Patient Protection and Affordable Care Act
 |
| 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. 3590) byCharles Rangel (D–NY) on 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 (60–39) with 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 and percentage of people without health insurance, with estimates ranging from 20-24 million additional persons 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 governments, conservativeadvocacy groups, labor 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]
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] 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 marketwere 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 credit[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 plan, Medicaid, Medicare 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 CBO, Gruber 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 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
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-payments, co-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] Such states can exempt states 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 out due to the structure of 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 mitigating 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 conservativeHeritage 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 Hatch, Chuck Grassley, Bob 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]
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 Baucus, Jeff Bingaman and Kent Conrad, along with Republicans Mike Enzi, Chuck 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 rating and 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 Baker, Bob Dole, Tom 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]
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 Finance committees. With the Republican Senate minority vowing to filibuster, 60 votes would be necessary to pass the Senate.[169] At the start of the 111th Congress, Democrats had only 58 votes; the Senate seat in Minnesota ultimately won by Al Franken was still undergoing a recount, while Arlen Specter was still a Republican (he became a Democrat in April, 2009).
Negotiations were undertaken attempting to satisfy moderate Democrats and to bring Republican senators aboard; particular attention was given to Republicans Bennett, Enzi, Grassley and Snowe. On July 7 Franken was sworn into office, providing a potential 60th vote. On August 25 Ted Kennedy—a longtime healthcare reform advocate—died. Paul Kirk was appointed as Senator Kennedy’s temporary replacement on September 24.
After the Finance Committee vote on October 15, negotiations turned to moderate Democrats. Majority leader Harry Reid focused on satisfying centrists. The holdouts came down to Joe Lieberman of Connecticut, an independent who caucused with Democrats, and conservative Nebraska Democrat Ben Nelson. Lieberman’s demand that the bill not include a public option[153][170] was met,[171] although supporters won various concessions, including allowing state-based public options such as Vermont’s Green Mountain Care.[171][172]
Senate vote by state.
Democratic yes (58)
Independent yes (2)
Republican no (39)
Republican not voting (1)
The White House and Reid addressed Nelson’s concerns[173] during a 13-hour negotiation with two concessions: a compromise on abortion, modifying the language of the bill “to give states the right to prohibit coverage of abortion within their own insurance exchanges”, which would require consumers to pay for the procedure out of pocket if the state so decided; and an amendment to offer a higher rate of Medicaid reimbursement for Nebraska.[147][174] The latter half of the compromise was derisively termed the “Cornhusker Kickback”[175] and was repealed in the subsequent reconciliation amendment bill.
On December 23, the Senate voted 60–39 to end debate on the bill: a cloture vote to end the filibuster. The bill then passed, also 60–39, on December 24, 2009, with all Democrats and two independents voting for it, and all Republicans against (except Jim Bunning, who did not vote).[176] The bill was endorsed by the AMA and AARP.[177]
On January 19, 2010, Massachusetts Republican Scott Brown was elected to the Senate in a special election to replace Kennedy, having campaigned on giving the Republican minority the 41st vote needed to sustain Republican filibusters.[147][178][179] His victory had become significant because of its effects on the legislative process. The first was psychological: the symbolic importance of losing Kennedy’s traditionally Democratic Massachusetts seat made many Congressional Democrats concerned about the political cost of passing a bill.[180][181]
House
House vote by congressional district.
Democratic yes (219)
Democratic no (34)
Republican no (178)
No representative seated (4)
Brown’s election meant Democrats could no longer break a filibuster in the Senate. In response, White House Chief of 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]
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
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] From Q4-2013 to Q1-2016, a Gallup survey found that the uninsured rate among adults declined from 17.1% to 11.0%, a decline of 6.1 percentage points.[196] In a 2016 review, Obama presented data showing that the uninsured rate had declined by 43%, from 16.0% in 2010 to 9.1% in 2015, mostly in 2014.[197] The uninsured rate dropped in every congressional district in the U.S. between 2013 and 2015.[198]
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.[199] As of December 2016 there were 32 states (including Washington DC) that had adopted the Medicaid extension, while 19 states had not.[200]
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]
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.[201] 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.[202]
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.[203] 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.[204]
Medicaid expansion
Medicaid expansion by state.[205]
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.[200] 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.[199] 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.[206] 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.[207] 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.[208]
States that rejected the Medicaid expansion could maintain their Medicaid eligibility thresholds, which in many states were significantly below 133% of the poverty line.[209]Many states did not make Medicaid available to childless adults at any income level.[210] Because subsidies on exchange insurance plans were not available to those below the poverty line, such individuals had no new options.[211][212] 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.[206]
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.[213] The federal government initially paid for 100% of the expansion (through 2016). The subsidy tapered to 90% by 2020 and continued to shrink thereafter.[214] Several states argued that they could not afford their 10% contribution.[214][215] 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,[216]
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.[217] 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.[218]
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.[219]
Healthcare insurance 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.[221] 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.[222]
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.[202] From 2008-2010 (prior to Obamacare) health insurance premiums rose by an average of 10% per year.[223]
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.[224][225][226][227] A 2013 study estimated that changes to the health system had been responsible for about a quarter of the recent reduction in inflation.[228] 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.[229]
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.[230]
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 deductible, co-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.[231]
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.[232]
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.[233]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.[234]
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][235][236] The 2011 comprehensive CBO estimate projected a net deficit reduction of more than $200 billion during the 2012–2021 period:[8][237] 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,[238][239] revenue would exceed spending in those subsequent years.[240] 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”[241]—ultimately extending the solvency of the Medicare trust fund by 8 years.[242]
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.[243][244][245]
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 Advantage policies that the Government Accountability Office and Medicare Payment Advisory Commission found to be excessively costly relative to government Medicare;[246][247] and reductions in Medicare reimbursements to hospitals that failed standards of efficiency and care.[246]
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.[241][248] 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”.[249]
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.[250][251][252] 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.[253][254][255]
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.”[256]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.[257]
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;[258][259] stating, “innovations in the delivery of medical care, like greater use of electronic medical records[260] 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.”[258]
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.[261] 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”.[262][263]
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[264] for employees working over 30 hours per week.[265]
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.”[266] 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.[267]
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.[268] 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.[269][270] 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.[271][272] In the public sector full-time jobs turned into part-time jobs much more than in the private sector.[271][273] A 2016 study found only limited evidence that ACA had increased part-time employment.[274]
Several businesses and the state of Virginia added a 29-hour-a-week cap for their part-time employees,[275][unreliable source?][276][unreliable source?] to reflect the 30-hour-or-more definition for full-time worker.[268] 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).[270] Trends in working hours[277] and the effects of the Great Recession correlate with part-time working hour patterns.[278][279] 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.[270][277][280] Relatively few firms employ over 50 employees[270] and more than 90% of them offered insurance.[281] Workers without employer insurance could purchase insurance on the exchanges.[282]
Most policy analysts (on both right and left) were critical of the employer mandate provision.[269][281] They argued that the perverse incentives regarding part-time hours, even if they did not change existing plans, were real and harmful;[283][284] that the raised marginal cost of the 50th worker for businesses could limit companies’ growth;[285] that the costs of reporting and administration were not worth the costs of maintaining employer plans;[283][284] and noted that the employer mandate was not essential to maintain adequate risk pools.[286][287] The effects of the provision generated vocal opposition from business interests and some unions not granted exemptions.[284][288]
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.[289]
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.[290]
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.[291]
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.[292][293] About 29% of whites approve of the law, compared with 61% of Hispanics and 91% of African Americans.[294]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.[295]
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.[296] 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.[297][298]
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.[299] Other polls found that people were concerned that the law would cost more than projected and would not do enough to control costs.[300]
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.[296] 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”.[301] 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”.[302]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).[303]
A 2014 poll reported that 26% of Americans support ACA.[304] Another held that 8% of respondents say that the Affordable Care Act “is working well the way it is”.[305] In late 2014, a Rasmussen poll reported Repeal: 30%, Leave as is: 13%, Improve: 52%, i.e., 65% wanted to leave ACA alone or improve upon it.[306]
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.[307] 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.[308]
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.[309]
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.[310] Approximately 45% were unsure whether the repeal of Obamacare also meant the repeal of the Affordable Care Act.[310] 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%).[310]
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.[311]
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][312] 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.[313] 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.[313] Use of the term in a positive sense was suggested by Democrat John Conyers.[314] Obama endorsed the nickname, saying, “I have no problem with people saying Obama cares. I do care.”[315]
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…”.[316]
In October 2013 the Associated Press and NPR began cutting back on use of the term.[317] 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”.[318]
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.[319] “Death panel” referred to two claims about early drafts.
One was that under the law, seniors could be denied care due to their age[320] 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).[321] 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.[322][323]
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.[324] The provision was not included in ACA.[325]
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.[326] A poll in August 2012 found that 39% of Americans believed the claim.[327] The allegation was named PolitiFact‘s “Lie of the Year”,[319][328] one of FactCheck.org‘s “whoppers”[329][330] and the most outrageous term by the American Dialect Society.[331]AARP described such rumors as “rife with gross—and even cruel—distortions”.[332]
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).[333][334][335][336][337]
Illegal immigrants
ACA does not provide benefits to illegal immigrants.[338] It explicitly denies insurance subsidies to “unauthorized (illegal) aliens”.[25][26][339]
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.”[340]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.[341]
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.[342] 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.”[343]
Opposition
Opposition and efforts to repeal the legislation have drawn support from sources that include labor unions,[344][345]conservative advocacy groups,[346][347] Republicans, small business organizations and the Tea Party movement.[348] These groups claimed that the law would disrupt existing health plans, increase costs from new insurance standards, and increase the deficit.[349] Some opposed the idea of universal healthcare, viewing insurance as similar to other unsubsidized goods.[350][351] President Donald Trump has repeatedly promised to “repeal and replace” it.[352][353]
As of 2013 unions that expressed concerns about ACA included the AFL-CIO,[354] which called ACA “highly disruptive” to union health care plans, claiming it would drive up costs of union-sponsored plans; the International Brotherhood of Teamsters, United 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.”[345] 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.”[344]
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.[355] Dayton later said he regretted his remarks after they were seized on by Republicans seeking to repeal the law.[356]
Legal challenges
National Federation of Independent Business v. Sebelius
Opponents challenged ACA’s constitutionality in multiple lawsuits on multiple grounds.[357][358][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.[359]
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.[360][361]
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.[362]
House v. Burwell
In 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 Obamacare 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.[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 conserv
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The Pronk Pops Show 1296, July 25, 2019, Part 2 — Story 1: Black Swan Song — Pathetic Incompetent Corrupt Swamp Swan Figurehead Special Counsel Robert Swan Mueller III Exposed As Fraud — “A Man’s Got to Know His Limitations” — Corrupt Democrat Punks — “Do I feel lucky?” Well, do ya, punk? — “Go Ahead Make My Day” — Impeach Trump — Big Lie Media and Lying Lunatic Leftist Losers Exposed — No Credibility and No Longer Trusted — No Evidence or Basis For Impeachment — Mueller “Outside My Purview”: Clinton Obama Democrat Criminal Conspiracy — American People Will Reelect Trump for Second Term in A Landslide Victory — Case Closed — Videos — Story 2: Investigation, Indicting, Prosecuting The Clinton Obama Democrat Criminal Conspirators — Videos
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Story 1: Black Swan Song — Pathetic Incompetent Corrupt Swamp Swan Figurehead Special Counsel Robert Swan Mueller III Exposed As Fraud — “A Man’s Got to Know His Limitations” — Corrupt Democrat Punks — “Do I feel lucky?” Well, do ya, punk? — “Go Ahead Make My Day” — Impeach Trump — Big Lie Media and Lying Lunatic Leftist Losers Exposed — No Credibility and No Longer Trusted — No Evidence or Basis For Impeachment — Mueller “Outside My Purview”: Clinton Obama Democrat Criminal Conspiracy — American People Will Reelect Trump for Second Term in A Landslide Victory — Videos
Black Swan – Last Dance Scene (“I was perfect…”)
The Real ‘Black Swan’: Double Speaks
Magnum Force (10/10) Movie CLIP – A Man’s Got to Know His Limitations (1973) HD
A Good Man Always Has to Know His Limitations
Dirty Harry Do You ( I ) Feel Lucky Punk? ( high quality)
Dirty Harry – inadmissible
Dirty Harry Do You Feel Lucky Punk
Dirty Harry – Best Quotes, Lines (Clint Eastwood)
WATCH: Rep. Nunes calls Mueller hearing ‘spectacle” and ‘political theater’ | Mueller testimony
WATCH: Rep. Brad Wenstrup’s full questioning of Robert Mueller | Mueller testimony
WATCH: Rep. Ben Cline’s full questioning of Robert Mueller | Mueller testimony
WATCH: Rep. Guy Reschenthaler’s full questioning of Robert Mueller | Mueller testimony
WATCH: Rep. Debbie Lesko’s full questioning of Robert Mueller | Mueller testimony
WATCH: Rep. Michael Turner’s full questioning of Robert Mueller | Mueller testimony
Jim Jordan pushes Mueller on investigating ‘how the false accusations started’
Joe diGenova: The public got to see Mueller’s incompetence
Joe diGenova: IG Horowitz and John Durham Have Both Already interviewed Joseph Mifsud
Mueller’s testimony riddled with shaky moments, incomplete answers
Robert Mueller testifies before Judiciary Committees on Capitol Hill (LIVE) | USA TODAY
Robert Mueller’s full testimony to House Judiciary committee
MUELLER HEARING: House Judiciary Committee Part 1
MUELLER HEARING: House Intelligence Committee Part 2
Full: Robert Mueller Testimony To Congress, Reaction And Analysis | NBC News
Collins at Mueller hearing: I hope this brings us closure
WATCH: Rep. Steve Chabot’s full questioning of Robert Mueller | Mueller testimony
WATCH: Rep. Ted Lieu’s full questioning of Robert Mueller | Mueller testimony
WATCH: Rep. Debbie Lesko’s full questioning of Robert Mueller | Mueller testimony
WATCH: Rep. F. James Sensenbrenner’s full questioning of Robert Mueller | Mueller testimony
Ratcliffe Questions Former Special Counsel Mueller on Report
Representative Turner questions Mueller
WATCH: Rep. Matt Gaetz’s full questioning of Robert Mueller | Mueller testimony
Rep. Jim Jordan blasts Mueller for dodging questions
Ohio Republican Rep. Jim Jordan presses former Special Counsel Robert Mueller on the origins of the Trump-Russia collusion investigation. Jordan says maybe a better course of action is to figure out how the false accusations started.
Rep. Gohmert grills Mueller: Did you know Strzok hated Trump?
Representative Nunes questions Mueller
WATCH: Rep. Ben Cline’s full questioning of Robert Mueller | Mueller testimony
Joe diGenova: The public got to see Mueller’s incompetence
Whitaker says it was clear Mueller didn’t have a grasp of Russia report
Tucker: Democrats believed Mueller would save America
Hannity: Mueller’s testimony was an unmitigated disaster
Ingraham: Trump beats the elites again
Jim Jordan says Dems are never going to stop going after Trump
Gowdy on Mueller: I would’ve beaten the hell out of that exoneration
Trump’s legal team takes victory lap after Mueller hearings
WATCH: Key moments from Mueller’s testimony
Takeaways and analysis of Mueller hearings
‘Disoriented’ Mueller’s stumbling responses to questions during blockbuster hearing leave social media concerned the special counsel seems a ‘confused old man’ but some think it is all a strategy to frustrate the committee members
By MEGAN SHEETS FOR DAILYMAIL.COM
PUBLISHED: 10:11 EDT, 24 July 2019 | UPDATED: 16:45 EDT, 24 July 2019
Perplexed viewers are questioning Robert Mueller’s ‘confused’ demeanor as he testifies in front of Congress.
The special counsel faced members of the House Judiciary and Intelligence Committees on Wednesday morning at a highly-anticipated hearing on the Russiainvestigation.
Viewers reacting on social media have noticed that Mueller appeared to stumble at multiple points.
‘Robert Mueller comes across as a doddering old fool with a questionable moral compass based on situational ethics who should never have been appointed in the first place based on reduced mental capacity,’ one person tweeted.
‘Mueller is acting like he doesn’t know what’s going on,’ another wrote. ‘He’s acting like a confused old man.’
Some are saying the wobbly performance is a delaying tactic on the part of the special counsel to frustrate Republican committee members determined to discredit findings that are damaging to President Donald Trump.
When it came to questions at the core of the report, Mueller has delivered firm answers without hesitation.
Asked whether Trump had been exonerated or if he could be charged with obstruction of justice when he leaves office, Mueller replied: ‘No’ and ‘Yes’ respectively.
‘Lots of twitter folks are dogging Mueller out for looking old and feeble,’ MSNBC’s Joy Reid tweeted. ‘But optically, that just makes the Republicans yelling at him look more absurd. Mueller is quite definitive in his one word answers, which only Dems are eliciting from him so far.’
Perplexed viewers are questioning Robert Mueller’s ‘confused’ demeanor as he testifies in front of members of the House Judiciary and Intelligence Committees on Wednesday morning
Viewers reacting on social media noticed that Mueller appeared to stumble at multiple points
Several Twitter users expressed the opinion that the 74-year-old veteran prosecutor’s shaky demeanor calls his entire report into question.
‘Listening too Mueller the cracking in his voice shows clearly that he is a conflicted Skunk and lying ! And I think he is senile !’
‘As I said when Mueller gave speech in May, he is feeble,’ radio personality Mark Levin tweeted. ‘I say that not as a personal attack but as a rational observation. It’s on display today during this hearing.
‘This underscores that the person who influenced this investigation most was Andrew Weissman, his top lieutenant.’
Replying to Levin’s tweet, one man wrote: ‘Agreed, Mueller looks geriatric and lost…. find that man a time machine.’
‘It’s quite entertaining. Mueller can’t make a coherent statement. Looks like the circus made a stop in DC,’ a woman tweeted.
‘I’d say Democrats right now regretting they ever subpoenaed Mueller. He looks confused,’ a man wrote.
Some viewers have said Mueller’s shaky demeanor calls his report into question
Others think Mueller sounds uncertain because he is being overly-cautious about coming off as impartial.
‘I’m concerned that Mueller is so concerned with not appearing political that he is really under-performing at times by failing to clarify things that need clarification,’ one woman wrote.
‘To let crazy GOP statements stand without clarification could be interpreted as agreement.’
Some noted that Mueller is being hindered by the mammoth task of manually searching through 397 pages to effectively answer questions about the report his team took two years to compile.
He repeatedly had to ask committee members for page numbers when asked to comment on specific sections.
One woman tweeted that Mueller would have a much easier time referring to the report if he had searchable copy on a computer.
‘Give Robert Mueller a computer, he desperately needs CTRL + F,’ Vice Media VP Katie Drummond wrote.
Ironically, the copy of the report released by the Justice Department was a scanned printout and thus couldn’t be searched. Several searchable versions have cropped up in the months since then.
Unfortunately for Mueller, witnesses are not allowed to use computers during hearings.
Mueller frequently had to pause and manually search through the 397-page report to effectively answer questions from lawmakers
Throughout the hearing, Democrats, who hold the majority on both committees present, worked to elicit short, definitive answers from Mueller.
House Judiciary Chairman Jerold Nadler asked him: ‘Director Mueller, the president has repeatedly claimed that your report found there was no obstruction and that it completely and totally exonerated him. But that is not what your report said, is it?
‘That is correct. That is not what the report said,’ Mueller responding.
‘Does that say there was no obstruction?’ Nadler followed up later.
‘No,’ the former special counsel said.
‘In fact, your report expressly states that it does not exonerate the president,’ Nadler told him.
‘Yes it does,’ Mueller replied.
Most of Mueller’s fumbles came in response to Republicans trying to get him to stray from his typical dry, technical explanations.
‘Where are you reading from?’ he asked one member, Rep James Sensenbrenner. ‘I am reading from my question,’ the Wisconsin Republican lawmaker told him.
Under questioning by Republican Rep Steve Chabot, Mueller didn’t show immediate familiarity with political intelligence firm Fusion GPS, a key player in the trail of the Steele Dossier, and a fixture of attention of President Trump and GOP critics of the Mueller probe.
‘When you talk about the firm that produced the Steele reporting, the name of the firm was Fusion GPS, is that correct?’
‘I’m not familiar with that,’ said Mueller.
‘That’s not a trick question. It’s Fusion GPS.’
Ohio Republican Rep Jim Jordan sought to draw Mueller out on the surveillance warrants for former Trump campaign adviser Carter Page, whose trips to Russia drew attention of investigators.
‘Director Mueller, the third FISA renewal happens a month after you’re named special counsel. What role did your office play in the third FISA renewal of Carter Page?’ Jordan asked.
‘I’m not going to talk to that,’ said Mueller.
In his prepared statement, Mueller began by defending his probe following an onslaught of attacks, and spelling out questions he will and will not answer.
He said he told his team at the start of the Russia probe to ‘work quietly, thoroughly and with integrity so that the public would have full confidence in the outcome.
‘We needed to do our work as thoroughly as possible and as expeditiously as possible. It was in the public interest for our investigation to be complete and not to last a day longer than necessary,’ Mueller said.
He said his team of lawyers and agents worked ‘fairly and with absolute integrity’ – minutes after President Trump once again attacked it as a ‘witch hunt’.
‘Our team would not leak or take other actions that would compromise the integrity of our work,’ said Mueller. ‘All decisions were made based on the facts and the law.’
Ohio Republican Rep Jim Jordan sought to draw Mueller out on the surveillance warrants for former Trump campaign adviser Carter Page, whose Russia trips drew investigators’ attention
Rep Doug Collins tried to get Mueller to contradict his report by asking him whether ‘collusion’ and ‘conspiracy’ are the same thing after Mueller testified that they weren’t.
Collins cited a portion of the report that states: ‘Collusion is not a specific offense or theory of liability found in the U.S. Code; nor is it a term of art in federal criminal law. To the contrary, even as defined in legal dictionaries, collusion is largely synonymous with conspiracy as that crime is set forth in the general federal conspiracy statute.’
Mueller critics declared that the special counsel had been bested by Collins, while experts explained that Collins’ citation was taken out of context.
The part of the report in question was about collusion in the sense of corporate collusion – when companies conspire in an illegal fashion to help each other at consumers’ expense.
Corporate collusion is unrelated to ‘collusion with Russia’, the colloquial term adopted in the debate about potential cooperation between the Trump campaign and the Russian government.
Both sides sought to get Mueller on record on the question of whether he had any potential conflict that would prevent him from overseeing the probe.
Georgia Democrat Rep Hank Johnson asked Mueller if he had any conflicts of interest that prevented him from being special counsel. Mueller said he did not. Trump has repeatedly said Mueller was ‘highly conflicted,’ saying he had interviewed to be his FBI director and that the two men had a nasty business dispute.
Some people on social media lambasted Republican committee members for trying to damage Mueller’s credibility.
‘No matter your political party, it’s absolutely disgusting to see those attacking Mueller’s integrity,’ one man tweeted.
‘The way the @JudiciaryGOP members talked and yelled at Robert Mueller is beyond awful. They’ve all lost their souls,’ another wrote.
‘Republicans can’t argue the facts, so they attack the investigation and the investigators,’ another said.
‘Remember this slander of Mueller the next time you hear republicans going on about their love & respect for veterans. They will throw anyone under the bus who doesn’t toe the party line.’
Some people on social media lambasted Republican committee members for trying to damage Mueller’s credibility
TOP 10 MUELLER TAKEAWAYS
Below are the 10 most important takeaways gleaned from Robert Mueller’s testimony before the House Judiciary and Intelligence Committees on Wednesday.
Mueller said all he wanted to say in his report
When Mueller finally agreed to testify before Congress – after more than two years of silence about the Russia investigation – the special counsel said he ‘would not provide information beyond that which is already public’ in the report published in April.
He stuck to that promise throughout Wednesday’s hearing, declining or deferring nearly 200 questions from committee members.
Mueller’s reasons for not answering included not wanting to speculate, being unable to detail internal Justice Department deliberations and being under orders not to broach specific topics.
Trump was paying attention
After saying that he couldn’t be bothered to watch Mueller’s testimony, President Trump made it clear that he was tuned in as he tweeted multiple reactions to the proceedings on Wednesday.
‘I’m not going to be watching Mueller because you can’t take all those bites out of the apple,’ Trump told reporters in the Oval Office on Monday. ‘We had no collusion, no obstruction.’
Before the hearing even kicked off Trump had posted seven tweets about the hearing, echoing his go-to attacks on ‘Mueller & his band of 18 Angry Democrats’.
Over the next eight hours tweeted and retweeted 14 posts about Mueller’s testimony, including multiple videos of Republican lawmakers grilling the special counsel.
‘TRUTH IS A FORCE OF NATURE!’ he declared just after 2.30pm.
Mueller didn’t subpoena Trump to avoid a lengthy court battle
The special counsel addressed why Trump wasn’t interviewed during the two-year-long investigation when New York Democratic Rep Sean Maloney asked him: ‘Why didn’t you subpoena the president?’
Trump’s legal team had refused to have him be interviewed in the probe because they felt such a meeting would amount to a ‘perjury trap’.
Before Congress Mueller stated that his team had ‘little success’ when pushing for an interview for over a year and decided that they didn’t want to delay the investigation with a lengthy court battle.
‘We did not want to exercise the subpoena power because of the necessity of expediting the end of the investigation,’ he said, adding that no one at the Justice Department pressured him to finish the probe.
Mueller acknowledged that Trump’s written answers to questions about possible conspiracy with Russia were ‘not as useful as the interview would be’.
Trump was not exonerated by the Russia investigation
Judiciary Committee Chairman Jerry Nadler, a New York Democrat, kicked off Wednesday’s proceedings by asking Mueller directly if the Russia investigation exonerated President Trump.
‘No,’ Mueller stated without hesitation.
That goes against the president’s repeated claims that the probe proved there was ‘no obstruction, no collusion’.
Mueller’s team never determined whether Trump committed a crime
While the majority of his answers were straightforward and technical, Mueller struggled when questioned about why he did not indict the president.
During an exchanged with California Democratic Rep Ted Lieu, Mueller stated that the reason he did not even consider indicting Trump on obstruction charges was because of guidance from the DOJ’s Office of Legal Counsel that a sitting president cannot be indicted.
That goes against assertions by Attorney General William Barr, who has repeatedly said the OLC’s opinion was not the only reason Mueller did not indict Trump.
Arizona Republican Rep Debbie Lesko asked Mueller to clarify that contradiction, at which point he said he ‘would have to look closer at it’.
He later conceded that he had misspoken when he characterized the OLC’s guidance to Lieu.
‘We did not reach a determination as to whether the President committed a crime,’ he said.
‘Based on Justice Department policy and principles of fairness, we decided we would not make a determination as to whether the president committed a crime.’
Mueller was much less steady than in previous hearings
At times, Mueller, 74, stumbled during answers, asking fast-talking lawmakers to repeat page citations and repeat their questions. He sometimes had to scan the hearing room to locate questioners.
Although his stock answer was to say issues were beyond the purview of his mandate, he also appeared not to recall specific information at times.
‘Where are you reading from?’ he asked one member, Rep. James Sensenbrenner. ‘I am reading from my question,’ the Wisconsin Republican lawmaker told him.
Under questioning by Republican Rep Steve Chabot, Mueller didn’t show immediate familiarity with political intelligence firm Fusion GPS, a key player in the trail of the Steele Dossier, and a fixture of attention of President Trump and GOP critics of the Mueller probe.
Viewers reacting on social media called out Mueller’s unsteadiness early on, remarking that he was acting ‘like a confused old man’.
Some said the wobbly performance could be a delaying tactic on the part of the special counsel to frustrate Republican committee members determined to discredit findings that are damaging to Trump.
Mueller and Trump have opposing accounts of what led up to special counsel appointment
Republicans probed Mueller’s professional links with Trump in an attempt to show he may have had a reason to be biased against the president – specifically questioning whether he was turned down for the FBI director position the day before being tapped to lead the Russia investigation.
Trump gave his version of events on Wednesday morning, tweeting: ‘It has been reported that Robert Mueller is saying that he did not apply and interview for the job of FBI Director (and get turned down) the day before he was wrongfully appointed Special Counsel.
‘Hope he doesn’t say that under oath in that we have numerous witnesses to the interview, including the Vice President of the United States!’
Mueller contradicted Trump’s account when Texas Republican Rep Louie Gohmert seized on his alleged conflicts of interest.
Gohmert asked Mueller about a meeting he had with Trump the day before the special counsel appointment and contended that it was a job interview for the FBI director slot.
Mueller stated that he was not interviewed ‘as a candidate’ for the position.
Mueller fiercely defended his team’s impartiality
The special counsel was calm and composed throughout the proceedings, save for one moment when Florida Republican Rep Greg Steube decried the political affiliations of the lawyers on his team.
Mueller said never in his 25 years in his position had he felt the need to ask the people he works with about their political affiliation.
Rep Gohmert also called Mueller’s hiring practices into question, particularly his appointment of FBI agent Peter Strzok – who was later removed from the probe after he was found to have sent anti-Trump text messages to a woman he was involved with.
Mueller said he did not know of Strzok’s disdain for Trump before the probe started and learned about it in the summer of 2017, several months into the investigation.
Republicans tried to collect evidence for a probe into Mueller’s investigation
Republicans committee members tried both the blast the origins of the Russia probe and potentially establish a record that might play out in an ongoing investigation overseen by Attorney General William Barr.
‘Before you arrested [Trump campaign foreign policy aide] George Papadopoulos in July of 2017, he was given $10,000 in ash in Israel. Do you know who gave him that cash?’ California Rep Devin Nunes asked Mueller.
‘Again, that’s outside our … questions such as that should go to the FBI or the department,’ said Mueller.
‘But it involved your investigation,’ said Nunes.
‘It involved persons involved in my investigation,’ said Mueller.
Trump lawyer Jay Sekulow released a statement saying: ‘This morning’s testimony exposed the troubling deficiencies of the Special Counsel’s investigation. The testimony revealed that this probe was conducted by a small group of politically-biased prosecutors who, as hard as they tried, were unable to establish either obstruction, conspiracy, or collusion between the Trump campaign and Russia. It is also clear that the Special Counsel conducted his two-year investigation unimpeded. The American people understand that this issue is over. They also understand that the case is closed.’
Democrats tried to breathe life into a dense, technical report
The Democrats, who hold a majority on both committees, made a concerted effort to present the investigation’s findings in a more provocative and damning light than they had been in the dense, 337-page report.
‘Your investigation determined that the Trump campaign — including Trump himself — knew that a foreign power was intervening in our election and welcomed it, built Russian meddling into their strategy, and used it,’ California Rep Adam Schiff, the House Intelligence Committee chair, said when the afternoon portion began.
‘Disloyalty to country. Those are strong words, but how else are we to describe a presidential campaign which did not inform the authorities of a foreign offer of dirt on their opponent, which did not publicly shun it, or turn it away, but which instead invited it, encouraged it, and made full use of it?’ Schiff continued.
‘That disloyalty may not have been criminal. Constrained by uncooperative witnesses, the destruction of documents and the use of encrypted communications, your team was not able to establish each of the elements of the crime of conspiracy beyond a reasonable doubt, so not a provable crime, in any event’, he added.
However, a levelheaded Mueller didn’t play along, making for a rather mundane hearing.
https://www.dailymail.co.uk/news/article-7281303/Muellers-stumbling-responses-blockbuster-hearing-leave-social-media-concerned.html
Here’s Why Mueller Kept Getting Asked About a Mysterious Maltese Professor
BY VERA BERGENGRUEN
In a moment that quickly made the rounds on conservative media on Wednesday, Rep. Jim Jordan sharply questioned Robert Mueller on the origins of the counterintelligence investigation into the Trump campaign’s ties to Russia.
The Ohio Republican pressed the former special counsel to detail who told George Papadopoulos, a young foreign policy aide on the Trump campaign, that the Russians had “dirt” on Hillary Clinton. When Mueller said he would not go into it, Jordan became heated.
“Yes you can, because you wrote about it – you gave us the answer!” Jordan said. “Joseph Mifsud.”
The name of the shadowy Maltese academic kept coming up on Wednesday as Republicans accused Mueller of covering up how the FBI came to investigate the Trump campaign’s alleged ties to Russia, a popular talking point for Trump allies. At the House Intelligence Committee hearing, Rep. Devin Nunes pointed to a large photo of Mifsud with then-U.K. foreign secretary Boris Johnson as evidence that he “has extensive contacts with Western governments and the FBI”.
Mifsud’s name would have been familiar for regular consumers of Fox News and conservative outlets that have spent two years dissecting what they believe was a “deep state” attempt to take down the Trump campaign. The London-based professor at the center of the Trump-Russia probe has not been seen in public since October 2017, just days after Papadopoulos pleaded guilty to lying to the FBI about his interactions with him. One of those was a key conversation in London in April 2016, in which Mifsud told him the Russians had damaging information on Clinton in the form of “thousands of emails.” Mifsud also introduced him to a Russian graduate student that Papadopoulos believed to be Putin’s niece, and connected him with an official with ties to the Russian foreign ministry who said he could set up a meeting with the country’s ambassador, according to Mueller’s report. Papadopoulos later relayed that information to an Australian diplomat, Alexander Downer, who passed it on to U.S. government officials, setting into motion the FBI investigation into Russian contacts with the Trump campaign.
Papadopoulos’ interactions with Mifsud, and his allegation that the Maltese professor was an FBI plant, has been at the center of some Republicans’ efforts to discredit Mueller’s probe. Papadopoulos told TIME in May that he believes he was part of an elaborate set-up by U.S. intelligence to sabotage Trump’s presidential campaign. Since serving a short sentence for lying to the FBI, Papadopoulos has continued to make the rounds alleging that Mifsud was a “Western intelligence operative” who tried to use him to entrap the Trump campaign.
“People are very fascinated about what I have to say, people are just like — their mouths are dropping,” he told TIME on April 17. “They’ve never heard this information because Mueller and the FBI wanted to keep me silenced.”
Perhaps anticipating this line of questioning, Mueller made it clear in his opening statement that he would be “unable to address questions about the opening of the FBI’s Russia investigation” because it is the subject of an ongoing review by the Justice Department.
That did not stop Jordan and Nunes, both vocal Trump supporters, from trying.
“He’s the guy who starts it all, and when the FBI interviews him, he lies three times and yet you don’t charge him with a crime,” Jordan exclaimed, angrily listing others charged by Mueller, including Michael Flynn and “13 Russians no one’s ever heard of.”
“But the guy who puts the country through this whole saga, starts it off, for three years we have lived this now, he lies and you guys don’t charge him,” he said.
“I’m not sure I agree with your characterization,” Mueller tersely responded, but Jordan’s performance was already going viral in conservative corners of the internet with headlines like “WATCH: Jim Jordan Steals the Show, Calls into Question Entire Basis of Probe!” and “‘BRUTAL’: Jim Jordan grills Mueller about why ‘guy who put this whole story in motion’ lied but wasn’t held accountable.” On Wednesday afternoon, Trump himself retweeted a clip of the exchange, indicating that Mifsud is unlikely to fade from the debate over the Russia investigation.
Joseph Mifsud
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Rome, Italy
University of Padua (MA)
Queen’s University Belfast(PhD)
Joseph Mifsud (born 1960)[1] is a Maltese academic, with reportedly high level connections to the Russian government.[2] In 2016, he became involved with George Papadopoulos, an advisor to the Donald Trump presidential campaign, and was later accused of being a link between that campaign and Russia. In 2018, he was described as missing, and an Italian court listed his location as “residence unknown”.[3] According to media reports he was in Rome as of April 2019.[4]
Contents
Education
Mifsud holds a bachelor’s degree in education from the University of Malta (1982) and a master’s degree in education from the University of Padua (1989).[1] He was awarded a PhD in 1995 from Queen’s University Belfast; his thesis was titled “Managing educational reform: a comparative approach from Malta (and Northern Ireland); a headteachers’ perspective”.[5]
Career
From 2006 to 2008, Mifsud served as the chef de cabinet of the Ministry of Foreign Affairs of Malta.[1] He later became a principal in the London Centre of International Law Practice. In 2008, he was named President of the Euro-Mediterranean University of Slovenia(EMUNI).[1][6] At least as early as 2010, he began making numerous trips to Russia.[7] He was a professorial teaching fellow at the University of Stirling in Scotland,[8] as well as director of the London Academy of Diplomacy, where he served as director from 2012 until it closed in 2016. The academy was partnered with the University of Stirling.[9][10][11] He has also served as president of the University Consortium of the Province of Agrigento in Sicily; in September 2018, an Italian court ordered him to repay the Consortium 49,000 euros ($56,700) in overpayments.[3]
In a 2017 interview, he claimed to be a member of the European Council on Foreign Relations (ECFR),[12] although the ECFR website in 2018 did not list him as a member.[13] He regularly attended meetings of the Valdai Discussion Club, an annual conference held in Russia, backed by the Kremlin and attended by Vladimir Putin.[14] According to a BBC report, Mifsud was in Moscow in April 2016 to speak on a panel run by the Valdai Club alongside Dr. Stephan Roh, a German multimillionaire lawyer and investor described as a “wheeler-dealer” by the BBC Newsnight program.[15] Roh, Mifsud’s former employer,[16] could not be reached for comment by the BBC and has since attempted to erase links between the two men on his company website. Another speaker at the Valdai Club was Ivan Timofeev, who works for a think tank close to the Russian Ministry of Foreign Affairs, whom Mifsud subsequently introduced to Papadopoulos via email.[15] Mifsud reportedly claimed to his former girlfriend that he was friends with Russian foreign minister Sergei Lavrov.[17]Mifsud himself denied having any contact with the Russian government, saying “I am an academic, I do not even speak Russian.”[8] The Mueller Report, released in 2019, said that Mifsud “maintained various Russian contacts while living in London”, including an unnamed person (name redacted), who was a former staff member of the Internet Research Agency, the Russian troll farm based in Saint Petersburg.[18]
Connection to George Papadopoulos
In March 2016, shortly after Papadopoulos was named as a foreign policy advisor to the Trump campaign, Mifsud met Papadopoulos in Rome. They later met again in London, where Mifsud allegedly introduced Papadopoulos to a Russian woman that he falsely claimed was Putin’s niece; Mifsud has denied the report.[8][14] At a meeting in April, Mifsud told Papadopoulos that he had learned that the Russian government had “dirt” on Hillary Clinton. Papadopoulos allegedly repeated the information to the Australian High Commissioner in London, Alexander Downer, who later reported to American authorities that Papadopoulos had apparently known about Russia’s theft of emails from Democratic sources before it was publicly reported. Papadopoulos has since publicly declared that he did tell Downer about the fact that he was offered “dirt” on Clinton but he has denied any recollection of communicating this theft of emails with Downer. The FBI then launched an investigation into possible connections between Russia and the Trump campaign.[19]
Volume 1 of the Mueller Report[20] states that Mifsud travelled to Moscow in April 2016, and upon his return told Papadopoulos that the Russian government had “dirt” on Hillary Clinton.[18] It also mentions that Papadopoulos “suggested to a representative of a foreign government that the Trump Campaign had received indications from the Russian government that it could assist the Campaign through the anonymous release of information damaging to candidate Clinton”. This would appear to corroborate the contact with Downer.
According to Mifsud, he was interviewed by the FBI in February 2017 while visiting the United States to speak at a conference.[21][22] The FBI has not confirmed that they interviewed him, but he is listed as a featured speaker at the February 2017 national meeting of Global Ties, an event sponsored by the U.S. Department of State.[23] Mifsud left the United States on 11 February 2017. Prosecutors with the investigation into Russian interference in the election suggested, in a 17 August 2018 sentencing memorandum for Papadopoulos, that they might have wanted to challenge, detain, or arrest Mifsud if Papadopoulos had told the truth about their interactions.[24]
Connection to Stephan Roh
Stephan Roh, a Russian-speaking[25] German lawyer and multimillionaire with close ties to Russia, has worked alongside Mifsud for years. Papadopoulos’s wife, who briefly worked for Mifsud, has described Roh as Mifsud’s lawyer, best friend, and funder. Roh owns multiple businesses, many headquartered in Moscow or Cyprus; he also co-owns Link Campus University, a university also known for its diplomatic, intelligence and analytical studies, such as the School of Analysis – Security and Intelligence section, and the place where Mifsud taught.[citation needed] The fact that Mifsud taught at the Link Campus University has been denied by the current president of this university, Vincenzo Scotti.[26] Roh was detained and questioned by investigators on Robert Mueller’s Special Counsel team in October 2017.[27]
Missing report
According to a filing in a U.S. federal court in the case Democratic National Committee v. Russian Federation in September 2018, Mifsud “is missing and may be deceased”. Mifsud’s whereabouts were unknown and he could not be served with the complaint.[28] He spoke to his girlfriend on 31 October 2017. The next day an Italian newspaper revealed that the “professor” referred to in news reports about Papadopoulos was Mifsud, and she has not heard from him since then.[29] According to CNN, he has “gone to ground” and was last seen on 6 November 2017 at Link University, a private university in Rome where he was teaching at the time.[21] In September 2018, an Italian court described his location as “residence unknown”.[3]
In September 2018, a few days after the DNC filing, his associate Stephan Roh told The Daily Caller that he had gotten an indirect message from “really good sources” indicating that Mifsud is alive and living under a new identity.[30] According to media reports he was in Rome as of April 2019.[4]
See also
References …
Robert Mueller
Jump to navigationJump to search
May 17, 2017 – May 29, 2019
September 4, 2001 – September 4, 2013
Barack Obama
Bruce J. Gebhardt
John S. Pistole
Timothy P. Murphy
Sean M. Joyce
January 20, 2001 – May 10, 2001
August 1998 – August 2001[1]
George W. Bush
August 1990 – January 1993[1]
Bill Clinton
1986–1987
August 7, 1944 (age 74)
New York City, New York, U.S.
Robert Swan Mueller III (/ˈmʌlər/; born August 7, 1944) is an American lawyer and government official who served as the sixth Director of the Federal Bureau of Investigation from 2001 to 2013.
A graduate of Princeton University and New York University, Mueller served as a Marine Corps officer during the Vietnam War, receiving a Bronze Star for heroism and a Purple Heart. He subsequently attended the University of Virginia School of Law. Mueller is a registered Republican in Washington, D.C., and was appointed and reappointed to Senate-confirmed positions by presidents George H. W. Bush, Bill Clinton, George W. Bush and Barack Obama.[5][6]
Mueller has served both in government and private practice. He was an assistant United States attorney; a United States attorney; United States assistant attorney general for the Criminal Division; a homicide prosecutor in Washington, D.C.; acting United States deputy attorney general; and director of the FBI. Mueller was also a partner at the D.C. law firm WilmerHale before being appointed as special counsel.
On May 17, 2017, Mueller was appointed by Deputy Attorney General Rod Rosenstein as special counsel overseeing an investigation into allegations of Russian interference in the 2016 U.S. presidential election and related matters.[7] Mueller submitted his report to Attorney General William Barr on March 22, 2019.[8] On April 18, 2019, the Department of Justice released the special counsel’s final report.[9][10] On May 29, 2019, Mueller officially resigned his post and the Office of the Special Counsel was closed.
Contents
Early life and education
Mueller was born on August 7, 1944 at Doctors Hospital in the New York City borough of Manhattan,[11][12] the first child of Alice C. Truesdale (1920–2007) and Robert Swan Mueller, Jr. (1916–2007). He has four younger sisters: Susan, Sandra, Joan, and Patricia.[13] His father was an executive with DuPont who had served as a Navy officer in the Atlantic and Mediterranean theaters during World War II.[13] His father majored in psychology at Princeton University and played varsity lacrosse, both of which he followed (see below).[13]
Mueller is of German, English and Scottish descent. His paternal great-grandfather, Gustave A. Mueller, was a prominent doctor in Pittsburgh, whose own father August C. E. Müller had immigrated to the United States in 1855 from the Province of Pomerania in the Kingdom of Prussia (a historical territory whose area included land now part of Poland and north-eastern edge of Germany).[14] On his mother’s side, he is a great-grandson of the railroad executive William Truesdale.[15]
Mueller grew up in Princeton, New Jersey, where he attended Princeton Country Day School, now known as Princeton Day School. After he completed eighth grade, his family moved to Philadelphia while Mueller himself went on to attend St. Paul’s School in Concord, New Hampshire, where he was captain of the soccer, hockey, and lacrosse teams and won the Gordon Medal as the school’s top athlete in 1962.[16][17] A lacrosse teammate and classmate at St. Paul’s School was future Massachusetts Senator and Secretary of State John Kerry.[18]
Mueller went on to study at Princeton University, where he continued to play lacrosse,[19] receiving a Bachelor of Arts in politics with a senior thesis on jurisdiction in the South West Africa cases in 1966.[19] Mueller earned a Master of Arts in international relations from New York University in 1967.
In 1968, Mueller joined the U.S. Marine Corps. After his military service, Mueller enrolled at the University of Virginia School of Law, where he served on the Virginia Law Review and graduated in 1973.[20]
United States Marine Corps service
Mueller as a Marine lieutenant
Mueller has cited his teammate David Spencer Hackett’s death in the Vietnam War as an influence on his decision to pursue military service.[21] Of his classmate, Mueller has said, “One of the reasons I went into the Marine Corps was because we lost a very good friend, a Marine in Vietnam, who was a year ahead of me at Princeton. There were a number of us who felt we should follow his example and at least go into the service. And it flows from there.”[22] Hackett was a Marine Corps first lieutenant in the infantry and was killed in 1967 in Quảng Trị Province by small arms fire.[23]
After waiting a year so a knee injury could heal, Mueller was accepted for officer training in the United States Marine Corps in 1968, attending training at Parris Island, Officer Candidate School, Army Ranger School, and Army jump school. Of these, he said later that he considered Ranger School the most valuable because he felt “more than anything teaches you about how you react with no sleep and nothing to eat.”[24][25]
In July 1968, he was sent to South Vietnam, where he served as a rifle platoon leader as a second lieutenant with Second Platoon, H Company, 2nd Battalion, 4th Marines, 3rd Marine Division.[12][26] On December 11, 1968, during an engagement in Operation Scotland II, he earned the Bronze Star with “V” device for combat valor for rescuing a wounded Marine under enemy fire during an ambush in which he saw half of his platoon become casualties.[27][28] In April 1969, he received an enemy gunshot wound in the thigh, recovered, and returned to lead his platoon until June 1969.[29] For his service in and during the Vietnam War, his military decorations and awards include: the Bronze Star Medal with Combat “V”, Purple Heart Medal, two Navy and Marine Corps Commendation Medals with Combat “V”, Combat Action Ribbon, National Defense Service Medal, Vietnam Service Medal with four service stars, Republic of Vietnam Gallantry Cross, Republic of Vietnam Campaign Medal, and Parachutist Badge.[12][29][25][30]
After recuperating at a field hospital near Da Hong, Mueller became aide-de-camp to 3rd Marine Division’s commanding general, then–Major General William K. Jones, where he “significantly contributed to the rapport” Jones had with other officers, according to one report.[24][31] Mueller had originally considered making the Marines his career, but he explained later that he found non-combat life in the Corps to be unexciting.[25]
Reflecting on his service in the Vietnam War, Mueller said, “I consider myself exceptionally lucky to have made it out of Vietnam. There were many—many—who did not. And perhaps because I did survive Vietnam, I have always felt compelled to contribute.”[32] In 2009, he told a writer that despite his other accomplishments he was still “most proud the Marine Corps deemed me worthy of leading other Marines.”[25]
After returning from Vietnam, Mueller was briefly stationed at Henderson Hall, before leaving active-duty service in August 1970 [31] at the rank of captain.[31]
Career
Private practice and Department of Justice
After receiving his Juris Doctor in 1973 from the University of Virginia School of Law, Mueller worked as a litigator at the firm Pillsbury, Madison and Sutro in San Francisco until 1976. He then served for 12 years in United States Attorney offices. He first worked in the office of the U.S. Attorney for the Northern District of California in San Francisco,[24] where he rose to be chief of the criminal division, and in 1982, he moved to Boston to work in the office of the U.S. Attorney for Massachusetts as an Assistant United States Attorney,[12] where he investigated and prosecuted major financial fraud, terrorism and public corruption cases, as well as narcotics conspiracies and international money launderers.[33]
After serving as a partner at the Boston law firm of Hill and Barlow, Mueller returned to government service. In 1989, he served in the United States Department of Justice as an assistant to Attorney General Dick Thornburghand as acting Deputy Attorney General. James Baker, with whom he worked on national security matters, said he had “an appreciation for the Constitution and the rule of law”.[34]:33–34
In 1990, he became the United States Assistant Attorney General in charge of the United States Department of Justice Criminal Division.[24] During his tenure, he oversaw prosecutions including that of Panamanian leader Manuel Noriega, the Pan Am Flight 103 (Lockerbie bombing) case, and of the Gambino crime family boss John Gotti.[35]
In 1991, he declared the government had been investigating the Bank of Credit and Commerce International (BCCI) since 1986 in more-than-usual media exposure.[36] Also in 1991, he was elected a fellow of the American College of Trial Lawyers.[12]
In 1993, Mueller became a partner at Boston’s Hale and Dorr, specializing in white-collar crime litigation.[24] He returned to public service in 1995 as senior litigator in the homicide section of the District of Columbia United States Attorney’s Office. In 1998, Mueller was named U.S. Attorney for the Northern District of California and held that position until 2001.[12]
Federal Bureau of Investigation
President George W. Bush nominated Mueller for the position of FBI director on July 5, 2001.[37] He and two other candidates, Washington lawyer George J. Terwilliger III and veteran Chicago prosecutor and white-collar crime defense lawyer Dan Webb, were up for the job, but Mueller, described at the time as a conservative Republican,[38][39] was always considered the front-runner.[40] Terwilliger and Webb both pulled out from consideration around mid-June, while confirmation hearings for Mueller before the Senate Judiciary Committee were quickly set for July 30, only three days before his prostate cancer surgery.[41][42]
Official portrait, circa 2001
The Senate unanimously confirmed Mueller as FBI director on August 2, 2001, voting 98–0 in favor of his appointment.[43] He had previously served as acting deputy attorney general of the United States Department of Justice (DOJ) for several months before officially becoming the FBI director on September 4, 2001, just one week before the September 11 attacks on the World Trade Center and the Pentagon.[12]
Mueller with President George Bush and Attorney General John Ashcroft, August 6, 2002
On February 11, 2003, one month before the U.S.-led invasion of Iraq, Mueller gave testimony to the Senate Select Committee on Intelligence. Mueller informed the American public that “[s]even countries designated as state sponsors of terrorism—Iran, Iraq, Syria, Sudan, Libya, Cuba, and North Korea—remain active in the United States and continue to support terrorist groups that have targeted Americans. As Director Tenet has pointed out, Secretary Powell presented evidence last week that Baghdad has failed to disarm its weapons of mass destruction, willfully attempting to evade and deceive the international community. Our particular concern is that Saddam Hussein may supply terrorists with biological, chemical or radiological material.”[44][45]Highlighting this worry in February 2003, FBI Special Agent Coleen Rowley wrote an open letter to Mueller in which she warned that “the bureau will [not] be able to stem the flood of terrorism that will likely head our way in the wake of an attack on Iraq”[46][47] and encouraged Mueller to “share [her concerns] with the President and Attorney General.”[47]
On March 10, 2004, while United States Attorney General John Ashcroft was at the George Washington University Hospital for gallbladder surgery,[48] James Comey, the then deputy attorney general, received a call from Ashcroft’s wife informing him that White House Chief of Staff Andrew Card and White House Counsel Alberto Gonzales were about to visit Ashcroft to convince him to renew a program of warrantless wiretapping under the Terrorist Surveillance Program which the DOJ ruled unconstitutional.[48] Ashcroft refused to sign, as he had previously agreed, but the following day the White House renewed the program anyway.[48] Mueller and Comey then threatened to resign.[49] On March 12, 2004, after private, individual meetings with Mueller and Comey at the White House, the president supported changing the program to satisfy the concerns of Mueller, Ashcroft, and Comey.[34]:289–290[49]
President Bush is presented with an honorary FBI Special Agent credential, 2008
He was inducted into the Ranger Hall of Fame in 2004.[31][50]
As director, Mueller also barred FBI personnel from participating in enhanced interrogations with the CIA.[51][52] At a dinner, Mueller defended an attorney (Thomas Wilner) who had been attacked for his role in defending Kuwaiti detainees. Mueller stood up, raised his glass, and said, “I toast Tom Wilner. He’s doing what an American should.” However, the White House pushed back, encouraging more vigorous methods of pursuing and interrogating terror suspects. When Bush confronted Mueller to ask him to round up more terrorists in the U.S., Mueller responded, saying, “If they [suspects] don’t commit a crime, it would be difficult to identify and isolate” them. Vice President Dick Cheney objected, by saying, “That’s just not good enough. We’re hearing this too much from the FBI.”[34]:157, 205, 270
In May 2011, President Barack Obama asked Mueller to continue at the helm of the FBI for two additional years beyond his normal 10-year term, which would have expired on September 4, 2011.[53] The Senate approved this request 100–0 on July 27, 2011.[54][55] On September 4, 2013, Mueller was replaced by James Comey.[56]
In June 2013, Mueller defended NSA surveillance programs in testimony before a House Judiciary Committee hearing.[57] He said that surveillance programs could have “derailed” the September 11 attacks.[58][59] Congressman John Conyers disagreed: “I am not persuaded that that makes it OK to collect every call.”[59] Mueller also testified that the government’s surveillance programs complied “in full with U.S. law and with basic rights guaranteed under the Constitution”.[60] He said that “We are taking all necessary steps to hold Edward Snowden responsible for these disclosures.”[61]
On June 19, 2017, in the case of Arar v. Ashcroft, Mueller, along with Ashcroft and former Immigration and Naturalization Services Commissioner James W. Ziglar and others, was shielded from civil liability by the Supreme Court for post-9/11 detention of Muslims under policies then brought into place.[62]
Return to private sector
Mueller at the White House in April 2013, discussing the Boston Marathon bombing, with (from left) President Obama, National Security Advisor Tom Donilon, Attorney General Eric Holder, Director of CIA John O. Brennan, and Lisa Monaco, Assistant to the President for Homeland Security and Counterterrorism
After leaving the FBI in 2013, Mueller served a one-year term as consulting professor and the Arthur and Frank Payne distinguished lecturer at Stanford University, where he focused on issues related to cybersecurity.[63]
In addition to his speaking and teaching roles, Mueller also joined the law firm WilmerHale as a partner in its Washington office in 2014.[64] Among other roles at the firm, he oversaw the independent investigation into the NFL‘s conduct surrounding the video that appeared to show NFL player Ray Rice assaulting his fiancée.[65] In January 2016, he was appointed as Settlement Master in the U.S. consumer litigation over the Volkswagen emissions scandal; as of May 11, 2017, the scandal has resulted in $11.2 billion in customer settlements.[66]
On October 19, 2016, Mueller began an external review of “security, personnel, and management processes and practices” at government contractor Booz Allen Hamilton after Harold T. Martin III was indicted for massive data theft from the National Security Agency.[67] On April 6, 2017, he was appointed as Special Master for disbursement of $850 million and $125 million for automakers and consumers, respectively, affected by rupture-prone Takata airbags.[68]
Mueller received the 2016 Thayer Award for public service from the United States Military Academy.[69] In June 2017, he received the Baker Award for intelligence and national security contributions from the nonprofit Intelligence and National Security Alliance.[70]
Special Counsel for the Department of Justice
“Appointment of Special Counsel to Investigate Russian Interference in the 2016 United States Election and Related Matters”, by then Deputy Attorney General Rod Rosenstein
On May 16, 2017, Mueller met with President Trump as a courtesy to provide perspectives on the FBI and input on considerations for hiring a new FBI Director.[71] This meeting was initially widely reported to have been an interview to serve again as the FBI Director.[72] President Trump broached resuming the position in their meeting; however, Mueller was ineligible to return as FBI Director due to statutory term limits, nor did Mueller have interest in resuming the position.[71]
The next day, Deputy Attorney General Rod Rosenstein appointed Mueller to serve as special counsel for the United States Department of Justice. In this capacity, Mueller oversaw the investigation into “any links and/or coordination between the Russian government and individuals associated with the campaign of President Donald Trump, and any matters that arose or may arise directly from the investigation”.[73]
Mueller’s appointment to oversee the investigation immediately garnered widespread support from both Democrats and Republicans in Congress.[74][75] Newt Gingrich, former Republican Speaker of the House of Representatives and prominent conservative political commentator, stated via Twitter that “Robert Mueller is a superb choice to be special counsel. His reputation is impeccable for honesty and integrity.”[76] Senator Charles Schumer (D–NY) said, “Former Director Mueller is exactly the right kind of individual for this job. I now have significantly greater confidence that the investigation will follow the facts wherever they lead.” Senator Rob Portman (R-OH) stated, “former FBI dir. Mueller is well qualified to oversee this probe”.[74] Some, however, pointed out an alleged conflict of interest. “The federal code could not be clearer—Mueller is compromised by his apparent conflict of interest in being close with James Comey,” Rep. Trent Franks (R–AZ), who first called for Mueller to step down over the summer, said in a statement to Fox News. “The appearance of a conflict is enough to put Mueller in violation of the code. … All of the revelations in recent weeks make the case stronger.”[77]
Upon his appointment as special counsel, Mueller and two colleagues (former FBI agent Aaron Zebley[78] and former assistant special prosecutor on the Watergate Special Prosecution Force James L. Quarles III) resigned from WilmerHale.[79] On May 23, 2017, the U.S. Department of Justice ethics experts announced they had declared Mueller ethically able to function as special counsel.[80] The spokesperson for the special counsel, Peter Carr, told NBC Newsthat Mueller has taken an active role in managing the inquiry.[81] In an interview with the Associated Press, Rosenstein said he would recuse himself from supervision of Mueller if he were to become a subject in the investigation due to his role in the dismissal of James Comey.[82]
On June 14, 2017, the Washington Post reported that Mueller’s office is also investigating Trump personally for possible obstruction of justice, in reference to the Russian probe.[83] The report was questioned by Trump’s legal team attorney Jay Sekulow, who said on June 18 on NBC‘s Meet the Press, “The President is not and has not been under investigation for obstruction, period.”[84] Due to the central role of the Trump family in the campaign, the transition, and the White House, the President’s son-in-law, Jared Kushner, was also reportedly under scrutiny by Mueller.[85] Also in June, Trump allegedly ordered the firing of Robert Mueller, but backed down when then-White House Counsel Don McGahnthreatened to quit.[86]
During a discussion about national security at the Aspen security conference on July 21, 2017, former CIA director John Brennan reaffirmed his support for Mueller and called for members of Congress to resist if Trump fires Mueller. He also said it was “the obligation of some executive-branch officials to refuse to carry out some of these orders that, again, are inconsistent with what this country is all about”.[87] After Peter Strzok, an investigator for Mueller, was removed from the investigation for alleged partiality, Senator Mark Warner, the Ranking Member of the United States Senate Select Committee on Intelligence in a speech on December 20, 2017, before the Senate warned of a constitutional crisis if the President fired Mueller.[88] On June 22, 2018, Warner hosted a fundraising party for 100 guests and was quoted there saying, “If you get me one more glass of wine, I’ll tell you stuff only Bob Mueller and I know. If you think you’ve seen wild stuff so far, buckle up. It’s going to be a wild couple of months.”[89]
Protect Mueller protest in Washington, D.C., 2018
On October 30, 2017, Mueller filed charges against former Trump campaign chairman Paul Manafort and campaign co-chairman Rick Gates. The 12 charges include conspiracy to launder money, violations of the 1938 Foreign Agents Registration Act (FARA) as being an unregistered agent of a foreign principal, false and misleading FARA statements, and conspiracy against the United States.[90]
On December 1, 2017, Mueller reached a plea agreement with former national security adviser Michael Flynn, who pleaded guilty to giving false testimony to the FBI about his contacts with Russian ambassador Sergey Kislyak.[91]As part of Flynn’s negotiations, his son, Michael G. Flynn, was not expected to be charged, and Flynn was prepared to testify that high-level officials on Trump’s team directed him to make contact with the Russians.[92][93][94] On February 16, 2018, Mueller indicted 13 Russian individuals and 3 Russian companies for attempting to trick Americans into consuming Russian propaganda that targeted Democratic nominee Hillary Clinton[95] and later President-elect Donald Trump.[96]
On February 20, 2018, Mueller charged attorney Alex van der Zwaan with making false statements in the Russia probe.[97][98][99]
On May 20, 2018, Trump criticized Mueller, tweeting “the World’s most expensive Witch Hunt has found nothing on Russia & me so now they are looking at the rest of the World!”[100] Mueller started investigating the August 2016 meeting between Donald Trump Jr. and an emissary for the crown princes of Saudi Arabia and the United Arab Emirates. The emissary offered help to the Trump presidential campaign.[101][100] Mueller is also investigating the Trump campaign’s possible ties to Turkey, Qatar, Israel, and China.[102]
On December 18, 2018, the Washington Post published an article concerning a report prepared for the U.S. Senate which stated that Russian disinformation teams had targeted Mueller.[103]
On March 22, 2019, Mueller concluded his investigation and submitted the Special Counsel’s final report to Attorney General William Barr.[104] A senior Department of Justice official said that the report did not recommend any new indictments.[8] On March 24, Attorney General Barr submitted a summary of findings to the United States Congress. He stated in his letter, “The Special Counsel’s investigation did not find that the Trump campaign or anyone associated with it conspired or coordinated with Russian in its efforts to influence the 2016 U.S. presidential election.” Mueller’s report also reportedly did not take a stance on whether or not Trump committed obstruction of justice; Barr quoted Mueller as saying “while this report does not conclude that the President committed a crime, it also does not exonerate him.”[105]
Cover page of the Mueller report.
On April 18, 2019, the Department of Justice released Report on the Investigation into Russian Interference in the 2016 Presidential Election, the special counsel’s final report and its conclusions.[9][10]
On May 29, 2019, Mueller announced that he was retiring as special counsel and that the office would be shut down, and he spoke publicly about the report for the first time.[106] Saying “The report is my testimony,” he indicated he would have nothing to say that wasn’t already in the report. On the subject of obstruction of justice, he said “under long-standing Department [of Justice] policy, a president cannot be charged with a crime while he is in office.”[107]He repeated his official conclusion that the report neither accused nor exonerated the president, while adding that any potential wrongdoing by a president must be addressed by a “process other than the criminal justice system”.[108] Mueller reasserted the involvement of Russian operatives in the 2016 Democratic National Committee email leak and their parallel efforts to influence American public opinion using social media.[107] Referring to those actions, he declared that “there were multiple, systematic efforts to interfere in our election. That allegation deserves the attention of every American.”[109]
Robert Mueller was initially scheduled to publicly testify before two House committees on July 17, 2019, with two hours for lawmakers to ask questions, but the hearing was postponed to July 24 with a third hour added for questions.[110] His verbal testimony is expected to help inform the public—Democrats believe most Americans have not read the report—and to help Democratic leadership finally decide whether or not to impeach the President.[111]In particular, the Democrats aim to highlight what they consider to be the worst examples of Trump’s conduct. Representative Jamie Raskin from Maryland said he would use visual aids, such as posters, to help people understand the implications of the Mueller report.[112] Republicans, on the other hand, plan to question Mueller on the origins of this investigation.[113]
Personal life
Mueller met his future wife, Ann Cabell Standish, at a high school party when they were 17.[114] Standish attended Miss Porter’s School in Farmington, Connecticut, and Sarah Lawrence College, before working as a special-education teacher for children with learning disabilities.[115] In September 1966, they married at St. Stephen’s Episcopal Church in Sewickley, Pennsylvania.[116][117] They have two daughters and three grandchildren.[118] One of their daughters was born with spina bifida.[119]
In 2001, Mueller’s Senate confirmation hearings to head the FBI were delayed several months while he underwent treatment for prostate cancer.[120] He was diagnosed in the fall of 2000, postponing being sworn in as FBI director until he received a good prognosis from his physician.[121]
Although raised Presbyterian, he became an Episcopalian later in life.[122]
Mueller and William Barr—the attorney general who supervised the late stage of Mueller’s special counsel investigation—have known each other since the 1980s and have been described as good friends. Mueller attended the weddings of two of Barr’s daughters, and their wives attend Bible study together.[123]
Military awards
Mueller received the following military awards and decorations:[30]
References …
https://en.wikipedia.org/wiki/Robert_Mueller
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Scholar: Russia collusion obsession is empty hysteria
Andrew Weissmann
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Columbia University (JD)
Andrew Weissmann (born c. 1958) is an American attorney. Since 2015 he has been the chief of the criminal fraud section of the U.S. Department of Justice. In June 2017 he was appointed to a management role on the 2017 special counsel team headed by Robert Mueller. To assume that position, Weissmann took a leave from his DOJ post.[1]
Contents
Education
Weissmann has a bachelor’s degree from Princeton University (1980). Following a Fulbright scholarship to the University of Geneva, he attended and graduated from Columbia Law School (1984). He then clerked for Judge Eugene Nickerson in the United States District Court for the Eastern District of New York.[2]
Career
From 1991 to 2002, Weissmann worked in the U.S. Attorney’s Office for the Eastern District of New York. While there he tried more than 25 cases involving members of the Genovese, Colombo and Gambino crime families.[1] He led the prosecution team in the Vincent Gigante case, in which Gigante was convicted.[3]
From 2002 to 2005, Weissmann was deputy director and then director of the task force investigating the Enron scandal.[1] His work resulted in the prosecution of more than 30 people for crimes including perjury, fraud, and obstruction including three of Enron’s top executives, Andrew Fastow, Kenneth Lay. and Jeffrey Skilling. In a follow-up case in U.S. District Court, Weissmann also was successful at arguing that auditing firm Arthur Andersen LLP had covered up for Enron. In that case, which resulted in the destruction of Andersen, he convinced the district judge to instruct the jury that they could convict the firm regardless of whether its employees knew they were violating the law.[3] That ruling was later unanimously overturned by the Supreme Court in Arthur Andersen LLP v. United States, in which the court held that “the jury instructions failed to convey the requisite consciousness of wrongdoing.”[3]
In 2005 Weissmann worked as special counsel under Mueller at the Federal Bureau of Investigation, then went into private practice at Jenner & Block in New York. In 2011 he returned to the FBI, serving as General Counsel under Mueller.[4] Since 2015 he has headed the criminal fraud section at DOJ. Weissmann has taught at NYU School of Law, Fordham Law School, and Brooklyn Law School.[2]
On June 19, 2017, Weissmann joined Special Counsel Mueller’s team to run and investigate Russian interference in the 2016 United States elections.[5][6] He was said to be “the architect of the case against former Trump campaign chairman Paul Manafort.” A news report in March 2019 said he would soon leave the Justice Department and become a faculty member at New York University and to work on public service projects.[7]
References
External links
https://en.wikipedia.org/wiki/Andrew_Weissmann
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