The Pronk Pops Show 930, July 18, 2017, Story 1: Will Trump Challenge The Washington Establishment To Achieve His Promises? You Betcha. Will He Win? Long Shot –A Movement Is Not A Viable Political Party That Can Beat The Democratic Party and Republican Party and Their Allies In The Big Government Bureaucracies, Big Lie Media and The Owner Donor Class — Votes Count — Independence Party???– Videos –Story 2: Replace Republicans With D and F Conservative Review Grades and Scores Root and Branch With Real Conservatives, Classical Liberals and Libertarians Until New Political Party Is Formed and Becomes A Viable Party — Videos

Posted on July 19, 2017. Filed under: American History, Breaking News, Budgetary Policy, Communications, Congress, Constitutional Law, Corruption, Countries, Culture, Defense Spending, Diet, Donald J. Trump, Donald Trump, Economics, Education, Elections, Empires, Employment, Energy, Exercise, Federal Government, Fiscal Policy, Food, Former President Barack Obama, Free Trade, Freedom of Speech, Government, Government Dependency, Government Spending, Health, Health Care, Health Care Insurance, History, House of Representatives, Human, Human Behavior, Independence, Insurance, Labor Economics, Language, Law, Life, Lying, Media, Medicare, Mike Pence, Monetary Policy, News, Philosophy, Photos, Politics, Polls, President Barack Obama, President Trump, Progressives, Radio, Raymond Thomas Pronk, Rule of Law, Scandals, Senate, Social Security, Tax Policy, Trade Policy, Unemployment, United States of America, Videos, Wealth, Welfare Spending, Wisdom | Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |

Project_1

The Pronk Pops Show Podcasts

Pronk Pops Show 930,  July 18, 2017

Pronk Pops Show 929,  July 17, 2017

Pronk Pops Show 928,  July 13, 2017

Pronk Pops Show 927,  July 12, 2017

Pronk Pops Show 926,  July 11, 2017

Pronk Pops Show 925,  July 10, 2017

Pronk Pops Show 924,  July 6, 2017

Pronk Pops Show 923,  July 5, 2017

Pronk Pops Show 922,  July 3, 2017 

Pronk Pops Show 921,  June 29, 2017

Pronk Pops Show 920,  June 28, 2017

Pronk Pops Show 919,  June 27, 2017

Pronk Pops Show 918,  June 26, 2017 

Pronk Pops Show 917,  June 22, 2017

Pronk Pops Show 916,  June 21, 2017

Pronk Pops Show 915,  June 20, 2017

Pronk Pops Show 914,  June 19, 2017

Pronk Pops Show 913,  June 16, 2017

Pronk Pops Show 912,  June 15, 2017

Pronk Pops Show 911,  June 14, 2017

Pronk Pops Show 910,  June 13, 2017

Pronk Pops Show 909,  June 12, 2017

Pronk Pops Show 908,  June 9, 2017

Pronk Pops Show 907,  June 8, 2017

Pronk Pops Show 906,  June 7, 2017

Pronk Pops Show 905,  June 6, 2017

Pronk Pops Show 904,  June 5, 2017

Pronk Pops Show 903,  June 1, 2017

Pronk Pops Show 902,  May 31, 2017

Pronk Pops Show 901,  May 30, 2017

Pronk Pops Show 900,  May 25, 2017

Pronk Pops Show 899,  May 24, 2017

Pronk Pops Show 898,  May 23, 2017

Pronk Pops Show 897,  May 22, 2017

Pronk Pops Show 896,  May 18, 2017

Pronk Pops Show 895,  May 17, 2017

Pronk Pops Show 894,  May 16, 2017

Pronk Pops Show 893,  May 15, 2017

Pronk Pops Show 892,  May 12, 2017

Pronk Pops Show 891,  May 11, 2017

Pronk Pops Show 890,  May 10, 2017

Pronk Pops Show 889,  May 9, 2017

Pronk Pops Show 888,  May 8, 2017

Pronk Pops Show 887,  May 5, 2017

Pronk Pops Show 886,  May 4, 2017

Pronk Pops Show 885,  May 3, 2017

Pronk Pops Show 884,  May 1, 2017

Pronk Pops Show 883 April 28, 2017

Pronk Pops Show 882: April 27, 2017

Pronk Pops Show 881: April 26, 2017

Pronk Pops Show 880: April 25, 2017

Pronk Pops Show 879: April 24, 2017

Pronk Pops Show 878: April 21, 2017

Pronk Pops Show 877: April 20, 2017

Pronk Pops Show 876: April 19, 2017

Pronk Pops Show 875: April 18, 2017

Pronk Pops Show 874: April 17, 2017

Pronk Pops Show 873: April 13, 2017

Pronk Pops Show 872: April 12, 2017

Pronk Pops Show 871: April 11, 2017

Pronk Pops Show 870: April 10, 2017

Pronk Pops Show 869: April 7, 2017

Pronk Pops Show 868: April 6, 2017

Pronk Pops Show 867: April 5, 2017

Pronk Pops Show 866: April 3, 2017

Image result for cartoons big government republicans

Image result for cartoons big government republicansImage result for branco cartoons big government republicansImage result for branco cartoons big government republicansImage result for branco cartoons big government republicans failure to repeal obamacareImage result for branco cartoons big government republicans failure to repeal obamacareImage result for branco cartoons big government republicans failure to repeal obamacareImage result for branco cartoons big government republicans failure to repeal obamacare

Thank you from cartoonist A.F. Branco

Thank you for your conservative cartoons and many laughs.

An interview with political cartoonist Antonio F. Branco

Story 1: Will Trump Challenge The Washington Establishment To Achieve His Promises? You Betcha. Will He Win? Long Shot –A Movement Is Not A Viable Political Party That Can Beat The Democratic Party and Republican Party and Their Allies In The Big Government Bureaucracies, Big Lie Media and The Owner Donor Class — Votes Count — Independence Party?? — Videos —

Donald Trump vs The Establishment

How Liberal Is Donald Trump?

Full Show – Republicans Embrace Failing Obamacare, Trump Says Let It Fail

Liberals react to the 2016 Election result exactly the way you expected.

The Donald and butthurt Liberals

Milton Friedman on Classical Liberalism

Milton Friedman: The Two Major Enemies of a Free Society

Milton Friedman schools young Bernie Sanders about poverty

Milton Friedman: Why people refuse to reduce the government size?

The Difference Between Classical Liberals and Libertarians (Steve Davies Part 2)

What Is Libertarianism? – Learn Liberty

What is Classical Liberalism? – Learn Liberty

What Is Libertarianism? – Learn Liberty

The Decline and Triumph of Classical Liberalism (Pt. 1) – Learn Liberty

Classical Liberalism: The Decline and Triumph of Classical Liberalism (Pt. 2) – Learn Liberty

Pat Buchanan: The establishment is in a panic over Trump

The Rise of Conservatism: Crash Course US History #41

The Reagan Revolution: Crash Course US History #43

How the Republican Party went from Lincoln to Trump

From white supremacy to Barack Obama: The history of the Democratic Party

The Inconvenient Truth About the Democratic Party

Bill Whittle – Racism – Democrats and Republicans switch sides?

The history of the racist Democrat party in under 12 minutes by Billy Whittle

Who Are America’s Elites? – Ben Shapiro

456. The Iron Fist of the Ruling Class | Angelo Codevilla

LIMBAUGH: Washington Establishment FEAR Trump SUCCEEDING

Rush Limbaugh: “The Media did not make Donald Trump, and they can’t destroy him”

How Did The U.S. End Up With A Two-Party System?

George Carlin ~ The Ruling Class And What They Own

Story 2: Replace Republicans With D and F Conservative Review Grades and Scores Root and Branch With Real Conservatives, Classical Liberals and Libertarians Until New Political Party Is Formed and Becomes A Viable Party — Videos

Conservative Review: LIBERTY SCORECARD

https://www.conservativereview.com/scorecard

MUST WATCH: President Trump Reacts to GOP Healthcare Bill Collapse – “Let ObamaCare Fail” (FNN)

Sarah Sanders Press Briefing on GOP Healthcare Bill Failure 7/18/17

Richard Epstein: Obamacare’s Collapse, the 2016 Election, & More

“The Classical Liberal Constitution” (featuring the author, Richard Epstein)

The Classical Liberal Constitution

Total Proof Republicans Lied About Repealing Obamacare

Hannity to GOP: Get the job done or get out of Washington

Sen. Paul: The Republican plan kept the death spiral

The Newsroom – Rinos, Real Republicans, The Tea Party, The Founding Fathers on religion and more

Mark Levin Destroys Leftist Democrats And RINO Republicans

Senate Majority Leader Mitch McConnell

KY F 42%

Republican Senate Whip John Cornyn

 

 

 

House Speaker Paul Ryan

House Majority Leader Kevin McCarthy

The Pronk Pops Show Podcasts Portfolio

Listen To Pronk Pops Podcast or Download Shows 926-930

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Listen To Pronk Pops Podcast or Download Shows 800-805

Listen To Pronk Pops Podcast or Download Shows 793-799

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Listen To Pronk Pops Podcast or Download Shows 732-737

Listen To Pronk Pops Podcast or Download Shows 727-731

Listen To Pronk Pops Podcast or Download Shows 720-726

Listen To Pronk Pops Podcast or DownloadShows 713-719

Listen To Pronk Pops Podcast or DownloadShows 705-712

Listen To Pronk Pops Podcast or Download Shows 695-704

Listen To Pronk Pops Podcast or Download Shows 685-694

Listen To Pronk Pops Podcast or Download Shows 675-684

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Listen To Pronk Pops Podcast or Download Shows 660-667

Listen To Pronk Pops Podcast or Download Shows 651-659

Listen To Pronk Pops Podcast or Download Shows 644-650

Listen To Pronk Pops Podcast or Download Shows 637-643

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Listen To Pronk Pops Podcast or Download Shows 617-628

Listen To Pronk Pops Podcast or Download Shows 608-616

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Listen To Pronk Pops Podcast or Download Shows 585- 589

Listen To Pronk Pops Podcast or Download Shows 575-584

Listen To Pronk Pops Podcast or Download Shows 565-574

Listen To Pronk Pops Podcast or Download Shows 556-564

Listen To Pronk Pops Podcast or Download Shows 546-555

Listen To Pronk Pops Podcast or Download Shows 538-545

Listen To Pronk Pops Podcast or Download Shows 532-537

Listen To Pronk Pops Podcast or Download Shows 526-531

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Listen To Pronk Pops Podcast or Download Shows 490-499

Listen To Pronk Pops Podcast or Download Shows 480-489

Listen To Pronk Pops Podcast or Download Shows 473-479

Listen To Pronk Pops Podcast or Download Shows 464-472

Listen To Pronk Pops Podcast or Download Shows 455-463

Listen To Pronk Pops Podcast or Download Shows 447-454

Listen To Pronk Pops Podcast or Download Shows 439-446

Listen To Pronk Pops Podcast or Download Shows 431-438

Listen To Pronk Pops Podcast or Download Shows 422-430

Listen To Pronk Pops Podcast or Download Shows 414-421

Listen To Pronk Pops Podcast or Download Shows 408-413

Listen To Pronk Pops Podcast or Download Shows 400-407

Listen To Pronk Pops Podcast or Download Shows 391-399

Listen To Pronk Pops Podcast or Download Shows 383-390

Listen To Pronk Pops Podcast or Download Shows 376-382

Listen To Pronk Pops Podcast or Download Shows 369-375

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Listen To Pronk Pops Podcast or Download Shows 354-359

Listen To Pronk Pops Podcast or Download Shows 346-353

Listen To Pronk Pops Podcast or Download Shows 338-345

Listen To Pronk Pops Podcast or Download Shows 328-337

Listen To Pronk Pops Podcast or Download Shows 319-327

Listen To Pronk Pops Podcast or Download Shows 307-318

Listen To Pronk Pops Podcast or Download Shows 296-306

Listen To Pronk Pops Podcast or Download Shows 287-295

Listen To Pronk Pops Podcast or Download Shows 277-286

Listen To Pronk Pops Podcast or Download Shows 264-276

Listen To Pronk Pops Podcast or Download Shows 250-263

Listen To Pronk Pops Podcast or Download Shows 236-249

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Listen To Pronk Pops Podcast or Download Shows 202-210

Listen To Pronk Pops Podcast or Download Shows 194-201

Listen To Pronk Pops Podcast or Download Shows 184-193

Listen To Pronk Pops Podcast or Download Shows 174-183

Listen To Pronk Pops Podcast or Download Shows 165-173

Listen To Pronk Pops Podcast or Download Shows 158-164

Listen To Pronk Pops Podcast or Download Shows151-157

Listen To Pronk Pops Podcast or Download Shows 143-150

Listen To Pronk Pops Podcast or Download Shows 135-142

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Listen To Pronk Pops Podcast or Download Shows 124-130

Listen To Pronk Pops Podcast or Download Shows 121-123

Listen To Pronk Pops Podcast or Download Shows 118-120

Listen To Pronk Pops Podcast or Download Shows 113 -117

Listen To Pronk Pops Podcast or Download Show 112

Listen To Pronk Pops Podcast or Download Shows 108-111

Listen To Pronk Pops Podcast or Download Shows 106-108

Listen To Pronk Pops Podcast or Download Shows 104-105

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Listen To Pronk Pops Podcast or Download Shows 94-97

Listen To Pronk Pops Podcast or Download Show 93

Listen To Pronk Pops Podcast or Download Show 92

Listen To Pronk Pops Podcast or Download Show 91

Listen To Pronk Pops Podcast or Download Shows 88-90

Listen To Pronk Pops Podcast or Download Shows 84-87

Listen To Pronk Pops Podcast or Download Shows 79-83

Listen To Pronk Pops Podcast or Download Shows 74-78

Listen To Pronk Pops Podcast or Download Shows 71-73

Listen To Pronk Pops Podcast or Download Shows 68-70

Listen To Pronk Pops Podcast or Download Shows 65-67

Listen To Pronk Pops Podcast or Download Shows 62-64

Listen To Pronk Pops Podcast or Download Shows 58-61

Listen To Pronk Pops Podcast or Download Shows 55-57

Listen To Pronk Pops Podcast or Download Shows 52-54

Listen To Pronk Pops Podcast or Download Shows 49-51

Listen To Pronk Pops Podcast or Download Shows 45-48

Listen To Pronk Pops Podcast or Download Shows 41-44

Listen To Pronk Pops Podcast or Download Shows 38-40

Listen To Pronk Pops Podcast or Download Shows 34-37

Listen To Pronk Pops Podcast or Download Shows 30-33

Listen To Pronk Pops Podcast or Download Shows 27-29

Listen To Pronk Pops Podcast or Download Shows 17-26

Listen To Pronk Pops Podcast or Download Shows 16-22

Listen To Pronk Pops Podcast or Download Shows 10-15

Listen To Pronk Pops Podcast or Download Shows 1-9

 

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

The Pronk Pops Show 919, June 27, 2017, Part 1 — Story 1: Breaking BIG — Big Interventionist Government — Obamacare and Obamacare Lite — The Progressive Two-Party Tyranny of The Democratic and Republican Parties — Fake Repeal and Fake Replace Is Not Real Repeal of Obamacare and All Obamacare Regulations and Replace With Free Enterprise Individual Health Insurance Markets Not Centralized Federal Control and Regulation with Massive Subsidies Of Health Insurance Industry — Collectivists vs Individualists — Replace The C, D, F BIG Progressive Republican Senators and Representatives — The Party’s Over — Videos

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

Project_1

The Pronk Pops Show Podcasts

Pronk Pops Show 919,  June 27, 2017

Pronk Pops Show 918,  June 26, 2017 

Pronk Pops Show 917,  June 22, 2017

Pronk Pops Show 916,  June 21, 2017

Pronk Pops Show 915,  June 20, 2017

Pronk Pops Show 914,  June 19, 2017

Pronk Pops Show 913,  June 16, 2017

Pronk Pops Show 912,  June 15, 2017

Pronk Pops Show 911,  June 14, 2017

Pronk Pops Show 910,  June 13, 2017

Pronk Pops Show 909,  June 12, 2017

Pronk Pops Show 908,  June 9, 2017

Pronk Pops Show 907,  June 8, 2017

Pronk Pops Show 906,  June 7, 2017

Pronk Pops Show 905,  June 6, 2017

Pronk Pops Show 904,  June 5, 2017

Pronk Pops Show 903,  June 1, 2017

Pronk Pops Show 902,  May 31, 2017

Pronk Pops Show 901,  May 30, 2017

Pronk Pops Show 900,  May 25, 2017

Pronk Pops Show 899,  May 24, 2017

Pronk Pops Show 898,  May 23, 2017

Pronk Pops Show 897,  May 22, 2017

Pronk Pops Show 896,  May 18, 2017

Pronk Pops Show 895,  May 17, 2017

Pronk Pops Show 894,  May 16, 2017

Pronk Pops Show 893,  May 15, 2017

Pronk Pops Show 892,  May 12, 2017

Pronk Pops Show 891,  May 11, 2017

Pronk Pops Show 890,  May 10, 2017

Pronk Pops Show 889,  May 9, 2017

Pronk Pops Show 888,  May 8, 2017

Pronk Pops Show 887,  May 5, 2017

Pronk Pops Show 886,  May 4, 2017

Pronk Pops Show 885,  May 3, 2017

Pronk Pops Show 884,  May 1, 2017

Pronk Pops Show 883 April 28, 2017

Pronk Pops Show 882: April 27, 2017

Pronk Pops Show 881: April 26, 2017

Pronk Pops Show 880: April 25, 2017

Pronk Pops Show 879: April 24, 2017

Pronk Pops Show 878: April 21, 2017

Pronk Pops Show 877: April 20, 2017

Pronk Pops Show 876: April 19, 2017

Pronk Pops Show 875: April 18, 2017

Pronk Pops Show 874: April 17, 2017

Pronk Pops Show 873: April 13, 2017

Pronk Pops Show 872: April 12, 2017

Pronk Pops Show 871: April 11, 2017

Pronk Pops Show 870: April 10, 2017

Pronk Pops Show 869: April 7, 2017

Pronk Pops Show 868: April 6, 2017

Pronk Pops Show 867: April 5, 2017

Pronk Pops Show 866: April 3, 2017

Pronk Pops Show 865: March 31, 2017

Pronk Pops Show 864: March 30, 2017

Pronk Pops Show 863: March 29, 2017

Pronk Pops Show 862: March 28, 2017

Pronk Pops Show 861: March 27, 2017

Pronk Pops Show 860: March 24, 2017

Pronk Pops Show 859: March 23, 2017

Pronk Pops Show 858: March 22, 2017

Pronk Pops Show 857: March 21, 2017

Pronk Pops Show 856: March 20, 2017

Pronk Pops Show 855: March 10, 2017

Pronk Pops Show 854: March 9, 2017

Pronk Pops Show 853: March 8, 2017

Pronk Pops Show 852: March 6, 2017

Pronk Pops Show 851: March 3, 2017

Pronk Pops Show 850: March 2, 2017

Pronk Pops Show 849: March 1, 2017

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

National Debt Clock 

http://www.usdebtclock.org/

Image result for Progressive republicans and democrats the two party tyranny

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

 

Image result for Per capita health care expenditures by country 2015

Image result for Per capita health care expenditures by country 2015

 

Image result for Per capita health care expenditures by country 2015

Image result for Per capita health care expenditures by country 2015

Image result for Per capita health care expenditures by country 2015

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

Judy Holliday – The Party’s Over

Judy Holliday The Party’s Over Lyrics

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

It’s time to wind up

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

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

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

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

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

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

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

I won’t vote to keep ObamaCare: Rand Paul

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

MARK LEVIN: Senate Health Care Bill Is 95% OBAMACARE

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

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

Republicans delay Senate health care vote

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

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

Milton Friedman – Collectivism

Milton Friedman on universal health care

Milton Friedman – The Social Security Myth

Milton Friedman – The Welfare Establishment

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

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

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

Milton Friedman – Why Tax Reform Is Impossible

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

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

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

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

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

Milton Friedman – Morality & Capitalism

Lacking enough GOP votes, Senate pushes back health bill

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

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

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

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

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

Republicans have one major problem on Obamacare

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

Is Obamacare Working? The Affordable Care Act Five Years Later

Why Are American Health Care Costs So High?

How Health Insurance Works

Senate postpones health care bill vote

Individual Health Insurance VS. Group Health Insurance

Published on Aug 14, 2009

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

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

Published on Aug 16, 2012

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

How Demented and Sick Our Republic Has Become By Design

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

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

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

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

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

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

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

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

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

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

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

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

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

What’s in the Senate Republican Health-Care Bill

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

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

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

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

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

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

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

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

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

Secrets reviewed “Rediscovering Americanism”last week and wrote:

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

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

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

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

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

Dems face identity crisis

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 June 25

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

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

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

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

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

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

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

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

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

Patient Protection and Affordable Care Act

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

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

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

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

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

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

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

Provisions

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

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

Individual insurance

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

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

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

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

Among the groups who remained uninsured were:

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

Subsidies

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

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

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

Mandates

Individual

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

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

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

Business

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

Excise taxes

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

Insurance standards

Essential health benefits

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

Contraceptives

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

Risk management

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

Risk corridor program

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

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

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

Temporary reinsurance

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

Risk adjustment

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

Other provisions

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

The ACA has several other provisions:

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

Exchanges

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

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

State waivers

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

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

Accountable Care Organizations

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

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

Others

Legislative history

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

Background

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

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

John Chafee

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

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

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

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

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

Healthcare debate, 2008–10

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

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

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

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

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

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

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

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

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

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

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

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

Senate

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

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

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

Senate vote by state.

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

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

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

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

House

House vote by congressional district.

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

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

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

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

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

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

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

Impact

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

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

Coverage

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

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

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

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

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

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

Insurance exchanges

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

Medicaid expansion

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

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

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

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

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

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

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

Healthcare insurance costs

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

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

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

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

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

Effect on deductibles and co-payments

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

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

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

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

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

Health outcomes

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

Federal deficit

CBO estimates of revenue and impact on deficit

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

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

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

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

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

Opinions on CBO projections

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

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

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

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

Economic consequences

CBO estimated in June 2015 that repealing the ACA would:

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

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

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

Employer mandate and part-time work

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

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

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

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

Hospitals

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

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

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

Public opinion

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

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

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

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

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

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

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

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

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

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

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

Political aspects

“Obamacare”

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

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

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

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

Common misconceptions

“Death panels”

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

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

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

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

Members of Congress

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

Illegal immigrants

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

Exchange “death spiral”

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

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

Opposition

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

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

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

Legal challenges

National Federation of Independent Business v. Sebelius

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

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

Contraception mandate

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

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

House v. Price

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

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

Non-cooperation

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

Repeal efforts

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

2017 House Budget

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

2013 federal government shutdown

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

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

2017 repeal effort

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

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

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

Implementation history

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

Existing individual health plans

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

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

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

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

2010

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

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

2011

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

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

2012

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

2013

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

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

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

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

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

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

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

2014

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

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

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

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

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

2015

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

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

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

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

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

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

2016

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

Employers

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

Insurers

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

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

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

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

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

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

Costs

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

Cooperatives

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

Medicaid

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

2017

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

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

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

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

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

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

See also

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

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The Truth About Immigration: What They Won’t Tell You! Stefan Molyneux

ReihanSalam

Pat Caddell poll shows TPP trade pact bad deal for GOP

March 10, 2016, National Press Club, Bloomberg Room, Washington, D.C. – Americans for Limited Government releases the results of a comprehensive national poll conducted on our behalf by Pat Caddell examining voter attitudes toward the trade issue with an emphasis on economic security issues, including the Trans-Pacific Partnership. Senator Jeff Sessions provided his reaction to the polling data along with Americans for Limited Government President Rick Manning.

Political Insiders Part 1: Race for the GOP nomination

Pat Caddell Says: Media Have Become an “Enemy of the American people”

To Catch a Thief

Cary Grant – To Catch a Thief 1955

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

GOP Leaders, Tech Execs Plot Against Trump At Secret NeoCon Island Meeting

Last Thursday, in a speech delivered at the University of Utah, Mitt Romney blindsided Donald Trump in what amounted to a scathing indictment of the billionaire’s ability to lead the country.

 

If we Republicans choose Donald Trump as our nominee, the prospects for a safe and prosperous future are greatly diminished,” Romney said, in an apparent effort to play party elder. “If Donald Trump’s plans were ever implemented, the country would sink into prolonged recession,” Romney continues, hitting Trump on the economy. “A few examples. His proposed 35 percent tariff-like penalties would instigate a trade war and that would raise prices for consumers, kill our export jobs and lead entrepreneurs and businesses of all stripes to flee America.”

We covered the story exhaustively, and for those who would enjoy a review of the verbal melee, see here, here, and here.

More important than what Romney said (after all, it’s not as though he’s the first person to essentially call Trump a demagogic lunatic who has no business being President) was what his speech represented: all-out panic on the part of the GOP establishment.

This is it folks. Trump is on the verge of winning the nomination and although most still think he can’t beat Hillary, the national election is a wildcard. If Trump can go from laughingstock to presumed GOP nominee in nine months, there’s no reason to think he can’t ride the populist wave all the way to The White House.

With diplomats the world over voicing their concern, and with America’s reputation on the line (of course we can debate about what’s left of that reputation after Bush and Obama) heavyweights from across America’s political aristocracy and business community are scrambling to figure out how to derail Trump’s momentum. In short, the Michael Bloomberg deus ex machina isn’t coming and Joe Biden isn’t likely to ride into the race in a red Camaro and save the day either, so what now?

That question, apparently, was on the agenda at the American Enterprise Institute’s annual World Forum, a secretive affair held on Sea Island, Georgia.

(the scene)

“The main topic at the closed-to-the-press confab? How to stop Republican front-runner Donald Trump,” Huff Post writes. Here’s a list of attendees:

  • Apple CEO Tim Cook,
  • Google co-founder Larry Page,
  • Napster creator and Facebook investor Sean Parker,
  • Tesla Motors and SpaceX honcho Elon Musk
  • Senate Majority Leader Mitch McConnell (R-Ky.),
  • political guru Karl Rove,
  • House Speaker Paul Ryan,
  • GOP Sens. Tom Cotton (Ark.), Cory Gardner (Colo.), Tim Scott (S.C.), Rob Portman (Ohio) and Ben Sasse (Neb.),
  • Energy and Commerce Committee Chair Fred Upton (Mich.),
  • Rep. Kevin Brady (Texas)
  • Kevin McCarthy (Calif.),
  • Cathy McMorris Rodgers (Wash.),
  • Budget Committee Chairman Tom Price (R-Ga.),
  • Financial Services Committee Chairman Jeb Hensarling (Texas)
  • Diane Black (Tenn.)

A specter was haunting the World Forum–the specter of Donald Trump,” the Weekly Standard founder Bill Kristol wrote in an emailed report from the conference, borrowing the opening lines of the Communist Manifesto. “There was much unhappiness about his emergence, a good deal of talk, some of it insightful and thoughtful, about why he’s done so well, and many expressions of hope that he would be defeated.”

http://www.zerohedge.com/news/2016-03-08/gop-leaders-tech-execs-plot-against-trump-secret-neocon-island-meeting

S, TPP, TRADE

66 PERCENT OF REPUBLICANS OPPOSE PACIFIC TRADE DEAL AFTER THEY FIND OUT WHAT’S IN IT, PAT CADDELL-ALG POLL SHOWS

Americans for Limited Government President Rick Manning today issued the following statement releasing the results of a poll by Pat Caddell conducted on behalf of Americans for Limited Government showing Republican voters overwhelmingly opposed to the Trans-Pacific Partnership (TPP) after they find out what’s in it:

“The most striking thing about the Caddell poll is that Republicans are even more likely to oppose bad trade deals than Independents or Democrats. Once they find out what’s in it, Republican voters overwhelmingly oppose TPP, 66 percent to 15 percent. Democrats only oppose it 44 percent to 30 percent, and Independents oppose it 52 percent to 19 percent.stop tpp fast track

“These results confound the conventional wisdom that the GOP is the party of ‘free trade.’ As a matter of fact, Republicans overwhelmingly oppose trade deals that benefit foreign countries and not the American people, representing an outright rejection of corporate cronyism and being replaced by cheap foreign labor.

“This collapse in support is directly related to the rejection of corporate cronyism that has permeated Washington, D.C. and should again serve as a wake-up call to every GOP member of Congress that business as usual is over.”

Online Survey of Likely U.S. Voters, February 23 – March 3, 2016, Toplines, Caddell & Associates on behalf of Americans for Limited Government at https://getliberty.org/wp-content/uploads/2016/03/Pat-Caddell-ALG-TPP-Poll-Toplines-3-10-16.pdf

Business Donors and Top GOP Leaders Hold Secret Conclaves to Stop Donald Trump

Multiple sources are reporting that GOP insiders, governors, donors, and tech CEOs recently gathered at two separate meetings to keep GOP frontrunner Donald Trump from winning the party’s nomination for president.

One gathering was at the Republican Governors Association meeting in Park City, Utah. The governors were treated to a slide show purporting to prove that Trump could be held to less than the 1,237 delegates he would need to win the nomination outright.

According to the Washington Post, the plan was predicated on Trump losing such states as Florida, Ohio, Illinois, and a few others. If Trump is kept from winning outright, the slide show contended, then a brokered convention would result, and from there party insiders could push someone other than Trump for the nomination.

The key, though, is to keep Trump to the lowest delegate count possible. “It’s one thing if [Trump] goes to the convention and he’s got 48 percent, 49 percent of the delegates,” Tennessee’s Republican Governor Bill Haslam said. “Then it’s a hard thing to see if there’s a convention floor battle. But if he goes to the convention and he’s got 35 or 40 percent, that’s a whole different thing.”

The Huffington Post reported that a handful of tech CEOs also met the weekend of March 6 at an isolated Georgia resort with GOP leadership to derail the Trump train.

The meeting on Georgia’s Sea Island was reportedly attended by Apple’s Tim Cook, Tesla Motor’s Elon Musk, Facebook investor Larry Page, Senate Majority Leader

Sen. Mitch McConnell (R-KY) 44% (R, KY),  and House Speaker Rep. Paul Ryan (R-WI) 56%(R, WS),

along with several other GOP leaders. The meeting was sponsored by the American Enterprise Institute.

While the event was supposed to be off-the-record, Weekly Standard chief William Kristol tweeted that the meeting was haunted by the “specter of Donald Trump.”

“The key task now, to once again paraphrase Karl Marx, is less to understand Trump than to stop him,” Kristol reportedly wrote. “In general, there’s a little too much hand-wringing, brow-furrowing, and fatalism out there and not quite enough resolving to save the party from nominating or the country electing someone who simply shouldn’t be president.”

The group of leaders also discussed the possibility of a brokered convention and reviewed plans to keep Trump from gaining the GOP nomination.

This is, of course, far from the only time GOP insiders have tried to float the idea of a brokered convention.

Recently audio of Rubio campaign manager Terry Sullivan was leaked wherein the operative discussed similar plans to force Trump into a brokered convention and for keeping him below the needed delegate county ahead of the convention. The audio was reportedly from a meeting of top Rubio donors held in New York.

http://www.breitbart.com/big-government/2016/03/07/tech-ceos-and-top-republicans-take-secret-meetings-to-stop-trump-with-brokered-convention/

The Pronk Pops Show Podcasts Portfolio

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The Pronk Pops Show 470, May 22, 2015, Story 1: Part 1 of 3: American People Leaving Both Democratic and Republican Parties In Search of A Party With Principles and Leaders With Integrity and Defenders of The United States Constitution — A New Direction For America — Videos

Posted on May 22, 2015. Filed under: American History, Banking System, Blogroll, Breaking News, Budgetary Policy, Business, College, Communications, Computers, Congress, Constitutional Law, Corruption, Crime, Culture, Economics, Education, Empires, Employment, European History, Federal Government, Fiscal Policy, Foreign Policy, Genocide, Government, Government Dependency, Government Spending, Health Care, Health Care Insurance, History, Housing, Illegal Immigration, Immigration, Insurance, Investments, Labor Economics, Law, Legal Immigration, Media, Middle East, Monetary Policy, Philosophy, Photos, Politics, Polls, President Barack Obama, Pro Life, Radio, Raymond Thomas Pronk, Scandals, Socials Security, Tax Policy, Taxation, Taxes, Unemployment, United States Constitution, Videos, Violence, War, Wealth, Wisdom | Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |

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The Pronk Pops Show Podcasts

Pronk Pops Show 470 May 22, 2015

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Pronk Pops Show 465 May 15, 2015

Pronk Pops Show 464 May 14, 2015

Pronk Pops Show 463 May 13, 2015

Pronk Pops Show 462 May 8, 2015

Pronk Pops Show 461 May 7, 2015

Pronk Pops Show 460 May 6, 2015

Pronk Pops Show 459 May 4, 2015 

Pronk Pops Show 458 May 1, 2015 

Pronk Pops Show 457 April 30, 2015 

Pronk Pops Show 456: April 29, 2015 

Pronk Pops Show 455: April 28, 2015

Pronk Pops Show 454: April 27, 2015

Pronk Pops Show 453: April 24, 2015

Pronk Pops Show 452: April 23, 2015 

Pronk Pops Show 451: April 22, 2015

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Pronk Pops Show 419: February 18, 2015

Pronk Pops Show 418: February 16, 2015

Pronk Pops Show 417: February 13, 2015

Pronk Pops Show 416: February 12, 2015

Pronk Pops Show 415: February 11, 2015

Pronk Pops Show 414: February 10, 2015

Pronk Pops Show 413: February 9, 2015

Pronk Pops Show 412: February 6, 2015

Pronk Pops Show 411: February 5, 2015

Pronk Pops Show 410: February 4, 2015

Pronk Pops Show 409: February 3, 2015

Pronk Pops Show 408: February 2, 2015

Story 1: Part 1 of 3: American People Leaving Both Democratic and Republican Parties In Search of A Party With Principles and Leaders With Integrity and Defenders of The United States Constitution — A New Direction For America — Videos

Five Finger Death Punch – Wrong Side Of Heaven

[

Gallup: Partisan split at historic level

Gallup Poll: Americans Overwhelmingly Want GOP Congress to Set Country’s Agenda, Not Obama

Most Political Independents Ever In USA

How Are Conservative And Liberal Brains Different?

Poll Record High 42 Percent Americans Identify As Independents

Against the USA, Naked Communist Conspiracy Is Unfolding, NWO

1.U.S. acceptance of coexistence as the only alternative to atomic war.
2.U.S. willingness to capitulate in preference to engaging in atomic war.
3.Develop the illusion that total disarmament by the United States would be a demonstration of moral strength.
4.Permit free trade between all nations regardless of Communist affiliation
5.Extension of long-term loans to Russia & satellites.
6.Provide American aid to all nations regardless
7.Grant recognition of Red China. Admission of Red China to the U.N.
8.Set up East and West Germany as separate states under supervision of the U.N.
9.Prolong the conferences to ban atomic tests because the U.S. has agreed to suspend tests as long as negotiations are in progress.
10.Allow all Soviet satellites individual representation in the U.N.
11.Promote the U.N. as the only hope for mankind. Demand that it be set up as a one-world government with its own independent armed forces.
12.Resist any attempt to outlaw the Communist Party.
13.Do away with all loyalty oaths.
14.Continue giving Russia access to the U.S. Patent Office.
15.Capture one or both of the political parties.
16.Use technical decisions of the courts to weaken by claiming their activities violate civil rights.
17.Get control of the schools. Promote Communist propaganda. Soften the curriculum. Get control of teachers’ associations.
18.Gain control of all student newspapers.
19.Use student riots to foment public protests against programs or organizations which are under Communist attack.
20.Infiltrate the press. Get control of book-review assignments, editorial writing, policymaking positions.
21.Gain control of key positions in radio, TV, and motion pictures.
22.Continue discrediting American culture by degrading all forms of artistic expression. “eliminate all good sculpture from parks and buildings, substitute shapeless, awkward and meaningless forms.”
23.Control art critics and directors of art museums.
24.Eliminate all laws governing obscenity by calling them “censorship” and a violation of free speech.
25.Break down cultural standards of morality by promoting pornography and obscenity 26.Present homosexuality, degeneracy and promiscuity as “normal, natural, healthy.”
27.Infiltrate the churches and replace revealed religion with “social” religion. Discredit the Bible as a “religious crutch.”
28.Eliminate prayer or religious expression in the schools
29.Discredit the American Constitution by calling it inadequate, old-fashioned, a hindrance to cooperation between nations on a worldwide basis.
30.Discredit the American Founding Fathers.
31.Belittle all forms of American culture and discourage the teaching of American history
32.Support any socialist movement to give centralized control over any part of the culture; education, social agencies, welfare programs, mental health clinics, etc.
33.Eliminate all laws or procedures which interfere with the operation of communism
34.Eliminate the House Committee on Un-American Activities.
35.Discredit and eventually dismantle the FBI.
36.Infiltrate and gain control of more unions.
37.Infiltrate and gain control of big business.
38.Transfer some of the powers of arrest from the police to social agencies. Treat all behavioral problems as psychiatric disorders which no one but psychiatrists can understand or treat.
39.Dominate the psychiatric profession and use mental health laws as a means of gaining coercive control over those who oppose Communist goals.
40.Discredit the family. Encourage promiscuity, masturbation, easy divorce.
41.Emphasize the need to raise children away from the negative influence of parents. Attribute prejudices, mental blocks and retarding to suppressive influence of parents.
42.Create the impression that violence and insurrection are legitimate aspects of the American tradition; that students and special-interest groups should rise up and use “united force” to solve economic, political or social problems.
43.Overthrow all colonial governments before natives are ready for self-government.
44.Internationalize the Panama Canal.
45.Repeal the Connally reservation so the United States cannot prevent the World Court from seizing jurisdiction over domestic problems and individuals alike.

Mind Control, Psychology of Brainwashing, Sex & Hypnosis

Fit vs. UnFit, Eugenics, Planned Parenthood & Psychology, Mind Control Report

Yuri Bezmenov: Psychological Warfare Subversion & Control of Western Society

The Subversion Factor, Part 1: Moles In High Places

The Subversion Factor, Part 2: The Open Gates of Troy

G. Edward Griffin – The Collectivist Conspiracy

youtube=https://www.youtube.com/watch?v=jAdu0N1-tvU]

The Quigley Formula – G. Edward Griffin lecture

Robert Welch in 1974 reveals NWO

Robert Welch Speaks: A Touch of Sanity (1965)

Robert Welch Speaks: In One Generation (1974)

CORPORATE FASCISM: The Destruction of America’s Middle Class

CULTURAL MARXISM: The Corruption of America

Countdown to Financial Collapse – A Conversation with G. Edward Griffin

WRCFresnoTV — G. Edward Griffin — The Federal Reserve, Taxes, The I.R.S. & Solutions

Rammstein “We’re all living in America” (HD) English Subtitle

Series Id:           LNS14000000
Seasonally Adjusted
Series title:        (Seas) Unemployment Rate
Labor force status:  Unemployment rate
Type of data:        Percent or rate
Age:                 16 years and over

Series Id:           LNS13327709
Seasonally Adjusted
Series title:        (seas) Total unemployed, plus all marginally attached workers plus total employed part time for economic reasons, as a percent of all civilian labor force plus all marginally attached workers
Labor force status:  Aggregated totals unemployed
Type of data:        Percent or rate
Age:                 16 years and over
Percent/rates:       Unemployed and mrg attached and pt for econ reas as percent of labor force plus marg attached

Series Id:           LNS11300000
Seasonally Adjusted
Series title:        (Seas) Labor Force Participation Rate
Labor force status:  Civilian labor force participation rate
Type of data:        Percent or rate
Age:                 16 years and over

Series Id:           LNS12000000
Seasonally Adjusted
Series title:        (Seas) Employment Level
Labor force status:  Employed
Type of data:        Number in thousands
Age:                 16 years and over

Series Id:           LNS13000000
Seasonally Adjusted
Series title:        (Seas) Unemployment Level
Labor force status:  Unemployed
Type of data:        Number in thousands
Age:                 16 years and over

Series Id:           LNS15000000
Seasonally Adjusted
Series title:        (Seas) Not in Labor Force
Labor force status:  Not in labor force
Type of data:        Number in thousands
Age:                 16 years and over

WASHINGTON, D.C. — After reaching a more than two-year high in early 2015, Americans’ satisfaction with the direction of the U.S. continues to fall. Twenty-six percent of Americans say they are satisfied with the way things are going in the nation in May, down slightly from 32% in January and February.

Satisfaction With the Direction of the U.S.

The latest data are from Gallup’s May 6-10 poll.

Satisfaction jumped nine points in January to 32%, a promising sign that Americans’ moods were improving after a year of lower figures throughout 2014, ranging between 20% and 27%. Since February, though, satisfaction has dipped only slightly each month, but these small drops have resulted in a six-point decline since the beginning of the year. Satisfaction remains below the 36% historical average for Gallup’s trend dating back to 1979.

The drop in Americans’ satisfaction with the way things are going parallels the recent decline in economic confidence. Americans had a more positive outlook on the economy at the dawn of 2015, but these views, like satisfaction, have edged down in recent months.

Satisfaction With the Direction of the U.S. vs. Economic Confidence

Views of the nation’s direction have certainly been brighter in the past. Majorities of Americans were typically satisfied with the direction of the U.S. between 1998 and mid-2002 — including a record high of 71% in February 1999. But satisfaction declined steadily in the latter half of President George W. Bush’s presidency as the public grew disillusioned with the war in Iraq and the national economy suffered. This dip in satisfaction culminated in 7% of Americans, a record low, saying they were satisfied with the direction of the nation in October 2008 as the global economy collapsed and the U.S. stock market plummeted.

Satisfaction improved significantly during the first year of President Barack Obama’s term — reaching 36% in August 2009. It has not returned to that level since, ranging between 11% and 33% throughout Obama’s time in office.

Americans Still List Economy, Gov’t and Unemployment as Top Problems

Though the 14% of Americans who name dissatisfaction with government, Congress and politicians as the top problem facing the U.S. has fallen five points since April, it still remains the most commonly mentioned problem — a distinction it has held for six months.

The economy in general (12%) and unemployment (10%) have remained at the top of the list for several years. But mentions of these issues are down significantly from their recent peaks — the economy reached a high of 37% in 2012, and unemployment reached a high of 39% in 2011.

Trends in Top

Race relations and racism (8%), immigration (6%), a decline in moral, religious and family ethics (6%), the state of the healthcare system (5%) and terrorism (5%) were also among the most frequently cited problems facing the nation.

Most Commonly Named Problems in April 2015 vs. May 2015

Bottom Line

After years of dysfunctional government, the economy and unemployment dominating Americans’ mentions of the top problem facing the nation, fewer mention these problems now than in recent years. Still, these three problems remain at the forefront of Americans’ concerns, and may be driving Americans’ high level of dissatisfaction with the nation’s direction.

Although Americans’ confidence in the economy is higher this year than in recent years, it is still negative. And while fewer mention dysfunctional government as the nation’s top problem, Americans still strongly disapprove of Congress’ performance and remain divided on Obama’s.

Meanwhile, mentions of unemployment as a top problem have dipped as more U.S. workers report their workplaces are hiring and the unemployment rate as reported by the BLS declines. But unemployment still remains one of the most frequently cited problems.

Survey Methods

Results for this Gallup poll are based on telephone interviews conducted May 6-10, 2015, with a random sample of 1,024 adults, aged 18 and older, living in all 50 U.S. states and the District of Columbia. For results based on the total sample of national adults, the margin of sampling error is ±4 percentage points at the 95% confidence level. All reported margins of sampling error include computed design effects for weighting.

Each sample of national adults includes a minimum quota of 50% cellphone respondents and 50% landline respondents, with additional minimum quotas by time zone within region. Landline and cellular telephone numbers are selected using random-digit-dial methods.

http://www.gallup.com/poll/183248/americans-satisfaction-direction-wanes.aspx?utm_source=Politics&utm_medium=newsfeed&utm_campaign=tiles

Trend: Party affiliation in U.S. plus leaners

Story Highlights

  • Congressional job approval at 19%, essentially unchanged
  • Approval of GOP Congress similar among Republicans and Democrats

WASHINGTON, D.C. — Congressional job approval, currently at 19%, remains stuck near historical lows, despite a number of recent high-profile legislative achievements.

Congressional Job Approval Ratings: 2001-2015

Over the past month, Congress has confirmed the stalled nomination of Attorney General Loretta Lynch and both chambers passed a bill that was signed into law regarding Medicare. Bills that would authorize limited congressional oversight on any international agreement with Iran and help victims of human trafficking passed the Senate with little or no opposition. The uptick in activity, though hardly historic, is notable compared with the past two Congresses. Those Congresses, marked by divided control of the two chambers, were known for their entrenched partisan gridlock and few legislative accomplishments. And Americans didn’t care for their inability to agree — they gave Congress its lowest approval ever over this time period. Gallup found in June 2013, six months into the previous Congress, that gridlock and ineffectiveness were the most frequently cited reason for Americans’ disapproval of Congress.

Several months into this new Congress, the accomplishments that have been realized could give one the impression that the gridlock is softening, particularly over the past month. But these achievements have had virtually no impact on Congress’s job approval compared with early April (15%).

And, of course, Congress is far from working perfectly now, even if the pace of work appears to have increased. Most dramatically, the Senate failed to overcome a Democratic filibuster Tuesday afternoon that would give the president enhanced authority in negotiating trade bills, though the May survey was conducted before this occurrence. Legislation authorizing the use of military force in Iraq and Syria to fight ISIS, proposed by the administration and which many members of Congress support, remains stalled.

GOP Congress Has Low Approval Among Republicans

A key reason the current 114th Congress appears to be having more legislative success than the two Congresses before it is that the House and Senate are now under one party’s control. Unified GOP control of Capitol Hill should, at least in theory, boost Republicans’ overall approval of Congress. But the expected “Republican rally” for Congress has yet to materialize — 21% of Republicans and Republican leaners approve of Congress, not much different from the 18% of independents and of Democrats who approve. Nor is Republican support notably higher than the 15% it reached in 2014, despite the decided Republican tilt of this year’s legislature.

Congressional Job Approval, by Party Identification, May 2015

Bottom Line

After years of dysfunction, Congress is moving forward on key pieces of legislation. No longer shackled by split control — though still facing a president of the opposite party — the legislative branch is suddenly finding some areas of agreement. But even if it appears that the gridlock is easing, the overwhelming majority of Americans still disapprove of Congress. If Congress continues passing bipartisan legislation, more Americans might soften their stance. Still, it may be that Americans are largely not aware of or impressed by Congress’ recent legislative successes. Or it may be that the hit to Congress’ reputation over the last several years — evident not only in dismal job approval ratings, but also fallinglevels of trust and confidence — will take a long time to reverse.

Survey Methods

Results for this Gallup poll are based on telephone interviews conducted May 6-10, 2015, with a random sample of 1,024 adults, aged 18 and older, living in all 50 U.S. states and the District of Columbia. For results based on the total sample of national adults, the margin of sampling error is ±4 percentage points at the 95% confidence level. All reported margins of sampling error include computed design effects for weighting.

Each sample of national adults includes a minimum quota of 50% cellphone respondents and 50% landline respondents, with additional minimum quotas by time zone within region. Landline and cellular telephone numbers are selected using random-digit-dial methods.

http://www.gallup.com/poll/183128/five-months-gop-congress-approval-remains-low.aspx?utm_source=Politics&utm_medium=newsfeed&utm_campaign=tiles

Story Highlights

  • 31% say they are socially liberal, 31% socially conservative
  • This is the first time conservatives have not outnumbered liberals
  • Conservatives maintain edge on economic issues

PRINCETON, N.J. — Thirty-one percent of Americans describe their views on social issues as generally liberal, matching the percentage who identify as social conservatives for the first time in Gallup records dating back to 1999.

Trend: Americans' Self-Description of Views on Social Issues

Gallup first asked Americans to describe their views on social issues in 1999, and has repeated the question at least annually since 2001. The broad trend has been toward a shrinking conservative advantage, although that was temporarily interrupted during the first two years of Barack Obama’s presidency. Since then, the conservative advantage continued to diminish until it was wiped out this year.

The newfound parity on social ideology is a result of changes in the way both Democrats and Republicans describe their social views. The May 6-10 Gallup poll finds a new high of 53% of Democrats, including Democratic-leaning independents, describing their views on social issues as liberal.

Trend: Ideological Identification on Social Issues, Democrats and Democratic Leaners, 2001-2015

Democrats were more likely to describe their views on social issues as moderate rather than liberal from 2001 to 2005. Since then, socially liberal Democrats have outnumbered socially moderate Democrats in all but one year.

Meanwhile, the 53% of Republicans and Republican leaners saying their views on social issues are conservative is the lowest in Gallup’s trend. The drop in Republicans’ self-identified social conservatism has been accompanied by an increase in moderate identification, to 34%, while the percentage identifying as socially liberal has been static near 10%.

Trend: Ideological Identification on Social Issues, Republicans and Republican Leaners, 2001-2015

These trends echo the pattern in Gallup’s overall ideology measure, which dates back to 1992 and shows increasing liberal identification in recent years. As with the social ideology measure, the longer-term shifts are mainly a result of increasing numbers of Democrats describing their views as liberal rather than moderate. That may reflect Democrats feeling more comfortable in describing themselves as liberal than they were in the past, as much as a more leftward shift in Democrats’ attitudes on political, economic and social issues.

Conservatives Still Lead Liberals on Economic Issues

In contrast to the way Americans describe their views on social issues, they still by a wide margin, 39% to 19%, describe their views on economic issues as conservative rather than liberal. However, as on social ideology, the gap between conservatives and liberals has been shrinking and is lower today than at any point since 1999, with the 39% saying they are economically conservative the lowest to date.

Trend: Americans' Self-Description of Views on Economic Issues

Currently, 64% of Republicans identify as conservative economically, which is down from 70% the previous two years and roughly 75% in the early years of the Obama presidency. During George W. Bush’s administration, Republicans were less likely to say they were economic conservatives, with as few as 58% doing so in 2004 and 2005. The trends suggest Republicans’ willingness to identify as economic conservatives, or economic moderates, is influenced by the party of the president in office, and perhaps the types of financial policies the presidential administration is pursuing at the time.

Trend: Ideological Identification on Economic Issues, Republicans and Republican Leaners, 2001-2015

Democrats are also contributing to the trend in lower economic conservative identification. While the plurality of Democrats have consistently said they are economically moderate, Democrats have been more likely to identify as economic liberals than as economic conservatives since 2007. The last two years, there has been a 15-percentage-point gap in liberal versus conservative identification among Democrats on economic matters.

Trend: Ideological Identification on Economic Issues, Democrats and Democratic Leaners, 2001-2015

Implications

Americans’ growing social liberalism is evident not only in how they describe their views on social issues but also in changes in specific attitudes, such as increased support for same-sex marriage and legalizing marijuana. These longer-term trends may be attributable to changing attitudes among Americans of all ages, but they also may be a result of population changes, with younger, more liberal Americans entering adulthood while older, more conservative adults pass on. Gallup found evidence that population replacement is a factor in explaining changes in overall ideology using an analysis of birth cohorts over time.

The 2016 presidential election will thus be contested in a more socially liberal electorate — and a less economically conservative one — than was true of prior elections. Economically and socially conservative candidates may still appeal to the Republican Party base in the primaries, but it may be more important now than in the past for the GOP nominee to be a bit less conservative on social issues in order to appeal to the broader general electorate.

And while Americans are less economically conservative than in the past, economic conservatives still outnumber economic liberals by about 2-to-1. As a result, Democrats must be careful not to nominate a candidate who is viewed as too liberal on economic matters if their party hopes to hold the White House beyond 2016.

Survey Methods

Results for this Gallup poll are based on telephone interviews conducted May 6-10, 2015, with a random sample of 1,024 adults, aged 18 and older, living in all 50 U.S. states and the District of Columbia. For results based on the total sample of national adults, the margin of sampling error is ±4 percentage points at the 95% confidence level. All reported margins of sampling error include computed design effects for weighting.

Each sample of national adults includes a minimum quota of 50% cellphone respondents and 50% landline respondents, with additional minimum quotas by time zone within region. Landline and cellular telephone numbers are selected using random-digit-dial methods.

http://www.gallup.com/poll/183386/social-ideology-left-catches-right.aspx?utm_source=Politics&utm_medium=newsfeed&utm_campaign=tiles

AGAINST THE GRAIN
Democrats’ Vanishing Future

Hillary Clinton is not the only Democratic comeback candidate on the 2016 ticket. Senate Democrats are betting on the past to rebuild their party for the future.

BY JOSH KRAUSHAAR

One of the most underappreciated stories in recent years is the deterioration of the Democratic bench under President Obama’s tenure in office. The party has become much more ideologically homogenous, losing most of its moderate wing as a result of the last two disastrous midterm elections. By one new catch-all measure, a party-strength index introduced by RealClearPolitics analysts Sean Trende and David Byler, Democrats are in their worst position since 1928. That dynamic has manifested itself in the Democratic presidential contest, where the bench is so barren that a flawed Hillary Clinton is barreling to an uncontested nomination.

But less attention has been paid to how the shrinking number of Democratic officeholders in the House and in statewide offices is affecting the party’s Senate races. It’s awfully unusual to see how dependent Democrats are in relying on former losing candidates as their standard-bearers in 2016. Wisconsin’s Russ Feingold, Pennsylvania’s Joe Sestak, Indiana’s Baron Hill, and Ohio’s Ted Strickland all ran underwhelming campaigns in losing office in 2010—and are looking to return to politics six years later. Party officials are courting former Sen. Kay Hagan of North Carolina to make a comeback bid, despite mediocre favorability ratings and the fact that she lost a race just months ago that most had expected her to win. All told, more than half of the Democrats’ Senate challengers in 2016 are comeback candidates.

On one hand, most of these candidates are the best choices Democrats have. Feingold and Strickland are running ahead of GOP Sens. Ron Johnson and Rob Portman in recent polls. Hill and Hagan boast proven crossover appeal in GOP-leaning states that would be challenging pickups. Their presence in the race gives the party a fighting chance to retake the Senate.

(RELATED: What’s Next In the House Benghazi Committee’s Hillary Clinton Investigation)

But look more closely, and the reliance on former failures is a direct result of the party having no one else to turn to. If the brand-name challengers didn’t run, the roster of up-and-coming prospects in the respective states is short. They’re also facing an ominous historical reality that only two defeated senators have successfully returned to the upper chamber in the last six decades. As political analyst Stu Rothenberg put it, they’re asking “voters to rehire them for a job from which they were fired.” Senate Democrats are relying on these repeat candidates for the exact same reason that Democrats are comfortable with anointing Hillary Clinton for their presidential nomination: There aren’t any better alternatives.

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For a portrait of the Democrats’ slim pickings, just look at the political breakdown in three of the most consequential battleground states. Republicans hold 12 of Ohio’s 16 House seats, and all six of their statewide offices. In Wisconsin, Republicans hold a majority of the state’s eight House seats and four of five statewide partisan offices. In Pennsylvania, 13 of the 18 representatives are Republicans, though Democrats hold all the statewide offices. (One major caveat: Kathleen Kane, the Democrats’ once-hyped attorney general in the state, is under criminal investigation and has become a political punchline.) These are all Democratic-friendly states that Obama carried twice.

If Strickland didn’t run, the party’s hopes against Portman would lie in the hands of 30-year-old Cincinnati Councilman P.G. Sittenfeld, who would make unexpected history as one of the nation’s youngest senators with a victory. (Sittenfeld is still mounting a long-shot primary campaign against Strickland.) Without Feingold in Wisconsin, the party’s only logical option would be Rep. Ron Kind, who has regularly passed up opportunities for a promotion. Former Milwaukee Mayor Tom Barrett already lost to Gov. Scott Walker twice, and businesswoman Mary Burke disappointed as a first-time gubernatorial candidate last year. And despite the Democratic establishment’s publicized carping over Joe Sestak in Pennsylvania, the list of alternatives is equally underwhelming: His only current intra-party opposition is from the mayor of Allentown.

(RELATED: Hillary Clinton to Launch Her Campaign, Again)

In the more conservative states, the drop-off between favored recruits and alternatives is even more stark. Hagan would be a flawed nominee in North Carolina, but there’s no one else waiting in the wings. The strongest Democratic politician, Attorney General Roy Cooper, is running for governor instead. And in Indiana, the bench is so thin that even the GOP’s embattled governor, Mike Pence, isn’t facing formidable opposition. Hill, who lost congressional reelection campaigns in both 2004 and 2010, is not expected to face serious primary competition in the race to succeed retiring GOP Sen. Dan Coats.

Even in the two swing states where the party landed young, up-and-coming recruits to run, their options were awfully limited. In Florida, 32-year-old Rep. Patrick Murphy is one of only five House Democrats to represent a district that Mitt Romney carried in 2012—and his centrism has made him one of the most compelling candidates for higher office. The Democratic Senatorial Campaign Committee quickly rallied behind his campaign (in part to squelch potential opposition from firebrand congressman Alan Grayson). But if Murphy didn’t run, the alternatives would have been limited: freshman Rep. Gwen Graham and polarizing Democratic National Committee Chair Debbie Wasserman Schultz being the most logical alternatives.

In Nevada, Democrats boast one of their strongest challengers in former state Attorney General Catherine Cortez Masto, vying to become the first Latina ever elected to the Senate. But her ascension is due, in part, to the fact that other talented officeholders lost in the 2014 statewide wipeout. Democratic lieutenant-governor nominee Lucy Flores, hyped by MSNBC as a “potential superstar,” lost by 26 points to her GOP opponent. Former Secretary of State Ross Miller, another fast-rising pol, badly lost his bid for attorney general against a nondescript Republican. By simply taking a break from politics, Cortez Masto avoided the wave and kept her prospects alive for 2016.

(RELATED: Newly Released Clinton Email Detail Benghazi Correspondence)

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This isn’t an assessment of Democratic chances for a Senate majority in 2017; it’s a glaring warning for the party’s longer-term health. If Clinton can’t extend the Democrats’ presidential winning streak—a fundamental challenge, regardless of the political environment—the party’s barren bench will cause even more alarm for the next presidential campaign. And if the Democrats’ core constituencies don’t show up for midterm elections—an outlook that’s rapidly becoming conventional wisdom—Democrats have serious challenges in 2018 as well. It’s why The New Yorker’s liberal writer John Cassidy warned that a Clinton loss next year could “assign [Republicans] a position of dominance.”

By focusing on how the electorate’s rapid change would hand Democrats a clear advantage in presidential races, Obama’s advisers overlooked how the base-stroking moves would play in the states. Their optimistic view of the future has been adopted by Clinton, who has been running to the left even without serious primary competition.

But without a future generation of leaders able to compellingly carry the liberal message, there’s little guarantee that changing demographics will secure the party’s destiny. The irony of the 2016 Senate races is that Democrats are betting on the past, running veteran politicians to win them back the majority—with Clinton at the top of the ticket. If that formula doesn’t work, the rebuilding process will be long and arduous.

http://www.nationaljournal.com/against-the-grain/democrats-vanishing-future-20150521

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The Pronk Pops Show 251, April 28, 2014, Story 1: Lying Vietnam Turncoat and Secretary of State John Kerry Says Israel Could Become “An Apartheid State” in Remarks To The Trilateral Commission — Kerry Desperate As His Foreign Policy Initiatives Go Down The Drain — John Kerry Just Another Cut and Run Democrat — Kerry and Obama Foreign Policy Failures — Videos

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Story 1: Lying Vietnam Turncoat and Secretary of State John Kerry Says Israel Could Become “An Apartheid State” in Remarks To The Trilateral Commission — Kerry Desperate As His Foreign Policy Initiatives Go Down The Drain — John Kerry Just Another Cut and Run Democrat — Kerry and Obama Foreign Policy Failures — Videos

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John Forbes Kerry (born December 11, 1943) is an American politician who is the 68th and current United States Secretary of State. He served as a United States Senator from Massachusetts from 1985 to 2013, and was chairman of the Senate Foreign Relations Committee. Kerry was the presidential nominee of the Democratic Party in the 2004 Presidential Election but lost to incumbent George W. Bush.

The son of an Army Air Corps veteran, Kerry was born in Aurora, Colorado. He attended boarding school in Massachusetts and New Hampshire and went on to graduate from Yale University class of 1966, where he majored in political science and became a member of the influential Skull and Bones secret society. He enlisted in the Naval Reserve in 1966, and during 1968–1969 served an abbreviated four-month tour of duty in South Vietnam as officer-in-charge (OIC) of a Swift Boat. For that service, he was awarded combat medals that include the Silver Star, Bronze Star, and three Purple Hearts. Securing an early return to the United States, Kerry joined the Vietnam Veterans Against the War in which he served as a nationally recognized spokesman and as an outspoken opponent of the Vietnam War. He appeared before the Senate Committee on Foreign Affairs where he deemed United States war policy in Vietnam to be the cause of “war crimes.”

After receiving his J.D. from Boston College Law School, Kerry worked as an Assistant District Attorney and co-founded a private firm. He served as Lieutenant Governor of Massachusetts under Michael Dukakis from 1983 to 1985, where he worked on an early forerunner to the national Clean Air Act. He won a tight Democratic primary in 1984 for the U.S. Senate and was sworn in the following January. On the Senate Foreign Relations Committee, he led a series of hearings from 1987 to 1989 which were a precursor to the Iran–Contra affair.

In 2002, Kerry voted to authorize the President “to use force, if necessary, to disarm Saddam Hussein”, but warned that the administration should exhaust its diplomatic avenues before launching war. Kerry based his 2004 presidential campaign on opposition to the Iraq War. He and his running mate Senator John Edwards lost the race, finishing 35 electoral votes behind the Republican ticket headed by President George W. Bush (just 19 short of the 270 required for election). Subsequently, he established the Keeping America’s Promise PAC.

Kerry became chairman of the Senate Foreign Relations Committee in 2009, and in 2011 he was appointed to the Joint Select Committee on Deficit Reduction. Having been nominated by President Barack Obama to succeed outgoing Secretary of State Hillary Rodham Clinton and then confirmed by the U.S. Senate by a vote of 94–3 on January 29, 2013, Kerry assumed the office on February 1, 2013.

After returning to the United States, Kerry joined the Vietnam Veterans Against the War (VVAW). Then numbering about 20,000,[60] VVAW was considered by some (including the administration of President Richard Nixon) to be an effective, if controversial, component of the antiwar movement.[61] According to Nixon Secretary of Defense Melvin Laird, “I didn’t approve of what he did, but I understood the protesters quite well”, and he declined two requests from the Navy to court martial Reserve Lieutenant Kerry over his antiwar activity.[62]

On April 22, 1971, Kerry became the first Vietnam veteran to testify before Congress about the war, when he appeared before a Senate committee hearing on proposals relating to ending the war. He was still a member of the United States Navy Reserve, holding the rank of Lieutenant Junior Grade. Wearing green fatigues and service ribbons, he spoke for nearly two hours with the Senate Foreign Relations Committee in what has been named the Fulbright Hearings, after the Chairman of the proceedings, Senator J. W. Fulbright. Kerry began with a prepared speech, in which he presented the conclusions of the Winter Soldier Investigation, and then went on to address larger policy issues.

John Kerry Offered to sell out Democracy programs in Cuba Dick Morris TV: Lunch ALERT!

 

Noam Chomsky “Israel: An Apartheid State”

 

Exclusive: Kerry Warns Israel Could Become ‘An Apartheid State’

The secretary of state said that if Israel doesn’t make peace soon, it could become ‘an apartheid state,’ like the old South Africa. Jewish leaders are fuming over the comparison.

If there’s no two-state solution to the Israeli-Palestinian conflict soon, Israel risks becoming “an apartheid state,” Secretary of State John Kerry told a room of influential world leaders in a closed-door meeting Friday.

Senior American officials have rarely, if ever, used the term “apartheid” in reference to Israel, and President Obama has previously rejected the idea that the word should apply to the Jewish state. Kerry’s use of the loaded term is already rankling Jewish leaders in America—and it could attract unwanted attention in Israel, as well.

It wasn’t the only controversial comment on the Middle East that Kerry made during his remarks to the Trilateral Commission, a recording of which was obtained by The Daily Beast. Kerry also repeated his warning that a failure of Middle East peace talks could lead to a resumption of Palestinian violence against Israeli citizens. He suggested that a change in either the Israeli or Palestinian leadership could make achieving a peace deal more feasible. He lashed out against Israeli settlement-building. And Kerry said that both Israeli and Palestinian leaders share the blame for the current impasse in the talks.

Kerry also said that at some point, he might unveil his own peace deal and tell both sides to “take it or leave it.”

“A two-state solution will be clearly underscored as the only real alternative. Because a unitary state winds up either being an apartheid state with second-class citizens—or it ends up being a state that destroys the capacity of Israel to be a Jewish state,” Kerry told the group of senior officials and experts from the U.S., Western Europe, Russia, and Japan. “Once you put that frame in your mind, that reality, which is the bottom line, you understand how imperative it is to get to the two-state solution, which both leaders, even yesterday, said they remain deeply committed to.”

According to the 1998 Rome Statute, the “crime of apartheid” is defined as “inhumane acts… committed in the context of an institutionalized regime of systematic oppression and domination by one racial group over any other racial group or groups and committed with the intention of maintaining that regime.” The term is most often used in reference to the system of racial segregation and oppression that governed South Africa from 1948 until 1994.

Former president Jimmy Carter came under fire in 2007 for titling his book on Middle East peace Palestine: Peace or Apartheid. Carter has said publicly that his views on Israeli treatment of the Palestinians are a main cause of his poor relationship with President Obama and his lack of current communication with the White House. But Carter explained after publishing the book that he was referring to apartheid-type policies in the West Bank, not Israel proper, and he was not accusing Israel of institutionalized racism.

“Apartheid is a word that is an accurate description of what has been going on in the West Bank, and it’s based on the desire or avarice of a minority of Israelis for Palestinian land,” Carter said.

“Injecting a term like apartheidinto the discussion doesn’t advance that goal [of peace],” Obama said. “It’s emotionally loaded, historically inaccurate, and it’s not what I believe.”

Leading experts, including Richard Goldstone, a former justice of the South African Constitutional Court who led the United Nations fact-finding mission on the Gaza conflict of 2008 and 2009, have argued that comparisons between the Israeli treatment of the Palestinians and “apartheid” are offensive and wrong.

“One particularly pernicious and enduring canard that is surfacing again is that Israel pursues ‘apartheid’ policies,” Goldstone wrote in The New York Times in 2011. “It is an unfair and inaccurate slander against Israel, calculated to retard rather than advance peace negotiations.”

In a 2008 interview with Jeffrey Goldberg, then-Sen. Barack Obama shot down the notion that the word “apartheid” was acceptable in a discussion about Israel’s treatment of the Palestinians:

“There’s no doubt that Israel and the Palestinians have tough issues to work out to get to the goal of two states living side by side in peace and security, but injecting a term like apartheid into the discussion doesn’t advance that goal,” Obama said. “It’s emotionally loaded, historically inaccurate, and it’s not what I believe.”

State Department spokeswoman Jen Psaki told The Daily Beast that Kerry was simply repeating his view, shared by others, that a two-state solution is the only way for Israel to remain a Jewish state in peace with the Palestinians.

“Secretary Kerry, like Justice Minister Livni, and previous Israeli Prime Ministers Olmert and Barak, was reiterating why there’s no such thing as a one-state solution if you believe, as he does, in the principle of a Jewish State. He was talking about the kind of future Israel wants and the kind of future both Israelis and Palestinians would want to envision,” she said. “The only way to have two nations and two peoples living side by side in peace and security is through a two-state solution. And without a two-state solution, the level of prosperity and security the Israeli and Palestinian people deserve isn’t possible.”

But leaders of pro-Israel organizations told The Daily Beast that Kerry’s reference to “apartheid” was appalling and inappropriately alarmist because of its racial connotations and historical context.

“One particularly pernicious and enduring canard that is surfacing again is that Israel pursues ‘apartheid’ policies,” Goldstone wrote in The New York Times in 2011. “It is an unfair and inaccurate slander against Israel, calculated to retard rather than advance peace negotiations.”

Yet Israel’s leaders have employed the term, as well. In 2010, for example, former Prime Minister and Defense Minister Ehud Barak used language very similar to Kerry’s. “As long as in this territory west of the Jordan River there is only one political entity called Israel it is going to be either non-Jewish, or non-democratic,” Barak said. “If this bloc of millions of ­Palestinians cannot vote, that will be an apartheid state.”

“While we’ve heard Secretary Kerry express his understandable fears about alternative prospects for Israel to a two-state deal and we understand the stakes involved in reaching that deal, the use of the word ‘apartheid’ is not helpful at all. It takes the discussion to an entirely different dimension,” said David Harris, executive director of the American Jewish Committee, an organization that has been supportive of Kerry’s peace process initiative. “In trying to make his point, Kerry reaches into diplomatic vocabulary to raise the stakes, but in doing so he invokes notions that have no place in the discussion.”

Kerry has used dire warnings twice in the past to paint a picture of doom for Israel if the current peace process fails. Last November, Kerry warned of a third intifada of Palestinian violence and increased isolation of Israel if the peace process failed. In March, Democrats and Republican alike criticized Kerry for suggesting that if peace talks fail, it would bolster the boycott, divestment and sanctions (BDS) movement against Israel.

“It’s in the Palestinian playbook to tie Israel to these extreme notions of time being on the Palestinian side, that demographics are on the Palestinian side, and that Israel has to confront notions of the Jewishness of the state,” Harris said.

Kerry on Friday repeated his warning that a dissolution of the peace process might lead to more Palestinian violence. “People grow so frustrated with their lot in life that they begin to take other choices and go to dark places they’ve been before, which forces confrontation,” he said.

The secretary of state also implied, but did not say outright, that if the governments of Israeli Prime Minister Bibi Netanyahu or Palestinian Authority President Mahmoud Abbas left power, there could be a change in the prospects for peace. If “there is a change of government or a change of heart,” Kerry said, “something will happen.”

Kerry criticized Israeli settlement construction as being unhelpful to the peace process and he also criticized Palestinian leaders for making statements that declined to recognize the right of Israel to exist as a Jewish state.

“There is a fundamental confrontation and it is over settlements. Fourteen thousand new settlement units announced since we began negotiations. It’s very difficult for any leader to deal under that cloud,” Kerry said.

He acknowledged that the formal negotiating process that he initiated and led since last summer may soon stop. But he maintained that his efforts to push for a final settlement will continue in one form or another.

“The reports of the demise of the peace process have consistently been misunderstood and misreported. And even we are now getting to the moment of obvious confrontation and hiatus, but I would far from declare it dead,” Kerry said. “You would say this thing is going to hell in a handbasket, and who knows, it might at some point, but I don’t think it is right now, yet.”

Kerry gave both Israeli and Palestinian leaders credit for sticking with the peace process for this long. But he added that both sides were to blame for the current impasse in the talks; neither leader was ready to make the tough decisions necessary for achieving peace.

“There’s a period here where there needs to be some regrouping. I don’t think it’s unhealthy for both of them to have to stare over the abyss and understand where the real tensions are and what the real critical decisions are that have to be made,” he said. “Neither party is quite ready to make it at this point in time. That doesn’t mean they don’t have to make these decisions.”

Kerry said that he was considering, at some point, publicly laying out a comprehensive U.S. plan for a final agreement between the Israelis and the Palestinians, in a last-ditch effort to forge a deal before the Obama administration leaves office in 2017.

“We have enough time to do any number of things, including the potential at some point in time that we will just put something out there. ‘Here it is, folks. This is what it looks like. Take it or leave it,’” Kerry said

http://www.thedailybeast.com/articles/2014/04/27/exclusive-kerry-warns-israel-could-become-an-apartheid-state.html

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