The GOP Base Is Beyond Trump’s Control 

You can get elected as an outsider, but once in office, you have to actually govern.

The conservative movement is caught in a Catch-22 of its own making. In the war against “the establishment,” we have made being an outsider the most important qualification for a politician. The problem? Once elected, outsiders by definition become insiders. This isn’t just a semantic point. The Constitution requires politicians to work through the system if they’re going to get anything done.

.. Look at all the senators who rode the tea-party wave into power: Ted Cruz, Rand Paul, Marco Rubio, Ron Johnson, Pat Toomey, Mike Lee. To one extent or another, they are now seen as swamp things, not swamp drainers, by the pitchfork populists.

.. Merely talking like a halfway responsible politician — “we don’t have the votes,” “we have to pay for it” — is proof of selling out. Trump bashes NBC News as ‘Fake News’ on Twitter

.. He wore the animosity of his colleagues, including the GOP leadership, like a badge of honor. He was the leader of the insurrectionists. He had only one problem: He talked like a creature of the establishment — largely because the Princeton- and Harvard-trained former Supreme Court clerk and career politician was one. He knew the lyrics to every populist fight song, but he couldn’t carry the tune.

..But not only did Donald Trump jump into the fray at the height of populist fervor, the field was also divided 17 ways. No one spoke less like a politician. No one who understood how governing works would have promised the things Trump promised —

  • health coverage for all, for less money,
  • eliminate the debt,
  • bring all those jobs back, etc. —

because they’d either know or care that such things are literally impossible.

.. The establishment remains the villain and Trump the hero for his willingness to say or tweet things that make all the right people angry. For his most ardent supporters, the fault for his legislative failures lies entirely with the swamp, the establishment, or the “Deep State.”

.. he most important factor was Moore’s demonization of the establishment, particularly Senate majority leader Mitch McConnell. The voters valued sticking their thumbs in the establishment’s eye more than giving Trump a win.

.. there is remarkably little intellectual or ideological substance to the current populist fever. Strange was more conservative than Moore but less bombastic. Moore opposed Obamacare repeal and, until recently, couldn’t say what DACA was. In other words, MAGA populism is less of an agenda and more of a mood.

The Looming Republican Disgrace Read more at: http://www.nationalreview.com/article/449720/republican-health-care-bill-looming-disgrace?utm_source=Sailthru&utm_medium=email&utm_campaign=NR%20Week%20in%20Review%202017-07-23&utm_term=VDHM

A majority is a terrible thing to waste.

On the cusp of a historic failure, the party has begun the finger-pointing, and it’s hard to argue with any of it.

  • The establishment is right that Trump is incapable of true legislative leadership.
  • The Trumpists are right that the establishment is ineffectual.
  • Conservatives are right that moderates don’t really want to repeal Obamacare, whatever they’ve said in the past.
  • And pragmatists are right that a few conservatives are beholden to a self-defeating purity.

.. At least Collins, an ideological outlier in the Republican Conference, has been consistent. She voted against the repeal-only bill in 2015, and the GOP leadership never thought she was gettable.

.. For Rand Paul, clearly, a perhaps once-in-a-generation opportunity to significantly reform two entitlement programs isn’t as important as scoring cheap points against his colleagues in the cause of getting as many cable hits as possible.

.. it’s particularly important that the Utah senator keep the big picture in view; torpedoing the entire effort over a relatively technical question about the insurance risk pools — Lee’s current posture — would be a disastrous mistake.

GOP opponents to Senate health-care bill see vote delay as an advantage

A vocal conservative opponent of the measure, Sen. Rand Paul, predicted the delay would strengthen critics’ position by giving them more time to mobilize against the bill.

“The longer the bill is out there, the more conservative Republicans are going to discover it is not repeal,” Paul (R-Ky.) said Sunday in an interview with CBS’s “Face the Nation.”

Paul said he spoke with Trump on Friday and suggested the president support repealing the Affordable Care Act and deciding the details of a replacement plan later if the latest version of the bill does not pass.

.. Trump administration officials failed to gain support from influential Republicans such as Nevada Gov. Brian Sandoval (R). Opposition from Sandoval and others will make it easier for undecided Republican senators from those states to vote “no” on the bill, potentially further endangering its prospects.

.. (63 percent) believes it is more important for the government to provide health coverage to low-income people compared with cutting taxes (27 percent). Among Republicans, 48 percent favored cutting taxes, compared with 39 percent who favored providing health coverage for low-income people.

.. “President Trump and I believe the Senate health-care bill strengthens and secures Medicaid for the neediest in our society,” Pence said

.. Collins strongly disagreed in an interview Sunday with CNN.

“You can’t take more than $700 billion out of the Medicaid program and not think that it’s going to have some kind of effect,” she said during an appearance on “State of the Union.”

.. “This bill imposes fundamental, sweeping changes in the Medicaid program, and those include very deep cuts that would affect some of the most vulnerable people in our society, including disabled children and poor seniors. It would affect our rural hospitals and our nursing homes, and they would have a very hard time even staying in existence.”

.. Pence’s speech was criticized by Democrats, health-care advocates and even some Republicans for mischaracterizing the possible ramifications of the GOP bill.

.. During the same speech, the vice president went after Ohio Gov. John Kasich (R), a critic of the legislation, by suggesting his state’s expansion of Medicaid left nearly 60,000 residents with disabilities “stuck on waiting lists, leaving them without the care they need for months or even years.”

The claim alienated many at the meeting, partly because waiting lists for Medicaid’s home- and community-based services were not affected by the program’s expansion under the ACA, and partly because many interpreted Pence’s remark as an overly aggressive shot at Kasich. The Ohio governor’s stance against the bill could shape the position of Sen. Rob Portman (R-Ohio), a pivotal vote for Republicans who is undecided on the current version. Some fear Pence missed an opportunity to woo Portman with his remark against Kasich.

.. Collins estimated Sunday that there are eight to 10 Republican senators with “serious concerns”

.. Health and Human Services Secretary Tom Price and Seema Verma, administrator of the Centers for Medicare and Medicaid Services, worked to undermine that report and a forthcoming analysis by the Congressional Budget Office showing the legislation’s cost and insurance impact.

.. The Avalere study projected marked reductions in federal Medicaid funding to all 50 states, ranging from 27 percent to 39 percent by 2036.

The Simplicity of a Health Deal

The GOP must realize protection for pre-existing conditions is here to stay.

Will the most conservative members of Congress accept that the politics of health care have changed?
.. Will they acknowledge that any reform must include continued protections for pre-existing medical conditions?
.. two camps of defectors from the Senate’s reform bill. One consists of Republican moderates— Rob Portman, Dean Heller, Susan Collins, Lisa Murkowski —who claim the bill is too mean to poor and sick people.
.. With the stakes this high, the Senate leadership will gladly shuffle some money toward opioid treatment, rural health-care providers or Medicaid. So getting the “moderates” on board is simple and transactional. They name a price, they get pork, they vote yes.
.. Sens. Ron Johnson, Mike Lee, Rand Paul and Ted Cruz have been clear from the start that any bill must lower premiums, which involves getting rid of costly ObamaCare mandates. And there is no question that among the most expensive mandates are those designed to protect individuals with pre-existing conditions—in particular “community rating,” which requires insurers to charge the same prices regardless of health status.

The House Freedom Caucus was so intent on getting rid of community rating that it nearly derailed the bill. Only after the conference added an amendment allowing states to apply for waivers from community rating did the most conservative members finally came on board.

..every American remembers two particular provisions of the law—pre-existing conditions and coverage for children up to 26. These policies are simple and sound good. And they have become over the years a new standard in most people’s minds.
..Conservatives will argue their side just needs to do a better job explaining how these mandates drive up costs for everyone, or lower the quality of care.
..conservatives face a choice. They can work with their colleagues to minimize the costs of the mandates (there are innovative ways to do this) and build in different free-market reforms to lower premiums.