Tag Archives: Congress

Analysis: The outsider dealmaker faltering in White House

Donald Trump campaigned as an outsider — celebrating his lack of political experience by selling himself as a dealmaker willing to buck Republican orthodoxy and his own party’s leadership. He alone would reshape Washington.

He’s tried governing the same way.

His actions are a blitz.

He rarely consults old Washington hands.

And he hangs the threat of retribution over anyone who challenges him.

And now he and his party have been dealt a stinging defeat on a signature campaign promise, a defeat that further weakens a president whose approval rating has hovered under 40 percent and humiliates Republicans who have pledged for seven long years to undo President Barack Obama’s health care law.

Trump’s haphazard approach to the health care bill — first demanding a House vote despite an uncertain result, then suddenly suggesting he’d support a future bipartisan solution — underscored Trump’s political identity: He is seemingly uninterested in leading a political party or unifying the federal government.

The failed vote — despite Republican control of the White House and both houses of Congress — highlighted severe cracks within the GOP that Trump’s presidency won’t easily mend.

Trump now wants to turn to tax reform, an ambitious, complicated plan at the center of his agenda, and he does so wounded by the health care collapse as well as the uncertain legal status of his travel ban and an ongoing federal investigation into possible contacts and coordination between his campaign aides and Russian officials.

The loss exposed a limit to Trump’s go-it-alone style, one forged over decades in the business world and seemingly proven effective by his improbable win.

The novice campaigner used the sheer force of his celebrity and personality to draw loyal supporters and frequently bend the Republican Party to his whims.

He defied the party leadership repeatedly, skipped a debate, refused to sign a loyalty pledge and turned the scathing power of his Twitter account on fellow Republicans even after he clinched the nomination and the party pined for unity.

Experts say Trump’s style has hurt his ability to govern effectively.

“Donald Trump’s ‘Art of the Deal’ doesn’t work in Washington. Politics is a profession and you have to know how to collect votes,” said Douglas Brinkley, a presidential historian at Rice University. “Trump is a salesperson and he oversold what he can get done.”

Brinkley said Trump’s failure stood in stark contrast to the master negotiations conducted by presidents Franklin D. Roosevelt and Lyndon Johnson, who enjoyed majorities in both houses of Congress and achieved sweeping legislative accomplishments.

Instead, Trump’s initial struggles were reminiscent of the problems Jimmy Carter faced when he declared that his fellow Democrats were “an albatross around my neck” while facing intraparty rebellion.

More than two dozen members of the House Freedom Caucus oppose the health care plan because they say it doesn’t go far enough to undo Obamacare.

Some moderate Republicans, meanwhile, were turned off by a recent Congressional Budget Office analysis predicting 24 million people would lose coverage in a decade.

Republicans seemed willing to risk Trump’s wrath, taking comfort in the political safety their deep-red home districts provide against his possible attacks.

Trump was once a Democrat. He favored abortion rights most of his adult life and espoused views on trade similar to those of liberal Democratic presidential candidate Bernie Sanders.

He often doesn’t work in specifics, allowing supporters to read in what they want and he abruptly shifts stances — like when he abandoned his vow to send Hillary Clinton to prison — yet rarely losing support of his loyal backers. That degree of unpredictability gave some credibility to his ultimatum to force a vote or keep Obamacare in place, despite his years-long crusade against it.

Trump’s commitment to the bill seemed wavering. He said “there were things in this bill that I didn’t particularly like” and, for the first time, suggested that he would support a bipartisan health care measure.

He also claimed that “I’ve never said repeal and replace Obamacare within 64 days,” a surprising statement considering he vowed to do so “on day one” nearly every night on the campaign trail.

Though Trump publicly abstained from blaming House Speaker Paul Ryan, the White House suggested some fault lay with members who opposed the measure. That act of political defiance should seem familiar to the occupant of the White House, according to one longtime Trump ally.

“The people who are defeating this are the ones most like Trump — ones willing to break from the pack,” said former House Speaker Newt Gingrich, who also questioned the wisdom of setting a hard deadline to pass the legislation.

“If it was a negotiating tactic, it wasn’t a good one,” said Gingrich, who suggested that relations between Trump and Ryan, always strained, would get worse.

“The president feels burned. I suspect you’ll see him far more engaged on matters like tax reform, which he is passionate about. But it will be more complicated now.”

Republican leaders’ failure to get the health plan through the House, a task considered easier than in the Senate, may portend even greater difficulty in passing complicated tax reform and the rest of Trump’s ambitious agenda.

“Doing big things is hard,” said Ryan.

No vote on health care: A humiliating defeat for Trump

In a humiliating failure, President Donald Trump and GOP leaders yanked their bill to repeal “Obamacare” off the House floor when it became clear it would fail badly — after seven years of nonstop railing against the health care law.

Democrats said Americans can “breathe a sigh of relief.”

Trump said Obama’s law was imploding “and soon will explode.”

Thwarted by two factions of fellow Republicans, from the center and far right, House Speaker Paul Ryan said President Barack Obama’s health care law, the GOP’s No. 1 target in the new Trump administration, would remain in place “for the foreseeable future.”

It was a stunning defeat for the new president after he had demanded House Republicans delay no longer and vote on the legislation, pass or fail.

His gamble failed.

Instead Trump, who campaigned as a master deal-maker and claimed that he alone could fix the nation’s health care system, saw his ultimatum rejected by Republican lawmakers who made clear they answer to their own voters, not to the president.

He had“never said repeal and replace it in 64 days,” a dejected but still combative Trump said at the White House.

However, he had repeatedly shouted during the presidential campaign that it was going down “immediately.”

The bill was withdrawn just minutes before the House vote was to occur and lawmakers said there were no plans to revisit the issue.

Republicans will try to move ahead on other agenda items, including overhauling the tax code, though the failure on the health bill can only make whatever comes next immeasurably harder.

Trump pinned the blame on Democrats.

“With no Democrat support we couldn’t quite get there,” he told reporters in the Oval Office. “We learned about loyalty, we learned a lot about the vote-getting process.”

The Affordable Care Act was approved in 2010 with no Republican votes.

Despite reports of backbiting from administration officials toward Ryan, Trump said: “I like Speaker Ryan. … I think Paul really worked hard.”

For his part, Ryan told reporters: “We came really close … but we came up short. … This is a disappointing day for us.”

But when asked how Republicans could face voters after their failure to make good on years of promises, Ryan quietly said: “It’s a really good question. I wish I had a better answer for you.”

Last fall, Republicans used the issue to gain and keep control of the White House, Senate and House. During the previous years, they had cast dozens of votes to repeal Obama’s law in full or in part, but when they finally got the chance to pass a repeal version that actually had a chance to become law, they couldn’t deliver.

Democrats could hardly contain their satisfaction.

The outcome leaves both Ryan and Trump weakened politically.

For the president, this piles a big early congressional defeat onto the continuing inquiries into his presidential campaign’s Russia connections and his unfounded wiretapping allegations against Obama.

Ryan was not able to corral the House Freedom Caucus, the restive band of conservatives that ousted the previous speaker. Those Republicans wanted the bill to go much further, while some GOP moderates felt it went too far.

Instead of picking up support, the bill went the other direction, with several key lawmakers coming out in opposition. Rep. Rodney Frelinghuysen of New Jersey, chairman of a major committee, Appropriations, said the bill would raise costs unacceptably on his constituents.

The defections raised the possibility that the bill would not only lose on the floor, but lose big.

The GOP bill would have eliminated the Obama statute’s unpopular fines on people who do not obtain coverage and would also have removed the often-generous subsidies for those who purchase insurance.

Republican tax credits would have been based on age, not income like Obama’s, and the tax boosts Obama imposed on higher-earning people and health care companies would have been repealed. The bill would have ended Obama’s Medicaid expansion and trimmed future federal financing for the federal-state program, letting states impose work requirements on some of the 70 million beneficiaries.

The nonpartisan Congressional Budget Office said the Republican bill would have resulted in 24 million additional uninsured people in a decade and lead to higher out-of-pocket medical costs for many lower-income and people just shy of age 65 when they would become eligible for Medicare. The bill would have blocked federal payments for a year to Planned Parenthood.

Republicans had never built a constituency for the legislation, and in the end the nearly uniform opposition from hospitals, doctors, nurses, the AARP, consumer groups and others weighed heavily with many members. On the other side, conservative groups including the Koch outfit argued the legislation did not go far enough in uprooting Obamacare.

Ryan made his announcement to lawmakers at a very brief meeting, where he was greeted by a standing ovation in recognition of the support he still enjoys from many lawmakers.

When the gathering broke up, Rep. Greg Walden of Oregon, chairman of the Energy and Commerce Committee that helped write the bill, told reporters: “”We gave it our best shot. That’s it. It’s done. D-O-N-E done. This bill is dead.”

Move to dump essential benefits could strand chronically ill

A last-minute attempt by conservative Republicans to dump standards for health benefits in plans sold to individuals would probably lower the average consumer’s upfront insurance costs, such as premiums and deductibles, said experts on both sides of the debate to repeal and replace the Affordable Care Act.

But, they add, it will likely also induce insurers to offer much skimpier plans, potentially excluding the gravely ill, and putting consumers at greater financial risk if they need care.

For example, a woman who had elected not to have maternity coverage could face financial ruin from an unintended pregnancy. A healthy young man who didn’t buy drug coverage could be bankrupted if diagnosed with cancer requiring expensive prescription medicine. Someone needing emergency treatment at a non-network hospital might not be covered.

What might be desirable for business would leave patients vulnerable.

“What you don’t want if you’re an insurer is only sick people buying whatever product you have,” said Christopher Koller, president of the Milbank Memorial Fund and a former Rhode Island insurance commissioner. “So the way to get healthy people is to offer cheaper products designed for the healthy people.”

Such a change could give carriers wide room to do that by eliminating or shrinking “essential health benefits” including hospitalization, prescription drugs, mental health treatment and lab services from plan requirements — especially if state regulators don’t step in to fill the void, analysts said.

As part of the push by House GOP leaders to gain more support for their plan, they amended the bill Thursday  to allow states to decide, starting next year, what if any benefits  insurers must provide on the individual market, rather than requiring health plans to include the law’s essential health benefits, according to House Ways and Means Chairman Kevin Brady (R-Texas).

The Affordable Care Act requires companies selling coverage to individuals and families through online marketplaces to offer 10 essential benefits, which also include maternity, wellness and preventive services — plus emergency room treatment at all hospitals. Small-group plans offered by many small employers also must carry such benefits.

Conservative House Republicans want to exclude the rule from any replacement, arguing it drives up cost and stifles consumer choice.

On Thursday, President Donald Trump agreed after meeting with members of the conservative Freedom Caucus to leave it out of the measure under consideration, said White House Press Secretary Sean Spicer. “Part of the reason that premiums have spiked out of control is because under Obamacare, there were these mandated services that had to be included,” Spicer told reporters.

Pushed by Trump, House Republican leaders agreed late Thursday to a Friday vote on the bill but were still trying to line up support.

“Tomorrow we will show the American people that we will repeal and replace this broken law because it’s collapsing and it’s failing families,” said House Speaker Paul Ryan, R-Wis. “And tomorrow we’re proceeding.” When asked if he had the votes, Ryan didn’t answer and walked briskly away from the press corps.

But axing essential benefits could bring back the pre-ACA days when insurers avoided expensive patients by excluding services they needed, said Gary Claxton, a vice president and insurance expert at the Kaiser Family Foundation. (Kaiser Health News is an editorially independent program of the foundation.)

“They’re not going to offer benefits that attract people with chronic illness if they can help it,”said Claxton, whose collection of old insurance policies shows what the market looked like before.

One Aetna plan didn’t cover most mental health or addiction services — important to moderate Republicans as well as Democrats concerned about fighting the opioid crisis. Another Aetna plan didn’t cover any mental health treatment. A HealthNet plan didn’t cover outpatient rehabilitative services.

Before the ACA most individual plans didn’t include maternity coverage, either.

The House replacement bill could make individual coverage for the chronically ill even more scarce than a few years ago because it retains an ACA rule that forces plans to accept members with preexisting illness, analysts said.

Before President Barack Obama’s health overhaul, insurers could reject sick applicants or charge them higher premiums.

Lacking that ability under a Republican law but newly able to shrink benefits, insurers might be more tempted than ever to avoid covering expensive conditions. That way the sickest consumers wouldn’t even bother to apply.

“You could see even worse holes in the insurance package” than before the ACA, said Sabrina Corlette, a research professor at the Center on Health Insurance Reforms at Georgetown University. “If we’re going into a world where a carrier is going to have to accept all comers and they can’t charge them based on their health status, the benefit design becomes a much bigger deal” in how insurers keep the sick out of their plans, she said.

Michael Cannon, an analyst at the libertarian Cato Institute and a longtime Obamacare opponent, also believes dumping essential benefits while forcing insurers to accept all applicants at one “community” price would weaken coverage for chronically ill people.

“Getting rid of the essential health benefits in a community-rated market would cause coverage for the sick to get even worse than it is under current law,” he said. Republicans “are shooting themselves in the foot if they the offer this proposal.”

Cannon favors full repeal of the ACA, allowing insurers to charge higher premiums for more expensive patients and helping consumers pay for plans with tax-favored health savings accounts.

In an absence of federal requirements for benefits, existing state standards would become more important. Some states might move to upgrade required benefits in line with the ACA rules but others probably won’t, according to analysts.

“You’re going to have a lot of insurers in states trying to understand what existing laws they have in place,” Koller said. “It’s going to be really critical to see how quickly the states react. There are going to be some states that will not.”

Mary Agnes Carey and Phil Galewitz contributed to this story.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation. This is published here under a Creative Commons license.

American Medical Association urges defeat of House health care bill

Citing projections that millions of people would lose coverage if the American Health Care Act were to become law, the American Medical Association urged members of Congress to oppose the amended legislation.

The AMA, in a press statement, said it would continue working with Congress to increase the number of Americans with quality, affordable health insurance, but the bill, as currently drafted, pushes policy in the wrong direction.

The AMA is nation’s largest physician group.

“Health insurance coverage is critically important,” the AMA stated in a letter to House members. “Without it, millions of American families could be just one serious illness or accident away from losing their home, business, or life savings.

“The AMA has long supported the availability of advanceable and refundable tax credits, inversely related to income, as a means to assist individuals and families to purchase health insurance.  The credits proposed under the AHCA are significantly less generous for those with the greatest need than provided under current law.  The reduced purchasing power with the AHCA tax credits will put insurance coverage out of reach for millions of Americans.”

The letter continued: “We also remain deeply concerned with the reduction of federal support for the Medicaid program and the resulting significant loss of coverage.  Medicaid expansion has provided access to critical services, including mental health and substance abuse treatment, for millions.  Not only will the AHCA force many states to roll back coverage to these millions of previously ineligible individuals, but the significant reduction in federal support for the program will inevitably have serious implications for all Medicaid beneficiaries, including the elderly, disabled, children, and pregnant women, as well.”

The letter concluded: “We continue to stand ready to work with Congress on proposals that will increase the number of Americans with quality, affordable health insurance coverage but, for the reasons cited above, urge members to oppose the American Health Care Act.”

Last week, the AMA launched a new website, patientsbeforepolitics.org, aimed at encouraging physicians and patients to join the effort to increase access to affordable, meaningful coverage for all Americans.

The interactive site provides the information on health care legislation moving through Congress, as well as the AMA’s efforts to help “shape the future of U.S. health care.”

In January, the AMA released its health system reform objectives — primary among them that people who currently have insurance should not become uninsured — and shared them with members of Congress.

Spring storm: Activists gathered outside Ryan’s Racine office to protest health care plan

About 250 people from Illinois and Wisconsin assembled outside House Speaker Paul Ryan’s office in Racine March 14 to demand he drop his health care repeal plan.

The demonstration took place days after the Congressional Budget Office’s analysis showed the House GOP health plan would cause 24 million Americans to lose their health coverage.

People from Fair Economy Illinois and the Jane Addams Senior Caucus joined with members of Citizen Action of Wisconsin — all People’s Action organizations — and with SEIU Healthcare Wisconsin and the Wisconsin Alliance for Retired Americans.

Protesters marched from Racine’s Monument Square on Main Street to Ryan’s office with cans of dog and cat food — the kind of lunch organizers say some seniors will have  if House Republicans pass their health plan is passed.

Outside the speaker’s office, people shared stories and fears of living without health insurance.

Reggie Griffin, of Chicago, is in his 70s and works as a home caregiver. He said he would be devastated by the defunding of Medicare because of chronic health conditions. “I want to live a life of dignity,” Griffin said, according to a news release from organizers of the protest. “There are some members of Congress, like Speaker Paul Ryan, who think I don’t deserve to live with dignity.”

“This is a huge test for our democracy, because the Republican repeal can’t survive once the people understand it’s true implications,” said Robert Kraig, executive director for Citizen Action of Wisconsin.

“This attack on seniors and families will devastate Midwest communities. It is irresponsible and ruthless,” added Anna Marin, manager of civic engagement for the Jane Addams Senior Caucus.

One of the speakers at yesterday’s action, Tammy Wolfgram, is a small business owner from Hartland.

Before the passage of the Affordable Care Act, Wolfgram, her husband and her daughter could not find any health insurance company that would sell them coverage because all three had pre-existing conditions.

She said they struggled to afford costly insurance with high deductibles on Wisconsin’s high-risk pool.

“If ACA is repealed, I don’t know what we will do,” Wolfgram said.

A report by the Congressional Budget Office released this week shows 14 million people will lose their insurance coverage by next year and 24 million by 2026.

“Anyone who believed GOP promises that people would still have health insurance under the Republican repeal plan now know that they were lied to; they are going to be left out in the cold,” said LeeAnn Hall, co-director of People’s Action and executive committee member of Health Care for America Now.

Deciphering CBO’s estimates on the Republicans’ health bill

The Congressional Budget Office is out with its estimate of what effects the Republican health bill, “The American Health Care Act,” would have on the nation’s health care system and how much it would cost the federal government.

The GOP plan is designed to partially repeal and replace the Affordable Care Act passed during the Obama administration.

Here are some of the CBO highlights:

• $337 billion reduction in the deficit. That’s CBO’s estimate over the next decade, taking into account both decreased government spending in the form of less help to individuals to purchase insurance and lower payments to states for the Medicaid program. It also includes decreased revenue from the repeal of the taxes imposed by the ACA to pay for the new benefits.

• 24 million more people without insurance in a decade. The federal budget experts estimate that people will lose insurance and that the drop will kick in quickly. In 2018, they say 14 million more people would join the ranks of the uninsured. It would reach the 24 million by 2026, when “an estimated 52 million people would be uninsured, compared with 28 million who would lack insurance that year under current law.”

• 15 percent of Planned Parenthood clinic patients would “lose access to care.” These patients generally live in areas without other sources of medical care for low-income people. The Republican bill would cut out Medicaid funding for Planned Parenthood for a year.

• 15 to 20 percent increase in 2018 premiums, but relief would follow. Monthly costs for insurance would go up at first, due to the elimination of the requirement for most people to have insurance or else pay a tax penalty. After 2018, CBO estimates that average premiums would actually drop by 10 percent by 2026 compared to current law. That is because the lower prices for younger people would encourage more to sign up. By contrast, the law would “substantially [raise] premiums for older people.”

• 95 percent of people who are getting Medicaid through the health law’s expansion would lose that enhanced federal funding. The CBO estimates that only 5 percent of enrollees in the expansion program would remain eligible for the higher federal payments by 2024, since the bill would phase out those payments to states as patients cycle in and out of eligibility.

• 14 million fewer Medicaid enrollees by 2026. That’s 17 percent fewer than projected under current law. The projection includes people who are currently eligible and would lose coverage, as well as people who might have become eligible if more states, as expected, expanded coverage under the ACA. CBO projects that is unlikely to happen now.

• $880 billion drop in federal Medicaid spending over the decade. That comes primarily by imposing, for the first time, a cap on federal contributions to the program for those with low incomes.

Published under a Creative Commons license. Kaiser Health News, a nonprofit health newsroom whose stories appear in news outlets nationwide, is an editorially independent part of the Kaiser Family Foundation.

 

House GOP health bill jettisons insurance mandate, much of Medicaid expansion

House Republicans unveiled their much anticipated health law replacement plan Monday, slashing the law’s Medicaid expansion and scrapping the mandate that individuals purchase coverage or pay a fine. But they opted to continue providing tax credits to encourage consumers to purchase coverage, although they would configure the program much differently than the current law.

The legislation would keep the health law’s provisions allowing adult children to stay on their parents’ health insurance plan until age 26 and prohibiting insurers from charging people with preexisting medical conditions more for coverage as long as they don’t let their insurance lapse.  If they do, insurers can charge a flat 30 percent late-enrollment surcharge on top of the base premium, under the Republican bill.

In a statement, House Speaker Paul Ryan (R-Wis.) said the proposal would “drive down costs, encourage competition, and give every American access to quality, affordable health insurance. It protects young adults, patients with preexisting conditions, and provides a stable transition so that no one has the rug pulled out from under them.”

The GOP plan, as predicted, kills most of the law’s taxes and fees and would not enforce the so-called employer mandate, which requires certain employers to provide a set level of health coverage to workers or pay a penalty.

Democrats quickly condemned the bill. “Tonight, Republicans revealed a Make America Sick Again bill that hands billionaires a massive new tax break while shifting huge costs and burdens onto working families across American,” House Minority Leader Nancy Pelosi tweeted. “Republican will force tens of millions of families to pay more for worse coverage — and push millions of Americans off of health coverage entirely.”

The legislation has been the focus of intense negotiations among different factions of the Republican Party and the Trump administration since January. The Affordable Care Act passed in 2010 without a single Republican vote, and the party has strongly denounced it ever since, with the House voting more than 60 times to repeal Obamacare. But more than 20 million people have gained coverage under the law, and President Donald Trump and some congressional Republicans have said they don’t want anyone to lose their insurance.

When Republicans took control of both Congress and the White House this year, they did not have an agreement on the path for replacement, with some lawmakers from states that have expanded Medicaid concerned about the effect of repeal and the party’s conservative wing pushing hard to jettison the entire law.

Sen. Rand Paul (R-Ky.), one of those favoring a full repeal, tweeted: “Still have not seen an official version of the House Obamacare replacement bill, but from media reports this sure looks like Obamacare Lite!”

Complicating the effort is the fact that Republicans have only 52 seats in the Senate so they cannot muster the 60 necessary to overcome a Democratic filibuster. That means they must use a complicated legislative strategy called budget reconciliation that allows them to repeal only part of the ACA that affect federal spending.

Beginning in 2020, the GOP plan would provide tax credits to help people pay for health insurance based on household income and age, with a limit of $14,000 per family. Each member of the family would accumulate credits, ranging from $2,000 for an individual under 30 to $4,000 for people ages 60 and higher. The credits would begin to diminish after individuals reached an income of $75,000 — or $150,000 for joint filers.

Consumers also would be allowed to put more money into tax-free health savings accounts and would lift the $2,500 cap on flexible savings accounts beginning in 2018.

The legislation would allow insurers to charge older consumers as much as five times more for coverage than younger people. The health law currently permits a three-to-one ratio.

Community health centers would receive $422 million in additional funding in 2017 under the legislation, which also places a one-year freeze on funding for Planned Parenthood and prohibits the use of tax credits to purchase health insurance that covers abortion.

Both the Energy and Commerce and Ways and Means Committees are scheduled to mark up the legislation Wednesday. The committees do not yet have any Congressional Budget Office analysis of how much the legislation would cost or how many people it would cover.

Party leaders have said they want to have the bill to President Trump next month.

In a statement, senior Democrats on both panels said the measure would charge consumers “more money for less care. It would dramatically drive up health care costs for seniors. And repeal would ration care for more than 70 million Americans, including seniors in nursing homes, pregnant women and children living with disabilities by arbitrarily cutting and capping Medicaid,” said Rep. Frank Pallone of New Jersey and Rep. Richard Neal of Massachusetts.

The House GOP plan makes dramatic changes to Medicaid, the state-federal health insurance program that covers 70 million low-income Americans. The program began in 1965 as an entitlement — which means federal and state funding is ensured regardless of cost and enrollment. But the Republican bill would cap federal funding for Medicaid for the first time.

The federal government picks up between half and 70 percent of Medicaid costs. The percentage varies based on the relative wealth of the state.

Under the GOP plan, federal funding would be based on what the government spent in the fiscal year that ended Sept. 30. Those amounts would be adjusted annually based on a state’s enrollment and medical inflation.

Currently, federal payments to states also take into account how generous the state’s benefits are and what rate it uses to pay providers. That means states like New York and Vermont get higher funding than states like Nevada and New Hampshire and those differences would be locked in for future years.

Republicans have pushed to cap federal funding to states in return for giving them more control in running the program.

The legislation also affects the health law’s expansion of Medicaid, in which the federal government provided enhanced funding to states to widen eligibility. The bill would also end that extra funding for anyone enrolling under the expansion guidelines starting in 2020. But the legislation would let states keep the extra funding Obamacare provided for individuals already in the expansion program who stay enrolled.

About 11 million Americans have gained Medicaid coverage since 2014.

Changing the expansion program is a delicate balance for the Republicans. Four GOP senators from states that took that option said Monday they would oppose any legislation that repealed the expansion.

“We are concerned that any poorly implemented or poorly timed change in the current funding structure in Medicaid could result in a reduction in access to life-saving health care services,” Sens. Rob Portman of Ohio, Shelley Moore Capito of West Virginia, Cory Gardner of Colorado and Lisa Murkowski of Alaska wrote in a letter to Majority Leader Mitch McConnell.

Provided under a creative commons license by Kaiser Health News. Kaiser Health News, a nonprofit health newsroom whose stories appear in news outlets nationwide, is an editorially independent part of the Kaiser Family Foundation

Trump hotel may be political capital of the nation’s capital

At a circular booth in the middle of the Trump International Hotel’s balcony restaurant, President Donald Trump dined on his steak — well-done, with ketchup — while chatting with British Brexit politician Nigel Farage.

A few days later, major Republican donors Doug Deason and Doug Manchester, in town for the president’s address to Congress, sipped coffee at the hotel with Rep. Darrell Issa, R-Calif.

After Trump’s speech, Treasury Secretary Steven Mnuchin returned to his Washington residence — the hotel — and strode past the gigantic American flag in the soaring lobby. With his tiny terrier tucked under an arm, Mnuchin stepped into an elevator with reality TV star and hotel guest Dog the Bounty Hunter, who particularly enjoyed the Trump-stamped chocolates in his room.

It’s just another week at the new political capital of the nation’s capital.

The $200 million hotel inside the federally owned Old Post Office building has become the place to see, be seen, drink, network — even live — for the still-emerging Trump set. It’s a rich environment for lobbyists and anyone hoping to rub elbows with Trump-related politicos — despite a veil of ethics questions that hangs overhead.

“I’ve never come through this lobby and not seen someone I know,” says Deason, a Dallas-based fundraiser for Trump’s election campaign.

For Republican Party players, it’s the only place to stay.

“I can tell you this hotel will be the most successful hotel in Washington, D.C.,” says Manchester, adding that he would know because he has developed the second-largest Marriott and second-largest Hyatt in the world. Manchester says Trump’s hotel will attract people based on its location near the White House and Congress, the quality renovation and the management team.

Then there’s also the access.

Although Trump says he is not involved in the day-to-day operations of his businesses, he retains a financial interest in them. A stay at the hotel gives someone trying to win over Trump on a policy issue or political decision a potential chit.

That’s what concerns ethics lawyers who had wanted Trump to sell off his companies as previous presidents have done.

“President Trump is in effect inviting people and companies and countries to channel money to him through the hotel,” said Kathleen Clark, a former ethics lawyer for the District of Columbia and a law professor at Washington University in St. Louis.

She said the “pay to play” danger is even greater than it would be if people wanted to donate to a campaign to influence a politician’s thinking. Spending money at a Trump property “is about personally enriching Donald Trump, who happens to be the president of the United States.”

The White House strongly disputes there’s any ethical danger in Trump’s business arrangements.

Trump can see his hotel from the White House. When a Fox News interviewer mentioned that to him recently, Trump responded, “Isn’t that beautiful?” But while the interviewer pointed out that he can see the property from his desk in the Oval Office, Trump said, “I’m so focused on what I’m doing here that I don’t even think about it.”

Still, Trump couldn’t resist the short trip over there for dinner on his only weekend night out in Washington since becoming president.

A reporter for the website Independent Journal Review was tipped off about Trump’s dining plans and sat at a table near him. He noted the president’s dinner fare and companions, who also included daughter Ivanka Trump and her husband, Trump adviser Jared Kushner.

On other nights, the posh hotel is the kind of place where on a mid-February evening, you could bump into Trump television personality Katrina Pierson having cocktails with Lynne Patton, a former Trump Organization executive who’s now working at the Department of Housing and Urban Development. Trump campaign and inauguration hands Tom Barrack, Boris Epshteyn, Nick Ayers and Rick Gates are among the many who have stayed there in recent weeks.

Rooms start at above $500 most nights, according to the hotel’s website and a receptionist. That’s up hundreds of dollars from when the hotel first opened, not long before Election Day. Patricia Tang, the hotel’s director of sales and marketing, declined to answer questions about how business is going.

The hotel has become a staging area for big political events.

Eric and Donald Trump Jr. posed for dozens of selfies with admirers at the hotel that bears their name before attending their father’s White House ceremony in late January to announce Judge Neil Gorsuch as the president’s pick for the Supreme Court.

Deason ran into the Trumps and fellow Texas donor Gentry Beach while at a meeting at the hotel that day with Trump’s campaign adviser Rudy Giuliani. During inauguration week, when Trump himself repeatedly visited, the hotel was “literally the center of the universe,” Deason said.

Last Tuesday, as Trump gave his first address to Congress, lobbyists and politicos watched the four large flat-screens above the bar, two tuned to Fox news and two to CNN. In what hotel staff said was an effort to avoid some of the obvious politics of the place, the TVs were muted, so people followed along on their own devices.

As Trump wrapped up, applause rose through the lobby and bar. Mnuchin waved to admirers gathered in the bar as he strolled through after Trump’s speech.

Mnuchin is one of the New Yorkers working in Washington who call it home during the week. White House economic adviser Gary Cohn is another. Linda McMahon, who heads the Small Business Administration, also has been staying there.

Administration officials “have been personally paying a fair market rate” for their accommodations, White House spokeswoman Lindsay Walters said.

Even Trump’s closest friends pay to stay.

Billionaire Phil Ruffin, Trump’s partner for his Las Vegas residential tower, said he shelled out $18,000 per night while he was in town for the inauguration, which he said surprised him since he’d given $1 million to Trump’s inauguration committee. Ruffin says he lightly complained about the high rate to the president.

“He said, ‘Well, I’m kind of out of it.’ So I didn’t get anywhere, didn’t get my discount,” Ruffin recalled.

Trump’s continued ownership of his hotel and other businesses has spawned lawsuits and ethics complaints, but so far no action on any of them. One accommodation Trump says he is making on the ethics front is to donate profits from foreign governments that spend money at his hotels.

Last week, Kuwait’s ambassador, Salem Al-Sabah, and his wife hosted a reception in the hotel’s presidential ballroom, in what was one of the first known instances of foreign money changing hands with the hotel division of the Trump Organization since he became president. A spokeswoman for the Trump Organization did not respond to questions about whether the money from the Kuwait Embassy has been or will be donated.

Mnuchin attended.

Progressive voices respond to the president’s speech

President Donald Trump delivered on Feb. 28 a speech to Congress. Here’s reaction to Trump’s remarks from progressive voices:
“The theme of tonight’s joint address to Congress — the ‘renewal of American spirit’ — felt painfully hollow as the only renewal I’ve seen since President Trump took office is a pernicious wave of nationalism, racism, misogyny, and antisemitism. Rather than detailing a plan to quell the violence and vandalism perpetrated by those who feel emboldened by his actions, President Trump touted his own perceived success while feigning concern for bipartisanship and unity.

“Much like his campaign, President Trump’s speech emphasized flash over substance, failing to provide tangible policy proposals to match his boasts and taking credit for the success of President Barack Obama. I found the president’s words empty and indicative of a weak person’s idea of what strength looks like. Not only did he fail to mention the fate of critical social safety programs that will undoubtedly suffer in the face of the president’s military spending increase, but it was also clear that vital issues like gender-based violence simply weren’t a concern of his administration.

“I find it incredulous that President Trump could claim a commitment to national security while failing to even mention how we will protect our nation’s women and daughters, especially when an average of three women are killed by a current or former partner every day in our country. Fortunately, Deborah Parker was by my side tonight as my guest to help stress our shared moral imperative to safeguard our nation’s most vulnerable. Deborah was instrumental in helping me reauthorize the Violence Against Women Act (VAWA) in 2013 to include critical provisions for Native American women and girls. With VAWA grant funding in jeopardy of being eliminated by the Trump administration, Deborah’s unique voice and steadfast advocacy is needed now more than ever.”

— U.S. Rep. Gwen Moore, D-Milwaukee

“Donald Trump claims he will ‘invest in women’s health’ but what he and the anti-abortion majority in Congress have proposed is exactly the opposite. His plans to gut Obamacare, push abortion out of reach for even more women, take away our birth control coverage, and make the Hyde Amendment permanent all amount to the same thing: taking care away from those that need it. We’re also deeply disturbed by his escalation of harmful policies against immigrant women and families and troubling statements about communities of color. We need policies that treat women — and all people — with respect and dignity, not more politics of pain and punishment.”

— Destiny Lopez, co-director of All* Above All

“Donald Trump’s address to Congress vividly illustrates just how out of touch he is with the reality of people’s lives. In his world, everything he does is ‘great’, when the reality is that his policies are causing pain, suffering, and uncertainty for millions, and most often for the most vulnerable. In just 40 days, he has aggressively used his executive powers to demonize and dehumanize immigrants, Muslims, and trans youth — and he’s just getting started. One thing that is certain though is that every time he opens his mouth, more people want to join the resistance movement against his extremism.”

Rea Carey, executive director, National LGBTQ Task Force

“The type of widespread deregulation that President Trump advocates would be detrimental to small businesses and their communities on a number of levels. Small business owners benefit from regulations that level the playing field and protect communities and investments that foster growth on Main Street.”

— Amanda Ballantyne, national director of the Main Street Alliance

“We’re disturbed by Donald Trump’s speech last night. He spoke of uniting America, but almost every idea, every proposal promises to lead to more division.

“Rather than focusing on addressing our challenges, Mr. Trump called for more policing, more immigration enforcement, and boasted progress on the Dakota Access Pipeline even as he gutted regulations for clean water — a slap in the face to indigenous people everywhere.

“And playing politics with human lives, Donald Trump and his allies in Congress seemed casually enthused about robbing 30 million people of their health care coverage, including the 13 million people who have benefited from the expansion of Medicaid.

“What we needed to hear from Donald Trump was a comprehensive economic security agenda. One that includes all the issues that impact women’s ability to survive and thrive: immigration reform, racial justice, workers’ rights, caregiving, and reproductive health care. All critical issues for women and people of color.

“We applaud several women Members of Congress who wore the colors of suffragists in protest of Trump’s ghastly agenda. The Ms.Foundation for Women joins them and will continue to lead the fight for economic and health parity. We won’t go back. Millions of lives depend on it.”

— Ms. Foundation president and CEO Teresa C. Younger

“Last night, Mr. Trump tried to trick us into believing he cares about the needs of middle income and working families all across the country. But Trump’s economic team is shamefully comprised of corporate elites from Goldman Sachs and other Wall Street firms who helped destroy our economy less than ten years ago. We will not allow these corporate bandits to loot the wealth of America’s families again.”

 Shannon Jackson, executive director, Our Revolution

“When he was elected, Donald Trump promised to be a president for all Americans, yet he continues to pursue policies that put the powerful above the people, and to attack the most vulnerable in our society. Tonight’s address, sadly, continues that trend.

“He touted his Task Force on Reducing Violent Crime, but his Justice Department has already pursued policies that fail to create a better criminal justice system.  The recent decision to continue to rely on private prisons for federal inmates is neither humane nor budget-wise. We need a justice system that can work better for all people.

“His continued push for Neil Gorsuch to serve on the highest court in the land obscures the judge’s troubling record and Trump’s own denigration of judges who disagree with him. Gorsuch has consistently shown that he puts powerful corporate interests above the rights of workers and ordinary people. The Constitution demands an independent judiciary, and the American people deserve a Supreme Court justice who will be independent and not serve as a rubber stamp for the President who appointed him.

“We urge caution on Trump’s call for immigration reform but look forward to working with lawmakers to ensure that proposed changes uphold our legacy as a nation of immigrants. The continuing attacks on immigrants and refugees that we see from our chief executive undermines this laudable goal.

“His call to Congress to repeal and replace the Affordable Care Act will not help protect the health and well-being of Americans, particularly the poor and underserved. Republican lawmakers know their constituents are benefiting from the Affordable Care Act, and yet they want to take this vital program away.

“Given the philosophy of our Secretary of Education, it was not surprising that Trump called for Congress to divert public funding for schools in private school voucher programs. Such efforts are likely to undermine federal civil rights protections and open the door to taxpayer-funded discrimination. And just a week after his administration rescinded Title IX guidance to protect transgender students, Trump called education ‘the civil rights issue of our time.’ That’s not what standing up for civil rights looks like.

“As we continue to address the challenges facing all Americans, we must do so in a manner that does the most good, consistent with our Constitution and the rule of law.”

— Wade Henderson, president and CEO of The Leadership Conference on Civil and Human Rights

Fact-checking the speech: Trump takes credit he hasn’t earned

President Donald Trump boasted Tuesday night about corporate job expansion and military cost-savings that actually took root under his predecessor and gave a one-sided account of the costs and benefits to the economy from immigration — ignoring the upside.

A look at some of his claims in his speech to Congress:

TRUMP: “According to the National Academy of Sciences, our current immigration system costs America’s taxpayers many billions of dollars a year.”

THE FACTS: That’s not exactly what that report says. It says immigrants “contribute to government finances by paying taxes and add expenditures by consuming public services.”

The report found that while first-generation immigrants are more expensive to governments than their native-born counterparts, primarily at the state and local level, immigrants’ children “are among the strongest economic and fiscal contributors in the population.” This second generation contributed more in taxes on a per capita basis, for example, than did non-immigrants in the period studied, 1994-2013.

The report found that the “long-run fiscal impact” of immigrants and their children would probably be seen as more positive “if their role in sustaining labor force growth and contributing to innovation and entrepreneurial activity were taken into account.”

TRUMP: “We’ve saved taxpayers hundreds of millions of dollars by bringing down the price” of the F-35 jet fighter.

THE FACTS: The cost savings he persists in bragging about were secured in full or large part before he became president.

The head of the Air Force program announced significant price reductions in the contract for the Lockheed F-35 fighter jet Dec. 19 — after Trump had tweeted about the cost but weeks before he met the company’s CEO about it.

Pentagon managers took action even before the election to save money on the contract. Richard Aboulafia, an analyst with the aerospace consulting firm Teal Group, said there is no evidence of any additional cost savings as a result of Trump’s actions.

TRUMP: “Since my election, Ford, Fiat-Chrysler, General Motors, Sprint, Softbank, Lockheed, Intel, Walmart and many others have announced that they will invest billions of dollars in the United States and will create tens of thousands of new American jobs.”

THE FACTS: It’s unlikely Trump is the sole or even primary reason for the expected hiring he cites. Many of the announcements reflect corporate decisions that predate his election.

In the case of Intel, construction of the Chandler, Arizona, factory referred to by Trump actually began during Barack Obama’s presidency. The project was delayed by insufficient demand for Intel’s high-powered computer chips, but the company now expects to finish the factory within four years because it anticipates business growth.

More important, even as some companies create jobs, others are laying off workers. The best measure of whether more jobs are actually being created is the monthly employment report issued by the Labor Department, which nets out those gains and losses. The department will issue its report for February, the first full month of Trump’s term, on March 10.

TRUMP: His budget plan will offer “one of the largest increases in national defense spending in American history.”

THE FACTS: Three times in recent years, Congress raised defense budgets by larger percentages than the $54 billion, or 10 percent, increase that Trump proposes. The base defense budget grew by $41 billion, or 14.3 percent, in 2002; by $37 billion, or 11.3 percent, in 2003, and by $47 billion, or 10.9 percent, in 2008, according to Defense Department figures.

TRUMP: “We will provide massive tax relief for the middle class.”

THE FACTS: Trump has provided little detail on how this would happen. Independent analyses of his campaign’s tax proposals found that most of the benefits would flow to the wealthiest families. The richest 1 percent would see an average tax cut of nearly $215,000 a year, while the middle one-fifth of the population would get a cut of just $1,010, according to the Tax Policy Center, a joint project by the Brookings Institution and Urban Institute.

TRUMP: “Ninety-four million Americans are out of the labor force.”

THE FACTS: That’s true, but for the vast majority of them, it’s because they choose to be.

That 94 million figure includes everyone aged 16 and older who doesn’t have a job and isn’t looking for one. So it includes retirees, parents who are staying home to raise children, and high school and college students who are studying rather than working.

They are unlikely to work regardless of the state of the economy. With the huge baby boomer generation reaching retirement age and many of them retiring, the population of those out of the labor force is increasing and will continue to do so, most economists forecast.

It’s true that some of those out of the workforce are of working age and have given up looking for work. But that number is probably a small fraction of the 94 million Trump cited

TRUMP: “According to data provided by the Department of Justice, the vast majority of individuals convicted for terrorism-related offenses since 9/11 came here from outside of our country. We have seen the attacks at home – from Boston to San Bernardino to the Pentagon and yes, even the World Trade Center.”

THE FACTS: It’s unclear what Justice Department data he’s citing, but the most recent government information that has come out doesn’t back up his claim. Just over half the people Trump talks about were actually born in the United States, according to Homeland Security Department research revealed last week. That report said of 82 people the government determined were inspired by a foreign terrorist group to attempt or carry out an attack in the U.S., just over half were native-born citizens.

Even the attacks Trump singled out weren’t entirely the work of foreigners. Syed Rizwan Farook, who along with his Pakistani wife killed 14 people in the deadly 2015 attack in San Bernardino, California, was born in Chicago.

It’s true that in the immediate aftermath of Sept. 11, the FBI’s primary concern was with terrorists from overseas feared to be plotting attacks in the United States. But that’s no longer the case.

The FBI and the Justice Department have been preoccupied with violent extremists from inside the U.S. who are inspired by the calls to violence and mayhem of the Islamic State group. The Justice Department has prosecuted scores of IS-related cases since 2014, and many of the defendants are U.S. citizens.

TRUMP: “Obamacare is collapsing … imploding Obamacare disaster.”

THE FACTS: There are problems with the 2010 health care law, but whether it’s collapsing is hotly disputed.

One of the two major components of the Affordable Care Act has seen a spike in premiums and a drop in participation from insurers. But the other component, equally important, seems to be working fairly well, even if its costs are a concern.

Trump and congressional Republicans want to repeal the whole thing, which risks leaving millions of people uninsured if the replacement plan has shortcomings. Some critics say GOP rhetoric itself is making things worse by creating uncertainty about the future.

The health law offers subsidized private health insurance along with a state option to expand Medicaid for low-income people. Together, the two arms of the program cover more than 20 million people.

Republican governors whose states have expanded Medicaid are trying to find a way to persuade Congress and the administration to keep the expansion, and maybe even build on it, while imposing limits on the long-term costs of Medicaid.

While the Medicaid expansion seems to be working, the markets for subsidized private health insurance are stressed in many states. Also affected are millions of people who buy individual policies outside the government markets, and face the same high premiums with no financial help from the health law.

Larry Levitt of the nonpartisan Kaiser Family Foundation says “implosion” is too strong a term. An AP count found that 12.2 million people signed up for this year, despite the Trump administration’s threats to repeal the law.

But a health care blogger and industry consultant, Robert Laszewski, agrees with Trump, saying too few young, healthy people have signed up to guarantee the stability of the insurance markets.

Find all AP Fact Checks at http://apne.ws/2kbx8bd.