Nine months into his first term, President Trump is perfecting a style of leadership commensurate with his campaign promise to disrupt business as usual in Washington. Call it governing by cattle prod.
.. In the face of his own unhappiness, the president is trying to raise the pain level wherever he can.
.. He cares about ratings, praise and success. Absent demonstrable achievements, he reverts to what worked during the campaign, which is to depend on his own instincts and to touch the hot buttons that roused his voters in 2016. As president, he has never tried seriously to reach beyond that base.
.. Trump has managed to turn an issue that once was about police violence in minority communities into a cultural battle about patriotism, the flag and pride in the military. His critics are now on the defensive.
.. There’s little doubt that part of the president’s motivation is to undo what former president Barack Obama did. He campaigned against Obamacare, although his prescriptions for what should replace it lacked consistency or, for that matter, clear alternatives
.. he has decided to force Congress to act on whether to fund the insurance subsidies that help lower-income Americans purchase health insurance. That’s another way he’s trying to bring the Democrats to the table,
.. Trump is trying to ratchet up attention to those problems but by threatening to walk away from the nuclear agreement has created a rift with U.S. partners
.. Foreign policy experts worry that by opening up a new confrontation with Iran, the administration may be stretching its capacity to handle both matters with the patience, skill and delicacy they require.
.. The president has proved himself capable and willing to start controversies and policy confrontations. That’s what being a disrupter is all about. But there is more to the presidency than initiating conflict, and on that measure, Trump has much to prove.
Cruelty, Incompetence and Lies
Graham-Cassidy, the health bill the Senate may vote on next week, is stunningly cruel. It’s also incompetently drafted: The bill’s sponsors clearly had no idea what they were doing when they put it together. Furthermore, their efforts to sell the bill involve obvious, blatant lies.
The Affordable Care Act, which has reduced the percentage of Americans without health insurance to a record low, created a three-legged stool:
- regulations that prevent insurers from discriminating against people with pre-existing conditions,
- a requirement that individuals have adequate insurance (and thus pay into the system while healthy)
- and subsidies to make that insurance affordable. For the lowest-income families, insurance is provided directly by Medicaid.
Graham-Cassidy saws off all three legs of that stool.
- it eliminates the individual mandate.
- sharply reduces funding relative to current law, and especially penalizes states that have done a good job of reducing the number of uninsured.
- And it effectively eliminates protection for Americans with pre-existing conditions.
Did Graham-Cassidy’s sponsors know what they were doing when putting this bill together? Almost surely not, or they wouldn’t have produced something that everyone, and I mean everyone, who knows anything about health care warns would cause chaos.
Republicans are trying to ram the bill through before the Congressional Budget Office has time to analyze it — an attempt that is in itself a violation of all previous norms, and amounts to an admission that the bill can’t bear scrutiny.
.. Lindsey Graham, Bill Cassidy, and the bill’s other sponsors have responded to these critiques the old-fashioned way — with lies.
.. Cassidy has also circulated a spreadsheet that purports to show most states actually getting increased funding under his bill. But the spreadsheet doesn’t compare funding with current law, which is the relevant question.
.. That’s actually a well-known dodge, one that Republicans have been using since Newt Gingrich tried to gut Medicare in the 1990s. As everyone in Congress — even Cassidy — surely knows, such comparisons drastically understate the real size of cuts, since under current law spending is expected to rise with inflation and population growth.
.. Republicans are desperate to destroy President Barack Obama’s legacy in any way possible, no matter how many American lives they ruin in the process.
.. most Republican legislators neither know nor care about policy substance. This is especially true on health care, where they never tried to understand why Obamacare looks the way it does, or how to devise a nonvicious alternative.
.. the evasions and lies we’re seeing on this bill have been standard G.O.P. operating procedure for years. The trick of converting federal programs into block grants, then pretending that this wouldn’t mean savage cuts, was central to every one of Paul Ryan’s much-hyped budgets.
.. Graham-Cassidy isn’t an aberration; it’s more like the distilled essence of everything wrong with modern Republicans.
.. But even if the handful of Republican senators who retain some conscience block it — we’re looking at you, John McCain — the underlying sickness of the G.O.P. will remain.
Health Insurers Plan Rate Hikes for Obamacare Exchanges
The health insurers’ rate hikes reflect the continuing collapse of Obamacare, as many state Obamacare exchanges continue to experience insurers exiting the Obamacare exchanges. Insurers also remain concerned about President Donald Trump’s potential decision to discontinue subsidies for health insurers to lower the cost of premiums. Conservatives argue that the Obamacare subsidies amount to handouts to large health conglomerates.
.. Sen. Tim Kaine (D-VA) argues that Republicans’ attempt to repeal Obamacare, as well as President Trump’s threat to remove subsidies to health insurers, created the health insurance rate hikes. Kaine said, “These actions, these statements, these inactions, this uncertainty, has created a huge set of chaos in the individual marketplace leading to instability for insurance carriers, higher premiums, and reduced competition
.. Kevin Lewis, the chief executive at Maine Community Health Options, said that its 19.6 percent increase in 2018 arises from healthy people exiting the Obamacare markets.
Wrecking the Ship of State
as insurers themselves have been explaining, the problem is the uncertainty created by Trump and company, especially the failure to make clear whether crucial subsidies will be maintained. In North Carolina, for example, Blue Cross Blue Shield has filed for a 23 percent rise in premiums, but declared that it would have asked for only 9 percent if it were sure that cost-sharing subsidies would continue.
.. So why hasn’t it received that assurance? Is it because Trump believes his own assertions that he can cause Obamacare to collapse, then get voters to blame Democrats? Or is it because he’s too busy rage-tweeting and golfing to deal with the issue?
..Or take the remarkable decision to take Saudi Arabia’s side in its dispute with Qatar .. there are no good guys in this quarrel, but every reason for the U.S. to stay out of the middle.
.. So what was Trump doing? There’s no hint of a strategic vision; some sources suggest that he may not even have known about the large U.S. base in Qatar and its crucial role.
.. The most likely explanation of his actions .. is that the Saudis flattered him — the Ritz-Carlton projected a five-story image of his face on the side of its Riyadh property — and their lobbyists spent large sums at the Trump Washington hotel.
.. it’s worth considering that Trump apparently ranted to European Union leaders about the difficulty of setting up golf courses in their nations. So maybe it was sheer petulance.