Rand Paul

The Pronk Pops Show 928, July 13, 2017, Story 1: Senate Revised Republican Repeal and Replacement Bill A Betrayal of Voters Who Gave Republicans Control of Senate and House — Does Not Repeal All Obamacare Mandates, Regulations and Taxes but Does Bailout Insurance Industry and States Who Extended Medicaid Benefits — Trump Should Veto This Betrayal By Republican Establishment of Republican Voters — Videos — Story 2: Estimated insolvency date of Social Security’s Trust fund is 2034 — and Medicare’s Hospital Trust Fund is 2029 —  Social Security and Medicare Benefits Will Be Cut or Taxes Raised or Combination of Benefit Cuts and Tax Increases — Videos — Story 3: Trump’s Broken Promises and Kept Promises — Good Intentions are Not Enough — Only Results Count — Videos

Posted on July 15, 2017. Filed under: American History, Banking System, Breaking News, Budgetary Policy, Coal, Communications, Computers, Congress, Corruption, Defense Spending, Donald J. Trump, Donald J. Trump, Donald Trump, Economics, Education, Employment, Fiscal Policy, Government, Government Dependency, Government Spending, Health, Health Care Insurance, History, House of Representatives, Independence, Investments, Labor Economics, Law, Life, Media, Medicare, Monetary Policy, Natural Gas, News, Oil, People, Philosophy, Photos, President Trump, Radio, Rand Paul, Raymond Thomas Pronk, Resources, Rule of Law, Scandals, Security, Senate, Social Security, Tax Policy, Taxation, Taxes, Trade Policy, Unemployment, United States of America, War, Wealth, Welfare Spending, Wisdom | Tags: , , , , , , , , , , , , , , , , |

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The Pronk Pops Show Podcasts

Pronk Pops Show 928,  July 13, 2017

Pronk Pops Show 927,  July 12, 2017

Pronk Pops Show 926,  July 11, 2017

Pronk Pops Show 925,  July 10, 2017

Pronk Pops Show 924,  July 6, 2017

Pronk Pops Show 923,  July 5, 2017

Pronk Pops Show 922,  July 3, 2017 

Pronk Pops Show 921,  June 29, 2017

Pronk Pops Show 920,  June 28, 2017

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

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Image result for U.S. debt as of July 15, 2017

Image result for U.S. debt as of July 15, 2017

 

 

Story 1: Senate Revised Republican Repeal and Replacement Bill A Betrayal of Voters Who Gave Republicans Control of Senate and House — Does Not Repeal All Obamacare Mandates, Regulations and Taxes but Does Bailout Insurance Industry and States Who Extended Medicaid Benefits — Trump Should Veto This Betrayal By Republican Establishment of Republican Voters — Videos —

Here’s what’s in the Senate GOP health care bill 2.0

Sen Bill Cassidy Healthcare reform first, then tax reform Fox News Video

Senate GOP Rolls Out Revised Health Care Bill To Repeal, Replace

Senate Republicans Reveal New Health Care Bill

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

Story 2: Estimated insolvency date of Social Security’s big trust fund is 2034 — and Medicare’s Hospital Trust Fund is 2029 —  Social Security and Medicare Benefits Will Be Cut or Taxes Raised or Combination of Benefit Cuts and Tax Increases — Videos

When will Medicare, Social Security trust funds run dry?

Trump Vows To Protect Social Security, Medicare & Medicaid

Donald Trump On Social Security

How Does Social Security Really Work?

US Debt & Unfunded Liabilities-Where we are going-Dr. Yaron Brook

Social Security is not a Ponzi Scheme!

Social Security is WORSE Than a Ponzi Scheme | THE PLAIN TRUTH by Judge Napolitano …

The Story of Your Enslavement

The Collapse of The American Dream Explained in Animation

George Carlin – It’s a Big Club and You Ain’t In It! The American Dream

George Carlin’s Greatest Speech

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U.S. Debt Clock

 

Image result for cartoons national debt us 20 trillion

Image result for cartoons national debt us 20 trillion

Why Is Healthcare So Expensive?

How to Solve America’s Spending Problem

Government: Is it Ever Big Enough?

The Bigger the Government…

The War on Work

What Creates Wealth?

The Promise of Free Enterprise

Why Capitalism Works

What is Crony Capitalism?

America’s Debt Crisis Explained

Consequences of Printing Money/ Inflation- Dr. Yaron Brook

Milton Friedman – Understanding Inflation

Milton Friedman – The Social Security Myth

Donald Trump’s $20 Trillion Problem

The Money Hole: America’s Debt Crisis

Social Security Trust Fund

youtube=https://www.youtube.com/watch?v=moG31hGZl14]

The Social Security Trust Fund

Alert!! The Fed is Pulling The Plug On The Entire Market, They’re Bringing Down The Economy

The U.S. Debt! Why America Is in Debt? The Federal Debt Grows

Social Security Benefits Demystified With Laurence Kotlikoff | Forbes

III – Unfunded Liabilities

Social Security trust fund will be depleted in 17 years, according to trustees report

BY PHILIP MOELLER  July 13, 2017 at 6:34 PM EDT

The annual trustee reports on Social Security and Medicare were released earlier today and showed little change from last year. With both programs facing longer-term deficits, these annual report cards have become a doomsday clock for senior benefits.

With both programs facing longer-term deficits, these annual report cards have become a doomsday clock for senior benefits.

The top line of today’s reports is that the estimated insolvency date of Social Security’s big trust fund is 2034 — unchanged from last year. The other big fund is Medicare’s hospital trust fund. Last year, it was projected to run out of funds in 2028, or 12 years. That date was rolled forward a year — to 2029 — in this year’s report.

Both funds are paid for by wage earners out of their Social Security payroll taxes. What the insolvency dates mean is that payroll taxes will be the only source of benefit payments once the trust fund reserves are gone. In the case of Social Security, payroll taxes in 2034 will be able to pay an estimated 77 percent of projected benefits. For Part A of Medicare, which covers hospital and nursing home expenses, payroll taxes in 2029 will pay an estimated 88 percent of the program’s projected expenses.

The Social Security report also projected that the program’s 2018 cost of living adjustment, or COLA, would be 2.2 percent, the largest in several years. The COLA sets annual increases in Social Security benefits and also helps determine the level of consumer payments each year for Medicare Part B premiums.

READ MORE: Column: For older Americans, the GOP health bills would be nothing short of devastating

The trustees also estimated that the payroll tax ceiling would rise to $130,500 next year from $127,200 this year. Individuals pay 7.65 percent of their wages in payroll taxes, with 6.2 percentage points to the Social Security trust funds and 1.45 percent to the Medicare trust fund. Employers pay the same amount. The Medicare component of the tax has no wage ceiling.

People on Medicare and Social Security have Part B premiums deducted from their monthly Social Security benefit payments. Under Social Security’s “hold harmless”rule, the Part B premiums can’t increase each year by more than the amount of any COLA-related boost in Social Security payments.

In recent years, Part B expenses have risen at rates much larger than COLA increases. People held harmless have been shielded from the full impact of this Part B inflation. Some people today pay only about $107 a month for Part B premiums, while others who were not held harmless this year are paying $134 a month.

The top line of today’s reports is that the estimated insolvency date of Social Security’s big trust fund is 2034 — unchanged from last year.

The trustees estimated that the monthly premium for Medicare Part B coverage will remain at $134 a month next year and in 2019. Part B’s annual deductible is also expected to remain at $183 through 2019.

The trustees also kept unchanged their estimates of the expected high-income surcharges for Part B premiums of wealthier Medicare enrollees through 2019. They will range from $187.50 to a maximum of $428.60 a month. However, surcharges for Part D premiums are estimated to increase next year, from a range of $13.30 to $76.20 a month this year, to a range of $14 to $80.60 a month in 2018.

Estimates for key elements of Part A hospital insurance payments were increased by 2.7 percent between 2017 and 2018, with the annual deductible for Part A hospital insurance estimated to rise to $1,352 next year from $1,316. Hospital and nursing home co-insurance payments also would rise 2.7 percent.

Part D drug premiums were projected to rise from a monthly base of $35.63 this year to $37.54 in 2018. Medicare earlier had announced that the maximum annual deductible for a Part D plan will rise to $405 in 2018 from $400 this year.

READ MORE: How does Social Security’s cost of living adjustment affect Medicare?

Under terms of the Affordable Care Act, the so-called “donut hole,” or coverage gap in Part D plans, will close completely by 2020. At that time, people will pay 25 percent of the costs of their drugs when they are in the coverage gap of their Part D plan.

Next year, they will pay 35 percent of the price for brand-name drugs and 44 percent of the price for generic drugs. The gap will begin next year after drug costs hit $3,750, up from $3,700 this year. Once expenses hit $5,000, up from $4,950 this year, people will be in the catastrophic coverage phase and will pay no more than 5 percent of the cost of their drugs.

The Social Security report also projected that the program’s 2018 cost of living adjustment, or COLA, would be 2.2 percent, the largest in several years.

The outlook could have been worse for Medicare. Its finances have been supported by high-income Medicare payroll and investment taxes that were imposed by the Affordable Care Act.

These taxes were removed in earlier versions of Republican bills designed to overturn the Affordable Care Act. These cuts were restored in the revised Senate bill that was released earlier today, although it was not immediately clear if Medicare would directly benefit from these taxes to the extent is has under terms of the Affordable Care Act.

Another Affordable Care Act provision related to Medicare would have triggered mandatory Medicare savings had the rate of health care inflation substantially exceeded overall inflation rates. Such a finding would activate an Independent Payment Advisory Board, or IPAB, which some Affordable Care Act critics have described as a death panel. However, the trustee report said health care inflation rates were not large enough to trigger the IPAB process.

Unlike Social Security, payroll taxes do not cover all or even most Medicare spending. Taxpayers foot the bills for most spending on Parts B and D of Medicare. Part B covers doctor, outpatient and durable medical equipment expenses. Part D is the Medicare prescription drug program. While consumer spending on both programs is substantial, they nonetheless run up hundreds of billions in annual deficits that are paid for out of general federal revenues.

http://www.pbs.org/newshour/making-sense/social-security-trust-fund-will-depleted-17-years-according-trustees-report/

Deficits, Debts and Unfunded Liabilities: The Consequences of Excessive Government Spending

Published on May 10, 2010

Huge budget deficits and record levels of national debt are getting a lot of attention, but this video explains that unfunded liabilities for entitlement programs are Americas real red-ink challenge. More important, this CF&P mini-documentary reveals that deficits and debt are symptoms of the real problem of an excessive burden of government spending. http://www.freedomandprosperity.org

Social Security trust fund projected to run dry by 2034

If lawmakers don’t act, Social Security’s trust fund will be tapped out in about 18 years.

That’s one takeaway from the Social Security and Medicare trustees’ annual report released Wednesday.

That doesn’t mean retirees will get nothing by 2034. It means that at that point the program will only have enough revenue coming in to pay 79% of promised benefits.

So if you’re expecting to get $2,000 a month, the program will only be able to pay $1,580.

Technically, Social Security is funded by two trust funds — one for retiree benefits and one for disability benefits.

The 2034 date is the exhaustion date for both funds when combined. But if considered separately, the old-age fund will be exhausted by 2035, after which it would be able to pay just 77% of benefits. And the disability fund will be tapped out by 2023, at which point it could only pay out 89% of promised benefits.

To make all of Social Security solvent for the next 75 years would require the equivalent of any of the following: immediately raising the Social Security payroll tax rate to 14.98% from 12.4% on the first $118,500 of wages; cutting benefits by 16%; or some combination of the two.

Medicare faces insolvency two years earlier than expected

In terms of Medicare, the trustees project that the trust fund for Part A, which covers hospital costs for seniors, will run dry by 2028. That’s two years earlier than they projected last year, due to lower than expected payroll taxes and a slower-than-estimated rate of reduction in inpatient use of hospital services.

But the exhaustion date is still 11 years later than had been projected before Congress passed the Affordable Care Act, now known as Obamacare.

By 2028, Medicare Part A would only be able to pay out 87% of expected benefits — a figure that would fall to 79% by 2043 before gradually increasing to 86% by 2090.

Medicare Part B, meanwhile, which helps seniors pay for doctor’s bills and outpatient expenses, is funded by a combination of premium payments and money from general federal revenue. The same is true of Part D, which offers prescription drug coverage. Both will be financed in full indefinitely, but only because the law requires automatic financing of it.

But their costs are growing quickly. The trustees estimate that the costs will grow to 3.5% of GDP by 2037 then to 3.8% by 2090, up from 2.1% last year.

“Social Security and Medicare remain secure in the medium-term,” said Treasury Secretary Jacob Lew. “But reform will be needed, and Congress should not wait until the eleventh hour to address the fiscal challenges given that they represent the cornerstone of economic security for seniors in our country.”

Where do the presidential candidates stand?

The country’s long-term debt is very much driven by entitlement program spending, particularly in Medicare. That’s largely because the costs for both programs are expected to grow faster than the economy for the next two decades and then stay at or near relatively high levels for years after.

So what exactly would the presumed presidential nominees do about that?

As much as he publicly laments the country’s debt, Donald Trump offers nothing in the way of substantive policy proposals to reform either Medicare or Social Security, beyond promising that he will not curb spending on them.

Instead, Trump has said he wants to recapture money from other areas of the economy to shore-up Social Security.

Meanwhile, Hillary Clinton has specified what she won’t do — e.g., raising the retirement age or cutting middle class benefits — but she doesn’t offer detailed or diverse policy prescriptions of what she would do.

For instance, she has said she wants to shore up Social Security, but then says she wants to expand benefits, which increase the program’s costs.

Her only specific solution is to ask “the highest-income Americans to pay more, including options to tax some of their income above the current Social Security cap, and taxing some of their income not currently taken into account by the Social Security system.”

Related: Moody’s: Trump’s plan would cost 3.5 million jobs

Advocates for curing Social Security’s impending shortfall have pushed for changes sooner rather than later, because the longer the country waits the more abrupt and drastic the changes need to be.

They also often call for a mix of tax increases and spending cuts to reduce how steep either have to be.

As for expanding Social Security benefits, some propose making them more generous but just for the most vulnerable populations — such as seniors living at or near the poverty line.

On Medicare, Clinton has said she would build on cost-savings initiatives created by Obamacare and allow Medicare to “negotiate for lower prices with drug and biologic manufacturers; demanding higher rebates.”

Trump has said he would repeal Obamacare, but he also supports letting Medicare negotiate for better drug prices.

That alone, however, would not save the program much money unless the Health and Human Services Secretary is given authority to legally require lower prices, according to the Committee for a Responsible Federal Budget.

http://money.cnn.com/2016/06/22/pf/social-security-medicare/index.html

Story 3: Trump’s Broken Promises and Kept Promises — Good Intentions are Not Enough — Only Results Count — Six Months And Still Waiting On The Big Promises — Videos

Trump vows to get special prosecutor to investigate Clinton

Trump Has to Turn the DOJ Loose and Indict Hillary Clinton and Remember the American Voter

Trump: I’m going to keep as many campaign promises as I can

76 of Donald Trump’s many campaign promises 2016

President Trump Advert – Promises Made, Promises Kept!

President Trump’s Promises Kept – Make America Great Again Rally in Iowa

Watch 50 Trump promises in 2 minutes

Victory After Victory In Trump’s First 6 Months

“He has Done Nothing!” CNN Panel SLAMS Trump On His First 6 Months As President

“Trump’s Lies Are INSANE!” Chris Wallace & Shep. Smith Is Fed Up With Trump

Tracking Trump’s Campaign Promises

Promise Broken: No action on Trump’s promise to sue accusers

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Trump-O-Meter Scorecard

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Promise KeptCompromisePromise BrokenStalledIn the WorksNot yet rated

Promise Promises Tracked
Promise Kept 9
Compromise 1
Promise Broken 3
Stalled 20
In the Works 38
Not yet rated 30

Tracking President Donald Trump’s campaign promises.

Promises we’ve rated recently

Eliminate Common Core

The Promise:“We’re cutting Common Core. We’re getting rid of Common Core. We’re bringing education locally.”

Update July 16th, 2017: No progress on Trump’s promise to kill Common Core

Build a safe zone for Syrian refugees

The Promise:“They should build a safe zone. Take a big piece of land in Syria and they have plenty of land, believe me. Build a safe zone for all these people, because I have a heart, I mean these people, it’s horrible to watch, But, they shouldn’t come over here. We should build a safe zone.”

Update July 14th, 2017: No clear progress on Syria safe zones

Bring back waterboarding

The Promise:“I would bring back waterboarding, and I’d bring back a hell of a lot worse than waterboarding,”

Update July 13th, 2017: Trump’s team mostly against waterboarding

Keep Guantanamo Bay Detention Center open

The Promise:“We’re going to keep, as you know, Gitmo, we’re keeping that open.”

Update July 7th, 2017: Trump committed to keeping Gitmo open

Suspend immigration from terror-prone places

The Promise:“And if people don’t like it, we’ve got to have a country folks. Got to have a country. Countries in which immigration will be suspended would include places like Syria and Libya. And we are going to stop the tens of thousands of people coming in from Syria.”

Update June 30th, 2017: Trump’s travel ban to take partial effect, administration defines ‘bona fide relationship’

Have mandatory minimum sentences for criminals caught trying to enter the United States illegally

The Promise:“On my first day in office, I am also going to ask Congress to pass ‘Kate’s Law’ – named for Kate Steinle – to ensure that criminal aliens convicted of illegal re-entry receive strong mandatory minimum sentences.”

Update June 29th, 2017: House passes bill for stricter penalties for criminal immigrants who re-enter country

Cancel all funding of sanctuary cities

The Promise:“We will end the sanctuary cities that have resulted in so many needless deaths. Cities that refuse to cooperate with federal authorities will not receive taxpayer dollars, and we will work with Congress to pass legislation to protect those jurisdictions that do assist federal authorities.”

Update June 29th, 2017: House passes bill to withhold certain federal grants from ‘sanctuary cities’

Establish a commission on radical Islam

The Promise:“One of my first acts as president will be to establish a commission on radical Islam which will include reformist voices in the Muslim community who will hopefully work with us.”

Update June 28th, 2017: Trump’s promised ‘commission on radical Islam’ doesn’t exist yet

Save the Carrier plant in Indiana

The Promise:“So here’s what’s going to happen: Within 24 hours, I’ll get a call — the head of Carrier — and he’ll say, ‘Mr. President, we’ve decided to stay in the United States. That’s what’s going to happen. 100 percent.”

Update June 27th, 2017: Carrier plant moves forward with planned job cuts

Suspend immigration from terror-prone places

The Promise:“And if people don’t like it, we’ve got to have a country folks. Got to have a country. Countries in which immigration will be suspended would include places like Syria and Libya. And we are going to stop the tens of thousands of people coming in from Syria.”

Update June 26th, 2017: U.S. Supreme Court accepts travel ban case, allows Trump’s order to partly take effect

Reverse Barack Obama’s Cuba policy

The Promise:“The president’s one-sided deal for Cuba and with Cuba benefits only the Castro regime but all the concessions that Barack Obama has granted the Castro Regime was done through executive order, which means they can be undone and that is what I intend to do unless the Castro Regime meets our demands.”

Update June 16th, 2017: Trump scales back Obama-era Cuba policies

Terminate Barack Obama’s immigration executive orders ‘immediately’

The Promise:“Immediately terminate President Obama’s two illegal executive amnesties (Deferred Action for Parents of Americans and Lawful Permanent Residents and Deferred Action for Childhood Arrivals). All immigration laws will be enforced — we will triple the number of ICE agents. Anyone who enters the U.S. illegally is subject to deportation. That is what it means to have laws and to have a country.”

Update June 16th, 2017: Trump administration rescinds memo for DAPA, keeps DACA

Create private White House veterans hotline

The Promise:“I will create a private White House hotline – that is answered by a real person 24 hours a day – to make sure that no valid complaint about the VA ever falls through the cracks. I will instruct my staff that if a valid complaint is not acted upon, then the issue be brought directly to me, and I will pick up the phone and fix it myself, if need be.”

Update June 15th, 2017: Vets’ hotline had its ‘soft launch’ on June 1

Remove existing Syrian refugees

The Promise:“I’m putting the people on notice that are coming here from Syria, as part of this mass migration, that if I win, if I win, they’re going back.”

Update June 15th, 2017: No efforts yet from Trump administration for mass deportation of Syrian refugees

Suspend immigration from terror-prone places

The Promise:“And if people don’t like it, we’ve got to have a country folks. Got to have a country. Countries in which immigration will be suspended would include places like Syria and Libya. And we are going to stop the tens of thousands of people coming in from Syria.”

Update June 12th, 2017: 9th Circuit Court of Appeals rules against Trump’s travel ban

Take no salary

“If I’m elected president, I’m accepting no salary.”

Create private White House veterans hotline

“I will create a private White House hotline – that is answered by a real person 24 hours a day – to make sure that no valid complaint about the VA ever falls through the cracks. I will instruct my staff that if a valid complaint is not acted upon, then the issue be brought directly to me, and I will pick up the phone and fix it myself, if need be.”

Enact term limits

“If I’m elected president, I will push for a constitutional amendment to impose term limits on all members of Congress.”

Impose death penalty for cop killers

“One of the first things I’d do in terms of executive order, if I win, will be to sign a strong, strong statement that would go out to the country, out to the world, that anybody killing a police man, a police woman, a police officer, anybody killing a police officer, the death penalty is going to happen,”

Appoint a special prosecutor to investigate Hillary Clinton

“I will ask, to appoint a special prosecutor. We have to investigate Hillary Clinton, and we have to investigate the investigation.”

Enact a temporary ban on new regulations

“We’re going to cancel every needless job-killing regulation and put a moratorium on new regulations until our economy gets back on its feet.”

Make no cuts to Medicare

“I’m not going to cut Social Security like every other Republican and I’m not going to cut Medicare or Medicaid.”

Invest $550 billion in infrastructure and create an infrastructure fund

 “The Trump Administration seeks to invest $550 billion to ensure we can export our goods and move our people faster and safer.”

Make no cuts to Social Security

“I’m not going to cut Social Security like every other Republican and I’m not going to cut Medicare or Medicaid.”

Make no cuts to Medicaid

“I’m not going to cut Social Security like every other Republican and I’m not going to cut Medicare or Medicaid.”

Eliminate Common Core

“We’re cutting Common Core. We’re getting rid of Common Core. We’re bringing education locally.”

Impose a hiring freeze on federal employees

“A hiring freeze on all federal employees to reduce federal workforce through attrition (exempting military, public safety, and public health).”

Slash federal regulations

“A requirement that for every new federal regulation, two existing regulations must be eliminated.”

Place lifetime ban on White House officials lobbying for foreign government

“I’m going to issue a lifetime ban against senior executive branch officials lobbying on behalf of a foreign government and I’m going to ask Congress to pass a campaign finance reform that prevents registered foreign lobbyists from raising money in American elections and politics.”

Place lifetime ban on foreign lobbyists raising money for American elections

“A complete ban on foreign lobbyists raising money for American elections.”

Defund Planned Parenthood

“I would defund it because of the abortion factor, which they say is 3 percent. I don’t know what percentage it is. They say it’s 3 percent. But I would defund it, because I’m pro-life.”

Approve the Keystone XL project and reap the profits

“I want it built, but I want a piece of the profits.”

Achieve energy independence

“Under my presidency, we will accomplish a complete American energy independence. Complete. Complete.”

Nominate someone from his list of justices to replace Antonin Scalia

“I am looking to appoint judges very much in the mold of Justice Scalia. I’m looking for judges — and I’ve actually picked 20 of them so that people would see.”

Expand mental health programs

“We need to reform our mental health programs and institutions in this country.”

Expand national right to carry to all 50 states

“That’s why I have a concealed carry permit and why tens of millions of Americans do, too. That permit should be valid in all 50 states.”

Add additional federal investment of $20 billion toward School Choice

“Immediately add an additional federal investment of $20 billion towards school choice.”

Eliminate wasteful spending in every department

“We are going to ask every department head and government to provide a list of wasteful spending projects that we can eliminate in my first 100 days.”

Open up libel laws

“I’m going to open up our libel laws so when they write purposely negative and horrible and false articles, we can sue them and win lots of money.”

Ensure funding for historic black colleges

“My plan will also ensure funding for historic black colleges and universities, more affordable two- and four-year college and support for trade and vocational education.”

Cancel global warming payments to the United Nations

“We’re going to put America first. That includes canceling billions in climate change spending for the United Nations.”

Renegotiate the Iran deal

“This deal if I win will be a totally different deal. This will be a totally different deal.”

Build a safe zone for Syrian refugees

“They should build a safe zone. Take a big piece of land in Syria and they have plenty of land, believe me. Build a safe zone for all these people, because I have a heart, I mean these people, it’s horrible to watch, But, they shouldn’t come over here. We should build a safe zone.”

Close parts of the Internet where ISIS is

Speaking of ISIS, “We’re losing a lot of people because of the Internet and we have to do something. We have to go see Bill Gates and a lot of different people that really understand what’s happening. We have to talk to them, maybe in certain areas closing that Internet up in some way. Somebody will say, ‘oh, freedom of speech, freedom of speech.’ These are foolish people… we’ve got to maybe do something with the Internet because they (ISIS) are recruiting by the thousands, they are leaving our country and then when they come back, we take them back.”

End the defense sequester

“As soon as I take office I will ask Congress to fully eliminate the defense sequester and will submit a new budget to rebuild our military. It is so depleted. We will rebuild our military.”

Keep Guantanamo Bay Detention Center open

“We’re going to keep, as you know, Gitmo, we’re keeping that open.”

Bring back waterboarding

“I would bring back waterboarding, and I’d bring back a hell of a lot worse than waterboarding,”

Develop a plan to defeat ISIS in 30 days

“We are going to convene my top generals and give them a simple instruction. They will have 30 days to submit to the Oval Office a plan for soundly and quickly defeating ISIS. We have no choice.”

Establish a commission on radical Islam

“One of my first acts as president will be to establish a commission on radical Islam which will include reformist voices in the Muslim community who will hopefully work with us.”

Move U.S. Embassy in Tel Aviv to Jerusalem

“We will move the American embassy to the eternal capital of the Jewish people, Jerusalem.”

Reverse Barack Obama’s Cuba policy

“The president’s one-sided deal for Cuba and with Cuba benefits only the Castro regime but all the concessions that Barack Obama has granted the Castro Regime was done through executive order, which means they can be undone and that is what I intend to do unless the Castro Regime meets our demands.”

Cancel the Paris climate agreement

“We’re going to cancel the Paris Climate Agreement and stop all payments of U.S. tax dollars to U.N. global warming programs.”

Increase the size of the U.S. Army to 540,000 active duty soldiers

“We will build an active army around 540,000 as the army’s Chief of Staff has said he needs desperately and really must have to protect our country.”

Rebuild the Marine Corps to 36 battalions

“We will build a Marine Corps based on 36 battalions, which the Heritage Foundation notes is the minimum needed to deal with major contingencies – we have 23 now.”

Provide the U.S. Air Force with 1,200 fighter aircraft

“We will build an Air Force of at least 1,200 fighter aircraft, which the Heritage Foundation again has shown to be needed to execute current missions.”

Rebuild the U.S. Navy toward the goal of 350 ships

“We will build a Navy of 350 surface ships and submarines as recommended by the bipartisan National Defense Panel.”

Call for an international conference to defeat ISIS

“As president, I will call for an international conference focused on this goal. We will work side-by-side with our friends in the Middle East, including our greatest ally, Israel.”

Reverse China’s entry into the World Trade Organization

“That means reversing two of the worst legacies of the Clinton years…First, the North American Free Trade Agreement, or NAFTA. Second, China’s entry into the World Trade Organization.”

Ask countries we protect to pay more for joint defense

 “I think NATO’s great. But it’s got to be modernized. And countries that we’re protecting have to pay what they’re supposed to be paying.”

Guarantee 6-week paid leave

“We can provide six weeks of paid maternity leave to any mother with a newborn child whose employer does not provide the benefit.”

Repeal Obamacare

“Real change begins with immediately repealing and replacing the disaster known as Obamacare.”

Change the vaccination schedule for children

“I am totally in favor of vaccines. But I want smaller doses over a longer period of time” to avoid possible links to Autism.

Get Congress to allow health insurance across state lines

“The insurance companies are getting rich off health care and health insurance and everything having to do with health. We’re going to end that. We’re going to take out the artificial boundaries, the artificial lines. We’re going to get a plan where people compete, free enterprise.”

Allow individuals to deduct health care insurance premiums from taxes

“Allow individuals to fully deduct health insurance premium payments from their tax returns under the current tax system.”

Create a health savings account

“Allow individuals to use Health Savings Accounts (HSAs). Contributions into HSAs should be tax-free and should be allowed to accumulate.”

Require price transparency from health care providers

“Require price transparency from all health care providers, especially doctors and health care organizations like clinics and hospitals.”

Administer Medicaid through block grants

“Our elected representatives in the House and Senate must … block-grant Medicaid to the states. Nearly every state already offers benefits beyond what is required in the current Medicaid structure.”

Allow free access to the drug market

“Remove barriers to entry into free markets for drug providers that offer safe, reliable and cheaper products.”

Increase veterans’ health care

“We are going to make sure every veteran in America has the choice to seek care at the Veterans Administration or to seek private medical care paid for by our government.”

Build a wall, and make Mexico pay for it

“I would build a great wall, and nobody builds walls better than me, believe me, and I’ll build them very inexpensively. I will build a great great wall on our southern border and I’ll have Mexico pay for that wall.”

Remove criminal undocumented immigrants

“A Trump administration will stop illegal immigration, deport all criminal aliens, and save American lives.”

Remove all undocumented immigrants

“We have at least 11 million people in this country that came in illegally. They will go out. They will come back — some will come back, the best, through a process. They have to come back legally. They have to come back through a process, and it may not be a very quick process, but I think that’s very fair, and very fine.”

Cancel all funding of sanctuary cities

“We will end the sanctuary cities that have resulted in so many needless deaths. Cities that refuse to cooperate with federal authorities will not receive taxpayer dollars, and we will work with Congress to pass legislation to protect those jurisdictions that do assist federal authorities.”

Establish a ban on Muslims entering the U.S.

“Donald J. Trump is calling for a total and complete shutdown of Muslims entering the United States until our country’s representatives can figure out what the hell is going on.”

Suspend immigration from terror-prone places

“And if people don’t like it, we’ve got to have a country folks. Got to have a country. Countries in which immigration will be suspended would include places like Syria and Libya. And we are going to stop the tens of thousands of people coming in from Syria.”

Limit legal immigration

“We will reform legal immigration to serve the best interests of America and its workers, the forgotten people. Workers. We’re going to take care of our workers.”

Use U.S. steel for infrastructure projects

“A Trump Administration will also ensure that we start using American steel for American infrastructure.”

Have mandatory minimum sentences for criminals caught trying to enter the United States illegally

“On my first day in office, I am also going to ask Congress to pass ‘Kate’s Law’ – named for Kate Steinle – to ensure that criminal aliens convicted of illegal re-entry receive strong mandatory minimum sentences.”

Remove existing Syrian refugees

“I’m putting the people on notice that are coming here from Syria, as part of this mass migration, that if I win, if I win, they’re going back.”

End birthright citizenship

“End birthright citizenship.”

Increase visa fees

“Increase fees on all border crossing cards – of which we issue about 1 million to Mexican nationals each year (a major source of visa overstays).”

Stop TPP

“I’m going to issue our notification of intent to withdraw from the Trans-Pacific Partnership.”

Renegotiate NAFTA

“A Trump administration will renegotiate NAFTA and if we don’t get the deal we want, we will terminate NAFTA and get a much better deal for our workers and our companies. 100 percent.”

Raise tariffs on goods imported into the U.S.

“Any country that devalues their currency to take unfair advantage of the United States and all of its companies that can’t compete will face tariffs and taxes to stop the cheating.”

Declare China a currency manipulator

“Instruct the Treasury Secretary to label China a currency manipulator.”

Adopt the penny plan

“The ‘Penny Plan’ would reduce non-defense, non-safety net spending by one percent of the previous year’s total each year. Over 10 years, the plan will reduce spending (outlays) by almost $1 trillion without touching defense or entitlement spending.”

Grow the economy by 4 percent a year

“We’re bringing it (the GDP) from 1 percent up to 4 percent. And I actually think we can go higher than 4 percent. I think you can go to 5 percent or 6 percent.”

Save the Carrier plant in Indiana

“So here’s what’s going to happen: Within 24 hours, I’ll get a call — the head of Carrier — and he’ll say, ‘Mr. President, we’ve decided to stay in the United States. That’s what’s going to happen. 100 percent.”

Hire American workers first

“Establish new immigration controls to boost wages and to ensure that open jobs are offered to American workers first.”

Replace J-1 Visa with Inner City Resume Bank

“The J-1 visa jobs program for foreign youth will be terminated and replaced with a resume bank for inner city youth provided to all corporate subscribers to the J-1 visa program.”

Eliminate the federal debt in 8 years

“We’ve got to get rid of the $19 trillion in debt. … Well, I would say over a period of eight years. And I’ll tell you why.”

Sue his accusers of sexual misconduct

“The events never happened. Never. All of these liars will be sued after the election is over.”

Not take vacations

“I would not be a president who took vacations. I would not be a president that takes time off.”

Release his tax returns after an audit is completed

“I’m under a routine audit and it’ll be released, and as soon as the audit is finished it will be released.”

Won’t say ‘Happy Holidays’

“If I become president, we’re going to be saying Merry Christmas at every store. You can leave (happy holidays) at the corner. …Other religions can do what they want.”

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The Pronk Pops Show 925, Story 1: Republicans Rush To Pass Repeal and Replace Obamacare Before August Recess with Pence, Cruz and McConnell Leading The Way — Videos — Story 2: Total Repeal of Obamacare Requires Total Repeal of All Obamacare Regulations Including Requiring Guaranteed Issue In Individual Health Insurance Market For Those With Preexisting Conditions, Community Rating Premiums and 10 Essential Health Care Benefits as Well As Repeal of The Individual and Employer Mandates and All Obamacare-Related Taxes– Address Individuals With Preexisting Conditions by State Special Risk Pools Insurance Coverage With State Subsidies Only and No Federal Subsidies — Otherwise Guaranteed Failure Just Like Obamacare Due To Adverse Selection — Leading To Single Government Payer Health Care System — Total Repeal of Obamacare Now Or Replace Your Representative and Senators Both Democrat and Republican Next November — It’s Now Or Never (O Sole Mio) — Videos

Posted on July 10, 2017. Filed under: American History, Biology, Blogroll, Breaking News, Communications, Computer, Congress, Countries, Donald J. Trump, Donald J. Trump, Donald J. Trump, Donald Trump, Donald Trump, Education, Elections, Employment, Freedom of Speech, Government, Government Spending, Health Care, Health Care Insurance, History, House of Representatives, Human, Insurance, Investments, Language, Law, Life, Media, Medical, Medicine, Mike Pence, National Interest, News, People, Philosophy, Photos, Politics, Polls, President Barack Obama, President Trump, Progressives, Rand Paul, Rand Paul, Raymond Thomas Pronk, Rule of Law, Science, Security, Senate, Success, Taxation, Taxes, Ted Cruz, Ted Cruz, United States of America, Videos, Wealth, Wisdom | Tags: , , , , , , , , , , , |

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Pronk Pops Show 891,  May 11, 2017

Pronk Pops Show 890,  May 10, 2017

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Pronk Pops Show 888,  May 8, 2017

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Pronk Pops Show 884,  May 1, 2017

Pronk Pops Show 883 April 28, 2017

Pronk Pops Show 882: April 27, 2017

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Story 1: Republicans Rush To Pass Repeal and Replace Obamacare Before August Recess with Pence, Cruz and McConnell Leading The Way — Videos —

Ronald Reagan speaks out on Socialized Medicine – Audio

Is the GOP plan to replace ObamaCare dead?

Vice President Pence ‘s Obamacare Listening Session with Ohio Small Business Owners

Trump’s push to replace Obamacare in trouble as Congress returns from recess

Sen. Cruz on ‘Face the Nation’ – July 9, 2017

Sen Mike Lee on the push to repeal ObamaCare

Lawmakers respond to Senate health care proposal

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

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

I won’t vote to keep ObamaCare: Rand Paul

Coolidge: The Best President You Don’t Know

Amity Shlaes on Coolidge’s life, ideas, and success in bringing about low taxes and small government

Uncommon Knowledge: The Great Depression with Amity Shlaes

Amity Shlaes: Calvin Coolidge, Better Than Reagan?

Archie Bunker on Democrats

 

Trump prods Congress to pass stalled healthcare overhaul

By Susan Cornwell and Ian Simpson | WASHINGTON

President Donald Trump on Monday prodded the Republican-led U.S. Congress to pass major healthcare legislation but huge obstacles remained, with a senior lawmaker saying the Senate was unlikely to take up the stalled bill until next week.

The House of Representatives approved its healthcare bill in May but the Senate’s version appeared to be in growing trouble as lawmakers returned to Washington from a week-long recess.

“I cannot imagine that Congress would dare to leave Washington without a beautiful new HealthCare bill fully approved and ready to go!” Trump wrote on Twitter, referring to the seven-year Republican quest to dismantle Democratic former President Barack Obama’s signature legislative achievement.

Lawmakers are set to take another recess from the end of July until Sept. 5.

Repealing and replacing the Affordable Care Act, dubbed Obamacare, was a central campaign pledge for the Republican president. But Senate Republican leaders have faced a revolt within their ranks, with moderate senators uneasy about the millions of Americans forecast to lose their medical insurance under the legislation and hard-line conservatives saying it leaves too much of Obamacare intact.

They were struggling to find a compromise that could attract the 50 votes needed for passage in a chamber Republicans control by a 52-48 margin, with Vice President Mike Pence casting a potential tie-breaking vote in the face of unified Democratic opposition.

No. 2 Senate Republican John Cornyn said Republicans could release an updated draft of their bill by the end of the week and told Fox News that senators could vote as early as Tuesday or Wednesday of next week.

 
U.S. President Donald Trump waves as walks on the South Lawn of the White House upon his return to Washington, U.S., from the G20 Summit in Hamburg, July 8, 2017. REUTERS/Yuri Gripas
“We’re going to continue to talk and listen and exchange ideas on how we can continue to make improvements,” Cornyn said on the Senate floor.

Also speaking on the Senate floor, Majority Leader Mitch McConnell gave no timetable for the bill. McConnell signaled his determination to keep working and said mere legislative “band-aids” would not suffice.

Senate Democratic leader Chuck Schumer said he had written to McConnell urging a bipartisan effort to stabilize the health insurance market, noting that McConnell had been quoted recently as saying Congress would need to shore up that market if lawmakers fail to repeal Obamacare.

The U.S. Centers for Medicare and Medicaid Services issued data on Monday showing a 38 percent decrease in applications by insurers to sell health plans in the Obamacare individual market in 2018 compared to this year. The agency said insurers continue to flee the exchanges, the online marketplace for health insurance set up under Obamacare.

MORE AMERICANS UNINSURED

With uncertainty hanging over the healthcare system, the percentage of U.S. adults without health insurance grew in the April-May-June period to 11.7 percent, up from 11.3 percent in the first quarter of 2017, according to Gallup-Sharecare Well-Being Index figures released on Monday. That translates into nearly 2 million more Americans who have become uninsured.

Scores of protesters voiced opposition to the legislation outside the Republican National Committee headquarters and at the offices of some Republican lawmakers including House of Representatives Speaker Paul Ryan, chanting slogans including “Trumpcare kills” and “Healthcare is a human right.”

U.S. Capitol Police said in a statement 80 people were arrested at 13 locations in House and Senate office buildings after they refused “to cease and desist with their unlawful demonstration activities.”

Republicans criticize Obamacare as a costly government intrusion into the healthcare system. Democrats call the Republican legislation a giveaway to the rich that would hurt millions of the most vulnerable Americans.

The Senate legislation would phase out the Obamacare expansion of the Medicaid health insurance program for the poor and disabled, sharply cut federal Medicaid spending beginning in 2025, repeal most of Obamacare’s taxes, end a penalty on Americans who do not obtain insurance and overhaul Obamacare’s subsidies to help people buy insurance with tax credits.

Leerink Partners analyst Ana Gupte said investors remained in a “wait-and-see” mode regarding the Senate legislation.

(For a graphic on who’s covered under Medicaid, click bit.ly/2u3O2Mu)

(Additional reporting by Susan Heavey, Eric Beech and Doina Chiacu; Writing by Will Dunham; Editing by Tom Brown)

http://www.reuters.com/article/us-usa-politics-healthcare-idUSKBN19V0YP

 

The Health 202: Cruz picks government health care subsidies as lesser of two evils

 July 10 at 9:03 AM
THE PROGNOSIS

Even conservatives acknowledge that the sickest Americans need help in paying their own steep insurance costs. In an ironic twist, some would rather have the government make up the difference rather than spreading expenses among the healthy.

Health insurance markets are so complicated, and the policy around them is so complex and intertwined, that politicians don’t always land ideologically on the issue where you’d think. Just look at how GOP Sen. Ted Cruz of Texas is trying to change the Obamacare overhaul that Senate Republicans will try to pass in the next three weeks before August recess. The former presidential candidate last week touted his ideas and on the Sunday shows yesterday, my colleague Sean Sullivan reports.

Cruz’s so-called “Consumer Freedom Amendment” — which conservatives have been rallying around as the revision they most want — would essentially free the healthiest Americans from covering the costs of the sickest Americans. But the sick would be even more heavily reliant on federal assistance as a result.

“You would likely see some market segmentation” Cruz told Vox last month. “But the exchanges have very significant federal subsidies, whether under the tax credits or under the stabilization funds.”

The Cruz amendment, which is being scored by the Congressional Budget Office as one of several potential changes to the Senate health-care bill, would result in segmenting the individual insurance market into two groups, experts say. Under it, insurers could sell cheaper, stripped-down plans free of Obamacare coverage requirements like essential health benefits or even a guarantee of coverage. These sparser plans would appeal to the healthiest Americans, who would gladly exchange fewer benefits for lower monthly premiums.

But insurers would also have to sell one ACA-compliant plan. The sickest patients would flock to these more expansive and expensive plans because they need more care and medications covered on a day-to-day basis. As a result, premiums for people with expensive and serious medical conditions like diabetes or cancer would skyrocket because all those with such serious conditions would be pooled together.

“The question is, would there be a premium spiral on the ACA-complaint market?” said Cori Uccello, a senior health fellow with the American Academy of Actuaries. “Can they ever price those premiums adequately if it’s just going to be the sickest people in there?”

It’s true that government subsidies — which under the Senate plan would be available to those earning up to 350 percent of the federal poverty level — would be even more crucial in order for these sicker Americans to afford the cost of their coverage, as would an extra infusion of federal “stabilization” money for states to cover their steep expenses.

Cruz hasn’t laid out all the details of how his amendment would work, nor is it even certain Senate Majority Leader Mitch McConnell (R-Ky.) will accept it as part of his health-care bill. But should it be adopted, and the Senate bill ultimately made law, the Cruz amendment would significantly shift how the individual insurance market operates.

But in Cruz’s mind, it would solve one of the biggest problems with Obamacare: that it robs the healthy to pay for the sick. He’s spent the last week pitching it as the legislative solution for passing the Senate bill.

“I think really the consumer freedom option is the key to bringing Republicans together and getting this repeal passed,” Cruz said on ABC yesterday.

Of course, everyone paying into the system for those who most need care is the way insurance is fundamentally supposed to work. The ACA requires insurers to offer a wider ranger of benefits in plans sold to everyone regardless of their health status. But to Cruz and his compatriots, requiring healthier people to buy cushier plans than they want or need is an abridgment of personal freedom and oversteps federal regulatory authority. So they’re more worried at the moment about rolling back more ACA regulations and less worried about federal spending.

“I think for conservatives it’s become a question of picking their poison,” Larry Levitt, president of the Kaiser Family Foundation, told me. “Is it government spending, or regulation? It’s almost like with this amendment, Sen. Cruz is acknowledging the need for a government entitlement program.”

Conservative groups that want a much fuller Obamacare repeal than the Senate bill provides have been jumping on the Cruz bandwagon, including Club for Growth, FreedomWorks and Tea Party Patriots.

.@SenTedCruz@SenMikeLee ‘Consumer Choice’ amendment, aka individual Obamacare Opt Out, is real step toward . We Support it!

From Tea Party Patriots founder Jenny Beth Martin:

If the Senate adopts the Cruz-Lee Amdt to the health care bill, @TPPatriots will be more likely to support the bill http://www.teapartypatriots.org/news/tea-party-patriots-signals-support-for-cruz-lee-amendment-to-senate-health-care-bill/ 

Photo published for Tea Party Patriots Signals Support for Cruz-Lee Amendment to Senate Health Care Bill

Tea Party Patriots Signals Support for Cruz-Lee Amendment to Senate Health Care Bill

Atlanta, GA – Tea Party Patriots President and co-founder Jenny Beth Martin released the following statement today regarding the amendment to the Senate health care bill offered by Senators Ted Cruz…

teapartypatriots.org

On the flip side, the Cruz amendment could help kill the Senate health-care bill in the end because it’s prompting fears among moderates (whose votes are also needed to pass the legislation) that patients with preexisting conditions could be harmed.

“I think that reopens an issue that I can’t support, that it would make it too difficult for people with preexisting conditions to get coverage,” Sen. Shelley Moore Capito (R-W.Va.) told the Charleston Gazette-Mail.

Cruz has said the Senate bill’s $100 billion stabilization fund for states could help cover costs for the resulting pricier coverage for those with preexisting conditions under his amendment. And to parry concerns about the increased federal spending, which to some is more than ironic coming from Cruz? The  talking point Capitol Hill aides and conservative wonks are adopting: Directly subsidizing costs for those with preexisting conditions is a more “honest” approach by the government than forcing healthy people to indirectly pay for their care by buying comprehensive coverage.

“If you’re going to have a subsidy, have it come directly from the taxpayer and call it a subsidy rather than try to dragoon people to do the government’s work,” said Chris Jacobs, a former GOP Hill staffer and founder of Juniper Research Group.

“It’s more honest and fair to have the government than to have healthy, middle-class families pay for it,” Conn Carroll, a spokesman for Sen. Mike Lee (R-Utah) said.

A co-sponsor of Cruz’s amendment, Lee is insisting it be added to the Senate bill before he’ll vote for it. Sens. Rand Paul of Kentucky and Ron Johnson of Wisconsin have sent similar signals. And remember — if more than two Republicans defect, the measure would be sunk in the Senate and the GOP effort to repeal-and-replace Obamacare would most likely meet a bitter end.

Some exciting news over at The Daily 202 from my colleague James Hohmann, whose newsletter makes its debut on Amazon Echo devices and Google Home as a flash briefing called “The Daily 202’s Big Idea.” Every morning, you can listen to James analyze one of the day’s most important political stories, along with three headlines you need to know. To learn how to add The Daily 202’s Big Idea to your flash briefings on your Echo device or Google Home, visit this page. You can also get the briefing on Apple Podcasts or wherever you get your podcasts.

https://www.washingtonpost.com/news/powerpost/paloma/the-health-202/2017/07/10/the-health-202-cruz-picks-government-health-care-subsidies-as-lesser-of-two-evils/59611958e9b69b7071abcae4/?utm_term=.7137a797b4cf

GOP, White House Plot ‘Urgent Blitz’ For Repeal Votes | The Last Word | MSNBC

Story 2: Total Repeal of Obamacare Requires Total Repeal of All Obamacare Regulations Including Requiring Guaranteed Issue In Individual Health Insurance Market For Those With Preexisting Conditions, Community Rating Premiums and 10 Essential Health Care Benefits as Well As Repeal of The Individual and Employer Mandates and All Obamacare-Related Taxes– Address Individuals With Preexisting Conditions by State Special Risk Pools Insurance Coverage With State Subsidies Only and No Federal Subsidies — Otherwise Guaranteed Failure Just Like Obamacare Due To Adverse Selection — Leading To Single Government Payer Health Care System — Total Repeal of Obamacare Now Or Replace Your Representative and Senators Both Democrat and Republican Next November — It’s Now Or Never (O Sole Mio) — Videos

Rush Limbaugh Podcast 7/11/17 – Exclusive: Vice President Mike Pence Calls the Show

AHCA Myth No. 1: People with Pre-existing Conditions Will Lose Coverage

Fox News host says coverage for preexisting conditions is a ‘luxury’

Dr. Siegel breaks down the pre-existing conditions challenge

The Pre-Existing Condition Scam

Should pre-existing conditions be left to the states?

Debate over pre-existing conditions stalling health-care reform?

Obamacare Replacement, Hill’s Blame Game, Prince Phil Says No Mas and the World Slides Into Insanity

Molyneux and Schiff For Liberty – Discrimination and Pre-Existing Conditions in Health Insurance

ObamaCare Revealed – Pre-Existing Conditions Coverage

Why Exactly Trump’s Healthcare Plan Failed

We Now Have Proof Obamacare Was Designed to Fail… and Here’s Why

Why Is Healthcare So Expensive?

Single-Payer Health Care: America Already Has It

Big Government Kills Small Businesses

Are You on the Wrong Side of History?

Socialism Makes People Selfish

Democratic Socialism is Still Socialism

Elvis – It’s Now Or Never (O Sole Mio)

 

 

It’s Now or Never
It’s now or never,
Come hold me tight
Kiss me my darling,
Be mine tonight
Tomorrow will be too late,
It’s now or never
My love won’t wait.
When I first saw you
With your smile so tender
My heart was captured,
My soul surrendered
I’d spend a lifetime
Waiting for the right time
Now that your near
The time is here at last.
It’s now or never,
Come hold me tight
Kiss me my darling,
Be mine tonight
Tomorrow will be too late,
It’s now or never
My love won’t wait.
Just like a willow,
We would cry an ocean
If we lost true love
And sweet

 

FACT VERSUS FEAR: THE AHCA AND PRE-EXISTING CONDITIONS

On May 4, 2017, the House of Representatives passed the American Health Care Act (AHCA), a bill to repeal and replace many provisions of the Affordable Care Act (ACA). Immediately following the vote, misinformation about the bill began spreading like wildfire, stoking fears and outrage. The issue which seems to be getting the most attention is the potential impact this legislation could have on people with pre-existing conditions. However, as the legislation now moves to the Senate for further consideration and amendment, it is important that all stakeholders be well informed, and understand what the legislation actually says and who may realistically be impacted by any possible changes to current law.

  • The number of people in the U.S. with a condition that would likely qualify as pre-existing is not easily known, primarily because there is not a specific, pre-determined list of conditions. Estimates vary depending on how one defines “pre-existing.”
  • Even the range included in a recent report from the Department of Health and Human Services varied by a margin of more than 2:1, from between 61 million to 133 million people.[1] That said, it is likely that approximately as many as a quarter of Americans, and possibly more, have a pre-existing health condition, making it understandable why some are concerned.
  • As the AHCA is currently written, the only people who could be charged a premium based on their health status are those with a pre-existing condition who are not enrolled in a large group health plan, are also living in a state that obtains a waiver, and have let their insurance lapse in the past year for 63 days or more. In this case, the increased premium would only be allowed for one year. Further, no one may be denied insurance because of a pre-existing condition.

Background

Before passage of the ACA, most laws pertaining to the regulation of the individual health insurance market were passed at the state level and could vary widely from one state to another. The McCarran-Ferguson Act of 1945 provided states primary responsibility for regulating the business of insurance.

The Employee Retirement Income Security Act of 1974 (ERISA) imposed federal standards on certain types and with respect to certain provisions of large group (employer-sponsored) health plans, some of which supersede state law.[2] Among the provisions included in ERISA is a requirement that plans be offered on a guaranteed-issue basis, meaning that insurers are prohibited from denying coverage to the group based on medical claims history; though, the policy may be medically underwritten, meaning the premiums are based on the insured’s health status.

In 1996, the Health Insurance Portability and Accountability Act (HIPAA) was passed and imposed additional federal health insurance standards across the individual, small group, and large group markets. In response to concerns of “job-lock”—the fear that leaving a job could result in the inability to regain health insurance if an individual had a pre-existing condition—HIPAA required all states to guarantee renewability of health insurance coverage to anyone who had creditable coverage for the past 18 months, with no more than a 63-day gap in coverage during that time.[3] However, while insurers were required to renew an individual’s policy from one year to the next, they were still not prohibited from medically underwriting individuals. Thus, some individuals found that while a plan was still technically available to them, the premium may have effectively priced them out of the market. Even those without a pre-existing condition may have found the cost of insurance to be significantly higher without the added employer contribution and tax advantage that such plans receive, which could make maintaining coverage, and HIPAA eligibility, more difficult.

Very few states previously had guarantee issue or renewability requirements or other protections for individuals not covered by HIPAA.[4] Most states permitted insurers to impose pre-existing condition exclusions, in which a pre-existing condition could be used to deny coverage altogether, or would not be covered by an individual’s new insurance policy for at least a certain amount of time, if not indefinitely. Varying “look-back” periods were also prevalent, which regulated the amount of time during which the insurer may check an individual’s claims history to make such a determination.

Current Law

The ACA attempted to mitigate these issues by imposing federal guaranteed issue requirements paired with community rating, which prohibits medical underwriting, across all health insurance markets. For many, these protections became the most important provisions of the ACA. However, there are economic consequences associated with such protections; primarily, higher average premiums in the individual market and increased spending by federal taxpayers. Multiple risk mitigation programs were included in order to help subsidize the cost of insuring high-risk, high-cost individuals, but the funding has not been sufficient. Insurers continue to lose money in the individual market, despite tens of billions of dollars in federal payments each year. In fact, many insurers have found the markets to be so unprofitable due to the many enhanced regulations, that they have decided they can no longer participate in the individual market in many states.[5]

The AHCA

The AHCA, passed by the House of Representatives on May 4, would repeal and replace many provisions of the ACA. One of the ACA’s most well-known provisions, the individual mandate which requires everyone to obtain health insurance, would be repealed (practically speaking, though not technically) and replaced with a continuous coverage provision.[6] These two policies are similar. The individual mandate imposes an annual penalty for not being insured equal to the greater of $695 per adult or 2.5 percent of household income.[7] The continuous coverage provision in this legislation would, instead of federally mandating that everyone buy insurance, incentivize individuals to remain insured by allowing for the imposition of a 30 percent premium surcharge for one year on individuals who signed up for coverage if they were uninsured for more than two months in the previous year.[8] After paying the surcharge for one year, individuals would return to paying regular community-rated premiums.

One provision that would not be repealed is the federal guaranteed issue requirement; insurers in every state would still be prohibited from denying insurance coverage to anyone on the basis of a pre-existing condition. In no circumstance would this protection be denied, though it seems much confusion surrounding this protection has stemmed from the adoption of several amendments to the underlying legislation.

The first relevant amendment is one that was negotiated by Rep. Mark Meadows (R-NC), on behalf of the Freedom Caucus. This amendment includes a provision pertaining to the “essential health benefits” established by the ACA—ten categories of care which are now required to be covered under every health insurance plan. The amendment would permit states, rather than the federal government, to define the EHB standards for themselves beginning in 2018.[9] However, this provision was ultimately struck.

A second amendment was offered by Rep. Tom MacArthur (R-NJ) to address concerns that states would drastically reduce benefit requirements. The MacArthur amendment reinstates the federal EHB standards, but would allow states to apply for waivers to a number of provisions, under certain conditions. Waivers would be permitted for the following: beginning in 2018, a change in age-rating restrictions (which determine how much more an insurer may charge an older person relative to a younger person); beginning in 2019, changes to the community rating provisions, which prohibit insurers from medically underwriting individuals; and, beginning in 2020, changes to the federal EHB standards, permitting states to set their own.

Any state seeking to obtain a community rating waiver must first have in place a program to help high-risk individuals enroll in coverage or a program providing incentives to insurers to enter the market and stabilize premiums, or an invisible risk-sharing program, as defined by the Schweikert/Palmer amendment.[10] All of these programs would be at least partially funded by the $138 billion provided over the next ten years by the Patient and State Stability Fund created by AHCA. The state must also specify how the waiver it is requesting would assist in: reducing average premiums in the state, increasing the number insured, stabilizing the health insurance market, stabilizing premiums for people with pre-existing conditions, or increasing plan choice in the state. If a state demonstrates it has met these conditions and obtains such a waiver, then it may permit insurers to waive the community rating protections, though only for individuals who have not maintained continuous coverage (save for the 63-day allowance) seeking to enroll in coverage in the individual and small group markets. In other words, individuals who would otherwise face a 30 percent surcharge as a result of not maintaining continuous coverage, would instead be medically underwritten for one year. However, under no circumstance may the gender rating protections be waived; insurers would continue to be prohibited from charging different rates based on whether an individual is a male or female.

Thus, the only people who could be charged a premium based on their health status are those with a pre-existing condition, not enrolled in a large group health plan, living in a state that obtains a waiver, who have let their insurance lapse in the past year for 63 days or more, and then only for one year. All others would continue to be protected by the community rating provisions currently in place under the ACA. Further, no one could be denied coverage because of the existence of a pre-existing condition, or even face a lock-out period.

Conclusion

The AHCA would not provide for the return to the status quo prior to the ACA. It is unlikely that many Americans will be impacted by the provisions of the MacArthur amendment. Finally, the AHCA must still be passed by the Senate and is likely to undergo significant reforms before it does, in which case, the legislation would again have to be passed by the House.

 

[1] https://aspe.hhs.gov/system/files/pdf/255396/Pre-ExistingConditions.pdf

[2] https://www.nahu.org/consumer/GroupInsurance.cfm

[3] There are some exceptions to the guaranteed renewability requirements.

[4] http://www.ncsl.org/research/health/individual-health-insurance-in-the-states.aspx

[5] http://kff.org/health-reform/issue-brief/2017-premium-changes-and-insurer-participation-in-the-affordable-care-acts-health-insurance-marketplaces/

[6] Technically, the mandate would not be repealed because legislative rules prohibit such a change through the reconciliation process, but the applicable penalty would be set to $0, rendering the mandate moot.

[7] https://www.healthcare.gov/fees/fee-for-not-being-covered/

[8] The continuous coverage provisions which match the 63-day rule of the HIPAA requirements.

[9] https://rules.house.gov/sites/republicans.rules.house.gov/files/115/policymngr-amdt.pdf

[10] https://rules.house.gov/sites/republicans.rules.house.gov/files/115/AHCA/Palmer-Schweikert%20Amendment.pdf

Read more: https://www.americanactionforum.org/insight/fact-versus-fear-ahca-pre-existing-conditions/#ixzz4mSiu1KRn
Follow us: @AAF on Twitter

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

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Pronk Pops Show 856: March 20, 2017

Pronk Pops Show 855: March 10, 2017

Pronk Pops Show 854: March 9, 2017

Pronk Pops Show 853: March 8, 2017

Pronk Pops Show 852: March 6, 2017

Pronk Pops Show 851: March 3, 2017

Pronk Pops Show 850: March 2, 2017

Pronk Pops Show 849: March 1, 2017

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

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National Debt Clock 

http://www.usdebtclock.org/

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

 

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Image result for Per capita health care expenditures by country 2015

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Judy Holliday – The Party’s Over

Judy Holliday The Party’s Over Lyrics

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

It’s time to wind up

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

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

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

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

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

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

Should Republicans Punt On Health Care Reform?

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

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

I won’t vote to keep ObamaCare: Rand Paul

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

Republicans delay Senate health care vote

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

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

Milton Friedman – Collectivism

Milton Friedman on universal health care

Milton Friedman – The Social Security Myth

Milton Friedman – The Welfare Establishment

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

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

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

Milton Friedman – Why Tax Reform Is Impossible

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

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

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

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

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

Milton Friedman – Morality & Capitalism

Lacking enough GOP votes, Senate pushes back health bill

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

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

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

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

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

Republicans have one major problem on Obamacare

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

Is Obamacare Working? The Affordable Care Act Five Years Later

Why Are American Health Care Costs So High?

How Health Insurance Works

Senate postpones health care bill vote

Individual Health Insurance VS. Group Health Insurance

Published on Aug 14, 2009

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

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

Published on Aug 16, 2012

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

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

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

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

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

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

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

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

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

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

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

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

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

What’s in the Senate Republican Health-Care Bill

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

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

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

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

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

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

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

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

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

Secrets reviewed “Rediscovering Americanism”last week and wrote:

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

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

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

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

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

Dems face identity crisis

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 June 25

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

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

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

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

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

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

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

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

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

Patient Protection and Affordable Care Act

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

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

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

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

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

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

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

Provisions

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

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

Individual insurance

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

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

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

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

Among the groups who remained uninsured were:

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

Subsidies

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

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

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

Mandates

Individual

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

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

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

Business

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

Excise taxes

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

Insurance standards

Essential health benefits

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

Contraceptives

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

Risk management

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

Risk corridor program

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

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

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

Temporary reinsurance

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

Risk adjustment

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

Other provisions

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

The ACA has several other provisions:

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

Exchanges

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

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

State waivers

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

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

Accountable Care Organizations

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

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

Others

Legislative history

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

Background

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

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

John Chafee

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

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

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

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

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

Healthcare debate, 2008–10

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

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

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

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

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

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

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

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

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

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

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

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

Senate

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

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

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

Senate vote by state.

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

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

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

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

House

House vote by congressional district.

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

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

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

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

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

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

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

Impact

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

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

Coverage

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

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

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

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

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

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

Insurance exchanges

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

Medicaid expansion

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

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

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

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

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

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

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

Healthcare insurance costs

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

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

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

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

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

Effect on deductibles and co-payments

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

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

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

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

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

Health outcomes

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

Federal deficit

CBO estimates of revenue and impact on deficit

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

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

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

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

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

Opinions on CBO projections

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

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

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

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

Economic consequences

CBO estimated in June 2015 that repealing the ACA would:

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

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

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

Employer mandate and part-time work

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

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

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

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

Hospitals

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

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

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

Public opinion

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

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

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

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

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

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

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

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

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

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

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

Political aspects

“Obamacare”

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

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

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

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

Common misconceptions

“Death panels”

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

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

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

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

Members of Congress

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

Illegal immigrants

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

Exchange “death spiral”

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

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

Opposition

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

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

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

Legal challenges

National Federation of Independent Business v. Sebelius

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

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

Contraception mandate

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

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

House v. Price

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

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

Non-cooperation

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

Repeal efforts

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

2017 House Budget

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

2013 federal government shutdown

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

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

2017 repeal effort

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

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

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

Implementation history

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

Existing individual health plans

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

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

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

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

2010

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

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

2011

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

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

2012

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

2013

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

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

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

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

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

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

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

2014

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

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

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

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

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

2015

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

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

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

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

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

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

2016

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

Employers

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

Insurers

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

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

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

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

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

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

Costs

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

Cooperatives

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

Medicaid

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

2017

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

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

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

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

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

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

See also

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

Party Affiliation

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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

Posted on June 26, 2017. Filed under: American History, Barack H. Obama, Blogroll, Breaking News, Budgetary Policy, Business, Congress, Corruption, Countries, Culture, Donald J. Trump, Donald J. Trump, Donald Trump, Donald Trump, Economics, Education, Elections, Empires, Employment, Energy, Federal Government, Fiscal Policy, Foreign Policy, Former President Barack Obama, Freedom of Speech, Government, Government Dependency, Government Spending, Health, Health Care, Health Care Insurance, History, House of Representatives, Human, Illegal Immigration, Immigration, Insurance, Iraq, Islamic State, Labor Economics, Law, Legal Immigration, Libya, Life, Media, Medical, Medicare, Monetary Policy, News, Oil, People, Philosophy, Photos, Politics, Polls, President Barack Obama, President Trump, Radio, Rand Paul, Raymond Thomas Pronk, Religion, Resources, Rule of Law, Science, Security, Senate, Social Security, Success, Surveillance and Spying On American People, Syria, Tax Policy, Taxation, Taxes, Technology, Terror, Terrorism, Trade Policy, United States of America, Violence, War, Wealth, Welfare Spending, Wisdom, Yemen | Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |

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The Pronk Pops Show Podcasts

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 supreme court decisions june 26, 2017

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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

Part of Trump’s travel ban will go into effect

Supreme Court travel order decision is a Trump win: Fmr. Rep. Hoekstra

Panel Discusses: Supreme Court Allows Part of Trump Travel Ban to Take Effect

Here’s what the Supreme Court ruling on Trump’s travel ban means

Why the travel ban ruling is a political win for Trump

Hume: Admin is in ‘pretty good shape’ with travel ban case

Supreme Court to Hear Trump’s Travel Ban, Orders Temporary Stay

Varney & Co : Sekulow: Trump travel ruling a huge win for administration : 6/26/2017

It’s an absolutely boffo slam dunk for Trump in SCOTUS travel ban case.

Lionel on SCOTUS Travel Ban Decision Inter Alia

Ben Shapiro: Supreme Court’s decisions on Trump’s travel ban & public funds for churches

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

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The Pronk Pops Show Podcasts

Pronk Pops Show 906,  June 7, 2017

Pronk Pops Show 905,  June 6, 2017

Pronk Pops Show 904,  June 5, 2017

Pronk Pops Show 903,  June 1, 2017

Pronk Pops Show 902,  May 31, 2017

Pronk Pops Show 901,  May 30, 2017

Pronk Pops Show 900,  May 25, 2017

Pronk Pops Show 899,  May 24, 2017

Pronk Pops Show 898,  May 23, 2017

Pronk Pops Show 897,  May 22, 2017

Pronk Pops Show 896,  May 18, 2017

Pronk Pops Show 895,  May 17, 2017

Pronk Pops Show 894,  May 16, 2017

Pronk Pops Show 893,  May 15, 2017

Pronk Pops Show 892,  May 12, 2017

Pronk Pops Show 891,  May 11, 2017

Pronk Pops Show 890,  May 10, 2017

Pronk Pops Show 889,  May 9, 2017

Pronk Pops Show 888,  May 8, 2017

Pronk Pops Show 887,  May 5, 2017

Pronk Pops Show 886,  May 4, 2017

Pronk Pops Show 885,  May 3, 2017

Pronk Pops Show 884,  May 1, 2017

Pronk Pops Show 883 April 28, 2017

Pronk Pops Show 882: April 27, 2017

Pronk Pops Show 881: April 26, 2017

Pronk Pops Show 880: April 25, 2017

Pronk Pops Show 879: April 24, 2017

Pronk Pops Show 878: April 21, 2017

Pronk Pops Show 877: April 20, 2017

Pronk Pops Show 876: April 19, 2017

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Pronk Pops Show 873: April 13, 2017

Pronk Pops Show 872: April 12, 2017

Pronk Pops Show 871: April 11, 2017

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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

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Pronk Pops Show 863: March 29, 2017

Pronk Pops Show 862: March 28, 2017

Pronk Pops Show 861: March 27, 2017

Pronk Pops Show 860: March 24, 2017

Pronk Pops Show 859: March 23, 2017

Pronk Pops Show 858: March 22, 2017

Pronk Pops Show 857: March 21, 2017

Pronk Pops Show 856: March 20, 2017

Pronk Pops Show 855: March 10, 2017

Pronk Pops Show 854: March 9, 2017

Pronk Pops Show 853: March 8, 2017

Pronk Pops Show 852: March 6, 2017

Pronk Pops Show 851: March 3, 2017

Pronk Pops Show 850: March 2, 2017

Pronk Pops Show 849: March 1, 2017

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

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FISA: 702 Collection

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

How the Senate hearing on surveillance turned into a Russia hearing

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

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

Heinrich Questions Top Intelligence Officials In Senate Intel Committee Hearing

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

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

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

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

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

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

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

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

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

Rand Paul on Obama Illegally Spying on Americans | NSA Wiretapping

Section 702 of the FISA Amendments Act

FISA Hearing – Sec 702 Intel Surveillance – IMPORTANT

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

Bill Binney explodes the Russia witchhunt

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

NSA Whistleblower Bill Binney on Tucker Carlson 03.24.2017

NSA Whistleblower Bill Binney On 9/11

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

NSA Whistleblower William Binney: The Future of FREEDOM

State of Surveillance: Police, Privacy and Technology

The Fourth Amendment Explained: US Government Review

Why We’re Losing Liberty

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

Rand Paul Shames Homeland Security on Spying on Americans

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

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CHUCK ROSS
Reporter

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

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

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

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

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

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

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

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

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

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

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

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

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

MAY 7, 2014

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

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

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

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

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

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

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

 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 

FISA Authority and Blanket Surveillance: A Gatekeeper Without Opposition

Vol. 40 No. 3

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

Surveillance and espionage were once practices ordinary Americans only read about in novels or saw in movie theaters. That is no longer true. America is at the center of a worldwide communications network. It is home to the world’s most popular telecommunications, email, instant message, and video chat providers. Because of America’s unique role, hundreds of millions of users send communications through American soil. At the same time, America’s enemies have grown from nation-states, like the Soviet Union, to small cells of terrorists that use ordinary communications networks. Taken together, it is not surprising that signals intelligence agencies like the National Security Agency (NSA), which intercept and analyze these signals, would seek and use surveillance powers to conduct more surveillance at home.

Part of this new regime means that more legal process to gather intelligence is being served on companies in the United States. Recent revelations have declassified documents describing the NSA’s broad “collect now, search later” approach to surveillance. This means that some electronic communications providers, and their in-house and outside counsel, are faced with new forms of legal process. But unlike criminal process, which is rooted in a large body of publicly available case law and which often comes to light in the course of criminal trials, this new process comes to these providers in secret. As documents recently declassified by the director of national intelligence demonstrate, the government has served a number of different kinds of orders on providers—each of whom must assess when and how they might comply with or challenge those orders.

My firm and I represented one such provider in In re Directives [Redacted] Pursuant to Section 105B of the Foreign Intelligence Surveillance Act [Redacted], 551 F.3d 1004 (FISA Ct. Rev. 2008). That case presented a challenge that more providers may face as the NSA explores its surveillance capabilities. The provider received process known as a 105B directive (which is now called a 702 directive) starting in 2007. In contrast with typical criminal process, there was no prior court review or approval of particular surveillance targets. Instead, a 702 directive, like the one served on that provider, approved of the government’s procedure for conducting surveillance—not its targets.

 

Faced with this process, the provider had to make decisions about how it could respond. The provider chose not to comply with the process, and the government filed a motion to compel in the Foreign Intelligence Surveillance Court (FISC), a secret court charged with reviewing and approving some types of surveillance.

The course of that litigation proved complex. The Foreign Intelligence Surveillance Court of Review (FISCR), which handles appeals from the FISC, had published a single opinion before the In re Directives case, and while the lower court, the FISC, had rules for proceedings, there were no publicly available decisions on which to rely in litigating the procedural aspects of the case. The merits of the case too were litigated in the dark. No docket was made available, and there was no public mention of the case until after it was appealed and the FISCR entered its decision. Some documents related to the case are still being declassified, but in the words of the FISCR’s declassified decision, there was “multitudinous briefing” in the FISC and ample briefing on appeal.

The FISCR released its opinion in In re Directives in 2009, and a beam of light shone on its decisions for the first time in seven years. But then the FISC went dark again. In late 2013, however, the director of national intelligence, in response to increased public pressure seeking information on surveillance activities, began releasing more FISC opinions that are instructive on how the FISC operates and how it has been interpreting the Fourth Amendment and process under the Foreign Intelligence Surveillance Act, 50 U.S.C. § 1801 et seq. (FISA) in the intervening years, giving much needed guidance to providers and outside counsel.

 

The History of FISA

Understanding how to advise clients faced with FISA process, the challenges they face, and how to revise FISA to address public concerns about the NSA’s “collect now, search later” surveillance requires some history, legal analysis, and creative thinking. FISA’s history provides context for the reforms needed to adjust the balance between surveillance and privacy. Current events provide information about the extent of the problem. And creative thinking is required to create solutions.

FISA occupies an uneasy place. It resides where intelligence gathering meets the Fourth Amendment. FISA addresses the problem of how, and when, the government can conduct surveillance for intelligence-gathering purposes on United States soil. Over time, Congress has addressed this delicate balance by amending FISA to expand and contract surveillance capabilities. Today, FISA provides a comprehensive set of procedures for obtaining and using “foreign intelligence information” within the United States.

Before Congress passed FISA in 1978, there were no clear rules for when the executive branch could conduct clandestine surveillance for foreign intelligence purposes. Prior to FISA, every president since at least 1931 used surveillance to protect national security interests—even when no law specifically allowed that surveillance. See Sen. Rep. No. 94-755 (1976), Book III, Supplementary Detailed Staff Reports on Intelligence Activities and the Rights of Americans [hereinafter Church Report], available at www.intelligence.senate.gov/pdfs94th/94755_III.pdf. Presidents justified this surveillance by pointing to their role as commander-in-chief combined with their duty and authority to execute the laws of the United States. U.S. Const. art. II, § 1, § 2, cl. 1; see Church Report, supra, at 279.

This power remained relatively untested until the seminal case United States v. U.S. District Court for Eastern District of Michigan, Southern Division, 407 U.S. 297 (1972), also known as the Keith case. There, the government prosecuted three individuals for conspiring to bomb an office of the Central Intelligence Agency in Ann Arbor, Michigan. The Keith defendants moved to compel the government to disclose electronic surveillance information the government collected without first getting a warrant. The attorney general argued the surveillance satisfied the Fourth Amendment because it was necessary “to gather intelligence information deemed necessary to protect the nation from attempts of domestic organizations to attack and subvert the existing structure of the Government.” Id. at 300. The Supreme Court found that the government must get a warrant before engaging in domestic surveillance, but limited its opinion to “domestic aspects of national security” and stated that it “express[ed] no opinion as to the issues which may be involved with respect to activities of foreign powers or their agents.” Id. at 321. Keith changed the landscape of domestic surveillance, but lower courts struggled to decide when surveillance required a warrant and when surveillance fell outside Keith’s holding; as a result, they increasingly invalidated surveillance. See Zweibon v. Mitchell, 516 F.2d 594, 651 (D.C. Cir. 1975).

Faced with this uncertainty and the revelations about warrantless surveillance, the Senate created the Church Committee to investigate the executive branch’s use of warrantless surveillance. The committee’s report provided revelations much like those that are coming to light today as a result of Edward Snowden’s leaks. The committee’s report, which is actually 14 separate reports regarding intelligence abuses, provides one of the most extensive, in-depth examinations of the use and abuse of surveillance powers in the United States. The Church Report revealed that from the early 1960s to 1972, the NSA targeted certain Americans’ international communications by placing their names on a watch list. It contended that intercepting these Americans’ communications was part of monitoring programs it was conducting against international communications channels. As is the case in news reports today, “to those Americans who have had their communications—sent with the expectation that they were private—intentionally intercepted and disseminated by their Government, the knowledge that NSA did not monitor specific communications channels solely to acquire their message is of little comfort.” Church Report, supra, at 735.

History tends to repeat itself. Today, newspapers have reported that the NSA engages in bulk telephone records surveillance using the “Business Records” provision in section 215 of FISA (50 U.S.C. § 1861). This bulk surveillance, however, isn’t anything new. The Church Report provides shockingly similar revelations about the NSA’s Operation SHAMROCK. Much like recent revelations about today’s bulk records collection, Operation SHAMROCK, which lasted all the way from August 1945 until May 1975, collected millions of telegrams leaving or transiting the United States and monitored certain telephone links between the United States and South America. As part of this monitoring, the NSA intercepted Americans’ international communications and disseminated those communications to other intelligence agencies. In doing so, the NSA “never informed the companies that it was analyzing and disseminating telegrams of Americans.” Unlike today, however, “the companies, who had feared in 1945 that their conduct might be illegal, apparently never sought assurances that NSA was limiting its use to the messages of foreign targets once the intercept program had begun.” Church Report, supra, at 740–41.

The NSA discontinued SHAMROCK in 1975, but it still incidentally collected Americans’ communications—much like it does (to a lesser extent) today. The Church Committee described the NSA’s “initial interception of a stream of communications” as “analogous to a vacuum cleaner.” “NSA picks up all communications carried over a specific link that it is monitoring. The combination of this technology and the use of words to select communications of interest results in NSA analysts reviewing the international messages of American citizens, groups, and organizations for foreign intelligence.” Id. at 741. This is eerily similar to the FISC’s description of bulk records collection as recently as October 2011, in which it stated “that NSA has acquired, is acquiring, and . . . will continue to acquire tens of thousands of wholly domestic communications,” Redacted, slip op. at 33 (FISA Ct. Oct. 3, 2011), because it intercepts all communications over certain Internet links it is monitoring and is “unable to exclude certain Internet transactions.” Id. at 30.

 

Purposes of FISA

That history tells us where FISA comes from and the problems Congress was trying to solve. Congress had two main goals: provide some oversight where there was none, and draw clear lines so that law enforcement would know when it could use foreign intelligence process and when it had to follow ordinary criminal process. To address these goals, FISA contains two important parts. First, it established a framework for judicial review by creating the Foreign Intelligence Surveillance Court and the Foreign Intelligence Surveillance Court of Review. It also created a new FISA process to replace criminal process such as warrants, subpoenas, surveillance orders, and pen register/trap and trace orders. The FISA versions of each of these has less stringent requirements for the government to satisfy than criminal process. See 50 U.S.C. § 1801–12 (electronic surveillance equivalent to Title III orders), 50 U.S.C. § 1821–29 (physical searches like search warrants), 50 U.S.C. § 1841–46 (pen registers and trap-and-trace devices), 50 U.S.C. § 1861–62 (business records like grand jury subpoenas).

Second, FISA addressed when law enforcement can and cannot use these FISA processes to conduct surveillance or gather evidence. As it was originally enacted, law enforcement could obtain FISA process, rather than criminal process, when the “primary purpose” of surveillance was to gather foreign intelligence information. At the same time, Congress explicitly excluded activities conducted abroad from FISA’s reach. It also did not provide protection for U.S. citizens when they left the United States. See H.R. Rep. No. 95–1283, at 51 (1978).

To fill in the gaps FISA left and to provide rules of executive branch intelligence agencies, President Reagan issued Executive Order 12,333, United States Intelligence Activities (46 Fed. Reg. 59,941 (Dec. 4, 1981)). That order (as amended) remains the basis for executive branch surveillance for foreign intelligence purposes. What is important is that the order sets forth procedures that apply where FISA did not, specifically for surveillance of United States persons located abroad. Id. § 2.5.

Foreign intelligence gathering continued under FISA and Executive Order 12,333 for nearly two decades without major revision or challenge, until the attacks of September 11, 2001. Following 9/11, Congress passed the USA Patriot Act, which amended FISA by expanding law enforcement authority and lowering the standards required to obtain surveillance authority. Pub. L. No. 107–56 (H.R. 3162), 115 Stat. 272 (2001). The act eliminated the “primary purpose” test and replaced it with a “significant purpose” test. Id. § 218. The “primary purpose” test led law enforcement to create a wall between agencies that engaged in criminal prosecutions (such as parts of the Federal Bureau of Investigation and the Department of Justice) and agencies that primarily engaged in foreign intelligence gathering (such as the NSA). One of the problems identified in the aftermath of 9/11 was a reluctance to share information because of this “primary purpose” rule—and the fear that doing so could put surveillance or criminal prosecutions at risk.

In a rare published decision (there have been only two), the FISCR upheld the “significant purpose” test in In re Sealed Case, 310 F.3d 717 (FISA Ct. Rev. 2002). The FISC court had found that the “significant purpose” standard was lower than the “primary purpose” standard but that the Fourth Amendment did not require more. The court concluded that the procedures and government showings required under FISA, even if they do not meet the warrant requirement, come close enough that FISA as amended by the Patriot Act meets the balancing test between Fourth Amendment rights and the need to protect against national security threats. In re Sealed Case would prove to be a launching point for reconciling FISA with the Fourth Amendment and for chipping away at the warrant requirement for foreign intelligence-gathering purposes.

In December 2005, a New York Times article revealed a warrantless domestic wiretapping program, the Terrorist Surveillance Program (TSP), in which the NSA was allowed to eavesdrop on communications where at least one party was not a United States person. According to reports, technical glitches resulted in some “purely domestic” communications being subject to surveillance. The surveillance was based on a 2002 executive order that allowed the NSA to monitor international email messages and international telephone calls transmitted by communications networks based in the United States—surveillance that was outside the scope of review in In re Sealed Case. That executive order claimed that FISA’s warrant requirements were implicitly superseded by the passage of the congressional resolution authorizing the use of military force against terrorists and that the president’s inherent authority under Article II of the Constitution to conduct foreign surveillance trumped FISA.

A group of plaintiffs sought to challenge the TSP in American Civil Liberties Union v. National Security Agency, 438 F. Supp. 2d 754 (E.D. Mich. 2006). The district court ruled that the surveillance violated the Fourth Amendment, finding that the TSP was implemented without regard to the Fourth Amendment or to FISA, and thus violated FISA, the standards of Title III, and the Fourth Amendment. On appeal, however, the Sixth Circuit dismissed the case, finding that the plaintiffs lacked standing to challenge the TSP because they had not alleged that they were the actual victims of warrantless surveillance. ACLU v. NSA, 493 F.3d 644 (6th Cir. 2007); see also Clapper v. Amnesty Int’l, 133 S. Ct. 1138 (2013).

The Protect America Act of 2007

Following the public outcry in response to the New York Times article and the ACLU decision, the Bush administration proposed the Protect America Act of 2007 (PAA), Pub. L. No. 110-55, 121 Stat. 552, which was designed to address surveillance of communications facilities located in the United States that transmit communications between individuals both of whom are located abroad. PAA § 105A. Again, just as in 1978, the government needed more guidance on when FISA applied and when the executive branch was free of its requirements. The PAA addressed a new problem: capturing wholly foreign communications on U.S. soil. In the past, to capture foreign communications between non-U.S. persons, the government simply implemented surveillance on foreign communications networks, which are not subject to restrictions imposed by the Fourth Amendment or any statute. Now that foreign communications could be transferred within the United States and the TSP’s constitutionality had been called into doubt, the intelligence community required a new tool to continue that surveillance. The PAA, by providing a number of procedures to conduct surveillance of targets outside the United States, and in an attempt to avoid resort to traditional warrants and Title III orders, implemented a system of internal controls at the NSA as well as overarching review of policies and procedures by the FISC. The PAA was a stopgap measure, to preserve some aspects of warrantless surveillance of foreign communications transmitted within the United States while Congress worked to overhaul FISA.

Notably, the PAA, like the Patriot Act, again changed the test of when the FISA process does and does not apply. The PAA changed the focus from the identity of the party targeted to whether a party was present in the United States. This change made it much simpler for the attorney general and the director of national intelligence to approve surveillance—rather than certifying that both parties to the communication were foreign powers or agents of foreign powers, they now only had to certify that the target of the surveillance was located outside the United States. Under the PAA, the director of national intelligence and the attorney general could permit, for up to one year, “the acquisition of foreign intelligence information concerning persons reasonably believed to be outside the United States” if they determined that the acquisition met five specified criteria and the minimization procedures for that surveillance were approved by the FISC. PAA § 105B. In practical terms, the government could serve providers with orders that the FISC approved, and then name the targets of surveillance later.

One provider, Yahoo, challenged this in In re Directives [Redacted] Pursuant to Section 105B of the Foreign Intelligence Surveillance Act [Redacted], 551 F.3d 1004 (FISA Ct. Rev. 2008). In that case, the government revealed that it not only complied with the PAA but also voluntarily complied with Executive Order 12,333, 46 Fed. Reg. 59,941, 59,951 (Dec. 4, 1981), which taken together mean that the certifications at issue “permit surveillances conducted to obtain foreign intelligence for national security purposes when those surveillances are directed against foreign powers or agents of foreign powers reasonably believed to be located outside the United States.” In re Directives, 551 F.3d at 1008. The court upheld these warrantless searches, finding that because the purpose of the surveillance was to gather foreign intelligence information, it fell under a “foreign intelligence exception to the Fourth Amendment’s warrant requirement” so long as it was directed against foreign powers or agents of foreign powers reasonably believed to be located outside the United states. Id. at 1012.

The court also found that the searches were reasonable because they complied with Executive Order 12,333, which required probable cause to believe that an individual is outside the United States and a finding that such surveillance was necessary, and which limited the duration of the surveillance and thus contained sufficient protections to avoid risk of mistake or executive branch misconduct.

The PAA was a stopgap measure and was eventually replaced by the FISA Amendments Act of 2008 (FAA), Pub. L. No. 110-261, § 403, 122 Stat. 2436, 2473. The FAA repealed the most troublesome provision of the PAA, which provided for warrantless surveillance of foreign intelligence targets “reasonably believed” to be outside the United States, even if they were U.S. persons, by adding a new section to FISA entitled “Additional Procedures Regarding Certain Persons Outside the United States.” Much of this section enshrines the protections present in Executive Order 12,333’s treatment of U.S. persons that the court relied on in In re Sealed Case and In re Directives to uphold the surveillance of United States persons located abroad.

The FAA again addressed the question of when FISA applies via a complicated web of procedures and processes for each category of target subject to surveillance: individuals outside the country that are not “U.S. Persons” (section 1881a), acquisitions inside the country targeting U.S. persons outside the country (section 1881b), and U.S. persons outside the country (section 1881c). Different processes are required for each type of target, but in a nutshell, U.S. persons receive slightly more protection. The most important change is that there is no prior judicial review of surveillance conducted in the United States that targets non-U.S. persons located outside the United States. FAA § 1881a. To conduct surveillance of U.S. persons outside the United States, however, the government must first obtain FISC approval of the particular targets. FAA § 1881b.

 

Time to Address Problems

FISA’s history and current events demonstrate that we are at a point in the cycle where it is again time to address the two basic questions: How do we provide oversight of intelligence-gathering activities? And when does this oversight apply? FISA, from a textual perspective, provides the government with far-reaching authority for surveillance and specific process for each type of surveillance it may want to conduct, but the public was relatively unaware of how the government used that authority until Edward Snowden leaked classified documents in late 2013 providing some detail on the NSA’s use of surveillance activities. In response, the government has begun declassifying a wealth of FISC decisions, letters to Congress, and other information regarding the NSA’s use of FISA authorities. A detailed analysis of these opinions could lead to a new report as voluminous as the Church Committee’s reports, but even a high-level analysis provides some context for moving forward.

The recently released opinions—such as Redacted, LEXIS 157706 (FISA Ct. Oct. 3, 2011), and Redacted II, LEXIS 157706 (FISA Ct. Nov. 30, 2011)—confirm what appeared to be the case in In re Directives, that the FISC has adopted an exception to the warrant requirement for foreign intelligence gathering—particularly where the government seeks communications that are not wholly domestic. In those cases, despite finding that the NSA knowingly collected wholly domestic communications that had nothing to do with foreign intelligence, the FISC generally approved most of the government’s targeting and minimization procedures. On a bad set of facts for the government, the FISC held that only a small part of the NSA’s surveillance program was unconstitutional and only because the NSA did not make enough of an effort to delete wrongly collected communications—a problem the NSA soon remedied. Redacted II, LEXIS 157705 (FISA Ct. Nov. 30, 2011).

The window left open in Keith seems to be closed. Similarly, the FISC has approved of the NSA’s “collect now, restrict searching later” approach to minimization. See In re Application of the F.B.I. for an Order Requiring the Production of Tangible Things from [Redacted], No. BR 13-109, LEXIS 134786 (FISA Ct. Sept. 13, 2013). In other words, the FISC has found no constitutional or statutory impediment to the government “over collecting” data—so long as it does not intentionally collect wholly domestic communications and it has minimization procedures to restrict access. There is no indication that the government has used its surveillance powers improperly (except in a limited number of circumstances attributable to NSA employee misconduct), but the FISC has not taken a robust view of the Fourth Amendment.

As was the case back in the late 1970s, the American public has reacted to executive surveillance activities—some of which are eerily similar to the NSA’s use of surveillance authority in the mid– to late 1970s. And as was the case in the late 1970s, it may again be time for Congress to take action. The problems remain quite similar to those Congress faced in 1978: provide oversight where there is none, or where it is inadequate, and make clear when the government can, and cannot, use different types of FISA process.

In late 2013, numerous members of Congress began proposing bills to reform FISA and provide new protections. See Mark M. Jaycox, “Cheat Sheet to Congress’ NSA Spying Bills,” Elec. Frontier Found. (Sept. 11, 2013), http://www.eff.org/deep links/2013/08/effs-cheat-sheet. Given the heated nature of the current debate, it is likely that the particular content of these bills will change daily, and summarizing their particularities is best left to blogs. Still, the bills generally fall into two categories: increasing transparency and restructuring the process. A few bills address bulk collection of records under section 215, but none takes a comprehensive approach to changing the question of when FISA applies and when it does not.

The current system of checks and balances under the FAA is simply not enough. It’s not because of a lack of desire by the providers to defend their users. Unlike the telephone and telegraph companies that did not act to end NSA spying in the Operation SHAMROCK era, providers today are taking a much more active role in the process. Yahoo challenged the FISA process in 2008, interest groups have filed actions seeking information about surveillance practices, and now providers have brought declaratory judgment actions seeking to reveal more information about surveillance process they receive.

One of the pending bills, Senator Blumenthal’s FISA Court Reform Act of 2013, Senate Bill 1460 and Senate Bill 1467, provides an answer that, having had the experience of litigating before the FISC myself, I believe could provide much needed improvements. That bill provides for a new Office of the Special Advocate, which introduces an adversary to the court. (This is similar to the public privacy advocate that President Obama recently proposed.) The act attempts to solve a basic problem with the current oversight procedures: There is no true adversarial process for most of the legal issues that arise. The newly declassified opinions the director of national intelligence has released make this abundantly clear. Setting aside the legal arguments, the procedural history of the opinions indicates delays on the government’s part, a lack of supervision after the court issues its orders, and a preference for secrecy over public disclosure at any cost. Appointing a special advocate ad litem for the public would ensure that novel legal arguments in the FISA court would face a consistent, steady challenge no matter who the provider is, thereby strengthening the FISA process by subjecting results to checks and balances.

Without such a process, the court and the Department of Justice must work through difficult legal issues with no balancing input. An advocate could participate in all cases involving a new statute or authority or a new interpretation or application of an existing authority. The special advocate could choose the cases in which to be involved, or the court or a provider that receives process could request its involvement where an opposition would be useful to test and evaluate the government’s legal arguments. The special advocate’s office could be established with proper security safeguards to draft, store, and access classified records more efficiently. It could also be required to report to the public and Congress the number of cases it has argued and how often it has limited or pared back the government’s requests. It would provide a vital counterpoint for legislators exercising their oversight duties.

The special advocate would be especially useful in cases in which the government demands access to communications in a way that may have a profound effect on people other than the target, such as when decryption may be involved or when a provider is asked to provide assistance in ways that are unlike traditional wiretaps.

Providing for an advocate in front of the court would also resolve several problems for companies and individuals faced with receiving FISA process or having evidence gathered using that process used against them. The statutory process as it stands now does not necessarily provide for complete transparency or a level playing field for the provider. As the published decision in In re Directives makes clear, a phalanx of 11 government lawyers, including the acting solicitor general of the United States, was involved in defending the statute. The decision also shows that some of the documents relied on by the court of review were classified procedures submitted as part of an ex parte appendix that remains sealed. 551 F.3d at 1013–14.

If an advocate were present in other matters before the FISC, the government and court would be more likely to provide more public information on what challenges have and have not been successful. Public access would also provide litigators with a much greater opportunity to use those challenges in advising and defending their clients. The FISC’s decisions may or may not have been correct, depending on your view, but the secrecy employed up to this point erodes the safeguards built into our adversarial court system. The presence of an advocate would help to ensure that the government cannot continue to keep new opinions classified, unless it is truly in the interest of national security to do so.

Revising FISA is no easy task, and analyzing and responding to the FISA process presents thorny questions. There is one constant throughout the history of surveillance, as was the case in the Church Report and as is the case today with news reports about NSA surveillance: The government will use the surveillance power it is given to its fullest. This article does not opine on when that is and is not appropriate. America’s long history of surveillance and current events demonstrate a need to revise the process and take a hard look at whether courts have the tools to oversee executive branch surveillance and when the executive branch should be allowed to use foreign intelligence procedures. Introducing an advocate to test the government’s theories and surveillance in every case—even the ones it brings ex parte—would go a long way toward ensuring that the American public is not shocked again.

https://www.americanbar.org/publications/litigation_journal/2013-14/spring/fisa_authority_and_blanket_surveillance_gatekeeper_without_opposition.html

Meet Executive Order 12333: The Reagan rule that lets the NSA spy on Americans

July 18, 2014

John Napier Tye served as section chief for Internet freedom in the State Department’s Bureau of Democracy, Human Rights and Labor from January 2011 to April 2014. He is now a legal director of Avaaz, a global advocacy organization.

In March I received a call from the White House counsel’s office regarding a speech I had prepared for my boss at the State Department. The speech was about the impact that the disclosure of National Security Agency surveillance practices would have on U.S. Internet freedom policies. The draft stated that “if U.S. citizens disagree with congressional and executive branch determinations about the proper scope of signals intelligence activities, they have the opportunity to change the policy through our democratic process.”

But the White House counsel’s office told me that no, that wasn’t true. I was instructed to amend the line, making a general reference to “our laws and policies,” rather than our intelligence practices. I did.

Even after all the reforms President Obama has announced, some intelligence practices remain so secret, even from members of Congress, that there is no opportunity for our democracy to change them.

Public debate about the bulk collection of U.S. citizens’ data by the NSA has focused largely on Section 215 of the Patriot Act, through which the government obtains court orders to compel American telecommunications companies to turn over phone data. But Section 215 is a small part of the picture and does not include the universe of collection and storage of communications by U.S. persons authorized under Executive Order 12333.

From 2011 until April of this year, I worked on global Internet freedom policy as a civil servant at the State Department. In that capacity, I was cleared to receive top-secret and “sensitive compartmented” information. Based in part on classified facts that I am prohibited by law from publishing, I believe that Americans should be even more concerned about the collection and storage of their communications under Executive Order 12333 than under Section 215.

Bulk data collection that occurs inside the United States contains built-in protections for U.S. persons, defined as U.S. citizens, permanent residents and companies. Such collection must be authorized by statute and is subject to oversight from Congress and the Foreign Intelligence Surveillance Court. The statutes set a high bar for collecting the content of communications by U.S. persons. For example, Section 215 permits the bulk collection only of U.S. telephone metadata — lists of incoming and outgoing phone numbers — but not audio of the calls.

Executive Order 12333 contains no such protections for U.S. persons if the collection occurs outside U.S. borders. Issued by President Ronald Reagan in 1981 to authorize foreign intelligence investigations, 12333 is not a statute and has never been subject to meaningful oversight from Congress or any court. Sen. Dianne Feinstein (D-Calif.), chairman of the Senate Select Committee on Intelligence, has said that the committee has not been able to “sufficiently” oversee activities conducted under 12333.

Unlike Section 215, the executive order authorizes collection of the content of communications, not just metadata, even for U.S. persons. Such persons cannot be individually targeted under 12333 without a court order. However, if the contents of a U.S. person’s communications are “incidentally” collected (an NSA term of art) in the course of a lawful overseas foreign intelligence investigation, then Section 2.3(c) of the executive order explicitly authorizes their retention. It does not require that the affected U.S. persons be suspected of wrongdoing and places no limits on the volume of communications by U.S. persons that may be collected and retained.

“Incidental” collection may sound insignificant, but it is a legal loophole that can be stretched very wide. Remember that the NSA is building a data center in Utah five times the size of the U.S. Capitol building, with its own power plant that will reportedly burn $40 million a year in electricity.

“Incidental collection” might need its own power plant.

A legal regime in which U.S. citizens’ data receives different levels of privacy and oversight, depending on whether it is collected inside or outside U.S. borders, may have made sense when most communications by U.S. persons stayed inside the United States. But today, U.S. communications increasingly travel across U.S. borders — or are stored beyond them. For example, the Google and Yahoo e-mail systems rely on networks of “mirror” servers located throughout the world. An e-mail from New York to New Jersey is likely to wind up on servers in Brazil, Japan and Britain. The same is true for most purely domestic communications.

Executive Order 12333 contains nothing to prevent the NSA from collecting and storing all such communications — content as well as metadata — provided that such collection occurs outside the United States in the course of a lawful foreign intelligence investigation. No warrant or court approval is required, and such collection never need be reported to Congress. None of the reforms that Obama announced earlier this year will affect such collection.

Without any legal barriers to such collection, U.S. persons must increasingly rely on the affected companies to implement security measures to keep their communications private. The executive order does not require the NSA to notify or obtain consent of a company before collecting its users’ data.

The attorney general, rather than a court, must approve “minimization procedures” for handling the data of U.S. persons that is collected under 12333, to protect their rights. I do not know the details of those procedures. But the director of national intelligence recently declassified a document (United States Signals Intelligence Directive 18) showing that U.S. agencies may retain such data for five years.

Before I left the State Department, I filed a complaint with the department’s inspector general, arguing that the current system of collection and storage of communications by U.S. persons under Executive Order 12333 violates the Fourth Amendment, which prohibits unreasonable searches and seizures. I have also brought my complaint to the House and Senate intelligence committees and to the inspector general of the NSA.

I am not the first person with knowledge of classified activities to publicly voice concerns about the collection and retention of communications by U.S. persons under 12333. The president’s own Review Group on Intelligence and Communication Technologies, in Recommendation 12 of its public report, addressed the matter. But the review group coded its references in a way that masked the true nature of the problem.

At first glance, Recommendation 12 appears to concern Section 702 of the FISA Amendments Act, which authorizes collection inside the United States against foreign targets outside the United States. Although the recommendation does not explicitly mention Executive Order 12333, it does refer to “any other authority.” A member of the review group confirmed to me that this reference was written deliberately to include Executive Order 12333.

Recommendation 12 urges that all data of U.S. persons incidentally collected under such authorities be immediately purged unless it has foreign intelligence value or is necessary to prevent serious harm. The review group further recommended that a U.S. person’s incidentally collected data never be used in criminal proceedings against that person, and that the government refrain from searching communications by U.S. persons unless it obtains a warrant or unless such searching is necessary to prevent serious harm.

The White House understood that Recommendation 12 was intended to apply to 12333. That understanding was conveyed to me verbally by several White House staffers, and was confirmed in an unclassified White House document that I saw during my federal employment and that is now in the possession of several congressional committees.

In that document, the White House stated that adoption of Recommendation 12 would require “significant changes” to current practice under Executive Order 12333 and indicated that it had no plans to make such changes.

All of this calls into question some recent administration statements. Gen. Keith Alexander, a former NSA director, has said publicly that for years the NSA maintained a U.S. person e-mail metadata program similar to the Section 215 telephone metadata program. And he has maintained that the e-mail program was terminated in 2011 because “we thought we could better protect civil liberties and privacy by doing away with it.” Note, however, that Alexander never said that the NSA stopped collecting such data — merely that the agency was no longer using the Patriot Act to do so. I suggest that Americans dig deeper.

Consider the possibility that Section 215 collection does not represent the outer limits of collection on U.S. persons but rather is a mechanism to backfill that portion of U.S. person data that cannot be collected overseas under 12333.

Proposals for replacing Section 215 collection are currently being debated in Congress. We need a similar debate about Executive Order 12333. The order as used today threatens our democracy. There is no good reason that U.S. citizens should receive weaker privacy and oversight protections simply because their communications are collected outside, not inside, our borders.

I have never made any unauthorized disclosures of classified information, nor would I ever do so. I fully support keeping secret the targets, sources and methods of U.S. intelligence as crucial elements of national security. I was never a disgruntled federal employee; I loved my job at the State Department. I left voluntarily and on good terms to take a job outside of government. A draft of this article was reviewed and cleared by the State Department and the NSA to ensure that it contained no classified material.

When I started at the State Department, I took an oath to protect the Constitution of the United States. I don’t believe that there is any valid interpretation of the Fourth Amendment that could permit the government to collect and store a large portion of U.S. citizens’ online communications, without any court or congressional oversight, and without any suspicion of wrongdoing. Such a legal regime risks abuse in the long run, regardless of whether one trusts the individuals in office at a particular moment.

I am coming forward because I think Americans deserve an honest answer to the simple question: What kind of data is the NSA collecting on millions, or hundreds of millions, of Americans?

https://www.washingtonpost.com/opinions/meet-executive-order-12333-the-reagan-rule-that-lets-the-nsa-spy-on-americans/2014/07/18/93d2ac22-0b93-11e4-b8e5-d0de80767fc2_story.html?utm_term=.0be4d4e8beac

A Primer on Executive Order 12333: The Mass Surveillance Starlet

JUNE 2, 2014

Many news reports have focused on Section 215 of the Patriot Act (used to collect all Americans’ calling records) and Section 702 of the Foreign Intelligence Surveillance Act Amendments Act (FAA) (used to collect phone calls, emails and other Internet content) as the legal authorities supporting much of the NSA’s spying regime. Both laws were passed by Congress and are overseen by the Foreign Intelligence Surveillance Court (FISA court). However, it’s likely that the NSA conducts much more of its spying under the President’s claimed inherent powers and only governed by a document originally approved by President Reagan titled Executive Order 12333. The Senate Select Committee on Intelligence is currently conducting a secret investigation into the order, but Congress as a whole—including the Judiciary committee—must release more information about the order to the public.

EO 12333 was first written in 1981 in the wake of Watergate and the Foreign Intelligence Surveillance Act, an act passed by Congress that regulates spying conducted on people located within the United States. Since FISA only covers specific types of spying, the President maintains that the executive branch remains free to spy abroad on foreigners with little to no regulation by Congress.

Executive Order 12333

The Executive Order does three things: it outlines what it governs, when the agencies can spy, and how they can spy. In broad strokes, the Executive Order mandates rules for spying on United States persons (a term that includes citizens and lawful permanent residents wherever they may be) and on anyone within the United States. It also directs the Attorney General and others to create further policies and procedures for what information can be collected, retained, and shared.

The first section of the order covers the role of every agency conducting intelligence in the Intelligence Community, which includes seventeen different agencies, including well-known entities like the Central Intelligence Agency (CIA) and the NSA, and lesser-known entities like the Office of Terrorism and Financial Intelligence in the Department of Treasury. The roles vary by agency. For instance, the NSA is, among other things, responsible for “collection, processing and dissemination of signals intelligence,” while the CIA is responsible for “national foreign intelligence.

The Information Collected

The Executive Order purports to cover all types of spying conducted with the President’s constitutional powers—including mass spying. That’s important to note because some of the spying conducted under EO 12333 is reportedly similar to the mass spying conducted under Section 702 of the FAA. Under this type of spying, millions of innocent foreigners’ communications are collected abroad, inevitably containing Americans’ communications. In the Section 702 context, this includes techniques like Prism and Upstream. While we don’t know for sure, the Executive Order probably uses similar techniques or piggybacks off of programs used for Section 702 spying.

The second section of the EO partly covers mass spying by establishing what information intelligence agencies can collect, retain, and share about US persons. The current guidelines, the United States Signals Intelligence Directive SP0018, also known as “USSID 18,” are (just like the “minimization procedures” based off of them) littered with loopholes to over-collect, over-retain, and over-share Americans’ communications—all without a probable cause warrant or any judicial oversight.

Defenders (.pdf) of the mass spying conducted under the Executive Order point out the order “protects” such US person information with guidelines like USSID 18, but such protections are window-dressing, at best. Policies like USSID 18 and other accompanying Executive Order guidelines such as the “Special Procedures Governing Communications Metadata Analysis” allow for extensive use of US person information and data without a probable cause warrant. Indeed, news reports and Congressional testimony confirm the “Special Procedures” are used to map Americans’ social networks. The procedures are clear evidence the government believes that Fourth Amendment’s protections stop at the border.

Uses of Executive Order 12333

We do know a little about the spying conducted using EO 12333, but more must be revealed to the public. One early news report revealed it was the NSA’s claimed authority for the collection of Americans’ address books and buddy lists. It’s also involved in the NSA’s elite hacking unit, the Tailored Access Operations unit, which targets system administrators and installs malware while masquerading as Facebook servers. And in March, the Washington Postrevealed the order alone—without any court oversight—is used to justify the recording of “100 percent of a foreign country’s telephone calls.” The NSA’s reliance on the order for foreign spying includes few, if any, Congressional limits or oversight. Some of the only known limits on Executive spying are found in Executive procedures like USSID 18, the metadata procedures discussed above, and probably other still-classified National Security Policy Directives, none of which have been publicly debated much less approved by Congress or the courts.

The extent of the NSA’s reliance on Executive Order 12333 demands that the government release more information about how the order is used, or misused. And Congress—specifically the Judiciary and Intelligence committees—must reassert the same aggressive and diligent oversight they performed in the 1970s and 1980s.

https://www.eff.org/deeplinks/2014/06/primer-executive-order-12333-mass-surveillance-starlet

Maintaining America’s Ability to Collect Foreign Intelligence: The Section 702 Program

May 13, 2016 21 min read Download Report

Authors:Paul Rosenzweig, Charles Stimson andDavid Shedd

Select a Section 1/0

Section 702 of the Foreign Intelligence Surveillance Act (FISA) will, in its current form, come up for reauthorization in 2017. Broadly speaking, the Section 702 program targets non-U.S. persons reasonably believed to be located outside the United States, in order to acquire foreign intelligence. Over the past several years, this surveillance of the online activities of foreigners has been a critical and invaluable tool for American intelligence professionals and officials. Knowledgeable officials note that more than 25 percent of all current U.S. intelligence is based on information collected under Section 702.[1]

Still, there are those who have concerns about the program. These critics believe that the program, as currently implemented, infringes on Americans’ rights. Their concern hinges on the inevitable reality that in the course of collecting information about foreign actors, the Section 702 program will also collect information about American citizens. As a result, some opponents liken the Section 702 program to the government telephony metadata program disclosed by Edward Snowden, and characterize Section 702 as an instance of government overreach.[2] Such comparisons are misguided and unfair. The program is so vital to America’s national security that Congress should reauthorize Section 702 in its current form.

Section 702 Explained

Section 702 has its origins in President George W. Bush’s terrorist surveillance program and the Patriot Act. That program was initiated in the immediate aftermath of the 9/11 terror attacks, on the President’s own authority. That reliance on exclusive presidential authority contributed to the controversy that initially attended the program—some vocal critics saw it as an example of executive overreach.

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That aspect of the criticism was significantly ameliorated, if not eliminated, several years later, when Congress fully discussed and authorized the activities in question. Indeed, the governing law was adopted and amended twice, after the program had been initiated on the President’s own authority. First, Congress adopted a temporary measure known as the Protect America Act in 2007.[3] Then, it passed the FISA Amendments Act (FAA) in 2008. This is the statute that includes the new Section 702.[4]

Under Section 702, the U.S. Attorney General and the Director of National Intelligence (DNI) may jointly authorize surveillance of people who are not “U.S. persons.” U.S. persons is a term of art in the intelligence community (IC) that means people who are not only American citizens but also covers permanent-resident aliens. As such, the targets of Section 702 surveillance can be neither citizens nor permanent residents of the U.S.

Section 702 authorizes the government to acquire foreign intelligence by targeting non-U.S. persons “reasonably believed” to be outside U.S. borders. Taken together, these two requirements identify the fundamental domain of Section 702 surveillance: it applies to foreigners on foreign soil. It is expressly against the law to attempt collection of information from targets inside the U.S.—whether Americans or foreigners—or to deliberately target the collection of online communications of American citizens.[5]

The law also requires the government to develop “targeting procedures”—the steps the government needs to take in order to ensure that the target is outside the United States at any time that electronic surveillance is undertaken. Obviously, that is sometimes difficult. A cell phone number, for instance, remains the same whether the phone is physically overseas or in the U.S., and the fact that someone has a U.S. cell phone number does not necessarily indicate whether the owner or user of that cell phone is a foreigner or an American. Hence, targeting must be tied to the geolocation of a phone and some knowledge about the owner/user, rather than solely to the phone’s number. Ultimately, it is the targeting procedures, not the targets themselves, that must be approved by the U.S. Foreign Intelligence Surveillance Court (FISC).[6]

To conduct this surveillance, the government can compel assistance from Internet service providers (ISPs) and telephone companies in acquiring foreign intelligence information—that is, information relating to a foreign espionage program or international terrorism. The government often compensates these providers for the necessary effort. According to The Washington Post, the payments range from $250 million to nearly $400 million annually.[7] Some critics of the program suspect that as a result, surveillance turns from a legal obligation to a source of income. Finally, it is important to note that not only regulated carriers, such as traditional cable and telephone companies (such as AT&T or Verizon), are required to participate, but also newer technology companies to include Google, Facebook, and Skype.

The Incidental Collection Issue

If that were all that the 702 program involved, it would likely not be particularly controversial. Few Americans have expressed grave concerns about America’s overseas intelligence collection. Significantly, the 702 program cannot be used to target any U.S. person or any person located in the U.S., whether that person is an American or a foreigner. The government is also prohibited from “reverse targeting” under 702—that is, the government cannot target a non-U.S. person outside the U.S. when the real interest is to collect the communications of a person in the U.S. or of any U.S. person, regardless of location.

But a residual issue arises because of the inevitability of inadvertent collection—the incidental collection of information about Americans as part of the authorized collection of foreign intelligence.

To see why this happens, one needs to understand two distinct aspects of the Section 702 program: one portion that goes by the name of PRISM, and another that is referred to colloquially as “upstream collection.”[8]

PRISM collection is relatively straightforward. A hypothetical can explain: The government has information about a particular e-mail address, or a particular individual, linking it or him to a foreign terrorist organization. That address (john.doe@xyz.com) or that individual’s name (John Doe) is known as a “selector”; it is a basis for sifting through vast quantities of data, and selecting what will be collected and analyzed.

The Attorney General and the DNI certify the selector as relating to a non-U.S. person who is outside the United States, and who is reasonably believed to be connected to a foreign intelligence activity. Then, the National Security Agency (NSA) sends a query about that selector to an ISP. The ISP, in turn, is required to hand over to the government any communications it might have that were sent to—or from—the identified selector. The NSA receives all data collected through PRISM, and makes portions of it available to the CIA and the FBI.

Upstream collection, by contrast, does not focus on the ISP. Instead, it focuses on the “backbone,” through which all telephone and Internet communications travel, which lies “upstream” within the telecommunications infrastructure. For example, an individual’s ISP might be a local company, while the backbone that carries its Internet traffic across the ocean to Europe is almost certainly operated by a larger provider, such as Verizon or AT&T.

There are several additional differences that distinguish upstream collection from PRISM. Most notably, upstream collection can involve “about” communications. “About” communications refer to selectors that occur within the content of the monitored communication, instead of, in the example of e-mail, in the “To” or “From” line.

So, if the government were using a name—John Doe—as a selector, under the upstream collection program, it would also collect foreign intelligence–related communications in which that name appeared in the body of the communication. Say, for example, that two al-Qaeda members are communicating via e-mail, and one says to the other: “We should recruit Doe.” That e-mail would be subject to upstream collection and would be a good example of an “about” communication. The e-mail is about Doe. Under the PRISM program, by contrast, the government would collect e-mails to and from the user name, and nothing more.

As should be evident, in some cases, these programs might result unintentionally in the collection of information about an American. If two Americans are communicating domestically in an exchange that names a foreign intelligence target (say, an e-mail that mentions an al-Qaeda operative by name), that e-mail might be incidentally collected by upstream collection. Likewise, an e-mail between two terrorist targets might be collected that incidentally includes information not only about legitimately identified U.S. persons (the recruit target John Doe), but also others. An e-mail might also mention Mary Doe—even though no evidence exists of any connection between Mary Doe and a foreign intelligence matter.

This prospect of collecting American data led Congress to include certain requirements that would reduce, though not entirely eliminate, the possibility that the data could be misused. Under the FAA, when information is collected about an American, whether incidentally as part of an authorized investigation, or inadvertently as the result of a mistake, the government is required to apply FISC-approved “minimization” procedures to determine whether such information may be retained or disseminated.

When lawyers and intelligence professionals use the word “minimization” in the context of intelligence collection, it means that any information inadvertently collected on a U.S. person is retained (if at all) only for a limited time, and that information about Americans is used and revealed and further disseminated only under narrowly defined circumstances. Minimization requirements may also mean deleting the information entirely. As with the targeting procedures, these minimization procedures are approved by the FISC—but again, the approval is for the entire system of minimization, not for each individual case.

So, for example, under these minimization rules, the NSA, CIA, and FBI are subject to certain limitations in how they are permitted to query and analyze the data they have lawfully collected. For example, they must demonstrate a reasonable likelihood that targeting a particular item in the information collected will result in the development of foreign intelligence. In other words, the rules limit when a U.S. person can be targeted for examination, and how long data about an American can be retained before it is deleted.

The Effectiveness of Section 702

With that background in mind, it is useful to turn to more practical questions about the program: Does it work? Is it being abused?

The public record suggests that the Section 702 program has indeed helped in the fight against terrorism. Classified records might provide additional support for this conclusion but they are unavailable to us.[9] The Privacy and Civil Liberties Oversight Board (PCLOB)—a bipartisan panel in the executive branch that reviews actions the executive branch takes to protect the country from terrorism, and also monitors civil liberty concerns—has reported that more than one-quarter of NSA reports on international terrorism include information that is based in whole, or in part, on data collected under the Section 702 program.

The PCLOB found that the 702 program “makes a substantial contribution to the government’s efforts to learn about the membership, goals, and activities of international terrorist organizations, and to prevent acts of terrorism from coming to fruition.”[10] Additionally, the program has “led the government to identify previously unknown individuals who are involved in international terrorism, and it has played a key role in discovering and disrupting specific terrorist plots aimed at the United States and other countries.”[11]

Although the details supporting these findings are classified, the board has also said that the program has played a role in discovering, and disrupting, specific terrorist plots aimed at the United States by enabling the government to identify previously unidentified individuals involved in international terrorism.[12] Additionally, the U.S. House of Representatives Permanent Select Committee on Intelligence (HPSCI) has posted three declassified examples from the NSA that involved the effective use of Section 702 collection in 2009: the New York City Subway Attack Plot; the Chicago Terror Investigation; and Operation Wi-Fi.

A few critics of the 702 program have disputed its actual impact in the New York City Subway Attack Plot and the Chicago Terror Investigation. TheGuardian interviewed several people who were involved in the two investigations and reviewed U.S. and British court documents.[13] Based on this incomplete record, The Guardian concluded that these investigations began with “conventional” surveillance methods—such as “old-fashioned tip-offs” of the British intelligence services—rather than from leads produced by NSA surveillance.

But the fact remains that current and former intelligence officials, members from both political parties across two Administrations, national security law experts in the private sector, and the PCLOB maintain that 702 has been and continues to be a very important intelligence tool for overseas intelligence collection.

Section 702 Criticisms v. Facts

Some of the criticisms of Section 702 are little more than philosophical objections to the concept of overseas surveillance.

Setting aside those concerns, there are other specific criticisms, each of which lacks merit. For example, there has been criticism that there is no significant publicly available data on how little, or how much, incidental collection there is about U.S. persons. Such data would be helpful to know in assessing the program. According to the PCLOB, in 2013 the NSA approved 198 U.S. person identifiers to be used as content query terms. The real issue is the frequency with which U.S. persons’ information was collected incidentally to the general foreign intelligence mission, and what is done with the information. After all, if the volume of incidental collection even remotely came close to what is collected as useful data on terrorism activities, including threats, skepticism about Section 702’s efficacy would be warranted.

Given that the targets of Section 702 collection are non-U.S. persons reasonably believed to be located overseas, it can reasonably be inferred that the predominant portion of the collected data does not contain U.S. person information. Although it would be useful to have an accurate estimate of how much incidental U.S. person information actually resides within the remaining portion of the data collected under the Section 702 program, it has proved very difficult to find any solution that would provide such an estimate. The first problem is that the collected data is often not readily identifiable as being associated with a U.S. person and would require the application of additional scarce technological and analytic resources in an effort to make those associations. The second problem is that the targets of the Section 702 collection efforts do not always communicate with persons of foreign intelligence interest. Ironically, an effort to ascertain an accurate estimate of non-pertinent U.S. person information lying dormant in the collected data is inconsistent with the purpose of Section 702, which is to identify foreign intelligence information. Such an effort to provide an estimate would result in more invasive review of U.S. person information.

FISA itself takes a more practical approach in attempting to understand the potential U.S. person privacy implications raised by Section 702 collection. It requires the head of each element of the Intelligence Community to conduct an annual review and to provide an accounting of the references to U.S. persons in intelligence reporting.[14] This outcome-based approach focuses on the U.S. person information that is actually being seen by the Intelligence Community, in order to assess whether there is any prejudicial impact on privacy rights. Also, the Office of the Director of National Intelligence (ODNI) recently released its “Statistical Transparency Report Regarding Use of National Security Authorities–Annual Statistics for Calendar Year 2015.”[15] The report estimates that 94,368 non-U.S. persons are targets of Section 702 collection. By comparison, the report estimates that the IC used 4,672 known U.S. person search terms in 23,800 queries of the lawfully collected Section 702 data. The report also notes that in 2015, the NSA disseminated 4,290 Section 702 intelligence reports that included U.S. person information. Of those reports, the U.S. person information was masked in 3,168 reports and unmasked in 1,122 reports. The remaining major criticisms of the 702 program are more systematic and definitional. One critique is that the government uses too broad a means in its first stage of collection, which is then followed by a more refined collection of data.[16] Judge Thomas F. Hogan of the FISC has described the program more accurately: “While in absolute terms, the scope of acquisition under Section 702 is substantial, the acquisitions are not conducted in a bulk or indiscriminate manner. Rather they are effected through…discrete targeting decisions for individual selectors.”[17]

Another complaint about the Section 702 program is that U.S. person data is retained—at least partially—at all. Under current rules, when the U.S. government targets someone abroad, it is not required to discard the incidentally collected communications of U.S. persons—if authorities conclude that those conversations constitute foreign intelligence.

In that event, even incidental conversations by or about U.S. persons may be retained. And the threshold for querying a U.S. person within the data collected is relatively low. To affirmatively query the data collected about a U.S. person, all that is needed is a determination that the search is reasonably likely to return foreign intelligence information. “Reasonably likely” is an especially easy standard to meet. It does not, for example, require any particularized suspicion that the U.S. person who is subject of the inquiry is engaged in any wrongdoing himself.

For that reason, a Presidential Review Board, as well a few Members of Congress, believe that Section 702 collection on Americans goes too far.[18] The program, they argue, is permissible and lawful without individual case supervision or a warrant requirement precisely because it targets non-Americans. So they contend that when the communications of U.S. persons are queried, probable cause and warrant requirements should apply. Any loophole that allows that particular querying should be closed because the government should not be able to obtain “back door” evidence against U.S. persons that it could otherwise only obtain with judicial approval.

But there is no “back door” here—a query does not collect any additional data. The FISC specifically holds that the 702 collection is constitutional and entirely consistent with the Fourth Amendment’s protections. The court found that “the querying provisions of the FBI Minimization Procedures strike a reasonable balance between the privacy interests of U.S. persons and persons in the United States, on the one hand, and the government’s national security interests, on the other.”[19] Even the fact that the “FBI’s use of those provisions to conduct queries designed to return evidence of crimes unrelated to foreign intelligence” did “not preclude the Court from concluding that taken together, the targeting and minimization procedures submitted with the 2015 Certifications are consistent with the requirements of the Fourth Amendment.”[20]

Obviously, Congress itself did not agree with these systematic and definitional complaints. While the focus of Section 702 collection is on non-U.S. persons located overseas, one of the specifically intended benefits of Section 702 was its ability to provide tip and lead information about persons in the United States who might be conspiring with overseas terrorists. This limited information might prove useful in helping to establish the probable cause necessary to obtain full surveillance coverage of these domestic suspects. It is also important to understand that the response to complaints about the theoretical possibility of abuse under FISA revolves around tight controls. The PCLOB found little evidence of abuse of the Section 215 metadata program, and in the case of Section 702 implementation found virtually no intentional misuse of the collection authorities where U.S. persons were concerned:

Over the years, a series of compliance issues were brought to the attention of the FISA court by the government. However, none of these compliance issues involved significant intentional misuse of the system. Nor has the Board seen any evidence of bad faith or misconduct on the part of any government officials or agents involved with the program. Rather, the compliance issues were recognized by the [FISA] court—and are recognized by the Board—as a product of the program’s technological complexity and vast scope, illustrating the risks inherent in such a program.[21]

Similarly, the PCLOB included a section in its 702 report called “Compliance Issues.” According to the PCLOB, the few instances of error in the administration of the 702 program were infrequent and mainly minor and administrative in nature. That is why the PCLOB found that “internal and external compliance programs have not to date identified any intentional attempts to circumvent or violate the procedures or the statutory requirements, but both unintentional incidents of noncompliance and instances where Intelligence Community personnel did not fully understand the requirements of the statute.”[22]

In other words, all of the errors in the program were accidental or due to mistakes. None was the product of intentional misconduct. Indeed, the non-compliance incident rate has been substantially below 1 percent, according to the PCLOB.[23] Over half of the reported incidents involved instances in which the “NSA otherwise complied with the targeting and minimization procedures in tasking and de-tasking a selector, but failed to make a report to the NSD and ODNI” in a timely fashion.[24]

Two other common reasons why compliance errors occurred are that: (1) the wrong selector was tasked due to a typographical error, or (2) a delay in de-tasking (removing the selector) resulted when an analyst de-tasked some, but not all, of the Section 702-tasked selectors placed on a non-U.S. person target known to be traveling to the United States.[25]

Taken together, these minor administrative errors accounted for “almost 75% of the compliance incidents,” according to the PCLOB.[26]

Section 702: Constitutional and Lawful

One last aspect of Section 702 needs to be addressed: the suggestion that the program might in some way be unconstitutional or unlawful. This Backgrounder concludes that relevant case law firmly supports the constitutionality and legality of the Section 702 program. To support this conclusion, we provide a brief history of relevant case law.

The predicate case is United States v. United States District Court,[27] sometimes known as the Keith case, after Judge Damon Keith, the federal district court judge who oversaw the case.

The case hearkens back to an era of protest and civil unrest in the United States. It involved several leaders of the so-called White Panther Party—a white supremacist group—who were charged with bombing a CIA office in Ann Arbor, Michigan, in 1968. Their phones were wiretapped by order of U.S. Attorney General John Mitchell, who served under President Richard Nixon. Mitchell said that no warrant was required to authorize the interception, because the defendants posed a “clear and present danger to the structure or existence of the government.”

Judge Keith responded that the Attorney General’s rationale was insufficient, and ruled that warrantless interception and surveillance of domestic conversations was unconstitutional. When the case reached the Supreme Court, the justices agreed with Judge Keith, establishing as precedent the idea that a warrant was needed before electronic surveillance commenced, even if the domestic surveillance was related to national security.

As Justice Lewis Powell said in writing for the Court, the “price of lawful public dissent must not be a dread of subjection to an unchecked surveillance power.” Justice Powell continued, “Nor must the fear of un-authorized official eavesdropping deter vigorous citizen dissent and discussion of government action in private conversation. For private dissent, no less than open public discourse, is essential to our free society.”

Notably, however, the Court limited its holding to domestic surveillance, and said that different rules might apply when the surveillance occurred outside the United States, or was directed at a foreign power—or at non-Americans. Regarding surveillance of non-Americans overseas, courts around the country have agreed with the implicit suggestion of the Supreme Court, holding that surveillance for foreign intelligence purposes need only be reasonable (and that a warrant is not required).[28] That distinction—between domestic and foreign surveillance—is preserved in FISA, which allows more relaxed FISA procedures (for which a criminal warrant was not required) only when the purpose of the investigation is to collect foreign intelligence.

In Vernonia School District 47J v. Acton, the Supreme Court upheld the drug testing of high school athletes and explained that the exception to the warrant requirement applied “when special needs, beyond the normal need for law enforcement, make the warrant and probable cause requirements impracticable.”[29] Although Vernonia was not a foreign intelligence case—far from it—the principles from the Court’s “special needs” cases influenced later cases in the national security context.

In “In re: Sealed Case,” the United States Foreign Intelligence Surveillance Court of Review held that FISA did not require the government to demonstrate to the FISA court that its primary purpose in conducting electronic surveillance was not criminal prosecution and, significantly, the PATRIOT Act’s amendment to FISA, permitting the government to conduct surveillance of agents of foreign powers if foreign intelligence was the “significant purpose” of the surveillance, did not violate the Fourth Amendment.[30] The court avoided an express holding that a foreign intelligence exception exists, but held that FISA could survive on reasonableness grounds.

In 2008, “In re: Directives Pursuant to Section 105B of FISA” applied the principles derived from the special needs cases to conclude that the foreign intelligence surveillance authorized by the Protect America Act possesses characteristics that qualify it for a foreign intelligence exception to the warrant requirement of the Fourth Amendment.[31]

Notably, the “In re: Directives” decision cites a Fourth Circuit opinion for the proposition that there is a high degree of probability that requiring a warrant would hinder the government’s ability to collect time-sensitive information and thus impede vital national security interests.[32]

In April 2016, the first decision addressing the constitutionality of upstream collection under Section 702 was publicly released. The FISA court issued a declassified opinion[33] in which it concluded that use of information collected under Section 702 authority for domestic investigations satisfied both constitutional standards and was within the statutory bounds of the FISA Amendments Act. Notably, for purposes of this discussion, the court reached this conclusion after having had the benefit of a public advocate who articulated a position contrary to that of the government.[34] Judge Hogan cites “In re: Directives” in support of the proposition that the Fourth Amendment does not require the government to obtain a warrant to conduct surveillance in order “to obtain foreign intelligence for national security purposes [that] is directed against foreign powers or agents of foreign powers reasonably believed to be located outside of the United States.”

Section 702: Continuing Improvements

On February 5, 2016, the PCLOB issued its “Recommendations Assessment Report.” The purpose of the report was to assess whether the DNI had responded appropriately to recommendations it had made for the improvement of the program.

The DNI had taken action to the PCLOB recommendations. Indeed, with respect to the 10 recommendations relating to the Section 702 program, the PCLOB Recommendations Assessment Report determined that five recommendations have been fully implemented; one has been substantially implemented; three are in the process of being implemented; and one has been partially implemented.[35]

The historical record demonstrates the effectiveness of both the PCLOB’s oversight function and the responsiveness of the DNI to its recommendations—a win-win story in the new age of intelligence oversight.[36]

Conclusions

First, Section 702 is constitutional, statutorily authorized, and carefully constructed to address a vital U.S. national security requirement: the collection of vital information relating to foreign threats.

Second, it seems clear that, in light of careful scrutiny by the PCLOB, the specter of alleged abuse of the program is more theoretical than real.

Third, the Section 702 program has great current utility and provides invaluable intelligence of practical impact and not replaceable by other means of collection.

The benefits of the Section 702 program greatly outweigh its (theoretical) costs and the program should continue as currently authorized. Indeed, the record suggests that the 702 Program is invaluable as a foreign intelligence collection tool. The fruits of the program constitute more than 25 percent of the NSA’s reports concerning international terrorism. It has clearly defined implementation rules and robust oversight by all three branches of government, and is a necessary tool for defending the nation.

Congress should reauthorize 702 in its entirety. There is no need for a further sunset of the act’s provisions, as it has demonstrated its usefulness; and an arbitrarily forced reconsideration by Congress is unnecessary, a waste of time and money, and at the expense of national security.

The program can, and should, be implemented in a manner that is consistent with American values. To quote General Michael Hayden, former director of the NSA and former CIA director:

[A]n American strategy for cyberspace must reflect and serve our ideals. In our zeal to secure the internet, we must be careful not to destroy that which we are trying to preserve, an open, accessible, ubiquitous, egalitarian, and free World Wide Web. There are nations—like Iran, China, Russia and others—who view precisely those attributes as the very definition of cyber security threats. Their concern is not digital theft, but the free movement of ideas. We must take care that in our efforts to prevent the former, we do not legitimize their efforts to prevent the latter.[37]

A properly configured Section 702 program has met that challenge to the benefit of the American public. At a time when international terrorism is on the rise, the United States must have a lawful, robust foreign intelligence capability.

—David R. Shedd is a Visiting Distinguished Fellow in the Kathryn and Shelby Cullom Davis Institute for National Security and Foreign Policy, Paul Rosenzweig is a Visiting Fellow in the Douglas and Sarah Allison Center for Foreign Policy, of the Davis Institute, and Charles D. Stimson is Manager of the National Security Law Program and Senior Legal Fellow in the Center for National Defense, of the Davis Institute, at The Heritage Foundation.

JUNE 06, 2017 5:27 PM

Republicans worried about leaks consider cutting back surveillance authority