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Has there ever been a time when the Congressional Budget Office played a more consequential role than it is playing right now? Somewhat surprisingly for an office full of eggheads and number crunchers, it has become a nexus of controversy and contention, itslatest assessments eagerly awaited and assumed to have a dramatic impact on every debate it touches.

Today, the CBO released its latest score of the most recent version of the Republican effort to repeal and replace the Affordable Care Act, and once again, it shows the effects of the bill to be horrific.The bill would cut Medicaid by $756 billion and result in 22 million fewer Americans with health coverage by 2026, with 15 million of those coverage losses happening in the first year. In other words, its another score that offers a vivid picture of the damage that Republican plans would do.

Which is why Republicans have launched a full-scale assault on the CBO, trying to discredit it so that no one will listen when the CBO explains what consequences Republican plans would actually have.

It isnt all that surprising that Republicans would try to do that the creation of alternate realities they can shape has often been a core part of their political project. What matters is that it has failed. The reasons why can actually give us some hope that our politics retains some tether connecting it to reality.

But first, thats not the only CBO-related news. A group called the Protect Democracy Project filed a lawsuit today against the Office of Management and Budget, seeking a court order requiring OMB to immediately turn over any communications regarding plans it might have to attack and discredit the CBO, including emails coming from Newt Gingrich, who has been publicly advocating that the CBO be abolished. The basic idea of the lawsuit seems to be that the administration is planning to destroy the CBO, and the public deserves to know what theyre up to.

But this isnt just about health care theres a longer game being played. Yes, the administration is stricken by what the CBO has said about the various iterations of Republicans health-care plan. But it isalso almost certainly worried about whats to come on issues such as infrastructure and especially tax reform. Cutting taxes is the goal nearest and dearest to Republican hearts, and theres a good chance that when Republicans come up with a bill, the CBO will say that its going to explode the deficit. Under current rules, that will restrict what Republicans can do if they want to pass it through reconciliation with only 50 votes in the Senate.

The only way to get around that would be to change Senate rules so the CBO was no longer the arbiter of whether a bill does or doesnt increase the deficit. That would be a radical step, and I dont know if Senate Republicans are even contemplating it. But if they were, a campaign to discredit the CBO would have to be the first part of the plan.

So the stakes are high. And in the health-care debate, the CBOs judgments have been absolutely crushing for Republicans. Its score of the first House bill showed that it would lead to 24 million Americans without health coverage, an assessment that was widely reported on the news. Democrats repeated the 24 million number a zillion times, and polls showed the bills popularity somewhere between that of Martin Shkreli and canker sores. When Paul Ryan revised the bill, he pushed it through to a vote before CBO could get a chance to score it, obviously fearing what the score would reveal (the eventual score of that version showed 23 million losing coverage). The scores of Senate versions have not been much better, and as a result any Republican who tries to defend the effort inevitably gets the CBO figures thrown at them.

All of which is why Republicans are trying so hard to discredit the CBO. Its almost like its not a fair analysis, saidWhite House budget director Mick Mulvaney, complaining that the office is using methodologies designed by Democrats. Never mind that the current director of the CBO, Keith Hall, is a Republican economist and veteran of the George W. Bush administration who was picked for the job in 2015 by the Republican leadership in Congress. At some point, youve got to ask yourself, has the day of the CBO come and gone? Mulvaney said in May. The White House even made a video attacking the CBO (the video misspelled inaccurately not once but twice).

Both parties have at times complained about one CBO score or another when those scores didnt turn out the way they would have liked. But the critical point about this Republican effort is that it isnt succeeding. The news media continue to accept the CBOs judgments for what they are: not perfect by any means, but the best nonpartisan, objective measure we have to assess what important bills will do.

When Republicans go around bad-mouthing the CBO and accusing its workers of being nothing but liberal shills, they might be able to convince their own supporters that its true. But the more ambitious your goals, the more youll need to expand beyond your own base to gather support. So while Republicans might be able to get the Fox & Friends audience on board with their campaign to discredit the CBO, if theyre trying to remake the American health-care system or enact an enormous tax cut for the wealthy, that wont be enough. The attack on the CBO is so nakedly cynical and partisan that it just isnt going to have broad persuasive power. That means that those brutal numbers, whether its 24 million losing coverage or 32 million losing coverage or whatever the latest score reveals, will continue to be disseminated. Reality actually stands a chance.

Maybe the better answer for Republicans would be to write bills that wont have such a devastating effect on Americans, which would get them better CBO scores. Just an idea.

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The Republican attack on the CBO is failing. That should give us hope. - Washington Post

(Victoria Walker/The Washington Post)

Sen. John McCain (R-Ariz.) has been diagnosed with a brain tumor, his office said Wednesday, throwing into doubt when and if he will return to Washington to resume his duties in the Senate.

The Mayo Clinic said doctors diagnosed a tumor called a glioblastoma after surgery to remove a blood clot above McCains left eye last week. The senator and his family are considering treatment options, including a combination of chemotherapy and radiation, according to the hospital.

McCain, 80, has been away from the Senate this week, recovering from the surgery and undergoing tests. His office issued a statement describing him in good spirits and noting that his doctors say his underlying health is excellent but not indicating when he will return to the Senate.

Glioblastoma is an aggressive type of brain cancer, and the prognosis for this kind of cancer is generally poor. Sen. Edward M. Kennedy (D-Mass.) survived less than 15 months after his was found in 2008. McCains doctors said the tissue of concern was removed during the blood-clot procedure.

[5 questions about the brain cancer diagnosed in Sen. John McCain]

(Ashleigh Joplin/The Washington Post)

McCains significance inside Congress is hard to overstate and his absence, however long, will reverberate across the Capitol.

The Arizonans illness leaves Senate Majority Leader Mitch McConnell (R-Ky.) and by proxy President Trump, who has openly mocked the Arizona senator with 51 votes, the barest of majorities at a time when Republicans are divided on such issues as health care, taxes and defense spending.

McCains absence would also deprive the Senate of its moral conscience on many key issues, particularly in the ongoing investigation of the Trump campaigns potential involvement in Russian meddling in the 2016 campaign.

Colleagues from both parties reacted swiftly to McCains announcement with sadness and encouragement. Trump exhorted McCain to get well soon and declared the senator a fighter. Former presidents Barack Obama and Bill Clinton both tweeted their good wishes.

McConnell said: I know that he will face this challenge with the same extraordinary courage that has characterized his life. The entire Senate familys prayers are with John, Cindy and his family, his staff, and the people of Arizona he represents so well.

We all look forward to seeing this American hero again soon.

[Give it hell: Obama, lawmakers react to John McCains cancer diagnosis]

McCain, a prisoner of war in Vietnam and a two-time presidential candidate, is known for his unfiltered opinions and willingness to buck Republican Party orthodoxy. Along with Sen. Lindsey O. Graham (R-S.C.), perhaps his closest friend in the Senate, McCain has become one of Trumps leading Republican critics, particularly on issues of foreign policy and national security.

Sen. John Hoeven (R-N.D.) said the news of McCains diagnosis was announced during a meeting between GOP senators and White House staff on health care. Hoeven said the news left the group in stunned disbelief.

It was very emotional, Hoeven said. I think for all of us hes a special person.

Graham also attended the meeting and told others there that he had spoken with McCain and described him as resolved and determined.

He said, Im going to have to stay here a little bit longer and take some treatments, but Ill be back, Graham said of McCain. He said, Ive been through worse, and basically then we started talking about health care and the NDDA a reference to the National Defense Authorization Act.

McCain has staunchly defended Trumps national security team he has particular respect for Defense Secretary Jim Mattis and national security adviser H.R. McMaster. But McCain has criticized the president for campaigning on a promise to fortify the countrys defenses without, in his view, devoting enough money to the task.

McCain has also criticized Trumps apparent affinity for Russia and its president, Vladimir Putin, warning that Russia is an enemy that should not be trusted and becoming one of the earliest Republicans to lend his support to a congressional investigation of Russias ties to the election.

John McCain has always been a warrior. Its who he is, said House Speaker Paul D. Ryan (R-Wis.). I know John is going to fight this with the same sheer force of will that has earned him the admiration of the nation. And all of us, not as Republicans or Democrats, but as Americans, are behind him. The prayers of the whole House are with Senator McCain and his family.

McCains formal title is chairman of the Senate Armed Services Committee, but McConnell essentially deputized him after his second presidential bid, in 2008, to run all national security issues for Senate Republicans.

But McCains standing from his stature borne of overcoming torture in Vietnam to his denunciations of Trump as a candidate and as president reaches far across the aisle. He is an iconic figure as beloved by Democrats as Republicans.

Almost every major bipartisan deal of the last 15 years has come with McCains backing, on issues including immigration, outlawing torture and the Senates internal rules.

Democrats line up to travel with McCain overseas because foreign leaders treat him as if hes a prime minister, winning audiences that are usually reserved for a secretary of state.

His fights with fellow senators have been legendary, but so have his dealmaking skills.

Heartbreaking news, wrote Sen. Chris Murphy (D-Conn.) on Twitter. He said he traveled the world with McCain and learned a lot from him. Murphy added: there is no one tougher.

In a written statement she posted on Twitter, McCains daughter, Meghan McCain, said the news of her fathers illness has affected every one of us in the McCain family. She said they live with anxiety about what comes next, which they have endured before. McCain has a history of melanoma, a dangerous form of skin cancer.

She added, it wont surprise you to learn that in all this, the one of us who is most confident and calm is my father. He is the toughest person I know. The cruelest enemy could not break him.

McCains absence could complicate the fate of the annual National Defense Authorization Act, massive legislation that McCain has played an outsized role in shepherding through Congress since he took over as chairman of the Senates Armed Services Committee in 2015.

From that perch, McCain has made a name for himself attempting to hold contractors to account over stalled projects while driving an overhaul of the acquisition process. He has pushed for greater investments to improve the quality and availability of materiel and training, an expansion of the U.S. military footprint abroad, particularly in hotspots like Afghanistan and Iraq, and an unprecedented focus on improving the countrys ability to safeguard against cyberthreats and hacking.

McCain was relentless in his criticism of Obamas understanding of national security, accusing him of compromising the nations security by making nuclear deals with Iran and pulling troops out of Afghanistan and Iraq. But McCain was also open to working with the president to explore closing the detention facility at Guantanamo Bay. That effort ultimately failed.

McCains absence from the Senate this week came as GOP leaders struggled to bring their failing push to rewrite the 2010 Affordable Care Act to a conclusion. Leaders had intended to vote on a bill this week but postponed their plans late Saturday after McCain said he would be out recovering from the surgery to remove the blood clot.

On Monday, McConnell scrapped plans to vote on the bill altogether once it became clear it would not have the support to pass even with McCain in town to vote. McCain had voiced skepticism about the GOP repeal and replace plan. It was unclear that he would ever get to yes on it.

About 12,400 new cases of glioblastoma are expected in 2017, according to the American Brain Tumor Association. It is the most common of all malignant brain tumors, and a tumor that more commonly occurs in older adults than younger people.

Matthias Holdhoff, an associate professor at the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, said the first step after a diagnosis is to surgically remove as much of the glioblastoma as possible. But that can be difficult; it is a tumor that spreads through extensions into the tissue, more like a mesh work than a lump.

Its not just a matter of the cancer, but where it is and what its doing to the patient, said Chevy Chase, Md., oncologist Frederick Smith, speaking generally about glioblastomas and not specifically about McCains case. A blood clot over the eye tends to indicate the tumor was in the brains frontal lobe, which controls cognition among other things, he said.

Again speaking generally of patients with this diagnosis, they might be fine for a number of months or even years. But they are never cured.

Lenny Bernstein, Laurie McGinley, Kelsey Snell, Lena H. Sun and Ed OKeefe contributed to this report.

Read more at PowerPost

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John McCain, Republican senator from Arizona, diagnosed with brain tumor - Washington Post

Math is not the friend of the Republican Party.

As the GOP leadership fights to find the votes from Trumpcare, the bill that just wont die, the Congressional Budget Office issued two new scores for how Republican proposals would affect the health insurance system.

First, the government office confirmed that a bill to repeal Obamacare without replacing it the Obamacare Repeal Reconciliation Act of 2017, or ORRA would result in 32 million more people losing health insurance compared to the status quo, and a doubling of premiums for those lucky enough to retain insurance. Thats bad math. (Well, good math, but bad for the GOP.)

That forecast is so devastating in part because Republicans in pursuit of an Obamacare repeal have no choice but to use the reconciliation process, which requires only a simple majority rather than the usual 60 votes. (Democrats obviously wont sign on, in any number, to destroy President Obamas signature legislative achievement.) And because reconciliation bills can deal only with taxes and spending, the ORRA would eliminate the taxes and spending contained in the Affordable Care Act while leaving many of its regulations intact.

The result would be the worst of both worlds for insurers and the now-insured. Obamacares historic expansion of Medicaid would be eliminated, and so would the subsidies that make purchasing insurance on individual exchanges more affordable. But insurers still would be required to issue insurance regardless of preexisting conditions, and this insurance still would have to provide comprehensive coverage.

Guess what would come next? An almost-immediate death spiral: Effective premiums would skyrocket, which means that only the sick and desperate would maintain insurance while healthy people fled the market in droves, causing prices to increase even more. (You may have heard that the ACA is already in a death spiral, but this is simply false the existing exchanges have, for the most part, stabilized.)

In other words, the ORRA would devastate Medicaid and completely destroy the individual market for health insurance. Maybe the number of people who would lose coverage would be somewhat less than the CBOs projected 32 million, and maybe it would be even more, but its somewhere in that ballpark, and no logical analysis would conclude otherwise.

Although repeal-without-replace is the GOPs worst idea yet, the partys latest affirmative replacement plan isnt all that much better, as the CBO score issued Thursday makes clear. It would cut coverage by 22 million, raise premiums by 20% on average and cut Medicaid by $772 billion while giving the wealthy and corporations $541 billion in tax breaks. Deductibles would be an outright disaster; someone making $26,500 in 2026 would pay $13,000 or half his income compared with $800 under the ACA.

So its the same old, same old. The House bill that passed in May, as well as the Senates two proposals for remaking Obamacare, would all substantially cut the spending that helps people afford insurance on the individual markets. All of these schemes would lead to a huge increase in the number of uninsured. None contain any material benefit to anyone except wealthy taxpayers.

These bills were never going to be popular if scored accurately. Theres just no way to slash costs without slashing the insurance rolls. Thats simple math.

And that highlights the importance of the CBO. If Democrats and liberal commentators alone claimed that Republican legislation would lead to death spirals and all the rest, the media would cast it as a views differ or on the one hand, on the other hand issue. Reporters would repeat, without comment, ridiculous Republican assertions that massive cuts in healthcare spending wouldnt hurt anyone because The Market Is Magic and Innovation, etc. But the CBO has the authority to get the truth out there, and this has made the resistance to Trumpcare much more effective.

At this point, the Republican Party could grow up and get a heart. It could choose not to propose policies that take away important benefits from tens of millions of people to help only a few. It seems more likely, however, that Republicans will respond by undermining the CBO and perhaps stop using its analyses altogether. One party will continue living in the world of fact, while the other will enter the realm of pure fantasy.

Math is not the friend of the Republican Party, so the Republican Party is not the friend of math. The CBO is helping kill Trumpcare, but Trumpcare ultimately could kill the CBO.

Scott Lemieux is an instructor of political science at SUNY Albany and a regular contributor to the New Republic and the Week.

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Math is not the friend of the Republican Party - Los Angeles Times

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House Republican dismisses Trump as 'a distraction' MSNBC Donald Trump was sworn in as the nation's president exactly six months ago today, and it's not exactly a secret that his tenure has been burdened by a series of failures, scandals, and mistakes. At this point, the nation's first amateur president hasn ... Trump demands Republicans replace Obamacare before August recess, but McConnell is waryUSA TODAY all 11 news articles »

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House Republican dismisses Trump as 'a distraction' - MSNBC

Senate Majority Leader Mitch McConnellemployed an iron fist over the Republican health care effort, keeping top lieutenants in the dark about key decisions and withholding detailed policy information from the conference as a whole until just before it was released publicly.

Now with theseven-year effort to gut the 2010 health care law in tatters,it falls on the Kentucky Republican to deal with the aftermath, and quell concerns about whether he can continue to lead effectively.

With no clear direction forward, the rest of the ambitious GOP agenda remainsuncertain.

Republicans on Tuesday were largely noncommittal over what would come next, and several instead chose to continue to harp on the potential damage to the party if its long-held antipathy of the law does not yield measurable progress.

We have to have the confidence of the American people that we can get things done. There will be millions of people who see significantly higher premiums because we havent been able to come to a consensus on this particular issue, Sen. Mike Rounds of South Dakota said.

I continue to believe we can and will get this done, Texas Sen. Ted Cruzsaid. Every Republican for the last seven years has campaigned on repealing Obamacare. I think the credibility of the conference is seriously undermined if we fail to deliver on that promise.

Questions also linger over what impact McConnells strategy choosing to craft a bill largely behind closed doors and placing strict deadlines on his own members has had on the morale of the GOP conference.

Sen. Ron Johnson, for example, declined to say on Tuesday whether he still trusts McConnell following the health care failure, citing assurances the majority leader made to moderate lawmakers that the GOPs proposed cuts to Medicaid would never go into effect.

I was very troubled with those comments, the Wisconsin Republican said.

When asked whether McConnell is solely to blame for the failure, Johnson said, I dont know, who wrote the bill?

And while the Senate Republican Conference tries to recover from a monumental defeat on the health care effort,President Donald Trump vowed to move forward with his plan to let the health care law collapse.

I think were probably in that position where well let Obamacare fail, he said. Were not going to own it. Im not going to own it, he said, despite the GOP locking Democrats out of the process.

Following Tuesdaysweekly Republican policy luncheon, McConnell said the chamber would hold a vote sometime in the near future on legislation from 2015 to repeal the health care law that was vetoed by President Barack Obama. The majority leaderinformed senators Tuesday that, at the request of the president and vice president, the vote would take place early next week.

Its pretty clear that there are not 50 Republicans at the moment to vote for a replacement for Obamacare, he told reporters. This has been a very, very challenging experience for all of us.

But the vote on an initial procedural hurdle looks destined to fail. Three Republican senators have said they wouldnt support the motion to proceedthat would allowthe 2015 repeal legislation to come up for a vote, enough to block it.

What comes after that likely failure remains an open question, but McConnells top allies expect work to begin on a bipartisan health care bill.

I suspect there will be discussions on a bipartisan bill, Senate Majority Whip John Cornyn of Texas said. To me, thats unfortunate in a sense because I think the Democrats are strongly committed to Obamacare and are unwilling to admit the structural problems which create the problems we are having in the individual market today.

And while the conference continues to try to chart a path forward, skeptical lawmakers are holding back any direct criticism.

I dont want to ascribe blame to anyone, said Sen. Lisa Murkowski of Alaska, one of the three GOP senatorswho vowed to vote against the 2015 repeal bill. I have long held that a committee process allows for a way to go forward that, while not easy, does allow for, typically, a product that has gone through greater vetting.

Senate Health, Education, Labor and Pensions Chairman Lamar Alexander, in a statement released on Tuesday, said his panel would soon turn to work on measures to shore up the insurance markets that have shown signs of turmoil.

However the votes come out on the health care bill, the Senate health committee has a responsibility during the next few weeks to hold hearings to continue exploring how to stabilize the individual market. I will consult with Senate leadership and then I will set those hearings after the Senate votes on the health care bill, the Tennessee Republican said.

Other members continue to try to push their respective proposals. Louisiana Sen. Bill Cassidy, for example, is still advocating for a bill he is working on alongside Sen. Lindsey Graham of South Carolina that would essentially give states a bulk amount of funding each year to manage their insurance systems.

Obviously, leadership wants to know that there is an interest in this among everybody, so we are trying to develop that interest, Cassidysaid.

And despite a looming battle on the overhaul of the U.S. tax code that promises to be as difficult, if not more so, than the health care debate, Republican members are optimistic.

At the end of the day, what we have to do is cobble together the votes to move forward on other issues. The reality of it is this is a setback, but its not, in my opinion, an unexpected setback, South Carolina Sen. Tim Scottsaid.

Andrew Siddons and John T. Bennett contributed to this report.

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Senate Health Care Failure Prompts Republican Soul Searching - Roll Call