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Whether its leaders and members realize it, the Republican Party is at risk of becoming the Vladimir Putin-aligned party in the United States. It can be convincingly argued that its already similar to Putin-supported parties in Europe, given Donald Trumps presidency, the Republican bases increasingly favorable views of Moscow, and the House GOP leaderships disinterest in investigating and preventing Russian interference.

Increasingly sophisticated Russian influence and cyberoperations threaten Americans ability to choose their own leaders. This isnt hyperbole. In fact, its hard to overstate just how serious this issue is. Yet, President Trump continues to sow doubt about whether Moscow even interfered in the 2016 presidential elections and to suggest the questions insignificance by ignoring it all together.

Our commander in chief seems more interested in protecting Moscow than he does in deterring its future attacks. The Washington Post reported that the administration is actually considering allowing the Russian government to reopen the two spy compounds that President Barack Obama closed in late December in response to Russias election attack. There are also reports that the White House plans to step up lobbying efforts against a new Russia sanctions bill that the Senate passed with overwhelming bipartisan support this month. The measure would add new financial sanctions and require congressional review before Trump could lift these or other retaliatory measures currently levied against Moscow, including the closing of the two compounds.

Worse, Trump appears to have some support in this from Republican leaders in the House. House Speaker Paul D. Ryan, R-Wisconsin, and Majority Leader Kevin McCarthy, R-California, have delayed the bill, citing the constitutional requirement that such bills originate in the House.

This is little more than a red herring. Nothing prevents them from inserting the text of the Senate bill into a House measure, passing it and sending it back to the Senate for final approval, which it would likely grant under expedited procedures. Instead, Ryan and McCarthy appear to be more interested in delaying and weakening the bill.

Behind their neglect are changing Republican voter opinions, which are becoming alarmingly more pro-Russian. According to a Morning Consult-Politico poll conducted in May, 49 percent of Republican voters consider Russia to be either an ally or friendly. Only 12 percent consider it an enemy. In 2015, only 12 percent of Republicans held a favorable view of Russian President Vladimir Putin, according to Gallup. As of February, that figure had jumped to 32 percent.

These dangerous trends impair the nations will to protect itself, and they are entirely the result of Republican leaderships failure to oppose Trump from the beginning. Republican voters had long held a healthy distrust of Putin, but Trumps persistent affinity for Moscow and other Republican leaders silence are changing Republican voters minds, now making it politically costly for GOP leaders to defend the nation from this foreign adversary.

Because they control the executive and legislative branches, it is ultimately up to Republican leaders to prevent future Russian attacks on American democracy, even if such attacks may benefit the party electorally. Deterrence is an indispensable part of this equation. It cannot be accomplished without punishing Moscow for its violations of our sovereignty and threatening harsher responses for future trespasses.

In passing the Russia sanctions bill, Senate Republicans have shown they understand this. GOP leaders in the House must work with their Senate colleagues to pass a strong sanctions package that requires a congressional review of changes to Russia sanctions implementation desired by the president. He simply cannot be trusted to protect the integrity of Americas democracy on his own.

Republican leaders and the party are at a crossroads. They will either choose liberty in an independent America or to serve a distant, foreign master who seeks no more than to enrich and empower himself at the expense of free society everywhere. If Republican leaders choose the latter, the majority of Americans will have no choice but to hold them accountable as opponents to the cause of freedom.

Evan McMullin is a former CIA operations officer who ran as an independent candidate in the 2016 presidential election. He is co-founder of the nonprofit Stand Up Republic.

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Republicans are risking becoming the party of Putin - Bangor Daily News

Why are Republicans on Capitol Hill having so much trouble repealing and replacing Obamacare? There are reasons all over the place: subsidies, tax credits, tax cuts, Medicaid, essential health benefits, and many others. But there is one fundamental obstacle to getting rid of Obamacare, and it is very simple: Once the government starts giving away, it can't take back.

Go back to October 2013, when Texas Republican Sen. Ted Cruz was leading an effort to defund Obamacare. It was an impossible goal; the GOP was in the minority in the Senate and a Democrat was in the White House. Under those circumstances, defunding President Obama's signature achievement simply wasn't going to happen. Establishment Republicans were angry at Cruz for raising the hopes of the party's base before certain disappointment.

But there was one sense in which Cruz was right and the words he spoke four years ago are resonating today in the GOP's struggle to repeal, or, more accurately, rewrite Obamacare.

Cruz based the defund effort on his contention that once Obamacare was fully in place and subsidies began to flow that was scheduled to begin on Jan. 1, 2014 there would be no stopping it.

"The Obama strategy, I believe, is that on January 1, subsidies kick in," Cruz told a meeting of the Kingwood, Texas tea party in August 2013. "And his strategy is very simple: He knows that in modern times no major entitlement has ever gone into effect and been unwound. Never been done. His strategy is to get as many Americans as possible hooked on the subsidies, addicted to the sugar."

"I think if we're going to stop Obamacare, we have to do it now," Cruz continued. "If we get to January 1, this thing is here forever."

Of course, Republicans did not defund Obamacare there was never any chance they could and the subsidies began. And now, exactly as Cruz (and others) predicted, the entitlement program is proving extremely difficult to repeal. That is because, as Obama and the Democrats who passed it knew, Republicans trying to repeal Obamacare would be taking back something the government had already given to millions of Americans. Once the giving started, Cruz knew, there's no taking back.

And that's where Republicans are now. They've come up with a different way to provide subsidies, but regardless of name, they are trying to reduce those subsidies and make them available to fewer people. They are trying to cut back on the subsidized benefits insurance companies are required to provide to customers. They are trying to reduce the predicted number of people on Medicaid. They are trying to take back, not give. And it is proving very, very hard.

Other Republicans said similar things during the defunding battle back in 2013. Sen. Mike Lee said, "Before this law kicks in in full force on January 1, 2014, we have one last shot." Sen. Marco Rubio said, "This is our last chance and our last best chance to do something about this." Sen. David Vitter said, "Once (Obamacare) gets into law and starts to put down roots, it's going to be difficult to disrupt."

And now it is.

What the 2013 fight showed, and what the current fight is showing again, is that the Republicans' actual last chance to get rid of Obamacare was the 2012 election. That was before the health care law went into effect, before it touched millions of American lives, and when it could still be repealed without great disruption. But when Barack Obama won re-election and could safeguard (and prop up) Obamacare through its early years, the Republican chance to repeal was gone.

Now Republicans are fighting among themselves over a bill that would make substantial changes in Obamacare but leave the structure of the law intact. And several GOP lawmakers enough to scuttle any final agreement are still afraid of cuts in subsidies, in coverage, and in the Medicaid expansion.

Maybe Republicans will succeed. But whatever they do, it won't resemble the root-and-branch repeal they attempted when Obama was president when they knew he would veto any repeal effort that got to his desk. The Republican effort that passes Congress today will be a much-scaled-back measure that could more accurately be called an Obamacare fix.

It all shows that Cruz was right back in 2013. Once Obamacare's subsidies and benefits began to flow, he reminded us, "this thing is here forever."

Byron York is chief political correspondent for The Washington Examiner.

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When Republicans saw the troubled future of Obamacare repeal - Meridian Star

The dirtiest little secret of the Republicans Obamacare repeal campaign is that its genesis has nothing to do with the Affordable Care Act as such, but with a long-cherished desire to gut Medicaid, which predated the ACA by nearly a half-century.

To advance this goal, conservatives and GOP leaders have asserted consistently that Medicaid doesnt work or even harms its beneficiaries. Health economist Austin Frakt of Veterans Affairs and Boston University now has done Medicaids defenders an important service by issuing a call to collect in one place all the claims that the program is broken or harmful, and then pointing us to research debunking those smears.

To be fair, the goal of gutting Medicaid as part of Obamacare repeal isnt really much of a secret. House Speaker Paul Ryan, R-Wisc., gave the game away in a videotaped discussion with National Reviews Rich Lowry in March. There he confessed, So Medicaid, sending it back to the states, capping its growth rate, we've been dreaming of this since I've been around since you and I were drinking at a keg.... I've been thinking about this stuff for a long time.

Ryan is 47 now, so he would have been dreaming about cutting Medicaid in the early 1990s while drinking at a keg, perhaps at frat parties at his alma mater, Miami University of Ohio. The ACA was enacted in 2010.

Other examples abound of Republican and conservative hostility to Medicaid. A 2013 survey of 13 state governors who opposed its expansion under the ACA found five who listed as a principal rationale that its a broken system [that] harms its beneficiaries. Health and Human Services Secretary Tom Price told a congressional hearing in March that Medicaid has decreased peoples ability to access care. The right-wing American Action Forum says the program is harming those who need it most.

We reported last week on a drive-by attack on Medicaid wholly unsupported by the facts launched by right-wing pundit Ben Domenech on the CBS program Face the Nation, and on right-wing healthcare commentator Avik Roys long crusade against the program.

In this video posted in March, House Speaker Ryan confessed that he's been out to gut Medicaid since long before the Affordable Care Act existed

In this video posted in March, House Speaker Ryan confessed that he's been out to gut Medicaid since long before the Affordable Care Act existed

In perhaps the most appalling example, Seema Verma, who as the administrator of HHS Centers for Medicare and Medicaid Services is in charge of the program, cast doubt in an op-ed last week that Medicaid works for those it was designed to serve. Verma based her conclusion that Medicaid had justifiably taken a lot of heat in recent years on three studies that have been widely questioned and even more widely misinterpreted.

None of these claims is true. So lets look at this evidence.

Heres a short-cut version, produced in 2011 by Frakt and co-authors Aaron Carroll, Harold Pollack and Uwe Reihardt: If Medicaid actually harmed health, instrumental variables studies would show that; they don't, they wrote in the New England Journal of Medicine. Other complementary research, such as the RAND Health Insurance Experiment and studies of patients 65 years of age or older who were uninsured before entering Medicare, support the belief that basic public health insurance coverage improves health.

One of the most oft-cited studies questioning the efficacy of Medicaid is a 2010 study of surgical outcomes from the University of Virginia. The 900,000 surgeries in the sample were from 2003 to 2007. The researchers found that in-hospital mortality for Medicaid patients was worse than for uninsured or privately insured patients, though lower than Medicare patients.

But as an analysis by the Milbank Memorial Fund observed, there were lots of questions about this conclusion. The Virginia researchers tried to adjust for some risk factors distinguishing the Medicaid population from the others, but they couldnt adjust for everything.

Among the factors they acknowledged might contribute to mortality and skew the results, the Medicaid patients had the highest incidence of AIDS, and metastatic cancers, depression, liver disease, neurologic disorders, and psychoses. They suffered from social factors associated with poverty, including drug abuse and delayed diagnoses, and lacked support and resources for care at home.

Despite all that, it turned out that Medicaid patients actually did better than some other patients in such surgeries as lung resections, pancreatectomies, and aortic aneurysm operations, and had fewer complications in some categories. A blanket conclusion that Medicaid patients did worse simply was unwarranted.

Its also the case, as Kevin Drum of Mother Jones points out, that mortality is an inadequate metric for assessing a healthcare program, since the vast majority of doctor visits arent for life-threatening conditions. But they can be for conditions that can profoundly affect ones quality of life, not to mention ones financial condition, if they go untreated. In any case, he adds, since the average age of Medicaid enrollees is 38, there wont be much mortality in that group to begin with, so any changes are unlikely to be meaningful.

The best-known study of the effect of Medicaid coverage is the so-called Oregon Experiment, which has the best pedigree of all such studies: It was done by researchers at Harvard and MIT, including such supporters of universal healthcare as Jonathan Gruber. Medicaid critics constantly cite it as proof that having Medicaid coverage is no better than being uninsured, to quote Avik Roy.

New England Journal of Medicine, via Kevin Drum, Mother Jones

No better than uninsurance? Really? Medicaid significantly reduced the financial strain on its enrollees in Oregon.

No better than uninsurance? Really? Medicaid significantly reduced the financial strain on its enrollees in Oregon. (New England Journal of Medicine, via Kevin Drum, Mother Jones)

The problem here is that the authors of the study disagree with that. The study, which followed newly enrolled Medicaid patients for two years, found no improvement in three markers associated with cardiac health and diabetes: cholesterol, high blood pressure and blood sugar levels. But the figures for those were not statistically significant, which makes them useless for assessing the programs effects.

The researchers did, however, find a statistically significant reduction in the incidence of depression, a significant increase in the diagnosis of diabetes and the use of diabetes medications, and in cholesterol screening, pap smears, mammograms and other screening tests. They also found a significant reduction in financial strain from medical costs. Catastrophic expenses, defined as those exceeding 30% of income, were nearly eliminated.

These benefits can be traced directly to Medicaid coverage, and theyre not trivial. The fact that Medicaids critics return to the Oregon results over and over, cherry pick a few findings, and misinterpret those should tell you something. Its that declaring Medicaid to be useless, or no better or even worse than having no insurance at all is merely a shibboleth.

Its an incantation that gets endlessly repeated as truth, even though empirical studies show that theres no truth in it at all. Verma, by citing both the Virginia and the Oregon studies in her op-ed without acknowledging their limitations, turned in a shameful performance.

The congressional Republicans backing the Obamacare repeal bills that cut the meat and bones out of Medicaid to the tune of $800 billion to $1 trillion, must have some ulterior motivation. It cant be improving its users health, because what theyre planning would achieve just the opposite. What could it be?

Keep up to date with Michael Hiltzik. Follow @hiltzikm on Twitter, see his Facebook page, or email michael.hiltzik@latimes.com.

Return to Michael Hiltzik's blog.

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Republicans say Medicaid doesn't work, so it should be cut. Here are all the ways they're wrong - Los Angeles Times

Story highlights

Despite tweets on Friday from President Donald Trump and several high-profile Republican senators, the "repeal, then replace later" option is not really on the table and isn't something that will be pursued by GOP leadership as they try to pull together the 50 votes they need to pass their health care plan. Negotiations are continuing as planned for a proposal that repeals and replaces Obamacare simultaneously.

As CNN reported Friday, there is almost no chance senators will vote on a health care bill the week senators return from recess. Expect the health care negotiations to be a multi-week process.

Senate Majority Leader Mitch McConnell is sending several different proposals and basic outlines to the Congressional Budget Office to help speed up the final scoring process, as CNN reported several times last week. Although the top White House legislative official, Marc Short, said Sunday on Fox News that McConnell sent two bills to CBO for scoring; that's not exactly the case. McConnell actually sent two outlines, plus several other proposals that may make it into a final bill.

The future of the proposal continues to depend on whether there is some compromise resolution on the same issues, including a softer landing for the eventual Medicaid reforms and how to craft some acceptable version of Texas Sen. Ted Cruz's regulations amendment into the final proposal. In his comments Sunday, Short appeared to give the White House endorsement to Cruz's regulations proposal, which if so would be no small thing.

Opioid funding and changes to regulations related to the use of health savings accounts appear to be settled and locked in.

A still looming, very real fight that will be coming when they return: whether to repeal the 3.8% investment tax in Obamacare or not. This is not at all settled, but sources tell CNN this is something that won't be dealt with until Congress returns to Washington.

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Here's where Republicans' health care plans stand - CNN

In a story that was ostensibly about new Supreme Court Justice Neil M. Gorsuch's voting record, NPR legal affairs reporter Nina Totenberg dropped this tantalizing piece of news about Justice Anthony M. Kennedy's potential retirement:

Kennedy may also have thought it best to ensure that there is a full complement of nine justices for at least a year. He could even have been put off by President Trump's tweets about the judiciary.

But it is unlikely that Kennedy will remain on the court for the full four years of the Trump presidency. While he long ago hired his law clerks for the coming term, he has not done so for the following term (beginning Oct. 2018), and has let applicants for those positions know he is considering retirement.

That's called burying the lead. And it's a piece of news that, especially after a tough first six months of the Trump administration, Republicans will be very, very happy to see.

It's not terribly surprising that Kennedy would consider retirement indeed, there was some thought he could even have announced it last week, when the court's term ended but this looks like a pretty good indicator that it will come at some point in President Trump's first term. If Kennedy is considering retiring in 2018, is he really going to stick it out until 2021, when he will be 84 years old? That seems even more unlikely now than it did before.

The upshot? It would mean thatDemocrats wouldn't have a chance to unseat Trump before the next big Supreme Court vacancy comes along. And not only that, but it would seem they may not even have a chance to stop it the other way: with a Senate majority. If Kennedy announces his retirement in advance of the term beginning in October 2018, logic suggests that the GOP would be able to fill it before that election.

Even if the vacancy is filled after the midterms, though, Democrats face a very difficult mapin November 2018. To win three seats and the Senate majority, they effectively need to win the two competitive states on the map Arizona and Nevada along with a very red state like Texas. Oh, and they also have to successfully defend a bunch of Trump states where Democratic incumbents are up for reelection.

Basically: If this vacancy happens before 2018, that's great for the GOP. But if it happens basically at any point in the next three years, that's likely to begravy, too. The key is for it to happen before late 2020.

And it's difficult to overstate the significance of all this.Indeed, if nothing else of real substance gets accomplished on Trump's watch, it all might have been worth it for the GOP merely for his potential appointment to replace Kennedy. Kennedy is the swing vote on a pretty evenly divided nine-vote Supreme Court, and replacing him with a more conservative justice would tilt the court further to the rightfor years or potentially decades to come.

Replacing Kennedy with a Gorsuch-esquejustice would give us five justices that were to Kennedy's right. And that, according to Andrew D. Martin's and Kevin M. Quinn's scores of the ideology of Supreme Court justices, would be basically unprecedented.

Here's how the Supreme Court looked between 1935 and 2015 before Antonin Scalia died and was replaced by the ideologically similar Gorsuch. Keep an eye on that yellow line for the median justice, and imagine it being John G. Roberts Jr. instead of Kennedy.

At that point, Democrats would basically have to hope that the George W. Bush-appointed chief justice would be more liberal than Bush intended. And then they'd have to hope that future vacancies come at much more opportune times.

(h/t Rick Hasen)

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Republicans just quietly got some very good Supreme Court news - Washington Post