The Pronk Pops Show 939, August 2, 2017, Breaking News — Story 1: President Trump For National Unity Furiously Signs Flawed Russia, Iran, and North Korea Sanctions Bill — Videos — Story 2: Trump Announces New Immigration Policy — Reforming American Immigration for Strong Employment (RAISE) Act — Videos

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The Pronk Pops Show Podcasts

Pronk Pops Show 939,  August 2, 2017

Pronk Pops Show 938,  August 1, 2017

Pronk Pops Show 937,  July 31, 2017

Pronk Pops Show 936,  July 27, 2017

Pronk Pops Show 935,  July 26, 2017

Pronk Pops Show 934,  July 25, 2017

Pronk Pops Show 934,  July 25, 2017

Pronk Pops Show 933,  July 24, 2017

Pronk Pops Show 932,  July 20, 2017

Pronk Pops Show 931,  July 19, 2017

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

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Image result for RAISE ACT immigration

Image result for Reforming American Immigration for a Strong Economy (RAISE) Act. charts on numbers 

Breaking News — Story 1: President Trump For National Unity Furiously Signs Flawed Russia, Iran, and North Korea Sanctions Bill — Videos —

President Trump signs Russian sanctions bill Fox News Video

President Trump signs new Russia sanctions, questions whether bill interferes with foreign policy 

BREAKING NEWS 8/2/17 PRESIDENT TRUMP SIGNS NEW RUSSIA SANCTIONS BILL

January 3, 2017: Sen. Tom Cotton joined Tucker Carlson Tonight on Fox News

Trump Signs Sanctions Bill – Another Deep State Victory

Real Bipartisanship: Republicans And Democrats Unite For New Cold War

Germany growing sick of US sanctions on Russia

Russians See Sanctions Regime as a Blessing in Disguise

Trump signs Russia sanctions bill but blasts Congress

In a pair of statements, the president said parts of the law violate the Constitution.

President Donald Trump on Wednesday signed a bipartisan bill placing new sanctions on Russia — but in a statement, he claimed multiple aspects of the legislation violate the Constitution.

The sanctions, aimed at punishing Russia for its interference in the 2016 election, limit the president’s power to lift the sanctions without congressional approval and were initially resisted by the administration.

In one of two statements released almost simultaneously Wednesday morning by the White House, Trump said he supports the law’s efforts to crack down on the actions of Iran, North Korea and Russia. But the White House protested what it sees as congressional encroachment on the president’s power in foreign affairs.

“In its haste to pass this legislation, the Congress included a number of clearly unconstitutional provisions,” Trump said in one statement. “My Administration particularly expects the Congress to refrain from using this flawed bill to hinder our important work with European allies to resolve the conflict in Ukraine, and from using it to hinder our efforts to address any unintended consequences it may have for American businesses, our friends, or our allies.”

The president’s second statement included a stepped-up defense of his own administration’s foreign policy and input on the legislation. Trump said that “despite its problems,” he had signed the bill “for the sake of national unity.” The statement characterized the governments of Iran and North Korea as “rogue regimes,” a label he did not apply to the Russian government.

Even as he continues to label Russian interference in the election a “hoax,” the statement went further in acknowledging the intrusion than Trump has in the past.

“I also support making clear that America will not tolerate interference in our democratic process, and that we will side with our allies and friends against Russian subversion and destabilization,” the statement said.

Still, Trump was quick to push back on what he views as congressional overreach.

“The bill remains seriously flawed — particularly because it encroaches on the executive branch’s authority to negotiate. Congress could not even negotiate a health care bill after seven years of talking,” Trump said, in reference to congressional Republicans’ latest failure to repeal and replace the Affordable Care Act.

“I built a truly great company worth many billions of dollars. That is a big part of the reason I was elected,” the president continued. “As President, I can make far better deals with foreign countries than Congress.”

The statements drew mixed reaction on Capitol Hill.

Senate Foreign Relations Chairman Bob Corker, a leading architect of the sanctions bill, told reporters he was not concerned about Trump’s statement, though he said he had not yet seen it.

“Both countries talk privately in ways that are very different from how they talk publicly,” the Tennessee Republican said of U.S.-Russia relations. “But this was a necessary step that we took, and I’m glad we took it.”

In addition to allowing lawmakers to handcuff Trump on any future changes to Russia sanctions, the legislation converts some existing sanctions from executive orders into law, making them more difficult to roll back, and imposes new sanctions focused on Moscow’s reported cyber-meddling in the November election. The legislation’s Iran and North Korea sanctions were broadly popular in both parties and with the Trump administration.

Although White House officials asserted that some of the preferred changes to the legislation were included before its final passage last week, the administration had long underscored its opposition to provisions that will impede Trump’s ability to warm relations with Russian President Vladimir Putin.

“The action by the Congress to put these sanctions in place and the way that they did, neither the president nor I are very happy about that,” Secretary of State Rex Tillerson told reporters Tuesday. “We were clear that we didn’t think it was going to be helpful to our efforts.”

Still, Tillerson added, “we can’t let it take us off track of trying to restore the relationship” with Russia.

Even as Trump criticized the measure, he added that “I nevertheless expect to honor the bill’s waiting periods to ensure that Congress will have a full opportunity to avail itself of the bill’s review procedures.”

That apparent concession by Trump did not assuage Democratic concerns about his signing statement. House Minority Leader Nancy Pelosi of California warned in a statement that Trump’s interpretation of the sanctions bill “raises serious questions about whether his administration intends to follow the law, or whether he will continue to enable and reward Vladimir Putin’s aggression.”

And some Republicans who played a key role in the sanctions package raised their own alarms.

“Look, whether it was President Bush, President Obama, or President Trump, I’ve never been a fan of signing statements,” said Sen. Cory Gardner of Colorado. “I think they’re a way for any president to usurp the role of the legislative branch. And that’s why I’ve always been concerned, regardless of who issued them, on any matter.”

The bill enjoyed wide bipartisan support. The House passed the sanctions by a vote of 419-3, and the Senate cleared it 98-2 — making any presidential veto futile and sure to be overridden.

With multiple investigations into whether the Trump campaign colluded with Russia, a veto also would have been politically disastrous.

After weeks of waffling, the White House confirmed over the weekend that Trump would sign the bill.

The White House still sought to characterize the bill as a win, with press secretary Sarah Huckabee Sanders saying in a statement on Friday that Trump “negotiated regarding critical elements of it” and decided to sign it “based on its responsiveness to his negotiations.”

The statement Wednesday also contained a warning — not to Russia, but to Congress.

“The Framers of our Constitution put foreign affairs in the hands of the President,” Trump said. “This bill will prove the wisdom of that choice.”

http://www.politico.com/story/2017/08/02/trump-signs-bipartisan-russia-sanctions-bill-241242

 

Furious Trump signs Russian sanctions into law – then issues tirade against ‘unconstitutional’ bill and boasts his billions show why Congress shouldn’t stop him making deals with Putin

  • President Donald Trump signed legislation imposing new sanctions on Russia, North Korea, and Iran
  • The White House did not organize a ceremony of any kind for it
  • Trump said in a statement he signed the bill for the sake of ‘national unity’ 
  • The White House lobbied to water down restrictions in the bill
  • It passed Congress overwhelmingly with veto-proof majorities
  • Secretary of State Rex Tillerson said he and the president were not ‘very happy’ about the sanctions bill 

President Donald Trump signed legislation Wednesday that slaps sanctions on Russia and limits his own ability to create waivers – but at the same time issued a furious statement calling it ‘flawed’.

He signed the bill, which Secretary of State Rex Tillerson publicly said he wasn’t happy about, in private.

Then the White House sent out statement by the president revealing the depths of his unhappiness and boasting that his billions showed he was far better at deal-making than Congress.

Trump said despite some changes, ‘the bill remains seriously flawed – particularly because it encroaches on the executive branch’s authority to negotiate.’

He called parts of it ‘unconstitutional’ and signaled fresh tensions with Republicans by criticizing their failure to repeal and replace Obamacare.

President Donald Trump has signed legislation that slaps sanctions on Russia and limits his own ability to create waivers

‘Congress could not even negotiate a healthcare bill after seven years of talking. By limiting the Executive’s flexibility, this bill makes it harder for the United States to strike good deals for the American people, and will drive China, Russia, and North Korea much closer together.

‘The Framers of our Constitution put foreign affairs in the hands of the President. This bill will prove the wisdom of that choice,’ Trump said in a statement.

‘Yet despite its problems, I am signing this bill for the sake of national unity. It represents the will of the American people to see Russia take steps to improve relations with the United States. We hope there will be cooperation between our two countries on major global issues so that these sanctions will no longer be necessary.’

In a message to Congress in response to the bill, Trump singled out provisions his lawyers considers in conflict with Supreme Court case law – and asserts his own latitude to carry out the law as he sees fit.

Secretary of State Rex Tillerson said Trump wasn't happy with the bill

Secretary of State Rex Tillerson said Trump wasn’t happy with the bill

‘My Administration will give careful and respectful consideration to the preferences expressed by the Congress in these various provisions,’ the president said in one point – in language certain to irk lawmakers who consider the law much more than a preference.

‘My administration … expects the Congress to refrain from using this flawed bill to hinder our important work with European allies to resolve the conflict in Ukraine, and from using it to hinder our efforts to address any unintended consequences it may have for American businesses, our friends, or our allies,’ he said.

The president also complained about what he said were ‘clearly unconstitutional provisions’ in the legislation relating to presidential powers to shape foreign policy.

 White House counselor Kellyanne Conway confirmed the signing on Fox News.

The bill passed Congress by overwhelming margins sufficient to override a presidential veto. The White House lobbied to water down restrictions in the bill.

The bill contains language meant to prevent the president from lifting them without approval from Congress – provisions that got drafted amid concerns Trump would lift or limit sanctions amid his frequent praise for Russian President Vladimir Putin and desire to improve ties between the two powers.

Secretary of State Rex Tillerson told reporters he shared misgivings with the president, as they try to improve relations with Russia.

‘Neither the president nor I are very happy about that,’ Tillerson said. ‘We were clear that we didn’t think that was going to be helpful to our efforts, but that’s the decision they made.’

The FBI and congressional intelligence panels are probing Trump campaign connections to Russians during the election.

SIGN OF THE TIMES: Russian President Vladimir Putin speaks during a news conference after the G20 summit in Hamburg, northern Germany, July 8, 2017

SIGN OF THE TIMES: Russian President Vladimir Putin speaks during a news conference after the G20 summit in Hamburg, northern Germany, July 8, 2017

Then-candidate Donald Trump holds up a signed pledge during a press availability at Trump Tower in Manhattan, New York September 3, 2015

Then-candidate Donald Trump holds up a signed pledge during a press availability at Trump Tower in Manhattan, New York September 3, 2015

Justice Department lawyers and security officials were reviewing Russia sanctions legislation Tuesday

Justice Department lawyers and security officials were reviewing Russia sanctions legislation Tuesday

Trump during the campaign repeatedly called for better relations with Russia. The U.S. intelligence community concluded that the Russian government backed a campaign to interfere in the presidential election.

Despite communications with Russian President Vladimir Putin capped off by two one-on-one meetings in Europe, Trump has struggled to meet his goal.

Putin said last weekend that Russia would expel more than 700 U.S. diplomats from Russia in retaliation for the sanctions legislation.

I’M WORTH BILLIONS – I CAN MAKE BETTER DEALS THAN CONGRESS

Today, I signed into law the ‘Countering America’s Adversaries Through Sanctions Act,’ which enacts new sanctions on Iran, North Korea, and Russia. I favor tough measures to punish and deter bad behavior by the rogue regimes in Tehran and Pyongyang. I also support making clear that America will not tolerate interference in our democratic process, and that we will side with our allies and friends against Russian subversion and destabilization.

That is why, since taking office, I have enacted tough new sanctions on Iran and North Korea, and shored up existing sanctions on Russia.

Since this bill was first introduced, I have expressed my concerns to Congress about the many ways it improperly encroaches on Executive power, disadvantages American companies, and hurts the interests of our European allies.

My Administration has attempted to work with Congress to make this bill better. We have made progress and improved the language to give the Treasury Department greater flexibility in granting routine licenses to American businesses, people, and companies. The improved language also reflects feedback from our European allies – who have been steadfast partners on Russia sanctions – regarding the energy sanctions provided for in the legislation. The new language also ensures our agencies can delay sanctions on the intelligence and defense sectors, because those sanctions could negatively affect American companies and those of our allies.

Still, the bill remains seriously flawed – particularly because it encroaches on the executive branch’s authority to negotiate. Congress could not even negotiate a healthcare bill after seven years of talking. By limiting the Executive’s flexibility, this bill makes it harder for the United States to strike good deals for the American people, and will drive China, Russia, and North Korea much closer together. The Framers of our Constitution put foreign affairs in the hands of the President. This bill will prove the wisdom of that choice.

Yet despite its problems, I am signing this bill for the sake of national unity. It represents the will of the American people to see Russia take steps to improve relations with the United States. We hope there will be cooperation between our two countries on major global issues so that these sanctions will no longer be necessary.

Further, the bill sends a clear message to Iran and North Korea that the American people will not tolerate their dangerous and destabilizing behavior. America will continue to work closely with our friends and allies to check those countries’ malignant activities.

I built a truly great company worth many billions of dollars. That is a big part of the reason I was elected. As President, I can make far better deals with foreign countries than Congress.

In his statement about the bill, Trump highlighted a series of concerns about the legislation. Had he vetoed it, Congress could have easily overridden him.

‘Since this bill was first introduced, I have expressed my concerns to Congress about the many ways it improperly encroaches on Executive power, disadvantages American companies, and hurts the interests of our European allies,’ Trump complained.

‘My Administration has attempted to work with Congress to make this bill better. We have made progress and improved the language to give the Treasury Department greater flexibility in granting routine licenses to American businesses, people, and companies. The improved language also reflects feedback from our European allies – who have been steadfast partners on Russia sanctions – regarding the energy sanctions provided for in the legislation. The new language also ensures our agencies can delay sanctions on the intelligence and defense sectors, because those sanctions could negatively affect American companies and those of our allies.’

 Russia hawk Sen. John McCain of Arizona responded in a statement: ‘I welcome President Trump’s decision to sign legislation imposing new sanctions on Russia, Iran, and North Korea. The enactment of this legislation, which enjoyed overwhelming bipartisan support in both houses of Congress, sends a strong message to friend and foe alike that the United States will hold nations accountable for aggressive and destabilizing behavior that threatens our national interests and those of our allies and partners.’

McCain also called out Trump’s signing statement. ‘The concerns expressed in the President’s signing statement are hardly surprising, though misplaced. The Framers of our Constitution made the Congress and the President coequal branches of government. This bill has already proven the wisdom of that choice,’ he wrote.

“While the American people surely hope for better relations with Russia, what this legislation truly represents is their insistence that Vladimir Putin and his regime must pay a real price for attacking our democracy, violating human rights, occupying Crimea, and destabilizing Ukraine.’

http://www.dailymail.co.uk/news/article-4754014/President-Donald-Trump-signs-Russia-sanctions-bill.html#ixzz4ocylqTKe

 

President Vladimir V. Putin of Russia met with President Trump for the first time during the Group of 20 summit meeting in Hamburg, Germany, this month. CreditStephen Crowley/The New York Times

MOSCOW — The last time the Kremlin forced a sweeping reduction of local staff at the American Embassy in Moscow, a young diplomat named Steven Pifer found himself working four days a week on arms control, as usual. But on the fifth day, he navigated the capital in a big truck to move furniture or haul mammoth grocery loads.

The entire staff of the embassy, except the ambassador, was assigned one day each week to grunt work called All Purpose Duty, Mr. Pifer recalled in an interview on Monday, when they shed their dark suits and polished loafers to mow the lawns, fix the plumbing, cook in the cafeteria and even clean the toilets.

That was a last hurrah for the Cold War in 1986, and although the embassy now functions on a far more complex scale, many current and former diplomats expect a similar effort in the wake of President Vladimir V. Putin’s announcement on Sunday that the United States diplomatic mission in Russia must shed 755 employees by Sept. 1.

“The attitude in the embassy was if they think that they will shut us down, we will show them,” said Mr. Pifer, who went on to become an American ambassador to Ukraine and is now a senior fellow at the Brookings Institution in Washington. “I think the embassy will adapt this time, too.”

Russia demanded that the United States reduce its diplomatic staff to equal the 455 Russian diplomats working in the United States, including at the mission to the United Nations. That means cutting about 60 percent of a work force estimated at 1,200 to 1,300 people, the vast majority of whom are Russians.

Given the continuing deterioration in relations between the two countries, core functions like political and military analysis will be preserved, along with espionage, experts said, while programs that involve cooperation on everything from trade to culture to science are likely to be reduced or eliminated.

Besides the State Department, a dizzying array of American government agencies have employees at the embassy, including the Departments of Agriculture and Commerce as well as NASA and the Library of Congress.

The other area expected to take a heavy hit will be public services, like issuing visas to Russian travelers to the United States, which is likely to slow to a glacial pace.

The Russian staff can be broken down into two broad categories: specialists who help individual departments in the embassy like public relations, and basic service workers employed as security guards, drivers, janitors, electricians and a host of other maintenance functions.

As of 2013, the latest year for which public records are available, there were 1,279 staff members working in the American Embassy in Moscow and in consulates in St. Petersburg, Yekaterinburg and Vladivostok, according to a report by the Inspector General’s Office. Of those, 934 were not Americans, including 652 basic service workers. The numbers are believed to have stayed roughly the same.

Russian staff members working in various departments like the political or economic section often provide the embassy’s institutional memory, because they stay on the job for years while American diplomats rotate every two or three years. (If the Russian employees stay for at least 15 years, they are eligible for special immigration visas to the United States and their salaries are high by Russian standards.)

It is the Russians who tend to notice nuances in domestic news coverage or in Mr. Putin’s speeches, or who direct diplomats toward public events or responsible journalists. The Russian employees provide continuity, an American diplomat who recently left Moscow said, speaking anonymously because he was not authorized to speak publicly.

Gen. Bruce McClintock, the American Defense attaché from 2014 to 2016 and now a RAND Corporation analyst, said Russian employees were often more effective in organizing meetings with government officials, while experienced translators ensured that the positions of both sides were clear in often complex discussions.

Russia had already chipped away at embassy programs, anyway, he noted. In 2013, it shuttered USAID, for example, and in 2014, in response to the West’s cutting off military cooperation after the Ukraine crisis, it closed the Defense Threat Reduction Agency.

Although the work continued, it was much harder to coordinate because its 10 employees had departed, said General McClintock.

Russian nationals are not given the security clearances needed to work in the more clandestine branches of the embassy. Indeed, in the chancellery itself, no Russians worked above the fourth floor in the roughly 10-story building, former Russian employees said.

The American Embassy, which held a staff meeting on Monday to confirm the news to its employees, refused to comment on the events, while in Washington the State Department would say only that it was studying the Russian government’s request.

The general hostility toward the United States means Moscow was already considered a hardship post for American diplomats, and the new measures will lower morale further, diplomats said.

Russian employees are confused and do not yet understand how the changes will be carried out, a former Russian employee now working outside the country said, adding with dark humor that Stalin used to say there were no irreplaceable people.

Russian employees who worked for specialized departments feel especially vulnerable because they carry a certain stigma in Russia’s current nationalistic mood. Michael McFaul, a Stanford University professor who was the American ambassador from 2012 to 2014, remembered trying to help find work for 70 Russians who were let go when the Kremlin closed the USAID office.

It was especially hard because “many Russian companies would not consider hiring these ‘tainted’ people,” he said in an email.

In recent years, local employees have come under increasing pressure from the Russian security service, the F.S.B., according to current and former employees. Russians escorting delegations of American musicians around the country were harassed, for example, or some in Moscow returned home from work to find agents sitting in their living rooms, demanding that they inform on their employers, they said.

Mr. Pifer said American diplomats who lived through the 1986 clampdown learned all kinds of things about Soviet life that they would not have otherwise.

One of his colleagues, who had to navigate customs, wrote a slightly tongue-in-cheek diplomatic cable titled “The 29 Steps Needed to Clear a Container of Furniture,” detailing every stamp issued on every piece of paper. The cable was a huge hit back in Washington, he said.

In previous spats with the United States or the West in general, Mr. Putin often chose measures that hurt Russians the most, not least because Russia’s limited economic reach globally means it does not have many options.

Angered over sanctions imposed by Congress under the Magnitsky Act in 2012, he banned Americans from adopting Russian children. When the West imposed economic and military sanctions after the Russian annexation of Crimea in 2014, he barred a broad array of food imports, forcing up prices and limiting the options for Russian consumers.

This time, hundreds of Russians will lose their jobs and Russian travelers hoping to visit the United States are likely to wait months for visas. Some 50 Russians were employed in the consular section that processes visas, according to the inspector general’s report.

“I don’t think Mr. Putin is terribly worried about this,” Mr. Collins said, noting the presidential election looming in March. “As he is running for election, it is comfortable for him to show that he can stand up to the Americans and to protect Russian interests and that is what he is doing.”

Outside the embassy on Monday, many of those emerging from the visa section suggested the Russian measures could only make a bad situation worse. Anecdotal evidence suggested that on both sides, what used to take weeks had already slowed to months.

Shavkat Butaev, 50, who works for a company that helps Russians get visas, said rejections were way up, too. “It was never like this before. Fifty, 60 people get rejected every day,” he said.

Oleg Smirnov, an 18-year-old student studying in the United States to become a psychiatrist, said that he had hoped President Trump would improve relations and that he was worried about possible fallout on immigration policy.

“These mutual sanctions look like a game played with water guns,” he said

https://www.nytimes.com/2017/07/31/world/europe/russia-sanctions-embassy.html

Story 2: Trump Announces New Immigration Policy — Reforming American Immigration for Strong Employment (RAISE) Act — Videos

Trump announces new immigration policy

Published on Aug 2, 2017

President Trump announced the Reforming American Immigration for Strong Employment (RAISE) Act on Aug. 2, which aims to cut immigration by half from the current level of more than 1 million green cards granted per year.

 

Pres Trump and Sens Cotton and Perdue Introduce “The Raise Act”. Excellent!

August 2, 2017: Sen. Cotton and Sen. Perdue Answer Questions about the RAISE Act at the White House

 

Jim Acosta vs Stephen Miller – Immigration – White House Press Briefing 8/2/17

Senator Tom Cotton, Immigration Reform, and the RAISE Act

Senators David Perdue and Tom Cotton RAISE Act Press Conference

Immigration by the Numbers — Off the Charts

Sen.Barbara Jordan Legal Immigration Recommendations

2015 Barbara Jordan TV ad

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

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

Milton Friedman – Illegal Immigration – PT 1

Milton Friedman – Illegal Immigration – PT 2

Why Free Markets Work: Milton Friedman on Political Economy (1996)

Obama’s Amnesty & How Illegal Immigration Affects Us

The Impact of Immigration on Jobs and Income

 

Trump, GOP senators unveil measure to cut legal immigration

Trump, GOP senators unveil measure to cut legal immigration

President Trump on Wednesday teamed up with two conservative Republican senators to roll out new legislation aimed at dramatically curbing legal immigration to the United States, a key Trump campaign promise.

Sens. Tom Cotton (R-Ark.) and David Perdue (R-Ga.) have been working with White House officials to revise and expand a bill released earlier this year that would halve the number of people who receive legal permanent residence over a decade.

The senators joined Trump at a White House ceremony to announce the measure.

The president told reporters in the Roosevelt Room that the measure “would represent the most significant reform to our immigration system in a half a century.”
They say the legislation would move the United States to a “merit-based” immigration system and away from the current model, which is largely based on family ties.
The measure reflects Trump’s rhetoric during the 2016 campaign, when he argued that the spike in legal immigration over the past several decades has taken job opportunities away from American citizens and threatened national security.
“As a candidate, I campaigned on creating a merit-based immigration system that protects U.S. workers and taxpayers and that’s why we are here today,” he said, adding the measure would “reduce poverty, increase wages and save taxpayers billions and billions of dollars.”
Trump met with Cotton and Perdue in March to discuss the legislation, known as the Reforming American Immigration for a Strong Economy (RAISE) Act.
The bill would mark a dramatic change in U.S. immigration laws, and could open up a nasty internal fight among Republicans.

The legislation would eliminate immigration preferences currently given to extended family members and adult children of U.S. citizens seeking green cards, and it would cap the number of accepted refugees at 50,000 — half of the Obama administration’s target for 2017.

It would also end the State Department’s Diversity visa lottery, which the senators say is “plagued with fraud.” The program had been allotted 50,000 visas for the 2018 fiscal year.

About 1 million immigrants receive green cards per year.

Conservative outside groups immediately praised the legislation and called for the Senate to vote on the bill.

“The RAISE Act helps realize President Trump’s vision of making America great again by making immigration great again as well. It provides a pathway for a modern, smarter immigration system while protecting those Americans struggling to make ends meet,” said Dan Stein, president of Federation for American Immigration Reform.

Roy Beck, president of NumbersUSA, added that the Cotton-Perdue bill will “do more than any other action to fulfill” Trump’s campaign pledges on immigration.

The legislation faces an uphill battle in the Senate, however, where it’s expected to get pushback from Democrats as well as GOP senators who oppose strict limits on legal immigration and want a broader reform effort that would address the roughly 11 million undocumented immigrants living in the U.S.

If Cotton and Perdue can get GOP leadership to bring the legislation up for a vote, supporters will need to cobble together 60 senators, including at least eight Democrats or independents, to agree to start debate on the legislation.

Sen. Lindsey Graham (R-S.C.) and a handful of Republicans — including GOP Sens. Jeff Flake (Ariz.), Lisa Murkowski (Alaska) and Dean Heller (Nev.) — have been working on bills this year to allow undocumented immigrants who entered the country as children to, at least temporarily, remain in the country legally.

Hundreds of thousands of undocumented immigrants have been granted temporary reprieves from deportation under the Obama-era Deferred Action for Childhood Arrivals program. But it does not confer legal status on immigrants.

Cotton and Perdue would need to win over their votes, as well as Sen. John McCain. The Arizona Republican, who is currently undergoing cancer treatment, was critical of their earlier bill.

The White House roll out could give the legislation a boost of momentum, but the earlier version of the Cotton-Perdue bill garnered zero cosponsors.

Critics of the measure say it would devastate families’ effort to reunite with their overseas relatives while providing few economic benefits.

“If this is an acknowledgement that our immigration system is broken, the Trump administration and these senators are right, but this is the wrong way to fix it,” said Ali Noorani, executive director of the National Immigration Forum. “Cutting legal immigration for the sake of cutting immigration would cause irreparable harm to the American worker and their family.”

“Congress should focus on stopping illegal immigration – not on restricting the legal immigration that grows our economy,” said John Feinblatt, president of the former New York City Mayor Michael Bloomberg-backed group New American Economy.

http://thehill.com/homenews/administration/344924-trump-gop-senators-unveil-measure-to-cut-legal-immigration

Sen. Cotton Officially Introduces RAISE Act

PUBLISHED:

Thu, FEB 16th 2017 @ 9:40am EST

Sen. Tom Cotton (R-Ark.) has officially introduced the Reforming American Immigration for Strong Employment (RAISE) Act, S. 354, in the Senate. The bill would reduce legal immigration by up to 50% by ending future chain migration and the diversity visa lottery.

Roy Beck, President and Founder of NumbersUSA responded saying, “the RAISE Act has a number — S. 354 — and one that we will do all possible to ensure that lives on through history as one of the great achievements of this period of our country.”

The RAISE Act would:

  • End the Visa Lottery
  • Limit annual refugee admissions to 50,000
  • End chain migration
  • Reduce the worldwide level of family-sponsored immigrants from 480,000 to 88,000 by prioritizing nuclear family
  • Add a nonimmigrant visa for parents of adult U.S. citizens (W-Visa)
    • 5-year renewable visa
    • No work authorization or ability to receive public benefits

The RAISE Act would reduce legal immigration to the United States by 50% in an effort to diminish its impact on vulnerable American workers. First, it eliminates the visa lottery and limits refugee admissions to 50,000 per year, removing the ability of the President to unilaterally adjust upward refugee admissions. Further, it eliminates chain migration by limiting family-sponsored immigration to the spouses and minor children of U.S. citizens and legal permanent residents.

While U.S. citizens maintain the ability to sponsor nuclear family members without numerical limitation, the worldwide level of family-sponsored immigration is reduced from 480,000 to 88,000 to account for the elimination of the extended-family categories. Finally, a new nonimmigrant visa category is created for parents of adult U.S. citizens. Under this new category, sponsored alien parents would receive a renewable 5-year visa, but must be financially independent or supported financially by the adult son or daughter, as the visa does not authorize the alien to work or receive any form of public benefit.

https://www.numbersusa.com/news/sen-cotton-officially-introduces-raise-act

 

 

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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

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Thank you from cartoonist A.F. Branco

Thank you for your conservative cartoons and many laughs.

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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: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |

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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

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

Judy Holliday – The Party’s Over

Judy Holliday The Party’s Over Lyrics

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

It’s time to wind up

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

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

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

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

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

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

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

I won’t vote to keep ObamaCare: Rand Paul

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

MARK LEVIN: Senate Health Care Bill Is 95% OBAMACARE

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

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

Republicans delay Senate health care vote

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

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

Milton Friedman – Collectivism

Milton Friedman on universal health care

Milton Friedman – The Social Security Myth

Milton Friedman – The Welfare Establishment

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

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

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

Milton Friedman – Why Tax Reform Is Impossible

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

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

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

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

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

Milton Friedman – Morality & Capitalism

Lacking enough GOP votes, Senate pushes back health bill

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

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

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

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

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

Republicans have one major problem on Obamacare

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

Is Obamacare Working? The Affordable Care Act Five Years Later

Why Are American Health Care Costs So High?

How Health Insurance Works

Senate postpones health care bill vote

Individual Health Insurance VS. Group Health Insurance

Published on Aug 14, 2009

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

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

Published on Aug 16, 2012

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

How Demented and Sick Our Republic Has Become By Design

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

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

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

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

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

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

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

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

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

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

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

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

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

What’s in the Senate Republican Health-Care Bill

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

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

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

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

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

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

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

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

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

Secrets reviewed “Rediscovering Americanism”last week and wrote:

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

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

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

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

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

Dems face identity crisis

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 June 25

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

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

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

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

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

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

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

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

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

Patient Protection and Affordable Care Act

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

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

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

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

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

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

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

Provisions

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

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

Individual insurance

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

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

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

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

Among the groups who remained uninsured were:

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

Subsidies

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

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

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

Mandates

Individual

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

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

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

Business

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

Excise taxes

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

Insurance standards

Essential health benefits

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

Contraceptives

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

Risk management

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

Risk corridor program

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

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

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

Temporary reinsurance

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

Risk adjustment

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

Other provisions

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

The ACA has several other provisions:

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

Exchanges

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

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

State waivers

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

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

Accountable Care Organizations

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

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

Others

Legislative history

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

Background

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

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

John Chafee

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

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

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

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

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

Healthcare debate, 2008–10

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

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

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

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

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

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

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

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

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

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

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

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

Senate

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

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

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

Senate vote by state.

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

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

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

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

House

House vote by congressional district.

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

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

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

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

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

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

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

Impact

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

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

Coverage

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

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

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

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

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

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

Insurance exchanges

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

Medicaid expansion

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

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

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

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

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

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

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

Healthcare insurance costs

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

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

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

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

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

Effect on deductibles and co-payments

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

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

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

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

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

Health outcomes

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

Federal deficit

CBO estimates of revenue and impact on deficit

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

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

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

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

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

Opinions on CBO projections

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

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

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

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

Economic consequences

CBO estimated in June 2015 that repealing the ACA would:

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

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

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

Employer mandate and part-time work

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

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

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

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

Hospitals

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

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

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

Public opinion

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

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

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

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

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

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

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

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

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

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

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

Political aspects

“Obamacare”

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

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

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

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

Common misconceptions

“Death panels”

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

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

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

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

Members of Congress

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

Illegal immigrants

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

Exchange “death spiral”

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

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

Opposition

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

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

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

Legal challenges

National Federation of Independent Business v. Sebelius

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

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

Contraception mandate

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

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

House v. Price

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

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

Non-cooperation

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

Repeal efforts

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

2017 House Budget

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

2013 federal government shutdown

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

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

2017 repeal effort

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

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

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

Implementation history

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

Existing individual health plans

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

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

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

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

2010

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

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

2011

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

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

2012

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

2013

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

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

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

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

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

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

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

2014

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

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

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

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

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

2015

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

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

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

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

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

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

2016

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

Employers

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

Insurers

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

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

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

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

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

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

Costs

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

Cooperatives

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

Medicaid

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

2017

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

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

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

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

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

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

See also

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

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

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

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

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

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Otto Warmbier has died, hospital says

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

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

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

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

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

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

Check back for more on this breaking story.

Sodium thiopental

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

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

Uses

Anesthesia

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

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

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

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

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

Medically induced coma

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

Status epilepticus

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

Euthanasia

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

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

Lethal injection

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

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

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

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

Truth serum

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

Psychiatry

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

Mechanism of action

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

Controversies

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

Metabolism

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

Dosage

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

Side effects

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

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

Contraindications

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

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

History

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

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

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

See also

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

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Communication channel between Washington and Moscow to be suspended immediately

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Tensions rise in Syria as Russia, Iran send US warnings

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

___

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

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

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The Pronk Pops Show 868, April 6, 2017, Story 1: Neoconservatives and Progressive Global Interventionists Elite Banging The War Drums For American Empire Warfare and Welfare State vs. We The People America First Non-interventionists For American Republic Peace and Prosperity Economy — American People Not Readily Accepting Big Lie Media Propaganda on Syria Chemical Gas Air Attack — Another False Flag — Sunni and Shia Have Being Killing Each Other For Hundreds of Years — Stop Being Imperial Umpire For A Religious Sectarian Civil War and Proxy War — National Interest — Oil and Gas — Videos

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Breaking News

Undeclared War!

President Trump Launches 59 Cruise Missile Attack From Two U.S. Destroyers Against Syrian Air Base 

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U.S. Launches Missiles at Syrian Base After Chemical Weapons Attack

The United States launched dozens of cruise missiles Thursday night at a Syrian airfield in response to what it believes was Syria’s use of banned chemical weapons that killed at least 100 people, U.S. military officials told NBC News.

Two U.S. warships in the Mediterranean Sea fired 59 Tomahawk missiles intended for a single target — Ash Sha’irat in Homs province in western Syria, the officials said. That’s the airfield from which the United States believes the government of Syrian President Bashar al-Assad fired the banned weapons.

There was no immediate word on casualties. U.S. officials told NBC News that people were not targeted and that aircraft and infrastructure at the site were hit, including the runway and gas fuel pumps.y

Trump Speaks on Missile Strike in Syria 2:48

“Assad choked out the lives of helpless men, women and children,” President Donald Trump said in remarks from Mar-a-Lago, his family compound in Palm Beach, Florida.

“It is in this vital national security interest of the United States to prevent and deter the spread and use of deadly chemical weapons,” said Trump, who called on other countries to end the bloodshed in Syria.

Related: Trump: Why I Launched a Missile Attack on Syria

Trump is in Florida for a meeting with Chinese President Xi Jinpeng. Defense Secretary James Mattis, Secretary of State Rex Tillerson and national security adviser H.R. McMaster traveled to Florida with him.

Defense Secretary James Mattis, Secretary of State Rex Tillerson and national security adviser H.R. McMaster traveled to Florida with Trump. In Washington, Vice President Mike Pence returned to the White House after having gone home for dinner Thursday evening.

Syrian television characterized the missile strike “as American aggression” Friday morning. But Ahrar Al Sham, the largest Syrian armed rebel group, told NBC News it “welcomes any U.S. intervention through surgical strikes that would deter the Assad regime capabilities to kill civilians and shorten the suffering of our people.”

Syria Crisis: Trump Given Military Options After Chemical Attack 2:25

Tillerson and Nikki Haley, the U.S. ambassador to the United Nations, have bluntly blamed Syria for the chemical weapons attack, whose victims included at least 25 children.

Tillerson told reporters on Thursday that “there is no doubt in our minds” that the Syrian regime was responsible for the attack. And in a combative speech at the U.N. Security Council on Wednesday, Haley warned: “When the United Nations consistently fails in its duty to act collectively, there are times in the life of states that we are compelled to take our own action.”y

Tillerson on Assad Regime: He Has ‘No Role’ to Govern Syria0:58

NBC News reported Thursday that Defense Secretary James Mattis briefed President Donald Trump on U.S. military options, which included carrying out targeted strikes against those responsible for Tuesday’s attack.

There was no immediate reaction from Russia, which Tillerson and Haley have accused of turning a blind eye to Syria’s transgressions.

“Russia cannot escape responsibility for this,” Haley said at the United Nations. “They chose to close their eyes to the barbarity. They defied the conscience of the world.”

Thursday, Tillerson urged Russia to “consider carefully their continued support of the Assad regime.”

Story 1: Progressive Global Interventionists Elite Banging The War Drums For American Empire Warfare and Welfare State vs. We The People America First Non-interventionists For American Republic Peace and Prosperity Economy — American People Not Readily Accepting Big Lie Media Propaganda on Syria Chemical Gas Air Attack — Another False Flag — Sunni and Shia Have Being Killing Each Other For Hundreds of Years — Stop Being Imperial Umpire For A Religious Sectarian Civil War — National Interest — Oil and Gas — Videos

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Just days after the US Administration changed course on Syrian President Assad, saying he could stay, an alleged chemical weapon attack that killed dozens of civilians has been blamed on the Syrian government. Did Assad sign his own death warrant with such an attack…or does some other entity benefit?

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Aftermath of Syrian chemical attack sparks outrage

World leaders condemn the Syrian chemical attack

Syria nerve gas attack: Chemical weapons expert debunks Assad’s defense

War in Syria: Russia and West clash over Idlib gas attack (part 1)

Published on Apr 5, 2017

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On Tuesday in Idlib, a province in the Northwest of Syria, at least seventy people were killed, 20 of them children, in what appears to have been a chemical weapon attack in the rebel-held town of Khan Sheikhoun. Initial reports point to the nerve agent Sarin gas. Our panel of experts asks who was behind this attack. What explanations are being given, and do they stack up?
Click here for PART TWO.

Another suspected chemical weapons attack is latest chapter in brutal Syrian conflict

‘Assad Has Unleashed Horror in Syria’: World Reacts to Alleged Chemical Attack

Syria Gas Attack: Russia says chemical depot held by rebels bombed

Turkish President Erdogan calls chemical attack in Syria “inhuman and unacceptable”

“The Desperate BBC Propaganda Machine Blames Assad For Chemical Attack Before Any Investigation.”

Russia denies involvement in reported Syrian chemical attack

Children caught in Syria ‘chemical attack’- BBC News

Published on Apr 5, 2017

The UN Security Council has held an emergency session to discuss the suspected gas attack on a rebel-held town in Syria. The attack is believed to have killed more than 70 people, including children. The Syrian government has denied responsibility, while its ally Russia says the gas came from rebel weapons on the ground. But those claims have been widely rejected by western governments, as our Chief International Correspondent Lyse Doucet reports.

Syria conflict: ‘Chemical attack’ in Idlib kills 58 – BBC News

Published on Apr 4, 2017

At least 58 people have been killed and dozens wounded in a suspected chemical attack on a rebel-held town in north-western Syria, a monitoring group says. The Syrian Observatory for Human Rights reported that strikes on Khan Sheikhoun by Syrian government or Russian jets had caused many people to choke. Later, aircraft fired rockets at local clinics treating some of the survivors, medics and opposition activists said. The Syrian government has repeatedly denied using chemical weapons.

UN Ambassador Nikki Haley Condemns Russia, Iran After Chemical Attack In Syria | NBC News

UK: Chemical Attack Bears All Hallmarks of Assad

UNSC holds emergency meeting on Syria chemical attack

WATCH LIVE: U.N. Security Council Holds Emergency Meeting On Syria Chemical Attack | TIME

The TRUTH About the Syria Gas Attack

Hillary in Rat Line for Syria False Flag Sarin Gas Attack says Pulitzer Prize Winning Journalist

Sy Hersh Reveals Potential Turkish Role in Syria Chemical Strike That Almost Sparked U.S. Bombing

Global Empire – The World According to Seymour Hersh [Part Two]

Published on Aug 10, 2016

Tariq Ali talks to investigative journalist, Seymour Hersh, about his revelations concerning the chemical attack at Ghouta, Syria in August 2013.

Seymour Hersh Exposes Erdogan’s Chemical Adventure in Syria

Published on Apr 8, 2014

The US author reveals secret US reports warning that Al-Nusrah terrorist group affiliated with Qatar and Turkey, posses a chemical weapons cell. Worst threat since 9/11.

Global Empire – The World According to Seymour Hersh [Part One]

Published on Aug 10, 2016

Tariq Ali talks to investigative journalist, Seymour Hersh, about the assassination of Osama bin Laden in Pakistan in 2011 and describes what the Americans and Pakistanis knew about his whereabouts.

Global Empire – Syria After Trump

Seymour Hersh: Obama “Cherry-Picked” Intelligence on Syrian Chemical Attack to Justify U.S. Strike

Published on Dec 9, 2013

Writing in the London Review of Books, Hersh argues that the Obama administration “cherry-picked intelligence to justify a strike against Assad.” The administration failed to disclose it knew Syrian rebels in the al-Nusra Front had the ability to produce chemical weapons. Evidence obtained in the days after the attack was also allegedly distorted to make it appear it was gathered in real time.

Whose sarin? Seymour M. Hersh
Barack Obama did not tell the whole story this autumn when he tried to make the case that Bashar al-Assad was responsible for the chemical weapons attack near Damascus on 21 August. In some instances, he omitted important intelligence, and in others he presented assumptions as facts. Most significant, he failed to acknowledge something known to the US intelligence community: that the Syrian army is not the only party in the country’s civil war with access to sarin, the nerve agent that a UN study concluded — without assessing responsibility — had been used in the rocket attack. In the months before the attack, the American intelligence agencies produced a series of highly classified reports, culminating in a formal Operations Order — a planning document that precedes a ground invasion — citing evidence that the al-Nusra Front, a jihadi group affiliated with al-Qaida, had mastered the mechanics of creating sarin and was capable of manufacturing it in quantity. When the attack occurred al-Nusra should have been a suspect, but the administration cherry-picked intelligence to justify a strike against Assad.

In his nationally televised speech about Syria on 10 September, Obama laid the blame for the nerve gas attack on the rebel-held suburb of Eastern Ghouta firmly on Assad’s government, and made it clear he was prepared to back up his earlier public warnings that any use of chemical weapons would cross a ‘red line’: ‘Assad’s government gassed to death over a thousand people,’ he said. ‘We know the Assad regime was responsible … And that is why, after careful deliberation, I determined that it is in the national security interests of the United States to respond to the Assad regime’s use of chemical weapons through a targeted military strike.’ Obama was going to war to back up a public threat, but he was doing so without knowing for sure who did what in the early morning of 21 August.

He cited a list of what appeared to be hard-won evidence of Assad’s culpability: ‘In the days leading up to August 21st, we know that Assad’s chemical weapons personnel prepared for an attack near an area where they mix sarin gas. They distributed gas masks to their troops. Then they fired rockets from a regime-controlled area into 11 neighbourhoods that the regime has been trying to wipe clear of opposition forces.’ Obama’s certainty was echoed at the time by Denis McDonough, his chief of staff, who told the New York Times: ‘No one with whom I’ve spoken doubts the intelligence’ directly linking Assad and his regime to the sarin attacks.

But in recent interviews with intelligence and military officers and consultants past and present, I found intense concern, and on occasion anger, over what was repeatedly seen as the deliberate manipulation of intelligence. One high-level intelligence officer, in an email to a colleague, called the administration’s assurances of Assad’s responsibility a ‘ruse’. The attack ‘was not the result of the current regime’, he wrote. A former senior intelligence official told me that the Obama administration had altered the available information — in terms of its timing and sequence — to enable the president and his advisers to make intelligence retrieved days after the attack look as if it had been picked up and analyzed in real time, as the attack was happening. The distortion, he said, reminded him of the 1964 Gulf of Tonkin incident, when the Johnson administration reversed the sequence of National Security Agency intercepts to justify one of the early bombings of North Vietnam. The same official said there was immense frustration inside the military and intelligence bureaucracy: ‘The guys are throwing their hands in the air and saying, “How can we help this guy” — Obama — “when he and his cronies in the White House make up the intelligence as they go along?”‘…()

Obama Was Lying!

President Obama’s Syria Address [FULL SPEECH]

Seymour Hersh’s Latest Bombshell: U.S. Military Undermined Obama on Syria with Tacit Help to Assad

Published on Dec 22, 2015

A new report by the Pulitzer-winning veteran journalist Seymour Hersh says the Joints Chiefs of Staff has indirectly supported Bashar al-Assad in an effort to help him defeat jihadist groups. Hersh reports the Joint Chiefs sent intelligence via Russia, Germany and Israel on the understanding it would be transmitted to help Assad push back Jabhat al-Nusra and the Islamic State. Hersh also claims the military even undermined a U.S. effort to arm Syrian rebels in a bid to prove it was serious about helping Assad fight their common enemies. Hersh says the Joints Chiefs’ maneuvering was rooted in several concerns, including the U.S. arming of unvetted Syrian rebels with jihadist ties, a belief the administration was overly focused on confronting Assad’s ally in Moscow, and anger the White House was unwilling to challenge Turkey and Saudi Arabia over their support of extremist groups in Syria. Hersh joins us to detail his claims and respond to his critics.

US, Russia Announce Syria Chemical Weapons Deal

U.S. Ship Begins Neutralizing Syrian Chemical Weapons

MV Cape Ray Storage Area Tour

MV Cape Ray Disposal Practice

MV Cape Ray FDHS

Published on Jul 2, 2014

As part of the U.N. Organization for the Prohibition of Chemical Weapons (OPCW) Joint Mission to eliminate chemical materials from the Syrian Arab Republic, the U.S. will destroy approximately 700 metric tons of chemicals aboard the MV Cape Ray. Danish and Norwegian vessels will transport the chemicals to a yet-unnamed Italian port for transfer to the MV Cape Ray. The MV Cape Ray, part of the U.S. Maritime Administration’s Ready Reserve Fleet, has been retrofitted with two field-deployable hydrolysis systems designed to neutralize the dangerous chemicals before disposal at a commercial facility.

MV Cape Ray’s Bridge

MV Cape Ray Command Post Tour

MV Cape Ray Laboratory Tour

False flag

From Wikipedia, the free encyclopedia
“False colors” redirects here. For the imaging technique, see False-color.

This US Douglas A-26 C Invader was painted in fake Cuban Air Force colors for the military invasion of Cuba undertaken by the CIA-sponsored paramilitary group Brigade 2506 in April 1961.

The contemporary term false flag describes covert operations that are designed to deceive in such a way that activities appear as though they are being carried out by entities, groups, or nations other than those who actually planned and executed them.[1]

Historically, the term “false flag” has its origins in naval warfare where the use of a flag other than the belligerent’s true battle flag before (but not while) engaging the enemy has long been accepted as a permissible ruse de guerre; by contrast, flying a false flag while engaging the enemy constitutes perfidy.[1]

Operations carried out during peace-time by civilian organizations, as well as covert government agencies, can (by extension) also be called false flag operations if they seek to hide the real organization behind an operation.[citation needed]

Use in warfare

In land warfare such operations are generally deemed acceptable in certain circumstances, such as to deceive enemies providing that the deception is not perfidious and all such deceptions are discarded before opening fire upon the enemy. Similarly in naval warfare such a deception is considered permissible provided the false flag is lowered and the true flag raised before engaging in battle:[2]auxiliary cruisers operated in such a fashion in both World Wars, as did Q-ships, while merchant vessels were encouraged to use false flags for protection.

Such masquerades promoted confusion not just of the enemy but of historical accounts: in 1914 the Battle of Trindade was fought between the British auxiliary cruiser RMS Carmania and the German auxiliary cruiser SMS Cap Trafalgar which had been altered to look like Carmania. (Contrary to some possibly mendacious accounts, the RMS Carmania had not been altered to resemble the Cap Trafalgar.)

Another notable example was the World War II German commerce raider Kormoran which surprised and sank the Australian light cruiser HMAS Sydney in 1941 while disguised as a Dutch merchant ship, causing the greatest recorded loss of life on an Australian warship. While Kormoran was fatally damaged in the engagement and its crew captured the outcome represented a considerable psychological victory for the Germans.[3]

Other examples from WWII included a Kriegsmarineensign in the St Nazaire Raid and captured a German code book: the old destroyer Campbeltown, which the British planned to sacrifice in the operation, was provided with cosmetic modifications that involved cutting the ship’s funnels and chamfering the edges to resemble a German Type 23torpedo boat.

By this ruse the British were able to get within two miles (3 km) of the harbour before the defences responded, where the explosive-rigged Campbeltown and commandos successfully disabled or destroyed the key dock structures of the port.[4][5]

Air warfare

In December 1922–February 1923, Rules concerning the Control of Wireless Telegraphy in Time of War and Air Warfare, drafted by a commission of jurists at the Hague regulates:[6]

Art. 3. A military aircraft must carry an exterior mark indicating its nationality and its military character.
Art. 19. The use of false exterior marks is forbidden.

This draft was never adopted as a legally binding treaty, but the ICRC states in its introduction on the draft that ‘To a great extent, [the draft rules] correspond to the customary rules and general principles underlying treaties on the law of war on land and at sea’,[7] and as such these two non–controversial articles were already part of customary law.[8]

Land warfare

In land warfare, the use of a false flag is similar to that of naval warfare: the trial of Otto Skorzeny, who planned and commanded Operation Greif, by a U.S. military tribunal at the Dachau Trials included a finding that Skorzeny was not guilty of a crime by ordering his men into action in American uniforms. He had relayed to his men the warning of German legal experts: that if they fought in American uniforms, they would be breaking the laws of war; however, they probably were not doing so simply by wearing the American uniforms. During the trial, a number of arguments were advanced to substantiate this position and the German and U.S. military seem to have been in agreement.

In the transcript of the trial,[9] it is mentioned that Paragraph 43 of the Field Manual published by the War Department, United States Army, on 1 October 1940, under the entry Rules of Land Warfare states “National flags, insignias and uniforms as a ruse – in practice it has been authorized to make use of these as a ruse. The foregoing rule (Article 23 of the Annex of the IVth Hague Convention), does not prohibit such use, but does prohibit their improper use. It is certainly forbidden to make use of them during a combat. Before opening fire upon the enemy, they must be discarded’.”

The American Soldiers’ Handbook was also quoted by Defense Counsel: “The use of the enemy flag, insignia, and uniform is permitted under some circumstances. They are not to be used during actual fighting, and if used in order to approach the enemy without drawing fire, should be thrown away or removed as soon as fighting begins.” Subsequently, the outcome of the trial has been codified in the 1977 Protocol Additional to the Geneva Conventions of 12 August 1949 (Protocol I):

Article 37. – Prohibition of perfidy

1. It is prohibited to kill, injure, or capture an adversary by resort to perfidy. Acts inviting the confidence of an adversary to lead him to believe that he is entitled to, or is obliged to accord, protection under the rules of international law applicable in armed conflict, with intent to betray that confidence, shall constitute perfidy. The following acts are examples of perfidy:
(a) The feigning of an intent to negotiate under a flag of truce or of a surrender;
(b) The feigning of an incapacitation by wounds or sickness;
(c) The feigning of civilian, non-combatant status; and
(d) The feigning of protected status by the use of signs, emblems or uniforms of the United Nations or of neutral or other States not Parties to the conflict.
2. Ruses of war are not prohibited. Such ruses are acts which are intended to mislead an adversary or to induce him to act recklessly but which infringe no rule of international law applicable in armed conflict and which are not perfidious because they do not invite the confidence of an adversary with respect to protection under that law. The following are examples of such ruses: the use of camouflage, decoys, mock operations and disinformation.

Article 38. – Recognized emblems

1. It is prohibited to make improper use of the distinctive emblem of the Red Cross, Red Crescent or Red Lion and Sun or of other emblems, signs or signals provided for by the Conventions or by this Protocol. It is also prohibited to misuse deliberately in an armed conflict other internationally recognized protective emblems, signs or signals, including the flag of truce, and the protective emblem of cultural property.
2. It is prohibited to make use of the distinctive emblem of the United Nations, except as authorized by that Organization.

Article 39. – Emblems of nationality

1. It is prohibited to make use in an armed conflict of the flags or military emblems, insignia or uniforms of neutral or other States not Parties to the conflict.
2. It is prohibited to make use of the flags or military emblems, insignia or uniforms of adverse Parties while engaging in attacks or in order to shield, favour, protect or impede military operations.
3. Nothing in this Article or in Article 37, paragraph 1 ( d ), shall affect the existing generally recognized rules of international law applicable to espionage or to the use of flags in the conduct of armed conflict at sea.

Cyber warfare

A false flag in the cyber domain is slightly different and easier to perpetrate than in other physical theaters of war. Cyber false flags refer to tactics used in covert cyber attacks by a perpetrator to deceive or misguide attribution attempts including the attacker’s origin, identity, movement, and/or code/exploitation. This misdirection tactic can cause misattribution (permitting response and/or counterattack as a condiciosine qua non under international law) or misperception which can lead to retaliation against the wrong adversary.

Cyber false flags can exist in the cyber domain when:

  1. Weaponized cyber exploits use recycled code/variants from previous attacks;
  2. Exploits are developed to mimic the scope and complexity of other malware;
  3. Exploits are procured rather than developed;
  4. Exploits are executed from new/unknown operator command servers;
  5. Malware calls out to or connects to known operator command servers;
  6. The action or attack is outsourced;
  7. The compromise is socially engineered to misguide investigations towards other operators;
  8. The audit trail or lack thereof conceals actual intent or actions with other exploits designed to mislead investigators.

As pretexts for war

Russo-Swedish War

In 1788, the head tailor at the Royal Swedish Opera received an order to sew a number of Russian military uniforms. These were then used by the Swedes to stage an attack on Puumala, a Swedish outpost on the Russo-Swedish border, on 27 June 1788. This caused an outrage in Stockholm and impressed the Riksdag of the Estates, the Swedish national assembly, who until then had refused to agree to an offensive war against Russia. The Puumala incident allowed King Gustav III of Sweden, who lacked the constitutional authority to initiate unprovoked hostilities without the Estates’ consent, to launch the Russo-Swedish War (1788–1790).[10]

Second Sino-Japanese War

Japanese experts inspect the scene of the ‘railway sabotage’ on South Manchurian Railway

In September 1931, Japanese officers fabricated a pretext for invading Manchuria by blowing up a section of railway. Though the explosion was too weak to disrupt operations on the rail line, the Japanese nevertheless used this Mukden incident to seize Manchuria and create a puppet government for what they termed the “independent” state of Manchukuo.[11]

World War II

Gleiwitz incident

Alfred Naujocks

The Gleiwitz incident in 1939 involved Reinhard Heydrich fabricating evidence of a Polish attack against Germany to mobilize German public opinion for war and to justify the war with Poland. Alfred Naujocks was a key organiser of the operation under orders from Heydrich. It led to the deaths of Nazi concentration camp victims who were dressed as German soldiers and then shot by the Gestapo to make it seem that they had been shot by Polish soldiers. This, along with other false flag operations in Operation Himmler, would be used to mobilize support from the German population for the start of World War II in Europe.[12]

The operation failed to convince international public opinion of the German claims, and both Britain and France—Poland’s allies—declared war two days after Germany invaded Poland.[13]

Winter War

On November 26, 1939, the Soviet armyshelled Mainila, a Russian village near the Finnish border. Soviet authorities blamed Finland for the attack and used the incident as a pretext to invade Finland, starting the Winter War, four days later.[14]

Cuban Revolution

Operation Northwoods

Operation Northwoods memorandum (13 March 1962)[15]

The proposed, but never executed, 1962 Operation Northwoods plot by the U.S. Department of Defense for a war with Cuba involved scenarios such as fabricating the hijacking or shooting down of passenger and military planes, sinking a U.S. ship in the vicinity of Cuba, burning crops, sinking a boat filled with Cuban refugees, attacks by alleged Cuban infiltrators inside the United States, and harassment of U.S. aircraft and shipping and the destruction of aerial drones by aircraft disguised as Cuban MiGs.[16] These actions would be blamed on Cuba, and would be a pretext for an invasion of Cuba and the overthrow of Fidel Castro‘s communist government. It was authored by the Joint Chiefs of Staff, but then rejected by President John F. Kennedy. The surprise discovery of the documents relating to Operation Northwoods was a result of the comprehensive search for records related to the assassination of President John F. Kennedy by the Assassination Records Review Board in the mid-1990s.[17] Information about Operation Northwoods was later publicized by James Bamford.[18]

As a tactic to undermine political opponents

Reichstag fire

Main article: Reichstag fire

The Reichstag fire was an arson attack on the Reichstag building in Berlin on 27 February 1933. The fire started in the Session Chamber,[19] and, by the time the police and firemen arrived, the main Chamber of Deputies was engulfed in flames. Police searched the building and found Marinus van der Lubbe, a young Dutchcouncil communist and unemployed bricklayer, who had recently arrived in Germany to carry out political activities.[citation needed]

The fire was used as evidence by the Nazis that the Communists were beginning a plot against the German government. Van der Lubbe and four Communist leaders were subsequently arrested. Adolf Hitler, who was sworn in as Chancellor of Germany four weeks before, on 30 January, urged President Paul von Hindenburg to pass an emergency decree to counter the “ruthless confrontation of the Communist Party of Germany“.[20] With civil liberties suspended, the government instituted mass arrests of Communists, including all of the Communist parliamentary delegates. With their bitter rival Communists gone and their seats empty, the National Socialist German Workers Party went from being a plurality party to the majority; subsequent elections confirmed this position and thus allowed Hitler to consolidate his power.[citation needed]

Historians disagree as to whether Van der Lubbe acted alone, as he said, to protest the condition of the German working class, or whether the arson was planned and ordered by the Nazis, then dominant in the government themselves, as a false flag operation.[21][22]

Project TP-Ajax

On 4 April 1953, the CIA was ordered to undermine the government of Iran over a four-month period, as a precursor to overthrowing Prime Minister Mohammad Mosaddegh.[23] One tactic used to undermine Mosaddegh was to carry out false flag attacks “on mosques and key public figures”, to be blamed on Iranian communists loyal to the government.[23]

The CIA project was code-named TP-Ajax, and the tactic of a “directed campaign of bombings by Iranians posing as members of the Communist party”,[24] involved the bombing of “at least” one well known Muslim’s house by CIA agents posing as Communists.[24] The CIA determined that the tactic of false flag attacks added to the “positive outcome” of Project TPAJAX.[23]

However, as “the C.I.A. burned nearly all of its files on its role in the 1953 coup in Iran”, the true extent of the tactic has been difficult for historians to discern.[25]

Pseudo-operations

Pseudo-operations are those in which forces of one power disguise themselves as enemy forces. For example, a state power may disguise teams of operatives as insurgents and, with the aid of defectors, infiltrate insurgent areas.[26] The aim of such pseudo-operations may be to gather short or long-term intelligence or to engage in active operations, in particularassassinations of important enemies. However, they usually involve both, as the risks of exposure rapidly increase with time and intelligence gathering eventually leads to violent confrontation. Pseudo-operations may be directed by military or police forces, or both. Police forces are usually best suited to intelligence tasks; however, military provide the structure needed to back up such pseudo-ops with military response forces. According to US military expert Lawrence Cline (2005), “the teams typically have been controlled by police services, but this largely was due to the weaknesses in the respective military intelligence systems.”[citation needed]

Charlemagne Péralte of Haiti was assassinated in 1919, after checkpoints were passed by military disguised as guerrilla fighters.

The State Political Directorate (OGPU) of the Soviet Union set up such an operation from 1921 to 1926. During Operation Trust, they used loose networks of White Army supporters and extended them, creating the pseudo-“Monarchist Union of Central Russia” (MUCR) in order to help the OGPU identify real monarchists and anti-Bolsheviks.[citation needed]

An example of a successful assassination was United States MarineSergeantHerman H. Hanneken leading a patrol of his HaitianGendarmerie disguised as enemy guerrillas in 1919. The Patrol successfully passed several enemy checkpoints in order to assassinate the guerilla leader Charlemagne Péralte near Grande-Rivière-du-Nord. Hanneken was awarded the Medal of Honor and was commissioned a Second Lieutenant for his deed.[citation needed]

During the Mau Mau uprising in the 1950s, captured Mau Mau members who switched sides and specially trained British troops initiated the pseudo-gang concept to successfully counter Mau Mau. In 1960 Frank Kitson, (who was later involved in the Northern Irish conflict and is now a retired British General), published Gangs and Counter-gangs, an account of his experiences with the technique in Kenya; information included how to counter gangs and measures of deception, including the use of defectors, which brought the issue a wider audience.[citation needed]

Another example of combined police and military oversight of pseudo-operations include the Selous Scouts in the former country Rhodesia (now Zimbabwe), governed by white minority rule until 1980. The Selous Scouts were formed at the beginning of Operation Hurricane, in November 1973, by Major (later Lieutenant Colonel) Ronald Reid-Daly. As with all Special Forces in Rhodesia, by 1977 they were controlled by COMOPS (Commander, Combined Operations) Commander Lieutenant General Peter Walls. The Selous Scouts were originally composed of 120 members, with all officers being white and the highest rank initially available for black soldiers being colour sergeant. They succeeded in turning approximately 800 insurgents who were then paid by Special Branch, ultimately reaching the number of 1,500 members. Engaging mainly in long-range reconnaissance and surveillance missions, they increasingly turned to offensive actions, including the attempted assassination of Zimbabwe People’s Revolutionary Army leader Joshua Nkomo in Zambia. This mission was finally aborted by the Selous Scouts, and attempted again, unsuccessfully, by the Rhodesian Special Air Service.[27]

Some offensive operations attracted international condemnation, in particular the Selous Scouts’ raid on a Zimbabwe African National Liberation Army (ZANLA) camp at Nyadzonya Pungwe, Mozambique in August 1976. ZANLA was then led by Josiah Tongogara. Using Rhodesian trucks and armored cars disguised as Mozambique military vehicles, 84 scouts killed 1,284 people in the camp-the camp was registered as a refugee camp by the United Nations (UN). Even according to Reid-Daly, most of those killed were unarmed guerrillas standing in formation for a parade. The camp hospital was also set ablaze by the rounds fired by the Scouts, killing all patients.[28] According to David Martin and Phyllis Johnson, who visited the camp shortly before the raid, it was only a refugee camp that did not host any guerrillas. It was staged for UN approval.[29]

According to a 1978 study by the Directorate of Military Intelligence, 68% of all insurgent deaths inside Rhodesia could be attributed to the Selous Scouts, who were disbanded in 1980.[30]

If the action is a police action, then these tactics would fall within the laws of the state initiating the pseudo, but if such actions are taken in a civil war or during a belligerent military occupation then those who participate in such actions would not be privileged belligerents. The principle of plausible deniability is usually applied for pseudo-teams. (See the above section Laws of war). Some false flag operations have been described by Lawrence E. Cline, a retired US Army intelligence officer, as pseudo-operations, or “the use of organized teams which are disguised as guerrilla groups for long- or short-term penetration of insurgent-controlled areas.”[citation needed]

Pseudo Operations should be distinguished, notes Cline, from the more common police or intelligence infiltration of guerrilla or criminal organizations. In the latter case, infiltration is normally done by individuals. Pseudo teams, on the other hand, are formed as needed from organized units, usually military or paramilitary. The use of pseudo teams has been a hallmark of a number of foreign counterinsurgency campaigns.”[26]

Similar false flag tactics were also employed during the Algerian civil war, starting in the middle of 1994. Death squads composed of Département du Renseignement et de la Sécurité (DRS) security forces disguised themselves as Islamist terrorists and committed false flag terror attacks. Such groups included the Organisation of Young Free Algerians (OJAL) or the Secret Organisation for the Safeguard of the Algerian Republic (OSSRA)[31] According to Roger Faligot and Pascal Kropp (1999), the OJAL was reminiscent of “the Organization of the French Algerian Resistance (ORAF), a group of counter-terrorists created in December 1956 by the Direction de la surveillance du territoire (Territorial Surveillance Directorate, or DST) whose mission was to carry out terrorist attacks with the aim of quashing any hopes of political compromise”.[32]

Espionage

Main article: False flag penetrator

In espionage the term “false flag” describes the recruiting of agents by operatives posing as representatives of a cause the prospective agents are sympathetic to, or even the agents’ own government. For example, during the Cold War, several female West German civil servants were tricked into stealing classified documents by agents of the East GermanStasi intelligence service, pretending to be members of West German peace advocacy groups (the Stasi agents were also described as “Romeos,” indicating that they also used their sex appeal to manipulate their targets, making this operation a combination of the false flag and “honey trap” techniques).[33]

The technique can also be used to expose enemy agents in one’s own service, by having someone approach the suspect and pose as an agent of the enemy. Earl Edwin Pitts, a 13-year veteran of the U.S. Federal Bureau of Investigation and an attorney, was caught when he was approached by FBI agents posing as Russian agents.[citation needed]

British intelligence officials in World War II allowed double agents to fire-bomb a power station and a food dump in the UK to protect their cover, according to declassified documents. The documents stated the agents took precautions to ensure they did not cause serious damage. One of the documents released also stated: “It should be recognised that friends as well as enemies must be completely deceived.”[34]

Civilian usage

While false flag operations originate in warfare and government, they also can occur in civilian settings among certain factions, such as businesses, special interest groups, religions, political ideologies and campaigns for office.[citation needed]

Businesses

In business and marketing, similar operations are being employed in some public relations campaigns (see Astroturfing). Telemarketing firms practice false flag type behavior when they pretend to be a market research firm (referred to as “sugging“). In some rare cases, members of an unsuccessful business will destroy some of their own property to conceal an unrelated crime (e.g., safety violations, embezzlement) but make it appear as though the destruction was done by a rival company.[citation needed]

Political campaigning

Political campaigning has a long history of this tactic in various forms, including in person, print media and electronically in recent years. This can involve when supporters of one candidate pose as supporters of another, or act as “straw men” for their preferred candidate to debate against. This can happen with or without the candidate’s knowledge. The Canuck letter is an example of one candidate creating a false document and attributing it as coming from another candidate in order to discredit that candidate.[citation needed]

In the final days of Florida’s 1994 gubernatorial campaign, Democratic Governor Lawton Chiles ran a false flag operation that paid for tens of thousands of calls to elderly voters using false organization names. The calls purported to be from Republican groups and told voters that Jeb Bush was against Social Security and seniors. Chiles denied his campaign was behind the calls. After winning re-election and facing an investigation, Chiles admitted the truth in November 1995.[35]

In 2006, individuals practicing false flag behavior were discovered and “outed” in New Hampshire[36][37] and New Jersey[38] after blog comments claiming to be from supporters of a political candidate were traced to the IP address of paid staffers for that candidate’s opponent.

On 19 February 2011, Indiana Deputy Prosecutor Carlos Lam sent a private email to Wisconsin Governor Scott Walker suggesting that he run a “‘false flag’ operation” to counter the protests against Walker’s proposed restrictions on public employees’ collective bargaining rights:

If you could employ an associate who pretends to be sympathetic to the unions’ cause to physically attack you (or even use a firearm against you), you could discredit the unions … Employing a false flag operation would assist in undercutting any support that the media may be creating in favor of the unions.[39][40]

The press had acquired a court order to access all of Walker’s emails and Lam’s email was exposed. At first, Lam vehemently denied it, but eventually admitted it and resigned.[40]

Ideological

A bomb threat forged by Scientology operatives.

Proponents of political or religious ideologies will sometimes use false flag tactics. This can be done to discredit or implicate rival groups, create the appearance of enemies when none exist, or create the illusion of organized and directed persecution. This can be used to gain attention and sympathy from outsiders, in particular the media, or to convince others within the group that their beliefs are under attack and in need of protection.

In retaliation for writing The Scandal of Scientology, some members of the Church of Scientology stole stationery from author Paulette Cooper‘s home and then used that stationery to forge bomb threats and have them mailed to a Scientology office. The Guardian’s Office also had a plan for further operations to discredit Cooper known as Operation Freakout, but several Scientology operatives were arrested in a separate investigation and the plan was exposed.[41]

See also

Concepts

Examples

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

42 FALSE-FLAG ATTACKS OFFICIALY ADMITTED TO

Mirrored from Washington’s Blog (due to their server being swamped)

Presidents, Prime Ministers, Congressmen, Generals, Spooks, Soldiers and Police ADMIT to False Flag Terror

In the following instances, officials in the government which carried out the attack (or seriously proposed an attack) admit to it, either orally, in writing, or through photographs or videos:

(1) Japanese troops set off a small explosion on a train track in 1931, and falsely blamed it on China in order to justify an invasion of Manchuria. This is known as the “Mukden Incident” or the “Manchurian Incident”. The Tokyo International Military Tribunal found: “Several of the participators in the plan, including Hashimoto [a high-ranking Japanese army officer], have on various occasions admitted their part in the plot and have stated that the object of the ‘Incident’ was to afford an excuse for the occupation of Manchuria by the Kwantung Army ….” And see this.

(2) A major with the Nazi SS admitted at the Nuremberg trials that – under orders from the chief of the Gestapo – he and some other Nazi operatives faked attacks on their own people and resources which they blamed on the Poles, to justify the invasion of Poland.

(3) Nazi general Franz Halder also testified at the Nuremberg trials that Nazi leader Hermann Goering admitted to setting fire to the German parliament building in 1933, and then falsely blaming the communists for the arson.

(4) Soviet leader Nikita Khrushchev admitted in writing that the Soviet Union’s Red Army shelled the Russian village of Mainila in 1939 – while blaming the attack on Finland – as a basis for launching the “Winter War” against Finland. Russian president Boris Yeltsin agreed that Russia had been the aggressor in the Winter War.

(5) The Russian Parliament, current Russian president Putin and former Soviet leader Gorbachev all admit that Soviet leader Joseph Stalin ordered his secret police to execute 22,000 Polish army officers and civilians in 1940, and then falsely blamed it on the Nazis.

(6) The British government admits that – between 1946 and 1948 – it bombed 5 ships carrying Jews attempting to flee the Holocaust to seek safety in Palestine, set up a fake group called “Defenders of Arab Palestine”, and then had the psuedo-group falsely claim responsibility for the bombings (and see this, this and this).

(7) Israel admits that in 1954, an Israeli terrorist cell operating in Egypt planted bombs in several buildings, including U.S. diplomatic facilities, then left behind “evidence” implicating the Arabs as the culprits (one of the bombs detonated prematurely, allowing the Egyptians to identify the bombers, and several of the Israelis later confessed) (and see this and this).

(8) The CIA admits that it hired Iranians in the 1950’s to pose as Communists and stage bombings in Iran in order to turn the country against its democratically-elected prime minister.

(9) The Turkish Prime Minister admitted that the Turkish government carried out the 1955 bombing on a Turkish consulate in Greece – also damaging the nearby birthplace of the founder of modern Turkey – and blamed it on Greece, for the purpose of inciting and justifying anti-Greek violence.

(10) The British Prime Minister admitted to his defense secretary that he and American president Dwight Eisenhower approved a plan in 1957 to carry out attacks in Syria and blame it on the Syrian government as a way to effect regime change.

(11) The former Italian Prime Minister, an Italian judge, and the former head of Italian counterintelligence admit that NATO, with the help of the Pentagon and CIA, carried out terror bombings in Italy and other European countries in the 1950s and blamed the communists, in order to rally people’s support for their governments in Europe in their fight against communism. As one participant in this formerly-secret program stated: “You had to attack civilians, people, women, children, innocent people, unknown people far removed from any political game. The reason was quite simple. They were supposed to force these people, the Italian public, to turn to the state to ask for greater security” (and see this) (Italy and other European countries subject to the terror campaign had joined NATO before the bombings occurred). And watch this BBC special. They also allegedly carried out terror attacks in France, Belgium, Denmark, Germany, Greece, the Netherlands, Norway, Portugal, the UK, and other countries.

False flag attacks carried out pursuant to this program include – by way of example only:

(12) In 1960, American Senator George Smathers suggested that the U.S. launch “a false attack made on Guantanamo Bay which would give us the excuse of actually fomenting a fight which would then give us the excuse to go in and [overthrow Castro]”.

(13) Official State Department documents show that, in 1961, the head of the Joint Chiefs and other high-level officials discussed blowing up a consulate in the Dominican Republic in order to justify an invasion of that country. The plans were not carried out, but they were all discussed as serious proposals.

(14) As admitted by the U.S. government, recently declassified documents show that in 1962, the American Joint Chiefs of Staff signed off on a plan to blow up AMERICAN airplanes (using an elaborate plan involving the switching of airplanes), and also to commit terrorist acts on American soil, and then to blame it on the Cubans in order to justify an invasion of Cuba. See the following ABC news report; the official documents; and watch this interview with the former Washington Investigative Producer for ABC’s World News Tonight with Peter Jennings.

(15) In 1963, the U.S. Department of Defense wrote a paper promoting attacks on nations within the Organization of American States – such as Trinidad-Tobago or Jamaica – and then falsely blaming them on Cuba.

(16) The U.S. Department of Defense even suggested covertly paying a person in the Castro government to attack the United States: “The only area remaining for consideration then would be to bribe one of Castro’s subordinate commanders to initiate an attack on Guantanamo.”

(17) The NSA admits that it lied about what really happened in the Gulf of Tonkin incident in 1964 … manipulating data to make it look like North Vietnamese boats fired on a U.S. ship so as to create a false justification for the Vietnam war.

(18) A U.S. Congressional committee admitted that – as part of its “Cointelpro” campaign – the FBI had used many provocateurs in the 1950s through 1970s to carry out violent acts and falsely blame them on political activists.

(19) A top Turkish general admitted that Turkish forces burned down a mosque on Cyprus in the 1970s and blamed it on their enemy. He explained: “In Special War, certain acts of sabotage are staged and blamed on the enemy to increase public resistance. We did this on Cyprus; we even burnt down a mosque.” In response to the surprised correspondent’s incredulous look the general said, “I am giving an example”.

(20) A declassified 1973 CIA document reveals a program to train foreign police and troops on how to make booby traps, pretending that they were training them on how to investigate terrorist acts:

The Agency maintains liaison in varying degrees with foreign police/security organizations through its field stations ….

[CIA provides training sessions as follows:]

a. Providing trainees with basic knowledge in the uses of commercial and military demolitions and incendiaries as they may be applied in terrorism and industrial sabotage operations.

b. Introducing the trainees to commercially available materials and home laboratory techniques, likely to he used in the manufacture of explosives and incendiaries by terrorists or saboteurs.

c. Familiarizing the trainees with the concept of target analysis and operational planning that a saboteur or terrorist must employ.

d. Introducing the trainees to booby trapping devices and techniques giving practical experience with both manufactured and improvised devices through actual fabrication.

***

The program provides the trainees with ample opportunity to develop basic familiarity and use proficiently through handling, preparing and applying the various explosive charges, incendiary agents, terrorist devices and sabotage techniques.

(21) The German government admitted (and see this) that, in 1978, the German secret service detonated a bomb in the outer wall of a prison and planted “escape tools” on a prisoner – a member of the Red Army Faction – which the secret service wished to frame the bombing on.

(22) A Mossad agent admits that, in 1984, Mossad planted a radio transmitter in Gaddaffi’s compound in Tripoli, Libya which broadcast fake terrorist trasmissions recorded by Mossad, in order to frame Gaddaffi as a terrorist supporter. Ronald Reagan bombed Libya immediately thereafter.

(23) The South African Truth and Reconciliation Council found that, in 1989, the Civil Cooperation Bureau (a covert branch of the South African Defense Force) approached an explosives expert and asked him “to participate in an operation aimed at discrediting the ANC [the African National Congress] by bombing the police vehicle of the investigating officer into the murder incident”, thus framing the ANC for the bombing.

(24) An Algerian diplomat and several officers in the Algerian army admit that, in the 1990s, the Algerian army frequently massacred Algerian civilians and then blamed Islamic militants for the killings (and see this video; and Agence France-Presse, 9/27/2002, French Court Dismisses Algerian Defamation Suit Against Author).

(25) The United States Army’s 1994 publication Special Forces Foreign Internal Defense Tactics Techniques and Procedures for Special Forces – updated in 2004 – recommends employing terrorists and using false flag operations to destabilize leftist regimes in Latin America. False flag terrorist attacks were carried out in Latin America and other regions as part of the CIA’s “Dirty Wars“. And see this.

(26) Similarly, a CIA “psychological operations” manual prepared by a CIA contractor for the Nicaraguan Contra rebels noted the value of assassinating someone on your own side to create a “martyr” for the cause. The manual was authenticated by the U.S. government. The manual received so much publicity from Associated Press, Washington Post and other news coverage that – during the 1984 presidential debate – President Reagan was confronted with the following question on national television:

At this moment, we are confronted with the extraordinary story of a CIA guerrilla manual for the anti-Sandinista contras whom we are backing, which advocates not only assassinations of Sandinistas but the hiring of criminals to assassinate the guerrillas we are supporting in order to create martyrs.

(27) An Indonesian fact-finding team investigated violent riots which occurred in 1998, and determined that “elements of the military had been involved in the riots, some of which were deliberately provoked“.

(28) Senior Russian Senior military and intelligence officers admit that the KGB blew up Russian apartment buildings in 1999 and falsely blamed it on Chechens, in order to justify an invasion of Chechnya (and see this report and this discussion).

(29) As reported by BBC, the New York Times, and Associated Press, Macedonian officials admit that the government murdered 7 innocent immigrants in cold blood and pretended that they were Al Qaeda soldiers attempting to assassinate Macedonian police, in order to join the “war on terror”.

(30)  At the July 2001 G8 Summit in Genoa, Italy, black-clad thugs were videotaped getting out of police cars, and were seen by an Italian MP carrying “iron bars inside the police station”.  Subsequently, senior police officials in Genoa subsequently  admitted that police planted two Molotov cocktails and faked the stabbing of a police officer at the G8 Summit, in order to justify a violent crackdown against protesters.

(31) The U.S. falsely blamed Iraq for playing a role in the 9/11 attacks – as shown by a memo from the defense secretary – as one of the main justifications for launching the Iraq war. Even after the 9/11 Commission admitted that there was no connection, Dick Cheney said that the evidence is “overwhelming” that al Qaeda had a relationship with Saddam Hussein’s regime, that Cheney “probably” had information unavailable to the Commission, and that the media was not ‘doing their homework’ in reporting such ties. Top U.S. government officials now admit that the Iraq war was really launched for oil … not 9/11 or weapons of mass destruction. Despite previous “lone wolf” claims, many U.S. government officials now say that 9/11 was state-sponsored terror; but Iraq was not the state which backed the hijackers. (Many U.S. officials have alleged that 9/11 was a false flag operation by rogue elements of the U.S. government; but such a claim is beyond the scope of this discussion. The key point is that the U.S. falsely blamed it on Iraq, when it knew Iraq had nothing to do with it.).

(32) Although the FBI now admits that the 2001 anthrax attacks were carried out by one or more U.S. government scientists, a senior FBI official says that the FBI was actually told to blame the Anthrax attacks on Al Qaeda by White House officials (remember what the anthrax letters looked like). Government officials also confirm that the white House tried to link the anthrax to Iraq as a justification for regime change in that country.

(33) According to the Washington Post, Indonesian police admit that the Indonesian military killed American teachers in Papua in 2002 and blamed the murders on a Papuan separatist group in order to get that group listed as a terrorist organization.

(34) The well-respected former Indonesian president also admits that the government probably had a role in the Bali bombings.

(35) Police outside of a 2003 European Union summit in Greece were filmed planting Molotov cocktails on a peaceful protester

(36) Former Department of Justice lawyer John Yoo suggested in 2005 that the US should go on the offensive against al-Qaeda, having “our intelligence agencies create a false terrorist organization. It could have its own websites, recruitment centers, training camps, and fundraising operations. It could launchfake terrorist operations and claim credit for real terrorist strikes, helping to sow confusion within al-Qaeda’s ranks, causing operatives to doubt others’ identities and to question the validity of communications.”

(37) Similarly, in 2005, Professor John Arquilla of the Naval Postgraduate School – a renowned US defense analyst credited with developing the concept of ‘netwar’ – called for western intelligence services to create new “pseudo gang” terrorist groups, as a way of undermining “real” terror networks. According to Pulitzer-Prize winning journalist Seymour Hersh, Arquilla’s ‘pseudo-gang’ strategy was, Hersh reported, already being implemented by the Pentagon:

“Under Rumsfeld’s new approach, I was told, US military operatives would be permitted to pose abroad as corrupt foreign businessmen seeking to buy contraband items that could be used in nuclear-weapons systems. In some cases, according to the Pentagon advisers, local citizens could be recruited and asked to join up with guerrillas or terrorists

The new rules will enable the Special Forces community to set up what it calls ‘action teams’ in the target countries overseas which can be used to find and eliminate terrorist organizations. ‘Do you remember the right-wing execution squads in El Salvador?’ the former high-level intelligence official asked me, referring to the military-led gangs that committed atrocities in the early nineteen-eighties. ‘We founded them and we financed them,’ he said. ‘The objective now is to recruit locals in any area we want. And we aren’t going to tell Congress about it.’ A former military officer, who has knowledge of the Pentagon’s commando capabilities, said, ‘We’re going to be riding with the bad boys.'”

(38) United Press International reported in June 2005:

U.S. intelligence officers are reporting that some of the insurgents in Iraq are using recent-model Beretta 92 pistols, but the pistols seem to have had their serial numbers erased. The numbers do not appear to have been physically removed; the pistols seem to have come off a production line without any serial numbers. Analysts suggest the lack of serial numbers indicates that the weapons were intended for intelligence operations or terrorist cells with substantial government backing. Analysts speculate that these guns are probably from either Mossad or the CIA. Analysts speculate that agent provocateurs may be using the untraceable weapons even as U.S. authorities use insurgent attacks against civilians as evidence of the illegitimacy of the resistance.

(39) Undercover Israeli soldiers admitted in 2005 to throwing stones at other Israeli soldiers so they could blame it on Palestinians, as an excuse to crack down on peaceful protests by the Palestinians.

(40) Quebec police admitted that, in 2007, thugs carrying rocks to a peaceful protest were actually undercover Quebec police officers (and see this).

(41) A 2008 US Army special operations field manual recommends that the U.S. military use surrogate non-state groups such as “paramilitary forces, individuals, businesses, foreign political organizations, resistant or insurgent organizations, expatriates, transnational terrorism adversaries, disillusioned transnational terrorism members, black marketers, and other social or political ‘undesirables.'” The manual specifically acknowledged that U.S. special operations can involve both counterterrorism and “Terrorism” (as well as “transnational criminal activities, including narco-trafficking, illicit arms-dealing, and illegal financial transactions.”)

(42)  The former head of Secret Services and Head of State of Italy (Francesco Cossiga) advised the 2008 minister in charge of the police, on how to deal with protests from teachers and students:

He should do what I did when I was Minister of the Interior … infiltrate the movement with agents provocateurs inclined to do anything …. And after that, with the strength of the gained population consent,  … beat them for blood and beat for blood also those teachers that incite them. Especially the teachers. Not the elderly, of course, but the girl teachers yes.

(43) At the G20 protests in London in 2009, a British member of parliament saw plain clothes police officers attempting to incite the crowd to violence.

(44) Egyptian politicians admitted (and see this) that government employees looted priceless museum artifacts in 2011 to try to discredit the protesters.

(45) Rioters who discredited the peaceful protests against the swearing in of the Mexican president in 2012 admitted that they were paid 300 pesos each to destroy everything in their path. According to Wikipedia, photos also show the vandals waiting in groups behind police lines prior to the violence.

(46) A Colombian army colonel has admitted that his unit murdered 57 civilians, then dressed them in uniforms and claimed they were rebels killed in combat.

(47) On November 20, 2014, Mexican agent provocateurs were transported by army vehicles to participate in the 2014 Iguala mass kidnapping protests, as was shown by videos and pictures distributed via social networks.

(48) The highly-respected writer for the Telegraph Ambrose Evans-Pritchard says that the head of Saudi intelligence – Prince Bandar – recently admitted that the Saudi government controls “Chechen” terrorists.

(49) High-level American sources admitted that the Turkish government – a fellow NATO country – carried out the chemical weapons attacks blamed on the Syrian government; and high-ranking Turkish government admitted on tape plans to carry out attacks and blame it on the Syrian government.

(50) The Ukrainian security chief admits that the sniper attacks which started the Ukrainian coup were carried out in order to frame others. Ukrainian officials admit that the Ukrainian snipers fired on both sides, to create maximum chaos.

(51) Britain’s spy agency has admitted (and see this) that it carries out “digital false flag” attacks on targets, framing people by writing offensive or unlawful material … and blaming it on the target.

(52) U.S. soldiers have admitted that if they kill innocent Iraqis and Afghanis, they then “drop” automatic weapons near their body so they can pretend they were militants

(53) Similarly, police frame innocent people for crimes they didn’t commit. The practice is so well-known that the New York Times noted in 1981:

In police jargon, a throwdown is a weapon planted on a victim.

Newsweek reported in 1999:

Perez, himself a former [Los Angeles Police Department] cop, was caught stealing eight pounds of cocaine from police evidence lockers. After pleading guilty in September, he bargained for a lighter sentence by telling an appalling story of attempted murder and a “throwdown”-police slang for a weapon planted by cops to make a shooting legally justifiable. Perez said he and his partner, Officer Nino Durden, shot an unarmed 18th Street Gang member named Javier Ovando, then planted a semiautomatic rifle on the unconscious suspect and claimed that Ovando had tried to shoot them during a stakeout.

Wikipedia notes:

As part of his plea bargain, Perez implicated scores of officers from the Rampart Division’s anti-gang unit, describing routinely beating gang members, planting evidence on suspects, falsifying reports and covering up unprovoked shootings.

(As a side note – and while not technically false flag attacks – police have been busted framing innocent people in many other ways, as well.)

(54) A former U.S. intelligence officer recently alleged:

Most terrorists are false flag terrorists or are created by our own security services.

(55) The head and special agent in charge of the FBI’s Los Angeles office said that most terror attacks are committed by the CIA and FBI as false flags.  Similarly, the director of the National Security Agency under Ronald Reagan – Lt. General William Odom said:

By any measure the US has long used terrorism. In ’78-79 the Senate was trying to pass a law against international terrorism – in every version they produced, the lawyers said the US would be in violation.

(audio here).

(56) Leaders throughout history have acknowledged the “benefits” of of false flags to justify their political agenda:

Terrorism is the best political weapon for nothing drives people harder than a fear of sudden death”.
– Adolph Hitler

“Why of course the people don’t want war … But after all it is the leaders of the country who determine the policy, and it is always a simple matter to drag the people along, whether it is a democracy, or a fascist dictatorship, or a parliament, or a communist dictatorship … Voice or no voice, the people can always be brought to the bidding of the leaders. That is easy. All you have to do is to tell them they are being attacked, and denounce the pacifists for lack of patriotism and exposing the country to danger. It works the same in any country.”
– Hermann Goering, Nazi leader.

“The easiest way to gain control of a population is to carry out acts of terror. [The public] will clamor for such laws if their personal security is threatened”.
– Josef Stalin

Postscript: Private parties – such as NBC News, as well as Muslims, Jews, Scientologists, African-Americans and Neo-Nazis – play this game as well.

www.whatreallyhappened.comhttp://www.whatreallyhappened.com/WRHARTICLES/42falseflags.php#ixzz4dVI2Q7La

The Red Line and the Rat Line

Seymour M. Hersh on Obama, Erdoğan and the Syrian rebels

In 2011 Barack Obama led an allied military intervention in Libya without consulting the US Congress. Last August, after the sarin attack on the Damascus suburb of Ghouta, he was ready to launch an allied air strike, this time to punish the Syrian government for allegedly crossing the ‘red line’ he had set in 2012 on the use of chemical weapons.Then with less than two days to go before the planned strike, he announced that he would seek congressional approval for the intervention. The strike was postponed as Congress prepared for hearings, and subsequently cancelled when Obama accepted Assad’s offer to relinquish his chemical arsenal in a deal brokered by Russia. Why did Obama delay and then relent on Syria when he was not shy about rushing into Libya? The answer lies in a clash between those in the administration who were committed to enforcing the red line, and military leaders who thought that going to war was both unjustified and potentially disastrous.

Obama’s change of mind had its origins at Porton Down, the defence laboratory in Wiltshire. British intelligence had obtained a sample of the sarin used in the 21 August attack and analysis demonstrated that the gas used didn’t match the batches known to exist in the Syrian army’s chemical weapons arsenal. The message that the case against Syria wouldn’t hold up was quickly relayed to the US joint chiefs of staff. The British report heightened doubts inside the Pentagon; the joint chiefs were already preparing to warn Obama that his plans for a far-reaching bomb and missile attack on Syria’s infrastructure could lead to a wider war in the Middle East. As a consequence the American officers delivered a last-minute caution to the president, which, in their view, eventually led to his cancelling the attack.

For months there had been acute concern among senior military leaders and the intelligence community about the role in the war of Syria’s neighbours, especially Turkey. Prime Minister Recep Erdoğan was known to be supporting the al-Nusra Front, a jihadist faction among the rebel opposition, as well as other Islamist rebel groups. ‘We knew there were some in the Turkish government,’ a former senior US intelligence official, who has access to current intelligence, told me, ‘who believed they could get Assad’s nuts in a vice by dabbling with a sarin attack inside Syria – and forcing Obama to make good on his red line threat.’

The joint chiefs also knew that the Obama administration’s public claims that only the Syrian army had access to sarin were wrong. The American and British intelligence communities had been aware since the spring of 2013 that some rebel units in Syria were developing chemical weapons. On 20 June analysts for the US Defense Intelligence Agency issued a highly classified five-page ‘talking points’ briefing for the DIA’s deputy director, David Shedd, which stated that al-Nusra maintained a sarin production cell: its programme, the paper said, was ‘the most advanced sarin plot since al-Qaida’s pre-9/11 effort’. (According to a Defense Department consultant, US intelligence has long known that al-Qaida experimented with chemical weapons, and has a video of one of its gas experiments with dogs.) The DIA paper went on: ‘Previous IC [intelligence community] focus had been almost entirely on Syrian CW [chemical weapons] stockpiles; now we see ANF attempting to make its own CW … Al-Nusrah Front’s relative freedom of operation within Syria leads us to assess the group’s CW aspirations will be difficult to disrupt in the future.’ The paper drew on classified intelligence from numerous agencies: ‘Turkey and Saudi-based chemical facilitators,’ it said, ‘were attempting to obtain sarin precursors in bulk, tens of kilograms, likely for the anticipated large scale production effort in Syria.’ (Asked about the DIA paper, a spokesperson for the director of national intelligence said: ‘No such paper was ever requested or produced by intelligence community analysts.’)

Last May, more than ten members of the al-Nusra Front were arrested in southern Turkey with what local police told the press were two kilograms of sarin. In a 130-page indictment the group was accused of attempting to purchase fuses, piping for the construction of mortars, and chemical precursors for sarin. Five of those arrested were freed after a brief detention. The others, including the ringleader, Haytham Qassab, for whom the prosecutor requested a prison sentence of 25 years, were released pending trial. In the meantime the Turkish press has been rife with speculation that the Erdoğan administration has been covering up the extent of its involvement with the rebels. In a news conference last summer, Aydin Sezgin, Turkey’s ambassador to Moscow, dismissed the arrests and claimed to reporters that the recovered ‘sarin’ was merely ‘anti-freeze’.

The DIA paper took the arrests as evidence that al-Nusra was expanding its access to chemical weapons. It said Qassab had ‘self-identified’ as a member of al-Nusra, and that he was directly connected to Abd-al-Ghani, the ‘ANF emir for military manufacturing’. Qassab and his associate Khalid Ousta worked with Halit Unalkaya, an employee of a Turkish firm called Zirve Export, who provided ‘price quotes for bulk quantities of sarin precursors’. Abd-al-Ghani’s plan was for two associates to ‘perfect a process for making sarin, then go to Syria to train others to begin large scale production at an unidentified lab in Syria’. The DIA paper said that one of his operatives had purchased a precursor on the ‘Baghdad chemical market’, which ‘has supported at least seven CW efforts since 2004’.

A series of chemical weapon attacks in March and April 2013 was investigated over the next few months by a special UN mission to Syria. A person with close knowledge of the UN’s activity in Syria told me that there was evidence linking the Syrian opposition to the first gas attack, on 19 March in Khan Al-Assal, a village near Aleppo. In its final report in December, the mission said that at least 19 civilians and one Syrian soldier were among the fatalities, along with scores of injured. It had no mandate to assign responsibility for the attack, but the person with knowledge of the UN’s activities said: ‘Investigators interviewed the people who were there, including the doctors who treated the victims. It was clear that the rebels used the gas. It did not come out in public because no one wanted to know.’

In the months before the attacks began, a former senior Defense Department official told me, the DIA was circulating a daily classified report known as SYRUP on all intelligence related to the Syrian conflict, including material on chemical weapons. But in the spring, distribution of the part of the report concerning chemical weapons was severely curtailed on the orders of Denis McDonough, the White House chief of staff. ‘Something was in there that triggered a shit fit by McDonough,’ the former Defense Department official said. ‘One day it was a huge deal, and then, after the March and April sarin attacks’ – he snapped his fingers – ‘it’s no longer there.’ The decision to restrict distribution was made as the joint chiefs ordered intensive contingency planning for a possible ground invasion of Syria whose primary objective would be the elimination of chemical weapons.

In the aftermath of the 21 August attack Obama ordered the Pentagon to draw up targets for bombing. Early in the process, the former intelligence official said, ‘the White House rejected 35 target sets provided by the joint chiefs of staff as being insufficiently “painful” to the Assad regime.’ The original targets included only military sites and nothing by way of civilian infrastructure. Under White House pressure, the US attack plan evolved into ‘a monster strike’: two wings of B-52 bombers were shifted to airbases close to Syria, and navy submarines and ships equipped with Tomahawk missiles were deployed. ‘Every day the target list was getting longer,’ the former intelligence official told me. ‘The Pentagon planners said we can’t use only Tomahawks to strike at Syria’s missile sites because their warheads are buried too far below ground, so the two B-52 air wings with two-thousand pound bombs were assigned to the mission. Then we’ll need standby search-and-rescue teams to recover downed pilots and drones for target selection. It became huge.’ The new target list was meant to ‘completely eradicate any military capabilities Assad had’, the former intelligence official said. The core targets included electric power grids, oil and gas depots, all known logistic and weapons depots, all known command and control facilities, and all known military and intelligence buildings.

Britain and France were both to play a part. On 29 August, the day Parliament voted against Cameron’s bid to join the intervention, the Guardian reported that he had already ordered six RAF Typhoon fighter jets to be deployed to Cyprus, and had volunteered a submarine capable of launching Tomahawk missiles. The French air force – a crucial player in the 2011 strikes on Libya – was deeply committed, according to an account in Le Nouvel Observateur; François Hollande had ordered several Rafale fighter-bombers to join the American assault. Their targets were reported to be in western Syria.

By the last days of August the president had given the Joint Chiefs a fixed deadline for the launch. ‘H hour was to begin no later than Monday morning [2 September], a massive assault to neutralise Assad,’ the former intelligence official said. So it was a surprise to many when during a speech in the White House Rose Garden on 31 August Obama said that the attack would be put on hold, and he would turn to Congress and put it to a vote.

At this stage, Obama’s premise – that only the Syrian army was capable of deploying sarin – was unravelling. Within a few days of the 21 August attack, the former intelligence official told me, Russian military intelligence operatives had recovered samples of the chemical agent from Ghouta. They analysed it and passed it on to British military intelligence; this was the material sent to Porton Down. (A spokesperson for Porton Down said: ‘Many of the samples analysed in the UK tested positive for the nerve agent sarin.’ MI6 said that it doesn’t comment on intelligence matters.)

The former intelligence official said the Russian who delivered the sample to the UK was ‘a good source – someone with access, knowledge and a record of being trustworthy’. After the first reported uses of chemical weapons in Syria last year, American and allied intelligence agencies ‘made an effort to find the answer as to what if anything, was used – and its source’, the former intelligence official said. ‘We use data exchanged as part of the Chemical Weapons Convention. The DIA’s baseline consisted of knowing the composition of each batch of Soviet-manufactured chemical weapons. But we didn’t know which batches the Assad government currently had in its arsenal. Within days of the Damascus incident we asked a source in the Syrian government to give us a list of the batches the government currently had. This is why we could confirm the difference so quickly.’

The process hadn’t worked as smoothly in the spring, the former intelligence official said, because the studies done by Western intelligence ‘were inconclusive as to the type of gas it was. The word “sarin” didn’t come up. There was a great deal of discussion about this, but since no one could conclude what gas it was, you could not say that Assad had crossed the president’s red line.’ By 21 August, the former intelligence official went on, ‘the Syrian opposition clearly had learned from this and announced that “sarin” from the Syrian army had been used, before any analysis could be made, and the press and White House jumped at it. Since it now was sarin, “It had to be Assad.”’

The UK defence staff who relayed the Porton Down findings to the joint chiefs were sending the Americans a message, the former intelligence official said: ‘We’re being set up here.’ (This account made sense of a terse message a senior official in the CIA sent in late August: ‘It was not the result of the current regime. UK & US know this.’) By then the attack was a few days away and American, British and French planes, ships and submarines were at the ready.

The officer ultimately responsible for the planning and execution of the attack was General Martin Dempsey, chairman of the joint chiefs. From the beginning of the crisis, the former intelligence official said, the joint chiefs had been sceptical of the administration’s argument that it had the facts to back up its belief in Assad’s guilt. They pressed the DIA and other agencies for more substantial evidence. ‘There was no way they thought Syria would use nerve gas at that stage, because Assad was winning the war,’ the former intelligence official said. Dempsey had irritated many in the Obama administration by repeatedly warning Congress over the summer of the danger of American military involvement in Syria. Last April, after an optimistic assessment of rebel progress by the secretary of state, John Kerry, in front of the House Foreign Affairs Committee, Dempsey told the Senate Armed Services Committee that ‘there’s a risk that this conflict has become stalemated.’

Dempsey’s initial view after 21 August was that a US strike on Syria – under the assumption that the Assad government was responsible for the sarin attack – would be a military blunder, the former intelligence official said. The Porton Down report cause