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In Cuban-majority House district, Republican rivalry spills into court Miami Herald The Republican primary for a Cuban-majority Miami House district has turned into a political slugfest more bitter than the strongest cafecito. It's a race marked by allegations of dishonesty and attacks on the candidates' Cuban ties. The contenders ...

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In Cuban-majority House district, Republican rivalry spills into court - Miami Herald

Nevada Sen. Dean Heller speaks at a town hall inside the Reno-Sparks Convention Center on April 17 in Reno. Heller says he opposes the health care proposal put forth by Senate GOP leaders. David Calvert/Getty Images hide caption

Nevada Sen. Dean Heller speaks at a town hall inside the Reno-Sparks Convention Center on April 17 in Reno. Heller says he opposes the health care proposal put forth by Senate GOP leaders.

When senators come back to Washington on Monday, a handful of Republicans will help decide the fate of legislation that could reshape health care in America.

One of them is Nevada Republican Dean Heller.

Sen. Heller is one of a small bunch of Republicans who have said they will not support the latest draft proposal to repeal and replace the Affordable Care Act, or Obamacare. Republican leadership can only lose the support of two of its own senators and still pass such a bill.

The Republican senators who say they'll vote no on the latest health care plan fall into two camps. Members of the party's right wing think this proposal is too timid and doesn't go far enough to undo the Affordable Care Act. More moderate Republicans, like Heller, think it is harsh and goes too far.

"I'm telling you right now, I cannot support a piece of legislation that takes away insurance away from tens of millions of Americans and hundreds of thousands of Nevadans," he said.

Nevada's popular governor, Brian Sandoval, was the first Republican governor in the country to expand Medicaid under the Affordable Care Act. More than 200,000 uninsured people got coverage after the expansion.

With that expansion of coverage, many people here are watching the fate of this bill to learn whether they'll be able to keep going to the doctor.

Heller's position has prompted advocacy groups and constituents on both sides of the issue to flood his office with calls.

For weeks, protesters have been showing up outside the senator's Las Vegas office urging him to oppose any changes to the health care system that would roll back provisions like the Medicaid expansion or funding for Planned Parenthood.

Opponents of the Republican health care proposal protest outside Republican Sen. Dean Heller's office in Nevada. Ari Shapiro/NPR hide caption

Opponents of the Republican health care proposal protest outside Republican Sen. Dean Heller's office in Nevada.

Cyndy Hernandez, who helped organize the most recent protest, says Heller's opposition to the bill GOP leadership is crafting isn't necessarily a done deal "not until he marks that button on his desk in the Senate chamber."

Patients at FirstMed clinic, where 80 percent of the patients are on Medicaid, voice their concern on a daily basis, nurse Maria Vital says. Administrators say the clinic would be forced to close without the funding it gets through the Affordable Care Act. Many of these patients went years without seeing a doctor for easily treatable conditions before the clinic opened, Vital says.

"They're very scared," she says. "They're asking us what will happen to them, and I tell them we will try to be here as long as we can for them."

Maria Vital is a nurse at FirstMed Clinic, where a majority of the patients are on Medicaid. Sam Gringlas/NPR hide caption

Maria Vital is a nurse at FirstMed Clinic, where a majority of the patients are on Medicaid.

Across town in Henderson, Taylor Lewis lives with her 7-year-old daughter Riley in a modest condo, with a couple of dogs and a large collection of plastic toy dinosaurs. Riley whispers their names as she pulls each one out of a big paper bag: stegosaurus, pterodactyl, Tyrannosaurus rex.

Ten days after Riley was born, a helicopter rushed her to the hospital for emergency heart surgery. When Taylor got over the shock of her daughter's near-death, she got another shock. The helivac bill totaled $20,000.

On top of being a single mom, Taylor has been working part time and studying part time she just finished her master's in public health.

Until she finds a full-time job, she depends on Medicaid to cover all of her daughter's medical costs.

She sometimes thinks about what her life would be like if Nevada had not expanded Medicaid coverage.

"I mean, I'd be without anything. I'd be without a car, a house," Taylor says.

Taylor Lewis sits with her 7-year-old daughter Riley. Until Taylor finds a full-time job, she says she depends on Medicaid to cover all of her daughter's medical costs. Ari Shapiro/NPR hide caption

Taylor Lewis sits with her 7-year-old daughter Riley. Until Taylor finds a full-time job, she says she depends on Medicaid to cover all of her daughter's medical costs.

For people on both sides of this debate, the stakes seem far higher than a typical piece of legislation.

People like Taylor feel that what has been proposed puts their lives on the line; Republicans who support the bill see a chance for lawmakers like Heller to keep a promise that Republicans have made in every campaign for nearly a decade.

Conservative talk radio host Wayne Allyn Root says nearly every caller now talks about voting Heller out of office because of his opposition to the draft proposal that Republicans floated in recent weeks.

"If Heller votes no on the repeal he's got to go, you gotta primary him," he says.

Root broadcasts out of his home studio for three hours each day. He has piles of framed photographs, including images of him with President Trump, Newt Gingrich and Ronald Reagan.

Root says his listeners are aghast that a Republican senator from their own state could be responsible for helping to kill this bill.

Wayne Allyn Root hosts a conservative talk radio show from his home studio. Sam Gringlas/NPR hide caption

Wayne Allyn Root hosts a conservative talk radio show from his home studio.

National groups on both sides have put millions of dollars into TV ads trying to sway Heller. The senator is home for the July Fourth recess this week, but he isn't spending that time holding town halls.

In the small town of Ely, he rode a horse in the July Fourth parade. He watched the fireworks in Elko, another town in rural northern Nevada. Even there, some people heckled him.

Heller declined the Republican Party's invitation to march in the town of Pahrump, which has the same spectrum of Republican views that's dividing the Senate.

Local party chairman Joe Burdzinski thinks the bill is too timid. He'd stand with senators like Rand Paul and Ted Cruz, holding out for a full repeal.

"The Republican Party has said for the last eight years we're gonna repeal and get rid of Obamacare. That's what Donald Trump said he wanted to do, that's what other Republicans running for office have said. Now they have to live up to that commitment to the American people because ... the American people voted for that," he says.

Leo Blundo, another official with the Nye County Republican Central Committee, has more sympathy for Sen. Heller, but doesn't quite believe Republican leaders who say this is the only train leaving the station.

Leo Blundo (left) and Joe Burdzinski are officials with the Nye County Republican Central Committee. Sam Gringlas/NPR hide caption

Leo Blundo (left) and Joe Burdzinski are officials with the Nye County Republican Central Committee.

"It's public knowledge we got both houses [of Congress]," he says. "Get some business done. ... Quit mickey-mousing around and get some work done."

For Heller, the considerations about Medicaid expansion and repeal promises might all take a back seat to a more pressing reality. He's up for re-election next year a Republican in a state that has gone blue for the last three presidential elections.

Whatever position he takes on the final bill, that race will be far from an easy win.

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Nevada Voters, Divided Over Health Care, Put Moderate Republican In Tough Spot - NPR

Good luck with that. Photo: Justin Sullivan/Getty Images

The Republican drive to repeal Obamacare is not yet dead, but its state of distress is sufficient to set off recriminations on the right on its presumed failure. The most popular explanation emerging on the right is that Republicans erred by promising Americans too much coverage. The problem for Republicans, argues Peter Suderman, is that they have not yet backed away from universal coverage rhetorically. Philip Klein laments a fatal concession made to liberals: the decision to take Obamacares approach to pre-existing conditions. They argue that the party should instead have designed a stingier program, with catastrophic coverage, rather than make commitments they couldnt carry out. Whats missing from the arguments is any serious analysis of why Republican rhetoric fudged the universal coverage question.

Since Obamacare passed Congress in 2010, Republicans have had two presidential elections to sell America on their alternative vision. When Mitt Romney lost the 2012 election, thus closing out the Republican Partys only opportunity to repeal Obamacare before its coverage expansion took effect, conservatives theorized that Romneys history prevented him from making the necessary full-throated denunciation of the hated law. (To wit, Erick Erickson: He did not articulate strong fiscal conservatism and he never repudiated Romneycare, thereby failing to make any credible attacks on Obamacare.)

Four years later, Trump ran as an opponent of Obamacare, but he hardly embraced an authentic conservative stance. Instead he made extravagant promises of more generous coverage, like I am going to take care of everybody Everybodys going to be taken care of much better than theyre taken care of now.

It is not merely bad luck that deprived conservatives of a committed champion of their health-care vision. Republican candidates responded to what they public has demanded. Indeed, Romneys experience creating the precursor to Obamacare, far from hurting him, provided the foundation for his best moment in the entire campaign. It came in the first presidential debate, when he cited his history as a guide to how he would act as president. (I do have a plan that deals with people with preexisting conditions. Thats part of my health-care plan. And what we did in Massachusetts is a model for the nation state by state.)

Conservatives cannot point to any real-world examples of a country or even a state that has successfully implemented the sort of health-care system they desire. (Some of them mistakenly cite Singapore, whose health-care system relies on massive state intervention American conservatives could never accept.) Thats because theres no electorate in any industrialized country that would tolerate it.

Is that because a conservative health-care plan with catastrophic coverage and high deductibles is technically impossible to design? No, its because such a plan is politically impossible to sustain. People dont want insurance coverage that only protects them against rare disasters. They want to be able to go to the doctor and get treated. In the English vernacular, comprehensive coverage is called good insurance and high-deductible insurance is called bad insurance.

Suppose we lived in a world in which Trump had decided to implement a true conservative health-care plan, and he persuaded Republicans in Congress to take the massive hit to their standing by passing one. What would happen next? Well, once it happened, and tens of millions of people were thrown into the individual market where they could only afford bad insurance, Democrats would start promising to give them good insurance instead. Eventually they would win and give it to them.

The Republican Partys fanatical struggle against Obamacare gave conservative intellectuals a great deal of false hope. By pressuring members of Congress to withhold support in Congress, the Supreme Court to make the Medicaid expansion optional, governors to sabotage state exchanges and turn down the Medicaid expansion, and imposing uncertainty on insurers, they generated an atmosphere of maximum chaos and controversy around the law. They managed to create the impression that Obamacare was a dirty piece of business, and that it was responsible for every bad thing in the health-care system. But they never sold the public on the idea that Americans should not have access to basic medical care.

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Why Didn't Republicans Promise a Conservative Health-Care Plan? Because They're Not Idiots. - New York Magazine

Sometimes, in some weird markets, too much consumer choice can be a bad thing.

Unfortunately for Republicans, health insurance happens to be one of those weird markets.

Republicans believe the problem with the health-care system is that Americans are forced to buy too much insurance, in plans that are too prescribed. Their solution is to give consumers more choices for what kinds of plans (including no plan at all) they can buy.

The Consumer Freedom Option, recently proposed by Sen. Ted Cruz (R-Tex.), is emblematic of this: It wouldallow insurers to sell plans that dont comply with Obamacare regulations (such as protections for preexisting conditions), so long as they also sell at least one plan that does.

Were guaranteeing them exactly what they have now but giving them more options, Sen. Mike Lee (R-Utah)saidSunday. Options that would inevitably unleash free-market forces, that would in turn bring down the price of health care.

(Jenny Starrs/The Washington Post)

And who doesnt like options?

Choice is as American as apple pie, a core perk of living in a capitalist society. We arefree to choosewhatever car or yogurt we want, from an enormous menu of colors, features, flavors and prices, and economists (generally) believe were happier for it.

But the health insurance market has some distinctive properties that mean too many choices can lead the whole market to unravel.This would leave nearly everyone consumers, insurers and health-care providers much worse off.

Why? The answer is somewhat counterintuitive. So counterintuitive, in fact, that the economists who figured it outwon Nobel Prizesfor the insight. Lets take it step by step.

At its core, offering greater choice in health plans means eliminating both standardization and basic quality minimums.

Eliminating standardization for example, Obamacares rules forwhat benefits are covered, coverage tiers and out-of-pocket maximums would make it much harder for consumers to comparison-shop.

Shopping for health insurance isalreadysuper-complicated and timeconsuming, and lots of people makeobjectively bad choices. You have to comb through fine print and in-network doctor lists. You have to sort out which deductibles and premiums match your familys likely needs and risk tolerance. Imagine how much more complicated this would become if insurers could offer many more plan configurations with more hidden exceptions and fewer quality controls.

Maybe one plan covers breast cancer but not throat cancer. Another covers statins, but only if youve never been diagnosed with heart disease, or maybe just one months supply. With so many variables, and so much opportunity for obfuscation, apples-to-apples comparisons become impossible.

Consumers might also end up buying mini-med insurance that turns out to cover virtually nothing. This happened a lot pre-Obamacare.

Theres a larger problem than consumer confusion, though. Its that the entire individual market would fall apart under Cruzs plan because of adverse selection the idea that people with higher health costs will self-select into more generous coverage.

The cost to a supermarket of selling you a yogurt is basically the same as the cost of selling me a yogurt. Thats not true for health insurance, where I might turn out to be a much more expensive customer than you are.

In a world where patients know more about their health status (e.g., a bum knee) or future health spending (e.g., pregnancy, long-delayed surgery) than insurers do, insurers try to attract only the cheapest, healthiest enrollees by offering the cheapest, stingiest plans. Cruz would eliminate quality minimums, remember.

When consumers have a choice of many plans, and insurers can tweak those plans to attract the healthiest patients, you get a death spiral.

In Cruzs health insurance market, sick people would end up in the relatively generous, Obamacare-compliant plans, which couldnt turn away patients and healthy people would get siphoned off into the mini-med plans, which could. Or these healthy people would drop their insurance altogether, since there would no longer be a mandate.

With only sick people in the Obamacare-compliant plans, the plans would become very expensive, causing slightly less sick people to drop out, causing the pool to get even sicker (and costlier), causing even more people to drop out. And so on.

Cruz says the government would kick in money to subsidize coverage in these plans, but weve already seen how limited Republicans appetite is for adequately funding high-risk pools (which Obamacare-compliant plans would essentially become).

In the end, wed have what we had on the individual market pre-ACA: healthy people buying razor-thin coverage, and few good answers for everyone else. All because Republicans gave consumers, and insurers, that beloved freedom to choose.

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The reason Republican health-care plans are doomed to fail - Washington Post

Women make up less than 10 percent of the Republican senators in Congress, and the GOPs most qualified (and only top-tier) female hopeful just walked off the Senate playing field with nary a protest from Republican leaders.

Missouri Rep. Ann Wagners challenge to Democratic Sen. Claire McCaskill has been one of the worst-kept secrets of the cycle. The third-term congresswoman, a former United States ambassador and onetimeco-chairwoman of the Republican National Committee, had $2.8 million in her campaign account at the end of March. She had been doing everything a future Senate candidate wassupposed to do, right up until Monday when she announced she was running for re-election toher 2nd District seatinstead.

Im not questioning Wagners commitment to her family or the community she mentioned in her announcement, but Im convinced the congresswoman would still be on pace to challenge McCaskill if there was evidence that the Republican establishment was excited about the prospect of her running for the Senate. McCaskills re-election race is rated a Tossup by Inside Elections.

What might be most remarkable about Wagners announcement is that she bowed out of a race that lacks another serious contender. Its clear that some Republicans in Missouri and Washington, D.C.,are enamored with Josh Hawley, the 37-year-old state attorney general who has been in elected office for six months. But there is no guarantee he will enter the Senate race. If he doesnt, leavingRepublicans without Wagner or Hawley, it could be a colossal miscalculation in a prime takeover target.

Of course, diversity for the sake of diversity is not good, but its hard to get a straight answer from Republicans as to why more wasnt done to encourage Wagner, particularly in the absence of another serious, announced challenger. And with a small pool of willing, capable, and qualified women to run for the Senate across the country, it seems like the party should embrace the ones who come along.

With 10 Democratic senators running for re-election in states President Donald Trump wonin 2016, Republicans have plenty of opportunities to add to their ranks, including adding women to their Senate conference. But there is a dearth of women in position to win.

State Sen. Leah Vukmir, 59, could develop into a credible candidate in Wisconsin. But she hasnt made an official announcement and could have a tough slog through a crowded primary against better-funded candidates before she even got a chance to face Democratic Sen. Tammy Baldwin.

Businesswoman Lena Epstein, 35, was co-chairwoman of Trumps campaign in Michigan and is challenging Democratic Sen. Debbie Stabenow. But as a first-time candidate, she is not a proven commodity. Kathy Neset, who runs an oil field consulting services company, was recently mentioned as a potential challenger to Democratic Sen. Heidi Heitkamp of North Dakota. But Neset would start the race as a political neophyte.

At a time when politicians are incredibly unpopular, strategists tend to fall in love with candidates (including Hawley) without voting records that can be exploited by opponents. But over two-thirds of the 99 elected senators previously served in the U.S. House or a state legislature (or both), so a voting record is not an electoral death sentence.

And in a state that remembers the Todd Akin debacle more than any other, a candidate who has had more time in the public eye may not be such a terrible idea.

In 2012, Indiana state Treasurer Richard Mourdock was viewed as a safe bet even after he knocked off Sen. Richard G. Lugar in the GOP primary, right up until the point when he offered his theological views on abortion during a high-profile debate.

One seemingly obvious way to avoid the temptation of some Republican men to offer their views on abortion and choice is to nominate a woman.

While Hawley is being hailed as a Republican savior who can unite all factions of the GOP, his electoral record is limited to a primary victory (in which he received $1.75 million from one contributor and his family and received considerable support from a Virginia-based super PAC) and a general election victory in a state Trump won by nearly 20 points over Hillary Clinton.

There was room for an anti-establishment candidate in a primary against Wagner, who has been in and round party politics for nearly three decades. But a serious candidate in that mold hadnt popped up yet and thats not the natural place for Hawley to run, considering he has support from prominent, longtime politicians such as former Sen. Jack C. Danforth, who served two terms as Missouris attorney general and was elected to the U.S. Senate before Hawley was born.

Of course, Hawley could run and defeat McCaskill in 2018. He could even become president of the United States one day by defeating 2016 Democratic Senate nominee Jason Kander. But it looks like Republicans missed a rare opportunity to help elect someone other than a white guy to the Senate.

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One Reason Why Republicans Don't Have More Women in the Senate - Roll Call