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Republicans may have failed to overthrow Obamacare last week, but there are plenty of ways they can chip away at it.

The Trump administration has already begun using its regulatory authority to water down less prominent aspects of the 2010 healthcare law.

Earlier last week, newly confirmed Health and Human Services Secretary Tom Price stalled the rollout of mandatory Medicare payment reform programs for heart attack treatment, bypass surgery and joint replacements finalized by the Obama administration in December.

The delays offer a glimpse at how President Donald Trump can use his administrative power to undercut aspects of the Affordable Care Act (ACA), including the insurance exchanges and Medicaid expansion that Republicans had sought to overturn.

The Republicans' failure to repeal Obamacare, at least for now, means it remains federal law. Price's power resides in how to interpret that law, and which programs to emphasize and fund.

Hospitals and physician groups have been counting on support from Medicare - the federal insurance program for the elderly and disabled - to continue driving payment reform policies built into Obamacare that reward doctors and hospitals for providing high quality care at a lower cost.

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The Obama Administration had committed to shifting half of all Medicare payments to these alternative payment models by 2018. Although he has voiced general support for innovative payment programs, Price has been a loud critic of mandatory federal programs that dictate how doctors should deliver healthcare.

Providers such as Dr. Richard Gilfillan, chief executive of Trinity Healthcare, a $15.9 billion Catholic health system, say they will press on with these alternative payment plans with or without the government's blessing. But they have been actively lobbying Trump officials for support, according to interviews with more than a dozen hospital executives, physicians and policy experts.

Without the backing of Medicare, the biggest payer in the U.S. healthcare system which Price now oversees, the nascent payment reform movement could lose momentum, sidelining a transformation many experts believe is vital to reining in runaway U.S. healthcare spending.

Price "can't change the legislation, but of course he's supposed to implement it. He could impact it," said John Rother, chief executive of the National Coalition on Health Care, a broad alliance of healthcare stakeholders that has been lobbying the new administration for support of value-based care.

The move Friday to pull the Republican bill only reinforces the risk to the existing law, which Trump said on Friday "will soon explode."

"It seems that the Trump Administration now faces a choice whether to actively undermine the ACA or reshape it administratively," Larry Levitt, senior vice president at Kaiser Family Foundation, wrote on Twitter.

"The ACA marketplaces weren't collapsing, but they could be made to collapse through administrative actions," he added.

NEW PAYMENT PLANS AT RISK

The United States spends $3 trillion a year on healthcare - more by far than 10 other wealthy countries - yet has the lowest life expectancy and the highest infant mortality rate, according to a 2013 Commonwealth Fund report.

Health costs have soared thanks in part to the traditional way doctors and hospitals get paid, namely by receiving a fee for each service they provide. So the more advanced imaging tests a doctor orders or pricey procedures they perform, the more money he or she makes, regardless of whether the patient's health improves.

"We have a completely broken economy in healthcare," said Blair Childs, senior vice president at hospital purchasing group Premier Inc. "Literally, all of the incentives in fee-for-service are for higher cost."

Alternative payment models are designed to remove incentives that reward overtreatment of patients. Private insurers are on board, with Aetna Inc, Anthem Inc, UnitedHealth Group and most Blue Cross insurers announcing plans to shift half of their reimbursement to alternative payment models to control costs.

To promote the shift to alternative payments, the ACA created an incubator program at the Centers for Medicare and Medicaid Services (CMS). The CMS innovation center is funded by $10 billion over 10 years to test payment schemes aimed at improving quality and cutting the cost of care.

The Obama administration's decision to make some of these payment programs mandatory has drawn the ire of Price, a former U.S. senator and orthopedic surgeon. In response to a mandatory payment program for joint replacements last September, for example, Price charged that the CMS innovation center was "experimenting with Americans health."

In his January 17 confirmation, Price said he was a "strong supporter of innovation," but said he believed the CMS innovation center "has gotten a bit off track."

TRUMP SETS WHEELS IN MOTION ON DAY 1

President Trump has already signed an executive order directing the HHS to begin unraveling Obamacare. In the early hours of his presidency, Trump directed government agencies to freeze regulations and take steps to weaken the healthcare law.

The order directed departments to "waive, defer, grant exemptions from, or delay the implementation" of provisions that imposed fiscal burdens on states, companies or individuals. These moves were meant to minimize the costs and regulatory burdens imposed on states, private entities and individuals.

David Cutler, the Harvard health economist who helped the Obama Administration shape the ACA, said Price could do all sorts of things to undermine the law.

"If he wants to blow it up, he can," Cutler said in an email. But if they do, he added, "they alone will own the failure."

See original here:
How Republicans Can Hobble ObamaCare Even Without Repeal - Fox Business

Photo: Spencer Platt/Getty Images

In his inaugural address, President Trump vowed that the forgotten men and women of our country will be forgotten no longer. He then suggested that the government has a responsibility to provide its righteous people with great schools for their children, safe neighborhoods for their families, and good jobs for themselves.

The hedge-fund billionaire who bankrolled Trumps campaign takes a different view. Robert Mercer reportedly believes that human beings have no inherent value other than how much money they make, and that society is upside down because government helps the weak people get strong, and makes the strong people weak by taking their money away, through taxes.

Thus far, Trumps governing style has been more in keeping with his donors private views than with his own official ones. The president has backed a health-care plan that finances a tax cut for millionaires by throwing millions of forgotten Americans off of Medicaid while proposing a budget that would slash spending on public housing, food assistance, after-school programs, and development funds for poor rural and urban areas.

These actions represent the normal part of the Trump presidency. The fact that the new Republican president is serving as a loyal general in the one percents class war would be wholly unremarkable, had Trump not campaigned as a populist outsider. But then, if Trump hadnt run as a populist outsider, its quite possible that there wouldnt be a new Republican president. The moguls success in the primary and general elections had many causes, but one was likely his avoidance of conservative platitudes about bootstraps and makers and takers.

Typically, Republicans attribute the despair of impoverished communities to the moral failings of individual poor people. But Trump never lamented the culture of poverty. Instead, he blamed the misery of the forgotten on rapacious elites who had failed to protect the righteous peoples economic interests.

This message when liberally (or, perhaps illiberally) salted with appeals to white racial resentment proved to be a winning one. In a country that saw its economic elite engineer a financial crisis and then reap the lions share of the gains once growth resumed the market for paeans to job creators has contracted sharply. This is true even within the Republican Party, which has grown increasingly reliant on the support of downwardly mobile white voters.

Trump wasnt the only Republican to recognize that his partys we built that shtick had fallen out of fashion. Paul Ryan took back his whole makers and takers spiel in March of 2016. And during their years-long assault on Obamacare, Republicans mostly attacked the law from the left: Instead of arguing against the morality of taxing the wealthy to expand Medicaid, many conservatives lamented that Obamacare had left too many Americans with insurance they cant afford to use.

Trump gave the GOP the rebrand it desperately needed. But, thus far, hes made few alterations to the actual product. And, judging by their failed attempt to pass a supply-side tax cut dressed as a health-care bill, Republicans believe that the only thing their agenda ever lacked was a racist reality star as its salesman.

But they are wrong about that: Movement conservatism is failing politically because its policies have never had less to offer the voters it relies on.

New research on the surging death rate among white, non-college-educated Americans offers a harrowing testament to this fact. In 2015, Princeton economists Anne Case and Angus Deaton discovered that an epidemic of suicides and substance abuse was driving up the mortality rate of middle-aged, working-class, white Americans even as medical advances were pushing down that rate for college-educated whites and every other racial and ethnic group.

Last week, Case and Deaton published a new paper exploring the causes of this development. It identifies a number of accessories to the crime: Stalled progress on the prevention of heart disease and climbing rates of obesity and diabetes contributed to their morbid finding.

But the prime culprit in their story is the collapsing social mobility and living standards of working-class Americans.

Since the great recession, black and white non-college-educated workers have seen their mortality rates rise, across every age group. And working-class African-Americans still suffer higher death rates than white ones do.

However, only the non-college-educated white population has seen a nearly continuous rise in its mortality rate over the last two decades. And that jump has been driven by a uniquely high spike in deaths of despair.

Case and Deaton suggest that, even though African-American workers are more materially disadvantaged than their white peers and have also suffered greatly from Americas industrial decline the demographic has found some cause for optimism in their nations lurching progress toward racial equality (their data set ends the year before Trump launched his campaign).

By contrast, non-college-educated white workers have seen their economic prospects drop from a higher peak and no countervailing narrative of cultural progress has arrested their sense of decline. This foreboding can pervade whole communities, and lead their most vulnerable members to seek relief in drinking, drugs, or death.

Case and Deaton argue that the erosion of traditional families and religious communities has contributed to the demographics despair, as movement conservatives always insisted. But just as Trump did on the campaign trail, the economists suggest that these breakdowns are rooted in the labor market. People dont struggle economically when they fail to get married and adopt middle-class social norms. They fail to do those things when they struggle economically building strong familial and communal ties is simply much more difficult when no one with your skill set is earning a living wage.

Movement conservatisms other anti-poverty prescription instilling self-reliance in the poor by kicking them out of their welfare hammocks also withers under the papers scrutiny. The United States has the thinnest safety net of any major, western nation. And it is also the only such country in which non-college-educated white workers are dying much younger than they used to.

Of course, there are plenty of other factors that contribute to this discrepancy. American physicians began routinely prescribing opioids for chronic pain beginning in the mid-1990s, after a U.S.-based company aggressively marketed oxycodone for that purpose. And Americas singularly high rate of gun ownership likely boosts its suicide rate.

Nonetheless, the rationale behind House Republicans push to add work requirements to Medicaid that providing a minimum standard of health care to the indigent unemployed breeds an unhealthy dependency is hard to reconcile with the superior health outcomes of workers in European nanny states.

The tenets of movement conservatism have always been belied by the lived experience of working people. But this tension is a lot more conspicuous today than it was when Reagan brought morning to America. Since then, the GOP has grown more radically right wing; income has grown more concentrated at the top; and Republicans have grown ever more dependent on the nonaffluent for votes.

Now, even the GOP base supports more government spending on health care and opposes tax cuts for the rich.

Trumps rise has alerted some conservatives to the bankruptcy of their ideology. In March 2015, David Brooks attributed the plight of the white working class to a plague of nonjudgmentalism explaining that what the downwardly mobile really needed was a stern lecture on its moral failings:

Exactly two years later, Brooks decided that, actually, those people could probably use a stronger social safety net, too:

If you want to preserve the market, you have to have a strong state that enables people to thrive in it. If you are pro-market, you have to be pro-state. You can come up with innovative ways to deliver state services, like affordable health care, but you cant just leave people on their own. The social fabric, the safety net and the human capital sources just arent strong enough.

Republicans can continue putting the superstitions of misanthropic billionaires above the needs of their downscale voters. But in doing so, they will send more forgotten men and women to early graves. And, eventually, the righteous people may take the GOP down with them.

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Last week, the GOP lawmaker suggested the intelligence community mistreated Trumps team. The night before, he met with a source at the White House.

Before GOP can move on to tax reform, it must deal with the real risk of an internal revolt against the current budget.

After Trumpcare failed to reach the House floor, Wall Street loses confidence in the presidents capacity to deliver a large corporate tax cut.

As part of a broader investigation into Kremlins 2016 election meddling.

Shell represent the United States.

Richard Haste was found guilty of departmental charges five years after shooting the unarmed 18-year-old.

A weird news alert.

With some help from the business community.

As many as 200 civilians may have been killed when three houses collapsed after a coalition attack on ISIS militants in the area.

And theyre starting to figure that out.

The nationwide demonstrations were the largest in the country since 2012.

The wounded president is trying to make sure his followers know that the failure of Trumpcare wasnt his fault.

The gunman is still at large. Terrorism is not suspected.

White House and GOP insiders have been leaking their stories following the demise of Trumpcare.

A new survey shows well-funded Democrat Jon Ossoff ahead of or even with his most likely GOP rivals in a second-round runoff in June.

The investigation into Khalid Masood is moving fast.

The collapse of Trumpcare could be the GOP version of Clintoncare: something none of them will hurry to repeat.

Some solid owns coming from the left side of the aisle this afternoon.

Ryan withdraws the GOPs health-care plan after concluding it cannot pass the House. Trump says he wont try to repeal Obamacare again anytime soon.

The Republican Party could not come up with a better idea.

More:
'Small Government' Conservatism Is Killing Republican Voters - New York Magazine

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In the past, presidents have told big lies mostly for one of two reasons. In the midst of scandal or failure, they told lies to protect themselves and deny that they had done wrong: I am not a crook, we did not trade arms for hostages, I did not have sexual relations with that woman. Or they lied to convince the public to go along with a policy initiative, whether a war or a tax cut or a new program, when the truth was insufficiently persuasive.

Unlike his predecessors, President Trump lies for any reason at all.

I imagine the sinking feeling his aides get when he blurts out another whopper. "Now I'm going to have to go out and defend this," they say with a sigh, then huddle together to arrive at the least laughable spin they can come up with, so they can rationalize the lie which Trump will of course be unwilling to retreat from.

White House staff have little choice but to reinforce, justify, and repeat their boss' lies, though I suppose they could retain some shred of dignity and integrity by quitting. But what about Trump's fellow Republicans, particularly the ones in Congress? They're in an uncomfortable position, knowing that he's still popular with the GOP base and so not having his back could have electoral costs. Being a "maverick" might sound appealing, but not when it's going to cost you lots of votes or hinder your ability to work with the rest of the party on your legislative priorities.

So with just a few exceptions, Republicans have chosen to get in line when Trump goes off on one of his near-daily flights of fantasy. Or at the very least, they try to avoid the subject and run from reporters who might bring it up. But they can't escape the taint of this presidency, and the longer it goes, the more likely each one of them is to get dirty.

Consider this remarkable interview Trump did with Time, in which he argued that it was fine for him to claim that Barack Obama tapped his phones, because: "When I said wiretapping, it was in quotes. Because a wiretapping is, you know today it is different than wiretapping. It is just a good description. But wiretapping was in quotes." Before we go on, let's acknowledge that even this idiotic explanation is false; I refer you to this tweet, free of any quotation marks or vague references that might be interpreted to refer broadly to surveillance:

Nevertheless, this is one of Trump's common explanations for his lies, that he didn't actually lie if he got the lie from somebody else ("Well, I'm not, well, I think, I'm not saying, I'm quoting, Michael, I'm quoting highly respected people and sources from major television networks"). When asked whether the country will be able to believe him when he asks for their trust during a future crisis, he responded, "The country believes me. Hey. I went to Kentucky two nights ago, we had 25,000 people in a massive basketball arena." In other words: People can trust that I tell the truth because my fans still come out to see me.

This is not exactly a compelling defense. So every time Trump says something ridiculous, Republicans have to ask themselves: Do I help him on this or not? Some lies he tells are exaggerated versions of the lies they themselves tell, like the idea that three million people voted illegally. Republicans have all invested in the lie that says there is massive voter fraud; most just are careful enough not to put any numbers on it.

Other lies, though, are purely personal to Trump, like the idea that he had the largest inauguration crowd in history. They don't justify a policy or serve some other collective purpose; they're just about Trump feeling good. Defending him on that does nothing to help you with anyone but Trump himself.

Then there are questions that aren't about policy, but threaten the administration to a profound enough degree that Republicans may feel they have no choice but to rally to Trump's defense. The ever-widening Russia scandal falls into that category, which is why we've seen only a few Republicans admit that there's something troubling about a hostile foreign dictator manipulating our election, or that a report that the president's campaign manager had a $10 million per year contract with a Russian oligarch to advance Vladimir Putin's political interests might raise some alarming questions.

If Republicans are tempted to distance themselves from Trump over the Russia scandal, they'll probably be stopped by the realization that any serious threat to his presidency quickly becomes an equally serious threat to their agenda. A president crippled by a major scandal will be far less able to deliver on tax cuts for the wealthy or deregulation for corporations.

And that was the reason almost every Republican lined up behind Trump in the first place: They may have had their reservations about him, but he'd help them do all the things they'd been yearning to do for eight years. Yet now they can't escape the devil's bargain they made.

There are some Republicans more enthusiastic about Trump than others and some that are more sycophantic toward him. But sooner or later, almost all of them will wind up defending him, whether it's about particular lies he's told or scandals he's embroiled in. The stain of cooperating with Donald Trump will be on all of them, and it will never wear off.

See original here:
Why Republicans dutifully defend Trump's most ridiculous lies - The Week Magazine

Facing a growing rebellion within his own ranks, Speaker Paul Ryan pulled the Republican Obamacare replacement plan from the House floor on Friday just before a scheduled vote.

The decision is a staggering defeat for Ryan and President Donald Trump in their first attempt to partner on major legislation and fulfill a seven-year Republican promise to repeal Obamacare. And it comes a day after Trump issued an ultimatum to House Republicans to vote for the bill or live with Obamacare.

Story Continued Below

GOP lawmakers decided they can, in fact, live with Obamacare, at least for now.

A Republican leadership aide said Trump and Ryan spoke by phone at 3 p.m. and that the president asked the speaker to pull the bill. Ryan told reporters that his advice to Trump was to cancel the vote.

But the reality is that Ryan and his leadership team had been bleeding votes all day and were not close to passing the American Health Care Act. The speaker went to the White House and told Trump as much just an hour earlier.

Republicans were begging Ryan and party leaders to pull the bill to save them from having to vote on an unpopular measure. But Trump badly wanted to move ahead so he would "know who my friends are," he said, according to a Republican lawmaker who met with him. Democrats were unwavering in their opposition, and conservative outside groups despised the bill from the start.

And while GOP leaders had called Trump "the ulimate closer," he wasn't able to move many votes, especially among hard-line conservatives in the House Freedom Caucus. Trump admitted after the bill was pulled that he was "10 to 15 votes" shy of victory, a stunning margin considering how much effort he and Ryan had put into their lobbying campaign during the last week.

Ryan also knew, though, that if the bill had come up for a vote, it would have failed by a much larger margin than the whip counts. Once rank-and-file members knew it would fail, they'd reverse course and vote "no" in order to protect themselves politically, which their leaders would bless. That much larger margin of defeat would be an even bigger setback for Trump. In a sense, Ryan protected Trump from his own combative instincts, said GOP insiders.

"I will not sugarcoat this, this is a disappointing day for us," Ryan said at a press conference following the stunning announcement. "This is a setback, no two ways about it."

Ryan admitted that the Affordable Care Act, enacted seven years earlier almost to the day, "remains the law of the land... We're going to be living with Obamacare for the foreseeable future."

Ryan insisted Trump was not at fault for the failure.

"The president gave his all in this effort," Ryan added. "He's been fantastic."

The Freedom Caucus the group that took down Speaker John Boehner remained unwilling to compromise with Trump and Ryan, believing that their bill didn't do nearly enough to unwind Obamacare.

"Some of the members of that caucus were voting with us, but not enough were," Ryan said. "I met with their chairman today, and he made it clear that the votes weren't going to be there from their team. And that was sufficient to provide the balance of votes to have this not pass."

Democrats, for their part, were doing cartwheels in the Capitol. They've bloodied Trump, bashed Ryan, and showed that even in a GOP-run Washington, they still matter big time.

Today is a great day for our country," said House Minority Leader Nancy Pelosi (D-Calif.). "It's a victory. What happened on the floor is a victory for the American people for our seniors, for people with disabilities, for our children, for our veterans."

On the other side of the aisle, the internal GOP finger-pointing has already begun, showing the long-term damage inside the Republican Conference from this fight.

Rep. Michael Burgess (R-Texas), who helped craft the Republican health care legislation, was livid after the decision to pull the bill.

"The architects of Obamacare, they own this damn thing," the Texas Republican said. "There were people who were not interested in solving the problem. They win today."

Rep. Mo Brooks (R-Ala.), a member of the Freedom Caucus, said the bill's demise was a "good day for America."

Despite Freedom Caucus Chairman Mark Meadows' central role in defeating the bill and thus leaving Obamacare as the law of the land, the North Carolina Republican insisted he still wanted to repeal the Democratic health care law.

"I remain wholeheartedly committed to following through on this promise," Meadows said in a statement. "President Trump is committed to repealing Obamacare and replacing it with a system that works for American families, and I look forward to working with him to do just that."

Trump has staked his early presidency on repealing and replacing Obamacare, embracing his image as a dealmaker and closer throughout the process. House leaders were happy to oblige as well, referring to Trump as the ultimate closer as he met with reluctant House members.

Hes left everything on the field when it comes to this bill, White House spokesman Sean Spicer said Friday afternoon, describing Trump as working tirelessly to get the bill across the finish line. He added, You cant force someone to vote a certain way.

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As Ryan and his allies scrambled to convince wary colleagues to back their health care plan, they watched as conservative and moderates in their caucus began to declare their opposition. As defections mounted, Ryan traveled to the White House to reveal to Trump his faltering whip count and to discuss whether to pull the bill. But the administration seemed intent on proceeding as planned.

We want the vote," a senior administration official said as Ryan made his way up Pennsylvania Avenue. "If they want to go against the president, they should do it on live TV."

Ultimately, though, Ryan prevailed. Moderate Republicans such as Virginia Rep. Barbara Comstock and Ohio Rep. David Joyce disclosed their opposition even as Ryan was meeting with Trump. It became clear early Friday afternoon that the bill was poised for defeat, as members on the fence broke against it.

The bill met sharp resistance from both ends of the Republican caucus, as hard-line conservatives in the House Freedom Caucus contended it failed to do away with Obamacares core components and moderates argued that its curbs on Medicaid could harm vulnerable constituents. Ultimately, those competing pressures proved irreconcilable.

Rep. Charlie Dent (R-Pa.), a moderate who came out against the bill two days ago, insisted that Friday's debacle was actually not a big deal and said its time to move on."

"There are a lot of people in this building who talk and say everything is catastrophic and cataclysmic, well we know thats not the case," Dent said. "If you want to do health care reform, do it on a bipartisan basis. We have to sit down and regroup.

Rep. Barry Loudermilk (R-Ga.) warned it wasnt the end of Republican efforts to repeal Obamacare.

The game is not over, so its not a win or loss," he said. Were gonna get back together after we get a weekends rest, were going to assess where we are. The votes were razor thin, from what I understand, so were close to where we need to be."

Read more:
Republicans yank Obamacare repeal bill - POLITICO

House Republicans simply did not have enough GOP votes to pass the health care bill, which also was supported by President Donald Trump.

Republican leaders pulled the bill from the House floor minutes ahead of a schedule vote, rather than watch it go down to defeat.

According to a tally by NBC News, at least 34 Republicans had said publicly over the last few days that they were planning to vote against the measure or leaning toward voting no on the "American Health Care Act." It's possible there were other Republican lawmakers who also would have voted no but had not yet made their position public. All House Democrats had planned to vote against the bill.

Related: Trump Warns: GOP Will Lose Seats By Opposing Health Care Bill

Here are the House Republicans who opposed the bill:

Jim Jordan (OH)

Mark Meadows (NC)

Justin Amash (MI)

Dave Brat (VA)

Raul Labrador (ID)

Mo Brooks (AL)

Rob Wittman (VA)

Thomas Massie (KY)

Tom Garrett (VA)

Ileana Ros-Lehtinen (FL)

Leonard Lance (NJ)

Louie Gohmert (TX)

John Katko (NY)

Brian Fitzpatrick (PA)

Walter Jones (NC)

Ted Budd (NC)

Mark Sanford (SC)

Rick Crawford (AR)

Ted Yoho (FL)

Scott DesJarlais (TN)

Paul Gosar (AZ)

Rod Blum (IA)

Andy Harris (MD)

Dan Donovan (NY)

Frank LoBiondo (NJ)

David Young (IA)

Charlie Dent (PA)

Jaime Herrera Beutler (WA)

Mark Amodei (NV)

Daniel Webster (FL)

Andy Biggs (AZ)

Rodney Frelinghuysen (NJ)

Dave Joyce (OH)

Barbara Comstock (VA)

Read the rest here:
These Republicans Could Doom GOP Health Bill - NBC News