President largely sidesteps the bully pulpit in pushing health-care bill

With the Republican push to revamp the Affordable Care Act stalled again, even some allies of President Trump question whether he has effectively used the bully pulpit afforded by his office and are increasingly frustrated by distractions of his own making.

.. The lackluster sales job, combined with recent controversial tweets and public statements targeting the media, has diminished the focus on the president’s leading legislative priority at a key juncture in the Senate, allies and analysts say.

“It’s a mystery,” said Barry Bennett, a Republican operative who advised Trump’s campaign last year and remains close to the White House. “I don’t know what they’re doing.”

.. Trump’s public efforts to dismantle the health-care law, however, contrast sharply with President Barack Obama’s efforts to build support in advance of its 2010 passage. Obama gave a joint address to Congress on health care. He fielded questions at town hall meetings around the country. And he even bantered on live television with hostile lawmakers at a Republican retreat.

.. Not only has Trump been unsuccessful at swinging public opinion toward the legislation, but also “he hasn’t really tried that much,”

.. It’s not hard to imagine other things Trump could be doing to try to boost support for the GOP plan among the public and, by extension, on Capitol Hill, Bennett said.

Trump could make much better use of Twitter, urging his 33 million followers to call their senators and ask them to back the GOP bill, Bennett said.
.. Trump could have visited several states last week, holding events that highlight the sharp rise in premiums under Obamacare
.. “You use the model that works for you,” Spicer said, noting that Trump has advanced a health-care bill further in the process at this point in his term than Obama. The ACA did not pass until the second year of Obama’s first term.

“We’ve been more efficient,” Spicer said.

Republican Senators Face Pushback From Governors on the Health Bill

That means Republican leaders must flip at least seven of the nine GOP senators who have already said publicly they oppose the bill, a challenge compounded by the recess.

.. In a recent Wall Street Journal/NBC News poll, 16% of respondents said the version of the bill passed by the House was a good idea.

.. Mr. Hutchinson has advocated that the health bill either maintain higher levels of funding or exempt elderly and disabled people from caps on Medicaid spending. Without the extra federal help, he said, he would be forced to end the Medicaid expansion immediately.

.. “Providing extra flexibility to the governors to design programs which are suited for their particular populations is a good thing,” Louisiana Gov. John Bel Edwards, a Democrat, told reporters last week. “But we cannot pretend that giving me all the flexibility in the world will allow me to provide meaningful coverage to the same people who have it today if you give me half as much money.”

Shields and Brooks on GOP’s health care bill gridlock, Trump tweet backlash

The basic problem is that this is a bill that massively redistributes wealth to the rich.

Trump’s Super Pac attacked the most vulnerable member of his party

Brooks: It’s more than unhelpful.  Its a corruption of the public sphere.

Shields: He’s more engaged with Morning Joe than with Healthcare Policy

One of the things that may offend people is Mafioso extortionate behavior: using the National Inquirer to take down opponents.

Shields: this adds to the credibility of James Comey

I remember when Republicans got upset with Bill Clinton for not wearing a suit and tie in the Oval Office


The Good, the Bad, and the Senate Health-Care Bill

It is a function of some things they’ve come to prioritize about the individual health-insurance market and Medicaid, and some things they’ve learned about the intricacies of the Byrd rule and Senate procedural constraints.

.. After seven years of saying they want to repeal and replace Obamacare, congressional Republicans have been forced to confront the fact that many of them, perhaps most, actually don’t quite want to do that.

.. That doesn’t mean that most of them never did. The case for repeal was strongest in the three or four years between the enactment and implementation of Obamacare. As more time passes since the beginning of implementation three and a half years ago, and more people’s lives become intertwined with the program for good and bad, the case for addressing Obamacare’s immense deficiencies by repeal weakens

.. I still think it is very much the case that the cause of good policy (almost regardless of your priorities in health care) would be better served by a repeal and replacement, with appropriate transition measures, than by this sort of tinkering — you’d get more coverage, a better health-financing system, and a more appropriate role for government.

.. The president has been an additional unpredictable political constraint — as the more coherent of his musings on health care have all suggested he is not comfortable with repealing and replacing the law, or at least is unfamiliar with the tradeoffs involved and unhappy when he learns about them.

.. But another thing Republicans have learned in these six months is that Donald Trump is an exceptionally weak president, probably the weakest of their lifetimes, and he is likely to accept whatever they do. He’ll celebrate it, sitting himself front and center while they stand around him awkwardly. He’ll praise it wildly and inaccurately. And he’ll sign it — even if pretty soon thereafter, in the wake of bad press, he tries to distance himself from it on Twitter and calls them names.

.. It is pegged to a less comprehensive insurance model and will both cost less and leave more room for more variation in insurance design — though this obviously means it will be less valuable and helpful to some of the people now getting subsidies.

.. Where today, people newly covered by Obamacare’s Medicaid expansion (who tend to be childless adults with relatively higher incomes than the non-expansion population) are funded by the federal government on much better terms than the traditional Medicaid population (which tends to include more women with children and people with even lower incomes), the Senate bill would gradually equalize funding for the two groups, effectively shifting Medicaid’s focus back to the most vulnerable of its beneficiaries.

.. the Senate bill would provide an income and age-based subsidy that would allow these lowest-income individuals to afford at least modest insurance coverage in the individual market.

.. the Senate bill as written would probably mean that Medicaid would cost the federal government about 30 percent more ten years from now than it does today (as opposed to about 65 percent more under current law), and would cover something like the same number of people at that point as today (as opposed to 10 million more under current law)

.. once states got their bearings about just how much it would allow them to do, we could see some genuinely different approaches to health-insurance regulation among the different states — with blue and red models, rural and urban approaches, and more and less competitive systems.

.. alters a portion of a broader pre-existing statute. But it is very broad. In its scope and structure, this redesigned waiver would be unlike anything else in American federalism — which also means we don’t know how it would work. Those of us inclined to look favorably upon a bottom-up, experimental mindset in policy design will be inclined to think the best of the possibilities here.

.. it looks like this provision would render any insurer who offers an individual-market plan that covers abortion in a given state ineligible to benefit from the stability fund in that state. It seems to me, though I can’t say I’m sure, that this would effectively mean that no insurance plans in the individual market would cover abortion. It could easily even mean that California, which has a state law requiring individual-market plans to cover elective abortion, would have to repeal that law or else forgo access to the stability fund.

The Senate’s Flawed Health-Care Bill

The Senate Republican health-care bill would not repeal and replace Obamacare. The federal government would remain the chief regulator of health insurance. No state would be allowed to experiment with different models for protecting people with pre-existing conditions. Federal policy would continue to push people away from inexpensive catastrophic coverage. The bill also seems unlikely to stabilize insurance markets, even though their current instability is one of the main Republican talking points for passing it. The legislation gets rid of the “individual mandate” — Obamacare’s fines for not buying insurance — but keeps the regulations that made the mandate necessary. The result is likely to be that healthy people leave the market and sick people face much higher premiums.

.. From a conservative perspective, the chief selling point of the bill is Medicaid reform.

.. But the reform is delayed until after the 2024 presidential election.

.. We suspect that the Congressional Budget Office will find that most of the reduction in insurance rolls results from people’s choosing not to buy insurance when they’re not being threatened with fines.

.. The bill’s subsidies for people outside of Medicare, Medicaid, and the employer-based insurance system could simply be given to the states to distribute to that population without having to comply with Obamacare’s regulations.

Understanding Republican Cruelty

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.

.. 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.

.. 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.

.. 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.

.. 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.

.. remember this moment. For this is what modern Republicans do; this is who they are.

Health Care is Complicated. Trump’s Pitch? Not So Much.

If your only source of information was President Trump, this is what you would know about the American Health Care Act, the Republican legislation to repeal and replace Obamacare.

 Trump rarely years from a narrow set of talking points:
Obamacare is dead.  It is a disaster.
It will be great, tremendous, phenomenal.
Premiums will come down.  We will take care of every single need, but it’s not going to cost that kind of money.