National Interest

The Pronk Pops Show 920, June 28, 2017, Part 2 — Story 1: Breaking BIG — Big Interventionist Government — Obamacare and Obamacare Lite — The Progressive Two-Party Tyranny of The Democratic and Republican Parties — Fake Repeal and Fake Replace Is Not Real Repeal of Obamacare and All Obamacare Regulations and Replace With Free Enterprise Individual Health Insurance Markets Not Centralized Federal Control and Regulation with Massive Subsidies Of Health Insurance Industry — Collectivists vs Individualists — Replace The C, D, F BIG Progressive Republican Senators and Representatives — The Party’s Over — Videos

Posted on June 28, 2017. Filed under: American History, Banking System, Blogroll, Breaking News, Budgetary Policy, Communications, Congress, Constitutional Law, Corruption, Countries, Defense Spending, Donald J. Trump, Donald Trump, Economics, Elections, Employment, Federal Government, Fiscal Policy, Freedom of Speech, Government, Government Dependency, Government Spending, Health, Health Care, Health Care Insurance, History, House of Representatives, Human, Human Behavior, Independence, Labor Economics, Law, Life, Media, Medicare, Monetary Policy, National Interest, News, People, Philosophy, Photos, Politics, Progressives, Radio, Rand Paul, Raymond Thomas Pronk, Regulation, Rule of Law, Scandals, Senate, Social Security, Tax Policy, Taxation, Taxes, Ted Cruz, Trade Policy, United States of America, Videos, Wealth, Welfare Spending, Wisdom | Tags: , , , , , , , , , , , , |

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The Pronk Pops Show Podcasts

Pronk Pops Show 920,  June 28, 2017 posted as soon as possible

Pronk Pops Show 919,  June 27, 2017 posted as soon as possible

Pronk Pops Show 918,  June 26, 2017 

Pronk Pops Show 917,  June 22, 2017

Pronk Pops Show 916,  June 21, 2017

Pronk Pops Show 915,  June 20, 2017

Pronk Pops Show 914,  June 19, 2017

Pronk Pops Show 913,  June 16, 2017

Pronk Pops Show 912,  June 15, 2017

Pronk Pops Show 911,  June 14, 2017

Pronk Pops Show 910,  June 13, 2017

Pronk Pops Show 909,  June 12, 2017

Pronk Pops Show 908,  June 9, 2017

Pronk Pops Show 907,  June 8, 2017

Pronk Pops Show 906,  June 7, 2017

Pronk Pops Show 905,  June 6, 2017

Pronk Pops Show 904,  June 5, 2017

Pronk Pops Show 903,  June 1, 2017

Pronk Pops Show 902,  May 31, 2017

Pronk Pops Show 901,  May 30, 2017

Pronk Pops Show 900,  May 25, 2017

Pronk Pops Show 899,  May 24, 2017

Pronk Pops Show 898,  May 23, 2017

Pronk Pops Show 897,  May 22, 2017

Pronk Pops Show 896,  May 18, 2017

Pronk Pops Show 895,  May 17, 2017

Pronk Pops Show 894,  May 16, 2017

Pronk Pops Show 893,  May 15, 2017

Pronk Pops Show 892,  May 12, 2017

Pronk Pops Show 891,  May 11, 2017

Pronk Pops Show 890,  May 10, 2017

Pronk Pops Show 889,  May 9, 2017

Pronk Pops Show 888,  May 8, 2017

Pronk Pops Show 887,  May 5, 2017

Pronk Pops Show 886,  May 4, 2017

Pronk Pops Show 885,  May 3, 2017

Pronk Pops Show 884,  May 1, 2017

Pronk Pops Show 883 April 28, 2017

Pronk Pops Show 882: April 27, 2017

Pronk Pops Show 881: April 26, 2017

Pronk Pops Show 880: April 25, 2017

Pronk Pops Show 879: April 24, 2017

Pronk Pops Show 878: April 21, 2017

Pronk Pops Show 877: April 20, 2017

Pronk Pops Show 876: April 19, 2017

Pronk Pops Show 875: April 18, 2017

Pronk Pops Show 874: April 17, 2017

Pronk Pops Show 873: April 13, 2017

Pronk Pops Show 872: April 12, 2017

Pronk Pops Show 871: April 11, 2017

Pronk Pops Show 870: April 10, 2017

Pronk Pops Show 869: April 7, 2017

Pronk Pops Show 868: April 6, 2017

Pronk Pops Show 867: April 5, 2017

Pronk Pops Show 866: April 3, 2017

Pronk Pops Show 865: March 31, 2017

Pronk Pops Show 864: March 30, 2017

Pronk Pops Show 863: March 29, 2017

Pronk Pops Show 862: March 28, 2017

Pronk Pops Show 861: March 27, 2017

Pronk Pops Show 860: March 24, 2017

Pronk Pops Show 859: March 23, 2017

Pronk Pops Show 858: March 22, 2017

Pronk Pops Show 857: March 21, 2017

Pronk Pops Show 856: March 20, 2017

Pronk Pops Show 855: March 10, 2017

Pronk Pops Show 854: March 9, 2017

Pronk Pops Show 853: March 8, 2017

Pronk Pops Show 852: March 6, 2017

Pronk Pops Show 851: March 3, 2017

Pronk Pops Show 850: March 2, 2017

Pronk Pops Show 849: March 1, 2017

Image result for repeal and replace obamacareImage result for branco cartoon repeal and replace obamacare

Image result for repeal and replace obamacareImage result for american on group plans, individual plans, Medicare, MedicaidImage result for repeal and replace obamacare

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Image result for Progressive republicans and democrats the two party tyrannyImage result for cartoons on repeal and replace of obamacareImage result for Progressive republicans and democrats the two party tyranny

National Debt Clock 

http://www.usdebtclock.org/

Image result for Progressive republicans and democrats the two party tyranny

Part 2 — Story 1: Breaking BIG — Big Interventionist Government — Obamacare and Obamacare Lite — The Progressive Two-Party Tyranny of The Democratic and Republican Parties — Fake Repeal and Fake Replace Is Not Real Repeal of Obamacare and All Obamacare Regulations and Replace With Free Enterprise Individual Health Insurance Markets Not Centralized Federal Control and Regulation with Massive Subsidies Of Health Insurance Industry — Collectivists vs Individualists — Replace The C, D, F BIG Progressive Republican Senators, and Representatives — The Party’s Over — Videos

 

Image result for Per capita health care expenditures by country 2015

Image result for Per capita health care expenditures by country 2015

 

Image result for Per capita health care expenditures by country 2015

Image result for Per capita health care expenditures by country 2015

Image result for Per capita health care expenditures by country 2015

Image result for how many americans are in employer paid health insurance v. individual health insurance

Judy Holliday – The Party’s Over

Judy Holliday The Party’s Over Lyrics

The party’s over
It’s time to call it a day
They’ve burst your pretty balloon
And taken the moon away.

It’s time to wind up

The masquerade
Just make your mind up
The piper must be paid.

The party’s over
The candles flicker and dim
You danced and dreamed

Through the night
It seemed to be right
Just being with him.

Now you must wake up
All dreams must end
Take off your makeup

The party’s over
It’s all over, my friend.

Now you must wake up
All dreams must end
Take off your makeup
The party’s over
It’s all over, my friend.

Should Republicans Punt On Health Care Reform?

Poll: Only 17% approve of Senate health care bill | Trump polls 6/28/2017

President Trump Holds Meeting with GOP Senators After Delayed Healthcare Vote 6/27/17

I won’t vote to keep ObamaCare: Rand Paul

Sen. Rand Paul: Our Bill May Cost More In First 2 Years Than Obamacare Did | TODAY

Republicans delay Senate health care vote

Heller says he will not support the GOP Senate health-care bill

Senator Ron Johnson: ‘We Should Not Be Voting’ on Healthcare This Week | Meet The Press | MSNBC

Milton Friedman – Collectivism

Milton Friedman on universal health care

Milton Friedman – The Social Security Myth

Milton Friedman – The Welfare Establishment

Milton Friedman – Tyranny of the Status Quo – Part 1 – Beneficiaries

Milton Friedman – Tyranny of the Status Quo – Part 2 – Bureaucrats

Milton Friedman – Tyranny of the Status Quo – Part 3 – Politicians

Milton Friedman – Why Tax Reform Is Impossible

Milton Friedman – Health Care Reform (1992) pt 1/4

Milton Friedman – Health Care Reform (1992) pt 2/4

Milton Friedman – Health Care Reform (1992) pt 3/4

Milton Friedman – Health Care Reform (1992) pt 3/4

Milton Friedman – Health Care Reform (1992) pt 4/4

Milton Friedman – Morality & Capitalism

Lacking enough GOP votes, Senate pushes back health bill

Sen. Rand Paul: Senate health care bill needs more Obamacare ‘repeal’

Hardball with Chris Matthews 6/27/17 Republicans can’t repeal and replace Obamacare

Hume on GOP Health Care Fight: Either Way, Republicans Have a ‘Problem’

Rand Paul: Let’s Repeal Obamacare And Don’t Replace It

Rush Limbaugh Talks Obamacare With VP Mike Pence: “We Take The Teeth Out Of The Tiger”

Republicans have one major problem on Obamacare

Why Can’t America Have a Grown-Up Healthcare Conversation?

Is Obamacare Working? The Affordable Care Act Five Years Later

Why Are American Health Care Costs So High?

How Health Insurance Works

Senate postpones health care bill vote

Individual Health Insurance VS. Group Health Insurance

Published on Aug 14, 2009

Ok so lets contrast individual vs. group health insurance. One thing that a lot of people get wrong is individual health insurance, number one isn’t as good coverage and number two, cost more than a group coverage. Well, these two things are wrong. The first one, lets talk about cost. We find that individual health insurance is about 40% less than any group plan. You can load it up with all the features and benefits you are looking for in a group

Group vs. Individual Health Insurance: Health Insurance Facts & More

Published on Aug 16, 2012

‘We’re Amending Obamacare. We’re Not Killing It’

The Senate bill coming out Thursday would do many things to health care in the U.S., but it won’t get rid of the Affordable Care Act, and Mitch McConnell won’t claim that it does.

The health-care bill Senate Republicans plan to unveil on Thursday likely will make substantial changes to Medicaid and cut taxes for wealthy Americans and businesses. It will eliminate mandates and relax regulations on insurance plans, and it will reduce the federal government’s role in health care.

What it won’t do, however, is actually repeal the Affordable Care Act.

Lost in the roiling debate over health care over the last several weeks is that Republicans have all but given up on their longstanding repeal-and-replace pledge. The slogan lives on in the rhetoric used by many GOP lawmakers and the Trump White House but not in the legislation the party is advancing. That was true when House Republicans passed the American Health Care Act last month, which rolled back key parts of Obamacare but was not a full repeal. And it is even more true of the bill the Senate has drafted in secret, which reportedly will stick closer to the underlying structure of the law.

“We’re amending Obamacare. We’re not killing it,” a frustrated Jason Pye of the conservative group FreedomWorks told me earlier this month as the murky outlines of the Senate proposal were beginning to emerge.

Like the House bill, the Senate plan is expected to repeal the ACA’s employer and individual insurance mandates and most if not all of the tax increases Democrats levied to pay for new programs and benefits. But the Senate bill likely will only begin a years-long phase-out of the ACA’s Medicaid expansion in 2020 rather than end it as the House measure does.

The Senate also is expected to include more generous tax credits than the House bill that more closely resemble the system already in place under Obamacare. But the funding levels would still be lower than the current law. And according to Axios, the bill would allow states to opt out of some ACA insurance regulations, but it would do so by loosening existing waivers within the current law rather than follow the House in creating a new waiver system. And the Senate proposal would require that states adhere to more of Obamacare’s regulations than the House bill.Senate Majority Leader McConnell has quietly abandoned the language of “repeal-and-replace” that his office originated seven years ago in the immediate aftermath of the ACA’s enactment. In more than a dozen speeches on health care that McConnell has delivered on the Senate floor since the House passed its bill in early May, he hasn’t uttered the word “repeal” a single time, according to transcripts provided by the majority leader’s office. Nor has he repeated his own pledge to rip out Obamacare “root and branch.” “We’re going to make every effort to pass a bill that dramatically changes the current health care law,” McConnell told reporters on Tuesday, setting a new standard for the bill Republicans plan to release on Thursday.

When the year started, legislation leaving Obamacare substantially in place would have been dead on arrival with hardliners in the House and Senate, who demanded that party leaders expand on a bill that former President Barack Obama vetoed in 2015. That measure did not fully repeal the ACA either, bowing to Senate budget rules limiting how much of the law Republicans could scrap without a filibuster-proof 60 votes. But it eliminated the tax credits and subsidies undergirding the law’s insurance exchanges along with its tax increases and mandates. And with Republicans now in control of both Congress and the White House, conservatives in the House Freedom Caucus this spring began pushing the leadership to go further by repealing Obamacare’s core consumer protections guaranteeing the coverage of essential health benefits and prohibiting insurers from charging higher rates to people with preexisting conditions.

The deal that ultimately allowed the AHCA to pass the House was an under-appreciated turning point in the health-care debate. The concession that Speaker Paul Ryan and a few key moderates made to the Freedom Caucus was to allow states to opt out of some of Obamacare’s insurance regulations, most crucially on equal treatment for pre-existing conditions. But the concession that conservative lawmakers and outside groups made in return was just as significant: They agreed to back off their demand for full repeal and endorse—or at least not fight—a bill that fell far short of that goal.“While this legislation does not fully repeal Obamacare, it’s an important step in keeping that promise to lower healthcare costs,” the Freedom Caucus said in its statement upon passage of the AHCA. It was a message echoed by outside groups like FreedomWorks, Heritage Action, and the Club for Growth, who agreed to drop their opposition to the bill, a move that gave Republicans additional cover to vote for it. Conservatives had embraced an incrementalist approach to Obamacare. The new standard they adopted for health-care legislation was not whether it eliminated the Affordable Care Act but whether it would lower premiums for most consumers.One key question for McConnell is whether the most outspoken conservatives in his caucus—Senators Rand Paul of Kentucky, Ted Cruz of Texas, and Mike Lee of Utah—will judge the Senate bill by that more modest baseline. Republicans can lose no more than two votes to secure passage, and a group of moderate senators is proving just as difficult for party leaders to nail down. To this point, Paul has been the most critical of the GOP approach and the most likely to oppose the proposal from the right. The House bill, he complained, already kept 90 percent of Obamacare’s subsidies. “If this gets any more subsidies in it, it may well be equal to what we have in Obamacare. So it really wouldn’t be repeal,” Paul said on Tuesday, according to Bloomberg. Even so, the Kentucky conservative wouldn’t rule out supporting the bill until he read the text.Cruz and Lee have participated in the Senate process as members of the 13-man working group, and aides have said both have bought into McConnell’s incremental approach. But the two have each complained about the emerging draft in recent days, either on the substance or the top-down, secretive process used to write the bill. “We’re not there yet,” Cruz said Tuesday on Fox News. “The current draft doesn’t do nearly enough to lower premiums.”The Congressional Budget Office projected that in states that opted out of Obamacare’s insurance requirements under the waivers allowed in the House bill, average premiums would drop significantly. But the tradeoff is that people with preexisting conditions would face sharply higher costs or be priced out of insurance entirely. Conservatives have argued that the high cost of adhering to the ACA’s minimum coverage requirements has forced insurers to raise premiums in order to make a profit.Conservative activists briefly held out hope that the health-care bill would move further to the right in the Senate, buoyed by efforts by Cruz and Lee to have Republicans override parliamentary rulings limiting how much of Obamacare they could repeal through the budget reconciliation process. But party leaders never seriously considered that option, which moderate Republicans were likely to oppose.In recent weeks, conservatives have instead focused on demanding that the Senate preserve—or deepen—the reforms to Medicaid in the House bill while still repealing all of Obamacare’s tax hikes. “It is clear that significant portions of the Republican Party have no intention of actually repealing Obamacare despite campaigning on that objective for years,” Mike Needham, CEO of Heritage Action, said in a statement on Wednesday.

“Conservatives will evaluate legislative language when it becomes available, looking particularly at whether the legislation empowers states to get out of the onerous insurance mandates imposed by Obamacare, maintains and improves the House’s Medicaid reforms, and repeals Obamacare’s stifling taxes.”

Make no mistake, Republicans aren’t merely tinkering around the edges of the health-care system, or Obamacare. The Senate proposal that will come out on Thursday will significantly alter the federal funding of Medicaid and, in all likelihood, would result in millions fewer Americans having health insurance over the next decade, as projected by the CBO. And while they won’t be excited by the bill, conservative senators and activists might well come around to support it. They’d vote for the plan as a step in the right direction, a weakening of Obamacare. But like McConnell, they won’t be calling it something that it’s not: repeal.

https://www.theatlantic.com/politics/archive/2017/06/senate-republican-bill-obamacare-repeal/531108/

What’s in the Senate Republican Health-Care Bill

Like the House version, Mitch McConnell’s proposal would slash taxes, cut Medicaid, and eliminate Obamacare’s insurance mandates for individuals and employers.

The Senate Republican health-care bill is finally out in the open.

After weeks of secretive deliberations, party leaders on Thursday released a 142-page proposal that would slash taxes on the wealthy and businesses; reduce federal funding for Medicaid and phase out its expansion under the Affordable Care Act; and limit the tax credits available to help people purchase insurance on the individual market. The legislation, titled the Better Care Reconciliation Act of 2017, is officially labeled a “discussion draft,” but Senate Majority Leader Mitch McConnell wants Republicans to debate and vote on the bill by the end of next week.

Like the American Health Care Act that passed the House in May, the Senate bill is a substantial revision to Obamacare but not a wholesale repeal. And while Senate Republicans had vowed to start over rather than work off the unpopular House proposal, their version is structured the same way. The Senate measure mirrors the House bill in eliminating the ACA’s employer and individual insurance mandates and most of the tax increases it imposed to pay for new programs. Both proposals call for an overhaul of Medicaid funding that would allow states to institute work requirements and end the program’s status as an open-ended entitlement. The Senate bill would go further than the House’s $800 billion in cuts by reducing its growth rate beginning in 2025, but unlike the House version, it would begin a three-year phase-out of the program’s expansion in 2020. The AHCA would cut off the expansion entirely that year.

As expected, Democrats assailed the proposal as a draconian measure that would strip health insurance from millions all for the goal of providing tax cuts for the rich. They seized on comments that President Trump reportedly made to Republican senators in which he called the House proposal “mean.”
“Simply put: This bill will result in higher costs, less care, and millions of Americans will lose their health insurance, particularly through Medicaid,” Senate Minority Leader Charles Schumer said. “It’s every bit as bad as the House bill; in some ways, it’s even worse.”

But the McConnell was never intended to appeal to Democrats. Instead, the majority leader and the Senate policy staffers who wrote the bill were trying to strike a delicate balance between conservatives bent on ripping up Obamacare and moderate Republican senators who, though they campaigned on repeal, now want to preserve its central benefits. Whether McConnell achieved that middle ground is unclear, as few Republican senators leapt to embrace his proposal in the immediate aftermath of its release. The first official holdouts to emerge were a group of four conservatives: Senators Rand Paul of Kentucky, Ted Cruz of Texas, Mike Lee of Utah, and Ron Johnson of Wisconsin.“Currently, for a variety of reasons, we are not ready to vote for this bill, but we are open to negotiation and obtaining more information before it is brought to the floor,” they said in a joint statement. “There are provisions in this draft that represent an improvement to our current health care system, but it does not appear this draft as written will accomplish the most important promise that we made to Americans: to repeal Obamacare and lower their health care costs.”Their statement was significant because together, their opposition alone could sink the bill given the GOP’s narrow, 52-48 majority in the Senate. But its careful wording left a lot of room for any or all of the conservatives to come around by the time the bill hits the floor next week. Paul, who has been a critic of the GOP approach for months, was more harsh in a pair of tweets he sent on his own. “The current bill does not repeal Obamacare. It does not keep our promises to the American people,” he wrote. Paul had long been considered a likely no vote, as it is unlikely McConnell could move the bill far enough to the right to get his support without losing moderates.
The draft will also face the test of whether its provisions pass muster under the Senate’s complex rules for budget reconciliation, which would allow Republican to circumvent a Democratic filibuster. Aides on Thursday acknowledged that “there will be ongoing discussions with the Parliamentarian” in the Senate about certain parts of the bill.The Senate proposal targets abortion coverage by prohibiting the use of tax credits to buy insurance plans that cover the procedure, and it would ban funds from going to Planned Parenthood. Those provisions could jeopardize the support of two moderate Republicans, Senators Susan Collins of Maine and Lisa Murkowski of Alaska, who have said they oppose restricting federal funding to Planned Parenthood. A spokeswoman for Collins, Annie Clark, said Thursday she would be reviewing the bill into the weekend. “She has a number of concerns and will be particularly interested in examining the forthcoming CBO analysis on the impact on insurance coverage, the effect on insurance premiums, and the changes in the Medicaid program,” Clark said.The Senate bill also allows states to opt out of some of Obamacare’s insurance regulations, but it does not allow waivers that would let insurance companies charge higher rates to people with preexisting conditions. “We’re not touching preexisting conditions,” one top GOP staffer told reporters on a Thursday conference call. While the House bill created a new waiver system aimed at allowing states to get around Obamacare requirements, the Senate expands an existing waiver in the current law to make it easier for states to apply. The provision, aides said, would allow insurance companies in states that obtain waivers to sell plans that do not provide essential health benefits, including maternity care, hospitalization, and mental-health treatment.Unlike the House bill, the Senate proposal contains funding for cost-sharing payments for insurers to help stabilize the faltering individual insurance market under Obamacare. They would continue through 2019 before being repealed entirely. The payments are the subject of a lawsuit that House Republicans filed against the Obama administration three years ago, and while the Trump administration has continued the subsidies, its refusal to guarantee them over the long term has prompted more insurers to exit the ACA exchanges.McConnell has drawn criticism from senators in both parties for writing the bill behind closed doors without public hearings, though it’s unclear if the mounting frustration among some Republican senators about the process will threaten the legislation’s passage. In a floor speech on Thursday morning, the majority leader said senators would have “ample time” to review and amend the bill before a final vote. The Congressional Budget Office said it would release its analysis of the Senate bill’s cost and impact on insurance early next week. It found that the House bill would leave 23 million more people uninsured over the next decade while reducing average premiums depending on whether states opted out of Obamacare’s insurance regulations.“We debated many policy proposals. We considered many different viewpoints,” McConnell said. “In the end, we found that we share many ideas about what needs to be achieved and how we can achieve it. These shared policy objectives and the solutions to help achieve them are what make up the health care discussion draft that we talked through this morning.”Senate budget rules call for what’s known as a “vote-a-rama” where members of either party offer amendments in a single session. And in many ways, it appears McConnell’s draft is designed to be amended. The bill, for example, does not include funding for the opioid crisis that Senators Rob Portman of Ohio, Shelley Moore Capito of West Virginia, and others were demanding. Nor does it adopt their proposal for a longer, seven-year phase-out of the Medicaid expansion. But by omitting those provisions at the front end, McConnell could be inviting Portman, Capito, and other wavering senators to add them by amendment so they can claim credit for improving the bill when it comes to the floor. Similarly, the statement Paul, Cruz, Lee, and Johnson appeared to be a play for changes that could win their ultimate support.Republicans have a razor-thin majority of 52 seats, and McConnell can lose no more than two votes to pass the bill with a tie-breaker from Vice President Mike Pence. The majority leader will also face difficulty securing support from conservatives who feel the proposal doesn’t go far enough in dismantling Obamacare.https://www.theatlantic.com/politics/archive/2017/06/whats-in-the-senate-republican-health-care-bill/531258/
Mark Levin’s new book, “Rediscovering Americanism,” an assault on the media and progressives and a call for Americans to take back their country, debuts today at No. 1 on Amazon.

Showing the draw of the New York Times bestselling author and top syndicated radio host, his book is already on the way to becoming another big seller.

“My new book covers a lot of territory — philosophy, history, economics, law, culture, etc. And I look deeply into what is meant by Americanism, republicanism, individualism, capitalism. What do we mean by natural law, unalienable rights, liberty, and property rights? From where do these principles come? Why are they important?” he told Secrets.

It follows in the path of his other books and the nation: Liberty and Tyranny: A Conservative Manifesto; Ameritopia: The Unmaking of America; The Liberty Amendments; and Plunder and Deceit.

Secrets reviewed “Rediscovering Americanism”last week and wrote:

In the book, Levin attacks the embrace by the media, politicians, and academia of progressive promises of a “utopia” defined by the end of personal freedom and individuality.

He has a grim name for it: “The Final Outcome.” Levin wrote, “They reject history’s lessons and instead are absorbed with their own conceit and aggrandizement in the relentless pursuit of a diabolical project, the final outcome of which is an oppression of mind and soul.”

Levin added, “the equality they envision but dare not honestly proclaim, is life on the hamster wheel, where one individual is indistinguishable from the next.”

Paul Bedard, the Washington Examiner’s “Washington Secrets” columnist, can be contacted at pbedard@washingtonexaminer.com

http://www.washingtonexaminer.com/mark-levin-book-condemning-media-progressives-debuts-no-1-amazon/article/2627178

Dems face identity crisis

Democrats are grappling with how to keep their progressive base happy while winning over white working-class voters who left the party in the 2016 elections.

Defections by blue-collar voters cost Democrat Hillary Clinton the states of Michigan, Pennsylvania and Wisconsin, all of which went to President Trump. It was the first time since 1988 that a GOP presidential candidate had won Michigan or Pennsylvania, and the first time since 1984 in Wisconsin.

The fallout has created an identity crisis for a Democratic Party seeking to find its way forward in the post-Obama era.

A string of House special election losses culminating in Democrat Jon Ossoff’s disappointing defeat in Georgia last week has only intensified the scrutiny and second-guessing of Democratic strategy, to say nothing of the hand-wringing by party activists craving a victory.

“I’m not convinced we know what the best thing is for the party right now,” said Democratic strategist Jim Manley. “I’m not convinced we have the answers.”

Democrats trying to figure out what they’re doing wrong are focused on how they’ve seemingly lost a significant part of the Democratic base all while failing to turn out enough progressives.

There are different views about what to do across the party, with some questioning whether the white working-class voters can be won back by a party that seems to be tilting leftward with the rise of Sen. Bernie Sanders(I-Vt.) and other liberal voices.

“I’ve spoken to some folks who think we have to only choose one or the other,” said one former senior aide to President Barack Obama. “And after this election cycle, I think there are some who believe there may be some truth to that.”

A lot depends on whether the party can find the right candidate with the right message, particularly in 2020.

“Democrats need a reason for showing up. Give them a reason to believe, and we won’t be having this discussion,” the former Obama aide said.

Democrats say there is a way to appeal to both progressives and white working-class voters.

“Everybody is being too simplistic,” Democratic strategist Jamal Simmons said. “Voters are much more complex.”

Simmons said it’s not a matter of choosing to talk about police violence and climate change or the minimum wage and creating jobs.

Progressives, he said, want Democrats to talk about all of that.

They “want politicians to say something about Black Lives Matter and equality — they also want to know how they’re going to get their kids through college, pay off their house and get a better job,” he said. “The thing that’s most frustrating to me is this either-or dichotomy.”

Obama’s victories in 2008 and 2012 show Democrats can win over both groups, say some Democrats.

“This crisis is Democrats not realizing their own strengths, or being scared of articulating their core principles, rather than a crisis of having no agenda,” said Julian Zelizer, a professor of history and public affairs at Princeton University.

He said a focus on economics, climate change and being anti-Trump would animate the party.

“These are the places that 2018 candidates need to focus on, because they are ways to distinguish themselves from the GOP and its agenda,” he added. “Then they should continue to use Trump as a unifying theme. Often experts downplay this, but Republicans were very effective at using Obama that way.”

In recent days, particularly since the Ossoff loss, Democrats have been doing a lot of finger-pointing.

There’s been a movement to stop blaming the 2016 presidential election loss on Russia. And there have been calls to cut ties with current Democratic leaders like House Minority Leader Nancy Pelosi (D-Calif.). Some of those calls, within the House, come from lawmakers such as Rep. Tim Ryan (D-Ohio), who is worried about losing the white working class.

On the other end of the spectrum, some say Sanders’s bashing of Democrats has only deepened wounds.

“A lot of people are sick of it,” said Manley, a former adviser to then-Senate Majority Leader Harry Reid (D-Nev.). “The mainstream part of the party has had it up to here with what he’s been saying.”

Some Democrats are seeking to build a bridge between the two groups.

In an interview Sunday on ABC’s “This Week,” Senate Minority Leader Charles Schumer (D-N.Y.) said the party will unveil a “strong, bold, sharp-edged and commonsense economic agenda” in the coming weeks.

Addressing both wings of his party, he added, “I’m talking to Bernie Sanders. I’m talking to Joe Manchin. This is going to be really something that Democrats can be proud of, and I’m excited about it.”

Manchin, a Democratic senator from West Virginia, is among the most centrist members of Schumer’s conference.

Michael Tyler, a spokesman for the Democratic National Committee, said Democrats will look to expand their support across the party.

He acknowledged in an email to The Hill that in order to win elections, Democrats “have to focus on broadening and turning out our base and on reaching out to Americans who cast ballots for Donald Trump or didn’t vote at all.”

Tyler said Democrats are in the process of rebuilding a party “from an organization whose mission was solely to elect the president of the United States to one that organizes to elect Democrats up and down the ballot, from school board to Senate.”

But it may not be as easy as that, some strategists say.

Asked how the party rebounds and lures both working-class and progressive Democrats, Manley admitted: “I don’t have the faintest idea in this point in time. I’m still trying to digest what happened.”

http://thehill.com/homenews/campaign/339577-dems-face-identity-crisis

Replacing Obamacare is a make-or-break moment for Republicans

 June 25

Sen. Dean Heller (R-Nev.) threw himself off a political cliff last week when he declared full-throated opposition to the Senate version of the Obamacare repeal bill, and it remains to be seen if Heller is hanging by a limb out of sight and can climb back to electoral sanity or has hit rock bottom in his public career.Individual Senate Republicans face different political realities, but the caucus must somehow get the votes necessary to return the revised Obamacare “repeal and replace” bill to the House. To fail to do so is to condemn not only Heller and Arizona’s Sen. Jeff Flake to certain doom but probably others among the eight GOP senators up for reelection. The grass roots’ disgust with this betrayal will be so deep as to endanger every senator, even in deep red states such as Mississippi, Texas and Utah.The political crosswinds and upheavals in the country are already beyond predicting anything, so to add even more cause for grievance by betraying the central promise of the congressional GOP is beyond irresponsible. It is political insanity. Shut the door to the consultants, and throw out the polling senators. If the GOP defaults on its core promise, it is doomed as a party to minority status, probably as early as 2018 and certainly in 2020.

To fail this week almost certainly forfeits the House majority in next year’s midterm elections but perhaps also the Senate’s, and with the latter, the ability to confirm Supreme Court justices and lower court judges, pass budgets under reconciliation, have any chance at serious tax reform and of course approve the crucial repeal of the Defense Department sequestration.

This is of course an imperative vote on saving American health care. Next year, for example, there potentially will be at least 18 counties in Ohio without even a single option for an individuals seeking coverage. The swaths of America where there is only one provider are large and growing. “Choice for consumers” is a delusion, and soaring deductibles have made health care an illusion to millions more.

Obamacare is a catastrophe on its own terms, but the consequences of not passing its repeal are worse even beyond those awful health-care outcomes. It will forfeit every other Republican goal because failing to deliver on the central promise of eight years of debates and campaigns will shatter the credibility every Republican, not just those who block the bill. The party as a whole will be gravely wounded, perhaps beyond healing for a generation or more.

I don’t have to guess about this. I have been talking to the center-right of the country for three hours a day Monday through Friday for the past 17 years. I know the central argument of the conservative activists everywhere in the United States is that Beltway Republicans cannot be trusted to do anything hard. That argument was dented by the discipline with which the GOP put up with the mainstream media and Democrats’ slings and arrows in the fight over replacing Justice Antonin Scalia. Majority Leader Mitch McConnell (Ky.) rightly calculated that to surrender that hill would be to lose not just a political battle but the political war stretching long into the future. It was that big of a deal to the base.

The same is true of Obamacare. To vote “no” on whatever compromise arrives is to express contempt for the Republican Party as a whole – and its grass-roots activists and base voters — and for those ideas it stands for on all major matters, from a strong defense to low taxes to an originalist Supreme Court.

Thus Heller seemed to declare himself a hollow man when he said he could not vote for it, a man without any core beliefs because with his rambling statement he endangered all alleged core GOP beliefs, and thus the GOP will not support him. It isn’t about primaries; primary opponents need not materialize. It is about millions of conservatives who will simply give up on politics.

This is a make-or-break moment for Senate Republicans and the party itself. Sadly, for this conservative, the tone-deafness of Heller may not be unique. It may not even turn out to be particularly rare. We will know in a week. And not one GOP senator will be able to say he or she wasn’t warned.

https://www.washingtonpost.com/opinions/replacing-obamacare-is-a-make-or-break-moment-for-republicans/2017/06/25/c5f7775a-59c9-11e7-9fc6-c7ef4bc58d13_story.html?utm_term=.602544feab43

Patient Protection and Affordable Care Act

From Wikipedia, the free encyclopedia
Patient Protection and Affordable Care Act
Great Seal of the United States
Long title The Patient Protection and Affordable Care Act
Acronyms(colloquial) PPACA, ACA
Nicknames Affordable Care Act, Health Insurance Reform, Healthcare Reform, Obamacare
Enacted by the 111th United States Congress
Effective March 23, 2010; 7 years ago
Most major provisions phased in by January 2014; remaining provisions phased in by 2020
Citations
Public law 111–148
Statutes at Large 124 Stat.119through 124 Stat.1025(906 pages)
Legislative history
  • Introduced in the Houseasthe “Service Members Home Ownership Tax Act of 2009” (H.R. 3590byCharles Rangel (DNYon September 17, 2009
  • Committee consideration byWays and Means
  • Passed the House on October 8, 2009 (416–0)
  • Passed the Senate as the “Patient Protection and Affordable Care Act” on December 24, 2009 (60–39with amendment
  • House agreed to Senate amendment on March 21, 2010 (219–212)
  • Signed into law by PresidentBarack Obamaon March 23, 2010
Major amendments
Health Care and Education Reconciliation Act of 2010
Comprehensive 1099 Taxpayer Protection and Repayment of Exchange Subsidy Overpayments Act of 2011
United States Supreme Court cases
National Federation of Independent Business v. Sebelius
Burwell v. Hobby Lobby
King v. Burwell

The Patient Protection and Affordable Care Act, often shortened to the Affordable Care Act (ACA) and nicknamed Obamacare, is a United States federal statute enacted by the 111th United States Congress and signed into law by PresidentBarack Obama on March 23, 2010. Under the act, hospitals and primary physicians would transform their practices financially, technologically, and clinically to drive better health outcomes, lower costs, and improve their methods of distribution and accessibility.

The Affordable Care Act was designed to increase health insurance quality and affordability, lower the uninsured rate by expanding insurance coverage and reduce the costs of healthcare. It introduced mechanisms including mandates, subsidies, and insurance exchanges.[1][2] The law requires insurers to accept all applicants, cover a specific list of conditions and charge the same rates regardless of pre-existing conditions or sex.[3]

The ACA has caused a significant reduction in the number of people without health insurance, with estimates ranging from 20–24 million additional people covered during 2016.[4][5] Increases in overall healthcare spending have slowed since the law was implemented, including premiums for employer-based insurance plans.[6] The Congressional Budget Office reported in several studies that the ACA would reduce the budget deficit, and that repealing it would increase the deficit.[7][8]

As implementation began, first opponents, then others, and finally the president himself adopted the term “Obamacare” to refer to the ACA.[9]

The law and its implementation faced challenges in Congress and federal courts, and from some state governmentsconservativeadvocacy groupslabor unions, and small business organizations. The United States Supreme Court upheld the constitutionality of the ACA’s individual mandate as an exercise of Congress’s taxing power,[10] found that states cannot be forced to participate in the ACA’s Medicaid expansion,[11][12][13] and found that the law’s subsidies to help individuals pay for health insurance are available in all states, not just in those that have set up state exchanges.[14]

Together with the Health Care and Education Reconciliation Act amendment, it represents the U.S. healthcare system‘s most significant regulatory overhaul and expansion of coverage since the passage of Medicare and Medicaid in 1965.[15][16][17][18]

Provisions

The President and White House Staff react to the House of Representatives passing the bill on March 21, 2010.

The ACA includes provisions to take effect between 2010 and 2020, although most took effect on January 1, 2014. Few areas of the US health care system were left untouched, making it the most sweeping health care reform since the enactment of Medicare and Medicaid in 1965.[15][16][17][19][18] However, some areas were more affected than others. The individual insurance market was radically overhauled, and many of the law’s regulations applied specifically to this market,[15] while the structure of Medicare, Medicaid, and the employer market were largely retained.[16] Most of the coverage gains were made through the expansion of Medicaid,[20] and the biggest cost savings were made in Medicare.[16] Some regulations applied to the employer market, and the law also made delivery system changes that affected most of the health care system.[16] Not all provisions took full effect. Some were made discretionary, some were deferred, and others were repealed before implementation.

Individual insurance

Guaranteed issue prohibits insurers from denying coverage to individuals due to pre-existing conditions. States were required to ensure the availability of insurance for individual children who did not have coverage via their families.

States were required to expand Medicaid eligibility to include individuals and families with incomes up to 133% of the federal poverty level, including adults without disabilities or dependent children.[21] The law provides a 5% “income disregard”, making the effective income eligibility limit for Medicaid 138% of the poverty level.[22]

The State Children’s Health Insurance Program (CHIP) enrollment process was simplified.[21]

Dependents were permitted to remain on their parents’ insurance plan until their 26th birthday, including dependents that no longer live with their parents, are not a dependent on a parent’s tax return, are no longer a student, or are married.[23][24]

Among the groups who remained uninsured were:

  • Illegal immigrants, estimated at around 8 million—or roughly a third of the 23 million projection—are ineligible for insurance subsidies and Medicaid.[25][26] They remain eligible for emergency services.
  • Eligible citizens not enrolled in Medicaid.[27]
  • Citizens who pay the annual penalty instead of purchasing insurance, mostly younger and single.[27]
  • Citizens whose insurance coverage would cost more than 8% of household income and are exempt from the penalty.[27]
  • Citizens who live in states that opt out of the Medicaid expansion and who qualify for neither existing Medicaid coverage nor subsidized coverage through the states’ new insurance exchanges.[28]

Subsidies

Households with incomes between 100% and 400% of the federal poverty level were eligible to receive federal subsidies for policies purchased via an exchange.[29][30] Subsidies are provided as an advanceable, refundable tax credits.[31][32] Additionally, small businesses are eligible for a tax credit provided that they enroll in the SHOP Marketplace.[33] Under the law, workers whose employers offer affordable coverage will not be eligible for subsidies via the exchanges. To be eligible the cost of employer-based health insurance must exceed 9.5% of the worker’s household income.

Subsidies (2014) for Family of 4[34][35][36][37][38]
Income % of federal poverty level Premium Cap as a Share of Income Incomea Max Annual Out-of-Pocket Premium Premium Savingsb Additional Cost-Sharing Subsidy
133% 3% of income $31,900 $992 $10,345 $5,040
150% 4% of income $33,075 $1,323 $9,918 $5,040
200% 6.3% of income $44,100 $2,778 $8,366 $4,000
250% 8.05% of income $55,125 $4,438 $6,597 $1,930
300% 9.5% of income $66,150 $6,284 $4,628 $1,480
350% 9.5% of income $77,175 $7,332 $3,512 $1,480
400% 9.5% of income $88,200 $8,379 $2,395 $1,480
a.^ Note: In 2014, the FPL was $11,800 for a single person and $24,000 for family of four.[39][40] See Subsidy Calculator for specific dollar amount.[41] b.^ DHHS and CBO estimate the average annual premium cost in 2014 would have been $11,328 for a family of 4 without the reform.[36]

Premiums were the same for everyone of a given age, regardless of preexisting conditions. Premiums were allowed to vary by enrollee age, but those for the oldest enrollees (age 45-64 average expenses $5,542) could only be three times as large as those for adults (18-24 $1,836).[42]

Mandates

Individual

The individual mandate[43] is the requirement to buy insurance or pay a penalty for everyone not covered by an employer sponsored health planMedicaidMedicare or other public insurance programs (such as Tricare). Also exempt were those facing a financial hardship or who were members in a recognized religious sect exempted by the Internal Revenue Service.[44]

The mandate and the limits on open enrollment[45][46] were designed to avoid the insurance death spiral in which healthy people delay insuring themselves until they get sick. In such a situation, insurers would have to raise their premiums to cover the relatively sicker and thus more expensive policies,[43][47][48] which could create a vicious cycle in which more and more people drop their coverage.[49]

The purpose of the mandate was to prevent the healthcare system from succumbing to adverse selection, which would result in high premiums for the insured and little coverage (and thus more illness and medical bankruptcy) for the uninsured.[47][50][51] Studies by the CBOGruber and Rand Health concluded that a mandate was required.[52][53][54] The mandate increased the size and diversity of the insured population, including more young and healthy participants to broaden the risk pool, spreading costs.[55] Experience in New Jersey and Massachusetts offered divergent outcomes.[50][53][56]

Business

Businesses that employ 50 or more people but do not offer health insurance to their full-time employees pay a tax penalty if the government has subsidized a full-time employee’s healthcare through tax deductions or other means. This is commonly known as the employer mandate.[57][58] This provision was included to encourage employers to continue providing insurance once the exchanges began operating.[59] Approximately 44% of the population was covered directly or indirectly through an employer.[60][61]

Excise taxes

Excise taxes for the Affordable Care Act raised $16.3 billion in fiscal year 2015 (17% of all excise taxes collected by the Federal Government). $11.3 billion was an excise tax placed directly on health insurers based on their market share. The ACA was going to impose a 40% “Cadillac tax” on expensive employer sponsored health insurance but that was postponed until 2018. Annual excise taxes totaling $3 billion were levied on importers and manufacturers of prescription drugs. An excise tax of 2.3% on medical devices and a 10% excise tax on indoor tanning services were applied as well.[62]

Insurance standards

Essential health benefits

The National Academy of Medicine defined the law’s “essential health benefits” as “ambulatory patient services; emergency services; hospitalization; maternity and newborn care; mental health and substance use disorder services, including behavioral health treatment; prescription drugs; rehabilitative and habilitative services and devices; laboratory services; preventive and wellness services and chronic disease management; and pediatric services, including oral and vision care”[63][64][65][66][67][68][69] and others[70] rated Level A or B by the U.S. Preventive Services Task Force.[71] In determining what would qualify as an essential benefit, the law required that standard benefits should offer at least that of a “typical employer plan”.[68] States may require additional services.[72]

Contraceptives

One provision in the law mandates that health insurance cover “additional preventive care and screenings” for women.[73] The guidelines issued by the Health Resources and Services Administration to implement this provision mandate “[a]ll Food and Drug Administration approved contraceptive methods, sterilization procedures, and patient education and counseling for all women with reproductive capacity”.[74] This mandate applies to all employers and educational institutions except for religious organizations.[75][76] These regulations were included on the recommendations of the Institute of Medicine.[77][78]

Risk management

ACA provided three ways to control risk for insurers in the individual and business markets: temporary reinsurance, temporary risk corridors, and permanent risk adjustment.

Risk corridor program

The risk-corridor program was a temporary risk management device defined under the PPACA section 1342[79]:1 to encourage reluctant insurers into the “new and untested” ACA insurance market during the first three years that ACA was implemented (2014–2016). For those years the Department of Health and Human Services (HHS) “would cover some of the losses for insurers whose plans performed worse than they expected. Insurers that were especially profitable, for their part, would have to return to HHS some of the money they earned on the exchanges”[80][81]

According to an article in Forbes, risk corridors “had been a successful part of the Medicare prescription drug benefit, and the ACA’s risk corridors were modeled after Medicare’s Plan D.”[82] They operated on the principle that “more participation would mean more competition, which would drive down premiums and make health insurance more affordable” and “[w]hen insurers signed up to sell health plans on the exchanges, they did so with the expectation that the risk-corridor program would limit their downside losses.”[80] The risk corridors succeeded in attracting ACA insurers. The program did not pay for itself as planned with “accumulated losses” up to $8.3 billion for 2014 and 2015 alone. Authorization had to be given so that HHS could pay insurers from “general government revenues”. Congressional Republicans “railed against” the program as a ‘bailout’ for insurers. Then-Rep. Jack Kingston (R-Ga.), on the Appropriations Committee that funds the Department of Health and Human Services and the Labor Department “[slipped] in a sentence” — Section 227 — in the “massive” appropriationsConsolidated Appropriations Act, 2014 (H.R. 3547) that said that no funds in the discretionary spending bill “could be used for risk-corridor payments.” This effectively “blocked the administration from obtaining the necessary funds from other programs”[83] and placed Congress in a potential breach of contract with insurers who offered qualified health plans, under the Tucker Act[79] as it did not pay the insurers.[84][84]

On February 10, 2017, in the Moda Health v the US Government, Moda, one of the insurers that struggled financially because of the elimination of the risk corridor program, won a “$214-million judgment against the federal government”. Justice Thomas C. Wheeler stated, “the Government “made a promise in the risk corridors program that it has yet to fulfill. Today, the court directs the Government to fulfill that promise. After all, ‘to say to [Moda], ‘The joke is on you. You shouldn’t have trusted us,’ is hardly worthy of our great government.”[85]

Temporary reinsurance

Temporary reinsurance for insurance for insurers against unexpectedly high claims was a program that ran from 2014 through 2016. It was intended to limit insurer losses.[citation needed]

Risk adjustment

Of the three risk management programs, only risk adjustment was permanent. Risk adjustment attempts to spread risk among insurers to prevent purchasers with good knowledge of their medical needs from using insurance to cover their costs (adverse selection). Plans with low actuarial risk compensate plans with high actuarial risk.[citation needed]

Other provisions

In 2012 Senator Sheldon Whitehouse created this summary to explain his view on the act.

The ACA has several other provisions:

  • Annual and lifetime coverage caps on essential benefits were banned.[86][87]
  • Prohibits insurers from dropping policyholders when they get sick.[88]
  • All health policies sold in the United States must provide an annual maximum out of pocket (MOOP) payment cap for an individual’s or family’s medical expenses (excluding premiums). After the MOOP payment cap is reached, all remaining costs must be paid by the insurer.[89]
  • A partial community rating requires insurers to offer the same premium to all applicants of the same age and location without regard to gender or most pre-existing conditions (excluding tobacco use).[90][91][92] Premiums for older applicants can be no more than three times those for the youngest.[93]
  • Preventive care, vaccinations and medical screenings cannot be subject to co-paymentsco-insurance or deductibles.[94][95][96] Specific examples of covered services include: mammograms and colonoscopies, wellness visits, gestational diabetes screening, HPV testing, STI counseling, HIV screening and counseling, contraceptive methods, breastfeeding support/supplies and domestic violence screening and counseling.[97]
  • The law established four tiers of coverage: bronze, silver, gold and platinum. All categories offer the essential health benefits. The categories vary in their division of premiums and out-of-pocket costs: bronze plans have the lowest monthly premiums and highest out-of-pocket costs, while platinum plans are the reverse.[68][98] The percentages of health care costs that plans are expected to cover through premiums (as opposed to out-of-pocket costs) are, on average: 60% (bronze), 70% (silver), 80% (gold), and 90% (platinum).[99]
  • Insurers are required to implement an appeals process for coverage determination and claims on all new plans.[88]
  • Insurers must spend at least 80–85% of premium dollars on health costs; rebates must be issued to policyholders if this is violated.[100][101]

Exchanges

Established the creation of health insurance exchanges in all fifty states. The exchanges are regulated, largely online marketplaces, administered by either federal or state government, where individuals and small business can purchase private insurance plans.[102][103][104]

Setting up an exchange gives a state partial discretion on standards and prices of insurance.[105][106] For example, states approve plans for sale, and influence (through limits on and negotiations with private insurers) the prices on offer. They can impose higher or state-specific coverage requirements—including whether plans offered in the state can cover abortion.[107] States without an exchange do not have that discretion. The responsibility for operating their exchanges moves to the federal government.[105]

State waivers

From 2017 onwards, states can apply for a “waiver for state innovation” that allows them to conduct experiments that meet certain criteria.[108] To obtain a waiver, a state must pass legislation setting up an alternative health system that provides insurance at least as comprehensive and as affordable as ACA, covers at least as many residents and does not increase the federal deficit.[109] These states can be exempt from some of ACA’s central requirements, including the individual and employer mandates and the provision of an insurance exchange.[110] The state would receive compensation equal to the aggregate amount of any federal subsidies and tax credits for which its residents and employers would have been eligible under ACA plan, if they cannot be paid under the state plan.[108]

In May 2011, Vermont enacted Green Mountain Care, a state-based single-payer system for which they intended to pursue a waiver to implement.[111][112][113] In December 2014, Vermont decided not to continue due to high expected costs.[114]

Accountable Care Organizations

The Act allowed the creation of Accountable Care Organizations (ACOs), which are groups of doctors, hospitals and other providers that commit to give coordinated, high quality care to Medicare patients. ACOs were allowed to continue using a fee for service billing approach. They receive bonus payments from the government for minimizing costs while achieving quality benchmarks that emphasize prevention and mitigation of chronic disease. If they fail to do so, they are subject to penalties.[115]

Unlike Health Maintenance Organizations, ACO patients are not required to obtain all care from the ACO. Also, unlike HMOs, ACOs must achieve quality of care goals.[115]

Others

Legislative history

President Obama signing the Patient Protection and Affordable Care Act on March 23, 2010

Background

An individual mandate coupled with subsidies for private insurance as a means for universal healthcare was considered the best way to win the support of the Senate because it had been included in prior bipartisan reform proposals. The concept goes back to at least 1989, when the conservativeThe Heritage Foundation proposed an individual mandate as an alternative to single-payer health care.[125] It was championed for a time by conservative economists and Republican senators as a market-based approach to healthcare reform on the basis of individual responsibility and avoidance of free rider problems. Specifically, because the 1986 Emergency Medical Treatment and Active Labor Act (EMTALA) requires any hospital participating in Medicare (nearly all do) to provide emergency care to anyone who needs it, the government often indirectly bore the cost of those without the ability to pay.[126][127][128]

President Bill Clintonproposed a healthcare reform bill in 1993 that included a mandate for employers to provide health insurance to all employees through a regulated marketplace of health maintenance organizations. Republican Senators proposed an alternative that would have required individuals, but not employers, to buy insurance.[127]Ultimately the Clinton plan failed amid an unprecedented barrage of negative advertising funded by politically conservative groups and the health insurance industry and due to concerns that it was overly complex.[129] Clinton negotiated a compromise with the 105th Congress to instead enact the State Children’s Health Insurance Program (SCHIP) in 1997.[130]

John Chafee

The 1993 Republican alternative, introduced by Senator John Chafee as the Health Equity and Access Reform Today Act, contained a “universal coverage” requirement with a penalty for noncompliance—an individual mandate—as well as subsidies to be used in state-based ‘purchasing groups’.[131] Advocates for the 1993 bill included prominent Republicans such as Senators Orrin HatchChuck GrassleyBob Bennett and Kit Bond.[132][133] Of 1993’s 43 Republican Senators, 20 supported the HEART Act.[125][134] Another Republican proposal, introduced in 1994 by Senator Don Nickles (R-OK), the Consumer Choice Health Security Act, contained an individual mandate with a penalty provision;[135] however, Nickles subsequently removed the mandate from the bill, stating he had decided “that government should not compel people to buy health insurance”.[136] At the time of these proposals, Republicans did not raise constitutional issues with the mandate; Mark Pauly, who helped develop a proposal that included an individual mandate for George H. W. Bush, remarked, “I don’t remember that being raised at all. The way it was viewed by the Congressional Budget Office in 1994 was, effectively, as a tax.”[125]

Mitt Romney’s Massachusetts went from 90% of its residents insured to 98%, the highest rate in the nation.[137]

In 2006, an insurance expansion bill was enacted at the state level in Massachusetts. The bill contained both an individual mandate and an insurance exchange. Republican Governor Mitt Romney vetoed the mandate, but after Democrats overrode his veto, he signed it into law.[138] Romney’s implementation of the ‘Health Connector’ exchange and individual mandate in Massachusetts was at first lauded by Republicans. During Romney’s 2008 presidential campaign, Senator Jim DeMint praised Romney’s ability to “take some good conservative ideas, like private health insurance, and apply them to the need to have everyone insured”. Romney said of the individual mandate: “I’m proud of what we’ve done. If Massachusetts succeeds in implementing it, then that will be the model for the nation.”[139]

In 2007, a year after the Massachusetts reform, Republican Senator Bob Bennett and Democratic Senator Ron Wyden introduced the Healthy Americans Act, which featured an individual mandate and state-based, regulated insurance markets called “State Health Help Agencies”.[128][139] The bill initially attracted bipartisan support, but died in committee. Many of the sponsors and co-sponsors remained in Congress during the 2008 healthcare debate.[140]

By 2008 many Democrats were considering this approach as the basis for healthcare reform. Experts said that the legislation that eventually emerged from Congress in 2009 and 2010 bore similarities to the 2007 bill[131] and that it was deliberately patterned after Romney’s state healthcare plan.[141]

Healthcare debate, 2008–10

Healthcare reform was a major topic during the 2008 Democratic presidential primaries. As the race narrowed, attention focused on the plans presented by the two leading candidates, Hillary Clinton and the eventual nominee, Barack Obama. Each candidate proposed a plan to cover the approximately 45 million Americans estimated to not have health insurance at some point each year. Clinton’s proposal would have required all Americans to obtain coverage (in effect, an individual mandate), while Obama’s proposal provided a subsidy but rejected the use of an individual mandate.[142][143]

During the general election, Obama said that fixing healthcare would be one of his top four priorities as president.[144] Obama and his opponent, Sen. John McCain, proposed health insurance reforms though they differed greatly. Senator John McCain proposed tax credits for health insurance purchased in the individual market, which was estimated to reduce the number of uninsured people by about 2 million by 2018. Obama proposed private and public group insurance, income-based subsidies, consumer protections, and expansions of Medicaid and SCHIP, which was estimated at the time to reduce the number of uninsured people by 33.9 million by 2018.[145]

President Obama addressing Congress regarding healthcare reform, September 9, 2009

After his inauguration, Obama announced to a joint session of Congress in February 2009 his intent to work with Congress to construct a plan for healthcare reform.[146][147] By July, a series of bills were approved by committees within the House of Representatives.[148] On the Senate side, from June to September, the Senate Finance Committee held a series of 31 meetings to develop a healthcare reform bill. This group — in particular, Democrats Max BaucusJeff Bingaman and Kent Conrad, along with Republicans Mike EnziChuck Grassley and Olympia Snowe— met for more than 60 hours, and the principles that they discussed, in conjunction with the other committees, became the foundation of the Senate healthcare reform bill.[149][150][151]

Congressional Democrats and health policy experts like MIT economics professor Jonathan Gruber[152] and David Cutler argued that guaranteed issue would require both community ratingand an individual mandate to ensure that adverse selection and/or “free riding” would not result in an insurance “death spiral”.[153] This approach was taken because the president and congressional leaders had concluded that more progressive plans, such as the (single-payer)Medicare for All act, could not obtain filibuster-proof support in the Senate. By deliberately drawing on bipartisan ideas — the same basic outline was supported by former Senate majority leaders Howard BakerBob DoleTom Daschle and George J. Mitchell—the bill’s drafters hoped to garner the votes necessary for passage.[154][155]

However, following the adoption of an individual mandate, Republicans came to oppose the mandate and threatened to filibuster any bills that contained it.[125] Senate minority leader Mitch McConnell, who led the Republican congressional strategy in responding to the bill, calculated that Republicans should not support the bill, and worked to prevent defections:[156]

It was absolutely critical that everybody be together because if the proponents of the bill were able to say it was bipartisan, it tended to convey to the public that this is O.K., they must have figured it out.[157]

Republican Senators, including those who had supported previous bills with a similar mandate, began to describe the mandate as “unconstitutional”. Journalist Ezra Klein wrote in The New Yorker that “a policy that once enjoyed broad support within the Republican Party suddenly faced unified opposition.”[128] Reporter Michael Cooper of The New York Times wrote that: “the provision … requiring all Americans to buy health insurance has its roots in conservative thinking.”[127][134]

Tea Party protesters at the Taxpayer March on Washington, September 12, 2009

The reform negotiations also attracted attention from lobbyists,[158] including deals between certain lobby groups and the advocates of the law to win the support of groups that had opposed past reforms, as in 1993.[159][160] The Sunlight Foundation documented many of the reported ties between “the healthcare lobbyist complex” and politicians in both parties.[161]

During the August 2009 summer congressional recess, many members went back to their districts and held town hall meetings on the proposals. The nascent Tea Party movement organized protests and many conservative groups and individuals attended the meetings to oppose the proposed reforms.[147] Many threats were made against members of Congress over the course of the debate.[162][163]

When Congress returned from recess, in September 2009 President Obama delivered a speech to a joint session of Congress supporting the ongoing Congressional negotiations.[164] He acknowledged the polarization of the debate, and quoted a letter from the late Senator Edward “Ted” Kennedy urging on reform: “what we face is above all a moral issue; that at stake are not just the details of policy, but fundamental principles of social justice and the character of our country.”[165] On November 7, the House of Representatives passed the Affordable Health Care for America Act on a 220–215 vote and forwarded it to the Senate for passage.[147]

Senate

The Senate began work on its own proposals while the House was still working. The United States Constitution requires all revenue-related bills to originate in the House.[166] To formally comply with this requirement, the Senate used H.R. 3590, a bill regarding housing tax changes for service members.[167] It had been passed by the House as a revenue-related modification to the Internal Revenue Code. The bill became the Senate’s vehicle for its healthcare reform proposal, discarding the bill’s original content.[168] The bill ultimately incorporated elements of proposals that were reported favorably by the Senate Health and Financecommittees. With the Republican Senate minority vowing to filibuster, 60 votes would be necessary to pass the Senate.[169] At the start of the 111th Congress, Democrats had only 58 votes; the Senate seat in Minnesota ultimately won by Al Franken was still undergoing a recount, while Arlen Specter was still a Republican (he became a Democrat in April, 2009).

Negotiations were undertaken attempting to satisfy moderate Democrats and to bring Republican senators aboard; particular attention was given to Republicans Bennett, Enzi, Grassley and Snowe. On July 7 Franken was sworn into office, providing a potential 60th vote. On August 25 Ted Kennedy—a longtime healthcare reform advocate—died. Paul Kirk was appointed as Senator Kennedy’s temporary replacement on September 24.

After the Finance Committee vote on October 15, negotiations turned to moderate Democrats. Majority leaderHarry Reid focused on satisfying centrists. The holdouts came down to Joe Lieberman of Connecticut, an independent who caucused with Democrats, and conservative Nebraska Democrat Ben Nelson. Lieberman’s demand that the bill not include a public option[153][170] was met,[171] although supporters won various concessions, including allowing state-based public options such as Vermont’s Green Mountain Care.[171][172]

Senate vote by state.

  Democratic yes (58)
  Independent yes (2)
  Republican no (39)
 Republican not voting (1)

The White House and Reid addressed Nelson’s concerns[173] during a 13-hour negotiation with two concessions: a compromise on abortion, modifying the language of the bill “to give states the right to prohibit coverage of abortion within their own insurance exchanges”, which would require consumers to pay for the procedure out of pocket if the state so decided; and an amendment to offer a higher rate of Medicaid reimbursement for Nebraska.[147][174] The latter half of the compromise was derisively termed the “Cornhusker Kickback”[175] and was repealed in the subsequent reconciliation amendment bill.

On December 23, the Senate voted 60–39 to end debate on the bill: a cloture vote to end the filibuster. The bill then passed, also 60–39, on December 24, 2009, with all Democrats and two independents voting for it, and all Republicans against (except Jim Bunning, who did not vote).[176] The bill was endorsed by the AMA and AARP.[177]

On January 19, 2010, Massachusetts Republican Scott Brown was elected to the Senate in a special election to replace Kennedy, having campaigned on giving the Republican minority the 41st vote needed to sustain Republican filibusters.[147][178][179] His victory had become significant because of its effects on the legislative process. The first was psychological: the symbolic importance of losing Kennedy’s traditionally Democratic Massachusetts seat made many Congressional Democrats concerned about the political cost of passing a bill.[180][181]

House

House vote by congressional district.

  Democratic yes (219)
  Democratic no (34)
  Republican no (178)
  No representative seated (4)

Brown’s election meant Democrats could no longer break a filibuster in the Senate. In response, White House Chief of StaffRahm Emanuel argued that Democrats should scale back to a less ambitious bill; House SpeakerNancy Pelosi pushed back, dismissing Emanuel’s scaled-down approach as “Kiddie Care”.[182][183]

Obama remained insistent on comprehensive reform. The news that Anthem Blue Cross in California intended to raise premium rates for its patients by as much as 39% gave him new evidence of the need for reform.[182][183] On February 22, he laid out a “Senate-leaning” proposal to consolidate the bills.[184] He held a meeting with both parties’ leaders on February 25. The Democrats decided that the House would pass the Senate’s bill, to avoid another Senate vote.

House Democrats had expected to be able to negotiate changes in a House-Senate conference before passing a final bill. Since any bill that emerged from conference that differed from the Senate bill would have to pass the Senate over another Republican filibuster, most House Democrats agreed to pass the Senate bill on condition that it be amended by a subsequent bill.[181] They drafted the Health Care and Education Reconciliation Act, which could be passed by the reconciliation process.[182][185][186]

As per the Congressional Budget Act of 1974, reconciliation cannot be subject to a filibuster. But reconciliation is limited to budget changes, which is why the procedure was not used to pass ACA in the first place; the bill had inherently non-budgetary regulations.[187][188] Although the already-passed Senate bill could not have been passed by reconciliation, most of House Democrats’ demands were budgetary: “these changes—higher subsidy levels, different kinds of taxes to pay for them, nixing the Nebraska Medicaid deal—mainly involve taxes and spending. In other words, they’re exactly the kinds of policies that are well-suited for reconciliation.”[185]

Jim Clyburn and Nancy Pelosi celebrating after the House passes the amended bill on March 21

The remaining obstacle was a pivotal group of pro-life Democrats led by Bart Stupak who were initially reluctant to support the bill. The group found the possibility of federal funding for abortion significant enough to warrant opposition. The Senate bill had not included language that satisfied their concerns, but they could not address abortion in the reconciliation bill as it would be non-budgetary. Instead, Obama issued Executive Order 13535, reaffirming the principles in the Hyde Amendment.[189] This won the support of Stupak and members of his group and assured the bill’s passage.[186][190] The House passed the Senate bill with a 219–212 vote on March 21, 2010, with 34 Democrats and all 178 Republicans voting against it.[191] The next day, Republicans introduced legislation to repeal the bill.[192] Obama signed ACA into law on March 23, 2010.[193] Since passage, Republicans have voted to repeal all or parts of the Affordable Care Act over sixty times; no such attempt by Republicans has been successful.[194] The amendment bill, The Health Care and Education Reconciliation Act, cleared the House on March 21; the Senate passed it by reconciliation on March 25, and Obama signed it on March 30.

Impact

Coverage rate, employer market cost trends, budgetary impact, and income inequality aspects of the Affordable Care Act.

This chart illustrates several aspects of the Affordable Care Act, including number of persons covered, cost before and after subsidies, and public opinion.

Coverage

Affordable Care Act (ObamaCare). County By County Projected Insurer Participation in Health Insurance Exchanges.

The law has caused a significant reduction in the number and percentage of people without health insurance. The CDC reported that the percentage of people without health insurance fell from 16.0% in 2010 to 8.9% during the January–June 2016 period.[195] The uninsured rate dropped in every congressional district in the U.S. between 2013 and 2015.[196] The Congressional Budget Office reported in March 2016 that there were approximately 12 million people covered by the exchanges (10 million of whom received subsidies to help pay for insurance) and 11 million made eligible for Medicaid by the law, a subtotal of 23 million people. An additional 1 million were covered by the ACA’s “Basic Health Program,” for a total of 24 million.[4] CBO also estimated that the ACA would reduce the net number of uninsured by 22 million in 2016, using a slightly different computation for the above figures totaling ACA coverage of 26 million, less 4 million for reductions in “employment-based coverage” and “non-group and other coverage.”[4]

The Department of Health and Human Services (HHS) estimated that 20.0 million adults (aged 18–64) gained healthcare coverage via ACA as of February 2016, a 2.4 million increase over September 2015. HHS estimated that this 20.0 million included: a) 17.7 million from the start of open enrollment in 2013-2016; and b) 2.3 million young adults aged 19–25 who initially gained insurance from 2010-2013, as they were allowed to remain on their parent’s plans until age 26. Of the 20.0 million, an estimated 6.1 million were aged 19–25.[5] Similarly, the Urban Institute issued a report in in December 2016 that said that about 19.2 million non-elderly Americans had gained health insurance coverage from 2010 to 2015.[197] In March 2016, the CBO reported that there were approximately 27 million people without insurance in 2016, a figure they expected would range from 26-28 million through 2026. CBO also estimated the percentage of insured among all U.S. residents would remain at 90% through that period, 92-93% excluding unauthorized immigrants.[4]

Those states that expanded Medicaid had a 7.3% uninsured rate on average in the first quarter of 2016, while those that did not expand Medicaid had a 14.1% uninsured rate, among adults aged 18 to 64.[198] As of December 2016 there were 32 states (including Washington DC) that had adopted the Medicaid extension, while 19 states had not.[199]

By 2017, nearly 70% of those on the exchanges could purchase insurance for less than $75/month after subsidies, which rose to offset significant pre-subsidy price increases in the exchange markets.[200] Healthcare premium cost increases in the employer market continued to moderate. For example, healthcare premiums for those covered by employers rose by 69% from 2000-2005, but only 27% from 2010 to 2015,[6] with only a 3% increase from 2015 to 2016.[201]

The ACA also helps reduce income inequality measured after taxes, due to higher taxes on the top 5% of income earners and both subsidies and Medicaid expansion for lower-income persons.[202] CBO estimated that subsidies paid under the law in 2016 averaged $4,240 per person for 10 million individuals receiving them, roughly $42 billion. For scale, the subsidy for the employer market, in the form of exempting from taxation those health insurance premiums paid on behalf of employees by employers, was approximately $1,700 per person in 2016, or $266 billion total in the employer market. The employer market subsidy was not changed by the law.[4]

Insurance exchanges

As of August 2016, 15 states operated their own exchanges. Other states either used the federal exchange, or operated in partnership with or supported by the federal government.[203]

Medicaid expansion

Medicaid expansion by state, as of September 1, 2015.[204]

  Adopted the Medicaid expansion
  Medicaid expansion under discussion
  Not adopting Medicaid expansion

As of December 2016 there were 32 states (including Washington DC) that had adopted the Medicaid extension, while 19 states had not.[199] Those states that expanded Medicaid had a 7.3% uninsured rate on average in the first quarter of 2016, while those that did not expand Medicaid had a 14.1% uninsured rate, among adults aged 18 to 64.[198] Following the Supreme Court ruling in 2012, which held that states would not lose Medicaid funding if they didn’t expand Medicaid under the ACA, several states rejected expanded Medicaid coverage. Over half of the national uninsured population lived in those states.[205] In a report to Congress, the Centers for Medicare and Medicaid Services (CMS) estimated that the cost of expansion was $6,366 per person for 2015, about 49 percent above previous estimates. An estimated 9 million to 10 million people had gained Medicaid coverage, mostly low-income adults.[206] The Kaiser Family Foundation estimated in October 2015 that 3.1 million additional people were not covered because of states that rejected the Medicaid expansion.[207]

States that rejected the Medicaid expansion could maintain their Medicaid eligibility thresholds, which in many states were significantly below 133% of the poverty line.[208] Many states did not make Medicaid available to childless adults at any income level.[209] Because subsidies on exchange insurance plans were not available to those below the poverty line, such individuals had no new options.[210][211] For example, in Kansas, where only able-bodied adults with children and with an income below 32% of the poverty line were eligible for Medicaid, those with incomes from 32% to 100% of the poverty level ($6,250 to $19,530 for a family of three) were ineligible for both Medicaid and federal subsidies to buy insurance. Absent children, able-bodied adults were not eligible for Medicaid in Kansas.[205]

Studies of the impact of state decisions to reject the Medicaid expansion calculated that up to 6.4 million people could fall into this status.[212] The federal government initially paid for 100% of the expansion (through 2016). The subsidy tapered to 90% by 2020 and continued to shrink thereafter.[213] Several states argued that they could not afford their 10% contribution.[213][214] Studies suggested that rejecting the expansion would cost more than expanding Medicaid due to increased spending on uncompensated emergency care that otherwise would have been partially paid for by Medicaid coverage,[215]

A 2016 study led by Harvard University health economics professor Benjamin Sommers found that residents of Kentucky and Arkansas, which both accepted the Medicaid expansion, were more likely to receive health care services and less likely to incur emergency room costs or have trouble paying their medical bills than before the expansion. Residents of Texas, which did not accept the Medicaid expansion, did not see a similar improvement during the same period.[216] Kentucky opted for increased managed care, while Arkansas subsidized private insurance. The new Arkansas and Kentucky governors have proposed reducing or modifying their programs. Between 2013 and 2015, the uninsured rate dropped from 42% to 14% in Arkansas and from 40% to 9% in Kentucky, compared with 39% to 32% in Texas. Specific improvements included additional primary and preventive care, fewer emergency departments visits, reported higher quality care, improved health, improved drug affordability, reduced out-of-pocket spending and increased outpatient visits, increased diabetes screening, glucose testing among diabetes patients and regular care for chronic conditions.[217]

A 2016 DHHS study found that states that expanded Medicaid had lower premiums on exchange policies, because they had fewer low-income enrollees, whose health on is worse than that of those with higher income.[218]

Healthcare insurance costs

U.S. healthcare cost information, including rate of change, per-capita, and percent of GDP. (Data source: Centers for Medicare and Medicaid Services[219])

The law is designed to pay subsidies in the form of tax credits to the individuals or families purchasing the insurance, based on income levels. Higher income consumers receive lower subsidies. While pre-subsidy prices rose considerably from 2016 to 2017, so did the subsidies, to reduce the after-subsidy cost to the consumer. For example, a study published in 2016 found that the average requested 2017 premium increase among 40-year-old non-smokers was about 9 percent, according to an analysis of 17 cities, although Blue Cross Blue Shield proposed increases of 40 percent in Alabama and 60 percent in Texas.[220] However, some or all of these costs are offset by subsidies, paid as tax credits. For example, the Kaiser Foundation reported that for the second-lowest cost “Silver plan” (a plan often selected and used as the benchmark for determining financial assistance), a 40-year old non-smoker making $30,000 per year would pay effectively the same amount in 2017 as they did in 2016 (about $208/month) after the subsidy/tax credit, despite large increases in the pre-subsidy price. This was consistent nationally. In other words, the subsidies increased along with the pre-subsidy price, fully offsetting the price increases.[221]

Healthcare premium cost increases in the employer market continued to moderate after the implementation of the law. For example, healthcare premiums for those covered by employers rose by 69% from 2000-2005, but only 27% from 2010 to 2015,[6] with only a 3% increase from 2015 to 2016.[201] From 2008-2010 (before passage of the ACA) health insurance premiums rose by an average of 10% per year.[222]

Several studies found that the financial crisis and accompanying recession could not account for the entirety of the slowdown and that structural changes likely share at least partial credit.[223][224][225][226] A 2013 study estimated that changes to the health system had been responsible for about a quarter of the recent reduction in inflation.[227] Paul Krawzak claimed that even if cost controls succeed in reducing the amount spent on healthcare, such efforts on their own may be insufficient to outweigh the long-term burden placed by demographic changes, particularly the growth of the population on Medicare.[228]

In a 2016 review of the ACA published in JAMA, Barack Obama himself wrote that from 2010 through 2014 mean annual growth in real per-enrollee Medicare spending was negative, down from a mean of 4.7% per year from 2000 through 2005 and 2.4% per year from 2006 to 2010; similarly, mean real per-enrollee growth in private insurance spending was 1.1% per year over the period, compared with a mean of 6.5% from 2000 through 2005 and 3.4% from 2005 to 2010.[229]

Effect on deductibles and co-payments

While health insurance premium costs have moderated, some of this is because of insurance policies that have a higher deductibleco-payments and out-of-pocket maximums that shift costs from insurers to patients. In addition, many employees are choosing to combine a health savings account with higher deductible plans, making the impact of the ACA difficult to determine precisely.

For those who obtain their insurance through their employer (“group market”), a 2016 survey found that:

  • Deductibles grew by 63% from 2011 to 2016, while premiums increased 19% and worker earnings grew by 11%.
  • In 2016, 4 in 5 workers had an insurance deductible, which averaged $1,478. For firms with less than 200 employees, the deductible averaged $2,069.
  • The percentage of workers with a deductible of at least $1,000 grew from 10% in 2006 to 51% in 2016. The 2016 figure drops to 38% after taking employer contributions into account.[230]

For the “non-group” market, of which two-thirds are covered by the ACA exchanges, a survey of 2015 data found that:

  • 49% had individual deductibles of at least $1,500 ($3,000 for family), up from 36% in 2014.
  • Many marketplace enrollees qualify for cost-sharing subsidies that reduce their net deductible.
  • While about 75% of enrollees were “very satisfied” or “somewhat satisfied” with their choice of doctors and hospitals, only 50% had such satisfaction with their annual deductible.
  • While 52% of those covered by the ACA exchanges felt “well protected” by their insurance, in the group market 63% felt that way.[231]

Health outcomes

Insurance coverage helps save lives, by encouraging early detection and prevention of dangerous medical conditions. According to a 2014 study, the ACA likely prevented an estimated 50,000 preventable patient deaths from 2010 to 2013.[232]City University public health professors David Himmelstein and Steffie Woolhandler wrote in January 2017 that a rollback of the ACA’s Medicaid expansion alone would cause an estimated 43,956 deaths annually.[233]

Federal deficit

CBO estimates of revenue and impact on deficit

The CBO reported in several studies that the ACA would reduce the deficit, and that repealing it would increase the deficit.[7][8][234][235] The 2011 comprehensive CBO estimate projected a net deficit reduction of more than $200 billion during the 2012–2021 period:[8][236] it calculated the law would result in $604 billion in total outlays offset by $813 billion in total receipts, resulting in a $210 billion net deficit reduction.[8] The CBO separately predicted that while most of the spending provisions do not begin until 2014,[237][238] revenue would exceed spending in those subsequent years.[239] The CBO claimed that the bill would “substantially reduce the growth of Medicare’s payment rates for most services; impose an excise tax on insurance plans with relatively high premiums; and make various other changes to the federal tax code, Medicare, Medicaid, and other programs”[240]—ultimately extending the solvency of the Medicare trust fund by 8 years.[241]

This estimate was made prior to the Supreme Court’s ruling that enabled states to opt out of the Medicaid expansion, thereby forgoing the related federal funding. The CBO and JCT subsequently updated the budget projection, estimating the impact of the ruling would reduce the cost estimate of the insurance coverage provisions by $84 billion.[242][243][244]

The CBO in June 2015 forecasted that repeal of ACA would increase the deficit between $137 billion and $353 billion over the 2016–2025 period, depending on the impact of macroeconomic feedback effects. The CBO also forecasted that repeal of ACA would likely cause an increase in GDP by an average of 0.7% in the period from 2021 to 2015, mainly by boosting the supply of labor.[7]

Major new sources of increased tax receipts include:[95] higher Medicare taxes; annual fees on insurance providers; fees on the healthcare industry such as manufacturers and importers of brand-name pharmaceutical drugs and certain medical devices; limits on tax deductions of medical expenses and flexible spending accounts; a 40% excise tax on plans with annual insurance premiums in excess of $10,200 for an individual or $27,500 for a family; revenue from mandate penalty payments; a 10% federal sales tax on indoor tanning services. Predicted spending reductions included a reduction in Medicare reimbursements to insurers and drug companies for private Medicare Advantagepolicies that the Government Accountability Office and Medicare Payment Advisory Commission found to be excessively costly relative to government Medicare;[245][246] and reductions in Medicare reimbursements to hospitals that failed standards of efficiency and care.[245]

Although the CBO generally does not provide cost estimates beyond the 10-year budget projection period because of the degree of uncertainty involved in the projection, it decided to do so in this case at the request of lawmakers, and estimated a second decade deficit reduction of $1.2 trillion.[240][247] CBO predicted deficit reduction around a broad range of one-half percent of GDP over the 2020s while cautioning that “a wide range of changes could occur”.[248]

Opinions on CBO projections

The CBO cost estimates were criticized because they excluded the effects of potential legislation that would increase Medicare payments by more than $200 billion from 2010 to 2019.[249][250][251] However, the so-called “doc fix” is a separate issue that would have existed whether or not ACA became law – omitting its cost from ACA was no different from omitting the cost of other tax cuts.[252][253][254]

Uwe Reinhardt, a Princeton health economist, wrote. “The rigid, artificial rules under which the Congressional Budget Office must score proposed legislation unfortunately cannot produce the best unbiased forecasts of the likely fiscal impact of any legislation”, but went on to say “But even if the budget office errs significantly in its conclusion that the bill would actually help reduce the future federal deficit, I doubt that the financing of this bill will be anywhere near as fiscally irresponsible as was the financing of the Medicare Modernization Act of 2003.”[255]Douglas Holtz-Eakin, CBO director during the George W. Bush administration, who later served as the chief economic policy adviser to U.S. Senator John McCain‘s 2008 presidential campaign, alleged that the bill would increase the deficit by $562 billion because, he argued, it front-loaded revenue and back-loaded benefits.[256]

Scheiber and Cohn rejected critical assessments of the law’s deficit impact, arguing that predictions were biased towards underestimating deficit reduction. They noted that for example, it is easier to account for the cost of definite levels of subsidies to specified numbers of people than account for savings from preventive healthcare, and that the CBO had a track record of overestimating costs and underestimating savings of health legislation;[257][258] stating, “innovations in the delivery of medical care, like greater use of electronic medical records[259] and financial incentives for more coordination of care among doctors, would produce substantial savings while also slowing the relentless climb of medical expenses… But the CBO would not consider such savings in its calculations, because the innovations hadn’t really been tried on such large scale or in concert with one another—and that meant there wasn’t much hard data to prove the savings would materialize.”[257]

In 2010 David Walker, former U.S. Comptroller General then working for The Peter G. Peterson Foundation, stated that the CBO estimates are not likely to be accurate, because they were based on the assumption that the law would not change.[260] The Center on Budget and Policy Priorities objected that Congress had a good record of implementing Medicare savings. According to their study, Congress followed through on the implementation of the vast majority of provisions enacted in the past 20 years to produce Medicare savings, although not the payment reductions addressed by the annual “doc fix”.[261][262]

Economic consequences

CBO estimated in June 2015 that repealing the ACA would:

  • Decrease aggregate demand (GDP) in the short-term, as low-income persons who tend to spend a large fraction of their additional resources would have fewer resources (e.g., ACA subsidies would be eliminated). This effect would be offset in the long-run by the labor supply factors below.
  • Increase the supply of labor and aggregate compensation by about 0.8 and 0.9 percent over the 2021-2025 period. CBO cited the ACA’s expanded eligibility for Medicaid and subsidies and tax credits that rise with income as disincentives to work, so repealing the ACA would remove those disincentives, encouraging workers to supply more hours of labor.
  • Increase the total number of hours worked by about 1.5% over the 2021-2025 period.
  • Remove the higher tax rates on capital income, thereby encouraging additional investment, raising the capital stock and output in the long-run.[7]

In 2015 the Center for Economic and Policy Research found no evidence that companies were reducing worker hours to avoid ACA requirements[263] for employees working over 30 hours per week.[264]

The CBO estimated that the ACA would slightly reduce the size of the labor force and number of hours worked, as some would no longer be tethered to employers for their insurance. Cohn, citing CBO’s projections, claimed that ACA’s primary employment effect was to alleviate job lock: “People who are only working because they desperately need employer-sponsored health insurance will no longer do so.”[265] He concluded that the “reform’s only significant employment impact was a reduction in the labor force, primarily because people holding onto jobs just to keep insurance could finally retire”, because they have health insurance outside of their jobs.[266]

Employer mandate and part-time work

The employer mandate requires employers meeting certain criteria to provide health insurance to their workers. The mandate applies to employers with more than 50 employees that do not offer health insurance to their full-time workers.[267] Critics claimed that the mandate created a perverse incentive for business to keep their full-time headcount below 50 and to hire part-time workers instead.[268][269] Between March 2010 and 2014 the number of part-time jobs declined by 230,000, while the number of full-time jobs increased by 2 million.[270][271] In the public sector full-time jobs turned into part-time jobs much more than in the private sector.[270][272] A 2016 study found only limited evidence that ACA had increased part-time employment.[273]

Several businesses and the state of Virginia added a 29-hour-a-week cap for their part-time employees,[274][unreliable source?][275][unreliable source?] to reflect the 30-hour-or-more definition for full-time worker.[267] As of yet, however, only a small percent of companies have shifted their workforce towards more part-time hours (4% in a survey from the Federal Reserve Bank of Minneapolis).[269] Trends in working hours[276] and the effects of the Great Recessioncorrelate with part-time working hour patterns.[277][278] The impact of this provision may have been offset by other factors, including that health insurance helps attract and retain employees, increases productivity and reduces absenteeism; and the lower training and administration costs of a smaller full-time workforce over a larger part-time work force.[269][276][279] Relatively few firms employ over 50 employees[269] and more than 90% of them offered insurance.[280] Workers without employer insurance could purchase insurance on the exchanges.[281]

Most policy analysts (on both right and left) were critical of the employer mandate provision.[268][280] They argued that the perverse incentives regarding part-time hours, even if they did not change existing plans, were real and harmful;[282][283] that the raised marginal cost of the 50th worker for businesses could limit companies’ growth;[284] that the costs of reporting and administration were not worth the costs of maintaining employer plans;[282][283] and noted that the employer mandate was not essential to maintain adequate risk pools.[285][286] The effects of the provision generated vocal opposition from business interests and some unions not granted exemptions.[283][287]

A 2013/4 survey by the National Association for Business Economics found that about 75 percent of those surveyed said ACA hadn’t influenced their planning or expectations for 2014, and 85 percent said the law wouldn’t prompt a change in their hiring practices. Some 21 percent of 64 businesses surveyed said that the act would have a harmful effect and 5 percent said it would be beneficial.[288]

Hospitals

From the start of 2010 to November 2014, 43 hospitals in rural areas closed. Critics claimed that the new law caused these hospitals to close. Many of these rural hospitals were built using funds from the 1946 Hill–Burton Act, to increase access to medical care in rural areas. Some of these hospitals reopened as other medical facilities, but only a small number operated emergency rooms (ER) or urgent care centers.[289]

Between January 2010 and 2015, a quarter of emergency room doctors said they had seen a major surge in patients, while nearly half had seen a smaller increase. Seven in ten ER doctors claimed that they lacked the resources to deal with large increases in the number of patients. The biggest factor in the increased number of ER patients was insufficient primary care providers to handle the larger number of insured patients.[290]

Insurers claimed that because they have access to and collect patient data that allow evaluations of interventions, they are essential to ACO success. Large insurers formed their own ACOs. Many hospitals merged and purchased physician practices. The increased market share gave them more leverage in negotiations with insurers over costs and reduced patient care options.[115]

Public opinion

Prior to the law’s passage, polling indicated the public’s views became increasingly negative in reaction to specific plans discussed during the legislative debate over 2009 and 2010. Polling statistics showed a general negative opinion of the law; with those in favor at approximately 40% and those against at 51%, as of October 2013.[291][292] About 29% of whites approve of the law, compared with 61% of Hispanics and 91% of African Americans.[293]Opinions were divided by age of the person at the law’s inception, with a solid majority of seniors opposing the bill and a solid majority of those younger than forty years old in favor.[294]

Congressional Democrats celebrating the 6th anniversary of the Affordable Care Act in March 2016 on the steps of the U.S. Capitol.

Congressional Democrats celebrating the 6th anniversary of the Affordable Care Act in March 2016 on the steps of the U.S. Capitol.

Specific elements were popular across the political spectrum, while others, such as the mandate to purchase insurance, were widely disliked. In a 2012 poll 44% supported the law, with 56% against. By party affiliation, 75% of Democrats, 27% of Independents and 14% of Republicans favored the law overall. 82% favored banning insurance companies from denying coverage to people with pre-existing conditions, 61% favored allowing children to stay on their parents’ insurance until age 26, 72% supported requiring companies with more than 50 employees to provide insurance for their employees, and 39% supported the individual mandate to own insurance or pay a penalty. By party affiliation, 19% of Republicans, 27% of Independents, and 59% of Democrats favored the mandate.[295] Other polls showed additional provisions receiving majority support, including the creation of insurance exchanges, pooling small businesses and the uninsured with other consumers so that more people can take advantage of large group pricing benefits and providing subsidies to individuals and families to make health insurance more affordable.[296][297]

In a 2010 poll, 62% of respondents said they thought ACA would “increase the amount of money they personally spend on health care”, 56% said the bill “gives the government too much involvement in health care”, and 19% said they thought they and their families would be better off with the legislation.[298] Other polls found that people were concerned that the law would cost more than projected and would not do enough to control costs.[299]

Some opponents believed that the reform did not go far enough: a 2012 poll indicated that 71% of Republican opponents rejected it overall, while 29% believed it did not go far enough; independent opponents were divided 67% to 33%; and among the much smaller group of Democratic opponents, 49% rejected it overall and 51% wanted more.[295] In June 2013, a majority of the public (52–34%) indicated a desire for “Congress to implement or tinker with the law rather than repeal it”.[300] After the Supreme Court upheld the individual mandate, a 2012 poll held that “most Americans (56%) want to see critics of President Obama’s health care law drop efforts to block it and move on to other national issues”.[301]A 2014 poll reported that 48.9% of respondents had an unfavorable view of ACA vs. 38.3% who had a favorable view (of more than 5,500 individuals).[302]

A 2014 poll reported that 26% of Americans support ACA.[303] Another held that 8% of respondents say that the Affordable Care Act “is working well the way it is”.[304] In late 2014, a Rasmussen poll reported Repeal: 30%, Leave as is: 13%, Improve: 52%.[305]

In 2015, a CBS News / New York Times poll reported that 47% of Americans approved the health care law. This was the first time that a major poll indicated that more respondents approved ACA than disapproved of it.[306] The recurring Kaiser Health Tracking Poll from December 2016 reported that: a) 30% wanted to expand what the law does; b) 26% wanted to repeal the entire law; c) 19% wanted to move forward with implementing the law as it is; and d) 17% wanted to scale back what the law does, with the remainder undecided.[307]

Separate polls from Fox News and NBC/WSJ both taken during January 2017 indicated more people viewed the law favorably than did not for the first time. One of the reasons for the improving popularity of the law is that Democrats who opposed it in the past (many prefer a “Medicare for All” approach) have shifted their positions since the ACA is under threat of repeal.[308]

A January 2017 Morning Consult poll showed that 35% of respondents either believed that “Obamacare” and the “Affordable Care Act” were different or did not know.[309] Approximately 45% were unsure whether the “repeal of Obamacare” also meant the “repeal of the Affordable Care Act.”[309] 39% did not know that “many people would lose coverage through Medicaid or subsidies for private health insurance if the A.C.A. were repealed and no replacement enacted,” with Democrats far more likely (79%) to know that fact than Republicans (47%).[309]

A 2017 study found that personal experience with public health insurance programs leads to greater support for the Affordable Care Act, and the effects appear to be most pronounced among Republicans and low-information voters.[310]

Political aspects

“Obamacare”

The term “Obamacare” was originally coined by opponents as a pejorative. The term emerged in March 2007 when healthcare lobbyist Jeanne Schulte Scott used it in a health industry journal, writing “We will soon see a ‘Giuliani-care’ and ‘Obama-care’ to go along with ‘McCain-care’, ‘Edwards-care’, and a totally revamped and remodeled ‘Hillary-care‘ from the 1990s”.[9][311] According to research by Elspeth Reeve, the expression was used in early 2007, generally by writers describing the candidate’s proposal for expanding coverage for the uninsured.[312] It first appeared in a political campaign by Mitt Romney in May 2007 in Des Moines, Iowa. Romney said, “In my state, I worked on healthcare for some time. We had half a million people without insurance, and I said, ‘How can we get those people insured without raising taxes and without having government take over healthcare?’ And let me tell you, if we don’t do it, the Democrats will. If the Democrats do it, it will be socialized medicine; it’ll be government-managed care. It’ll be what’s known as Hillarycare or Barack Obamacare, or whatever you want to call it.”[9]

By mid-2012, Obamacare had become the colloquial term used by both supporters and opponents. In contrast, the use of “Patient Protection and Affordable Care Act” or “Affordable Care Act” became limited to more formal and official use.[312] Use of the term in a positive sense was suggested by Democrat John Conyers.[313] Obama endorsed the nickname, saying, “I have no problem with people saying Obama cares. I do care.”[314]

In March 2012, the Obama reelection campaign embraced the term “Obamacare”, urging Obama’s supporters to post Twitter messages that begin, “I like #Obamacare because…”.[315]

In October 2013 the Associated Press and NPR began cutting back on use of the term.[316] Stuart Seidel, NPR’s managing editor, said that the term “seems to be straddling somewhere between being a politically-charged term and an accepted part of the vernacular”.[317]

Common misconceptions

“Death panels”

On August 7, 2009, Sarah Palin pioneered the term “death panels” to describe groups that would decide whether sick patients were “worthy” of medical care.[318] “Death panel” referred to two claims about early drafts.

One was that under the law, seniors could be denied care due to their age[319] and the other that the government would advise seniors to end their lives instead of receiving care. The ostensible basis of these claims was the provision for an Independent Payment Advisory Board (IPAB).[320] IPAB was given the authority to recommend cost-saving changes to Medicare by facilitating the adoption of cost-effective treatments and cost-recovering measures when the statutory levels set for Medicare were exceeded within any given 3-year period. In fact, the Board was prohibited from recommending changes that would reduce payments to certain providers before 2020, and was prohibited from recommending changes in premiums, benefits, eligibility and taxes, or other changes that would result in rationing.[321][322]

The other related issue concerned advance-care planning consultation: a section of the House reform proposal would have reimbursed physicians for providing patient-requested consultations for Medicare recipients on end-of-life health planning (which is covered by many private plans), enabling patients to specify, on request, the kind of care they wished to receive.[323] The provision was not included in ACA.[324]

In 2010, the Pew Research Center reported that 85% of Americans were familiar with the claim, and 30% believed it was true, backed by three contemporaneous polls.[325] A poll in August 2012 found that 39% of Americans believed the claim.[326] The allegation was named PolitiFact‘s “Lie of the Year”,[318][327] one of FactCheck.org‘s “whoppers”[328][329] and the most outrageous term by the American Dialect Society.[330]AARP described such rumors as “rife with gross—and even cruel—distortions”.[331]

Members of Congress

ACA requires members of Congress and their staffs to obtain health insurance either through an exchange or some other program approved by the law (such as Medicare), instead of using the insurance offered to federal employees (the Federal Employees Health Benefits Program).[332][333][334][335][336]

Illegal immigrants

ACA does not provide benefits to illegal immigrants.[337] It explicitly denies insurance subsidies to “unauthorized (illegal) aliens”.[25][26][338]

Exchange “death spiral”

One argument against the ACA is that the insurers are leaving the marketplaces, as they cannot profitably cover the available pool of customers, which contains too many unhealthy participants relative to healthy participants. A scenario where prices rise, due to an unfavorable mix of customers from the insurer’s perspective, resulting in fewer customers and fewer insurers in the marketplace, further raising prices, has been called a “Death Spiral.”[339]During 2017, the median number of insurers offering plans on the ACA exchanges in each state was 3.0, meaning half the states had more and half had fewer insurers. There were five states with one insurer in 2017; 13 states with two; 11 states with three; and the remainder had four insurers or more. Wisconsin had the most, with 15 insurers in the marketplace. The median number of insurers was 4.0 in 2016, 5.0 in 2015, and 4.0 in 2014.[340]

Further, the CBO reported in January 2017 that it expected enrollment in the exchanges to rise from 10 million during 2017 to 13 million by 2027, assuming laws in place at the end of the Obama administration were continued.[341]Following a 2015 CBO report that reached a similar conclusion, Paul Krugman wrote: “But the truth is that this report is much, much closer to what supporters of reform have said than it is to the scare stories of the critics–no death spirals, no job-killing, major gains in coverage at relatively low cost.”[342]

Opposition

Opposition and efforts to repeal the legislation have drawn support from sources that include labor unions,[343][344]conservative advocacy groups,[345][346] Republicans, small business organizations and the Tea Party movement.[347]These groups claimed that the law would disrupt existing health plans, increase costs from new insurance standards, and increase the deficit.[348] Some opposed the idea of universal healthcare, viewing insurance as similar to other unsubsidized goods.[349][350] President Donald Trump has repeatedly promised to “repeal and replace” it.[351][352]

As of 2013 unions that expressed concerns about ACA included the AFL-CIO,[353] which called ACA “highly disruptive” to union health care plans, claiming it would drive up costs of union-sponsored plans; the International Brotherhood of TeamstersUnited Food and Commercial Workers International Union, and UNITE-HERE, whose leaders sent a letter to Reid and Pelosi arguing, ” ACA will shatter not only our hard-earned health benefits, but destroy the foundation of the 40-hour work week that is the backbone of the American middle class.”[344] In January 2014, Terry O’Sullivan, president of the Laborers’ International Union of North America (LIUNA) and D. Taylor, president of Unite Here sent a letter to Reid and Pelosi stating, “ACA, as implemented, undermines fair marketplace competition in the health care industry.”[343]

In October 2016, Mark Dayton, the governor of Minnesota and a member of the Minnesota Democratic–Farmer–Labor Party, said that the ACA had “many good features” but that it was “no longer affordable for increasing numbers of people” and called on the Minnesota legislature to provide emergency relief to policyholders.[354] Dayton later said he regretted his remarks after they were seized on by Republicans seeking to repeal the law.[355]

Legal challenges

National Federation of Independent Business v. Sebelius

Opponents challenged ACA’s constitutionality in multiple lawsuits on multiple grounds.[356][357][not in citation given] In National Federation of Independent Business v. Sebelius, the Supreme Court ruled on a 5–4 vote that the individual mandate was constitutional when viewed as a tax, although not under the Commerce Clause.

The Court further determined that states could not be forced to participate in the Medicaid expansion. ACA withheld all Medicaid funding from states declining to participate in the expansion. The Court ruled that this withdrawal of funding was unconstitutionally coercive and that individual states had the right to opt out without losing preexisting Medicaid funding.[358]

Contraception mandate

In March 2012 the Roman Catholic Church, while supportive of ACA’s objectives, voiced concern through the United States Conference of Catholic Bishops that aspects of the mandate covering contraception and sterilization and HHS‘s narrow definition of a religious organization violated the First Amendment right to free exercise of religion and conscience. Various lawsuits addressed these concerns.[359][360]

On June 25, 2015, the U.S. Supreme Court ruled 6–3 that federal subsidies for health insurance premiums could be used in the 34 states that did not set up their own insurance exchanges.[361]

House v. Price

In United States House of Representatives v. Price (previously United States House of Representatives v. Burwell) the House sued the administration alleging that the money for premium subsidy payments to insurers had not been appropriated, as required for any federal government spending. The ACA subsidy that helps customers pay premiums was not part of the suit.

Without the cost-sharing subsidies, the government estimated that premiums would increase by 20 percent to 30 percent for silver plans.[362] In 2017, the uncertainty about whether the payments would continue caused Blue Cross Blue Shield of North Carolina to try to raise premiums by 22.9 percent the next year, as opposed to an increase of only 8.8 percent that it would have sought if the payments were assured.[363]

Non-cooperation

Officials in Texas, Florida, Alabama, Wyoming, Arizona, Oklahoma and Missouri opposed those elements of ACA over which they had discretion.[364][365] For example, Missouri declined to expand Medicaid or establish a health insurance marketplace engaging in active non-cooperation, enacting a statute forbidding any state or local official to render any aid not specifically required by federal law.[366] Other Republican politicians discouraged efforts to advertise the benefits of the law. Some conservative political groups launched ad campaigns to discourage enrollment.[367][368]

Repeal efforts

ACA was the subject of unsuccessful repeal efforts by Republicans in the 111th112th, and 113th Congresses: Representatives Steve King (R-IA) and Michele Bachmann (R-MN) introduced bills in the House to repeal ACA the day after it was signed, as did Senator Jim DeMint (R-SC) in the Senate.[369] In 2011, after Republicans gained control of the House of Representatives, one of the first votes held was on a bill titled “Repealing the Job-Killing Health Care Law Act” (H.R. 2), which the House passed 245–189.[370] All Republicans and 3 Democrats voted for repeal.[371] House Democrats proposed an amendment that repeal not take effect until a majority of the Senators and Representatives had opted out of the Federal Employees Health Benefits Program; Republicans voted down the measure.[372] In the Senate, the bill was offered as an amendment to an unrelated bill, but was voted down.[373]President Obama had stated that he would have vetoed the bill even if it had passed both chambers of Congress.[374]

2017 House Budget

Following the 2012 Supreme Court ruling upholding ACA as constitutional, Republicans held another vote to repeal the law on July 11;[375] the House of Representatives voted with all 244 Republicans and 5 Democrats in favor of repeal, which marked the 33rd, partial or whole, repeal attempt.[376][377] On February 3, 2015, the House of Representatives added its 67th repeal vote to the record (239 to 186). This attempt also failed.[378]

2013 federal government shutdown

Strong partisan disagreement in Congress prevented adjustments to the Act’s provisions.[379] However, at least one change, a proposed repeal of a tax on medical devices, has received bipartisan support.[380] Some Congressional Republicans argued against improvements to the law on the grounds they would weaken the arguments for repeal.[283][381]

Republicans attempted to defund its implementation,[365][382] and in October 2013, House Republicans refused to fund the federal government unless accompanied with a delay in ACA implementation, after the President unilaterally deferred the employer mandate by one year, which critics claimed he had no power to do. The House passed three versions of a bill funding the government while submitting various versions that would repeal or delay ACA, with the last version delaying enforcement of the individual mandate. The Democratic Senate leadership stated the Senate would only pass a “clean” funding bill without any restrictions on ACA. The government shutdown began on October 1.[383][384][385] Senate Republicans threatened to block appointments to relevant agencies, such as the Independent Payment Advisory Board[386] and Centers for Medicare and Medicaid Services.[387][388]

2017 repeal effort

During a midnight congressional session starting January 11, 2017, the Senate of the 115th Congress of the United States voted to approve a “budget blueprint” which would allow Republicansto repeal parts of the law “without threat of a Democraticfilibuster.”[389][390] The plan, which passed 51-48, is a budget blueprint named by Senate Republicans the “Obamacare ‘repeal resolution.'”[391] Democrats opposing the resolution staged a protest during the vote.[392]

House Republicans announced their replacement for the ACA, the American Health Care Act, on March 6, 2017.[393] On March 24, 2017 the effort, led by Paul Ryan and Donald Trump, to repeal and replace the ACA failed amid a revolt among Republican representatives.[394]

On May 4, 2017, the United States House of Representatives voted to pass the American Health Care Act (and thereby repeal most of the Affordable Care Act) by a narrow margin of 217 to 213, sending the bill to the Senate for deliberation.[395] The Senate has indicated they will write their own version of the bill, instead of voting on the House version.[396]

Implementation history

Once the law was signed, provisions began taking effect, in a process that continued for years. Some provisions never took effect, while others were deferred for various periods.

Existing individual health plans

Plans purchased after the date of enactment, March 23, 2010, or old plans that changed in specified ways would eventually have to be replaced by ACA-compliant plans.[citation needed]

At various times during and after the ACA debate, Obama stated that “if you like your health care plan, you’ll be able to keep your health care plan”.[397][398] However, in fall 2013 millions of Americans with individual policies received notices that their insurance plans were terminated,[399] and several million more risked seeing their current plans cancelled.[400][401][402]

Obama’s previous unambiguous assurance that consumers’ could keep their own plans became a focal point for critics, who challenged his truthfulness.[403][404] On November 7, 2013, President Obama stated: “I am sorry that [people losing their plans] are finding themselves in this situation based on assurances they got from me.”[405] Various bills were introduced in Congress to allow people to keep their plans.[406]

In the fall of 2013, the Obama Administration announced a transitional relief program that would let states and carriers allow non-compliant individual and small group policies to renew at the end of 2013. In March 2014, HHS allowed renewals as late as October 1, 2016. In February 2016, these plans were allowed to renew up until October 1, 2017, but with a termination date no later than December 31, 2017.[citation needed]

2010

In June small business tax credits took effect. For certain small businesses, the credits reached up to 35% of premiums. At the same time uninsured people with pre-existing conditions could access the federal high-risk pool. Also, participating employment-based plans could obtain reimbursement for a portion of the cost of providing health insurance to early retirees.[407]

In July the Pre-Existing Condition Insurance Plan (PCIP) took effect to offer insurance to those that had been denied coverage by private insurance companies because of a pre-existing condition. Despite estimates of up to 700,000 enrollees, at a cost of approximately $13,000/enrollee, only 56,257 enrolled at a $28,994 cost per enrollee.[407]

2011

As of September 23, 2010, pre-existing conditions could no longer be denied coverage for children’s policies. HHS interpreted this rule as a mandate for “guaranteed issue“, requiring insurers to issue policies to such children.[citation needed] By 2011, insurers had stopped marketing child-only policies in 17 states, as they sought to escape this requirement.[408]

The average beneficiary in the prior coverage gap would have spent $1,504 in 2011 on prescriptions. Such recipients saved an average $603. The 50 percent discount on brand name drugs provided $581 and the increased Medicare share of generic drug costs provided the balance. Beneficiaries numbered 2 million[409]

2012

In National Federation of Independent Business v. Sebelius decided on June 28, 2012, the Supreme Court ruled that the individual mandate was constitutional when the associated penalties were construed as a tax. The decision allowed states to opt out of the Medicaid expansion. Several did so,[410] although some later accepted the expansion.[411][412]

2013

In January 2013 the Internal Revenue Service ruled that the cost of covering only the individual employee would be considered in determining whether the cost of coverage exceeded 9.5% of income. Family plans would not be considered even if the cost was above the 9.5% income threshold. This was estimated to leave 2–4 million Americans unable to afford family coverage under their employers’ plans and ineligible for subsidies.[413][414]

A June 2013 study found that the MLR provision had saved individual insurance consumers $1.2 billion in 2011 and $2.1 billion in 2012, reducing their 2012 costs by 7.5%.[415] The bulk of the savings were in reduced premiums, but some came from MLR rebates.

On July 2, 2013, the Obama Administration announced that it would delay the implementation of the employer mandate until 2015.[280][416][417]

The Community Living Assistance Services and Supports Act (or CLASS Act) was enacted as Title VIII of the ACA. It would have created a voluntary and public long-term care insurance option for employees.[121][123] In October 2011 the administration announced it was unworkable and would be dropped.[418] The CLASS Act was repealed January 1, 2013.[419]

The launch for both the state and federal exchanges was troubled due to management and technical failings. HealthCare.gov, the website that offers insurance through the exchanges operated by the federal government, crashed on opening and suffered endless problems.[420] Operations stabilized in 2014, although not all planned features were complete.[421][422]

CMS reported in 2013 that, while costs per capita continued to rise, the rate of increase in annual healthcare costs had fallen since 2002. Per capita cost increases averaged 5.4% annually between 2000 and 2013. Costs relative to GDP, which had been rising, had stagnated since 2009.[423] Several studies attempted to explain the reductions. Reasons included:

  • Higher unemployment due to the 2008-2010 recession, which limited the ability of consumers to purchase healthcare;
  • Out-of-pocket costs rose, reducing demand for healthcare services.[424] The proportion of workers with employer-sponsored health insurance requiring a deductible climbed to about three-quarters in 2012 from about half in 2006.[223]
  • ACA changes[223] that aim to shift the healthcare system from paying-for-quantity to paying-for-quality. Some changes occurred due to healthcare providers acting in anticipation of future implementation of reforms.[120][224]

2014

On July 30, 2014, the Government Accountability Office released a non-partisan study that concluded that the administration did not provide “effective planning or oversight practices” in developing the ACA website.[425]

In Burwell v. Hobby Lobby the Supreme Court exempted closely held corporations with religious convictions from the contraception rule.[426] In Wheaton College vs Burwell the Court issued an injunction allowing the evangelical college and other religiously affiliated nonprofit groups to completely ignore the contraceptive mandate.[427]

A study found that average premiums for the second-cheapest ( silver) plan were 10-21% less than average individual market premiums in 2013, while covering many more conditions. Credit for the reduced premiums was attributed to increased competition stimulated by the larger market, greater authority to review premium increases, the MLR and risk corridors.[citation needed]

Many of the initial plans featured narrow networks of doctors and hospitals.[428][not in citation given]

A 2016 analysis found that health care spending by the middle class was 8.9% of household spending in 2014.[429]

2015

By the beginning of the year, 11.7 million had signed up (ex-Medicaid).[430] On December 31, 2015, about 8.8 million consumers had stayed in the program. Some 84 percent, or about 7.4 million, were subsidized.[431]

Bronze plans were the second most popular in 2015, making up 22% of marketplace plan selections. Silver plans were the most popular, accounting for 67% of marketplace selections. Gold plans were 7%. Platinum plans accounted for 3%. On average across the four metal tiers, premiums were up 20% for HMOs and 18% for EPOs. Premiums for POS plans were up 15% from 2015 to 2016, while PPO premiums were up just 8%.[citation needed]

A 2015 study found 14% of privately insured consumers received a medical bill in the past two years from an out-of-network provider in the context of an overall in-network treatment event. Such out-of-network care is not subject to the lower negotiated rates of in-network care, increasing out-of-pocket costs. Another 2015 study found that the average out-of-network charges for the majority of 97 medical procedures examined “were 300% or higher compared to the corresponding Medicare fees” for those services.[citation needed]

Some 47% of the 2015 ACA plans sold on the Healthcare.gov exchange lacked standard out-of-network coverage. Enrollees in such plans, typically received no coverage for out-of-network costs (except for emergencies or with prior authorization). A 2016 study on Healthcare.gov health plans found a 24 percent increase in the percentage of ACA plans that lacked standard out-of-network coverage.[citation needed]

The December spending bill delayed the onset of the “Cadillac tax” on expensive insurance plans by two years, until 2020.[432]

The average price of non-generic drugs rose 16.2% in 2015 and 98.2% since 2011.[429]

2016

As of March 2016 11.1 million people had purchased exchange plans,[citation needed] while an estimated 9 million to 10 million people had gained Medicaid coverage, mostly low-income adults.[206] 11.1 million were still covered, a decline of nearly 13 percent.[433] 6.1 million uninsured 19-25 year olds gained coverage.[434]

Employers

A survey of New York businesses found an increase of 8.5 percent in health care costs, less than the prior year’s survey had expected. A 10 percent increase was expected for 2017. Factors included increased premiums, higher drug costs, ACA and aging workers. Some firms lowered costs by increasing cost-sharing (for higher employee contributions, deductibles and co-payments). 60% planned to further increase cost-sharing. Coverage and benefits were not expected to change. Approximately one fifth said ACA had pushed them to reduce their workforce. A larger number said they were raising prices.[435]

Insurers

The five major national insurers expected to lose money on ACA policies in 2016.[436] UnitedHealth withdrew from the Georgia and Arkansas exchanges for 2017, citing heavy losses.[203] Humana exited other markets, leaving it operating in 156 counties in 11 states for 2017.[437] 225 counties across the country had access to only a single ACA insurer. A study released in May estimated that 664 counties would have one insurer in 2017.[438][not in citation given]

Aetna cancelled planned expansion of its offerings and following an expected $300 million loss in 2016 and then withdrew from 11 of its 15 states.[439] In August 2016 Anthem said that its offerings were losing money, but also that it would expand its participation if a pending merger with Cigna was approved.[440] Aetna and Humana’s exit for 2017 left 8 rural Arizona counties with only Blue Cross/Blue Shield.[441]

Blue Cross/Blue Shield Minnesota announced that it would exit individual and family markets in Minnesota in 2017, due to financial losses of $500 million over three years.[442]

Another analysis found that 17 percent of eligibles may have a single insurer option in 2017. North Carolina, Oklahoma, Alaska, Alabama, South Carolina and Wyoming were expected to have a single insurer,[443] while only 2 percent of 2016 eligibles had only one choice.[444]

Aetna, Humana, UnitedHealth Group also exited various individual markets. Many local Blue Cross plans sharply narrowed their networks. In 2016 two thirds of individual plans were narrow-network HMO plans.[428]

One of the causes of insurer losses is the lower income, older and sicker enrollee population. One 2016 analysis reported that while 81% of the population with incomes from 100-150% of the federal poverty level signed up, only 45% of those from 150-200% did so. The percentage continued to decline as income rose: 2% of those above 400% enrolled.[445]

Costs

The law is designed to pay subsidies in the form of tax credits to the individuals or families purchasing the insurance, based on income levels. Higher income consumers receive lower subsidies. While pre-subsidy prices rose considerably from 2016 to 2017, so did the subsidies, to reduce the after-subsidy cost to the consumer. For example, a study published in 2016 found that the average requested 2017 premium increase among 40-year-old non-smokers was about 9 percent, according to an analysis of 17 cities, although Blue Cross Blue Shield proposed increases of 40 percent in Alabama and 60 percent in Texas.[220] However, some or all of these costs are offset by subsidies, paid as tax credits. For example, the Kaiser Foundation reported that for the second-lowest cost “Silver plan” (a plan often selected and used as the benchmark for determining financial assistance), a 40-year old non-smoker making $30,000 per year would pay effectively the same amount in 2017 as they did in 2016 (about $208/month) after the subsidy/tax credit, despite large increases in the pre-subsidy price. This was consistent nationally. In other words, the subsidies increased along with the pre-subsidy price, fully offsetting the price increases.[221]

Cooperatives

The number of ACA nonprofit insurance cooperatives for 2017 fell from 23 originally to 7 for 2017. The remaining 7 posted annual losses in 2015. A General Accountability Report found that co-ops’ 2015 premiums were generally below average. At the end of 2014, money co-ops and other ACA insurers had counted on risk corridor payments that didn’t materialize. Maryland’s Evergreen Health claims that ACA’s risk-adjustment system does not adequately measure risk.[citation needed]

Medicaid

Newly elected Louisiana Governor John Bel Edwards issued an executive order to accept the expansion, becoming the 32nd state to do so. The program was expected to enroll an additional 300,000 Louisianans.[446]

2017

More than 9.2 million people signed up for care on the national exchange (healthcare.gov) for 2017, down some 400,000 from 2016. This decline was due primarily to the election of President Trump, who pulled advertising encouraging people to sign up for coverage, issued an executive order that attempts to eliminate the mandate, and has created significant uncertainty about the future of the ACA. Enrollments had been running ahead of 2016 prior to President Obama leaving office, with 9.8 million expected to sign-up, so President Trump’s actions potentially cost about 600,000 national enrollments (i.e., 9.8 million expected − 9.2 million actual = 0.6 million impact).[447] Of the 9.2 million, 3.0 million were new customers and 6.2 million were returning. The 9.2 million excludes the 11 states that run their own exchanges, which have signed up around 3 million additional people.[447] These figures also exclude the additional coverage due to the Medicaid expansion, which covers another approximately 10 million persons, as described in the impact section above.

In February, Humana announced that it would withdraw from the individual insurance market in 2018, citing “further signs of an unbalanced risk pool.”[448] That month the IRS announced that it would not require that tax returns indicate that a person has health insurance, reducing the effectiveness of the individual mandate, in response to an executive order from President Donald Trump.[449]

Aetna CEO Mark Bertolini stated that ACA was in a “death spiral” of escalating premiums and shrinking, skewed enrollment.[450] However, a U.S. judge found that the Aetna CEO misrepresented why his company was leaving the exchanges; an important part of the reason was the Justice Department’s opposition to the intended merger between Aetna and Humana. Aetna announced that it would exit the exchange market in all remaining states.[451] It stated that its losses had grown from $100M in 2014 to $450M in 2016.[452]Wellmark withdrew from Iowa in April.[453] As of May, no insurer had indicated its intention to offer ACA insurance in Nebraska.[451] Also in May Blue Cross and Blue Shield of Kansas City announced it would withdraw from Missouri and Kansas’s individual markets in 2018, potentially leaving nearly 19,000 residents in Western Missouri without a coverage option.[454] Anthem announced plans to withdraw from Ohio[455] and later Wisconsin[456] and Indiana,[457] describing the market as “volatile” and referring to the difficulty in pricing its plans “due to the shrinking individual market as well as continual changes in federal operations, rules and guidance.”[455]

The CBO reported in March 2017 that the healthcare exchanges were expected to be stable; i.e., they were not in a “death spiral.”[458] In June, Centene announced that it intended to initiate coverage in Nevada, Kanasa and Missouri and expand coverage in Ohio and Florida.[459]

Molina Healthcare, a major Medicaid provider, said that it was considering exiting some markets in 2018, citing “too many unknowns with the marketplace program.” Molina lost $110 million in 2016 due to having to contribute $325 million more than expected to the ACA “risk transfer” fund that compensated insurers with unprofitable risk pools. These pools were established to help prevent insurers from artificially selecting lower-risk pools.[460]

In May the United States House of Representatives voted to repeal the ACA.[461][462]

See also

https://en.wikipedia.org/wiki/Patient_Protection_and_Affordable_Care_Act

Party Affiliation

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Listen To Pronk Pops Podcast or Download Shows 629-636

Listen To Pronk Pops Podcast or Download Shows 617-628

Listen To Pronk Pops Podcast or Download Shows 608-616

Listen To Pronk Pops Podcast or Download Shows 599-607

Listen To Pronk Pops Podcast or Download Shows 590-598

Listen To Pronk Pops Podcast or Download Shows 585- 589

Listen To Pronk Pops Podcast or Download Shows 575-584

Listen To Pronk Pops Podcast or Download Shows 565-574

Listen To Pronk Pops Podcast or Download Shows 556-564

Listen To Pronk Pops Podcast or Download Shows 546-555

Listen To Pronk Pops Podcast or Download Shows 538-545

Listen To Pronk Pops Podcast or Download Shows 532-537

Listen To Pronk Pops Podcast or Download Shows 526-531

Listen To Pronk Pops Podcast or Download Shows 519-525

Listen To Pronk Pops Podcast or Download Shows 510-518

Listen To Pronk Pops Podcast or Download Shows 500-509

Listen To Pronk Pops Podcast or Download Shows 490-499

Listen To Pronk Pops Podcast or Download Shows 480-489

Listen To Pronk Pops Podcast or Download Shows 473-479

Listen To Pronk Pops Podcast or Download Shows 464-472

Listen To Pronk Pops Podcast or Download Shows 455-463

Listen To Pronk Pops Podcast or Download Shows 447-454

Listen To Pronk Pops Podcast or Download Shows 439-446

Listen To Pronk Pops Podcast or Download Shows 431-438

Listen To Pronk Pops Podcast or Download Shows 422-430

Listen To Pronk Pops Podcast or Download Shows 414-421

Listen To Pronk Pops Podcast or Download Shows 408-413

Listen To Pronk Pops Podcast or Download Shows 400-407

Listen To Pronk Pops Podcast or Download Shows 391-399

Listen To Pronk Pops Podcast or Download Shows 383-390

Listen To Pronk Pops Podcast or Download Shows 376-382

Listen To Pronk Pops Podcast or Download Shows 369-375

Listen To Pronk Pops Podcast or Download Shows 360-368

Listen To Pronk Pops Podcast or Download Shows 354-359

Listen To Pronk Pops Podcast or Download Shows 346-353

Listen To Pronk Pops Podcast or Download Shows 338-345

Listen To Pronk Pops Podcast or Download Shows 328-337

Listen To Pronk Pops Podcast or Download Shows 319-327

Listen To Pronk Pops Podcast or Download Shows 307-318

Listen To Pronk Pops Podcast or Download Shows 296-306

Listen To Pronk Pops Podcast or Download Shows 287-295

Listen To Pronk Pops Podcast or Download Shows 277-286

Listen To Pronk Pops Podcast or Download Shows 264-276

Listen To Pronk Pops Podcast or Download Shows 250-263

Listen To Pronk Pops Podcast or Download Shows 236-249

Listen To Pronk Pops Podcast or Download Shows 222-235

Listen To Pronk Pops Podcast or Download Shows 211-221

Listen To Pronk Pops Podcast or Download Shows 202-210

Listen To Pronk Pops Podcast or Download Shows 194-201

Listen To Pronk Pops Podcast or Download Shows 184-193

Listen To Pronk Pops Podcast or Download Shows 174-183

Listen To Pronk Pops Podcast or Download Shows 165-173

Listen To Pronk Pops Podcast or Download Shows 158-164

Listen To Pronk Pops Podcast or Download Shows151-157

Listen To Pronk Pops Podcast or Download Shows 143-150

Listen To Pronk Pops Podcast or Download Shows 135-142

Listen To Pronk Pops Podcast or Download Shows 131-134

Listen To Pronk Pops Podcast or Download Shows 124-130

Listen To Pronk Pops Podcast or Download Shows 121-123

Listen To Pronk Pops Podcast or Download Shows 118-120

Listen To Pronk Pops Podcast or Download Shows 113 -117

Listen To Pronk Pops Podcast or Download Show 112

Listen To Pronk Pops Podcast or Download Shows 108-111

Listen To Pronk Pops Podcast or Download Shows 106-108

Listen To Pronk Pops Podcast or Download Shows 104-105

Listen To Pronk Pops Podcast or Download Shows 101-103

Listen To Pronk Pops Podcast or Download Shows 98-100

Listen To Pronk Pops Podcast or Download Shows 94-97

Listen To Pronk Pops Podcast or Download Show 93

Listen To Pronk Pops Podcast or Download Show 92

Listen To Pronk Pops Podcast or Download Show 91

Listen To Pronk Pops Podcast or Download Shows 88-90

Listen To Pronk Pops Podcast or Download Shows 84-87

Listen To Pronk Pops Podcast or Download Shows 79-83

Listen To Pronk Pops Podcast or Download Shows 74-78

Listen To Pronk Pops Podcast or Download Shows 71-73

Listen To Pronk Pops Podcast or Download Shows 68-70

Listen To Pronk Pops Podcast or Download Shows 65-67

Listen To Pronk Pops Podcast or Download Shows 62-64

Listen To Pronk Pops Podcast or Download Shows 58-61

Listen To Pronk Pops Podcast or Download Shows 55-57

Listen To Pronk Pops Podcast or Download Shows 52-54

Listen To Pronk Pops Podcast or Download Shows 49-51

Listen To Pronk Pops Podcast or Download Shows 45-48

Listen To Pronk Pops Podcast or Download Shows 41-44

Listen To Pronk Pops Podcast or Download Shows 38-40

Listen To Pronk Pops Podcast or Download Shows 34-37

Listen To Pronk Pops Podcast or Download Shows 30-33

Listen To Pronk Pops Podcast or Download Shows 27-29

Listen To Pronk Pops Podcast or Download Shows 17-26

Listen To Pronk Pops Podcast or Download Shows 16-22

Listen To Pronk Pops Podcast or Download Shows 10-15

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Read Full Post | Make a Comment ( None so far )

The Pronk Pops Show 916, June 21, 2017, Story 1: Four Time Lying Lunatic Left Losers — Another Democratic Candidate, Jon Ossoff, Lost To Trump Backed Republican, Karen Handel, In Georgia — Videos — Story 2: Progressive Propaganda From Big Lie Media Not Working — Videos

Posted on June 22, 2017. Filed under: American History, Blogroll, Books, Breaking News, Business, College, Communications, Computers, Congress, Corruption, Countries, Culture, Donald J. Trump, Donald J. Trump, Donald Trump, Donald Trump, Economics, Education, Elections, Empires, Employment, Government, Government Dependency, Government Spending, Hate Speech, Hillary Clinton, Hillary Clinton, Hillary Clinton, Hillary Clinton, History, House of Representatives, Housing, Human, Independence, Language, Law, Life, Lying, Media, National Interest, Networking, News, Obama, People, Philosophy, Photos, Politics, Polls, President Trump, Progressives, Radio, Raymond Thomas Pronk, Rule of Law, Scandals, Second Amendment, Security, Spying on American People, Success, Surveillance/Spying, Unemployment, United States Constitution, United States of America, Videos, Violence, War, Wealth, Wisdom | Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |

Project_1

The Pronk Pops Show Podcasts

Pronk Pops Show 916,  June 21, 2017

Pronk Pops Show 915,  June 20, 2017

Pronk Pops Show 914,  June 19, 2017

Pronk Pops Show 913,  June 16, 2017

Pronk Pops Show 912,  June 15, 2017

Pronk Pops Show 911,  June 14, 2017

Pronk Pops Show 910,  June 13, 2017

Pronk Pops Show 909,  June 12, 2017

Pronk Pops Show 908,  June 9, 2017

Pronk Pops Show 907,  June 8, 2017

Pronk Pops Show 906,  June 7, 2017

Pronk Pops Show 905,  June 6, 2017

Pronk Pops Show 904,  June 5, 2017

Pronk Pops Show 903,  June 1, 2017

Pronk Pops Show 902,  May 31, 2017

Pronk Pops Show 901,  May 30, 2017

Pronk Pops Show 900,  May 25, 2017

Pronk Pops Show 899,  May 24, 2017

Pronk Pops Show 898,  May 23, 2017

Pronk Pops Show 897,  May 22, 2017

Pronk Pops Show 896,  May 18, 2017

Pronk Pops Show 895,  May 17, 2017

Pronk Pops Show 894,  May 16, 2017

Pronk Pops Show 893,  May 15, 2017

Pronk Pops Show 892,  May 12, 2017

Pronk Pops Show 891,  May 11, 2017

Pronk Pops Show 890,  May 10, 2017

Pronk Pops Show 889,  May 9, 2017

Pronk Pops Show 888,  May 8, 2017

Pronk Pops Show 887,  May 5, 2017

Pronk Pops Show 886,  May 4, 2017

Pronk Pops Show 885,  May 3, 2017

Pronk Pops Show 884,  May 1, 2017

Pronk Pops Show 883 April 28, 2017

Pronk Pops Show 882: April 27, 2017

Pronk Pops Show 881: April 26, 2017

Pronk Pops Show 880: April 25, 2017

Pronk Pops Show 879: April 24, 2017

Pronk Pops Show 878: April 21, 2017

Pronk Pops Show 877: April 20, 2017

Pronk Pops Show 876: April 19, 2017

Pronk Pops Show 875: April 18, 2017

Pronk Pops Show 874: April 17, 2017

Pronk Pops Show 873: April 13, 2017

Pronk Pops Show 872: April 12, 2017

Pronk Pops Show 871: April 11, 2017

Pronk Pops Show 870: April 10, 2017

Pronk Pops Show 869: April 7, 2017

Pronk Pops Show 868: April 6, 2017

Pronk Pops Show 867: April 5, 2017

Pronk Pops Show 866: April 3, 2017

Pronk Pops Show 865: March 31, 2017

Pronk Pops Show 864: March 30, 2017

Pronk Pops Show 863: March 29, 2017

Pronk Pops Show 862: March 28, 2017

Pronk Pops Show 861: March 27, 2017

Pronk Pops Show 860: March 24, 2017

Pronk Pops Show 859: March 23, 2017

Pronk Pops Show 858: March 22, 2017

Pronk Pops Show 857: March 21, 2017

Pronk Pops Show 856: March 20, 2017

Pronk Pops Show 855: March 10, 2017

Pronk Pops Show 854: March 9, 2017

Pronk Pops Show 853: March 8, 2017

Pronk Pops Show 852: March 6, 2017

Pronk Pops Show 851: March 3, 2017

Pronk Pops Show 850: March 2, 2017

Pronk Pops Show 849: March 1, 2017

 Story 1: Four Time Lying Lunatic Left Losers — Another Democratic Candidate, Jon Ossoff, Lost To Trump Backed Republican, Karen Handel, In Georgia — Videos —

Image result for eric hoffer quotes propagandaImage result for cartoons democrat lost in georgia ossoff

Image result for cartoons democrat lost in georgia ossoff

Image result for cartoons democrat lost in georgia ossoff

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The Trump ‘referendum’ that wasn’t

The true meaning behind special election victories

Special Report : Political fallout from Karen Handel’s special election win : 6/20/2017

President Trump reacts to Georgia special election result

Political fallout from Karen Handel’s special election win

Karen Handel defeats Jon Ossoff in Georgia special election

Liberals Panic Karen Handel won the special election ( Democrats Lose Again )

Rush Limbaugh, Democrats Devastated Over Karen Handel Win over Jon Ossoff

Breathtakingly Incoherent Dems Blow the Georgia House Special Election and Can’t Figure Out Why

What Do You Need To Finally Understand the Poison of Alt-Left Mainstream Media?

Mark Steyn Coins a New Phrase “Deep State Dinner Theater” Excellent!

BREAKING NEWS TRUMP 6/21/17: Do you think America is at a turning point?

Jon Ossoff concedes Georgia race

RAW: Karen Handel addresses supporters after win

 

Story 2: Progressive Propaganda From Big Lie Media Not Working — Videos

10 Signs That Someone Is Lying

Former CIA Officer Will Teach You How to Spot a Lie l Digiday

Documentary on how the media lies to manipulate us

Propaganda-Behind Big Media-WE are BEING LIED to in a BIG WAY by the TV! TURN IT OFF!

Television = Mass Mind Control Propaganda

Propaganda & Engineering Consent for Empire with Mark Crispin Miller

War, US Government Corporate Propaganda, The CIA & The Russian “Putin Threat”

Propaganda Terms in the Media and What They Mean – Noam Chomsky

CRITICAL THINKING – Cognitive Biases: Anchoring [HD]

Scott Adams talks about the Comey fog of confirmation bias

Cognition: How Your Mind Can Amaze and Betray You – Crash Course Psychology #15

Image result for eric hoffer and the true believerImage result for eric hoffer and the true believerImage result for eric hoffer and the true believer

Image result for eric hoffer and the true believer

Eric Hoffer – Tyranny of the Intellectuals

Eric Hoffer pt. 1 of 5

Eric Hoffer pt. 2 of 5

Eric Hoffer pt. 3 of 5

Eric Hoffer pt. 4 of 5

Eric Hoffer pt. 5 of 5

Top Ten Quotes Of Eric Hoffer

Eric Hoffer: The True Believer and The Nature of Mass Movements

Why are Activists often Altruists? Why Low Image of Self?

Eric Hoffer “The Longshoreman Philosopher” predicted Donald Trump & 1940’s Port of Los Angeles

Image result for eric hoffer and the true believer

Propaganda and Manipulation: How mass media engineers and distorts our perceptions

7 Propaganda Techniques Used on You Every Day

Introduction to Propaganda

What is Brainwashing?

PROPAGANDA SOCIAL ENGINEERING AND THE MANUFACTURING OF HUMAN THOUGHT

Image result for confirmation bias and invincible ignorance

Image result for eric hoffer and the true believer

The Pronk Pops Show Podcasts Portfolio

Listen To Pronk Pops Podcast or Download Shows 916

Listen To Pronk Pops Podcast or Download Shows 906-915

Listen To Pronk Pops Podcast or Download Shows 889-896

Listen To Pronk Pops Podcast or Download Shows 884-888

Listen To Pronk Pops Podcast or Download Shows 878-883

Listen To Pronk Pops Podcast or Download Shows 870-877

Listen To Pronk Pops Podcast or Download Shows 864-869

Listen To Pronk Pops Podcast or Download Shows 857-863

Listen To Pronk Pops Podcast or Download Shows 850-856

Listen To Pronk Pops Podcast or Download Shows 845-849

Listen To Pronk Pops Podcast or Download Shows 840-844

Listen To Pronk Pops Podcast or Download Shows 833-839

Listen To Pronk Pops Podcast or Download Shows 827-832

Listen To Pronk Pops Podcast or Download Shows 821-826

Listen To Pronk Pops Podcast or Download Shows 815-820

Listen To Pronk Pops Podcast or Download Shows 806-814

Listen To Pronk Pops Podcast or Download Shows 800-805

Listen To Pronk Pops Podcast or Download Shows 793-799

Listen To Pronk Pops Podcast or Download Shows 785-792

Listen To Pronk Pops Podcast or Download Shows 777-784

Listen To Pronk Pops Podcast or Download Shows 769-776

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Listen To Pronk Pops Podcast or Download Shows 745-750

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Listen To Pronk Pops Podcast or Download Shows 732-737

Listen To Pronk Pops Podcast or Download Shows 727-731

Listen To Pronk Pops Podcast or Download Shows 720-726

Listen To Pronk Pops Podcast or DownloadShows 713-719

Listen To Pronk Pops Podcast or DownloadShows 705-712

Listen To Pronk Pops Podcast or Download Shows 695-704

Listen To Pronk Pops Podcast or Download Shows 685-694

Listen To Pronk Pops Podcast or Download Shows 675-684

Listen To Pronk Pops Podcast or Download Shows 668-674

Listen To Pronk Pops Podcast or Download Shows 660-667

Listen To Pronk Pops Podcast or Download Shows 651-659

Listen To Pronk Pops Podcast or Download Shows 644-650

Listen To Pronk Pops Podcast or Download Shows 637-643

Listen To Pronk Pops Podcast or Download Shows 629-636

Listen To Pronk Pops Podcast or Download Shows 617-628

Listen To Pronk Pops Podcast or Download Shows 608-616

Listen To Pronk Pops Podcast or Download Shows 599-607

Listen To Pronk Pops Podcast or Download Shows 590-598

Listen To Pronk Pops Podcast or Download Shows 585- 589

Listen To Pronk Pops Podcast or Download Shows 575-584

Listen To Pronk Pops Podcast or Download Shows 565-574

Listen To Pronk Pops Podcast or Download Shows 556-564

Listen To Pronk Pops Podcast or Download Shows 546-555

Listen To Pronk Pops Podcast or Download Shows 538-545

Listen To Pronk Pops Podcast or Download Shows 532-537

Listen To Pronk Pops Podcast or Download Shows 526-531

Listen To Pronk Pops Podcast or Download Shows 519-525

Listen To Pronk Pops Podcast or Download Shows 510-518

Listen To Pronk Pops Podcast or Download Shows 500-509

Listen To Pronk Pops Podcast or Download Shows 490-499

Listen To Pronk Pops Podcast or Download Shows 480-489

Listen To Pronk Pops Podcast or Download Shows 473-479

Listen To Pronk Pops Podcast or Download Shows 464-472

Listen To Pronk Pops Podcast or Download Shows 455-463

Listen To Pronk Pops Podcast or Download Shows 447-454

Listen To Pronk Pops Podcast or Download Shows 439-446

Listen To Pronk Pops Podcast or Download Shows 431-438

Listen To Pronk Pops Podcast or Download Shows 422-430

Listen To Pronk Pops Podcast or Download Shows 414-421

Listen To Pronk Pops Podcast or Download Shows 408-413

Listen To Pronk Pops Podcast or Download Shows 400-407

Listen To Pronk Pops Podcast or Download Shows 391-399

Listen To Pronk Pops Podcast or Download Shows 383-390

Listen To Pronk Pops Podcast or Download Shows 376-382

Listen To Pronk Pops Podcast or Download Shows 369-375

Listen To Pronk Pops Podcast or Download Shows 360-368

Listen To Pronk Pops Podcast or Download Shows 354-359

Listen To Pronk Pops Podcast or Download Shows 346-353

Listen To Pronk Pops Podcast or Download Shows 338-345

Listen To Pronk Pops Podcast or Download Shows 328-337

Listen To Pronk Pops Podcast or Download Shows 319-327

Listen To Pronk Pops Podcast or Download Shows 307-318

Listen To Pronk Pops Podcast or Download Shows 296-306

Listen To Pronk Pops Podcast or Download Shows 287-295

Listen To Pronk Pops Podcast or Download Shows 277-286

Listen To Pronk Pops Podcast or Download Shows 264-276

Listen To Pronk Pops Podcast or Download Shows 250-263

Listen To Pronk Pops Podcast or Download Shows 236-249

Listen To Pronk Pops Podcast or Download Shows 222-235

Listen To Pronk Pops Podcast or Download Shows 211-221

Listen To Pronk Pops Podcast or Download Shows 202-210

Listen To Pronk Pops Podcast or Download Shows 194-201

Listen To Pronk Pops Podcast or Download Shows 184-193

Listen To Pronk Pops Podcast or Download Shows 174-183

Listen To Pronk Pops Podcast or Download Shows 165-173

Listen To Pronk Pops Podcast or Download Shows 158-164

Listen To Pronk Pops Podcast or Download Shows151-157

Listen To Pronk Pops Podcast or Download Shows 143-150

Listen To Pronk Pops Podcast or Download Shows 135-142

Listen To Pronk Pops Podcast or Download Shows 131-134

Listen To Pronk Pops Podcast or Download Shows 124-130

Listen To Pronk Pops Podcast or Download Shows 121-123

Listen To Pronk Pops Podcast or Download Shows 118-120

Listen To Pronk Pops Podcast or Download Shows 113 -117

Listen To Pronk Pops Podcast or Download Show 112

Listen To Pronk Pops Podcast or Download Shows 108-111

Listen To Pronk Pops Podcast or Download Shows 106-108

Listen To Pronk Pops Podcast or Download Shows 104-105

Listen To Pronk Pops Podcast or Download Shows 101-103

Listen To Pronk Pops Podcast or Download Shows 98-100

Listen To Pronk Pops Podcast or Download Shows 94-97

Listen To Pronk Pops Podcast or Download Show 93

Listen To Pronk Pops Podcast or Download Show 92

Listen To Pronk Pops Podcast or Download Show 91

Listen To Pronk Pops Podcast or Download Shows 88-90

Listen To Pronk Pops Podcast or Download Shows 84-87

Listen To Pronk Pops Podcast or Download Shows 79-83

Listen To Pronk Pops Podcast or Download Shows 74-78

Listen To Pronk Pops Podcast or Download Shows 71-73

Listen To Pronk Pops Podcast or Download Shows 68-70

Listen To Pronk Pops Podcast or Download Shows 65-67

Listen To Pronk Pops Podcast or Download Shows 62-64

Listen To Pronk Pops Podcast or Download Shows 58-61

Listen To Pronk Pops Podcast or Download Shows 55-57

Listen To Pronk Pops Podcast or Download Shows 52-54

Listen To Pronk Pops Podcast or Download Shows 49-51

Listen To Pronk Pops Podcast or Download Shows 45-48

Listen To Pronk Pops Podcast or Download Shows 41-44

Listen To Pronk Pops Podcast or Download Shows 38-40

Listen To Pronk Pops Podcast or Download Shows 34-37

Listen To Pronk Pops Podcast or Download Shows 30-33

Listen To Pronk Pops Podcast or Download Shows 27-29

Listen To Pronk Pops Podcast or Download Shows 17-26

Listen To Pronk Pops Podcast or Download Shows 16-22

Listen To Pronk Pops Podcast or Download Shows 10-15

Listen To Pronk Pops Podcast or Download Shows 1-9

Read Full Post | Make a Comment ( None so far )

The Pronk Pops Show 917, June 22, 2017, Story 1: Senate Draft Bill To Repeal Obamacare Is Obamacare Lite! No Individual and Employer Mandates and Obamacare Taxes But Subsidies Remain — The Stupid Party Again Betrays Republican Voters By Not Repealing Obamacare Completely — Conservative and Libertarian Republicans Will Oppose Senate Draft Bill — Nothing For Trump To Sign Before Independence Day! — Videos — Story 2: More Republican Voters Will Be Leaving The Party and Become Independents — Waiting For A New Limited Government Party! — Obama Damaged Democratic Party and Trump Will Damage Republican Party — No Hope and No Change With Two Party Tyranny of Big Interventionist Government — BIG Parties — Videos

Posted on June 22, 2017. Filed under: American History, Blogroll, Breaking News, Budgetary Policy, Communications, Congress, Corruption, Countries, Diet, Donald J. Trump, Donald J. Trump, Donald Trump, Donald Trump, Economics, Education, Empires, Employment, Exercise, Federal Government, Fiscal Policy, Food, Food, Former President Barack Obama, Freedom of Speech, Government, Government Spending, Health, Health Care, Health Care Insurance, Hillary Clinton, Hillary Clinton, History, House of Representatives, Human, Human Behavior, Labor Economics, Life, Lying, Media, Medicare, National Interest, News, People, Philosophy, Photos, Politics, Polls, President Trump, Progressives, Radio, Raymond Thomas Pronk, Regulation, Rule of Law, Security, Senate, Social Science, Tax Policy, Taxation, Taxes, Ted Cruz, Unemployment, United States of America, Videos, Wealth, Welfare Spending, Wisdom | Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |

Project_1

The Pronk Pops Show Podcasts

Pronk Pops Show 917,  June 22, 2017

Pronk Pops Show 916,  June 21, 2017

Pronk Pops Show 915,  June 20, 2017

Pronk Pops Show 914,  June 19, 2017

Pronk Pops Show 913,  June 16, 2017

Pronk Pops Show 912,  June 15, 2017

Pronk Pops Show 911,  June 14, 2017

Pronk Pops Show 910,  June 13, 2017

Pronk Pops Show 909,  June 12, 2017

Pronk Pops Show 908,  June 9, 2017

Pronk Pops Show 907,  June 8, 2017

Pronk Pops Show 906,  June 7, 2017

Pronk Pops Show 905,  June 6, 2017

Pronk Pops Show 904,  June 5, 2017

Pronk Pops Show 903,  June 1, 2017

Pronk Pops Show 902,  May 31, 2017

Pronk Pops Show 901,  May 30, 2017

Pronk Pops Show 900,  May 25, 2017

Pronk Pops Show 899,  May 24, 2017

Pronk Pops Show 898,  May 23, 2017

Pronk Pops Show 897,  May 22, 2017

Pronk Pops Show 896,  May 18, 2017

Pronk Pops Show 895,  May 17, 2017

Pronk Pops Show 894,  May 16, 2017

Pronk Pops Show 893,  May 15, 2017

Pronk Pops Show 892,  May 12, 2017

Pronk Pops Show 891,  May 11, 2017

Pronk Pops Show 890,  May 10, 2017

Pronk Pops Show 889,  May 9, 2017

Pronk Pops Show 888,  May 8, 2017

Pronk Pops Show 887,  May 5, 2017

Pronk Pops Show 886,  May 4, 2017

Pronk Pops Show 885,  May 3, 2017

Pronk Pops Show 884,  May 1, 2017

Pronk Pops Show 883 April 28, 2017

Pronk Pops Show 882: April 27, 2017

Pronk Pops Show 881: April 26, 2017

Pronk Pops Show 880: April 25, 2017

Pronk Pops Show 879: April 24, 2017

Pronk Pops Show 878: April 21, 2017

Pronk Pops Show 877: April 20, 2017

Pronk Pops Show 876: April 19, 2017

Pronk Pops Show 875: April 18, 2017

Pronk Pops Show 874: April 17, 2017

Pronk Pops Show 873: April 13, 2017

Pronk Pops Show 872: April 12, 2017

Pronk Pops Show 871: April 11, 2017

Pronk Pops Show 870: April 10, 2017

Pronk Pops Show 869: April 7, 2017

Pronk Pops Show 868: April 6, 2017

Pronk Pops Show 867: April 5, 2017

Pronk Pops Show 866: April 3, 2017

Pronk Pops Show 865: March 31, 2017

Pronk Pops Show 864: March 30, 2017

Pronk Pops Show 863: March 29, 2017

Pronk Pops Show 862: March 28, 2017

Pronk Pops Show 861: March 27, 2017

Pronk Pops Show 860: March 24, 2017

Pronk Pops Show 859: March 23, 2017

Pronk Pops Show 858: March 22, 2017

Pronk Pops Show 857: March 21, 2017

Pronk Pops Show 856: March 20, 2017

Pronk Pops Show 855: March 10, 2017

Pronk Pops Show 854: March 9, 2017

Pronk Pops Show 853: March 8, 2017

Pronk Pops Show 852: March 6, 2017

Pronk Pops Show 851: March 3, 2017

Pronk Pops Show 850: March 2, 2017

Pronk Pops Show 849: March 1, 2017

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Story 1: Senate Draft Bill To Repeal Obamacare Is Obamacare Lite! No Individual and Employer Mandates and Obamacare Taxes But Subsidies Remain — The Stupid Party Again Betrays Republican Voters By Not Repealing Obamacare Completely — Conservative and Libertarian Republicans Will Oppose Senate Draft Bill — Nothing For Trump To Sign Before Independence Day! — Videos

Image result for ludwig von mises on government intervention into marketsImage result for ludwig von mises on government intervention into markets

“Once the principle is admitted that it is the duty of the government to protect the individual against his own foolishness, no serious objections can be advanced against further encroachments.”

“The champions of socialism call themselves progressives, but they recommend a system which is characterized by rigid observance of routine and by a resistance to every kind of improvement. They call themselves liberals, but they are intent upon abolishing liberty. They call themselves democrats, but they yearn for dictatorship. They call themselves revolutionaries, but they want to make the government omnipotent. They promise the blessings of the Garden of Eden, but they plan to transform the world into a gigantic post office. Every man but one a subordinate clerk in a bureau.”
~ Ludwig von Mises

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Image result for four gop senators opposed to senate draft of repeal and replace

 

Image result for List of pre-existing conditions

Image result for List of pre-existing conditions

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Here are the details of Senate Republican Obamacare replacement bill

  • The bill would significantly change how the federal government subsidizes individual health plans and funds Medicaid
  • GOP leaders want to have a vote on the bill before the Fourth of July recess.
  • The House’s own version of a health-care bill is deeply unpopular.
Dan Mangan | Kayla Tausche

Senate Minority Leader Sen. Mitch McConnell (R-KY)

Former Medicare administrator: Millions will still lose coverage under Senate health-care bill  6 Hours Ago | 03:20

Senate GOP leaders on Thursday finally released their secret health-care reform bill, which would repeal Obamacare taxes, restructure subsidies to insurance customers, and both phase out Medicaid’s expansion program and cap Medicaid spending.

Republicans plan to bring the controversial bill that was drafted in secret to a quick vote next week, but face potentially fatal opposition to it from several members of their own caucus.

The 142-page bill, if passed into law, would sharply reduce financial aid that currently helps millions of people obtain health coverage, while at the same time offering a tax break to primarily wealthy Americans to the tune of hundreds of billions of dollars. And it would loosen rules in a way that could lead to states allowing insurers to offer less-generous health plans.

The bill would repeal, retroactive to the beginning of 2016, the Obamacare rule requiring most Americans to have some form of health coverage or pay a tax penalty fine. That repeal is expected to sharply increase the number of people who don’t have insurance, which could in turn lead insurers to raise premiums.

And it would repeal, retroactively to the beginning of 2016, the “employer mandate,” which requires large employers to offer health insurance to workers or be fined.

Read the entire bill here

The bill also would continue for at least two years to offer reimbursements to health insurance companies for subsidies that reduce out-of-pocket costs for low income customers of Obamacare plans. But those subsidies would end in 2020, which would increase deductibles and other out-of-pocket health expenses for millions of customers.

The federal government’s share of funding for Medicaid, which is jointly run with individual states, would fall over the course of seven years to end up at around 57 percent of the cost of that program, which offers health coverage to the poor.

Under Obamacare, the federal government had guaranteed that its funding for adults newly eligible for Medicaid because of the Affordable Care Act would fall to no lower than 90 percent of their costs. That expansion program would begin being phased out in 2021, and fully repealed by three years later.

In another cost-cutting move, the bill would lower the maximum income level a household could have to still qualify for federal subsidies that help reduce the premiums people pay for enrollment for individual health plans. Obamacare currently bars subsidies to families that earn more than 400 percent of the federal poverty level. The new bill would reduce that cap to 350 percent of the poverty level.

Younger people, as a group, would end up paying less of a share of their income toward their individual health plans under the bill in comparison to what they pay now under Obamacare, while older people as a group would end up paying a larger share of their income.

Health plans that offer abortion services would not be eligible for the subsidies, according to the draft released Thursday.

The federal government also would end up spending less money subsidizing people’s insurance purchases by changing how the value of those subsidies are calculated. The bill would use a less-expensive type of individual health plan to calculate those subsidies, as opposed to the pricier plan used under Obamacare.

The bill also seeks to repeal, to the start of 2017, the 3.8 percent tax on net investment income.

The Trump administration is expected to back the bill, which most GOP senators were learning the details of during a meeting Thursday morning. The bill is named the “Better Care Reconciliation Act of 2017.”

“It’s going to be very good,” President Donald Trump said about an hour after the bill’s release. “A little negotiation, but it’s going to be very good.” Trump did not elaborate.

The House’s version of the bill, dubbed the American Health Care Act, is broadly unpopular among the public, and had been reportedly called “mean, mean, mean,” by Trump during a meeting with senators. Weeks earlier, Trump and House members who voted for the ACHA celebrated its passage in the Rose Garden of the White House.

A new NBC News/Wall Street Journal Poll released Thursday found that just 16 percent of Americans thought the House bill was a good idea, with 48 percent saying it is a bad idea.

“In broad strokes, the Senate bill is just like the House: Big tax cuts, big cut in federal heath spending, big increase in the uninsured,” tweeted Larry Levitt, an Obamacare expert at the Kaiser Family Foundation.

“Under the Senate bill, low-income people would pay higher premiums for bigger deductibles,” Levitt said.

He had noted on Twitter on Wednesday that “A 60 year-old at 351% of poverty currently gets a premium subsidy of $5,151 per year on average.” The Senate bill would eliminate all of that federal financial aid if it becomes law.

Senate GOP leaders want to have a vote on the bill by late next week, before Congress’ Fourth of July recess. They do not plan to hold any hearings on the legislation, infuriating Democrats, who were frozen out of the drafting process.

To pass, Republicans must get at least 50 GOP senators to vote for the bill, since no Democrat or independent is expected to vote for it. Vice President Mike Pence would break any tie, and would be expected to vote for the bill. There are 52 Republican senators.

On Thursday, about an hour after the bill was posted online, NBC’s Chuck Todd tweeted that a group of a conservative Republican senators were meeting, and that there are at least three GOP senators, and possibly more, who plan to announce later today that they will oppose the bill.

If that number proves to be accurate, it could be a death blow to the bill.

Sen. Rand Paul, R-Ky., told NBC that he and several other members of the GOP caucus would be making a statement on the bill later Thursday.

“It looks like we’re keeping Obamacare, not repealing it,” said Paul, who declined to say whether that meant he would vote against the bill.

Senate Majority Leader Mitch McConnell of Ky., center, followed by Majority Whip John Cornyn, R-Texas, leaves a Republican meeting on healthcare, Thursday, June 22, 2017, on Capitol Hill in Washington.

Jacquelyn Martin | AP
Senate Majority Leader Mitch McConnell of Ky., center, followed by Majority Whip John Cornyn, R-Texas, leaves a Republican meeting on healthcare, Thursday, June 22, 2017, on Capitol Hill in Washington.

Senate Majority Leader Mitch McConnell, R-Ky., said Thursday, “There will be ample time to analyze” and discuss the bill before the legislation is put to a vote.

While McConnell praised the bill on the floor of the Senate, many of his Republican caucus members avoided speaking with reporters staking them out in Congress, who wanted to ask about the legislation.

Democrats promptly blasted the bill, and castigated Republicans for planning to call a vote on it just a week after its details were released.

“The Republicans want to give a tax break to the wealthiest Americans,” said Senate Minority Leader Chuck Schumer, D-NY, on the floor of the Senate after release of the bill. “Simply put this bill will result in higher costs, less care, and millions of Americans will lose their health insurance.”

“It’s every bit as bad as the House bill. In many ways it’s even worse,” Schumer said. “The Senate bill is a wolf in sheep’s clothing, but this wolf has even sharper teeth than the House bill.”

House Speaker Paul Ryan, R-Wisc., during a press conference said, “From what I understand, their bill tracks along lines of House bill … [I] think that’s very good.”

Leslie Dach, director of the Obamacare-supporting group Protect Our Care Campaign, tore into the Senate’s bill, which, like Ryan, he compared to the House’s earlier bill.

“Senate Republicans promised to start over and write a plan that improves people’s health care,” Dach said. “Instead they doubled down on the failed House repeal approach that puts everyone’s health care last, and tax breaks for the wealthy first.”

“The heartless Senate health care repeal bill makes health care worse for everyone — it raises costs, cuts coverage, weakens protections and cuts even more from Medicaid than the mean House bill,” said Dach, who had served as senior counselor at the Department of Health and Human Services in the Obama administration.

“They wrote their plan in secret and are rushing forward with a vote next week because they know how much harm their bill does to millions of people.”

But Seema Verma, administrator for the federal Centers for Medicare and Medicaid Services, praised the Senate’s bill as she criticized Obamacare, a program that CMS oversees.

“I appreciate the work of the Senate as they continue to make progress fixing the crisis in health care that has resulted from Obamacare,” Verma said. “Skyrocketing premiums, rising costs and fewer choices have caused too many Americans to drop their insurance coverage.”

“Today, Obamacare is in a death spiral and millions ofAmericans are being negatively impacted as a result. They are trapped by mandates that force them to purchase insurance they don’t want and can’t afford,” she said. “The Senate proposal is built on putting patients first and in charge of their health-care decisions, bringing down the cost of coverage and expanding choices. Congress must act now to achieve the President’s goal to make sure all Americans have access to quality, affordable coverage.”

The Congressional Budget Office said it expects to release an analysis of the bill early next week Monday. The analysis will estimate how many people are likely to become uninsured in the next decade if the bill becomes law, as well as how premiums for individual health plans would be affected.

CBO aims to release estimate for Senate health care plan early next week https://www.cbo.gov/publication/52843 

CBO aims to release estimate for Senate health care plan early next week

CBO and the staff of the Joint Committee on Taxation are in the process of preparing an estimate for the Senate health care plan and aim to release it early next week.

cbo.gov

The CBO “score” would also include projections on the bill’s impact on federal spending.

The release of the draft comes more than six weeks after GOP leaders in the House barely managed to win passage for their own health-care legislation.

The House bill, the American Health Care Act, is widely unpopular, multiple polls have shown.

The nonpartisan CBO, in analyzing that bill, found that 23 million more Americans would become uninsured by 2026 if it became law than if Obamacare remained in place.

While many of those people would voluntarily cease buying insurance plans because of the elimination requirement that they have some form of health coverage or pay a fine, millions more would find their plans unaffordable because of either rising prices, the loss of government subsidies or both factors.

http://www.cnbc.com/2017/06/22/senate-republicans-finally-unveil-their-big-obamacare-replacement-bill.html

Track the Key Changes in the GOP’s Health Plan

By Hannah Recht, Zachary Tracer and Mira Rojanasakul

Published: March 22, 2017 | Last updated: June 22, 2017
Seven years after the Affordable Care Act was enacted, Republicans are trying to follow through on their promises to repeal and replace Obamacare. On March 6, Republican House leaders introduced their health plan, and Senate Republicans followed with their own bill on June 22. Congress will need to reconcile differences in the two proposals before a bill can reach President Donald Trump’s desk. We’ll track major policy changes and their impacts as Congress drafts and revises legislation to repeal Obamacare.
House bill introduced [March 6] ⟶ First House amendments [March 20] ⟶ First House vote canceled [March 24] ⟶ Passes House [May 4] ⟶ Senate bill introduced [June 22] ⟶ Passes Senate ⟶ House and Senate negotiate and revise bill ⟶ House and Senate pass final bill ⟶ President signs, becomes law
Medicaid Financing
House billCHANGE
House bill introduced  |  March 6, 2017

Currently, the federal government generally reimburses states for a fixed percentage of Medicaid expenditures, regardless of total spending or number of enrollees. The GOP bill would limit Medicaid reimbursement by a per-enrollee cost, based on 2016 average costs.

House amendment  |  March 20, 2017

Allows states to choose from two formulas for how they get federal Medicaid funding, and boosts the funding for elderly and disabled Medicaid enrollees, relative to the initial bill.

Senate billCHANGE
Senate bill introduced  |  June 22, 2017

Like the House bill, the Senate bill would allow states to choose between two formulas for federal Medicaid funding. But starting in 2025, the Senate bill would set a lower funding growth rate than the House bill would, meaning states would receive less money. Certain Medicaid enrollees would not be subject to these limits, including people with disabilities and children.

Budget impact: In the House bill, Federal Medicaid spending would decrease by $834 billion, from 2017 to 2026, relative to current law.

Decrease in Medicaid spending from current law, House bill
Source: Congressional Budget Office
Medicaid Expansion
House billREPEAL
House bill introduced  |  March 6, 2017

The ACA allowed states to expand Medicaid to individuals making as much as 138 percent of the federal poverty level, with federal funding. The GOP bill winds down Obamacare’s Medicaid expansion starting in 2020.

House amendment  |  March 20, 2017

Won’t provide extra funding to states that newly expand Medicaid.

Senate billREPEAL
Senate bill introduced  |  June 22, 2017

Medicaid expansion funding would be phased out between 2021 and 2024.

Human impact: In the House bill, Medicaid enrollment would decrease by 14 million people by 2026, about 17 percent.

Decrease in Medicaid enrollment from current law, House bill

0M

–3

–6

–9

–12

–15

Source: Congressional Budget Office
Premium Subsidies
House billCHANGE
House bill introduced  |  March 6, 2017

The ACA introduced subsidies based on income and the cost of health insurance, with some help available to people making up to 400 percent of the poverty level, or about $47,000 for an individual. The House bill would base subsidies mainly on age, phasing out funding beginning at an income of $75,000 for an individual.

Senate billCHANGE
Senate bill introduced  |  June 22, 2017

The Senate bill would maintain the ACA’s subsidies through 2019, but change how subsidies are allocated starting in 2020. The ACA calculates subsidies based on a mid-level coverage plan, while the Senate bill would use a cheaper type of plan. Subsidies would no longer be available to those above 350 percent of the poverty level, or about $42,000 for an individual.

Human impact: Many low-income subsidy recipients would lose thousands in premium subsidies, particularly older enrollees in higher-cost areas. In the House bill, some people who currently earn too much to qualify for subsidies would receive new assistance. The Senate bill does not offer similar assistance. Instead, it would place additional limits on who qualifies for subsidy assistance, making some middle-class recipients who currently receive subsidies ineligible.

Source: Congressional Budget Office
Essential Health Benefits
House billCHANGE
House amendment  |  March 23, 2017

The ACA requires health insurance plans to cover 10 broad categories of essential health benefits, as well as to provide preventive services at no cost. The bill initially left the requirement intact, but an amendment that would repeal that requirement was added. Instead, states will define their own list of benefits that are required for plans receiving premium subsidies beginning Jan. 1, 2018.

House amendment  |  May 3, 2017

An amendment was added that would leave essential health benefits intact—reinstating the federal standard. Instead, states could opt out of the requirement and apply for a waiver to define their own list of benefits that are required for plans receiving premium subsidies beginning Jan. 1, 2020.

Senate billCHANGE
Senate bill introduced  |  June 22, 2017

Senate bill adopts changes in House bill.

Human impact: The Congressional Budget Office expects that half of the U.S. population live in states that would waive some required benefits. Plans in these states would likely have lower premiums, but they would cover less. For instance, maternity care premiums could cost an additional $1,000 per month or more. Customers seeking comprehensive coverage could face premiums and out-of-pocket charges that are significantly higher than under current law.

Budget impact: Insurers in some states could offer plans with such limited coverage that CBO does not consider them health insurance. Those plans would still be eligible for millions of dollars in federal subsidies.

Source: Congressional Budget Office
Pre-existing Conditions
House billCHANGE
House amendment  |  May 3, 2017

The ACA requires health insurers to sell plans to individuals who are sick with so-called pre-existing conditions and not charge them more than healthy customers. An amendment would allow states to apply for a waiver that would let insurers charge higher premiums to people with pre-existing conditions that had a gap in coverage of at least 63 days in the prior year. To do so, states would have to establish some method (a special “high-risk” insurance pool, or subsidies) to help sick people.

Senate billNO CHANGE
Senate bill introduced  |  June 22, 2017

Insurance companies would not be allowed to charge customers with pre-existing conditions more than healthy customers.

Human impact: In states that allow insurers to charge people with pre-existing conditions more than healthy people, those less healthy individuals would face increasingly prohibitive premiums under the House bill. Eventually, the CBO predicts, less-healthy people may not be able to afford any coverage.

Source: Congressional Budget Office
Age Rating
House billCHANGE
House bill introduced  |  March 6, 2017

Obamacare lets health insurers charge their oldest customers no more than three times as much as their youngest ones. The GOP bill introduced widens the ratio to 5 to 1.

House amendment  |  March 20, 2017

Adds a provision that would let the Senate decide whether to increase subsidies that go to older Americans.

House amendment  |  May 3, 2017

Adds a provision that would allow states to apply for a waiver to give insurers permission to charge older customers even more than the 5 to 1 ratio.

Senate billCHANGE
Senate bill introduced  |  June 22, 2017

Senate bill adopts changes in House bill.

Human impact: Premiums would significantly rise for older people and decrease for younger people. Low-income older adults would face much higher premiums than under current law, even with federal subsidies.

Source: Congressional Budget Office
State Grants
House billNEW
House bill introduced  |  March 6, 2017

Includes a new $100 billion fund designed to help states stabilize their individual health insurance markets or help low-income people get health care.

House amendment  |  March 23, 2017

Adds $15 billion to the fund to be used for maternity, newborn, mental health and substance abuse coverage.

House amendment  |  April 6, 2017

Adds $15 billion for the Federal Invisible Risk Sharing Program, designed to help insurers cover the costs of sick and expensive patients.

House amendment  |  May 3, 2017

Adds $8 billion in funding from 2018 through 2023 to help individuals afford higher premiums in states that let insurers charge sick people more.

Senate billNEW
Senate bill introduced  |  June 22, 2017

The Senate bill would include $112 billion in state grant funds, primarily to stabilize state insurance markets and cover expensive patients. It would also allocate $2 billion in 2018 for substance abuse treatment.

Human impact: The grants would lead to slightly lower premiums in the individual market and encourage insurer participation. The new funding would not be enough to significantly lower costs for people with pre-existing conditions.

Budget impact: Both bills would require more than $100 billion in additional federal spending.

Source: Congressional Budget Office
Medicaid Work Requirements
House billNEW
House amendment  |  March 20, 2017

Gives states the option of requiring some Medicaid recipients to work or pursue job training.

Senate billNEW
Senate bill introduced  |  June 22, 2017

Senate bill adopts changes in House bill.

Human impact: According to the Kaiser Family Foundation, 10 million non-elderly adult Medicaid recipients who don’t receive Social Security are not working. Some of these adults would be excluded from work requirements due to disability, pregnancy or caretaker status, but many would be expected to complete job training or find employment in order to keep their insurance.

Source: Kaiser Family Foundation
Insurance Mandates
House billREPEAL
House bill introduced  |  March 6, 2017

The House bill ends Obamacare’s requirement that individuals have health coverage and that most employers offer it. Instead, when people who’ve gone uninsured decide to buy health insurance, they’ll have to pay a 30 percent surcharge on their premiums for one year.

Senate billREPEAL
Senate bill introduced  |  June 22, 2017

The Senate bill ends Obamacare’s requirement that individuals have health coverage and that most employers offer it.

Human impact: Though about 1 million people are expected to buy insurance in 2018 in order to avoid future surcharges, twice as many would choose not to purchase insurance long-term because of the House bill surcharge or insurance documentation requirements.

Budget impact: Revenue loss of $210 billion from 2017 to 2026 from repealing insurance penalties. The new premium surcharge would go to insurers directly, not the government.

Source: Congressional Budget Office
Planned Parenthood and Abortion Care
House billNEW
House bill introduced  |  March 6, 2017

Ends all federal funding for Planned Parenthood for one year. The bill also prohibits federal funds from going to insurance plans that cover abortions, other than those necessary to save the life of the woman, or in cases of rape or incest.

House amendment  |  March 20, 2017

Adds additional safeguards to prevent government funds from being used for some abortions.

Senate billNEW
Senate bill introduced  |  June 22, 2017

Senate bill adopts changes in House bill.

Human impact: Several thousand Medicaid-covered births would occur because of the loss of Planned Parenthood contraceptive and abortion care, particularly among women in areas without other providers that serve low-income patients.

Budget impact: Direct spending would decrease by $234 million between 2017 and 2026, but new births due to the Planned Parenthood provision would increase Medicaid spending by $77 million over the same period.

Source: Congressional Budget Office
Individual Taxes
House billREPEAL
House bill introduced  |  March 6, 2017

Repeals a 0.9 percent Medicare payroll surtax and a 3.8 percent investment-income tax on wealthy individuals that were introduced in the ACA, effective 2018.

House amendment  |  March 20, 2017

Ends the taxes in 2017, rather than 2018.

House amendment  |  March 23, 2017

Postpones repeal of the additional Medicare tax to 2023.

Senate billREPEAL
Senate bill introduced  |  June 22, 2017

Senate bill adopts changes in House bill.

Human impact: Wealthy individuals would get a tax break. In counties that backed Trump, taxpayers would save $6.6 billion, while taxpayers in Clinton counties would save $21.6 billion.

Budget impact: From 2017 to 2026, the repeal would lose $172 billion in Net Investment Tax revenue and about $64 billion in Medicare tax revenue from 2023 to 2026. Repealing the Medicare tax in 2017 would have resulted in an additional $63 billion loss.

Source: Congressional Budget Office
Industry Taxes
House billREPEAL
House bill introduced  |  March 6, 2017

Repeals ACA taxes imposed on health insurers, pharmaceutical companies, medical-device companies and tanning salons, effective 2018.

House amendment  |  March 20, 2017

Ends the taxes in 2017, rather than 2018.

Senate billREPEAL
Senate bill introduced  |  June 22, 2017

Repeals most taxes immediately. A tax on providers would be phased out in 2025.

Budget impact: Loss of $199 billion in tax revenue from 2017 to 2026.

Tax revenue lost, 2017–2026
Source: Congressional Budget Office
Cadillac Tax
House billCHANGE
House bill introduced  |  March 6, 2017

Obamacare imposes a tax on very generous health insurance benefits, which was delayed to 2020. The bill introduced further pushes the tax back to 2025.

House amendment  |  March 20, 2017

Delays the tax to 2026.

Senate billCHANGE
Senate bill introduced  |  June 22, 2017

Senate bill adopts changes in House bill.

Budget impact: Loss of $66 billion in tax revenue through 2026.

Tax revenue lost

$0B

–3

–6

–9

–12

–15

Source: Congressional Budget Office
Dependent Coverage
No proposed change to current law

The ACA requires health insurers to allow children to remain on their parents’ plans, up to age 26.

https://www.bloomberg.com/graphics/2017-healthcare-bill-changes/

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The Pronk Pops Show 914, June 19, 2017, Story 1: Otto Warmbier Died After Being Released From North Korea in A Coma — Videos — Story 2: Time For Strategic Patience Is Over — Take Out The Korean Dictator, Missiles, Nuclear Bomb Facilities, Artillery and Rocket Launchers In Range of South Korea — Regularly Planned and Scheduled War — Videos — Story 3: U.S. Navy F-18 Fighter Shoots Down Syrian SU -22 Fighter Over Raqqa, Syria After U.S. Allies On Ground Bombed– Russia Warns U.S. Planes Will Be Considered Targets — Videos — Story 4: Interventionist Foreign Policy of Progressive Democrats and Republicans (Neocons) Projecting Power of American Empire — No War Ever Declared Or American People Consulted — Videos

Posted on June 19, 2017. Filed under: American History, Blogroll, Breaking News, Communications, Congress, Constitutional Law, Countries, Crime, Culture, Defense Spending, Diet, Donald J. Trump, Donald J. Trump, Donald J. Trump, Donald Trump, Donald Trump, Education, Empires, Exercise, Food, Foreign Policy, Former President Barack Obama, Freedom of Speech, Government Spending, Health, Health Care, History, House of Representatives, Human, Human Behavior, Independence, Japan, Language, Law, Life, Lying, Media, Medicine, National Interest, News, North Korea, Obama, People, Philosophy, Photos, Politics, Polls, President Trump, Progressives, Raymond Thomas Pronk, Resources, Scandals, Security, Senate, Social Science, South Korea, Success, Taxation, Taxes, Terror, Terrorism, Unemployment, United States of America, Videos, War, Wealth, Wisdom | Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |

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Pronk Pops Show 883 April 28, 2017

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Story 1: Otto Warmbier Died After Being Released From North Korea in A Coma — Videos

GLOBALNEWS: North Korea Invites More Western Tourists To Visit Days After Sending One Home In A Coma

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Otto Warmbier has died, hospital says

CINCINNATI — Otto Warmbier has died, University of Cincinnati Medical Center announced Monday.

Warmbier died at 2:20 p.m. Monday, days after he was released from captivity in North Korea.

In a statement, family members said Warmbier had been unable to speak, see or react to verbal commands since his return to Cincinnati June 13.

“He looked very uncomfortable – almost anguished,” family members said. “Although we would never hear his voice again, within a day the countenance of his face changed – he was at peace. He was home and we believe he could sense that.”

Family members thanked the hospital’s staff for the care they provided Warmbier but said ” the awful torturous mistreatment our son received at the hands of the North Koreans ensured that no other outcome was possible beyond the sad one we experienced today.”

“It would be easy at a moment like this to focus on all that we lost – future time that won’t be spent with a warm, engaging, brilliant young man whose curiosity and enthusiasm for life knew no bounds,” the family said. “But we choose to focus on the time we were given to be with this remarkable person. You can tell from the outpouring of emotion from the communities that he touched – Wyoming, Ohio and the University of Virginia to name just two – that the love for Otto went well beyond his immediate family.”

Check back for more on this breaking story.

Sodium thiopental

From Wikipedia, the free encyclopedia
Sodium thiopental
Sodium thiopental.svg
Sodium-thiopental-3D-vdW-2.png
Clinical data
AHFS/Drugs.com Monograph
Routes of
administration
Intravenous (most common), oral or rectal
ATC code
Legal status
Legal status
Pharmacokinetic data
Biological half-life 5.5[1]-26 hours[2]
Identifiers
CAS Number
  • 71-73-8 Yes (sodium salt)
    76-75-5 (free acid)
PubChem CID
DrugBank
ChemSpider
UNII
KEGG
ChEBI
ChEMBL
ECHA InfoCard 100.000.896
Chemical and physical data
Formula C11H17N2NaO2S
Molar mass 264.32 g/mol
3D model (Jmol)
Chirality Racemic mixture
 Yes (what is this?)  (verify)

Sodium thiopental, also known as Sodium Pentothal (a trademark of Abbott Laboratories, not to be confused with pentobarbital), thiopental, thiopentone, or Trapanal (also a trademark), is a rapid-onset short-acting barbiturate general anesthetic that is an analogue of thiobarbital. Sodium thiopental was a core medicine in the World Health Organization‘s “Essential Drugs List“, which is a list of minimum medical needs for a basic healthcare system, but was supplanted by propofol.[3] It was previously the first of three drugs administered during most lethal injections in the United States, but the U.S. manufacturer Hospira stopped manufacturing the drug and the EU banned the export of the drug for this purpose.[4]

Uses

Anesthesia

Sodium thiopental is an ultra-short-acting barbiturate and has been used commonly in the induction phase of general anesthesia. Its use has been largely replaced with that of propofol, but retains popularity as an induction agent for rapid sequence intubation and in obstetrics.[citation needed] Following intravenous injection, the drug rapidly reaches the brain and causes unconsciousness within 30–45 seconds. At one minute, the drug attains a peak concentration of about 60% of the total dose in the brain. Thereafter, the drug distributes to the rest of the body, and in about 5–10 minutes the concentration is low enough in the brain that consciousness returns.[citation needed]

A normal dose of sodium thiopental (usually 4–6 mg/kg) given to a pregnant woman for operative delivery (caesarian section) rapidly makes her unconscious, but the baby in her uterus remains conscious. However, larger or repeated doses can depress the baby.[5]

Sodium thiopental is not used to maintain anesthesia in surgical procedures because, in infusion, it displays zero-order elimination kinetics, leading to a long period before consciousness is regained. Instead, anesthesia is usually maintained with an inhaled anesthetic (gas) agent. Inhaled anesthetics are eliminated relatively quickly, so that stopping the inhaled anesthetic will allow rapid return of consciousness. Sodium thiopental would have to be given in large amounts to maintain an anesthetic plane, and because of its 11.5- to 26-hour half-life, consciousness would take a long time to return.[6]

In veterinary medicine, sodium thiopental is used to induce anesthesia in animals. Since it is redistributed to fat, certain lean breeds of dogs such as sight hounds will have prolonged recoveries from sodium thiopental due to their lack of body fat and their lean body mass. Conversely, obese animals will have rapid recoveries, but it will be some time[vague] before it is entirely removed (metabolized) from their bodies. Sodium thiopental is always administered intravenously, as it can be fairly irritating; severe tissue necrosis and sloughing can occur if it is injected incorrectly into the tissue around a vein.[citation needed]

Sodium thiopental decreases the cardiac stroke volume, which results in a decrease in cardiac output. The decrease in cardiac output occurs in conjunction with a decrease in systemic vascular resistance, which results in hypotension. However, in comparison with propofol, the reflex tachycardia seen during states of hypotension is relatively spared (a bradycardia is common after administration of propofol) and therefore the observed fall in blood pressure is generally less severe.

Medically induced coma

In addition to anesthesia induction, sodium thiopental was historically used to induce medical comas.[7] It has now been superseded by drugs such as propofol because their effects wear off more quickly than thiopental. Patients with brain swelling, causing elevation of intracranial pressure, either secondary to trauma or following surgery, may benefit from this drug. Sodium thiopental, and the barbiturate class of drugs, decrease neuronal activity and therefore decrease the production of osmotically active metabolites, which in turn decreases swelling. Patients with significant swelling have improved outcomes following the induction of coma. Reportedly, thiopental has been shown to be superior to pentobarbital in reducing intracranial pressure.[8] This phenomenon is also called a reverse steal effect.[citation needed]

Status epilepticus

In refractory status epilepticus, thiopental may be used to terminate a seizure.

Euthanasia

Sodium thiopental is used intravenously for the purposes of euthanasia. In both Belgium and the Netherlands, where active euthanasia is allowed by law, the standard protocol recommends sodium thiopental as the ideal agent to induce coma, followed by pancuronium bromide.[9]

Intravenous administration is the most reliable and rapid way to accomplish euthanasia. A coma is first induced by intravenous administration of 20 mg/kg thiopental sodium (Nesdonal) in a small volume (10 ml physiological saline). Then, a triple dose of a non-depolarizing neuromuscular blocking drug is given, such as 20 mg pancuronium bromide (Pavulon) or 20 mg vecuronium bromide (Norcuron). The muscle relaxant should be given intravenously to ensure optimal availability but pancuronium bromide may be administered intramuscularly at an increased dosage level of 40 mg.[9]

Lethal injection

Along with pancuronium bromide and potassium chloride, thiopental is used in 34 states of the U.S. to execute prisoners by lethal injection. A very large dose is given to ensure rapid loss of consciousness. Although death usually occurs within ten minutes of the beginning of the injection process, some have been known to take longer.[10] The use of sodium thiopental in execution protocols was challenged in court after a study in the medical journal The Lancet reported autopsies of executed inmates showed the level of thiopental in their bloodstream was insufficient to cause unconsciousness.

On December 8, 2009, the State of Ohio became the first to use a single dose of sodium thiopental for its capital execution, following the failed use of the standard three-drug cocktail during a recent execution, due to inability to locate suitable veins. Kenneth Biros was executed using the single-drug method.[11]

The state of Washington is now the second state in the U.S. to use the single-dose sodium thiopental injections for death penalty executions. On September 10, 2010, Cal Coburn Brown was executed. This was the first execution in the state to use a single dose, single drug injection. His death was pronounced approximately one and a half minutes after the intravenous administration of five grams of the drug.[12]

After its use for execution of Jeffrey Landrigan in the U.S., the UK introduced a ban on the export of sodium thiopental in December 2010,[13] after it was established that no European supplies to the U.S. were being used for any other purpose.[14] The restrictions were based on “the European Union Torture Regulation (including licensing of drugs used in execution by lethal injection)”.[15] From 21 December 2011 the European Union extended trade restrictions to prevent the export of certain medicinal products for capital punishment, stating that “the Union disapproves of capital punishment in all circumstances and works towards its universal abolition”.[16]

Truth serum

Thiopental (Pentothal) is still used in some places as a truth serum to weaken the resolve of a subject and make them more compliant to pressure.[17] The barbiturates as a class decrease higher cortical brain functioning. Some psychiatrists hypothesize that because lying is more complex than telling the truth, suppression of the higher cortical functions may lead to the uncovering of the truth. The drug tends to make subjects loquacious and cooperative with interrogators; however, the reliability of confessions made under thiopental is questionable.[18] “Sodium pentathol” as a truth serum has become a trope in films, comics and literature, and even appears in popular music.[19]

Psychiatry

Psychiatrists have used thiopental to desensitize patients with phobias,[20] and to “facilitate the recall of painful repressed memories.”[21] One psychiatrist who worked with thiopental is the Dutch Professor Jan Bastiaans, who used this procedure to help relieve trauma in surviving victims of the Holocaust.[22]

Mechanism of action

Sodium thiopental is a member of the barbiturate class of drugs, which are relatively non-selective compounds that bind to an entire superfamily of ligand-gated ion channels, of which the GABAA receptor channel is one of several representatives. This superfamily of ion channels includes the neuronal nAChR channel, the 5HT3R channel, the GlyR channel and others. Surprisingly, while GABAA receptor currents are increased by barbiturates (and other general anesthetics), ligand-gated ion channels that are predominantly permeable for cationic ions are blocked by these compounds. For example, neuronal nAChR channels are blocked by clinically relevant anesthetic concentrations of both sodium thiopental and pentobarbital.[23] Such findings implicate (non-GABA-ergic) ligand-gated ion channels, e.g. the neuronal nAChR channel, in mediating some of the (side) effects of barbiturates.[24]The GABAA receptor is an inhibitory channel that decreases neuronal activity, and barbiturates enhance the inhibitory action of the GABAA receptor.[25]

Controversies

Following a shortage that led a court to delay an execution in California, a company spokesman for Hospira, the sole American manufacturer of the drug, objected to the use of thiopental in lethal injection. “Hospira manufactures this product because it improves or saves lives, and the company markets it solely for use as indicated on the product labeling. The drug is not indicated for capital punishment and Hospira does not support its use in this procedure.”[26] On January 21, 2011, the company announced that it would stop production of sodium thiopental from its plant in Italy because Italian authorities couldn’t guarantee that exported quantities of the drug would not be used in executions. Italy was the only viable place where the company could produce sodium thiopental, leaving the United States without a supplier.[27]

Metabolism

Thiopental rapidly and easily crosses the blood brain barrier as it is a lipophilic molecule. As with all lipid-soluble anaesthetic drugs, the short duration of action of sodium thiopental is due almost entirely to its redistribution away from central circulation towards muscle and fat tissue, due to its very high fat:water partition coefficient (aprx 10), leading to sequestration in fat tissue. Once redistributed, the free fraction in the blood is metabolized in the liver. Sodium thiopental is mainly metabolized to pentobarbital,[28] 5-ethyl-5-(1′-methyl-3′-hydroxybutyl)-2-thiobarbituric acid, and 5-ethyl-5-(1′-methyl-3′-carboxypropyl)-2-thiobarbituric acid.[29]

Dosage

The usual dose range for induction of anesthesia using thiopental is from 3 to 6 mg/kg; however, there are many factors that can alter this. Premedication with sedatives such as benzodiazepines or clonidine will reduce requirements, as do specific disease states and other patient factors. Among patient factors are: age, sex, and lean body mass. Specific disease conditions that can alter the dose requirements of thiopentone and for that matter any other intravenous anaesthetic are: hypovolemia, burns, azotemia, hepatic failure, hypoproteinemia, etc.[citation needed]

Side effects

As with nearly all anesthetic drugs, thiopental causes cardiovascular and respiratory depression resulting in hypotension, apnea and airway obstruction. For these reasons, only suitably trained medical personnel should give thiopental in an environment suitably equipped to deal with these effects. Side effects include headache, agitated emergence, prolonged somnolence, and nausea. Intravenous administration of sodium thiopental is followed instantly by an odor and/or taste sensation, sometimes described as being similar to rotting onions, or to garlic. The hangover from the side effects may last up to 36 hours.

Although individual molecules of thiopental contain one sulfur atom, it is not a sulfonamide, and does not show allergic reactions of sulfa/sulpha drugs.

Contraindications

Thiopental should be used with caution in cases of liver disease, Addison’s disease, myxedema, severe heart disease, severe hypotension, a severe breathing disorder, or a family history of porphyria.[30][31]

Co-administration of pentoxifylline and thiopental causes death by acute pulmonary edema in rats. This pulmonary edema was not mediated by cardiac failure or by pulmonary hypertension but was due to increased pulmonary vascular permeability.[32]

History

Sodium thiopental was discovered in the early 1930s by Ernest H. Volwiler and Donalee L. Tabern, working for Abbott Laboratories. It was first used in human beings on March 8, 1934, by Dr. Ralph M. Waters[33] in an investigation of its properties, which were short-term anesthesia and surprisingly little analgesia.[34] Three months later,[35] Dr. John S. Lundy started a clinical trial of thiopental at the Mayo Clinic at the request of Abbott.[36]Abbott continued to make the drug until 2004, when it spun off its hospital-products division as Hospira.

Thiopental is famously associated with a number of anesthetic deaths in victims of the attack on Pearl Harbor. These deaths, relatively soon after the drug’s introduction, were said to be due to excessive doses given to shocked trauma patients. However, recent evidence available through freedom of information legislation was reviewed in the British Journal of Anaesthesia,[37] which has suggested that this story was grossly exaggerated. Of the 344 wounded that were admitted to the Tripler Army Hospital only 13 did not survive and it is unlikely that thiopentone overdose was responsible for more than a few of these.

Thiopental is still rarely used as a recreational drug, usually stolen from veterinarians or other legitimate users of the drug; however, more common sedatives such as benzodiazepines are usually preferred as recreational drugs, and abuse of thiopental tends to be uncommon and opportunistic.[citation needed]

See also

https://en.wikipedia.org/wiki/Sodium_thiopental

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Story 3: U.S. Navy F-18 Fighter Shoots Down Syrian SU -22 Fighter Over Raqqa, Syria After U.S. Allies On Ground Bombed– Russia Warns U.S. Planes Will Be Considered Targets — Videos

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Russia Vows to Shoot Down Any Aircraft West of Euphrates River

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Russia to treat US jets in Syria as ‘targets’ after America guns down first regime warplane

Communication channel between Washington and Moscow to be suspended immediately

Russia has said it will treat US warplanes operating in parts of Syria where its air forces are also present as “targets” amid a diplomatic row caused by the downing of a Syrian jet.

The country’s defence ministry said it would track US-led coalition aircraft with missile systems and military aircraft, but stopped short of saying it would shoot them down.

A hotline set up between Russia and the US to prevent mid-air collisions will also be suspended.

“All kinds of airborne vehicles, including aircraft and UAVs of the international coalition detected to the west of the Euphrates River will be tracked by the Russian SAM systems as air targets,” the Russian Defence Ministry said in a statement.

The warning comes after a US F-18 Super Hornet shot down a Syrian army SU-22 jet on Sunday in the countryside southwest of Raqqa – the first such downing of a Syrian jet by the US since the start of the country’s civil war in 2011.

Washington said the jet had dropped bombs near US-backed forces but Damascus said the plane was downed while flying a mission against Isis militants.

Russia’s defence ministry said the suspension of its communication line with the Americans would begin immediately.

The US did not use its hotline with Russia ahead of the downing of the Syrian government warplane, said the ministry, which accused the US of a “deliberate failure to make good on its commitments” under the deconfliction deal.

“The shooting down of a Syrian Air Force jet in Syria’s airspace is a cynical violation of Syria’s sovereignty,” the ministry said.

“The US’ repeated combat operations under the guise of ‘combating terrorism’ against the legitimate armed forces of a UN member-country are a flagrant violation of international law and an actual military aggression against the Syrian Arab Republic.”

Theresa May appealed to Russia to continue the use of “deconfliction” measures over the skies of Syria to reduce the risk of misunderstandings in what is a crowded airspace.

Russia, which has been providing air cover for Syria’s President, Bashar al-Assad, since 2015, has an agreement with the US aimed at preventing incidents involving either country’s warplanes engaged in operations in Syria.

Downing the jet was akin to “helping the terrorists that the US is fighting against”, Sergei Ryabkov, Russia’s deputy foreign minister, said.

A statement released by US Central Command on Sunday said the Syrian jet was “immediately shot down… in accordance with rules of engagement and in collective self-defence of Coalition partnered forces”.

“The Coalition’s mission is to defeat Isis in Iraq and Syria. The Coalition does not seek to fight Syrian regime, Russian, or pro-regime forces partnered with them, but will not hesitate to defend Coalition or partner forces from any threat,” it added.

“The Coalition presence in Syria addresses the imminent threat Isis in Syria poses globally. The demonstrated hostile intent and actions of pro-regime forces toward Coalition and partner forces in Syria conducting legitimate counter-Isis operations will not be tolerated.”

Tensions rise in Syria as Russia, Iran send US warnings

By BASSEM MROUE and NATALIYA VASILYEVA, Associated PressTHE ASSOCIATED PRESS STATEMENT OF NEWS VALUES AND PRINCIPLES

(AP) — Russia on Monday threatened aircraft from the U.S.-led coalition in Syrian-controlled airspace and suspended a hotline intended to avoid collisions in retaliation for the U.S. military shooting down a Syrian warplane.

The U.S. said it had downed the Syrian jet a day earlier after it dropped bombs near the U.S.-backed Syrian Democratic Forces conducting operations against the Islamic State group, adding that was something it would not tolerate.

The downing of the warplane — the first time in the six-year conflict that the U.S. has shot down a Syrian jet — came amid another first: Iran fired several ballistic missiles Sunday night at IS positions in eastern Syria in what it said was a message to archrival Saudi Arabia and the United States.

The developments added to already-soaring regional tensions and reflect the intensifying rivalry among the major players in Syria’s civil war that could spiral out of control just as the fight against the Islamic State group in its stronghold of Raqqa is gaining ground.

Russia, a key ally of Syrian President Bashar Assad, called on the U.S. military to provide a full accounting as to why it decided to shoot down the Syrian Su-22 bomber.

The U.S. military confirmed that one of its F-18 Super Hornets shot down a Syrian jet that had dropped bombs near the U.S. partner forces SDF. Those forces, which are aligned with the U.S. in the campaign against the Islamic State group, warned Syrian government troops to stop their attacks or face retaliation.

The Russian Defense Ministry said in a statement that as of Monday, all coalition jets and drones flying west of the Euphrates River will be tracked as potential targets.

Areas of northern Syria west of the Euphrates were controlled by IS before Syrian government forces captured most of them in recent months. The Russians, who have been providing air cover for Assad’s forces since 2015, appear to want to avoid further U.S. targeting of Syrian warplanes or ground troops that have come under U.S. attack in eastern Syria recently.

It was the second time Russia suspended a hotline intended to minimize incidents with the U.S. in Syrian airspace. In April, Russia briefly suspended cooperation after the U.S. military fired 59 missiles at a Syrian air base following a chemical weapons attack that Washington blamed on the Assad government.

Gen. Joseph Dunford, chairman of the Joint Chiefs of Staff, said Washington is working to re-establish communications aimed at avoiding mishaps involving U.S. and Russian air operations in Syria.

Speaking in Washington, the top U.S. military officer said the two sides were in delicate discussions to lower tensions.

“The worst thing any of us could do right now is address this with hyperbole,” Dunford said.

Viktor Ozerov, chairman of the defense and security committee at the upper chamber of Russian parliament, described his Defense Ministry’s statement as a warning.

“I’m sure that because of this, neither the U.S. nor anyone else will take any actions to threaten our aircraft,” he told the state-owned RIA Novosti news agency. “That’s why there’s no threat of direct confrontation between Russia and American aircraft.”

Ozerov insisted that Russia will be tracking the coalition’s jets, not shooting them down, but he added that “a threat for those jets may appear only if they take action that pose a threat to Russian aircraft.”

Iran said the missile strike by its powerful Revolutionary Guard hit Syria’s eastern city of Deir el-Zour on Sunday night and was in retaliation for two attacks in Tehran earlier this month that killed 17 people and were claimed by the Islamic State group.

It appeared to be Iran’s first missile attack abroad in over 15 years and its first in the Syrian conflict, in which it has provided crucial support to Assad. The muscle-flexing comes amid the worsening of a long-running feud between Shiite powerhouse Iran and Saudi Arabia, with supports Syrian rebels and has led recent efforts to isolate the Gulf nation of Qatar.

“The Saudis and Americans are especially receivers of this message,” Gen. Ramazan Sharif of the Revolutionary Guard told Iranian state TV in an interview.

It also raised questions about how U.S. President Donald Trump’s administration, which had previously put Iran “on notice” for its ballistic missile tests, will respond. Israel also is concerned about Iran’s missiles and has deployed a multilayered missile-defense system.

The missile attack came amid recent confrontations in Syria between U.S.-backed forces and Iranian-backed pro-government factions. The U.S. recently deployed a truck-mounted missile system in Syria as Iranian-backed forces cut off the advance of the U.S.-supported rebels along the Iraqi border.

Iranian officials threatened more strikes. Former Guard chief Gen. Mohsen Rezai wrote on Twitter: “The bigger slap is yet to come.”

U.S.-backed opposition fighters said Assad’s forces have been attacking them in the northern province of Raqqa and warned that if such attacks continue, the fighters will take action.

Clashes between Syrian troops and the SDF would escalate tensions and open a new front line in the many complex battlefields of the civil war, now in its seventh year. Clashes between the Kurdish-led SDF and Syrian forces have been rare and some rebel groups have even accused them of coordinating on the battlefield.

Both sides are battling the Islamic State group, with SDF fighters focusing on their march into the northern city of Raqqa, which the extremist group has declared to be its capital.

Syrian government forces have also been attacking IS in northern, central and southern parts of the country, seizing 25,000 square kilometers (9,600 square miles) and reaching the Iraqi border for the first time in years.

SDF spokesman Talal Sillo said the government wants to thwart the SDF offensive to capture Raqqa. He said government forces began attacking the SDF on Saturday, using warplanes, artillery and tanks in areas that SDF had liberated from IS.

Sillo also warned that if “the regime continues in its offensive against our positions in Raqqa province, this will force us to retaliate with force.”

The Britain-based Syrian Observatory for Human Rights, which tracks Syria’s war, said government forces expanded their presence in Raqqa province by capturing from IS the town of Rasafa.

___

Vasilyeva reported from Moscow. Associated Press writers Nasser Karimi in Tehran and Jon Gambrell in Dubai, United Arab Emirates, contributed.

http://hosted2.ap.org/APDefault/*/Article_2017-06-19-Syria/id-371357b2c20e4aaa982d07da071a7f7a

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The Pronk Pops Show 912, June 15, 2017, Story 1: Part 2: Attorney General Sessions Questioned By Senators of Senate Intelligence Committee — Democratic Distractions and Delusions Concerning Collusion and Obstructions With No Evidence or Crime — Cover Story Conspiracy Theory Falling Apart – – Videos — Story 2: The Cover-up of The Real Crimes, Obstruction of Justice of Obama Administration. Hillary and Bill Clinton and Loretta Lynch — Time For Three More Special Prosecutors — Videos

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Story 1: Part 2: Attorney General Sessions Questioned By Senators of Senate Intelligence Committee — Democratic Distractions and Delusions Concerning Trump/Russian Collusion and Trump Obstruction With No Evidence or Crime — Cover Story Conspiracy Theory Fairy Tale Falling Apart – – Videos —

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Sessions calls suggestion he colluded with Russia a ‘detestable lie’

The attorney general also denies that he had a third undisclosed meeting with Russian ambassador Sergey Kislyak.

06/13/2017 03:07 PM EDT

Updated 06/13/2017 04:40 PM EDT

Attorney General Jeff Sessions on Tuesday forcefully denied he engaged in any collusion with Russian officials during the campaign, calling such a suggestion a “detestable lie,” while saying he did not recall having a third undisclosed meeting with Russian ambassador Sergey Kislyak.

“The suggestion that I participated in any collusion or that I was aware of any collusion with the Russian government to hurt this country, which I have served with honor for over 35 years, or to undermine the integrity of our democratic process, is an appalling and detestable lie,” Sessions said as he testified before the Senate Intelligence Committee.

Sessions also pushed back against the idea that he had more meetings with Kislyak, after having been forced to clarify remarks from his confirmation hearing in January that he did not have communications with Russian officials during the campaign. Two previous meetings with Kisylak surfaced earlier this year, but Sessions said on Tuesday he doesn’t remember any further encounters, including an allegation he met with Kislyak in April 2016 at the Mayflower Hotel, which hosted a foreign policy speech by Donald Trump.

“I did not have any private meetings nor do I recall any conversations with any Russian officials at the Mayflower Hotel,” Sessions said.

He later elaborated that a brief interaction with Kislyak may have occurred, noting that “I may have had an encounter during the reception” but that would’ve been the extent of any communication.

Sessions took his uncomfortable star turn in the same seat occupied by James Comey five days ago as the former FBI director pointedly accused Trump of lying about his dismissal.

Sessions has found himself at the center of the Russian controversy in recent days, particularly after Comey’s testimony that he’d asked Sessions to intervene after Trump initiated a series of contacts the FBI director viewed as improper.

The ex-FBI chief also suggested Sessions realized something inappropriate was afoot when Trump asked Comey to stay behind at an Oval Office meeting at February, while dismissing Sessions and others from the room.

“My sense was the attorney general knew he shouldn’t be leaving, which is why he was lingering,” Comey testified.

Comey also said that in the one-on-one meeting that followed, Trump asked that the FBI “let…go” of a probe into former National Security Adviser Mike Flynn. Trump has said he made no such request.

Sessions denied on Tuesday that he stayed silent when Comey urged him never to leave him alone again with Trump — testifying that he urged the FBI and Justice Department officials to follow proper protocol in their communications with the White House.

That directly counters Comey’s testimony from last week, when the ex-FBI chief said Sessions had no response when he told the attorney general that him being left alone with Trump was inappropriate and should not happen. A Justice Department spokesman rejected Comey’s account following the June 8 hearing.

“He didn’t recall this, but I responded to his comment by agreeing that the FBI and the Department of Justice needed to be careful to follow department policies regarding appropriate contacts with the White House,” Sessions testified.

Sessions did not say if he made any effort to stop Trump from contacting the FBI, such as intervening with the president directly or seeking to pass such a message through the White House counsel or other officials.

The attorney general’s closely-watched testimony came as Washington buzzed about suggestions from Trump allies that the president was considering firing the man tapped last month to take over the probe into alleged Russian interference in the 2016 election: special counsel Robert Mueller.

Sessions would not specifically talk about Mueller’s job performance, but said, “I have confidence in Mr. Mueller.”

The attorney general cited his recusal from the Russia probe as one of the reasons he could not elaborate on Mueller. In March, Sessions declared that because of his role in the Trump campaign he was recusing himself from all inquiries related to Russia’s alleged interference in the 2016 elections.

During his testimony on Tuesday, Sessions disclosed more details of the timeline of his recusal: One day after he was sworn in as attorney general on Feb. 9, Sessions had his first meeting to generally discuss the recusal matter. Several meetings followed, and “it became clear to me over time that I qualified as a significant principal adviser type person to the campaign and it would be appropriate and the right thing for me to recuse myself.”

His recusal from matters related to the presidential campaign, which Sessions said was essentially in place from his first day as attorney general, is apparently so broad that he has never been briefed on Russian hacking attempts last year.

“I never received any detailed briefing on how the hacking occurred,” Sessions testified, saying he had only gotten his information about Russian interference in the 2016 campaign through the news media.

Speaking to Sen. Angus King (I-Maine), Sessions added that “you might have been very critical if I, as an active part of the campaign, was seeking intelligence related to something that might be relevant to the campaign.”

Sessions also said Tuesday that he would not claim executive privilege as he testifies “because that is the president’s power.” But he added that he would abide by longstanding DOJ practice to shield his discussions with Trump.

“I cannot and will not violate my duty to protect confidential communications with the president,” he said.

Sessions refused to answer a pivotal question from Sen. Dianne Feinstein (D-Calif.): whether he discussed Comey’s handling of the investigations into the Trump campaign with the president prior to the FBI director’s dismissal.

“I’m not able to discuss with you or confirm or deny the nature of a private conversation that I may have had with the president on this subject or others. I know this will be discussed, but that’s the rules that have been adhered to by the Department of Justice,” Sessions said.

Asked to react to Trump’s public statement that he had the Russia probe on his mind at the time of the firing, the attorney general demurred.

“I will have to let his words speak for himself. I’m not sure what was in his mind specifically when we talked to him,” Sessions said.

As Sessions declined to answer a series of questions, Democrats bluntly accused him of undermining Congress’s effort to get to the truth. Sen. Ron Wyden of Oregon said the lack of responses amounted to stonewalling.

“I am not stonewalling. I am following the historic policies of the Department of Justice,” the attorney general declared.

“You’re impeding this investigation,” Sen. Martin Heinrich of New Mexico said. “You are obstructing that congressional investigation by not answering the questions.”

Sessions insisted that he was not invoking executive privilege, but preserving Trump’s right to do so.

“I’m not able to invoke executive privilege that’s the president’s prerogative,” the attorney general said.

Resolving a longstanding question, Sessions acknowledged publicly for the first time Tuesday that he gave Comey no warning before his firing on May 9.

“Did you ever have a conversation about his failure to perform?” Sen. Mark Warner, the ranking Democrat on the committee, asked.

“I did not,” Sessions said.

“You never thought it was appropriate to raise those concerns before he was actually terminated by the president?” Warner asked.

“I did not do so,” Sessions said, noting that Deputy Attorney General Rod Rosenstein prepared a memo critiquing Comey’s performance. “It’s something that we both agreed to that a fresh start at the FBI was probably the best.”

“The timing seems a little peculiar,” Warner said.

Democratic senators and Comey have suggested that Sessions should not have been involved in the firing of the FBI director, particularly since investigations Sessions was recused from appear to have played roles in spurring that decision.

Sessions flatly rejected those arguments on Tuesday.

“It is absurd, frankly, to suggest that a recusal from a single specific investigation would render an Attorney General unable to manage the leadership of the various Department of Justice law enforcement components that conduct thousands of investigations,” Sessions said.

The usually genial Alabaman showed outbursts of anger, including under questioning from Wyden when the Oregon Democrat pressed Sessions on what Comey found so “problematic” about the attorney general that he felt his recusal was inevitable.

“Why don’t you tell me?” Sessions responded to Wyden, his tone escalating. “There are none … this is a secret innuendo.”

Sessions also offered his first-hand account of the Feb. 14 Oval Office encounter that resulted in Comey being alone with Trump.

“We were there. I was standing there and without revealing any conversation that took place, what I do recall is I did depart. I believe everyone else did depart and Director Comey was sitting in front of the president’s desk and they were talking….That in itself is not problematic,” Sessions said.

The attorney general confirmed that the next day Comey complained about the contact.

“He did not tell me at that time any detail about anything that was said that was improper,” Sessions said, claiming he “backed [Comey] up in his concern” about improper contacts.

“He was concerned about it….His recollection of what he said about his concern is consistent with my recollection,” the attorney general added.

http://www.politico.com/story/2017/06/13/sessions-calls-suggestion-he-colluded-with-russia-a-detestable-lie-239507

 

Executive privilege

From Wikipedia, the free encyclopedia

In the United States government, executive privilege is the power claimed by the President of the United States and other members of the executive branch to resist certain subpoenas and other interventions by the legislative and judicial branches of government to access information and personnel relating to the executive branch. The concept of executive privilege is not mentioned explicitly in the United States Constitution, but the Supreme Court of the United States ruled it to be an element of the separation of powers doctrine and derived from the supremacy of the executive branch in its own area of Constitutional activity.[1]

The Supreme Court confirmed the legitimacy of this doctrine in United States v. Nixon, but only to the extent of confirming that there is a qualified privilege. Once invoked, a presumption of privilege is established, requiring the Prosecutor to make a “sufficient showing” that the “Presidential material” is “essential to the justice of the case” (418 U.S. at 713–14). Chief JusticeWarren Burger further stated that executive privilege would most effectively apply when the oversight of the executive would impair that branch’s national security concerns.

Historically, the uses of executive privilege underscore the untested nature of the doctrine, since Presidents have generally sidestepped open confrontations with the United States Congress and the courts over the issue by first asserting the privilege, then producing some of the documents requested on an assertedly voluntary basis.

Early precedents

Executive privilege is a specific instance of the more general common-law principle of deliberative process privilege and is believed to trace its roots to the English crown privilege (now known as public-interest immunity).[2]

In the context of privilege assertions by US presidents, “In 1796, President George Washington refused to comply with a request by the House of Representatives for documents related to the negotiation of the then-recently adopted Jay Treaty with the Kingdom of Great Britain. The Senate alone plays a role in the ratification of treaties, Washington reasoned, and therefore the House had no legitimate claim to the material. Therefore, Washington provided the documents to the Senate but not the House.”[3]

President Thomas Jefferson continued the precedent for this in the trial of Aaron Burr for treason in 1809. Burr asked the court to issue a subpoena duces tecum to compel Jefferson to testify or provide his private letters concerning Burr. Chief Justice John Marshall, a strong proponent of the powers of the federal government but also a political opponent of Jefferson, ruled that the Sixth Amendment to the Constitution, which allows for these sorts of court orders for criminal defendants, did not provide any exception for the president. As for Jefferson’s claim that disclosure of the document would imperil public safety, Marshall held that the court, not the president, would be the judge of that. Jefferson refused to personally testify but provided selected letters.

In 1833, President Andrew Jackson cited executive privilege when Senator Henry Clay demanded he produce documents concerning statements the president made to his cabinet about the removal of federal deposits from the Second Bank of the United States during the Bank War.[4]

Cold War era

During the period of 1947–49, several major security cases became known to Congress. There followed a series of investigations, culminating in the famous HissChambers case of 1948. At that point, the Truman Administration issued a sweeping secrecy order blocking congressional efforts from FBI and other executive data on security problems.[citation needed] Security files were moved to the White House and Administration officials were banned from testifying before Congress on security related matters. Investigation of the State Department and other cases was stymied and the matter left unresolved.

During the Army–McCarthy hearings in 1954, Eisenhower used the claim of executive privilege to forbid the “provision of any data about internal conversations, meetings, or written communication among staffers, with no exception to topics or people.” Department of Defense employees were also instructed not to testify on any such conversations or produce any such documents or reproductions.[5] This was done to refuse the McCarthy Committee subpoenas of transcripts of monitored telephone calls from Army officials, as well as information on meetings between Eisenhower officials relating to the hearings. This was done in the form of a letter from Eisenhower to the Department of Defense and an accompanying memo from Eisenhower Justice. The reasoning behind the order was that there was a need for “candid” exchanges among executive employees in giving “advice” to one another. In the end, Eisenhower would invoke the claim 44 times between 1955 and 1960.

United States v. Nixon

The Supreme Court addressed “executive privilege” in United States v. Nixon, the 1974 case involving the demand by Watergatespecial prosecutorArchibald Cox that President Richard Nixonproduce the audiotapes of conversations he and his colleagues had in the Oval Office of the White House in connection with criminal charges being brought against members of the Nixon Administration. Nixon invoked the privilege and refused to produce any records.

The Supreme Court did not reject the claim of privilege out of hand; it noted, in fact, “the valid need for protection of communications between high Government officials and those who advise and assist them in the performance of their manifold duties” and that “[h]uman experience teaches that those who expect public dissemination of their remarks may well temper candor with a concern for appearances and for their own interests to the detriment of the decisionmaking process.” This is very similar to the logic that the Court had used in establishing an “executive immunity” defense for high office-holders charged with violating citizens’ constitutional rights in the course of performing their duties. The Supreme Court stated: “To read the Article II powers of the President as providing an absolute privilege as against a subpoena essential to enforcement of criminal statutes on no more than a generalized claim of the public interest in confidentiality of nonmilitary and nondiplomatic discussions would upset the constitutional balance of ‘a workable government’ and gravely impair the role of the courts under Article III.” Because Nixon had asserted only a generalized need for confidentiality, the Court held that the larger public interest in obtaining the truth in the context of a criminal prosecution took precedence.

“Once executive privilege is asserted, coequal branches of the Government are set on a collision course. The Judiciary is forced into the difficult task of balancing the need for information in a judicial proceeding and the Executive’s Article II prerogatives. This inquiry places courts in the awkward position of evaluating the Executive’s claims of confidentiality and autonomy, and pushes to the fore difficult questions of separation of powers and checks and balances. These ‘occasion[s] for constitutional confrontation between the two branches’ are likely to be avoided whenever possible. United States v. Nixon, supra, at 692.”[6]

Post-Watergate era

Clinton administration

The Clinton administration invoked executive privilege on fourteen occasions.

In 1998, President Bill Clinton became the first president since Nixon to assert executive privilege and lose in court, when a federal judge ruled that Clinton aides could be called to testify in the Lewinsky scandal.[7]

Later, Clinton exercised a form of negotiated executive privilege when he agreed to testify before the grand jury called by Independent CounselKenneth Starr only after negotiating the terms under which he would appear. Declaring that “absolutely no one is above the law”, Starr said such a privilege “must give way” and evidence “must be turned over” to prosecutors if it is relevant to an investigation.

George W. Bush administration

The Bush administration invoked executive privilege on six occasions.

President George W. Bush first asserted executive privilege to deny disclosure of sought details regarding former Attorney General Janet Reno,[8] the scandal involving Federal Bureau of Investigation (FBI) misuse of organized-crime informants James J. Bulger and Stephen Flemmi in Boston, and Justice Department deliberations about President Bill Clinton’s fundraising tactics, in December 2001.[9]

Bush invoked executive privilege “in substance” in refusing to disclose the details of Vice PresidentDick Cheney‘s meetings with energy executives, which was not appealed by the GAO. In a separate Supreme Court decision in 2004, however, Justice Anthony Kennedy noted “Executive privilege is an extraordinary assertion of power ‘not to be lightly invoked.’ United States v. Reynolds, 345 U.S. 1, 7 (1953).

Further, on June 28, 2007, Bush invoked executive privilege in response to congressional subpoenas requesting documents from former presidential counsel Harriet Miers and former political director Sara Taylor,[10] citing that:

The reason for these distinctions rests upon a bedrock presidential prerogative: for the President to perform his constitutional duties, it is imperative that he receive candid and unfettered advice and that free and open discussions and deliberations occur among his advisors and between those advisors and others within and outside the Executive Branch.

On July 9, 2007, Bush again invoked executive privilege to block a congressional subpoena requiring the testimonies of Taylor and Miers. Furthermore, White House CounselFred F. Fielding refused to comply with a deadline set by the chairman of the Senate Judiciary Committee to explain its privilege claim, prove that the president personally invoked it, and provide logs of which documents were being withheld. On July 25, 2007, the House Judiciary Committee voted to cite Miers and White House Chief of StaffJoshua Bolten for contempt of Congress.[11][12]

On July 13, less than a week after claiming executive privilege for Miers and Taylor, Counsel Fielding effectively claimed the privilege once again, this time in relation to documents related to the 2004 death of Army RangerPat Tillman. In a letter to the House Committee on Oversight and Government Reform, Fielding claimed certain papers relating to discussion of the friendly-fire shooting “implicate Executive Branch confidentiality interests” and would therefore not be turned over to the committee.[13]

On August 1, 2007, Bush invoked the privilege for the fourth time in little over a month, this time rejecting a subpoena for Karl Rove. The subpoena would have required the President’s Senior Advisor to testify before the Senate Judiciary Committee in a probe over fired federal prosecutors. In a letter to Senate Judiciary Chairman Patrick Leahy, Fielding claimed that “Mr. Rove, as an immediate presidential advisor, is immune from compelled congressional testimony about matters that arose during his tenure and that relate to his official duties in that capacity….”[14]

Leahy claimed that President Bush was not involved with the employment terminations of U.S. attorneys. Furthermore, he asserted that the president’s executive privilege claims protecting Josh Bolten, and Karl Rove are illegal. The Senator demanded that Bolten, Rove, Sara Taylor, and J. Scott Jennings comply “immediately” with their subpoenas, presumably to await a further review of these matters. This development paved the way for a Senate panel vote on whether to advance the citations to the full Senate. “It is obvious that the reasons given for these firings were contrived as part of a cover-up and that the stonewalling by the White House is part and parcel of that same effort”, Leahy concluded about these incidents.[15][16][17][18]

As of July 17, 2008, Rove still claimed executive privilege to avoid a congressional subpoena. Rove’s lawyer wrote that his client is “constitutionally immune from compelled congressional testimony.”[19]

House Investigation of the SEC

Leaders of the U.S. Securities and Exchange Commission testified on February 4, 2009 before the United States House Committee on Financial Services subcommittee including Linda Chatman Thomsen S.E.C. enforcement director, acting General CounselAndy Vollmer, Andrew Donohue, Erik Sirri, and Lori Richards and Stephen Luparello of FINRA. The subject of the hearings were on why the SEC had failed to act when Harry Markopolos, a private fraud investigator from Boston alerted the Securities and Exchange Commission; detailing his persistent and unsuccessful efforts to get the SEC to investigate Bernard Madoff, beginning in 1999.[20] Vollmer claimed executive privilege in declining to answer some questions.[21][22] Subcommittee chairmanPaul E. Kanjorski asked Mr. Vollmer if he had obtained executive privilege from the U.S. Attorney General.[21] “No … this is the position of the agency,” said Vollmer.[21] “Did the SEC instruct him not to respond to questions?” Mr. Kanjorski asked.[21] Vollmer replied that it was the position of the Commission and that “the answer is no.”[21] The SEC announced Vollmer would “leave the Commission and return to the private sector,” just 14 days after making the claim.[23]

Obama Administration

On June 20, 2012, President Barack Obama asserted executive privilege, his first, to withhold certain Department of Justice documents related to the ongoing Operation Fast and Furious controversy ahead of a United States House Committee on Oversight and Government Reform vote to hold Attorney General Eric Holder in Contempt of Congress for refusing to produce the documents.[24][25]

Later the same day, the United States House Committee on Oversight and Government Reform voted 23–17 along party lines to hold Attorney General Holder in contempt of Congress over not releasing documents regarding Fast and Furious.[26]

Executive privilege was also used in a lawsuit stemming from the 2012 implementation of the “Net Worth Sweep” against Fannie Mae and Freddie Mac. The Obama administration did not disclose roughly 11,000 documents from the plaintiffs in the discovery process as they related to the reasoning behind the 2012 actions.[citation needed]

Trump Administration

While investigating Russian interference in the 2016 election, the Senate Intelligence Committee subpoenaed former FBI Director James Comey to testify. Comey was fired several weeks before being subpoenaed but had appeared before the committee once before in March while still serving as director. Less than a week before the scheduled hearing, it was reported that President Trump was considering invoking executive privilege to prevent Comey’s testimony. [27][28] According to attorney Page Pate, it seems unlikely that executive privilege will be applicable here, as Trump has publicly spoken about the encounters in question multiple times.[29]

Sarah Huckabee Sanders, a White house spokesman, released a statement on June 5th stating: “The president’s power to assert executive privilege is very well-established. However, in order to facilitate a swift and thorough examination of the facts sought by the Senate Intelligence Committee, President Trump will not assert executive privilege regarding James Comey’s scheduled testimony.”[30]

https://en.wikipedia.org/wiki/Executive_privilege

 

 

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Special counsel is investigating Trump for possible obstruction of justice, officials say

Special counsel investigating Trump for possible obstruction of justice
The special counsel overseeing the investigation into Russia’s role in the 2016 election is interviewing senior intelligence officials to determine whether President Trump attempted to obstruct justice, officials said. (Patrick Martin,McKenna Ewen/The Washington Post)
The special counsel overseeing the investigation into Russia’s role in the 2016 election is interviewing senior intelligence officials as part of a widening probe that now includes an examination of whether President Trump attempted to obstruct justice, officials said.The move by special counsel Robert S. Mueller III to investigate Trump’s conduct marks a major turning point in the nearly year-old FBI investigation, which until recently focused on Russian meddling during the presidential campaign and on whether there was any coordination between the Trump campaign and the Kremlin. Investigators have also been looking for any evidence of possible financial crimes among Trump associates, officials said.

Trump had received private assurances from then-FBI Director James B. Comey starting in January that he was not personally under investigation. Officials say that changed shortly after Comey’s firing.

Five people briefed on the interview requests, speaking on the condition of anonymity because they were not authorized to discuss the matter publicly, said that Daniel Coats, the current director of national intelligence, Mike Rogers, head of the National Security Agency, and Rogers’s recently departed deputy, Richard Ledgett, agreed to be interviewed by Mueller’s investigators as early as this week. The investigation has been cloaked in secrecy, and it is unclear how many others have been questioned by the FBI.

The NSA said in a statement that it will “fully cooperate with the special counsel” and declined to comment further. The office of the director of national intelligence and Ledgett declined to comment.

The White House now refers all questions about the Russia investigation to Trump’s personal attorney, Marc Kasowitz.

“The FBI leak of information regarding the president is outrageous, inexcusable and illegal,” said Mark Corallo, a spokesman for Kasowitz.

The officials said Coats, Rogers and Ledgett would appear voluntarily, though it remains unclear whether they will describe in full their conversations with Trump and other top officials or will be directed by the White House to invoke executive privilege. It is doubtful that the White House could ultimately use executive privilege to try to block them from speaking to Mueller’s investigators. Experts point out that the Supreme Court ruled during the Watergate scandal that officials cannot use privilege to withhold evidence in criminal prosecutions.

The obstruction-of-justice investigation of the president began days after Comey was fired on May 9, according to people familiar with the matter. Mueller’s office has taken up that work, and the preliminary interviews scheduled with intelligence officials indicate that his team is actively pursuing potential witnesses inside and outside the government.

The interviews suggest that Mueller sees the question of attempted obstruction of justice as more than just a “he said, he said” dispute between the president and the fired FBI director, an official said.

With the term whirling around Washington, a former federal prosecutor explains what to know about the criminal charge of obstruction of justice. (Jenny Starrs/The Washington Post)

Investigating Trump for possible crimes is a complicated affair, even if convincing evidence of a crime were found. The Justice Department has long held that it would not be appropriate to indict a sitting president. Instead, experts say, the onus would be on Congress to review any findings of criminal misconduct and then decide whether to initiate impeachment proceedings.

Comey confirmed publicly in congressional testimony on March 20 that the bureau was investigating possible coordination between the Trump campaign and the Russians.

Comey’s statement before the House Intelligence Committee upset Trump, who has repeatedly denied that any coordination with the Russians took place. Trump had wanted Comey to disclose publicly that he was not personally under investigation, but the FBI director refused to do so.

Soon after, Trump spoke to Coats and Rogers about the Russia investigation.

Officials said one of the exchanges of potential interest to Mueller took place on March 22, less than a week after Coats was confirmed by the Senate to serve as the nation’s top intelligence official.

Coats was attending a briefing at the White House with officials from several other government agencies. When the briefing ended, as The Washington Post previously reported, Trump asked everyone to leave the room except for Coats and CIA Director Mike Pompeo.

Coats told associates that Trump had asked him whether Coats could intervene with Comey to get the bureau to back off its focus on former national security adviser Michael Flynn in its Russia probe, according to officials. Coats later told lawmakers that he never felt pressured to intervene.

A day or two after the March 22 meeting, Trump telephoned Coats and Rogers to separately ask them to issue public statements denying the existence of any evidence of coordination between his campaign and the Russian government.

Coats and Rogers refused to comply with the president’s requests, officials said.

It is unclear whether Ledgett had direct contact with Trump or other top officials about the Russia probe, but he wrote an internal NSA memo documenting the president’s phone call with Rogers, according to officials.

As part of the probe, the special counsel has also gathered Comey’s written accounts of his conversations with Trump. The president has accused Comey of lying about those encounters.

Mueller is overseeing a host of investigations involving people who are or were in Trump’s orbit, people familiar with the probe said. The investigation is examining possible contacts with Russian operatives as well as any suspicious financial activity related to those individuals.

Last week, Comey told the Senate Intelligence Committee that he had informed Trump that there was no investigation of the president’s personal conduct, at least while he was leading the FBI.

Comey’s carefully worded comments, and those of Andrew McCabe, who took over as acting FBI director, suggested to some officials that an investigation of Trump for attempted obstruction may have been launched after Comey’s departure, particularly in light of Trump’s alleged statements regarding Flynn.

“I took it as a very disturbing thing, very concerning, but that’s a conclusion I’m sure the special counsel will work towards, to try and understand what the intention was there, and whether that’s an offense,” Comey testified last week.

Mueller has not publicly discussed his work, and a spokesman for the special counsel declined to comment.

Accounts by Comey and other officials of their conversations with the president could become central pieces of evidence if Mueller decides to pursue an obstruction case.

Investigators will also look for any statements the president may have made publicly and privately to people outside the government about his reasons for firing Comey and his concerns about the Russia probe and other related investigations, people familiar with the matter said.

Comey testified before the Senate Intelligence Committee last week that he was certain his firing was due to the president’s concerns about the Russia probe, rather than over his handling of a now-closed FBI investigation into Hillary Clinton’s use of a private email server as secretary of state, as the White House had initially asserted. “It’s my judgment that I was fired because of the Russia investigation,” Comey said. “I was fired, in some way, to change — or the endeavor was to change the way the Russia investigation was being conducted.”

The fired FBI director said ultimately it was up to Mueller to make a determination whether the president crossed a legal line.

In addition to describing his interactions with the president, Comey told the Intelligence Committee that while he was FBI director he told Trump on three occasions that he was not under investigation as part of a counterintelligence probe looking at Russian meddling in the election.

Republican lawmakers seized on Comey’s testimony to point out that Trump was not in the FBI’s crosshairs when Comey led the bureau.

After Comey’s testimony, in which he acknowledged telling Trump that he was not under investigation, Trump tweeted that he felt “total and complete vindication.” It is unclear whether McCabe, Comey’s successor, has informed Trump of the change in the scope of the probe.

https://www.washingtonpost.com/world/national-security/special-counsel-is-investigating-trump-for-possible-obstruction-of-justice/2017/06/14/9ce02506-5131-11e7-b064-828ba60fbb98_story.html?utm_term=.411010e1599f

 

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The Pronk Pops Show 906, June 7, 2017, Story 1: Will Congress Reauthorize Section 702 Foreign Intelligence Surveillance Act? Yes with changes to protect the privacy of American People. — How About Executive Order 12333 That Allow The President To Target Americans Without A Warrant — Unconstitutional and Illegal — Happens Every Day! — Oversight My Ass –Videos — Story 2: National Security Agency Under Obama Spied On American People —  Obama’s Abuse of Power — Huge Scandal Ignored By Big Lie Media — Videos — Story 3: President Trump To Nominate Christopher A. Wray For FBI Director — Videos

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The Pronk Pops Show Podcasts

Pronk Pops Show 906,  June 7, 2017

Pronk Pops Show 905,  June 6, 2017

Pronk Pops Show 904,  June 5, 2017

Pronk Pops Show 903,  June 1, 2017

Pronk Pops Show 902,  May 31, 2017

Pronk Pops Show 901,  May 30, 2017

Pronk Pops Show 900,  May 25, 2017

Pronk Pops Show 899,  May 24, 2017

Pronk Pops Show 898,  May 23, 2017

Pronk Pops Show 897,  May 22, 2017

Pronk Pops Show 896,  May 18, 2017

Pronk Pops Show 895,  May 17, 2017

Pronk Pops Show 894,  May 16, 2017

Pronk Pops Show 893,  May 15, 2017

Pronk Pops Show 892,  May 12, 2017

Pronk Pops Show 891,  May 11, 2017

Pronk Pops Show 890,  May 10, 2017

Pronk Pops Show 889,  May 9, 2017

Pronk Pops Show 888,  May 8, 2017

Pronk Pops Show 887,  May 5, 2017

Pronk Pops Show 886,  May 4, 2017

Pronk Pops Show 885,  May 3, 2017

Pronk Pops Show 884,  May 1, 2017

Pronk Pops Show 883 April 28, 2017

Pronk Pops Show 882: April 27, 2017

Pronk Pops Show 881: April 26, 2017

Pronk Pops Show 880: April 25, 2017

Pronk Pops Show 879: April 24, 2017

Pronk Pops Show 878: April 21, 2017

Pronk Pops Show 877: April 20, 2017

Pronk Pops Show 876: April 19, 2017

Pronk Pops Show 875: April 18, 2017

Pronk Pops Show 874: April 17, 2017

Pronk Pops Show 873: April 13, 2017

Pronk Pops Show 872: April 12, 2017

Pronk Pops Show 871: April 11, 2017

Pronk Pops Show 870: April 10, 2017

Pronk Pops Show 869: April 7, 2017

Pronk Pops Show 868: April 6, 2017

Pronk Pops Show 867: April 5, 2017

Pronk Pops Show 866: April 3, 2017

Pronk Pops Show 865: March 31, 2017

Pronk Pops Show 864: March 30, 2017

Pronk Pops Show 863: March 29, 2017

Pronk Pops Show 862: March 28, 2017

Pronk Pops Show 861: March 27, 2017

Pronk Pops Show 860: March 24, 2017

Pronk Pops Show 859: March 23, 2017

Pronk Pops Show 858: March 22, 2017

Pronk Pops Show 857: March 21, 2017

Pronk Pops Show 856: March 20, 2017

Pronk Pops Show 855: March 10, 2017

Pronk Pops Show 854: March 9, 2017

Pronk Pops Show 853: March 8, 2017

Pronk Pops Show 852: March 6, 2017

Pronk Pops Show 851: March 3, 2017

Pronk Pops Show 850: March 2, 2017

Pronk Pops Show 849: March 1, 2017

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Story 1: Will Congress Reauthorize Section 702 Foreign Intelligence Surveillance Act? Yes with changes to protect the privacy of American People — How About Executive Order 12333 That Allows The President To Target American Citizens Without A Warrant — Unconstitutional and Illegal — Happens Every Day! — Oversight My Ass –Videos

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FISA: 702 Collection

In 2008, Congress passed a set of updates to the Foreign Intelligence Surveillance Act (FISA), including Section 702 which authorized warrantless surveillance of non-U.S. persons reasonably believed to be outside the country. However, documents leaked by Edward Snowden revealed that 702 was being used far more heavily than many expected, serving as the legal basis for the collection of large quantities of telephone and Internet traffic  passing through the United States (and unlike 215, including content rather than just metadata). Still, as 702 only permits overseas collection, most criticism of the provision has come from abroad. But many domestic privacy advocates also worry that large amounts of American communication are being swept up “incidentally” and then used as well.

How the Senate hearing on surveillance turned into a Russia hearing

Blunt Questions National Security Officials Regarding Russia Investigation & FISA 6/7/17

FULL: Rosenstein, Intel Chiefs Testify at Senate Hearing on President Trump and Russia Investigation

Heinrich Questions Top Intelligence Officials In Senate Intel Committee Hearing

Senator Kamala Harris Grills Deputy AG Rosenstein On Whether He Has Given Mueller Full Independence

Trump Russia Collusion Investigation, Part 1 – Senate Intelligence Committee – FISA 6/7/2017

Trump Russia Collusion Investigation, Part 2 – Senate Intelligence Committee – FISA 6/7/2017

Trump Russia Collusion Investigation, Part 3 – Senate Intelligence Committee – FISA 6/7/2017

‘You Went Back on a Pledge!’ Dem. Senator Gets Nasty With DNI Chief Dan Coats

June 7, 2017: Sen. Cotton’s Q&A at Senate Intel Committee FISA Hearing

OPENING STATEMENT: Director of National Intelligence Dan Coats Testifies at Senate Intel Committee

Senate Russia Investigation: National security officials testify to intelligence committee on FISA

Rand Paul on Unmaskings: ‘We Can’t Live in Fear of Our Own Intelligence Community’

Rand Paul on Obama Illegally Spying on Americans | NSA Wiretapping

Section 702 of the FISA Amendments Act

FISA Hearing – Sec 702 Intel Surveillance – IMPORTANT

NSA Spying On Americans ‘Widespread’ – Let Sec. 702 Expire!

Bill Binney explodes the Russia witchhunt

Obama’s NSA conducted illegal searches on Americans for years: Report

NSA Whistleblower Bill Binney on Tucker Carlson 03.24.2017

NSA Whistleblower Bill Binney On 9/11

William Binney – The Government is Profiling You (The NSA is Spying on You)

NSA Whistleblower William Binney: The Future of FREEDOM

State of Surveillance: Police, Privacy and Technology

The Fourth Amendment Explained: US Government Review

Why We’re Losing Liberty

Sen. Rand Paul Defends the Fourth Amendment – February 11, 2014

Rand Paul Shames Homeland Security on Spying on Americans

Top Intel Community Officials Deny That Trump Pressured Them On Russia Probe

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CHUCK ROSS
Reporter

The directors of the Office of National Intelligence and the National Security Agency testified on Wednesday that they have not been pressured by President Trump on the ongoing Russia investigation, undercutting recent reports that they were.

Dan Coats, the director of national intelligence, and Adm. Mike Rogers, the director of NSA, largely declined to discuss details about their interactions with Trump when pressed on the matter during a Senate Intelligence Committee hearing.

According to news reports published last month, Trump asked both Coats and Rogers to rebut stories that Trump was under investigation as part of the Russia probe.

Both Coats and Rogers reportedly felt uncomfortable with the requests from Trump.

But when asked about those interactions on Wednesday, both declined to discuss their specific conversations with Trump while stating that they have never felt pressure from the White House.

“In the three-plus years that I have been the director of the National Security Agency, to the best of my recollection, I have never been directed to do anything that I believe to be illegal, immoral, unethical or inappropriate. And to the best of my collection … I do not recall ever feeling pressured to do so,” Rogers told Virginia Sen. Mark Warner, the vice chairman of the Senate panel.

“Did the president … ask you in any way, shape or form to back off or downplay the Russia investigation?” Warner asked.

Rogers said that he would not discuss specifics of conversations he had with Trump, but added: “I stand by the comment I just made, sir.”

Coats, a former Indiana senator who was appointed by Trump, also denied ever being pressured to downplay the Russia investigation or any other.

On Tuesday, The Washington Post reported that Coats told associates on March 22 that Trump asked him to intervene with former FBI Director James Comey to push back against the Russia investigation.

“In my time of service … I have never been pressured, I have never felt pressure, to intervene or interfere in any way, with shaping intelligence in a political way or in relationship to an ongoing investigation,” Coats testified Wednesday.

http://dailycaller.com/2017/06/07/top-intel-community-officials-deny-that-trump-pressured-them-on-russia-probe/

The Way the NSA Uses Section 702 is Deeply Troubling. Here’s Why.

MAY 7, 2014

This blog post was updated at 5:10 pm PST 5/8/14.

The most recent disclosure of classified NSA documents revealed that the British spy agency GCHQ sought unfettered access to NSA data collected under Section 702 of the FISA Amendments Act. Not only does this reveal that the two agencies have a far closer relationship than GCHQ would like to publicly admit, it also serves as a reminder that surveillance under Section 702 is a real problem that has barely been discussed, much less addressed, by Congress or the President.

In fact, the “manager’s amendment” to the USA FREEDOM Act, which passed unanimously out of the House Judiciary Committee, has weakened the minimal changes to Section 702 that USA FREEDOM originally offered. Although Representative Zoe Lofgren—who clearly understands the import of Section 702—offered several very good amendments that would have addressed these gaps, her amendments were all voted down. There’s still a chance though—as this bill moves through Congress it can be strengthened by amendments from the floor.

Section 702 has been used by the NSA to justify mass collection of phone calls and emails by collecting huge quantities of data directly from the physical infrastructure of communications providers. Here’s what you should know about the provision and why it needs to be addressed by Congress and the President:

  • Most of the discussion around the NSA has focused on the phone records surveillance program. Unlike that program, collection done under Section 702 capturescontent of communications. This could include content in emails, instant messages, Facebook messages, web browsing history, and more.
  • Even though it’s ostensibly used for foreign targets, Section 702 surveillance sweeps up the communications of Americans. The NSA has a twisted, and incredibly permissive, interpretation of targeting that includes communications about a target, even if the communicating parties are completely innocent. As John Oliver put it in his interview with former NSA General Keith Alexander: “No, the target is not the American people, but it seems that too often you miss the target and hit the person next to them going, ‘Whoa, him!'”
  • The NSA has confirmed that it is searching Section 702 data to access American’s communications without a warrant, in what is being called the “back door search loophole.”  In response to questions from Senator Ron Wyden, former NSA director General Keith Alexander admitted that the NSA specifically searches Section 702 data using “U.S. person identifiers,” for example email addresses associated with someone in the U.S.
  • The NSA has used Section 702 to justify programs in which the NSA can siphon off large portions of Internet traffic directly from the Internet backbone. These programs exploit the structure of the Internet, in which a significant amount of traffic from around the world flows through servers in the United States. In fact, through Section 702, the NSA has access to information stored by major Internet companies like Facebook and Google.
  • Section 702 is likely used for computer security operations. Director of National Intelligence James Clapper noted Section 702’s use to obtain communications “regarding potential cyber threats” and to prevent “hostile cyber activities.” Richard Ledgett, Deputy Director of NSA, noted the use of intelligence authorities to mitigate cyber attacks.
  • The FISA Court has little opportunity to review Section 702 collection. The court approves procedures for 702 collection for up to a year. This is not approval of specific targets, however; “court review [is] limited to ‘procedures’ for targeting and minimization rather than the actual seizure and searches.” This lack of judicial oversight is far beyond the parameters of criminal justice.
  • Not only does the FISA Court provide little oversight, Congress is largely in the dark about Section 702 collection as well. NSA spying defenders say that Congress has been briefed on these programs. But other members of Congress have repeatedly noted that it is incredibly difficult to get answers from the intelligence community, and that attending classified hearings means being unable to share any information obtained at such hearings. What’s more, as Senator Barbara Mikulski stated: “‘Fully briefed’ doesn’t mean that we know what’s going on.”  Without a full picture of Section 702 surveillance, Congress simply cannot provide oversight.
  • Section 702 is not just about keeping us safe from terrorism. It’s a distressingly powerful surveillance tool. While the justification we’ve heard repeatedly is that NSA surveillance is keeping us safer, data collected under Section 702 can be shared in a variety of circumstances, such as ordinary criminal investigations. For example, the NSA has shared intelligence with the Drug Enforcement Agency that has led to prosecutions for drug crimes, all while concealing the source of the data.
  • The President has largely ignored Section 702. While the phone records surveillance program has received significant attention from President Obama, in his speeches and his most recent proposal, Section 702 remains nearly untouched.
  • The way the NSA uses Section 702 is illegal and unconstitutional—and it violates international human rights law. Unlike searches done under a search warrant authorized by a judge, Section 702 has been used by the NSA to get broad FISA court authorization for general search and seizure of huge swathes of communications. The NSA says this is OK because Section 702 targets foreign citizens. The problem is, once constitutionally protected communications of Americans are swept up, the NSA says these communications are “fair game” for its use.
  • Innocent non-Americans don’t even get the limited and much abused protections the NSA promises for Americans. Under international human rights law to which the United States is a signatory, the United States must respect the rights of all persons. With so many people outside the United States keeping their data with American companies, and so much information being swept up through mass surveillance, that makes Section 702 the loophole for the NSA to violate the privacy rights of billions of Internet users worldwide.

The omission of Section 702 reform from the discourse around NSA surveillance is incredibly concerning, because this provision has been used to justify some of the most invasive NSA surveillance. That’s why EFF continues to push for real reform of NSA surveillance that includes an end to Section 702 collection. You can help by educating yourself and engaging your elected representatives. Print out our handy one-page explanation of Section 702. Contact your members of Congress today and tell them you want to see an end to all dragnet surveillance, not just bulk collection of phone records.

https://www.eff.org/deeplinks/2014/05/way-nsa-uses-section-702-deeply-troubling-heres-why

 

By ZACK WHITTAKER CBS NEWS June 30, 2014, 4:02 PM
Legal loopholes could allow wider NSA surveillance, researchers say
CBS NEWS

NEW YORK — Secret loopholes exist that could allow the National Security Agency to bypass Fourth Amendment protections to conduct massive domestic surveillance on U.S. citizens, according to leading academics.

The research paper released Monday by researchers at Harvard and Boston University details how the U.S. government could “conduct largely unrestrained surveillance on Americans by collecting their network traffic abroad,” despite constitutional protections against warrantless searches.

One of the paper’s authors, Axel Arnbak of Harvard University’s Berkman Center for Internet & Society, told CBS News that U.S. surveillance laws presume Internet traffic is non-American when it is collected from overseas.

“The loopholes in current surveillance laws and today’s Internet technology may leave American communications as vulnerable to surveillance, and as unprotected as the internet traffic of foreigners,” Arnbak said.

Although Americans are afforded constitutional protections against unwarranted searches of their emails, documents, social networking data, and other cloud-stored data while it’s stored or in-transit on U.S. soil, the researchers note these same protections do not exist when American data leaves the country.

Furthermore, they suggest that Internet traffic can be “deliberately manipulated” to push American data outside of the country. Although the researchers say they “do not intend to speculate” about whether any U.S. intelligence agencies are actually doing this, they say it could provide a loophole for vacuuming up vast amounts of U.S. citizen data for intelligence purposes, thus “circumventing constitutional and statutory safeguards seeking to protect the privacy of Americans,” they warned.

Play VIDEO
Snowden: NSA programs “uncontrolled and dangerous”
The academic paper lands just over a year since the Edward Snowden revelations first came to light, outlining the massive scope of U.S. government surveillance, under the justification of preventing terrorism. Although the classified programs that make up the NSA’s data acquisition arsenal have only recently been disclosed over the past year, the laws that govern them have been under close scrutiny for years. The paper only adds fuel to the fire of the intelligence agency’s alleged spying capabilities, which have been heavily criticized by civil liberties and privacy groups alike.

“The fix has to come from the law — the same laws that apply to Internet traffic collected domestically should also apply to traffic that is collected abroad,” the paper’s co-author, Sharon Goldberg of Boston University’s Computer Science Department, said.

While the researchers do not say whether these loopholes are being actively exploited — saying their aim is solely to broaden the understanding of the current legal framework — the current legislation as it stands “opens the door for unrestrained surveillance,” they write.

Since the September 11 terrorist attacks, the subsequent introduction of the Patriot Act allowed certain kinds of data to be collected to help in the fight against terrorism — so-called “metadata,” such as the time and date of phone calls and emails sent, including phone numbers and email addresses themselves. But the contents of those phone calls or emails require a warrant. The classified documents leaked by Edward Snowden showed that while the public laws have been in effect for years or even decades, the U.S. government has used secret and classified interpretations of these laws for wider intelligence gathering outside the statutes’ text.

The Obama administration previously said there had been Congressional and Judicial oversight of these surveillance laws — notably Section 215 of the Patriot Act, which authorized the collection of Americans’ phone records; and Section 702 of the Foreign Intelligence Surveillance Act (FISA), which authorized the controversial PRISM program to access non-U.S. residents’ emails, social networking, and cloud-stored data.

But the researchers behind this new study say that the lesser-known Executive Order (EO) 12333, which remains solely the domain of the Executive Branch — along with United States Signals Intelligence Directive (USSID) 18, designed to regulate the collection of American’s data from surveillance conducted on foreign soil — can be used as a legal basis for vast and near-unrestricted domestic surveillance on Americans.

The legal provisions offered under EO 12333, which the researchers say “explicitly allows for intentional targeting of U.S. persons” for surveillance purposes when FISA protections do not apply, was the basis of the authority that reportedly allowed the NSA to tap into the fiber cables that connected Google and Yahoo’s overseas to U.S. data centers.

An estimated 180 million user records, regardless of citizenship, were collected from Google and Yahoo data centers each month, according to the leaked documents. The program, known as Operation MUSCULAR, was authorized because the collection was carried out overseas and not on U.S. soil, the researchers say.

The paper also said surveillance can also be carried out across the wider Internet by routing network traffic overseas so it no longer falls within the protection of the Fourth Amendment.

However, an NSA spokesperson denied that either EO 12333 or USSID 18 “authorizes targeting of U.S. persons for electronic surveillance by routing their communications outside of the U.S.,” in an emailed statement to CBS News.

“Absent limited exception (for example, in an emergency), the Foreign Intelligence Surveillance Act requires that we get a court order to target any U.S. person anywhere in the world for electronic surveillance. In order to get such an order, we have to establish, to the satisfaction of a federal judge, probable cause to believe that the U.S. person is an agent of a foreign power,” the spokesperson said.

The report highlights a fundamental fact about Internet traffic: Data takes the quickest route possible rather than staying solely within a country’s borders. Data between two U.S. servers located within the U.S. can still sometimes be routed outside of the U.S.

Although this is normal, the researchers warn data can be deliberately routed abroad by manipulating the Internet’s core protocols — notably the Border Gateway Protocol (BGP), which determines how Internet traffic is routed between individual networks; and the Domain Name Service (DNS), which converts website addresses to numerical network addresses.

If the NSA took advantage of the loophole by pushing Internet traffic outside of the U.S., it would have enough time to capture the data while it is outside the reach of constitutional protection.

The researchers rebuffed the NSA’s statement in an email: “We argue that these loopholes exist when surveillance is conducted abroad and when the authorities don’t ‘intentionally target a U.S. person’. There are several situations in which you don’t ‘target a U.S. person’, but Internet traffic of many Americans can in fact be affected.”

“We cannot tell whether these loopholes are exploited on a large scale, but operation MUSCULAR seems to find its legal and technical basis in them.”

Mark M. Jaycox, a legislative analyst at the Electronic Frontier Foundation (EFF), said: “If you are intentionally spying on a U.S. person, the government must go to the FISA Court,” he said. “That’s the way the law is supposed to operate.”

Describing how the NSA says it never “intentionally collects” U.S. information, he warned the agency’s foreign data dragnet would inevitably include U.S. data.

“The NSA is an intelligence organization — it’s going to be targeting foreigners. But it’s the way that its targeting millions of foreigners, and millions of foreign communications that will eventually pick up U.S. persons’ data and information. And once that data has been collected, it must be destroyed.”

“It’s a question the NSA can’t reconcile, so they lean heavily on saying they never ‘intentionally collect’ the U.S. person information,” he said

A recent primer on EO 12333 written by the privacy group said the order “mandates rules for spying… on anyone within the United States.” The group also notes because the order remains inside the Executive Branch, the Obama administration could “repeal or modify” it at will.

The American Civil Liberties Union said in a post on its website that the U.S. government interprets USSID 18 to “permit it to sweep up Americans’ international communications without any court order and with little oversight.”

Patrick Toomey, staff attorney at the American Civil Liberties Union’s National Security Project, said: “Today, Americans’ communications increasingly travel the globe — and privacy protections must reliably follow. This academic paper raises key questions about whether our current legal regime meets that standard, or whether it allows the NSA to vacuum up Americans’ private data simply by moving its operations offshore.”

He added that there should be a uniform set of laws that protect Americans’ privacy regardless of where they are in the world, and that Congressional oversight of all rules governing surveillance is needed for comprehensive reforms.

The ACLU has also filed a Freedom of Information lawsuit with a federal court in New York, questioning “whether it [EO 12333] appropriately accommodates the constitutional rights of American citizens and residents whose communications are intercepted in the course of that surveillance.”

Although there is no direct evidence yet to suggest the NSA has exploited this loophole, network monitoring firm Renesys observed two “route hijacking” events in June and November 2013 that led Internet traffic to be redirected through Belarus and Iceland on separate occasions. These events are virtually unnoticeable to the ordinary Internet user, but the side effect is that U.S. data may be readable by foreign governments traveling through their country’s infrastructure. It also could allow the NSA to capture that data by treating it as foreign data.

These legal and technical loopholes can allow “largely unrestrained surveillance on Americans communications,” the researchers wrote.

The NSA, whose job it is to produce intelligence from overseas targets, said for the first time in August 2013 that it derives much of its “foundational authority” for its operations from EO 12333. Recent Snowden disclosures shed new light on understanding the capabilities of the executive order.

It was also recently revealed that Snowden himself questioned the legal authority of EO 12333, according to one declassified email exchange released by the Director of National Intelligence James Clapper.

According to John Schindler, a former NSA chief analyst, speaking to The Washington Post in October, the sole aim of the NSA’s “platoon” of lawyers’ is to figure out “how to stay within the law and maximize collection by exploiting every loophole.”

“It’s fair to say the rules are less restrictive under [EO] 12333 than they are under FISA,” he added.

FISA expanded the NSA’s powers allowing it to obtain foreign intelligence — including economic and political surveillance of foreign governments, companies, news outlets and citizens. But the amended law in 2008 also restricted what can be collected on U.S. citizens.

The so-called “targeting” and “minimization” procedures, which remain classified but were reported as a result of the Snowden leaks, were introduced to ensure any data inadvertently collected on U.S. citizens from overseas would not be used in investigations. These were later criticized following subsequent leaks which suggested the rules on collecting U.S. persons’ data were more relaxed than the statute led the public to believe.

U.S. intelligence agencies can only do so much with U.S. data, therefore they have a “strong incentive to conduct surveillance abroad,” the researchers say, because legal protections under the Fourth Amendment and FISA do not apply outside U.S. territory.

“Programs under EO 12333 may collect startling amounts of sensitive data on both foreigners and Americans,” the paper summarizes, “without any meaningful congressional or judiciary involvement.”

http://www.cbsnews.com/news/legal-loopholes-could-let-nsa-surveillance-circumvent-fourth-amendment-researchers-say/

 

FISA Authority and Blanket Surveillance: A Gatekeeper Without Opposition

Vol. 40 No. 3

The author is with ZwillGen PLLC in Washington, D.C.