Chief Justice Roberts Set the Stage for the Insane Anti-Obamacare Ruling in Texas

s noted in a previous post, anti-gay, pro-Christofascist and general right wing ideologue U. S. District Court Judge Reed O'Connor (a GOP appointee) issued a ruling striking down the Affordable Health Care Act.  Numerous legal experts excoriated O'Connor's ruling and a number of state attorney generals, including Virginia Attorney General Mark Herring, have made it clear that they will oppose O'Connor's ruling.  While it is easy to blame the ruling out of Texas on O'Connor's general extremism and constant placement of Republican partisanship over the rule of law, a piece in The Atlantic lays part of the blame on Chief Justice John Roberts and his ill advised refusal to uphold Obamacare under the Commerce Clause of the U.S. Constitution and instead base his pro-Obamacare ruling on the power of taxation. With healthcare spending comprising nearly 20% of the U.S. economy and equating to roughly $10,739 per person for every American, it is ludicrous for Roberts to have pretended that healthcare was outside the scope of the Commerce Clause.  Admittedly, this is possibly viewed by many as a "nerdy lawyer analysis and hairsplitting," but it is important.  Here are article highlights:

Friday’s decision striking down the Affordable Care Act, Texas v. United States, is wrong and should be reversed on appeal for reasons ably explained by its many critics. Yet in focusing their wrath on the Texas decision, the critics overlook the fact that Chief Justice John Roberts put us in this mess by making a bad choice in the Supreme Court’s 2012 decision upholding Obamacare, NFIB v. Sebelius. Roberts erred—and opened the door to the Texas debacle—by failing to follow a famous and well-established 200-year-old precedent set by Chief Justice John Marshall.

Joining the four conservatives, Roberts maintained that the mandate could not be sustained as an exercise of Congress’s power to regulate interstate commerce. But he joined the four liberals to uphold the mandate under the taxing power.

Congress’s 2017 move to eliminate the tax on nonpurchasers of health insurance gave rise to the theory that the legal foundation for the individual mandate had thereby disappeared, and that therefore the whole law should go down, too. So ruled the judge in Texas v. United States. The argument is nonsensical, because without the tax, there is no mandate: People are free to decline health insurance with no legal consequence. But the argument would not even exist if Roberts had voted to uphold the mandate as an exercise of the commerce power.

The constitutional challenges to Obamacare harken back to the first great debate over the powers of Congress. In 1791, then–Treasury Secretary Alexander Hamilton proposed establishing a national bank to act as financier to the federal government. Congressional opponents objected that the Constitution gave no express power to create a national bank. Supporters responded that Congress necessarily possessed implied powers to effectuate those specifically enumerated in the Constitution.

Late in the debate, Congressman James Madison offered a novel constitutional theory against the bank bill. Yes, there were implied powers, he conceded, but those could reach only minor matters and could not extend to “great, substantive, and independent” objects, no matter how useful to implementing the enumerated powers. Creating a national bank fell into this latter “great powers” category.

Madison’s argument was voted down by a two-thirds House majority. Congress passed the bank bill, and President George Washington signed it into law.

This victory for implied congressional powers was confirmed by the Supreme Court three decades later, when states’ rights advocates challenged the constitutionality of the Second Bank of the United States, chartered by Congress to succeed Hamilton’s bank in 1816—at the request of President James Madison. In the celebrated 1819 case of McCulloch v. Maryland, Marshall upheld the constitutionality of the second bank. Although the Constitution did not expressly authorize Congress to create banks, Marshall concluded that under the Necessary and Proper Clause, Congress may enact any legislation that is “conducive,” “convenient,” “useful,” or “plainly adapted” to implementing an enumerated power.

In the 2012 Obamacare decision, Roberts could have joined the four liberals to uphold the individual mandate under the Commerce Clause power “to regulate commerce … among the several states.” Individuals who choose not to purchase health insurance may or may not be engaged in interstate commerce. But if an individual mandate to purchase health insurance is useful for effective regulation of the interstate health-care market, Congress has the implied power to enact it, according to Marshall’s theory in McCulloch.

Instead, Roberts joined the four conservative justices to define “commerce” as “economic activity,” and to conclude that the Commerce Clause does not permit Congress to regulate the “inactivity” of someone’s refusal to buy health insurance. Relying on Madison’s 1791 House speech, Roberts argued that regulating the “inactivity” of refusing to buy health insurance is “a great, substantive, and independent power” that cannot be implied, no matter how effective it might be in regulating the national health-care market.

Yet in McCulloch, Marshall had rejected this very contention. Marshall stated that no exercise of power could be deemed “great, substantive, and independent” if it was being used as a means to an end that falls within the enumerated powers. The individual mandate’s requirement to join the health-insurance pool is no end in itself, but rather a means to the plainly constitutional end of regulating the interstate market in health care.

Madison’s half-baked argument against implied powers never got off the ground. It was rejected by Congress and President Washington in 1791, and by the Supreme Court in 1819. Before Roberts resurrected it in 2012, it had not entered American constitutional jurisprudence. And for good reason: It doesn’t work. The bank, the military draft, and countless other federal laws belie the notion that the Constitution prohibits implied “great” powers. And if the draft can be implied, surely the individual mandate can be, too.

The Texas decision can easily be overturned, and Obamacare upheld, without Roberts revisiting his ill-fated choice of Madison over Marshall. But the Texas case highlights just why he should have sided with the long-standing precedent set by the Great Chief Justice, not the twice-rejected, eccentric argument of a flip-flopping congressman.

Medicaid Expansion Approved by Virginia General Assebly

Ralph Northam on inauguration day 2018.

In a major triumph for Governor Ralph Northam and Virginia Democrats - not to mention the tens of thousands of working Virginians who will benefit - the Virginia General Assembly has approved Medicaid expansion.  The move will end Virginia's export of taxes that have accrued to adjoining states which previously embraced Medicaid expansion, an aspect of the Affordable Health Care Act which Congressional Republicans have worked to kill with no regard for the millions of Americans who will be harmed through either a loss of health insurance coverage or significantly increased health insurance premiums all so the 1% could reap obscene tax cuts.   Many of Virginia's rural hospitals, especially in Southwest Virginia where bigotry and religious extremism make it difficult to attached a new industrial base, that have been teetering on bankruptcy  or closure, will be among the big winners on this development.   Here are highlights from the Virginian Pilot:

The Republican-controlled Virginia General Assembly gave final approval Wednesday evening to a state budget expanding Medicaid coverage to the state's poor, acting swiftly after the Senate broke years of partisan gridlock on the issue.

The House of Delegates voted Wednesday only about an hour after the state Senate voted in favor of expansion. Several Republicans in both chambers joined with Democrats to support Medicaid expansion.

The House had previously endorsed expansion, while the Senate had held out in opposition until Wednesday.

Democratic Gov. Ralph Northam is expected to sign the budget in coming days that continues the plan. Expanding Medicaid was a key provision of then-President Barack Obama's health care overhaul, and a tally from the Kaiser Family Foundation shows Virginia will become the 33rd state to approve Medicaid expansion.

Senate passage came by a 23-17 vote with four Republicans joining Democrats for passage. The House quickly followed about an hour later with a lopsided 67-31 final endorsement.

Wednesday's voting marked the end of a more than four-year battle over whether Virginia should expand the publicly funded health care program for the poor. 

Virginia Democrats have pushed for years to expand Medicaid, saying their state should not pass up the roughly $2 billion in extra federal funding the program would bring to the state.  Sen. Ben Chafin, a Republican lawmaker from Virginia's economically depressed southwest coal country, announced his support for expansion on the Senate floor. He said his rural area needed expansion to help bolster its hospitals and provide care for constituents in need.  "I came to the conclusion that no just wasn't the answer anymore," Chafin said.

Expanding Medicaid to cover more low-income families was a key provision of the Affordable Care Act secured by then-President Barack Obama.

A federal-state collaboration originally meant for poor families and severely disabled people, Medicaid has grown to become the largest government health insurance program, now covering 1 in 5 people. Obama's health care overhaul gave states the option of expanding Medicaid to cover more low-income adults.

The GOP-controlled General Assembly's support for Medicaid comes despite Trump administration rejections.

Last year, Virginia saw its state legislature reshaped by an anti-Trump wave as Democrats made unexpectedly large gains in the state House. And a failure by the GOP-led Congress to repeal and replace the health law helped spur several of Virginia's Republican state legislators to flip positions.

Democrats campaigned heavily on expanding Medicaid last year and some House Republicans were eager to take the issue off the table before next year's election, when both House and Senate seats are up.

The GOP Has Its Own Obamacare Now

click image to enlarge

Having been actively involved in politics for over twenty years, I continue to be mind boggled by the apparent death wish of congressional Republicans when it comes to passing measures that are viewed as abhorrent by the majority of voters.  The same group who railed against Obamacare for seven straight years are about to give Democrats a gift in the form of the Trump tax bill that will likely benefit Democrats for years and at almost the very same moment that Republicans lost their majority in the Virginia House of Delegates.  Due to a single vote no less.  Ed Gillespie campaigned on a similar give away to the rich and lost the Virginia gubernatorial contest by 9 percentage points.  All of this is lost on Paul Ryan who is near orgasmic over what he has showered on the 1%.  The Trump tax bill, together with Der Trumpenführer himself (a gift that goes on giving and giving), will likely see Democrats motivated and out for electoral revenge at levels not seen in decades.  A column in the Washington Post looks at how the Trump Tax Bill will likely come back to haunt Republicans, perhaps as early as November, 2018.  Here are excerpts (with a little editorialize by me):

Congratulations, Republicans. Now you have your own Obamacare.

Emerging from their caucus meeting in the Capitol basement Tuesday morning, House Republicans were jubilant about their tax bill, which was on course to clear Congress on Wednesday.

“It’s a total winner,” said Rep. Dave Brat (R-Va.). “And I never lie.” [except when his lips are moving]

Veteran Rep. Tom Cole (R-Okla.) observed: “They’re pretty giddy in there.”

Rep. Neal Dunn (R-Fla.), a urologist, announced: “This is good medicine for America.”

And for that prescription, added Majority Whip Steve Scalise (R-La.), “you don’t need a second opinion.”

Don’t you?  The deeply unpopular bill has the support of only a third of Americans, most of whom (correctly) perceive that it’s a giveaway to rich people and big corporations. “Any concerns that this won’t translate into a political win for Republicans?” ABC News’s Mary Bruce asked House Speaker Paul D. Ryan (R-Wis.).

“No concerns whatsoever,” Ryan replied. He blamed the bill’s unpopularity on opponents and the media spreading “mistruths” and said opinions will improve when people experience what’s in the bill. 

Where have I heard this before? Ah, yes, it was March 2010, as Obamacare was about to clear the House. Then-Speaker Nancy Pelosi (D-Calif.) said people should look beyond the “controversies” surrounding the bill, to when people experience its “very exciting” benefits. “We have to pass the bill so that you can find out what is in it,” she said.

Obamacare did much of what was advertised, and its popularity grew. But it didn’t do everything that was promised, and anything Americans didn’t like about the health-care system became the fault of Obamacare, even if unrelated to the law. Now, Republicans are making impossibly high promises, and if anything goes wrong — if the economy doesn’t boom, wages don’t soar and the middle class doesn’t rebound — it will be the fault of this legislation, soon to be labeled “the Trump Tax” by Democrats.

The parallels are eerie. . . . . Actually, the Trump Tax is in worse shape than Obamacare was. USA Today reported last week that the bill had “the lowest level of public support for any major piece of legislation enacted in the past three decades, including the Affordable Care Act in 2009.” In March 2009, the Quinnipiac poll foundopposition to Obamacare exceeded support by nine points; the latest Quinnipiac poll finds opposition to the tax bill exceeding support by 29 points.

Republicans worked hard to convince Americans that Obamacare was a transfer of wealth from the middle class to the poor. Democrats can now argue, truthfully, that the Trump Tax is a transfer of income from the middle class to the wealthy and big business. Under the law, the middle fifth of American households will see an average increase in after-tax income next year of $930, while the top 1 percent get an average increase of $51,140, according to the Tax Policy Center. The rich even get a greater proportional increase in after-tax income: 2.3 percent, compared with 1.4 percent for the middle class.

While the “forgotten man” Trump lured with phony populism gets little benefit, the things that bothered the forgotten man about the tax code — a tangled mess of loopholes for businesses, the rich and Wall Street — remain intact. This will be a “bigger albatross” for Republicans than Obamacare was for Democrats, argues Democratic strategist Jesse Ferguson. “They own the tax code. When you are upset about taxes, you’re going to be upset about the Trump Tax.”

On top of that, Republicans now have claimed ownership of health care. The tax bill kills the individual mandate that underpinned Obamacare, which will leave 13 million additional people without coverage.

Tuesday morning, Ryan declared (falsely) that the bill would “especially” benefit middle-income families. He said it would “bid up” wages, repatriate jobs, provide economic growth of 3 percent a year and create upward mobility. The bill, he said, “is what it will take to help people who are struggling.”

 And yes, in the process of giving tax cuts to the wealthy, the GOP bill will cause 13 million to lose health care coverage.  I truly am hoping for a GOP bloodbath come November, 2018. 

Republicans Once Again Seek to Throw Millions Off of Healthcare Coverage

Bill Cassidy and Lindsey Graham, a/k/a the Palmetto Queen - cohorts in cruelty

Apparently the zeal of Republicans to give a huge tax cut to the wealthiest Americans is never ending.  Hence, yet another effort to cobble together 50 votes for perhaps the ugliest GOP repeal and "replace" Trumpcare bill yet.  As with the previous GOP bills, this latest abomination would cause tens of millions of Americans to lose health care coverage and punish states that expanded Medicaid and sought to bring health care attainability to the working poor and others previously not qualifying for coverage.  Once again, it may be Republican women who may block the most cruel and heartless agenda of male Republicans in the U.S. Senate although that verdict is still out.  John McCain is remaining mum on his view of this latest example of the GOP's reverse Robin Hood effort to bring about a new Gilded Age.  The New York Times lets loose on Republicans in a main editorial.  Here are editorial excerpts:

Republican lawmakers have wasted much of the year trying to repeal the Affordable Care Act, a move that would deprive millions of people of health insurance. They’re back at it. Like a bad sequel to a terrible movie, a proposal whose main architects are Bill Cassidy of Louisiana and Lindsey Graham of South Carolina would in many ways be worse than bills that came before. It would punish states like California and New York that have done the most to increase access to health care and set in motion cuts to Medicaid, the federal-state program that provides insurance to nearly 70 million people, many of whom are disabled and elderly.

This is not an idle threat. President Trump wants this bill passed by the end of next week, before the expiration of a budget rule that allows the chamber to pass a health care bill with only 50 votes (and a tiebreaker from the vice president). It’s unclear whether the votes are there, . . .

It is hard to overstate the cruelty of the Graham-Cassidy bill. It would eliminate the mandate that even healthy people buy health insurance, end the subsidies that help people purchase coverage and stop the expansion of Medicaid. It would offer states block grants they could use to help people get insurance but would leave people at the mercy of individual state legislatures and, over all, would provide $239 billion less than what the federal government would spend under current law between 2020 and 2026, according to the Center on Budget and Policy Priorities.

Worse, the formula for determining state grants would penalize the 31 states that expanded Medicaid under the A.C.A. so as to provide more money to the 19 states that did not. This is a cynical attempt to win votes by taking money from generous states that are more likely to be governed by Democrats and giving some of it to representatives of stingier states that are more likely to elect Republicans.

Graham-Cassidy would further cripple Medicaid by putting a per-person cap on what the federal government spends on the program. Under current law, federal spending increases automatically to keep up with the rise in medical costs; a per-capita cap would leave governors, who are ultimately in charge of administering Medicaid, in the unenviable position of denying care to poor and older Americans.

The rush job proposed by Mr. Cassidy and Mr. Graham and endorsed by the president is deeply unfair and leaves other lawmakers with little time to understand what’s in the bill or its true costs. The Congressional Budget Office says it will not be able to determine the full impact of the legislation, including its effect on premiums and the number of people who have insurance, for several weeks.

The Senate should show a little patience; a better, more humane option awaits it. Senators Lamar Alexander, Republican of Tennessee, and Patty Murray, Democrat of Washington, are working on a bill that would strengthen the A.C.A. by appropriating money for health subsidies that help low-income families; Mr. Trump has threatened to end those payments administratively. Mr. Alexander and Ms. Murray expect to produce their legislation this week.

 Let's hope that the Cassidy/Graham bill fails and that the Alexander/Murray bill moves forward.   Meanwhile, it is needful to remember that a hallmark of today's GOP is cruelty to the less fortunate not to mention the coddling of white supremacists. 

Is The GOP Break From Trump Starting?

Driving home this evening I was listening to Steele and Ungar on the Sirius XM POTUS channel. The topic was whether or not Donald Trump was an aberration and whether the GOP would revert back to its historical positions.  At the time, I refrained from calling in, but if I had called in, my remarks would have been that the GOP will never revert back to it's historical self until the Christofascists and white supremacists are exiled from the party.  In my view,  it was the rise of these two groups within the GOP that set the stage for the rise of Trump and the appeal of his calls to racism and religious extremism under the guise of "make America great again" which to these groups translated to "make America white evangelical Christian again." That said, Congressional Republicans are showing signs that they neither fear Trump nor see him as a positive influence on their agenda.  Indeed, between the veto proof legislation on Russian sanctions and now bipartisan talk about health care reform, perhaps Republican members of Congress have realized that they need to proceed on their own without deference to the insane tweets emanating from the White House.  A piece in The Daily Beast looks at this possibility.  Here are highlights:

Congressional Republicans broke dramatically with the White House on Tuesday over the future of health care reform, with lawmakers entertaining bipartisan talks as the president scrambled for a way to salvage Obamacare repeal and replace efforts.

The talks aren’t expected to yield a quick legislative fix to Obamacare. Instead, Sen. Lamar Alexander (R-TN), the chairman of the Senate Committee on Health, Education, Labor and Pensions, said his committee would simply be hold hearings on possible actions Congress could take to stabilize the health insurance markets.

But the fact that talks were happening at all was a remarkable break from the message that the president and his team were hoping to send. While Senate Majority Leader Mitch McConnell (R-KY) spoke in the past tense during a press conference on Tuesday to discuss his party’s efforts to pass Obamacare repeal—“our problem on health care was not the Democrats; we didn't have 50 Republicans”—the administration was continuing to press Republicans to keep at it.

“There are not the votes in the Senate, as I’ve said repeatedly to the president and to all of you, to change the rules of the Senate. There’s not enough even to require 50 or 51 Republicans to agree to do that. The votes are simply not there,” McConnell told reporters.

Trump held talks on Monday with Arizona Gov. Doug Ducey, ostensibly to convince him to get his home state senator, John McCain, to drop opposition to the last Senate bill. . . . . But the likelihood of that happening is next to nil. Not only is McCain unlikely to return to Washington D.C. as he undergoes treatment for recently-diagnosed brain cancer; but lawmakers are already plotting negotiations for when they get back after Labor Day.

Alexander’s hearings will take place in September, during which the committee plans to hear from state insurance chiefs, governors, health care experts, and representatives from the insurance industry. In the interim, the senator has asked Trump to authorize a short-term stabilization measure known as cost-sharing-reduction (CRS) payments in order to buy Congress time to come up with a bipartisan solution.

[Alexander]  was joined by several other high-ranking Republicans too. Sen. John Thune (R-S.D.) also encouraged Trump to make the CSR payments, as did Sens. Bill Cassidy (R-LA) and Bob Corker (R-TN).

“There would be a lot of poor people that would, obviously, be negatively affected. And when you’re president, you’re president of the whole country. And while you might be dissatisfied with what you inherited, typically it’s best to try to figure out a way to move ahead in a manner that doesn’t harm folks,” Corker told The Daily Beast.

The fissure on health care between Senate Republicans and the White House presented Democrats with a rare political opening, but not one without its own set of complications.

Several Democratic aides told The Daily Beast that the party is eager to craft a modest deal with Republicans both as a means of stabilizing the individual insurance marketplace and removing the possibility that the GOP returns to a broader repeal-and-replace push—since the case or one would be weakened by the modest deal they struck.

Trump is expected to decide as soon as this week on whether to extend the CSR payments, which help offset costs for insurers and poorer Americans. If the president axes those payments, experts and lawmakers have warned that premiums could skyrocket and even more insurers could leave or threaten to leave the exchanges.

For Democrats, a prerequisite to crafting bipartisan reform is for the administration to alleviate that uncertainty.

“The idea that we’re doing this to just help insurance companies is hogwash. We would help the treasury, and frankly, we would be helping a lot of the people who are getting coverage in the exchanges,” Sen. Tom Carper (D-DE), a former governor who has helmed talks with Republicans for weeks, told The Daily Beast. Carped added that he hopes new White House Chief of Staff John Kelly “will talk some sense” into Trump.

If Trump sabotages the existing law, Carper said, Obamacare’s success or failure will rest on his shoulders.

“We have an old saying in Delaware: if you break it, you own it,” said Carper. “And if he breaks it, he will own it. And ironically and cruelly, some of the people who will suffer the most are the people who live in those red states that voted for him, including West Virginia and Kentucky and places like that.”

Is Obamacare's Repeal Finally Dead?

Out of all the Republicans in the United States Senate, only three had the decency and morality to vote "no" to Mitch McConnell's "skinny bill" that would have cause 16 million Americans to lose health insurance coverage according to the calculations of the Congressional Budget Office.  Thankfully, three Republican Senators was enough to kill this abortion of a bill hypocritically pushed by the political party that claims it is "pro-life." Pro-life now meaning opposition to abortion but a willingness to harm millions, including children and the elderly.  Once one passes from the womb, you are trash to be callously kicked to the curb unless, of course, one is lucky enough to be born to wealth.  The moral bankruptcy of the Republican Party is near complete. Ironically, it took two women,  Susan Collins and Lisa Murkowski - the latter of whom was threatened by Der Trumpenführer - and John McCain who is suffering from a life threatening battle with cancer - to stop the effort to harm millions so that the wealthy could reap a huge tax cut.  A column by conservative columnist Jennifer Rubin looks at what happened.  Here are highlights:

We’ve said it before, but the Senate has reached a new low point in a once revered body. . . . . To the rescue, however, rode two brave women and a war hero stricken with cancer.

Since the healthcare debate got underway, the Republican-controlled Senate has had a fundamental problem: It had no bill it could pass. We’re not talking about meeting the 60-vote threshold; they had not been able find 50 votes (plus Vice President Mike Pence’s tiebreaker) for any version of repeal and replace. So they hit upon the idea of passing an atrocious bill that would repeal the individual mandate, dumps 15 million people off healthcare insurance and raises premiums 20 percent. Then the kicker, as The Post reported Thursday:

In other words, millions more people wouldn’t have insurance, and it’d be more expensive for everybody else. It’s no wonder, then, that even the Republicans who are voting for this bill don’t want it to become law. Sen. Lindsey O. Graham (R-S.C.) called it a “disaster” and a “fraud.”

Three senators actually held a press conference to say they’d vote for it — but only if they got an ironclad guarantee the House wouldn’t pass it. That’s right: They would only pass something they hate in order to kick the can down the road, with no prospect they can find a bill satisfactory to enough Senate Republicans. Really, gentleman, that’s your idea of responsible governance?

[A] final (we think) vote on the skinny repeal took place in the wee hours of the night on Friday. . . . In the end, Sen. John McCain (R-Ariz.) — in a sort of Hollywood ending — voted no along with Sens. Lisa Murkowski (R-Alaska) and Susan Collins (R-Maine). The bill died, and with it perhaps, finally, the quixotic vote to end Obamacare.

And what was the excuse for the rest of the Senate? They all had the power to stop a bill many openly trashed as a joke and conceded would do great damage. Nevertheless, all hoped someone else would do the dirty work of derailing it. I’m hard-pressed to think of another instance in which virtually all senators of one party (save three) declared their inability to make a critically important decision. 

It took three brave souls, one in the twilight of his career, to finally put their constituents and the country above partisan hackery.

How any one moral can still call them self a Republican is baffling to me.  How much more depraved and hate-filled must the GOP become before they will open their eyes and face the fact that the GOP all of us once knew is dead and gone.  The election of Der Trumpenführer was its death knell. 

How Trump and GOP Can Still Sabotage Health Care for Millions

Moral bankruptcy: Republicans laughing it up when millions would be harmed.  

One can hope that Trumpcare is finally dead, but even if Mitch McConnell and Paul Ryan - in my view two of the most horrible, amoral men in America after Der Trumpenführer - admit that they cannot summon the votes to pass a bill mostly motivated by a desire to give huge tax breaks to the wealthy, there remain numerous ways in which they can, and likely will sabotage the Affordable Health Care Act damaging access to health care for millions of Americans.  Why would they do this?  In my view, two main reasons: (i) they have lied about Obamacare for 8 years and they will want to make their lies become a self-fulfilling prophecy, and (ii) if they can cause the ACA to fail, they open a back door route to kill it and give those ever sought at tax cuts to the wealthy.  That millions will be harmed simply doesn't matter because many of those to be harmed are viewed  rightly or wrongly as as "those people" - blacks, Hispanics, people in big cities - and the rest don't matter in the GOP quest for a new Gilded Age.  Paul Krugman looks at the insidious means of sabotage that may be employed.  Here are highlights:

Is Trumpcare finally dead? Even now, it’s hard to be sure, especially given Republican moderates’ long track record of caving in to extremists at crucial moments. But it does look as if the frontal assault on the Affordable Care Act has failed.

And let’s be clear: The reason this assault failed wasn’t that Donald Trump did a poor selling job, or that Mitch McConnell mishandled the legislative strategy. Obamacare survived because it has worked — because it brought about a dramatic reduction in the number of Americans without health insurance, and voters didn’t and don’t want to lose those gains.

Unfortunately, some of those gains will probably be lost all the same: The number of uninsured Americans is likely to tick up over the next few years. So it’s important to say clearly, in advance, why this is about to happen. It won’t be because the Affordable Care Act is failing; it will be the result of Trump administration sabotage.

Notably, [under the ACA] people aren’t automatically signed up for coverage, so it matters a lot whether the officials running the system try to make it work, reaching out to potential beneficiaries to ensure that they know what’s available, while reminding currently healthy Americans that they are still legally required to sign up for coverage. You can see this dependence on good intentions by looking at how health reform has played out at the state level. States that embraced the law fully, like California and Kentucky, made great progress in reducing the number of the uninsured; states that dragged their feet, like Tennessee, benefited far less. Or consider the problem of counties served by only one insurer; as a recent study noted, this problem is almost entirely limited to states with Republican governors.

But now the federal government itself is run by people who couldn’t repeal Obamacare, but would clearly still like to see it fail — if only to justify the repeated, dishonest claims, especially by the tweeter in chief himself, that it was already failing. Or to put it a bit differently, when Trump threatens to “let Obamacare fail,” what he’s really threatening is to make it fail.

On Wednesday The Times reported on three ways the Trump administration is, in effect, sabotaging the A.C.A. (my term, not The Times’s). First, the administration is weakening enforcement of the requirement that healthy people buy coverage. Second, it’s letting states impose onerous rules like work requirements on people seeking Medicaid. Third, it has backed off on advertising and outreach designed to let people know about options for coverage.

Actually, it has done more than back off. As reported by The Daily Beast, the Department of Health and Human Services has diverted funds appropriated by law for “consumer information and outreach” and used them instead to finance a social media propaganda campaign against the law that H.H.S. is supposed to be administering — a move, by the way, of dubious legality. Meanwhile, the department’s website, which used to offer helpful links for people seeking insurance, now sends viewers to denunciations of the A.C.A.

And there may be worse to come: Insurance companies, which are required by law to limit out-of-pocket expenses of low-income customers, are already raising premiums sharply because they’re worried about a possible cutoff of the crucial federal “cost-sharing reduction” subsidies that help them meet that requirement.

[T]his isn’t about policy, or even politics in the normal sense. It’s basically about spite: Trump and his allies may have suffered a humiliating political defeat, but at least they can make millions of other people suffer.

Can anything be done to protect Americans from this temper tantrum? In some cases, I believe, state governments can insulate their citizens from malfeasance at H.H.S. But the most important thing, surely, is to place the blame where it belongs. No, Mr. Trump, Obamacare isn’t failing; you are.

I'm sorry if I offend my Republican "friends," but Trump is basically human excrement.  The man is foul and toxic and he is harming the nation - perhaps at Vladimir Putin's bidding - and will harm millions of Americans before his reign of terror is over. 

Revised GOP Healthcare "Reform" Still Harms Millions

Mitch McConnell has unveiled his latest abortion of a healthcare "reform" bill that at the moment has failed to secure the support of 51 Republican Senators.  Why?  Because it still harms millions of Americans and would force them off of healthcare coverage - McConnell and his cronies describe this as  a "voluntary" decision ignoring the fact that tax cuts are worthless if one is not making enough income to pay significant amounts in income tax or pay insurance premiums - and seemingly double or triple counts various funds in a pathetic attempt to disguise the negative impact on citizens. The CBO is supposed to release its scoring of the bill on Monday and the  likely outcome is that the harm will be significantly worse than what is claimed by McConnell and his fellow GOP liars sycophants.  Meanwhile, Republicans continue to disingenuously  claim to care about "working families" and "Christian values." A piece in Talking Points Memo looks at the GOP's difficulties in selling a foul rotten fish.  Here are excerpts:

GOP leaders unveiled the Senate’s revised health care bill on Thursday, and the updated legislation included a version of a controversial amendment drafted by Sen. Ted Cruz (R-TX) that would allow insurers to offer cheap, bare-bones plans that cover few health care services as long as at least one plan per state complies with Obamacare’s regulations. To address concerns that Cruz’s amendment would lower prices for the young and healthy by making them skyrocket for the people who need a comprehensive insurance plan or have a pre-existing condition, the amendment purports to allocate billions in additional funding that states could use “to assist such health insurance issuers in covering high risk individuals.”

But as Sen. Susan Collins (R-ME) told reporters on Thursday, there is no additional money. Instead, the amendment takes money already appropriated in the bill for other needs and says it can be used for these payments to insurers under the Cruz Amendment.

“It seems to me you’re using that money over and over again,” she said. “It’s supposed to relieve the cost of high premiums. It’s supposed to solve the problem with deductibles being unaffordable. It’s supposed to be available for high-risk or reinsurance pool. It’s supposed to be available under the Cruz Amendment to help prevent a huge increase in rates for people with pre-existing conditions.”

Matthew Fiedler, a fellow at Brookings Institute’s Center for Health Policy, confirmed this double-dipping to TPM.

“The overall bill adds $70 billion to the stability fund,” he said. “But the Cruz amendment then redirects that same money to make payments to insurers designed to mitigate the problems that the Cruz amendment would create in the ACA-compliant market.”

“That funding will, of course, not be available to serve the stability fund’s other purposes,” he added.

Those other purposes include assisting the people booted off of Medicaid due to hundreds of billions of cuts in funding for the federal health care program, easing their transition into the individual health insurance market. It is also meant to provide funding for health savings accounts (HSA) that people could use to pay their insurance premiums.

Another piece in Huffington Post sums up the latest bill as follows:

At its core, however, the revised version of the Better Care Reconciliation Act ― which McConnell pulled two weeks ago because too few Republican senators planned to vote for it ― remains a vehicle for massive cuts to Medicaid, less financial assistance for people who buy private health insurance, and the return of skimpy junk insurance policies and discrimination against people with pre-existing conditions. Taxes on the rich would remain, but health care companies would enjoy a major tax cut.

This part of the bill is in addition to the sweeping changes the underlying measure would make to the health insurance system, including allowing insurers to sell policies with less coverage but higher deductibles and other out-of-pocket costs than are permitted under the Affordable Care Act.

The bill also would repeal the law’s individual mandate that most Americans obtain health coverage or face a tax penalty and its requirement that large employers offer health benefits to workers.

States would be allowed to waive that law’s requirements for coverage of core benefits ― such as hospitalizations, prescription drugs, maternity care and mental health. This would undermine protections for people with pre-existing conditions, who could be offered plans that don’t cover medical services and products needed to treat their ailments. People whose health coverage lapses for more than 63 days would be locked out of the insurance market for six months.

And insurers could charge older customers five times what they charge younger people, up from three times under the Affordable Care Act.

Today's GOP: The Face of Cruelty

I have often noted that, in my opinion, the Republican Party began its transformation into something hideous when evangelical and fundamentalist Christians began to hijack the party base.  A party that had been moderate on social issues and seemingly had little interest in policing people's bedrooms while pushing for fiscal conservatism became something very different and extreme.  First came near hysteria over abortion even as any form of science based sex education that would have decreased unwanted pregnancies was opposed tooth and claw (many far right Christians still would like to make contraception illegal and see Griswold v. Connecticut, which established a right to privacy in sexual matters, reversed).   This was followed by anti-gay hysteria which continues to this day.  Now, we see open hatred towards Muslims and those of other faiths - and anyone or anything that challenges beliefs based on Bronze Age myths, hence the push for creationism in public education and denial of climate change.  Through it all, the Christofascists as I call them have harbored a thinly disguised racism against anyone who doesn't have white skin.   The cancer has fully metastasized in the GOP even as country club Republicans - and I know many - pretend that the GOP of the 1960's and early 1970's is alive and well.  That party is dead and gone.  Logic, reason, and objective fact no longer matter and this hatred of others permeates GOP policies: the poor are poor because they deserve to be poor; the sick are responsible for their illness because of bad "choices" or their sinfulness; gays deserve abuse and discrimination because they "choose" to be gay; racial minorities deserve no social safety net because they are lazy and less than fully human.  It's a hideous mindset (and anything but Christian), but it explains much about the Republican effort to destroy Obamacare and health care in general.  A column in the New York Times looks at this push for open cruelty.  Here are excerpts:

The basics of Republican health legislation, which haven’t changed much in different iterations of Trumpcare, are easy to describe: Take health insurance away from tens of millions, make it much worse and far more expensive for millions more, and use the money thus saved to cut taxes on the wealthy.

Donald Trump may not get this — reporting by The Times and others, combined with his own tweets, suggests that he has no idea what’s in his party’s legislation. But everyone in Congress understands what it’s all about.

The puzzle — and it is a puzzle, even for those who have long since concluded that something is terribly wrong with the modern G.O.P. — is why the party is pushing this harsh, morally indefensible agenda.

Think about it. Losing health coverage is a nightmare, especially if you’re older, have health problems and/or lack the financial resources to cope if illness strikes. And since Americans with those characteristics are precisely the people this legislation effectively targets, tens of millions would soon find themselves living this nightmare.

Meanwhile, taxes that fall mainly on a tiny, wealthy minority would be reduced or eliminated. These cuts would be big in dollar terms, but because the rich are already so rich, the savings would make very little difference to their lives.

More than 40 percent of the Senate bill’s tax cuts would go to people with annual incomes over $1 million — but even these lucky few would see their after-tax income rise only by a barely noticeable 2 percent.

So it’s vast suffering — including, according to the best estimates, around 200,000 preventable deaths — imposed on many of our fellow citizens in order to give a handful of wealthy people what amounts to some extra pocket change. And the public hates the idea: Polling shows overwhelming popular opposition, even though many voters don’t realize just how cruel the bill really is.

Which brings me back to my question: Why would anyone want to do this?

I won’t pretend to have a full answer, but I think there are two big drivers — actually, two big lies — behind Republican cruelty on health care and beyond.

First, the evils of the G.O.P. plan are the flip side of the virtues of Obamacare. Because Republicans spent almost the entire Obama administration railing against the imaginary horrors of the Affordable Care Act — death panels! — repealing Obamacare was bound to be their first priority. . . . . Republicans, through their political opportunism and dishonesty, boxed themselves into a position that makes them seem cruel and immoral — because they are.

Yet that’s surely not the whole story, because Obamacare isn’t the only social insurance program that does great good yet faces incessant right-wing attack. Food stamps, unemployment insurance, disability benefits all get the same treatment. Why?

As with Obamacare, this story began with a politically convenient lie — the pretense, going all the way back to Ronald Reagan, that social safety net programs just reward lazy people who don’t want to work. And we all know which people in particular were supposed to be on the take [blacks and non-whites].

Now, this was never true . . . . some of the biggest beneficiaries of these safety net programs are members of the Trump-supporting white working class. But the modern G.O.P. basically consists of career apparatchiks who live in an intellectual bubble . . . . Or to put it another way, Republicans start from a sort of baseline of cruelty toward the less fortunate, of hostility toward anything that protects families against catastrophe.

In this sense there’s nothing new about their health plan. What it does — punish the poor and working class, cut taxes on the rich — is what every major G.O.P. policy proposal does. The only difference is that this time it’s all out in the open. . . . . this is what modern Republicans do; this is who they are.

I truly do not understand how a decent, moral person can continue to be a Republican.  Are they so brainwashed by Fox News and so driven by their racism and hatred of others that they simply close their eyes to depriving children and the elderly - and many others - of life-sustaining health care?  I cannot comprehend the mindset - which perhaps is a good thing or else I'd still be a Republican. Coming out as gay and becoming part of a minority that faces daily hatred from "Christians" and others does open one's eyes as to what other minorities face even though the mistreatment and prejudice is different.  I wish more of my Republican "friends" could have the experience. Ultimately, we are all the same: we all bleed, we all have hopes and dreams, and we all have loved ones we seek to protect.  Why is it so impossible for some to see through skin color, sexual orientation or religious belief to our common humanity?

Trumpcare: The Face of Republican Evil

Yesterday the GOP Senate healthcare bill saw the light of day and what could be seen was hideous if one feels any concern for children, the non-wealthy elderly and people with disabilities.   When disabled protesters in wheel chairs massed outside the office of GOP Senate Majority Leader Mitch McConnell to protest the bill, as reported by Think Progress and many other news outlets, Capitol police dragged them out of their wheel chairs, handcuffed and arrested.  Perhaps such treatment of the disabled is just a glimpse at what many disabled will suffer if the GOP Senate "healthcare reform" bill is enacted.  This bill is nothing than a humanitarian disaster to quote several critics.  Not surprisingly, the American Hospital Association has been quick to condemn it, recognizing that it would be a catastrophe for many hospitals, especially those in rural areas.   As explained below, this is very personal to me.  A piece in the New York Times looks at what we now know Republicans seek to inflict on millions of citizens in order to give massive tax breaks to the very wealthy.  Here are excerpts:

The bill is aligned with long-held Republican values, advancing states’ rights and paring back growing entitlement programs, while freeing individuals from requirements that they have insurance and emphasizing personal responsibility. Obamacare raised taxes on high earners and the health care industry, and essentially redistributed that income — in the form of health insurance or insurance subsidies — to many of the groups that have fared poorly over the last few decades.

The draft Senate bill, called the Better Care Reconciliation Act, would jettison those taxes while reducing federal funding for the care of low-income Americans. The bill’s largest benefits go to the wealthiest Americans, who have the most comfortable health care arrangements, and its biggest losses fall to poorer Americans who rely on government support. The bill preserves many of the structures of Obamacare, but rejects several of its central goals.

Like a House version of the legislation, the bill would fundamentally change the structure of Medicaid, which provides health insurance to 74 million disabled or poor Americans, including nearly 40 percent of all children. Instead of open-ended payments, the federal government would give states a maximum payment for nearly every individual enrolled in the program. The Senate version of the bill would increase that allotment every year by a formula that is expected to grow substantially more slowly than the average increase in medical costs. States would continue to receive extra funding for Obamacare’s expansion of Medicaid to more poor adults, but only temporarily. After several years, states wishing to cover that population would be expected to pay a much greater share of the bill, even as they adjust to leaner federal funding for other Medicaid beneficiaries — disabled children, nursing home residents — who are more vulnerable. High-income earners would get substantial tax cuts on payroll and investment income. Subsidies for those low-income Americans who buy their own insurance would decline compared with current law. Low-income Americans who currently buy their own insurance would also lose federal help in paying their deductibles and co-payments.

The bill does offer insurance subsidies to poor Americans who live in states that don’t offer them Medicaid coverage, a group without good insurance options under Obamacare. But the high-deductible plans that would become the norm might continue to leave care out of their financial reach even if they do buy insurance.

Under the bill, states would be able to apply for waivers that would let them eliminate consumer protection regulations, like rules that require all health plans to cover a basic package of benefits or that prevent insurance plans from limiting how much care they will cover in a given year.

States could get rid of the online marketplaces that help consumers compare similar health plans, and make a variety of other changes to the health insurance system. The standards for approval are quite permissive.

Americans with pre-existing conditions would continue to enjoy protection from discrimination: In contrast with the House health bill, insurers would not be allowed to charge higher prices to customers with a history of illness, even in states that wish to loosen insurance regulations.

But patients with serious illnesses may still face skimpier, less useful coverage. States may waive benefit requirements and allow insurers to charge customers more. Someone seriously ill who buys a plan that does not cover prescription drugs, for example, may not find it very valuable.

Subsidies under the bill would help middle-income consumers buy insurance that pays 58 percent of the average patient’s medical costs, down from 70 percent under Obamacare; it would also remove a different type of subsidy designed to lower deductibles further for Americans earning less than around $30,000 a year. Out-of-pocket spending is the top concern of most voters. The insurance they would buy under the bill might seem cheap at first, but it wouldn’t be if they ended up paying more in deductibles.

To me, this displays complete moral depravity - by those who claim to embrace "Christian values" and their supporters like evangelical Christians.  A piece in  Salon looks at how the GOP got this morally bankrupt.  Here are highlights:

In the hellish months since Donald Trump’s inauguration, a dark parlor game of sorts has cropped up in liberal circles that I like to call “Would an Impeachment Even Be Worth It?” With the full acknowledgment that it’s unlikely to happen as long as Republicans are in charge, participants still sip cocktails and ponder out loud the question of whether booting out Trump on his butt would be enough to save our democracy, considering the fact that the Republican slimeball taking his place would invariably sign a bunch of retrograde legislation setting back this country decades.

These discussions break down into two camps: those who think Trump presents a unique threat to our democracy and replacing him with someone in the succession line, like Vice President Mike Pence or House Speaker Paul Ryan, would at least preserve our democratic norms; and those who think the corruption started long before Trump and has spread throughout the Republican Party, rotting it from the inside out.

[M]y view that the Republican Party as a whole is irredeemably antidemocratic has been borne out, yet again, in the process that Senate Majority Leader Mitch McConnell has put into motion to destroy the Affordable Health Act, a process that will likely take out the U.S. health care system as we know it. One could even argue that bog-standard Republicans, under the leadership of Ryan and McConnell, represent an bigger threat to our democracy than Trump, possessing as they do more competence and cunning than the TV-addled overgrown toddler in the White House. McConnell has arranged to have the Senate version of the House’s American Health Care Act . . . . written in secret, with no hearings, no public discussion and no real debate. Republicans are barely even pretending the reason is anything other than the obvious: The bill is so terrible that it defies the will of people of all political stripes and sensibilities, whom legislators supposedly were elected to serve. McConnell’s contempt for the processes, much less the defining principles, of democracy couldn’t be more apparent. But he doesn’t really care. No doubt the election of Trump helped confirm the rising sense among Republicans that they can wipe their collective butts with the Constitution, flip the bird at their constituents and not really worry about losing many seats. Republican voters might not like it, but they like liberals, black people and feminists even less, so they will show up and dutifully vote against the Democrats every time. Losing health care access isn’t great, but for conservative voters, admitting that liberals might have a point is a hell from which there is no escape. . . . bedrock conservative voters don’t care about niceties like the rule of law or government by the people. They just want to punish women for having sex and gripe about “Obama phones,” and don’t care if the price paid is the ultimate ruin of this country.

In 1999/2000 one of my children was stricken with bacterial meningitis.  We were lucky, had purportedly "excellent healthcare coverage"  and my child had a miracle recovery (even if it wiped us out financially).  A key part of her survival was being in close proximity - less than 10 minutes - to a first rate hospital that could stabilize my child before a transport to a world class children's hospital.  If rural and inner city hospitals close thanks to Trumpcare, people will literally die for lack of close proximity to a hospital.  Mere minutes can make a life and death difference.

More recently, one of my grand children was born 2 months early.  He ended up staying in the hospital for a month.  A month earlier, my daughter had been ordered to do bed rest to try to delay his birth. Since Virginia and the USA do not have mandatory paid maternity leave, my daughter lost her heathcare coverage.  Thankfully, she signed up with Medicaid and my grandson had coverage. Without it, he may have died.

Sadly, average Americans simply no longer matter to the GOP, especially those like Mitch McConnell and Paul Ryan.   I'm sorry, but to me, voting Republican is now synonymous with moral bankruptcy.