Tag Archives: ACA

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Who works for whom in Washington?

Donald Trump thought he could strong-arm congressional Republicans into doing his bidding.

He wanted them to enact a repeal of the Affordable Care Act. GOP lawmakers — namely the more conservative members of their caucus — weren’t budging. Why? I believe it’s because they knew something that the president doesn’t understand: They work for their constituents; they do not work for the president.

When I heard today that Trumpcare went down in flames, I flashed back to another time, in an another era, when another lawmaker decided to stick it in the ear of his congressional leadership.

I recalled former U.S. Rep. Larry Combest, a Republican from Lubbock, who once defied the speaker of the House of Representatives who wanted Combest to back some legislation that he just couldn’t support.

It occurred in the late 1990s. Combest represented a largely rural West Texas congressional district that ran from southern Amarillo all the way to the Permian Basin.

GOP House Speaker Newt Gingrich was pushing something called Freedom to Farm, a dramatic overhaul of national farm policy. If memory serves, Freedom to Farm would have drastically reduced the amount of subsidies the government gave to farmers and ranchers to help them through difficult years. We get those kinds of seasons in West Texas, as you might know. Drought has this way of inhibiting dryland farmers’ ability to harvest crops; such a lack of moisture also restricts the amount of grain that ranchers use to feed their livestock.

Gingrich pushed Combest hard to back Freedom to Farm. Combest resisted. He finally voted against Freedom to Farm.

Combest was left to remind the speaker that he didn’t work for congressional leaders. He answered to the farmers and ranchers who elected him to Congress. These folks back home would suffer from Freedom to Farm and Combest wasn’t about to let them down.

I applauded Combest at the time, remarking in an editorial — and also in a couple of signed columns — that he showed guts by defying his congressional leadership and standing up for his constituents.

Congressional Republicans today don’t work for the president. They answer to their constituents at home, the folks whose votes upon which these lawmakers depend. They hate the GOP alternative to the ACA and let their congressmen and women know it in no uncertain terms. Democrats hate it, too.

That is how representative democracy works, Mr. President.

Just ask Larry Combest.

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So many lessons to learn from health care failure

Where in this world does one start to sort through the wreckage created by the Republican failure to repeal the Affordable Care Act and replace it with … something else?

Most of know the story by now. Donald J. Trump got elected president and promised to “repeal and replace” the ACA. Congressional Republicans, having retained control of both legislative chambers, finally had a president on their side. Repeal and replacement were slam dunks.

Or so they thought.

Then they cobbled together something that didn’t pass conservative and progressive muster. They couldn’t round up the votes to repeal the ACA, let alone approve something called the American Health Care Act.

Arm-twisting, threats and last-second negotiation resulted in the president’s first major legislative failure. House  Speaker Paul Ryan — a partner with the president on this fiasco — canceled the vote today.

Lessons learned here? Let’s take a peek at some of them.

* Trump bitched today at the White House that he had “no Democrat votes.” Really! He said that out loud to a room full of “enemy of the people” reporters. Well, irony apparently isn’t something that’s on Trump’s radar. President Obama didn’t have a single Republican vote when he got Congress to enact the ACA in 2010; but he damn sure tried to get some GOP support.

* Trump campaigned for the presidency on his record as a take-no-prisoners business mogul. He had no public service experience prior to running for president. His whole adult life had been geared toward personal enrichment. Then he discovered something about politics: It is that politicians have their own constituencies to worry about. If the voters who elect them don’t like what they’re doing, they have this annoying habit of voting them out of office.

Congressional Republicans didn’t like the AHCA because their voters back home didn’t like it. Do you get that, Mr. President? Your Republican colleagues don’t work for you; they work for the citizens in their congressional districts and in their states.

This ain’t reality TV, Mr. President. Politics is practiced by those who know what the hell they’re doing. Just because you’re the president doesn’t mean you get your way whenever you demand something of others.

* The ACA isn’t perfect. I’ll concede that along with anyone with half a brain. But as Speaker Ryan conceded today, it is “the law of the land.” Here’s a thought for the speaker and for the president: Why not try to tinker with the ACA? Fix what’s most egregiously wrong with it. If premiums are costing too much, find a method to cap them. If Americans are having trouble finding medical care within certain networks, find a way to streamline the process.

Throwing out a landmark health insurance overhaul simply because it was the creation of a president from the “other” party isn’t smart. What’s more, the ACA is patterned after a plan adopted in Massachusetts, which at the time was governed by a real Republican, Mitt Romney; you remember him, correct? The ACA in fact has Gov. Romney’s fingerprints all over it.

Ryan said today that “doing big things is hard.” No kidding, Mr. Speaker. Barack Obama learned that lesson, too. Indeed, as Vice President Joe Biden once said, “This is a big f****** deal.”

So … the Affordable Care Act remains on the books. Now the president and Congress can turn their attention to something else.

I just hope there aren’t more screw-ups on the horizon.

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Will the ‘system’ swallow POTUS whole?

This fantasy keeps ricocheting around my noggin. Here’s how it goes.

Donald J. Trump sold himself as a no-nonsense, kick-butt business mogul who brooked no foolishness from anyone. Then he got elected president and learned that “I alone” cannot repair what he said is wrong with the country.

He set out to “repeal and replace” the Affordable Care Act and then ran smack into the buzzsaw otherwise known as the House Freedom Caucus, whose members hate the cooked-up alternative to the ACA. Democrats hate it, too, as much as they hate the president.

If the ACA repeal fails today, does that signal the start of a string of failures for a man who told us over and over that he never seemed to fail at anything?

What, then, happens when he cannot enact tax reform, or get the wall built on our southern border, or institute an infrastructure rebuilding program?

What happens if he can’t “destroy ISIS” all by himself? What happens if he keeps getting stern resistance from those on the far right — who don’t trust him anyway — as well as those on the left who are still steamed that he got elected president in the first place?

My fantasy is that Trump might decide the fight ain’t worth it. He’ll call Vice President Pence into the Oval Office and tell the veep, “Mike, take it away. It’s all  yours, my man. I’m going to take Melania and Barron back to New York and we can vacation to our hearts’ content at Mar-a-Lago and no one will give a crap about how much it costs. Besides, this house in D.C. isn’t nearly as nice as my digs in Florida. I’m outta here.”

Yes, that’s why I call it a fantasy. However, one never knows.

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Trump now must get ready to attack other ‘top priorities’

If the Republican plan to overhaul health care fails, the president of the United States will have to face a serious quandary.

Which issue will become his top priority item?

Donald Trump said his first order of business was to repeal and replace the Affordable Care Act. His effort is now gasping for air. A vote on Friday stands as a now-or-never effort. If it fails, which it appears will occur, he will move on to other matters.

What’s next? Let’s see. Building the wall along our southern border? Renegotiating the North American Free Trade Agreement? Bringing back all those jobs that have moved offshore to China?

He won’t deal with Russian aggression in Ukraine, Syria or its meddling with the U.S. presidential election. That’s pretty much a given.

Trump, though, will have to pivot rapidly from health care overhaul.

Heaven knows he’s got a full plate of top-drawer issues to handle.

He did refer to the U.S. economy as a “disaster.” Oh, wait! Then he got that great jobs report for February in which non-farm payrolls grew by 235,000 individuals; joblessness fell to 4.7 percent.

And, no-o-o-o, the numbers weren’t cooked.

I am watching all this flailing right along with the rest of the country. The president cannot get his footing. He has been unable to fill many top administrative posts. He must appoint more than 140 federal judges, which is a consequence of Republicans blocking Barack Obama’s efforts to fill those vacancies when he was president.

And then …

We’ve got all those questions about Russian connections with the Trump campaign, the president’s bogus assertion of wiretapping and whether Donald Trump has any idea of just how he intends to actually govern.

Think of it: We’re only at Day 63. My head is spinning.

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Trump tries to stampede GOP into replacing the ACA

I think I understand what Donald J. Trump is trying to do to persuade his Republican colleagues in Congress to repeal the Affordable Care Act.

The president said a vote on Friday is the drop-dead event. If House of Representatives Republicans do not have the votes to enact the GOP alternative, then that’s it.

The Affordable Care Act will stand. President Barack Obama’s signature domestic policy initiative will remain. The president will move on. He’s done negotiating.

Don’t you get it?

Trump is now trying to persuade balky Freedom Caucus Republicans to vote for the American Health Care Act, or else face the prospect of failing to deliver on the president’s top-drawer campaign promise.

Will he do it? I have no clue. Whether he goes through with his threat likely depends on whether someone gets his attention long enough to persuade him to keep up the fight.

The AHCA is not an improvement over the ACA. The Congressional Budget Office says the AHCA will throw 24 million Americans off their health care plans. GOP lawmakers have been hearing from their constituents for weeks now about how much they hate the Republican alternative to the Affordable Care Act.

Trump throws down the gauntlet

Now it has come down to whether House Republicans actually care enough about health care “reform” to enact an alternative to what’s already on the books. It’s also an open question about whether the president actually cares about health care — at all!

Does he want to enact an actual improvement over the ACA or does he simply want to replace a health care plan promoted and pushed forward by his immediate predecessor? Does he really care about what the alternative contains?

Trump said he is done negotiating with his fellow Republicans. Either pass what’s on the table, he is saying, or we’ll just forget the whole thing.

What a way to lead.

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GOP turns tables on Democrats

John Boehner was a year away from becoming speaker of the U.S. House of Representatives in 2010, but he stood on the floor of the House to express his intense anger at his Democratic colleagues.

They were rushing the Affordable Care Act into law, the then-House minority leader declared. Democrats were shoving this “down our throats,” he hollered. He bellowed that no one had “read the bill!”

The ACA passed with no Republican votes.

Now the GOP is in charge of Congress. Boehner became speaker in 2011 and served until 2015. Republicans sought to repeal the ACA many times during Boehner’s tenure. They failed.

Now it’s Paul Ryan’s House. Speaker Ryan is working with a Republican president to enact something called the American Health Care Act.

What is the GOP strategy being mapped out by Ryan and Donald Trump. Why, they’re trying to rush this to a vote. They’re trying to “shove this down the throats” of conservative lawmakers who oppose it. They aren’t bothering to persuade Democrats, who are lined up en masse to oppose the AHCA, just as the GOP locked arms against the ACA in 2010.

Is it good enough now for Republicans to do the very thing they accused Democrats — with good reason, candidly — of doing?

Of course it isn’t!

The president declared that repealing and replacing the ACA was his top priority. The House was supposed to vote tonight on the AHCA. Ryan backed away from the vote. It’s now scheduled for Friday.

The president says a Friday vote — up or down — will be the end of his negotiating a replacement for the ACA. He said today he’s going to “move on” to other issues. Whether he does will depend on who gets to him. Trump does have this way of changing his mind.

Has there been sufficient comment and analysis on this Republican alternative to ACA, which was trotted out less than a month ago?

Nope. Not even close.

One difference between now and 2010: You aren’t going to hear the current House minority leader, Democrat Nancy Pelosi, screaming on the House floor about not having enough time to consider this health care insurance replacement. Rep. Pelosi is actually chuckling at what she calls the president’s “rookie mistakes.”

That’s the major difference. The tactics of today’s Republicans certainly resemble those employed by yesterday’s Democrats.

medical news

Picture speaks volumes about nature of health debate

This might be the most instructive picture taken during Donald J. Trump’s still-young presidency.

It cracks me up!

The picture shows a collection of individuals gathered around a White House conference room table. The topic at hand? Women’s health issues and whether the Republican-sponsored health care overhaul — the American Health Care Act — would cover certain aspects of health issues germane to women.

Pop quiz: Who is absent from this White House meeting.

Time’s up. The answer? Women. There isn’t a single woman present in this meeting of middle-aged men who are talking about whether the AHCA should include women’s health matters.

Media reported today that the white guys stood and gave Trump an ovation as he entered the room. I guess they were offering a show of respect for the president of the United States.

The person who should have gotten an even bigger round of applause would have been any female member of Trump’s policy team.

I have to wonder: What in the world would any of the people in the picture — even those who are actually married to women — bring to any serious discussion about women’s health?

They use a word in Washington to describe how certain gatherings appear to those who see them: They call them “optics.”

The optics of this meeting were stunning.

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Trump the ‘deal-maker’ faces grievous setback

Donald J. Trump told us — many times — during the 2016 presidential campaign that the greatest skill he would bring to the presidency would be his ability to close the deal.

He made a fortune working out the “best” deals in the history of business … he said.

Here we are. Trump is now the president of the United States. He promised to “repeal and replace” the Affordable Care Act with something more “affordable” and that no American would be left without health insurance.

Trump and congressional Republican leaders have produced something called the American Health Care Act. But there’s this little problem with it.

The Congressional Budget Office’s “scoring” of it pegs the number of Americans who would lose health insurance at 24 million. What’s more, the conservative Freedom Caucus in the House of Representatives hates the AHCA. They call it “Obamacare light.”

So do congressional Democrats. No surprise there.

Crucial vote coming up

The AHCA goes to a vote Thursday in the House. Freedom Caucus members aren’t budging. The president went to Capitol Hill to pitch the AHCA. He threatened some House members that they’d lose their seats in 2018 if they oppose the bill.

Freedom Caucus leaders say they now have enough votes to kill the AHCA. Which means that a Senate vote won’t matter.

Wasn’t this supposed to be the president’s main selling point? Is this how he closes the deal?

The Affordable Care Act, which has brought 20 million Americans into the health insurance system who previously couldn’t afford it, appears to much harder to “repeal and replace” than Donald Trump predicted it would be.

I will await the president’s response to what appears to be a stunning political setback in the making. I’m wondering if he’s going to say the House vote was “rigged.”

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Palin? … Palin? … Palin?

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I am risking getting some grief from readers of this blog by mentioning it … but where is Sarah Palin?

We all remember the former half-term Alaska governor, the 2008 Republican vice-presidential nominee, the former Fox News “contributor,” the former reality TV celebrity.

She was an ardent and vocal critic of the Affordable Care Act. You remember that, too?

She was out there yapping about “death panels” and how bureaucrats would determine who gets to live and who must die.

Palin also was an equally ardent supporter of Donald J. Trump’s candidacy for president and was thought to be a possible selection for veterans affairs secretary when the president was picking his Cabinet.

With all the debate and discussion about “repealing and replacing” the ACA, I keep waiting for Palin to weigh in. I await her pearls of wisdom about the best way to replace the ACA.

Where in the world is she? Has she retreated to Wasilla, Alaska, from where she emerged in 2008 to become U.S. Sen. John McCain’s running mate?

I know what you’re thinking about yours truly: You’ve trashed Palin incessantly; you cannot contain yourself every single time she opens her mouth; you don’t take her seriously. Why do you want to hear from her?

My answer? I don’t know. I just do.

She did become a major political figure, if only for a brief period. Running for VP on a major-party ticket made her a big deal. The McCain-Palin ticket did garner more than 59 million votes in the 2008 election — which ain’t bad, man!

Palin did become a darling of political conservatives, even as she went “rogue.” Her Fox colleagues welcomed her, as did those who watch the cable channel. I am going to presume, moreover, that she retains a considerable fan following among those very conservatives.

I’m not one of her fans. However, she bitched up a storm about the ACA when it was being debated in Congress and then enacted into law.

Here’s your chance, Sarah. Speak up! Tell us how we should provide a better health insurance plan for Americans.

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Government teaches POTUS a stern, necessary lesson

It’s been a lot of fun watching the president of the United States getting the education of his life about how the U.S. government actually works.

It’s not how he wants it to work. Donald J. Trump cannot snap his fingers and make things happen just because, well, he can. Oh no. The system is designed precisely to prevent such things from happening.

Trump got elected while promising to “drain the swamp” and get things done. “I alone” can repair what ails the country, Trump declared at his nominating convention this past summer.

No, sir. You alone can’t do a damn thing!

Which is fine by me. Think of it.

* He seeks to repeal and replace the Affordable Care Act with something called the American Health Care Act; then he and congressional Republican leaders run smack into the TEA Party caucus within the GOP, which hates the AHCA. Oh, and those damn Democrats hate it, too!

* Trump declared his desire to ban all Muslims from entering the United States. Then after being elected he cobbles together a measure to ban refugees from seven Muslim-majority nations from entering the United States. Who steps in? The courts. No can do, Mr. President. A federal judge in Washington state strikes down the first ban; then the 9th U.S. Circuit Court of Appeals upholds the judge.

* He tries again. Trump reintroduces what he calls a “watered-down version” of the first ban. The courts strike again. Uh, Mr. President, this order violates the Establishment Clause of the U.S. Constitution, the one that says government cannot favor one religion over any other; it’s in the First Amendment, Mr. President. You ought to read it.

* His budget? The president seeks to boost defense spending by $54 billion while cutting myriad programs that help poor Americans. Meals on Wheels … for example? Gone. Congress has declared the president’s proposed budget to be essentially DOA, which is the way it’s done in Washington, Mr. President.

As it’s been said often, sir: The president proposes, while Congress disposes.

He’s getting grief from Americans who are angry because his wife and young son aren’t living in the White House, costing the government many millions of extra dollars to keep them safe while they live in Trump Tower — in New York City!

More grief is coming from those who wonder why the president keeps jetting off seemingly every weekend to his glitzy, decadent resort in Palm Beach, Fla. That’s costing a lot of dough, too.

It’s all not very, um, populist of you, Mr. President.

This business mogul is used to getting things done his way. He is learning that the presidency doesn’t allow that kind of thing.

You see, one cannot govern the United States of America the way you’d run a business. I don’t give a damn what anyone says to the contrary. You see, the founders had it right when they crafted a government full of all kinds of restraints, checks and balances, and assorted roadblocks to prevent an omnipotent presidency.

Welcome to the world of governance, Mr. President.