the Democrats’ plan that would eviscerateMedicare. Democrats have already harmed seniors by slashing Medicare by more than $800 billion over 10 years to pay for Obamacare. Likewise, Democrats would gut Medicare with their planned government takeover of American health care.

The Democrats’ plan threatens America’s seniors

The Democrats’ plan means that after a life of hard work and sacrifice, seniors would no longer be able to depend on the benefits they were promised. By eliminating Medicare as a program for seniors, and outlawing the ability of Americans to enroll in private and employer-based plans, the Democratic plan would inevitably lead to the massive rationing of health care. Doctors and hospitals would be put out of business. Seniors would lose access to their favorite doctors. There would be long wait lines for appointments and procedures. Previously covered care would effectively be denied.

In practice, the Democratic Party’s so-called Medicare for All would really be Medicare for None. Under the Democrats’ plan, today’s Medicare would be forced to die.

The Democrats’ plan also would mean the end of choice for seniors over their own health care decisions. Instead, Democrats would give total power and control over seniors’ health care decisions to the bureaucrats in Washington, D.C.

The first thing the Democratic plan will do to end choice for seniors is to eliminate Medicare Advantage plans for about 20 million seniors as well as eliminate other private health plans that seniors currently use to supplement their Medicare coverage.

Next, the Democrats would eliminate every American’s private and employer-based health plan. It is right there in their proposed legislation: Democrats outlaw private health plans that offer the same benefits as the government plan.

Americans might think that such an extreme, anti-senior, anti-choice and anti-consumer proposal for government-run health care would find little support among Democrats in Congress.

Unfortunately, they would be wrong: 123 Democrats in the House of Representatives — 64 percent of House Democrats —, as well as 15 Democrats in the Senate, have already formally co-sponsored this legislation. Democratic nominees for governor in Florida, California, and Maryland are all campaigning in support of it, as are many Democratic congressional candidates.

Democrats want open-borders socialism

The truth is that the centrist Democratic Party is dead. The new Democrats are radical socialists who want to model America’s economy after Venezuela.

If Democrats win control of Congress this November, we will come dangerously close to socialism in America. Government-run health care is just the beginning. Democrats are also pushing massive government control of education, private-sector businesses and other major sectors of the U.S. economy.

Every single citizen will be harmed by such a radical shift in American culture and life. Virtually everywhere it has been tried, socialism has brought suffering, misery, and decay.

Indeed, the Democrats’ commitment to government-run health care is all the more menacing to our seniors and our economy when paired with some Democrats’ absolute commitment to ending enforcement of our immigration laws by abolishing Immigration and Customs Enforcement. That means millions more would cross our borders illegally and take advantage of health care paid for by American taxpayers.

Today’s Democratic Party is for open-borders socialism. This radical agenda would destroy American prosperity. Under its vision, costs will spiral out of control. Taxes will skyrocket. And Democrats will seek to slash budgets for seniors’ Medicare, Social Security, and defense.

Republicans believe that a Medicare program that was created for seniors and paid for by seniors their entire lives should always be protected and preserved. I am committed to resolutely defending Medicare and Social Security from the radical socialist plans of the Democrats. For the sake of our country, our prosperity, our seniors and all Americans — this is a fight we must win.

And now the Vulnerable Republicans throw ‘Hail Mary’ on pre-existing conditions

Jessie Hellman reported that just recently dozens of vulnerable House Republicans have recently signed on to bills or resolutions in support of pre-existing conditions protections, part of an eleventh-hour attempt to demonstrate their affinity for one of ObamaCare’s most popular provisions.

Thirty-two of the 49 GOP incumbents in races deemed competitive by the nonpartisan Cook Political Report have backed congressional measures on pre-existing conditions in the past six weeks, according to an analysis by The Hill.

The moves, coming in the final weeks of the midterm campaign cycle, mark a course reversal for members of a party that for years railed against ObamaCare, also known as the Affordable Care Act (ACA), and called for its repeal.

Now, facing the threat of a “blue wave” and an onslaught of health-care attacks from Democratic candidates, vulnerable Republicans are running ads on pre-existing conditions and co-sponsoring measures that critics deride as meaningless.

The congressional resolutions are “a quick Hail Mary for a list of endangered incumbents,” said Thomas Miller, a resident fellow at the right-leaning American Enterprise Institute, and co-author of “Why ObamaCare is Wrong for America.”

“They’re intended to provide at least some legislative cover in the event that they can read the polls and know there’s been a stampede of support for the broad-brushed pre-existing conditions protections similar to those in the ACA,” he said.

A Kaiser Family Foundation poll in August found that more than 72 percent of Americans think the protections — prohibiting insurers from denying coverage to people with pre-existing conditions or charging them more for coverage — should remain law.

Democrats in June seized on the Trump administration’s announcement in court that it would not defend ObamaCare’s protections for people with pre-existing conditions. The Department of Justice sided in large part with the 20 Republican state attorneys general who filed a lawsuit seeking to overturn ObamaCare.

Now Democrats, who are looking to flip both the House and Senate, are tying Republicans to that decision while highlighting the GOP’s ObamaCare repeal-and-replace efforts, which they say would have diminished pre-existing conditions protections for people in the individual market.

Tyler Law, the national press secretary for the Democratic Congressional Campaign Committee (DCCC), said the “overwhelming majority” of campaign ads from the DCCC and Democrats have focused on health care, with pre-existing conditions as the central theme.

“Republicans are stuck on defense, forced to respond to devastatingly effective ads on their record on pre-existing conditions, and touting nonbinding resolutions as they panic because they see the political fallout,” Law said.

“Republicans clearly recognize how politically disastrous their policies are in regards to pre-existing conditions,” he added. “They are now just making up an alternative record on which all of a sudden they seem to care about pre-existing conditions.”

Reps. David Young (Iowa) and Pete Sessions (Texas) — two Republicans running in competitive races this year — introduced separate resolutions in September supporting pre-existing conditions protections. Later that month, Rep. Steve Knight (R-Calif.), who is locked in a toss-up race, introduced a similar bill.

Another measure — the Pre-existing Conditions Protection Act of 2017 — was introduced by Rep. Greg Walden (R-Ore.) in February of last year but has attracted 16 Republican co-sponsors in the past month and a half — all but four of whom are running in competitive races. Twenty Republicans in competitive races co-sponsored the legislation last year.

Of the 23 Republican incumbents who are considered to be most in danger of losing their seat, according to Cook Political Report, 18 co-sponsored at least one of the resolutions or bills since September.

The measures, however, are more of a political statement. They aren’t expected to pass or even get a markup at the committee level.

“It’s a political gesture,” Miller said. “You don’t introduce bills in September of 2018 with the intent of marking it up.”

Democrats say it’s part of a transparent attempt by the GOP to deflect from their failed efforts to repeal ObamaCare.

“They’re trying to claim they support protections for people with pre-existing conditions. It’s really disingenuous,” said Maura Calsyn, managing director of health policy at the Center for American Progress, a liberal think tank. “They’re hoping the public is going to ignore their past votes and their past statements that they don’t support the ACA.”

While some Republicans have pointed to their vote in favor of the GOP-backed American Health Care Act as proof they support protections for pre-existing conditions, Democrats argue that the legislation didn’t match the protections guaranteed by the ACA.

The nonpartisan Congressional Budget Office concluded last year that under the GOP bill, people with pre-existing conditions “would ultimately be unable to purchase comprehensive nongroup health insurance at premiums comparable to those under current law if they could purchase it at all.”

Vulnerable Republicans have also been running ads about pre-existing conditions, sometimes with a focus on their family members.

Rep. Dana Rohrabacher (R-Calif.), who is a toss-up race against Democrat Harley Rouda, recently released an ad focusing on his daughter’s pre-existing condition — leukemia.

“So for her and all our families, we must protect America’s health-care system,” Rohrabacher says in the ad. “That’s why I’m taking on both parties, and fighting for those with pre-existing conditions.”

Rohrabacher, who voted multiple times to repeal the ACA, signed on to legislation Tuesday supporting pre-existing conditions protections.

“The Republicans who are pushing now to clean things up three weeks up before the election aren’t able to do it,” said Amanda Harrington, director of communications for Protect Our Care, a pro-ObamaCare advocacy group that is involved in the midterms. “The deficit they have created themselves on the issue of health care is far too steep for them to climb.”

There are many fights going forward as we get closer to the Mid-terms and if the majorities change in the House and Senate there are going to be many more. My hope is that the children in both the House and the Senate grow up and realize that they had better learn how to work together.

On my visit to California to spend some time with my daughter, I realized how bad things still were when we discussed the last few weeks and even though Judge Kavanaugh was investigated 7 times she still believed that he was a horrible person. There was no pursuing further discussion with her or anyone else in her group of graduate students.

I was amused last week when a favorite patient of mine and a long time strategist for the Democrat party was seen in my office. As I entered the exam room she raised her right hand and flashed me a peace sign. She then apologized for the behavior of her party during the Kavanaugh hearings and that she and her husband warned them of the possible blowback.

Remember, this lady agreed with me that no matter what good pieces of legislation put to a vote before the Mid-Term elections that the Democrats would vote against, even if the legislation was what the Democrats would “normally” be in agreement at any other time. What a farce and now how do we correct this type of behavior? I’m not sure unless we vote all of those in the House and the Senate out and find some candidates who really want to improve our country despite the media who fight each day to upset our free country for a sound bite to capture the next media attention spot despite the facts.

Newt Gingrich predicted that Ignoring health care could spell disaster for Republicans in 2018 elections. Maybe, But What About the “ME-To” Wave And All Men Are Bad?

43066034_1731880880274897_8358288627561660416_nAs Newt Gingrich wrote, the U.S. economy has been growing and breaking records ever since President Trump first took office and Republicans took control of Congress.

Many in the GOP are hoping this success will help them get re-elected in November. Some consultants I’ve spoken with seem to think it will inoculate Republican candidates against most all Democratic attacks.

They are mostly right, except for one area – health care.

Here I have to modify his thoughts. I think that after this Judge Kavanaugh circus we are, no the Democrats are not finished with the “Me To”/sexual assault and “All Men Are Bad” push. They are going to mobilize the women and some of the crazy men who will listen to their leaders.

But let us continue with the health care issue.

No doubt, Republicans should be proud of the enormous success of the economy. But the economy won’t reach its full potential and the GOP will not win big in the 2018 elections unless Republicans deal with the cost of health care in America.

The reason is simple:

Health care represents nearly one-fifth of our country’s economy and is the largest driver of government spending. It is also such a huge slice of household budgets that many Americans don’t end up feeling the benefits of the 4.1 percent growth in the gross domestic product (GDP). In 2016, individual health care costs amounted to $10,328 per person (in 1960, that figure was $146).

As Dave Winston and Myra Miller at The Winston Group have noted, with nearly half of Americans saying they are living paycheck-to-paycheck (with no reserves for emergencies) it is hard for people to “feel the prosperity” implicit in a remarkably strong macroeconomy. Their individual micro-economies are too deeply impacted by the cost of health care.

Additionally, health care costs are outpacing income growth because businesses have had to eschew raises and promotions to afford more and more health care costs. According to a 2017 report by the Kaiser Family Foundation and the Health Research & Education Trust and federal income data, “premiums for an employer-provided family insurance plan have climbed 19 percent, while worker pay increased 12 percent.” The additional money Americans are receiving in their paycheck from the Tax Cut and Jobs Act helps, but lowering health care costs still needs to be a priority.

A Republican party that hides from the challenge of modernizing the health system is a party, which has conceded a huge part of the political playing field to the left.

Fortunately for Republicans – and for the country – we now have leadership capable of developing a serious strategy for a dramatically improved health care system. Secretary of Health and Human Services Alex Azar has the knowledge and the experience to help shape a new, profoundly better health system for all Americans.

Secretary Azar’s move this week to widen access to less expensive, short-duration health insurance plans was a step in the right direction. These plans will give Americans more options to buy the level of insurance they need for themselves – rather than being forced to buy more expensive coverage they don’t necessarily need.

President Trump’s earlier announced plan for reducing prescription drug prices will also be a huge help for families, and the administration’s support for the expansion of association health plans will provide more options for small businesses and self-employed individuals.

So, while there is still more work to be done, Republicans can point to positive steps that have been taken and progress that has been made — but they can’t shy away from talking about health care.

This reality of half the nation operating on the margin is what drives support for government-run health care, which is now sweeping large parts of the Democratic Party.  If Republicans refuse to articulate a better solution, a large portion of the American people will decide that government bureaucracy is better than constant economic anxiety about unknowable, increasing health costs.

As I have written before, if the left wins on health care and puts in place a single-payer system, it would be a disaster.

So, to truly win the economic argument, Republicans must think through and win the health care argument. The dynamics of the fall campaign give them no choice. The Democrats’ government-run health care system will fill the gap left by the absence of a serious Republican alternative.

There is a long tradition of Republicans trying to avoid health issues. Consultants assert “it isn’t our topic.” Incumbents find it hard to communicate a clear policy or plan for improving the health system. “Repeal and Replace” was largely about repeal because Republicans lacked a coherent plan to replace ObamaCare. This is why it failed.

A Republican party that hides from the challenge of modernizing the health system is a party which has conceded a huge part of the political playing field to the left.

Conversely, a Republican party that can explain common sense improvements that will empower Americans to have longer lives, better health, greater convenience, more choices, and lower costs in healthcare is a party that can easily demolish the left’s arguments.

Healthcare Is The No. 1 Issue For Voters; A New Poll Reveals Which Healthcare Issue Matters Most

And as Robert Pearl, M.D. stated, depending on which news outlet, politician or pundit you ask, American voters will soon participate in the most important midterm election “in many years,” “in our lifetime” or even “in our country’s history.”The stakes of the November 2018 elections are high for many reasons, but no issue is more important to voters than health care. In fact, NBC News and The Wall Street Journal found that healthcare was the No. 1 issue in a poll of potential voters.

What’s curious about that survey, however, is that the pollsters didn’t ask the next, most-logical question.

What Healthcare Issue, Specifically, Matters Most To Voters?                                          To answer this question, I surveyed readers of my monthly newsletter. Will the opioid crisis sway voters at the polls? What about abortion rights? The price of drugs? The cost of insurance?

See for yourself:

Untitled. mid-term.elections

To understand the significance of these results, look closely at the top four:

  1. Prescription drug pricing (58%)
  2. Universal/single-payer coverage (57%)
  3. Medicare funding (50%)
  4. Medicaid funding (40%)

Notice a pattern here? All of these healthcare issues come down to one thing: money.

Healthcare Affordability: The New American Anxiety                                               Because the majority of my newsletter readers operate in the field of healthcare, they’re well informed about the industry’s macroeconomics. They understand healthcare consumes 18% of the gross domestic product (GDP) and that national health care spending now exceeds $3.4 trillion annually. The readers also know that Americans aren’t getting what they pay for. The United States has the lowest life expectancy and highest childhood mortality rate among the 11 wealthiest nations, according to the Commonwealth Fund Report. But these macroeconomic issues and global metrics are not what keeps healthcare professionals or their patients up at night. Eight in 10 Americans live paycheck to paycheck. Most don’t have the savings to cover out-of-pocket expenses should they experience a serious or prolonged illness. In fact, half of U.S. adults say that one large medical bill would force them to borrow money. The reality is that a cancer diagnosis or an expensive, lifelong prescription could spell financial disaster for the majority of Americans. Today, 62% of bankruptcy filings are due to medical bills.

To understand how we’ve arrived at this healthcare affordability crisis, we need to examine the evolution of health care financing and accountability over the past decade.

The Recent History Of Healthcare’s Money Problems

Until the 21st century, the only Americans who worried about whether they could afford medical care were classified as poor or uninsured. Today, the middle class and insured are worried, too. How we got here is a story of evolving policies, poor financial planning and, ultimately, buck-passing.

A big part of the problem was the rate of health care cost inflation, which has averaged nearly twice the annual rate of GDP growth. But there are other contributing factors, as well.

Take the evolution of Medicare, for example, the federal insurance program for seniors. For most of the program’s history, the government reimbursed doctors and hospitals at (approximately) the same rate as commercial insurers. That started to change after a series of federal budget cuts and sequestration reduced provider payments. Today, Medicare reimburses only 90% of the costs its enrollees incur and commercial insurers are forced to make up the difference. As a result, businesses see their premiums rise each year, not only to offset the growth in their employee’s medical expenses but also to compensate hospitals and physicians for the unreimbursed portion of the cost of caring for Medicare patients.

Combine two high-cost factors: general health care inflation and price constraints imposed by Medicare and what you get are insurance premiums rising much faster than business revenues.

To compensate, companies are shifting much of the added expense to their employees. The most effective way to do so: Raise deductibles. By increasing the maximum deductible annually, the company reduces the magnitude of its expenses the following year, at least until that limit is reached. A decade ago, only 5% of workers were enrolled in a high-deductible health plan. That number soared to 39.4% by 2016 and jumped again to 43.2% the following year.

High-deductible coverage holds individual patients and their families responsible for a major portion of annual healthcare costs, anywhere from $1,350 to $6,650 per person or $2,700 to $13,3000 per family. This exceeds what the average available savings for most American families and helps to explain the growing financial angst in this country.

And it’s not just employees under the age of 65 who are anxious. Medicare enrollees also fear that the cost of care will drain their savings. As drug prices continue to soar, Medicare enrollees are hitting what has been labeled “the donut hole,” which means that once the cost of their “Part D” prescriptions reaches a certain threshold, patients are on the hook for a significant part of the cost. Now, more and more seniors find themselves having to pay thousands of dollars a year for essential medications.

When it comes to paying for health care, the United States is an anxious nation in search of relief. The fear of not being able to afford out-of-pocket requirements is the reason so many voters have made health care their No. 1 priority as they head to the polls this November. And it’s why both parties are scrambling to deliver the right campaign message.

On Healthcare, Each Party Is A House Divided

In the last presidential election, the Democratic Party chose a traditional candidate, Hilary Clinton, whose views on healthcare were closer to the center than her leading challenger, Bernie Sanders. Two years later, the party is divided by those who believe that (a) the only way to regain control of Congress is by fronting centrist candidates who support and want to strengthen the Affordable Care Act as the best way to attract undecided and independent voters, and (b) those who will accept nothing less than a government-run single payer system: Medicare for all. The primary election of New York congressional candidate Alexandria Ocasio-Cortez, a Sanders supporter, over long-time incumbent Joseph Crowley, represents this growing rift within the party.

The Republicans also face two competing ideologies on healthcare. Since his election in 2016, President Donald Trump has sought to dismantle the ACA. In addition, he and his political allies want to shift control of Medicaid (the insurance program for low-income Americans) from the federal government to the states—a move that would lower health care spending while eroding coverage protection. There are others in the Republican Party who worry that shrinking Medicaid or undermining the health exchanges will come back to bite them. Most of them live and campaign in states where voters support the ACA.

Do The Parties Agree On Anything?

Regardless of party, everyone, from the president to the most fervent single-payer advocate, understands that voters are angry about the cost of their medications and the associated out-of-pocket expenses. And, not surprisingly, each party blames the other for our current situation. Last week, the president gave the Medicare program greater ability to reign in costs for medications administered in a physician’s office. In addition, Trump has promised a major announcement this week to achieve other reductions in drug costs. Of course, generous campaign contributions may dim the enthusiasm either party has for change once the voting is over.

Playing “What If” With Healthcare’s Future

If both chambers remain Republican controlled, we can expect further erosion of the ACA with more exceptions to coverage mandates and progressively less enforcement of its provisions. For Republicans, a loss of either the Senate (a long-shot) or the House (more likely), would slow this process.

But regardless of what happens in the midterms, no one should expect Congress to solve healthcare’s cost challenge soon. Instead, patient anxiety will continue to escalate for three reasons.

First, none of the espoused legislative options will do much to address the inefficiencies in the current delivery system. Therefore, prices will continue to rise and businesses will have little choice but to shift more of the cost on to their workers. Second, the Fed will persist in limiting Medicare reimbursement to doctors and hospitals, further aggravating the economic problems of American businesses. whose premium rates will rise faster than overall health care inflation. Finally, compromise will prove even more elusive since so many leading candidates represent the extremes of the political spectrum.

Politics, the economy, and health care will all be deeply entangled this November and for years to come. I believe the safest path, relative to improving the nation’s health, is toward the center. Amending the more problematic parts of the ACA is better than either of the two extreme positions. If our nation progressively undermines the current coverage provisions, millions of Americans will see their access to care erode. And on the other end, a Medicare-for-all health care system will produce large increases in utilization and cost.

It’s anyone’s guess what will happen in three months. But, whatever the outcome, I can guarantee that two years from now healthcare will remain top-of-mind for voters.

The Memo: GOP to win Kavanaugh fight but Dems vow midterm revenge

Niall Stanage noted that Brett Kavanaugh is set to be confirmed to the Supreme Court on Saturday, notching a big victory for President Trump and the Republican Party — but one that carries sizable complications.

Democrats believe their voters are now more fired up than ever to deliver a rebuke to the GOP in the November midterm elections.

They vow that women’s anger at the judge’s near-certain confirmation, despite allegations of sexual assault and misconduct against him, will be a potent electoral force.

“What I have seen is anger and outrage from women in a way that I’ve never seen before,” said Karine Jean-Pierre, senior adviser and national spokeswoman for MoveOn, a progressive group. “I don’t think Republicans realize what they have unleashed.”

One national women’s group, UltraViolet Action, issued a stark two-sentence statement Friday from co-founder Shaunna Thomas.

“This doesn’t end tomorrow. It ends in November,” Thomas said.

Sen. Kamala Harris(D-Calif.), widely predicted to become a 2020 presidential candidate, made a broader argument that the GOP had disrespected women by backing Kavanaugh.

“To all survivors of sexual assault: We hear you. We see you. We will give you dignity. Don’t let this process bully you into silence,” Harris tweeted as the Kavanaugh drama neared its peak on Friday afternoon in the Senate.

Some Republicans had expressed concern earlier this week when Trump mocked Kavanaugh’s most prominent accuser, Christine Blasey Ford, during a rally in Mississippi. They worried that the president’s rhetoric seemed likely to cause deeper erosion of support for the GOP among suburban women in particular — a demographic that is already skeptical of the president.

An NPR/PBS/Marist poll conducted in late September showed Trump’s job approval rating to be very negative among college-educated white women. Fifty-seven percent within that group disapproved of Trump’s job performance, whereas only 38 percent approved.

At that time, GOP strategist Liz Mair told The Hill: “The party is already in trouble with suburban women. I just have a sneaking suspicion that the Republicans will find a way to mess this up. We are already in trouble with a group of voters we need to not totally hate us.”

But by Friday such concerns seemed to have been supplanted by satisfaction about getting Kavanaugh to the finish line.

Republicans believe they will be rewarded by conservative voters who might not have gone to the polls had GOP senators proved unable to confirm Kavanaugh, who’s spent the past 12 years as a judge on the U.S. Court of Appeals for the District of Columbia Circuit. Many social conservatives voted for Trump with a degree of ambivalence in 2016, given his colorful personal life, but did so in the hope that he would tilt the Supreme Court in their favor.

Kavanaugh’s confirmation would give the nine-member high court a solid 5-4 conservative majority.

“At the moment it appears that Republican voters, Trump voters, have re-engaged and are heading to the polls,” said GOP pollster John McLaughlin on Friday.

Had Kavanaugh plunged to defeat, McLaughlin asserted, “you would have a lot of angry Trump voters who would blame the Republicans and not show up” for the Nov. 6 midterms.

The Kavanaugh drama came to a head on Friday afternoon when Sen. Susan Collins(R-Maine), who had not previously declared her position, announced she would support him.

Moments after her announcement, Sen. Joe Manchin (D-W.Va.) became the only Democrat to cross party lines to back the judge. Manchin is seeking re-election this year in a state that Trump carried by 42 points in 2016 over Hillary Clinton.

The liberal dismay about those decisions was immediately evident on social media and elsewhere.

Susan Rice, who served as U.S. ambassador to the United Nations during former President Obama’s administration, suggested she would be willing to challenge Collins when she comes up for reelection in 2020. It was not clear if Rice was being serious.

Democracy for America, a progressive group, announced that it would work with “anyone we can to finish the job” of defeating Collins.

In a parallel development, former Alaska Gov. Sarah Palin (R) suggested she would consider challenging Sen. Lisa Murkowski(R-Alaska), who voted against Kavanaugh in a procedural vote Friday morning.

“Hey, @LisaMurkowski – I can see 2022 from my house…” Palin tweeted, referring to the year when Murkowski is up for reelection.

Beyond that, the sheer bitterness of the battle over Kavanaugh is striking to all sides.

“The starting gun for the 2020 election was fired with this confirmation fight,” said Ron Bonjean, a Republican who served as a communications strategist in the battle to confirm Trump’s first Supreme Court nominee, Neil Gorsuch, in 2017.

“This rollercoaster nomination has bonded both parties together in a way,” Bonjean added, “because of the intensity of it, how close this vote was and the unfair tactics both sides claimed the other party utilized.”

The president seemed to begin a victory lap on Friday. “Very proud of the U.S. Senate for voting ‘YES’ to advance the nomination of Judge Brett Kavanaugh!” he tweeted.

Democrats are hoping that air of celebration will be short-lived.

Who is correct? We will soon see!