Well, the American Healthcare Act is back on the table this week with a vote possible next week. The bill will be amended to find a path to passage by catering to demands from the House Freedom Caucus but like the previous bill that was reasonably satisfying to House Republican moderates but anathema to the Freedom Caucus it is now pleasing the Freedom Caucus but is inching towards acceptance by the moderates.
The Freedom Caucus wanted to repeal the ten essential healthcare coverage required by the Affordable Care Act (ACA) or Obamacare, eliminate the requirement that insurers cover those with preexisting conditions and do not raise their premiums, and eliminate the program that pays insurers the difference between what they want to charge for premiums and what the insured pays providing the insured qualifies financially for the subsidy. Moderates wanted to keep those programs. The amendment to the bill seeks a middle ground.
Let’s take a look at where we came from in the effort to provide health insurance coverage for more Americans; Before the ACA insurance companies often denied those with preexisting conditions or offered coverage at a premium too expensive for most. Insurers could stop coverage for any number of reasons predominantly if the person covered is running up a large tab. Another reason to end coverage is finding a flaw in the application, and they could also set, after the fact, yearly or lifetime caps on how much they spend to cover claims.
The ACA changed that to the point that the additional 20 million who signed up and got coverage could not have done so without the ACA. Those individuals who qualified for the subsidy, the payment to insurers the difference between what they think the policy is worth and the insured’s ability to pay. Those who did not qualify for the subsidy paid the premium the insurer wanted and over a couple of years many of them experienced higher premiums, some significant.
Insurers agreed to cover the preexisting condition people but required young healthy Americans to buy a policy or pay a fine. Their premiums were largely low since they were less likely to file a claim while those with preexistings and older buyers more likely to file a claim.
Putting 20 million people in any market will create jobs and the ACA did just that with an estimated $5 million jobs created to service their needs either through medical practitioners, medical equipment and supplies and so on. But the ACA met with an inordinate amount of objections from Republicans, especially during the 2016 campaign period; it is a train wreck, a job killer, a deficit increaser none of which were true but the vitriol continued with a vengeance and many Americans began to believe the law was about the worst law on Earth.
The diatribes continued for 7 years with little detail behind the objections and even made it to the Supreme Court where opponents were miffed to find the law is constitutional even though may said it was not.
Over the past three or four years House Republicans introduced around 65 bills aiming to repeal or otherwise cripple the ACA knowing full well the bills would never be signed by the president if they even made it to the Senate.
Then Trump as elected and the Party found, or at least believed, it could get the repeal job done but the idea of turning those 20 million and more back to the old market where they again would not be covered was too much of a political hot potato. That’s where the current effort began; when Republicans realized not only that they did not have a plan to replace the law but that many provisions of the law were keepers.
So where has the horse trading brought us? The amendment to HR 1625 would seem to please both caucuses but doesn’t do what the ACA did and it will probably cost more money to implement. The preexisting condition requirement remains but insurers are allowed to charge more for the premiums. The 10 essential areas of coverage remain but states would have the right to not require them. So when House Speaker Paul Ryan (R-WI) tells you that people with preexisting conditions are protected don’t believe him.
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Hamilton on Congress
A President Struggling to Get on Track
By Lee H. Hamilton
I have significant differences with Donald Trump’s political stances, but I want him to enjoy a successful presidency. It’s good for neither the country nor the world when a U.S. president struggles or fails.
Yet I also believe that constructive criticism can help a president grow more capable. It’s in this spirit that I want to take a hard look at the Trump presidency so far.
President Trump’s personal and stylistic approaches may have served him in business and on the campaign trail, but are problematic in office. He has an unfortunate tendency to dodge blame for things that go wrong. He makes charges with no evidence to support them and refuses to admit he was wrong. He routinely over-inflates his achievements, as when he recently declared that “no administration has accomplished more in the first 90 days,” an assertion that no one familiar with FDR’s and other notable presidents’ first months in office would accept.
Crucially, he does not appear to know how to use or coordinate the levers of American power – economic, diplomatic and political. He appreciates military power, but lacks a coherent, comprehensive strategy and the clarity, consistency, and discipline required to apply one.
President Trump has also shown little evidence of the political skills necessary for success. He has been unable to build coalitions in Washington or rally public support around difficult-to-achieve policy goals. He shows little instinct for finding natural allies to help push legislation through. He shows no interest in inspiring and uniting Americans. And he has hurt himself with his bluster, tenuous relationship with the truth and flouting of the rules of ethics, transparency and conflicts of interest.
Throughout the campaign and his first weeks in office, he painted issues in easy-to-solve, black-and-white terms. Until, that is, he began to confront them as President. Recently, he has admitted that issue after issue is more complicated than he’d expected, which suggests that he had not considered them carefully before.
The President has made some solid choices, putting in place a measured, professional national security team in Defense Secretary James Mattis and National Security Advisor H.R. McMaster. But his policy rhetoric bears little relation to the reality of his accomplishments. We do not have universal, comprehensive health care at lower cost. Tax reform, immigration, cyber reform – it’s hard to find any meaningful progress on any of them.
Chances appear iffy for infrastructure investment in our states and communities that is not a boondoggle. Foreign policy seems to be guided by a team of generals who are competent in their areas of expertise, but unlikely to come up with the comprehensive economic, diplomatic and political policies needed to resolve conflicts and build stable relations abroad.
Given the President’s erratic, impulsive leadership and dizzying string of policy changes, where will we find stability over the next few years? One source of hope is the President himself. His policy switches on China and Syria may have been abrupt, but they moved us in the right direction. He seems to be capable of learning – and reversing himself – on a broad range of policies. He appears willing to accept the sober, mainstream advice of his national security team.
Ordinarily, I’d include Congress in any list of institutions capable of stabilizing a presidency that could go off the rails, but it seems unable to help the President improve his policies.
Instead, other forces have stepped into that role. The courts – especially on immigration -have kept him within the bounds of the Constitution. State and local governments are stepping up to lead on a variety of issues, including climate change. The media have been crucial in highlighting problems within the administration and the implications of its policies. And ordinary citizens have grown vocal in their opinions and active in trying to safeguard and improve their own corners of the world.
These are hopeful developments. But the Trump administration is still struggling to get on track, consumed with internal problems, at a time when we desperately need to move ahead on the serious problems we confront at home and abroad. My hope is that he can find his way to asserting the leadership the country and the world order need.
Lee Hamilton is a Senior Advisor for the Indiana University Center on Representative Government; a Distinguished Scholar, IU School of Global and International Studies; and a Professor of Practice, IU School of Public and Environmental Affairs. He was a member of the U.S. House of Representatives for 34 years.
“A bipartisan panel of experts ripped Egypt as a floundering authoritarian state April 25 and urged Congress to rethink its annual $1.5 billion aid package. The three witnesses at the Senate foreign aid hearing took turns describing Egypt under President Abdel Fattah al-Sisi as a military-run, economic basket case rampant with government-sponsored anti-Americanism. They argued that Egypt has lost the regional influence it had when the United States urged it to make peace with Israel in the late 1970s, making America’s generous military assistance both anachronistic and counterproductive.” Al Monitor
“The antimissile system that the United States deployed in South Korea over China’s objections is close to becoming operational, giving the two allies the capability to defend against missile attacks by the North, the South’s Defense Ministry said on Thursday. The United States deployed the Terminal High Altitude Area Defense system, known as Thaad, in South Korea in early March, after the North fired four missiles into the Sea of Japan. Beijing has vigorously opposed the system, fearing it could give the American military the ability to quickly detect and track missiles launched in China.” New York Times
“US authorities have prepared charges to seek the arrest of WikiLeaks founder Julian Assange, The site first gained wide attention for posting thousands of files stolen by the former US Army intelligence analyst now known as Chelsea Manning. Prosecutors have struggled with whether the First Amendment precluded the prosecution of Assange, but now believe they have found a way to move forward. During President Barack Obama’s administration, Attorney General Eric Holder and officials at the Justice Department determined it would be difficult to bring charges against Assange because WikiLeaks wasn’t alone in publishing documents stolen by Manning.” CNN