Polls

The Pronk Pops Show 919, June 27, 2017, Part 1 — 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 27, 2017. Filed under: American History, Breaking News, Budgetary Policy, Communications, Countries, Defense Spending, Donald J. Trump, Donald J. Trump, Donald Trump, Economics, Education, Elections, Employment, Fiscal Policy, Freedom of Speech, Government, Government Dependency, Government Spending, Health, Health Care Insurance, History, Human, Labor Economics, Law, Life, Media, Medicare, Monetary Policy, News, People, Philosophy, Photos, Politics, Polls, President Barack Obama, President Trump, Pro Life, Progressives, Raymond Thomas Pronk, Regulation, Rule of Law, Scandals, Security, Social Security, Success, Tax Policy, Taxation, Taxes, Terror, Terrorism, Unemployment, United States Constitution, United States of America, Videos, Wealth, Wisdom | Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |

Project_1

The Pronk Pops Show Podcasts

Pronk Pops Show 919,  June 27, 2017

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 cartoons on repeal and replace of obamacare

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 1 — 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.

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

I won’t vote to keep ObamaCare: Rand Paul

What is President Trump’s role in the health care fight?

MARK LEVIN: Senate Health Care Bill Is 95% OBAMACARE

Conservative George Will MOCKS Donald Trump And Derives Republicans Over Hypocrisy On Trumpcare

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

Trump triumphs, CNN implodes, the Russian myth is destroyed and the Alt-Left Media haven’t a clue.

How Demented and Sick Our Republic Has Become By Design

‘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. 119 through 124 Stat. 1025(906 pages)
Legislative history
  • Introduced in the House as the “Service Members Home Ownership Tax Act of 2009” (H.R. 3590byCharles Rangel (DNYon September 17, 2009
  • Committee consideration by Ways 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 President Barack Obama on 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 President Barack 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 governmentsconservative advocacy 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” appropriations Consolidated 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 conservative The 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 Clinton proposed 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 leader Harry 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 Staff Rahm Emanuel argued that Democrats should scale back to a less ambitious bill; House Speaker Nancy 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 Democratic filibuster.”[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

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The Pronk Pops Show 918, June 26, 2017, Story 1: Supreme Court 9-0 Decision Backs President Trump’s Travel Ban With Temporary Stay But Allows Refugees With A “Bona Fide” Relationship With Legal U.S. Residents To Enter U. S. — Will Hear Case In The Fall whether or not the travel ban is constitutional — Videos — Story 2: Supreme Court Rules in 7-2 Decision State Funding For Religious School Can Use Taxpayer Funds For Playground — Videos — Story 3: American People Optimistic As Consumer Confidence Increases — Awaiting The Trump Tax Cut and Total Repeal Of Obamacare — Videos

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Story 1: Supreme Court 9-0 Decision Backs President Trump’s Travel Ban But Allows Refugees With A “Bona Fide” Relationship With Legal U.S. Residents To Enter U. S. — Will Hear Case In The Fall whether or not the travel ban is constitutional — Videos —

US Supreme Court allows part of Trump travel ban to go into effect – BBC News

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The Democrat Vitriol Boomerang! Pres Trump Stronger Than Ever!

Trump claims ‘clear victory’ after Supreme Court says his ‘Muslim’ travel ban can go into effect NOW against people without U.S. ties

  • Supreme Court justices will act on Trump’s travel ban in the fall, and allowed a major part of it to go into effect immediately
  • Refugees and others from six Muslim-majority countries who already have a ‘bona fide relationship’ with legal U.S. residents will be allowed to come
  • While the case is pending, the lower court’s injunction will apply only to those people who have no U.S. ties
  • Rumors also abound in Washington, DC that Supreme Court Justice Anthony Kennedy, 80, may announce his retirement on Monday
  • Trump and press secretary Sean Spicer both called the outcome a ‘9-0’ decision, although the court didn’t say how large a majority of the justices approved it

President Donald Trump took a victory lap on Monday after the Supreme Court restored most of his executive order banning incoming travel from six terror-prone countries.

‘Today’s unanimous Supreme Court decision is a clear victory for our national security,’ the president said in a statement shortly after the high court ruled. ‘It allows the travel suspension for the six terror-prone countries and the refugee suspension to become largely effective.’

The Supreme Court said it will decide in the fall whether or not the travel ban is constitutional. Liberal state attorneys general have argued that it amounts to a religious test for entry into the U.S. since the affected countries all have Muslim majorities.

The court said that while the wheels of justice turn, the Trump administration can enforce the executive order against anyone from those nations who doesn’t already have a ‘bona fide relationship’ with a U.S. citizen or legal resident.

The stopgap measure, announced Monday morning, is largely a victory for Trump, who will be allowed – at least temporarily – to stem the flow of immigrants and refugees from Iran, Libya, Somalia, Sudan, Syria and Yemen.

Trump has said he would put his ban into effect 72 hours after the Supreme Court gives him a green light.

Technically, the justices left a lower court injunction in place, but only for people whose cases mirror those of the original plaintiffs – meaning ‘foreign nationals who have a credible claim of a bona fide relationship with a person or entity in the United States.’

‘All other foreign nationals are subject to the provisions of [the executive order],’ the court ruled.

President Donald Trump won a major victory – at least for now – on Monday, as the Supreme Court allowed him to enforce most of his travel ban against people from six terror-prone and Muslim-majority countries

President Donald Trump won a major victory – at least for now – on Monday, as the Supreme Court allowed him to enforce most of his travel ban against people from six terror-prone and Muslim-majority countries

Supreme Court justices decided to limit the reach of a lower court’s injunction against Trump’s travel ban, allowing much of it to take affect – at least until the high court hears the case formally in the fall

There are rumors that Supreme Court Justice Anthony Kennedy, 80, could announce his retirement from the bench as soon as this week

There are rumors that Supreme Court Justice Anthony Kennedy, 80, could announce his retirement from the bench as soon as this week

Trump framed the decision as a win for national security, mirroring his claims that controlling travel entries is a vital anti-terror tool.

‘As President, I cannot allow people into our country who want to do us harm,’ he said Monday. ‘I want people who can love the United States and all of its citizens, and who will be hardworking and productive.’

‘My number one responsibility as Commander in Chief is to keep the American people safe. Today’s ruling allows me to use an important tool for protecting our Nation’s homeland.’

White House press secretary Sean Spicer told reporters in an off-camera news briefing that Trump was ‘honored’ by Monday’s result which ‘allowed him to use an important tool to protect our nation’s homeland.’

Like Trump, he referred to the outcome as a ‘9-0’ decision.

Asked how that can be accurate when the Supreme Court did not publish a list of how many justices approved, he said he would check with the White House counsel’s office for clarification.

‘We’ll probably have further guidance for you as it becomes available,’ Spicer said.

White House press secretary Sean Spicer defended the travel ban and the Supreme Court ruling, but punted on a question about why the president called it a 9-0 ruling

White House press secretary Sean Spicer defended the travel ban and the Supreme Court ruling, but punted on a question about why the president called it a 9-0 ruling

PRESIDENT TRUMP REACTS

‘Today’s unanimous Supreme Court decision is a clear victory for our national security. It allows the travel suspension for the six terror-prone countries and the refugee suspension to become largely effective.

‘As President, I cannot allow people into our country who want to do us harm. I want people who can love the United States and all of its citizens, and who will be hardworking and productive.

‘My number one responsibility as Commander in Chief is to keep the American people safe. Today’s ruling allows me to use an important tool for protecting our Nation’s homeland. I am also particularly gratified that the Supreme Court’s decision was 9-0.’

The media circus that usually accompanies a Supreme Court decision day was evident this morning in Washington outside the high court

The media circus that usually accompanies a Supreme Court decision day was evident this morning in Washington outside the high court

Trump insisted the decision to lift most of a lower court's 'stay' against his travel ban was a unanimous one, but the administration hasn't substantiated that claim

Trump insisted the decision to lift most of a lower court’s ‘stay’ against his travel ban was a unanimous one, but the administration hasn’t substantiated that claim

Democratic National Committee chairman Tom Perez lashed out at the administration for proposing the ban in the first place.

‘Donald Trump’s Muslim ban is an unconstitutional and un-American assault on our country’s foundation of religious freedom,’ Perez said in a statement.

‘As a nation, our diversity is our greatest strength, and we cannot allow such prejudice to shut the doors of progress. Democrats will continue to fight this hatred every step of the way.’

But Attorney General Jeff Sessions called the ruling ‘an important step towards restoring the separation of powers’ between the White House and the federal courts.

‘We have seen far too often in recent months that the threat to our national security is real and becoming increasingly dangerous,’ he added.

‘Groups like ISIS and al Qaeda seek to sow chaos and destruction in our country, and often operate from war-torn and failed countries while leading their global terror network. It is crucial that we properly vet those seeking to come to America from these locations, and failing to do so puts us all in danger.’

The administration has said the ban was needed to allow an internal review of the screening procedures for visa applicants from the six relevant countries.

That review should be complete before October 2, the first day the justices could hear arguments in their new term.

Trump launched a nationwide controversy by signing an executive order a week after his inauguration, barring the entry of refugees and other travelers from Iran, Iraq, Libya, Somalia, Sudan, Syria and Yemen; Iraq was removed from a second version that the high court will review

Trump launched a nationwide controversy by signing an executive order a week after his inauguration, barring the entry of refugees and other travelers from Iran, Iraq, Libya, Somalia, Sudan, Syria and Yemen; Iraq was removed from a second version that the high court will review

The Supreme Court could have a vacancy by the time that autumn session rolls around, if Justice Anthony decides to retire as some expect.

Kennedy did not use the occasion of Monday’s scheduled high court announcements to say he would be stepping down.

But if he does, President Donald Trump will have a second pick in the first months of his administration. Kennedy’s departure could also allow conservatives to take firm control of the court.

Kennedy turns 81 next month and has been on the court for nearly 30 years. Several of his former law clerks have said they think he is contemplating stepping down in the next year or so.

Washington was abuzz with talk this weekend that President Donald Trump may soon have another chance to nominate a judge to the highest court in the land.

If the speculation pans out, that would give Trump his second high court pick in the first months of his administration.

The famed 'running of the interns' was a familiar sight on Monday as young staffers to news agencies hurried to bring written case decisions to their reporters and producers

The famed ‘running of the interns’ was a familiar sight on Monday as young staffers to news agencies hurried to bring written case decisions to their reporters and producers

 President Trump’s travel ban will head to the Supreme Court

Kennedy did not address the retirement rumors when he and his clerks gathered over the weekend for a reunion, according to three clerks who were there. The decision to push up the reunion by a year helped spark talk he might be leaving the court.

Kellyanne Conway, senior counselor to President Trump, declined Monday to join in on the conjecture.

‘That is totally Justice Kennedy’s decision and he has served for 30 years, almost 30 years, with distinction and care on the Court and that is entirely his decision,’ she said on Fox & Friends.

‘I do know that the president, when he appointed Neil Gorsuch, made very clear that at any time that he gets a federal appointment, whether it’s the Supreme Court level of the District courts the circuit courts, he will appoint people who have fidelity to the Constitution, they won’t legislate from the bench, make it up as they go along.’

Conway had declined to say in a Sunday interview whether the president and Kennedy had discussed retirement.

‘I will never reveal a conversation between a sitting justice and the president or the White House, but we’re paying very close attention to these last bit of decisions,’ she said on ABC News.

The original travel ban executive order triggered worldwide outrage as well as protests (above) in the United States like this one at New York City’s John F. Kennedy International Airport

In 2015, Kennedy wrote the majority opinion in Obergefell v. Hodges, the landmark case legalizing same sex marriage be made legal nationwide. Madeleine Troupe of Houston, Texas, wipes tears of joy after the Supreme Court legalized same sex marriage on June 26, 2015

In 2015, Kennedy wrote the majority opinion in Obergefell v. Hodges, the landmark case legalizing same sex marriage be made legal nationwide. Madeleine Troupe of Houston, Texas, wipes tears of joy after the Supreme Court legalized same sex marriage on June 26, 2015

If Kennedy does retire, that means President Donald Trump would be able to nominate a second justice to the bench. Trump is seen above during the swearing-in of his first nominee, Neil Gorsuch, at the White House on April 10, 2017

Justice Kennedy, who is known as a moderate Republican, was nominated by then-President Ronald Reagan in 1987.

Since Sandra Day O’Connor retired in 2006, Kennedy has been the key swing vote on a number of 5-4 decisions.

In 2015, Kennedy wrote the majority opinion in Obergefell v. Hodges, the landmark case whose ruling mandated that same sex marriage be made legal nationwide.

The concluding paragraph of Kennedy’s 28-page majority opinion was even used by many same sex and heterosexual couples alike as their wedding vows.

‘No union is more profound than marriage,’ Kennedy’s opinion says, ‘for it embodies the highest ideals of love, fidelity, devotion, sacrifice and family. In forming a marital union, two people become something greater than once they were.’

Several of his former law clerks have said they think he is contemplating stepping down in the next year or so.

Kennedy and his clerks were gathering over the weekend for a reunion that was pushed up a year and helped spark talk he might be leaving the court.

‘Soon we’ll know if rumors of Kennedy’s retirement are accurate,’ one former Kennedy clerk, George Washington University law professor Orin Kerr, said on Twitter Friday.

http://www.dailymail.co.uk/news/article-4640028/Supreme-Court-act-travel-ban-Kennedy-retire.html#ixzz4l9IuSa5T

Story 2: Supreme Court Rules in 7-2 Decision State Funding For Religious School Can Use Taxpayer Funds For Playground — Videos

 

U.S. Supreme Court Rules In Religious Rights Case

Supreme Court Rules Religious School Can Use Taxpayer Funds For Playground

The Supreme Court’s big announcements on religion

 

Story 3: American People Optimistic As Consumer Confidence Increases — Awaiting The Trump Tax Cut and Total Repeal Of Obamacare — Videos

Image result for  cartoons trumpcare

Good Question: How Is Consumer Confidence Measured?

Consumer Confidence Numbers Fall; No Reason To Worry, Still A Good Number

Declining oil prices good for the U.S. economy?

Oil price will see ‘further softness’ before rising through to the end of 2017 | IG

Surprise! Trumps Healthcare is Effectively Obamacare Lite. Conservative Critics Slam Plan

Shields and Brooks on the Senate health care bill unveiled, Trump’s tape clarification

CBO score: 22 million more uninsured under Senate health bill

Rand Paul on the Senate health care bill: Republicans ‘promised too much’ that they ‘can’t provide’

Sen. Rand Paul: We shouldn’t try to fix government intervention with more intervention. – 6/22/17

Fox host shreds Katrina Pierson for attacking anti-Trumpcare GOP senator

Secretary Price Applauds Senate Proposal to Repeal and Replace Obamacare

GOP health care bill will ruin the Republican Party: Ann Coulter

New MSNBC Host Begs Republican To Pass Trumpcare NOW

LYING republican senator gets DEBUNKED on Health care by Democrats 6/22/2017

America’s rising consumer confidence mostly due to the elderly and less-educated

After more than a decade of disappointment, American consumers are now more hopeful than at any point since the housing bubble:

Those who think surveys of expectations have predictive power for spending and saving might therefore conclude the uptick bodes well for America’s growth outlook. However, a closer look at who exactly is excited about the future suggests there is less here than meets the eye.

Deutsche Bank’s Torsten Slok points out that the improvement in expectations is entirely due to Americans without a college degree, rather than those with greater spending power and higher earning potential. Americans with degrees have been getting steadily less optimistic since mid-2015:

Americans without degrees are as optimistic now as they’ve ever been since the survey began nearly four decades ago. Only the peak of the tech bubble compares. By contrast, Americans with degrees are about as confident in the future as they were in September 2007, when the credit crisis had already begun:

The shift since the election looks even starker if you look at the gap in expectations across the two groups over time. The change since November 2016 is unprecedented:

Slightly less dramatic, but nevertheless revealing, is the change in expectations among younger people, who have their most productive years ahead of them, relative to older people, who do not.

Since the start of 2015, the outlook among the young has deteriorated sharply, albeit from a high base. Meanwhile, the expectations of Americans ages 55 and older have soared in the wake of the election to their highest level in more than fifteen years:

(Those in the prime of their working and spending years have had essentially unchanged expectations since the end of 2014.)

It’s less clear what these changes in “expectations” mean for what people will actually do, however. Consumers across the age and education distribution haven’t changed their views since the election when asked whether it’s a good or bad time to buy big-ticket items such as furniture, televisions, appliances, or cars:

By contrast, Americans seem less inclined to think “now is a good time to buy a house”. This was true across all education groups, although it is particularly severe among those who never made it past high school:

(Americans with better education seem to have appreciated that the best time to buy was when prices bottomed in 2012, and that buying has become steadily less attractive as mortgage rates and house prices have both increased.)

Americans over 35 have had more stable views on the housing market than the young. Those under 35 have become far more pessimistic about housing since 2015:

To recap:

The groups responsible for the aggregate change in sentiment are the least likely to experience big real wage increases and therefore the least likely to boost their spending. Moreover, they appear unwilling to translate their vague optimism about the future into specific expectations about behaviour.

So even if those expectations were reliable guides to the actual choices people make — something strongly debated among forecasters — there is little reason to believe the “Trump bump” in consumer sentiment is a harbinger for sharply rising real spending.

Related links:
NY Fed research implies small business expectations are mostly worthless — FT Alphaville
Global surveys or hard data – which are the fake news? — Gavyn Davies

https://ftalphaville.ft.com/2017/05/02/2188069/americas-rising-consumer-confidence-mostly-due-to-the-elderly-and-less-educated/?mhq5j=e1

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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

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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

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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

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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

Listen To Pronk Pops Podcast or Download Shows 759-768

Listen To Pronk Pops Podcast or Download Shows 751-758

Listen To Pronk Pops Podcast or Download Shows 745-750

Listen To Pronk Pops Podcast or Download Shows 738-744

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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Image result for branco CARTOONS senate draft bill does not repeal obaMACAREImage result for CARTOONS senate draft bill does not repeal obaMACARE

 

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

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“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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Senators Debate GOP Health Care Plan

GOP health care plan faces opposition

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Senate health care bill to be released today

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I’ve covered Obamacare since day one. I’ve never seen lying and obstruction like this.

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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/

The C, D, and F Rollover Republicans Want To Keep Obamacare Subsidies

This Is Not Repeal But Extending Obamacare

 

Conservative Review Scorecard of Senators

https://www.conservativereview.com/scorecard?chamber=senate&state=&party=R

 

 

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 Parties — Videos

 

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The Pronk Pops Show 915, June 20, 2017, Story 1: Will Congress Celebrate Independence Day July 4 By Passing Tax Reform And Repealing Obamacare? — Videos — Story 2: President Trump Flip Flopping On Immigration Law Enforcement By Not Terminating DACA Now! — Failing To Rollback The 30-60 Million Illegal Alien Invasion of The United States By Deporting Them All — Must Go After Employers Hiring Illegal Aliens — Videos — Story 3: More Mueller Milking The American Taxpayers Hires More Lawyers — Trump Should Fire Them All Now — Enough Is Enough — Videos

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The Pronk Pops Show Podcasts

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: Will Congress Celebrate Independence Day July 4 By Passing Tax Reform And Repealing Obamacare? — Videos —

Image result for trump tax reform

Image result for trump tax reformImage result for branco cartoons trump on DAPA and DACAImage result for branco cartoons trump tax reform

Image result for the fairtaxImage result for the fairtax

Story 2: President Trump Flip Flopping On Immigration Law Enforcement DACA (Dreamers) Still Exists — Failing To Rollback The 30-60 Million Illegal Alien Invasion of The United States — Must Go After Employers Hiring Illegal Aliens — Videos

Where’s That Senate Healthcare Bill? Senator John Thune Tells Us!

Will Republicans unite to pass health care and tax reform?

Ryan: ‘We’re going to cut taxes’

Treasury Secretary Steven Mnuchin On Tax Reform, Debt | CNBC

Ron Paul on Paul Ryan’s tax reform plan

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Tax reform coming this year – Paul Ryan

Trump ‘much closer’ on tax reform: Tony Sayegh

Can GOP-led Congress pass health care and tax reform?

Trump’s tax reform plan unveiled by Treasury Sec’y Steve Mnuchin, National Economic Dir. Gary Cohn

George Stephanopoulos GRILLS Treasury Secretary Steven Mnuchin on Trump’s Tax Plan

Senate tight on time to pass health care bill

Gingrich talks Trump’s plan to focus on tax reform

What is the FairTax legislation?

FAIRtax-What is It? Replaces income tax and payroll tax with sales tax

Pence on the Fair Tax

Freedom from the IRS! – FairTax Explained in Detail

FairTax: Fire Up Our Economic Engine (Official HD)

Sen. Moran Discusses FairTax Legislation on U.S. Senate Floor

Sen. Moran Speaks on Senate Floor about Finding Healthcare Solutions

Health care vote possible by July 4, McConnell tells Trump

Story highlights

  • Republicans met Tuesday to discuss health care legislation
  • Disagreements in the party have led a host of senators to declare the legislation is in trouble

Washington (CNN)The Senate may vote on health care legislation by July 4, Senate Majority Leader Mitch McConnell told President Donald Trump Tuesday afternoon at a White House meeting with congressional leaders.

McConnell said he expects the Congressional Budget Office will soon score the Senate’s version of the bill, which continues to be negotiated behind closed doors among Republicans, a source with direct knowledge of what was discussed at the meeting told CNN.
He did not set a firm deadline for the vote, but Republicans are impatient with the lack of progress and political quicksand the bill is creating and want the Senate to either act quickly on health care or move on to other business.
“We had a good, productive meeting with President Trump, Vice President Pence, and congressional leadership,” McConnell and House Speaker Paul Ryan said in a joint statement after the meeting. “The discussion focused on the continued progress of our shared legislative agenda and how we can accomplish our goals.”
After weeks of discussions about how to move forward in a small working group, Republican senators were briefed at a lunch Tuesday on what their options are to repeal and replace Obamacare and warned that the time is quickly approaching for decisions to finally be made.
“The time is now,” a Senate aide involved in discussions said. “We either go or we don’t.”
The aide said this is the natural point the chamber was bound to get to. The working group has spent several weeks tossing around ideas, but with conservatives and moderates still starkly divided on the best way to proceed, it’s time for leadership to make the call.
According to Senate aides, during the meeting leadership tried to make it clear that lawmakers need to show their cards and decide if they are going to get behind repealing Obamacare — a campaign promise that ultimately launched them to win back the majority in the House and the Senate in recent years.
“Leadership is stepping in now and making clear that this is what they all campaigned on, so they need to go now or move on,” the aide said.
Senators are clearly impatient.
Sen. Lindsey Graham, a Republican from South Carolina, asked if there would be a vote on the health care bill by July 4 said “there better be.”
“‘Cause this is not like fine wine, it doesn’t get better with age,” he added with a laugh.
“We’re at decision time,” a congressional aide close to the health care conversation said. “Decisions have to start being made in order to get the package ready.”
During their lunch Tuesday, Republicans were presented with a PowerPoint and a menu of options to overhaul Obamacare. But lawmakers emerging from the room were tight-lipped about what exactly is on the table. Key questions remain about how the GOP will phase out Medicaid expansion as well as how they will structure tax credits to help Americans purchase their health insurance under a Republican health care plan.
Sen. Dean Heller, a Republican from Nevada who is up for re-election in 2018, said he was still looking at the proposals and what he could support.
“The big print giveth. The small print taketh away. I’m waiting for the small print at this point,” Heller said.
“I’m not going to go into details. There’s been a lot of work done and we see where we go from here,” said moderate Maine Republican Sen. Susan Collins.
Sen. Rob Portman, an Ohio Republican who has been a fierce advocate of more slowly phasing out Medicaid expansion than the House’s repeal bill did, said the health care bill “needs some work still for me.”

Sticking points: Medicaid, tax credits

Most members wouldn’t get into details about what actually is on the table, but they were honest that there are still sticking points here that have to be resolved.
“They laid out the goals and then different ideas on how we achieve them and we are working on how to build consensus to get to the right mix on 50-plus votes,” said North Dakota Sen. John Hoeven.
Lawmakers remain split over what to do about Medicaid. The House bill would eliminate enhanced federal funding for Medicaid expansion in 2020 and curtail support for the program overall. Moderates like Portman have advocated to phase out funding to cover low-income adults under Medicaid expansion more gradually. Conservatives like Pennsylvania’s Pat Toomey want to shrink federal responsibility for the overall program even more that the House bill does by restructuring the growth rate for Medicaid funding.
The House plan would give states a set amount of money each year to cover their Medicaid enrollees. The funding level would increase annually based on the medical inflation rate in the Consumer Price Index, which grows more quickly than the standard inflation rate. Toomey argues that using the growth rate of medical care spending would lead to an unsustainable Medicaid program, so he advocates for tying Medicaid funding increases to the standard inflation rate instead.
Other options that are on the table include how to structure tax credits. Unlike the House’s health care repeal bill, which based the tax credits mainly on age, Senate Republicans have suggested tying them to income and even geographic location in order to make health care more affordable for low-income individuals living in areas that have expensive health care costs such as Alaska and rural America.
“There should be,” Republican Sen. Lisa Murkowski told reporters. “Alaska is an extreme outlier and part of it is just our geography, it’s our low-density population so if there is not some kind of geographic cost adjustor it makes it tough for me.”
However, adjusting the tax credits for income and geographic location would make them even more similar to Obamacare’s premium subsidies, which are tax credits based on income and cost of coverage in one’s area. Conservatives are sure to oppose this idea. Several, including Sen. Rand Paul of Kentucky, have said the House GOP tax credits already are too much like Obamacare’s subsidies.

Freedom Caucus crafting tax reform plan

05/04/2017 05:21 PM EDT

Updated 05/04/2017 08:08 PM EDT

The caucus, which roiled the Republican effort to repeal and replace Obamacare, would be parachuting in to what promises to be another pitched battle over the Republicans’ next marquee issue. Though it doesn’t have an official line yet on tax reform, members appear to be more aligned with the Trump administration than House Republican leaders on how deep tax cuts should be, if they need to be offset and whether to include a controversial import tax.

Mark Sanford, a caucus member from South Carolina, told POLITICO he is already identifying areas of disagreement with the House leaders’ tax plan. The health care bill that passed Thursday proved better for conservatives, Sanford said, so they’re aiming to have greater influence on the tax reform process from the beginning.

“Rather than react, then stop something, and then go in fits and starts forward, we can constructively engage at the front end and say this is more of what we believe,” he said. “Let’s … avoid the kind of dislocation that we saw in this particular [health care] bill about a month ago.”

The principles outlined recently by President Donald Trump pulled the Freedom Caucus off the sidelines, Mark Meadows (R-N.C.), its leader, said.

“We’re looking at President Trump’s tax reform plan to see how we can maybe put some legislative text to that to come alongside the administration,” Meadows said, “and hopefully agree more than we disagree and move what he proposed in those bullet points the other day. We’ve got guys working on that.”

“I think we’re going to try to have a lot of different ideas and hopefully we can have our input with Ways and Means,” he said, referring to the House tax-writing committee.

The group isn’t ready to roll out paper just yet.

Freedom Caucus members are awaiting a budget plan and reconciliation instructions, a budget tactic that will allow Republicans to circumvent a Democratic filibuster in the Senate, said Jim Jordan (R-Ohio), and then they’ll settle more details on a tax bill.

Already, though, there are signs that the caucus will nudge tax reform in Trump’s direction.

Trump has proposed a much lower business tax rate – 15 percent across-the-board – than House Republican leaders, and Meadows has said lower taxes are paramount. (Trump and the GOP leaders are closer on proposed rate cuts for individuals.)

Jordan would prefer that the Freedom Caucus plan not include the “border adjustment” import tax pushed by Speaker Paul Ryan and Ways and Means Chairman Kevin Brady (R-Texas). Border adjustment, which has sharply divided the business community, is a sticking point among Republicans, and Trump has been wary of the idea.

Other Freedom Caucus members have also been outspoken against border adjustment.

“A number of folks have registered grave concerns with the border adjustment tax in the way that it opens up a new revenue source for the federal government,” Sanford said.

Like Jordan, Sanford said the government needs to slash spending. Lowering overall outlays would help cover some of the cost of tax cuts, which Meadows said shouldn’t require a pay-for.

The resulting economic growth should also make up for not bringing in revenue equal to current levels, Meadows said.

“Revenue neutral is a fancy way of saying the tax burden stays the same, but you just shift around who pays what,” Jordan said. “Typically in that scenario, the connected class gets a good deal and the middle class gets a bad deal, so I’m not wedded to this revenue-neutral thing at all.”

That also aligns those caucus members with the White House. While Brady and Ryan have offered pay-fors, including the border adjustment provision, Treasury Secretary Steven Mnuchin has repeatedly said tax reform will “pay for itself” by unleashing economic growth.gns him with the White House, while Brady and Ryan have offered pay-fors.

http://www.politico.com/story/2017/05/04/freedom-caucus-tax-reform-plan-238003

Story 2: President Trump Flip Flopping On Immigration Law Enforcement By Not Terminating DACA Now! — Failing To Rollback The 30-60 Million Illegal Alien Invasion of The United States By Deporting Them All — Must Go After Employers Hiring Illegal Aliens — Videos —

Donald Trump’s Immigration Plan – Deport and then Mass Expedited Amnesty

How to solve the illegal immigration problem

Donald Trump on Immigration – Does He Favor An Amnesty?

Trump’s Touchback amnesty explained by Marc Thiessen

Rep Steve King discusses Trump’s touchback amnesty

Donald Trump is for Touchback Amnesty and not to be trusted on Illegal Immigration!

Trump Breaks MAJOR Campaign Promise By Backing DACA Amnesty Program

The Future of DACA and Dreamers still uncertain under President Trump

Marco Rubio: DACA has to End, It’s Unconstitutional

Trump just revoked an Obama amnesty program for illegal aliens

Trump Admin Rescinds DAPA Amnesty Program

125,000 ‘DACA’ Illegals Immigrants Got Work Permits Since President Trumps Inauguration!!!

Trump goes back on promise to ‘terminate’ DACA

This is what’s going on with DAPA and DACA

Trump Keeps DACA: Who Gets to Stay in the US, Who’s Left Out in the Cold

Trump’s Stance on DACA Has Immigration Hardliners Concerned

Ann Coulter: Trump better keep his promises

Trump will allow ‘DREAMers’ to remain in the US, for now

Ann Coulter Argues Eloquently Against Destroying America With Immigrants

Ann Coulter vs. media myths on immigration

Laura Ingraham – Analysis of illegal immigrants crossing the border

Published on Jun 2, 2015

How Many Illegal Aliens Are in the US? – Walsh – 1

How Many Illegal Aliens Are in the US? – Walsh – 2

Immigration by the Numbers — Off the Charts

6 Things To Know About Trump’s Reversal On ‘Dreamers’ June 16, 2017 4:38 PM ET

President Trump has reversed himself on one key campaign promise on immigration — and kept another.

The Department of Homeland Security says it will preserve, for now, an Obama administration program known as Deferred Action for Childhood Arrivals, or DACA. It’s the most explicit statement yet that the Trump administration will not seek to deport the so-called “Dreamers” who were brought to the U.S. illegally as children.

At the same time, Homeland Security Secretary John Kelly officially revoked another program that might have protected some of their parents from deportation.

Then-candidate Trump promised to get rid of both programs during last year’s campaign, saying “we will immediately terminate President Obama’s two illegal executive amnesties” during a major immigration speech in August 2016.

But his position on so-called “Dreamers” has been shifting since the election. Here’s where it stands now and what that could mean for “Dreamers” and their parents.

1. What did the Trump administration just do?

In a FAQ posted on its web site Thursday night, the Department of Homeland Security says current DACA recipients “will continue to be eligible for renewal,” and that DHS will continue to abide by “the terms of the original DACA program” as outlined by the Obama administration on June 15, 2012.

The Obama-era memo, issued five years ago this week, lays out who is eligible for DACA. It’s also what protects people who signed up for the program from deportation, and allows them to apply for work permits.

2. Does this go beyond what President Trump had said before?

Shortly after his inauguration, President Trump told ABC that DACA recipients “shouldn’t be very worried.”

“I do have a big heart. We’re going to take care of everybody,” he told ABC. “But I will tell you, we’re looking at this, the whole immigration situation, we’re looking at it with great heart.” Trump suggested that a new DACA policy would be forthcoming, but did not clarify what it was.

3. Is this a victory for immigrant rights activists?

Not exactly. It’s clearly a relief for some of the roughly 800,000 people who’ve signed up for DACA. As the fifth anniversary of the program approached, there were fears that the Trump administration might abolish it altogether.

“It is an important win for those 800,000 individuals,” says Muzna Ansari, immigration policy manager at the New York Immigration Coalition. “But in the grand scheme of things, there are 11 million undocumented immigrants living in this country, who have really been living in fear” under the Trump administration.

4. How do President Trump’s supporters feel about it?

Some are deeply disappointed. Others are willing to give the president the benefit of the doubt because his administration has been aggressively cracking down on illegal immigration across the board.

“He broke the DACA promise,” says Dan Stein, president of Federation for American Immigration Reform, which advocates for lower immigration levels. “Are we happy about it? No,” Stein said. “We think they should have allowed the work authorizations to expire. End of story, full stop.”

But Stein is taking the long view. He says the White House may want to use the DACA program as a bargaining chip in negotiations with Congressional Democrats on a broader immigration reform package.

5. What is DAPA, and how does it fit in?

DAPA is shorthand for Deferred Action for Parents of Americans and Lawful Permanent Residents. It’s another Obama-era program that would have extended protection from deportation even further. It was designed for the parents of U.S. citizens and legal residents who were themselves living in the U.S. illegally.

But it was quickly blocked by the courts, and never implemented.

DHS officially revoked DAPA on Thursday. But that was not a big surprise, since no one expected the Trump administration to defend the program in court, as the Obama administration had.

6. Is this a final decision on the future DACA?

In a word, no.

The White House and the Department of Homeland Security have been emphasizing that this is not a permanent decision, and that president could still change his mind and revoke that program, too.

But for now, the administration continues to accept new DACA applications. And DHS says that “no work permits will be terminated prior to their current expiration dates.”

http://www.npr.org/2017/06/16/533255575/trump-allows-dreamers-to-stay-removes-protections-for-parents

Trump: Illegal “Dreamers” Will Not Be Targets For Deportation

He flips. He flops.

I’m actually fine, as my expectations for Trump were basement-level, anyway. His adoring nationalists and assorted MAGA trolls might be a bit chaffed by this, however.

Then again, when you have no principles, you’ll swallow anything.

The AP featured an extensive interview with President Trump today, and he revealed his “evolving” views on foreigners who break the laws of a sovereign nation.

 Young immigrants brought to the U.S. illegally as children can “rest easy,” President Donald Trump said Friday, telling the “dreamers” they will not be targets for deportation under his immigration policies.

As a candidate, Trump strongly criticized President Barack Obama for “illegal executive amnesties,” including actions that allowed young people brought to the country illegally as children to be spared from deportation. But after the election, Trump started speaking more favorably about these immigrants, popularly dubbed “dreamers.”

On Friday, he said that when it comes to them, “This is a case of heart.”

Wait. What changed?

Jim Jamitis

He won, so no need to play the role. Got it.

This is actually a dramatic departure from Trump’s campaign rhetoric. He was going to deport, then build a great wall.

Of course, over time, it began to take on more nuance.

It would be a big, beautiful wall, with a big beautiful door.

Then, maybe deals could be made on a case-by-case basis.

As for the wall, the price tag is growing and we still don’t know who is paying for it. We know Mexico won’t.

The president, who took a hard line on immigration as a candidate, vowed anew to fulfill his promise to construct a wall along the U.S.-Mexico border. But he stopped short of demanding that funding for the project be included in a spending bill Congress must pass by the end of next week in order to keep the government running.

“I want the border wall. My base definitely wants the border wall,” Trump said in the Oval Office interview. Asked whether he would sign legislation that does not include money for the project, he said, “I just don’t know yet.”

He really needs to stop talking about a wall and focus more on the strategic fencing, boots on the ground, and drones flying along the border to monitor activity.

That, at least sounds like a workable plan, and would likely cost quite a bit less than the unworkable wall he’s promising.

http://www.redstate.com/sweetie15/2017/04/21/trump-illegal-dreamers-will-not-targets-deportation/

WASHINGTON — President Trump will not immediately eliminate protections for the so-called Dreamers, undocumented immigrants who came to the United States as small children, according to new memorandums issued by the administration on Thursday night.

But White House officials said on Friday morning that Mr. Trump had not made a decision about the long-term fate of the program and might yet follow through on a campaign pledge to take away work permits from the immigrants or deport them.

The Department of Homeland Security announced that it would continue the Obama-era program intended to protect those immigrants from deportation and provide them with work permits so they can find legal employment.

A fact sheet posted on the department’s website says that immigrants enrolled in the 2012 program, known as Deferred Action for Childhood Arrivals, “will continue to be eligible” to renew every two years, and notes that “no work permits will be terminated prior to their current expiration dates.”

A news release from the department said flatly that “the June 15, 2012, memorandum that created the Deferred Action for Childhood Arrivals (DACA) program will remain in effect.”

But officials at the White House and the Department of Homeland Security said on Friday morning that those statements were intended only to clarify that immigrants enrolled in the DACA program would not immediately be affected by a separate action officially ending a similar program for undocumented immigrants whose children are citizens or legal permanent residents.

“There has been no final determination made about the DACA program, which the president has stressed needs to be handled with compassion and with heart,” said Jonathan Hoffman, the assistant secretary for public affairs at the department. He added that John F. Kelly, the secretary of Homeland Security, “has noted that Congress is the only entity that can provide a long-term solution to this issue.”

Immigration rights activists, who have fiercely battled Mr. Trump’s travel ban and increased enforcement of other immigration laws, initially hailed the announcement, calling it a surprising turn of events from Mr. Trump.

“This is a big victory for Dreamers amid months of draconian and meanspirited immigration enforcement policy,” said David Leopold, an immigration lawyer. “The preservation of DACA is a tribute to the strength of the Dreamer movement.”

But after the White House clarified its intent, activists expressed regret. Mr. Leopold said in a second statement that “it’s no surprise that Trump would quickly walk back the preservation of DACA.” He added that the administration was trying to “cynically pit 800,000 Dreamers against the rest of the 11 million undocumented immigrants.”

Cecilia Muñoz, who led President Barack Obama’s domestic policy council and oversaw immigration policy for the White House, said, “It is unfortunate that their status is still temporary, and their peace of mind not complete.”

A decision to maintain the DACA program would be a reversal from Mr. Trump’s anti-immigrant language during the campaign and would disappoint some of the president’s most ardent supporters, who view the program started by Mr. Obama as an illegal grant of amnesty.

During the campaign, Mr. Trump repeatedly agreed with that sentiment. At one rally last summer, Mr. Trump vowed to “immediately terminate” the program, saying that Mr. Obama had “defied federal law and the Constitution.”

But once in office, Mr. Trump faced a new reality: the political risks of targeting for deportation a group of people who are viewed sympathetically by many Americans. In some cases, the immigrants did not know they were in the country illegally. Many attended American schools from the time they were in kindergarten.

Asked repeatedly about his intentions for the program since he took office, the president has hinted that he would not try to deport the Dreamers. But immigration activists had remained worried that the administration might still eliminate the program.

On Friday, young immigrants who have gained legal status through the program were eager for clarity.

“My initial reaction was, ‘Well, what’s the catch?’” said Carlos Robles-Shanahan, 27, a business consultant in Chicago who is waiting for his deferred action status to be renewed. “It felt like it sounds too good to be true. If they gave us that, what did they take away?”

Born in Mexico, Mr. Robles-Shanahan and his two siblings followed their parents to the Chicago area in 2004, when they were children. He and his brother were arrested and detained by immigration officials while traveling to Boston by train in 2010, but were given a temporary reprieve from deportation. Joining the deferred action program two years later, he said, allowed him to obtain financial aid from his college, teach for a year through a fellowship, earn a master’s degree in public policy, get a white-collar job and buy a house for his mother.

“DACA changed a ton of stuff for me and my brother, exponentially,” he said. “It was like a switch.”

Mr. Robles-Shanahan recently married a United States citizen and has begun the process of applying for a green card, but fears that his ability to work and live in the country will be jeopardized if his deferred action status is not renewed.

Confirmation that the Trump administration planned to preserve the program would have given young immigrants some certainty that they could apply for deferred action or renew their status, said Rigo Rivera, 27, who crossed the Mexican border when he was 9 to join his parents in Alpharetta, Ga. Many have been afraid to apply for fear of putting their information in the hands of federal authorities.

“With Trump, we can expect anything. Tomorrow he can say that he wants to deport us,” he said. “I don’t know what to make of this, or what to believe.”

Mr. Rivera, a prep worker in a restaurant kitchen who also leads a group of young undocumented activists, received protected status in 2013, allowing him to obtain a driver’s license, a Social Security number and permission to work legally.

But he said he worried that he and other young immigrants in the program would not be protected from deportation even if Mr. Trump does not formally end DACA, because of several recent episodes in which people like him have been detained despite their participation in the program.

The announcement that the DACA program will continue for the time being, a decision that affects about 800,000 people in the United States, came as the administration formally ended Mr. Obama’s attempt to expand it to also cover the parents of Dreamers.

In 2015, Mr. Obama proposed an expansion of the program, called Deferred Action for Parents of Americans, which could have shielded as many as five million people from deportation and provided work permits to them as well.

That program was never put in place because a Texas court blocked it at the request of a coalition of 26 state attorneys general. The Supreme Court deadlocked, 4 to 4, on a challenge to that ruling, but the decision by the Trump administration officially ends the litigation.

Correction: June 17, 2017
An earlier version of this article, using information from a Department of Homeland Security news release and a separate fact sheet, referred incorrectly to the status of the Obama-era immigration program known as Deferred Action for Childhood Arrivals. The program is continuing for now; President Trump has not decided to keep it permanently, according to a clarification released by the administration. The headline repeated the error.
https://www.nytimes.com/2017/06/16/us/politics/trump-will-allow-dreamers-to-stay-in-us-reversing-campaign-promise.html

Deferred Action for Childhood Arrivals

From Wikipedia, the free encyclopedia

Deferred Action for Childhood Arrivals (DACA) is an Americanimmigration policy founded by the Obama administration in June 2012. DACA allows certain illegal aliens who entered the country as minors, to receive a renewable two-year period of deferred action from deportation and eligibility for a work permit.

The policy was created after acknowledgment that these illegal students had been largely raised in the United States, and was seen as a way to remove immigration enforcement attention from “low priority” individuals with good behavior.[1] The illegal alien student population was rapidly increasing; approximately 65,000 illegal alien students graduate from U.S. high schools on a yearly basis.[2]

From the start, the Pew Research Center estimated that up to 1.7 million people might be eligible.[3] As of June 2016, U.S. Citizenship and Immigration Services (USCIS) had received 844,931 initial applications for DACA status, of which 741,546 (88%) were approved, 60,269 (7%) were denied, and 43,121 (5%) were pending. Over half of those accepted reside in California and Texas.[4]

In November 2014, U.S. President Barack Obama attempted to expand DACA.[5] However, in December 2014, Texas and 25 other states, all with Republican governors, sued in the District Court for the Southern District of Texas asking the court to enjoin implementation of both the DACA expansion and Deferred Action for Parents of Americans (a similar program).[6][7][8] In February 2015, Judge Andrew S. Hanen issued a preliminary injunction blocking the expansion from going into effect while the case, Texas v. United States, proceeds.[9][10] After progressing through the court system, an equally divided (4-4) Supreme Court left the injunction in place, without setting any precedent.[11]

On February 14, 2017 a CNN report on the detention of 23-year-old Daniel Ramirez Medina in Northwest Detention Center,[12]Tacoma, Washington following his arrest in his father’s Des Moines, Washington home, observed that “The case raises questions about what it could mean” for the 750,000 Dreamers, who had “received permission to stay under DACA.”[12][13]

On March 7, 2017 the Los Angeles Times[14] reported that 22-year-old Daniela Vargas of Jackson, Mississippi became the second DACA recipient to be detained by the Trump Administration, further raising speculation about President Trump’s commitment to Dreamers and questioning whether immigrants who speak out against the administration’s policies should fear retaliation [1].

Vargas was released from LaSalle Detention Center on March 10, 2017 [2] and Ramirez Medina’s release followed on March 29, 2017 [3]. However, questions remain regarding the future of DACA recipients due to the Trump administration’s initial plans [4].

On June 16, 2017, the United States Department of Homeland Security announced that it would rescind the executive order by the Barack Obama administration that expanded the DACA program, though the DACA program’s overall existence would continue to be reviewed.[15][16]

History

President Barack Obama announced the policy with a speech in the Rose Garden of the White House on 15 June 2012,[17] a date chosen as the 30th anniversary of Plyler v. Doe, a Supreme Court decision barring public schools from charging illegal alien children tuition. Republican Party leaders denounced the program as an abuse of executive power.[18]

USCIS began accepting applications for the program on 15 August 2012.[3]

Republican response

Nearly all Republicans in the House of Representatives (along with three Democrats) voted 224-201 to defund DACA in June 2013.[19] Lead author of the amendment Rep. Steve King (R-Iowa) stated, “The point here is…the President does not have the authority to waive immigration law, nor does he have the authority to create it out of thin air, and he’s done both with these Morton memos in this respect.”[20] However, in practice Congress does not have the ability to defund DACA since the program is almost entirely funded by its own application fees rather than congressional appropriations.[21]

Although politicians are divided on immigration issues related to DACA, former presidential candidate Mitt Romney stated that he would honor the grants of deferred action approved under DACA until a more permanent legislation was put into place.[22]

Under the presidency of Donald Trump, DACA has been under scrutiny, also in view of Trump’s earlier announcement during his candidacy that he intended to end that program.[23][24]

Implementation

DACA was formally initiated by a policy memorandum sent from Secretary of Homeland SecurityJanet Napolitano to the heads of U.S. Customs and Border Protection (CBP), U.S. Citizenship and Immigration Services (USCIS), and U.S. Immigration and Customs Enforcement (ICE). The memo formally directed them to exercise their enforcement discretion on behalf of individuals who met the requirements.[25]

To apply for DACA, illegal aliens must pay a $495 application fee, submit several, and produce documents showing they meet the requirements. They do not need legal representation.

Eligibility

To be eligible, illegal aliens must have entered the United States before their 16th birthday and prior to June 2007, be currently in school, a high school graduate or be honorably discharged from the military, be under the age of 31 as of June 15, 2012, and not have been convicted of a felony, significant misdemeanor or three other misdemeanors, or otherwise pose a threat to national security. The program does not provide lawful status or a path to citizenship,[26] nor does it provide eligibility for federal welfare or student aid.[27]

In August 2012, the Migration Policy Institute estimated that as many as 1.76 million people could be eligible for DACA. Of those, 28% were under 15 and would have to wait until reaching that age to apply. In addition, roughly 20% did not meet any of the education criteria, but could become eligible by enrolling in a program before submitting their application. 74% of the eligible population was born in Mexico or Central America. Smaller proportions came from Caribbean and South America (11%), Asia (9%), and the rest of the world (6%).[28]

To qualify for DACA, applicants must meet the following major requirements, although meeting them does not guarantee approval:[26]

  • Came to the United States before their 16th birthday
  • Have lived continuously in the United States since 15 June 2007
  • Were under age 31 on 15 June 2012 (i.e., born on 16 June 1981 or after)
  • Were physically present in the United States on 15 June 2012, and at the time of making their request for consideration of deferred action with USCIS
  • Had no lawful status on 15 June 2012
  • Have completed high school or a GED, have been honorably discharged from the armed forces, or are enrolled in school
  • Have not been convicted of a felony or serious misdemeanors, or three or more other misdemeanors, and do not otherwise pose a threat to national security or public safety

To show proof of qualification (verify these requirements), applicants must submit three forms; I-821D, Consideration of Deferred Action for Childhood Arrivals; I-765, Application for Employment Authorization; and I-765WS, Worksheet, as well as supporting documentation.[26]

Travel eligibility

In addition to the $495 application fee, if a DACA qualifying illegal alien wants to travel abroad there is an additional fee and application requirement.

Form I-131 Application Type D, with a fee of $575 needs to be submitted to USCIS.[29]

To receive advance parole one must travel abroad for the sole purpose of an educational, employment, or humanitarian purposes. This must be indicating on the Form I-131 as described below:

  • Educational purposes, such as studying abroad;
  • Employment purposes, such as overseas positions, interviews, training, or meetings with clients; or
  • Humanitarian purposes, such as travel for medical reasons, attend funeral services for a family member, or visit a sick relative.

Travel for leisure is not a valid purpose.[29]

Renewals

USCIS released the process for DACA renewals in June 2014 and directed applicants to file their documents during a 30-day window starting 150 days before the expiration of their previous DACA status. Renewing requires an additional $495 fee.[30]

As of June 2016, there had been 606,264 renewal cases, with 526,288 approved, 4,703 denied and 75,205 renewals pending.[4]

Expansion

In November 2014, U.S. President Barack Obama announced changes to DACA which would expand it to include illegal aliens who entered the country prior to 2010, eliminate the requirement that applicants be younger than 31 years old, and lengthen the renewable deferral period to two years. The Pew Research Center estimated that this would increase the number of eligible people by about 330,000.[31]

However, in December 2014, Texas and 25 other states, all with Republican governors, sued in the District Court for the Southern District of Texas asking the court to enjoin implementation of both the DACA expansion and Deferred Action for Parents of Americans (a similar program).[32][33][34] In February 2015, Judge Andrew S. Hanen issued a preliminary injunction blocking the expansion from going into effect while the case, Texas v. United States, proceeds.[35][36] After progressing through the court system, an equally divided (4-4) Supreme Court left the injunction in place, without setting any precedent.[11]

The court’s temporary injunction does not affect the existing DACA. Individuals may continue to come forward and request an initial grant of DACA or renewal of DACA under the guidelines established in 2012.[26]

Impact

A 2016 study found that DACA increased labor force participation and decreased the unemployment rate for DACA-eligible immigrants. DACA also increased the income of illegal aliens in the bottom of the income distribution. However, DACA had no significant effects on the likelihood of attending school. Using these estimates, DACA moved 50,000 to 75,000 unauthorized immigrants into employment.[27]

State responses]

State-level government officials are also divided on the issue. Although state governments cannot affect DACA itself, they can control the state benefits available to individuals under deferred action.

California

To assist those eligible under the program,[37] the state of California has agreed to support those who receive a DACA grant by allowing access to a state driver’s license,[38] provided that such individuals participate in specific state guidelines (such as paying income taxes). The state of California also allows DACA holding individuals to qualify for Medi-Cal.[39]

Arizona

Arizona became the first state to oppose President Obama’s order for DACA when Governor Jan Brewer issued a counter-order that prevents those with deferred status from receiving any state benefits.[40] This caused controversy,[41] as eligible and approved applicants would still be unable to obtain a driver’s license.[42] In May 2013, a federal district court held that this policy was likely unconstitutional. In 2014, the Ninth Circuit Court of Appeals issued a preliminary injunction against Brewer’s ban, and in November 2014 held this ban was in violation of the law.[43]

Maryland

Former Baltimore Mayor Stephanie Rawlings-Blake chose to open the city’s doors to undocumented immigrants to boost its dwindling population. The city boasts an executive order prohibiting officials from questioning an individual’s immigration status, especially about Maryland’s Dream Act, which grants in-state tuition rates to “any student who graduates from a Maryland high school and comes from a family who has paid taxes. If the individual is a male he must also complete his Selective Service form and prove his acceptance.”[44]

Illinois

In a New York Times interview, Chicago Mayor Rahm Emanuel stated that he wants to make Chicago the “most immigrant-friendly city in the country”. In addition to offering in-state tuition for illegal aliens, he has also made plans for an ordinance that would prevent illegal aliens with no criminal background from being turned over to immigration enforcement agencies.[45]

Texas

Although in-state tuition is still offered, Governor Rick Perry announced his opposition to DACA by distributing a letter to all state agencies, meant “to ensure that all Texas agencies understand that Secretary Napolitano’s guidelines confer absolutely no legal status whatsoever to any illegal alien who qualifies for the federal ‘deferred action’ designation.”[46]

Nebraska

Governor Dave Heineman, also joined in the opposition against DACA, confirming that the state, will continue its practice of not issuing driver’s licenses, welfare benefits, or other public benefits to illegal immigrants” regardless of deferred status. Since then, however, Nebraska legislature has made it legal for these people to acquire driver’s licenses.[47]

Michigan

In October 2012, the Michigan Secretary of State, Ruth Johnson, announced that Michigan will not issue drivers licenses or state identification of any kind to beneficiaries of Deferred Action for Childhood Arrivals.[48] In making this decision, it was clear that the Secretary of State erroneously conflated the notion of “lawful presence,” which is required under Michigan Law to issue a driver’s license, and “lawful status,” a different legal concept entirely.[49]USCIS has made it clear that DACA beneficiaries do not possess legal status, but does not state that DACA beneficiaries are unlawfully present; in fact, it states that DACA beneficiaries will not accrue unlawful presence time here while they are in this deferred action status.[50] The Secretary of State relied upon USCIS’ own explanation, which discusses legal status, not lawful presence.[50] In response to this policy, the ACLU filed a lawsuit against Johnson, alleging that the policy violated both Michigan law and the U.S. Constitution.[51] On January 18, 2013, USCIS updated their “Frequently Asked Questions” page about DACA, clarifying, among other things, that DACA beneficiaries are, in fact, lawfully present in the United States.[52] On 1 February 2013, Johnson reversed her policy and began issuing drivers licenses to DACA beneficiaries on February 19, 2013.[53]

North Carolina

North Carolina briefly suspended giving out driver’s licenses to DACA grantees while waiting for the state attorney general’s opinion. The attorney general decided that even without formal immigration status the DACA grantees were to be granted legal presence. After that, the state once again continued to give out drivers licenses and allowed the DACA grantees to become legal members of North Carolina.[54]

Virginia

On April 29, 2014, Virginia Attorney GeneralMark Herring sent a letter to the director of the State Council of Higher Education for Virginia (SCHEV), the presidents of Virginia public colleges and universities, and the chancellor of the Virginia Community College System, in response to inquiries from public institutions of higher education on whether DACA students are eligible for in-state tuition. The attorney general advised these institutions that under Virginia law, DACA students who meet Virginia’s domicile requirements are eligible for in-state tuition.[55][56]

See also

References

Story 3: More Mueller Milking The American Taxpayers — Trump Should Fire Them All Now — Enough Is Enough — Videos

War of Words on Special Counsel Mueller Hires 13 Lawyers.

Out of Control Investigations. Alan Dershowitz!

Mueller, Witness Flipper, and More on Hidden Obama Documents! Judge Nap!

Jay Sekulow: It’s a Witch Hunt – The Deep State

Trey Gowdy Questions Fmr Sec of DHS Jeh Johnson!

The Latest from Trey Gowdy! Some About Loretta Lynch and James Comey!

JAY SEKULOW FULL EXPLOSIVE INTERVIEW ON STATE OF THE UNION WITH JAKE TAPPER (6/18/2017)

Lou Dobbs & Legal Expert Delineate The Number Of Crimes Comey & Mueller Have Already Committed

Robert Mueller named special counsel for FBI Russia probe – USA News

Jay Sekulow on The Laura Ingraham Show (6 /16/ 2017)

Mueller’s Empire: Legions of Lawyers, Bottomless Budget, Limitless Jurisdiction

By Andrew C. McCarthy| June 21, 2017

So I’ve been wondering: Why on earth does a prosecutor, brought in to investigate a case in which there is no apparent crime, need a staff of 14 lawyers?

Or, I should say, “14 lawyers and counting.” According to the press spokesman for special counsel Robert Mueller—yeah, he’s got a press spokesman, too—there are “several more in the pipeline.”

Concededly, none of Mueller’s recruits requires Senate confirmation, as do Justice Department officials—notwithstanding that the former may end up playing a far more consequential role in the fate of the Trump administration. But does it seem strange to anyone else that, by comparison, the president of the United States has managed to get—count ’em—three appointees confirmed to Justice Department positions in five months?

A special counsel, the need for whom is far from obvious, has in just a few days staffed up with four times the number of lawyers. And all for a single investigation that the FBI has described as a counterintelligence probe—i.e., not a criminal investigation, the kind for which you actually need lawyers.

The way this is supposed to work is: the Justice Department first identifies a likely crime, and then assigns a prosecutor to investigate it. Here, by contrast, there are no parameters imposed on the special counsel’s jurisdiction. Mueller is loosed—with 14 lawyers and more coming—to conduct what I’ve called a “fishing expedition.”

Oh, and about those three Justice Department appointees: One of them, Attorney General Jeff Sessions, has already recused himself from the investigation in question—the department’s most high profile undertaking. Another, Deputy Attorney General Rod Rosenstein, is reportedly weighing whether he, too, should bow out. Perhaps he figures he has already done quite enough, having sicced a special-counsel investigation on the Trump Administration by flouting both the regulation that requires a basis for a criminal investigation before a special counsel is appointed, and the regulation that requires limiting the special counsel’s jurisdiction to the specific factual matter that triggers this criminal investigation.

For now, Mueller appears utterly without limits, in his writ and in his resources. As the ease with which he has staffed up shows, it is not hard to recruit lawyers. All you need is money. Mueller has a bottomless budget, thanks to a bit of Treasury Department chicanery known as “permanent, indefinite appropriations.”

Under the Constitution’s Appropriations Clause, no funding is supposed to be paid out of the treasury unless Congress has approved it in advance. Under the Framers’ design, with an eye toward limited, accountable government, every spending initiative must compete with every other one when Congress enacts a budget. Lawmakers must decide what we can and can’t afford when they draw on what is supposed to be the finite pot of money confiscated from taxpayers. We are supposed to know what we are underwriting and what it will cost.

These lawyers, overwhelmingly, are Democrats. Powerline’s Paul Mirengoff and the Daily Caller’s Chuck Ross have been tracking it: Mueller’s staffers contribute to Trump’s political opponents, some heavily.

Mueller’s special counsel investigation is somehow under no such restrictions, according to the Justice Department. He unilaterally decides how much staffing he needs. And unlike a normal prosecutor’s office, the special counsel does not have to apportion his resources over hundreds of cases. He can direct all of them at one investigative target.

In this instance, the target is Trump, and the resources—apart from what will be scores of FBI agents—include 14 lawyers (going on 15 … going on 16…).

These lawyers, overwhelmingly, are Democrats. Powerline’s Paul Mirengoff and the Daily Caller’s Chuck Ross have been tracking it: Mueller’s staffers contribute to Trump’s political opponents, some heavily. The latest Democratic talking-point about this unseemly appearance is that hiring regulations forbid an inquiry into an applicant’s political affiliation. That’s laughable. These are lawyers Mueller has recruited. They are not “applicants.” We’re talking about top-shelf legal talent, accomplished professionals who have jumped at the chance of a gig they do not need but, clearly, want.

The Democrats’ other rationalization is that Mueller, whose integrity is well established, is ultimately responsible for all prosecutorial decisions. I agree that Mueller’s personal probity entitles him to a presumption of ethical propriety. But a presumption is not a blank check.

Unlike many conservative commentators, I’ve contended that too much has been made of Mueller’s close personal friendship and longstanding professional ties to former FBI director James Comey. In drawing that conclusion, I have relied on Rosenstein’s description of the investigation assigned to Mueller. He said it is the same investigation Comey described in March 20 congressional testimony. That investigation is a counterintelligence probe—which is why I’ve never understood the need for a prosecutor. Since such investigations are not intended to build criminal cases, there seemed little prospect that Comey could become a critical prosecution witness. I reasoned that, in the unlikely event criminal charges became a possibility, Mueller could be trusted to consider the ethics of his participation.

Now, however, if reports are to be believed, Mueller is weighing whether the president is guilty of an obstruction crime. Putting aside my assessment that there would be no legal merit to such an allegation, there could be no doubting Comey’s importance as a witness in such a case. Mueller would then have to consider an ethical dilemma that the National District Attorneys Association, in its National Prosecution Standards (third edition), has described in the section on conflicts of interest (Standard 1-3.3, at p. 7):

The prosecutor should excuse himself or herself from any investigation, prosecution, or other matter where personal interests of the prosecutor would cause a fair-minded, objective observer to conclude that the prosecutor’s neutrality, judgment, or ability to administer the law in an objective manner may be compromised.

Notice that, consistent with the familiar ethical canon that lawyers must avoid even the appearance of impropriety, the standard here is based not on the lawyer’s personal rectitude or his subjective belief that he can administer the law impartially. The issue is: What would this look like to fair-minded observers?

Consequently, if this boundless investigation careens into a criminal prosecution, Mueller could have some major soul-searching to do. I thus confess to being taken aback that he has exacerbated the problem, rather than trying to mitigate it, with his staffing decisions. Into an investigation that was already fraught with political tension, the special counsel has recruited partisans—donors to politicians who describe themselves not as a loyal opposition but as the Trump “Resistance.” What are fair-minded people to make of that?

Not just one or two recruits, but 14 lawyers, with more to come.

Some personal perspective, if you’ll allow me. I had the good fortune to be a prosecutor in two of the better known criminal cases in modern American history. The Pizza Connection case, which I believe remains our longest federal criminal trial, involved a vast narcotics and money-laundering enterprise, overseen for well over a decade by the mafia in Sicily and the United States. The years-long investigation required gathering evidence on three continents, coordinating with a parallel, massive Italian prosecution, and ultimately indicting 36 mafiosi. The subsequent 17-month trial of 22 defendants, starting in late 1985, featured hundreds of witnesses and more than 2,400 wiretap conversations (translated into English from Italian). I was the junior member of a five-prosecutor team, which many of our peers found to be excessive despite the prosecution’s success.

Consequently, if this boundless investigation careens into a criminal prosecution, Mueller could have some major soul-searching to do. I thus confess to being taken aback that he has exacerbated the problem, rather than trying to mitigate it, with his staffing decisions.

I was the lead government lawyer in the terrorism investigation of the so-called Blind Sheikh’s jihadist cell, following the 1993 World Trade Center bombing and an unsuccessful plot to bomb New York City landmarks. The case involved extensive undercover investigations. We also probed the history of overseas jihadist movements, as well as that of covert American aid to the Afghan mujahideen’s war against the Red Army. There were classified-information challenges, including litigation over the admissibility in a criminal trial of evidence obtained under foreign-intelligence-gathering authorities. The eventual nine-month trial of 12 defendants, involved hundreds of witnesses and intercepted conversations (translated into English from Arabic).

We managed to get by with a team of three trial prosecutors and one appellate lawyer assigned to help us with the many novel legal issues. After all the defendants were convicted, I wrote the government’s appellate brief with the assistance of a single appellate editor. Not much staff, but the convictions and sentences were nevertheless upheld.

Why does special counsel Mueller need 14 lawyers (and more coming) for a counterintelligence investigation, as to which the intelligence professionals—agents, not lawyers—have found no “collusion with Russia” evidence after over a year of hard work? What will those lawyers be doing with no limits on their jurisdiction, with nothing but all the time and funding they need to examine one target, Donald Trump?

About the Author:

Andrew C. McCarthy
Andrew C. McCarthy is a former chief assistant U.S. attorney best known for successfully prosecuting the “Blind Sheikh” (Omar Abdel Rahman) and eleven other jihadists for waging a terrorist war against the United States – a war that included the 1993 World Trade Center bombing and a subsequent plot to bomb New York City landmarks. He is a recipient of the Justice Department’s highest honors, helped supervise the command-post near Ground Zero in lower Manhattan following the 9/11 attacks, and later served as an adviser to the Deputy Secretary of Defense. His several popular books include the New York Times bestsellers Willful Blindness: A Memoir of the Jihad and The Grand Jihad: How Islam and the Left Sabotage America. He is a senior fellow at National Review Institute and a contributing editor at National Review. He is a frequent guest commentator on national security, law, politics, and culture in national media, and his columns and essays also appear regularly in The New Criterion, PJ Media, and other major publications.

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

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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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