The GOP’s dramatic change in strategy to pass its health-care law
To get the Affordable Care Act passed, Democrats used a big-tent approach, convening health-care groups that did not normally talk to one another while cutting deals and strong-arming key industry players to build broad support for the plan. First, the drug companies got on board. Then came the hospitals and the doctors.“It was a little thuggish. You’d be at the table or you’d be on the menu,”.. “I think they were largely left out. This was — from what I can tell and, I think, smartly — done behind closed doors,”
.. As GOP lawmakers move their bill through the House, plowing forward without each industry’s blessing may free them from special interests, allowing them to craft a policy that reflects the desires of their voters.
.. Republicans argue that, far from rushed, the broad outlines of the bill have been out in the open since last summer, when House Speaker Paul D. Ryan (R-Wis.) introduced his “A Better Way” proposal.
.. “Our legislation gives the American people the freedom to make their own health care decisions.”
.. PhRMA.The industry trade group agreed to $80 billion in discounts on prescription drugs under Medicare and committed $150 million to an ad campaign to help get the bill passed.Among the concessions it won in return — efforts to control drug prices under the legislation were quashed.
.. The new bill gives the industry a big tax repeal, worth nearly $25 billion over a decade
.. A pharmaceutical industry official said that the industry is not going to be taking such a public or vocal approach this time, because the ACA insurance exchanges represent a tiny fraction of its business... hospitals may feel sidelined because their willingness to take cuts and support Obama’s law is still a sore spot for some Republicans... “Republicans generally feel there’s a lot of fat that can be cut from the hospital industry,” Condeluci said... Under the new bill, insurers would get a huge tax repeal worth $145 billion over a decade, more freedom to charge young people less and old people more for insurance, and a continuous-coverage rule
Decision Time Approaches for Republicans on Replacing Obamacare
A lot of conservatives want to get rid of the Medicaid expansion enacted under Obamacare. If you’re in a state that hasn’t expanded Medicaid, then to be covered you have to be at or under the poverty level. For a family of four, that’s $24,300 or less. If you’re in a state that did expand Medicaid, you qualify if your family of four gets by on $33,534 or less. Right now, 10 million to 11 million people are covered under Medicaid who wouldn’t be covered under the old rules. I’d bet a healthy chunk of those folks voted for Trump.
.. But right now, too many markets don’t have plans that most consumers consider anywhere near “affordable.” (It’s fair to argue whether people have a realistic definition of “affordable” when it comes to on-demand access to the miracles of modern medicine.) The conservative philosophy has argued, correctly, that competition brings prices down. The problem is that in a lot of places, there isn’t much competition at all. In 2016, 85 percent of people using the marketplace on Healthcare.gov had at least three insurers to choose from in their area. This year, it’s down to 57 percent. Even if you believe competition will bring prices down, that rarely happens overnight.
.. He said that Aetna’s heaviest utilizers of health care — the top 1 percent to 5 percent — are driving half of the costs in the exchanges.
.. Even worse, whenever a legislator has the courage to tell the public that trade-offs and compromises are necessary, a political challenger will insist that it is not, that it represents lawmakers being stupid, or spineless, or selling out.
.. In 2018, congressional challengers will declare that if elected, they will give you excellent coverage for all of your health care needs and lower premiums, co-pays, and deductibles, and a tax cut, and a pony. Because it is very easy to promise a better health-care system with no compromises and trade-offs; it is pretty much impossible to deliver it.
As President Trump is no doubt learning.
.. Michael Flynn, who was fired from his prominent White House job last month, has registered with the Justice Department as a foreign agent for $530,000 worth of lobbying work before Election Day that may have aided the Turkish government.
.. How do you “forget” that you did a half-million dollars’ worth of work for a foreign company?
Trump, an Outsider Demanding Loyalty, Struggles to Fill Top Posts
During President Trump’s transition to power, his team reached out to Elliott Abrams for help building a new administration. Mr. Abrams, a seasoned Republican foreign policy official, sent lists of possible candidates for national security jobs.
One by one, the answer from the Trump team came back no. The reason was consistent: This one had said disparaging things about Mr. Trump during the campaign; that one had signed a letter opposing him. Finally, the White House asked Mr. Abrams himself to meet with the president about becoming deputy secretary of state, only to have the same thing happen — vetoed because of past criticism.
.. Even after he won the Republican nomination last year, he did little to win over those who had opposed him,
.. Mr. Trump had “ruled out much of an entire generation of Republican public policy types” and alarmed others with his empowerment of Stephen K. Bannon, his chief strategist, to shape national security. Even some cabinet secretaries appear unable to pick their own staff.
.. For Mr. Trump, the challenge is more pronounced because he and his advisers feel they cannot trust some of the senior career professionals still working at the White House or cabinet departments. Leaks about Mr. Flynn and Mr. Trump’s phone calls with foreign leaders have convinced White House officials that they face an opposition within.
.. Another challenge has been Mr. Trump’s implementation of ethics rules that bar White House officials from lobbying for five years after they leave the government, prompting senior congressional officials and lobbyists to demur.
Onetime Trump Campaign Manager Lewandowski to Launch Consulting Firm
Its offices lie just blocks from the White House on 1717 Pennsylvania Avenue, according to its website–the same building that is currently housing Mr. Trump’s transition team.
.. The launch of a new political consulting firm by top Trump allies clashes with Mr. Trump’s pledge during the campaign to “drain the swamp” in Washington of lobbyists and consultants. Since being elected, Mr. Trump has tapped several top donors and some recently deregistered lobbyists for his transition team and administration posts.
.. “What it will do is it will provide companies opportunities to get a fast answer from the federal government,” he said. “That doesn’t mean it’s the answer they want.”
He added: “Helping provide strategic counsel to companies to get a fast no is more beneficial to them than a long maybe.”
.. Increasingly in recent years, those who previously registered as lobbyists have avoided doing so, calling themselves consultants or advisers instead.