Obamacare

Calling Balls and Strikes in the Supreme Court

Supreme Court Chief Justice John Roberts is unequivocally conservative, but as only the 17th chief justice in US history and after 16 years as chief justice, Roberts is in a position to tip the high court in either direction on highly partisan cases such as extreme gerrymandering, the citizenship question on the Census and, once more, on the constitutionality of Obamacare. (Photo Credit: Doug Mills/The New York Times)

Supreme Court Chief Justice John Roberts is unequivocally conservative, but as only the 17th chief justice in US history and after 16 years as chief justice, Roberts is in a position to tip the high court in either direction on highly partisan cases such as extreme gerrymandering, the citizenship question on the Census and, once more, on the constitutionality of Obamacare. (Photo Credit: Doug Mills/The New York Times)

Congress may be deadlocked, but the conservative slant of the US Supreme Court is undeniable with a distinctly conservative chief justice and four ready followers.

Yet, Chief Justice John Roberts, only the 17th chief justice in the history of the country, remains an enigmatic, even secretive figure who broke the hearts of conservatives in 2016 by confirming Obamacare was constitutional. Now, the court he oversees will be faced with deciding seminally partisan cases involving political gerrymandering that could test his ideological leanings. Oral arguments in the cases were made on Tuesday.

The cases involve extreme gerrymandering by Republicans in North Carolina and Democrats in Maryland that good-government advocates are opposing, with electoral results in the pivotal 2020 election in the balance. Both cases, experts say, will test Roberts to see if he is more ideologue than institutionalist. 

Without a lot of fanfare, Roberts has served as chief justice for 16 years. At just 64, he could serve for in his role for another 20 years.

Coincidentally, a biography of Roberts has just been published that confirms advocates from both the political left and right are wary of him, despite his privileged upbringing and a clearly conservative record on voting rights, affirmative action, campaign contributions, abortion rights and same-sex marriage. 

Joan Biskupic, in her biography The Chief: The Life and Turbulent Times of Chief Justice John Roberts, describes him as the son of a steel company executive and product of an upper-class, all-white suburban Catholic prep school education. Roberts then went to Harvard for his undergraduate and law school degrees.

As an attorney, Roberts argued 39 cases before the Supreme Court before his nomination by President George W. Bush to succeed retiring Justice Sandra Day O’Connor. When Chief Justice William Rehnquist died before his confirmation, Bush upgraded Roberts’ nomination to chief justice. In his confirmation hearing, Roberts compared the role of judges to baseball umpires who calls balls and strikes. 

Now, the chief justice, who also doubles as the adult-in-the-room swing vote on the court, must decide on a pair of mirror cases that reflect unvarnished political gerrymandering. He also will deal with a case involving the citizenship question on the 2020 US Census, which also pits GOP ideology against a clear violation of the federal Administrative Procedure Act.

Biskupic thinks these cases could expose a side of Roberts often overlooked – his eagerness to avoid civil division. Citing Roberts’ vote in the Obamacare ruling, she says: “Viewed only through a judicial lens, [Roberts’] moves were not consistent, and his legal arguments were not entirely coherent. But he brought people and their different interests together. His moves may have been good for the country at a time of division and a real crisis in health care, even as they engendered, in the years since, anger, confusion and distrust.”

Roberts has shown a willingness to cross swords with his conservative soul mates, such as when he admonished President Trump for trashing a federal court judge. However, conservatives will expect Roberts to stay at his ideological home on seminal cases involving raw politics. The question is whether Roberts will stick to his ideological roots or, in cases involving partisan issues, perform like his proverbial umpire calling balls and strikes.

 

Republicans Hold Their Breath; Democrats Keep Debating Themselves

The 2018 midterm election is just six months away, with congressional Republicans eager to defend their record in the face of unpredictable Trump tweets and Democrats still groping for the right mix of messages that will move America.

The 2018 midterm election is just six months away, with congressional Republicans eager to defend their record in the face of unpredictable Trump tweets and Democrats still groping for the right mix of messages that will move America.

With the pivotal 2018 midterm elections less than six months away, it is timely to assess likely Republican and Democratic campaign themes. They aren’t exactly obvious. And neither is the election outcome, which could be a blue wave or red dawn.

The one sure thing is that Republican candidates will be tethered to President Trump, whether they like it or not. His zig-zags on trade, immigration and diplomacy will vex GOP incumbents and hopefuls, especially in Farm and Rust Belt states. Trump’s doubling-down on culture war issues will buoy social conservatives and complicate campaigns for Republicans running in swing districts or blue states.

Democrats appear to be still arguing over their 2018 themes. Do they run against Trump and tout the prospect of his impeachment? Or do they focus on bread-and-butter issues such as health care, income security and retooling job training? And what about the ongoing Russia investigation?

Senate Majority Leader Mitch McConnell told NPR last week congressional Republicans should run on their record. “This is the best year and a half for right-of-center policies since I've been here,” he said. “Everything from tax relief, to repealing the individual mandate to 15 uses of the Congressional Review Act. We mentioned the courts, comprehensive tax reform.”

In the same interview, McConnell admitted the GOP faces a stiff wind to hold on to one or both houses of Congress. That’s largely because of the shadow cast by the Robert Mueller investigation into Russian meddling in the 2016 election, potential Trump campaign collusion with Kremlin-connected Russians and presidential obstruction of justice. The failure to reach a deal on immigration – from an expanded border wall to protections for DREAMers who were brought to the United States illegally by their parents, but have grown up in America. Then there is Trump going off message, even on the issue of the importance of the 2018 mid-term elections. 

Democrats are torn by deep divisions, which have clouded their 2018 campaign messaging and eroded what once was a commanding leaded over Republicans. The progressive wing of the Democratic Party wants the campaign to center on new initiatives such as universal health care insurance, a federal jobs guarantee, tougher enforcement of anti-trust regulations and allowing the US Post Office to enter the consumer lending business. Center-left Democrats worry that isn’t the political chemistry to turn red states into blue ones. In early-state contested primaries, progressive candidates seem to be carrying the day, but the question remains whether they can win in November.

If Democrats have an ace up their sleeve, it is the number of women running for office.

If Democrats weren’t confused enough, conservative commentators have egged them on, with political cracks about House Speaker Nancy Pelosi and identity politics.

The gang at FiveThirtyEight conducted an online chat about midterm election themes. Micah Cohen, the politics editor, put government corruption and Trump’s behavior at the top of his list and downplayed trade, the economy, education, Social Security and the Russian investigation. Nate Silver, the creator and editor of FiveThirtyEight, said Democrats should concentrate on health care, the Russian investigation and gun control because they are tangible issues. Senior political writer Claire Malone recommended centering on Trump administration corruption, ethical lapses and rollbacks of environmental and consumer protection.

Polling continues to show that Trump’s political base remains solid, even though there are some cracks beginning to appear among college-educated women and disaffected union workers. The same is true on the Democratic side, which has been energized by Trump policies and congressional attempts to repeal Obamacare. Republicans need to hold on to their moderates while Democrats need to hold on to their progressives. Both parties need to appeal to unaffiliated voters who think the country isn’t moving in the right direction and GOP control of all the levers of federal power hasn’t moved in the country in the right direction.

While the national stakes in the election are clear – control of the House and Senate, most congressional elections tend to boil down to local issues and candidates. But national politics does play a role. Texas Senator Ted Cruz’ role in a federal government shutdown earned him an unusually well-funded Democratic opponent. Democratic Senator Jon Tester of Montana is facing a stiff re-election test in the face of criticism by Trump on Tester’s role in blocking his nominee to head the Veterans Administration. If Trump can pull off a verifiable deal to denuclearize North Korea, that could sway voters in the fall.

Only 48 out of 435 House seats are regarded as competitive by political experts. To regain control of the House, Democrats need to flip 25 GOP seats and not lose any of their incumbents. Democrats will likely concentrate on the 25 House districts that gave majorities to Hillary Clinton in 2016, but are held by Republicans. A 25-seat switch in the midterm election following a presidential election is not uncommon historically.

Democratic chances to regain control of the Senate, which the GOP holds by a slim 51-49 margin, are complicated because they have far more incumbents to defends. Democratic hopes go out the window if they lose seats they hold now in West Virginia, Indiana, Missouri and Montana. Their best hopes to gain seats are in Nevada, Arizona, North Dakota and Tennessee,

Meanwhile, congressional Republican candidates will be holding their breath about the next Trump tweetstorm and Democrats will continue debating how to approach the American electorate as a preferred alternative to GOP control. For Republicans, six months can be like infinity. For Democrats, six months can go by in a blink of the eye.

 

Hurricane Harvey Blows DC Political Winds in New Direction

Devastation caused by Hurricane Harvey has shifted the political winds in Washington, DC to focus on funding relief efforts, which may provide the political cover for Congress to raise the debt ceiling and allow more time to come up with a spending bill before the new fiscal year begins October 1.

Devastation caused by Hurricane Harvey has shifted the political winds in Washington, DC to focus on funding relief efforts, which may provide the political cover for Congress to raise the debt ceiling and allow more time to come up with a spending bill before the new fiscal year begins October 1.

Hurricane Harvey tore into Texas and its winds continued to blow all the way to Washington, DC.

Congress returns to town Tuesday and now topping its list of to-dos is passage of legislation to add billions more in funding to the Federal Emergency Management Agency to cover soaring costs to build after the ravages of one of history’s worst hurricanes in Texas.

President Trump has called for $7.9 billion in increased funding, even though Texas Governor Greg Abbott predicts it will require as much as $180 billion to recover what was lost or damaged in Houston, Corpus Christie, Beaumont and other Southeast Texas communities.

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The increased funding comes as Congress must find a way to approve legislation raising the US debt ceiling and a funding measure to keep the federal government’s doors open when the new fiscal year begins October 1. Those already prickly political issues were complicated when Trump said he was willing to accept a government shutdown to get a down payment on funding of his border wall.

Congress is already under a tight deadline to raise the debt ceiling and approve a FY 2018 spending measure and now also must deal with funding Hurricane Harvey relief, legislation to maintain the so-called Dreamers program and possibly increased expenditures to fight a war with North Korea.

Congress is already under a tight deadline to raise the debt ceiling and approve a FY 2018 spending measure and now also must deal with funding Hurricane Harvey relief, legislation to maintain the so-called Dreamers program and possibly increased expenditures to fight a war with North Korea.

Trump seems to have backed off the border wall threat under the cover of pressing for immediate relief funding to hard-hit Texas and parts of Louisiana, which he visited twice since the hurricane made landfall August 25.

Even though there is no direct connection between increased FEMA funding and raising the debt ceiling, which reflects past federal spending, hurricane victim relief may give GOP congressional leaders the leverage they need to push through both measures without a lot of political infighting, especially from the conservative wing of the Republican Party. Both Texas senators, who have bona fide conservative credentials, have expressed support for more FEMA funding. Relief aid would be touted by Trump and other politicians as a significant legislative achievement.

If that happened, there would be would more space – and perhaps legislative days – for what are expected to be intense political negotiations over spending for the next fiscal year. The Trump administration has called for massive budget cuts in many federal agencies – including FEMA, but those cuts may not have much political traction, even among many Republicans.

Instead, GOP leaders may try to raise the stakes for congressional Democrats by threatening to cut back on spending for health care for children to gain political concessions on revisions to the Affordable Care Act and possibly other political objectives. There are bipartisan Capitol Hill discussions occurring on ways to repair, as opposed to repeal, Obamacare, which could become part of the budget conversation.

Congressional spending decisions rarely follow a straight line and the hard negotiating never occurs in public view. While budget negotiators may ignore Trump’s budget outline, there are less likely to dismiss the President’s push for major tax cuts. While there also is willingness and even preliminary discussion of a bipartisan tax reform measure, agreement is virtually impossible before the end of September when some kind of a spending bill must pass. That suggests Congress will resort once again to some kind of continuing resolution, perhaps to the end of the year, to allow more time for the tax issue to ferment – and the hurricane relief bill to grow.

All that is murky enough political water, but it will get murkier. Trump will announce his decision to roll back the Obama-era decision to grant work permits to the children of undocumented immigrants, possibly with a 6-month delay to give Congress a chance to act. While a number of states have threatened to sue if the so-called Dreamers program isn’t scrapped, many GOP congressional leaders, including Speaker Paul Ryan, have expressed support for legislation that would maintain the program.

The other wild card that could blow up budget talks is the heightening war of words between the United States and North Korea over its nuclear weapon capability. Diplomatic options seem to be dwindling and some kind of military action is becoming more probable, despite predictions of enormous collateral damage. At a minimum, the United States would need to reinforce its manpower levels in Asia. There are reports military units already have been put on notice. As we learned in Iraq and Afghanistan – and earlier in Vietnam, fighting on the ground and dropping bombs from the sky is budget-busting expensive.

It is hard to imagine how the political situation in Washington, DC could get much worse. Well, its name is Irma and it may be heading to Florida coast later this week.

Schrader Offers Democratic Plan to Repair Obamacare

Oregon Congressman Kurt Schrader and nine other House Democrats offered what they called “real, concrete solutions” to cracks in Obamacare’s individual market health insurance. The plan won’t go anywhere until it’s clear whether Senate Republicans have enough votes to pass their own Obamacare replacement bill, with a vote expected next week.

Oregon Congressman Kurt Schrader and nine other House Democrats offered what they called “real, concrete solutions” to cracks in Obamacare’s individual market health insurance. The plan won’t go anywhere until it’s clear whether Senate Republicans have enough votes to pass their own Obamacare replacement bill, with a vote expected next week.

Led by Oregon Congressman Kurt Schrader, 10 House Democrats have floated a plan to fix Obamacare as Senate Republicans prepare to vote on a revamped alternative that still slashes Medicaid spending by $700 billion.

Schrader said the House Democratic plan proposes “real, concrete solutions that will stabilize and improve the individual market, making Obamacare work better for everyone and getting us closer to universal coverage for all Americans.”

One of the key elements in the Schrader proposal is a $15 billion annual reinsurance fund to pay health insurers that enroll higher-cost, sicker individuals. Obamacare contained a similar reinsurance fund from 2014-2016. The concept is to ease the cost burden for insurers of expensive care for some patients so average premiums for participants in the individual market can be lowered.

Other features include continuation of payments to insurers that offer discounts to low-income patients, changing the enrollment period from November to May to coincide with when taxpayers receive income tax refunds and expanding tax credits for buying insurance based on age, geography and income. The plan calls for robust marketing of health plans with subsidies and drawing bidding areas that provide more competition for underserved rural areas.

"Although we’ve made progress, Members of Congress have to acknowledge that too many Americans still struggle with costs, especially people in the individual market," Schrader said.

Schrader and his colleagues also would allow people nearing retirement age the option to buy into Medicare coverage and permit younger adults to purchase catastrophic health plans that include primary care coverage with anticipated lower premiums.

Oregon Senator Ron Wyden urged a bipartisan approach to stabilize the individual health insurance market. He also encouraged steps to lower prescription drug costs, such as allowing Medicare to negotiate drug prices with pharmaceutical companies.

The first inklings of Democratic willingness to work on cracks in Obamacare came after Senate Majority Leader Mitch McConnell indicated that if a GOP alternative fails to pass, the only avenue left is a bipartisan approach. President Trump and political conservatives have said failing to repeal and replace Obamacare would break a longstanding Republican promise. Kentucky GOP Senator Rand Paul has announced he will oppose the GOP health care bill because it doesn’t go far enough toward repealing Obamacare provisions.

Meanwhile, GOP moderates are worried about the impact of large cuts to Medicaid on elderly and disabled Americans, who consume the largest amount of Medicaid funding. In the revised version of the Senate health care bill, more money is set aside to combat the national opioid crisis in a play to win over some wavering Senate moderates, but it still might not be enough.

Maine Senator Susan Collins, one of the moderates unconvinced by the redrafted plan, pointed out there is a $70 billion math error. The Better Care Reconciliation Act includes an amendment by Texas Senator Ted Cruz that would allow bare-bones health plans also provides $70 billion in federal support for health insurers. Except the $70 billion Cruz would use for this purpose is already allocated in the bill. Tim Jost, a health care law expert and professor at Washington and Lee University, told MSNBC that the bill “gives an additional $70 billion to the states and then the Cruz amendment gives it to insurers that offer compliant plans in addition to noncompliant plans.”

Congressional Republicans are using the budget reconciliation process to replace Obamacare because this procedural is not subject to Senate filibuster rules. But the 52-member Senate GOP majority is thin and only can afford to lose two members to pass its health care legislation. Senate Minority Leader Chuck Schumer has said Democrats would work with Republicans if they dropped the reconciliation process. According to The Hill, some Republican senators, including Lindsey Graham, have entertained informal conversations with Democrats about a bipartisan legislative approach.

The GOP-backed American Health Care Act passed the House earlier this year with a narrow 2-vote margin. The changes under consideration in the Senate, including retaining two taxes imposed by Obamacare, might erode that margin and make a reconsideration vote in the House uncertain. House Minority Leader Nancy Pelosi has not offered to work with Republicans on Obamacare-related legislation. Pelosi did say the Schrader-led proposal offer “promising ideas to put solutions over politics to strengthen the Affordable Care Act and continue to lower costs for seniors and hard-working families.”

Senate Delays August Recess as Another Russian Collusion Shoe Drops

A bustling beginning on Capitol Hill after the July 4 break, including a 2-week delay of the next recess, was overshadowed by yet another shoe dropping in the Trump-Russian collusion matter that involved someone in President Trump’s immediate family.

A bustling beginning on Capitol Hill after the July 4 break, including a 2-week delay of the next recess, was overshadowed by yet another shoe dropping in the Trump-Russian collusion matter that involved someone in President Trump’s immediate family.

The Senate will delay its August recess, the shape of a revamped GOP health care bill was released and Republicans said they would include funding for President Trump’s border wall in the Fiscal Year 2018 budget. And another shoe dropped on the ongoing story of Trump team collusion with Russians in the 2016 presidential election.

It was quite a beginning to a week after Members of Congress returned from their July 4 break.

Senate Majority Leader Mitch McConnell announced the senatorial August recess would be delayed until the third week of the month to allow time to consider legislation to repeal and replace Obamacare and confirm presidential nominees. The lack of major legislative victories prompted several members of the Senate GOP caucus to urge McConnell to shrink the month-long August recess.

The Republican bill to replace Obamacare will be released later this week and, according to McConnell, voted on next week. However, its basic outline surfaced today. Senior Republicans said the Medicaid cuts in the earlier version would remain. What’s different will be retaining at least two of Obamacare’s taxes – the 3.8 percent investment tax and 0.9 percent Medicare surtax on upper-income earners – to boost the amount available by $230 billion for tax credits to push down premium costs – and woo wavering Republican colleagues.

They also said an alternative version pushed by Texas Senator Ted Cruz, which would allow insurers to sell bare-bones policies, could be an amendment that is considered. Neither the emerging GOP health care plan or the Cruz amendment will have scoring from the Congressional Budget Office until early next week.

At least two Republican senators – Alaska’s Lisa Murkowski and Maine’s Susan Collins – gave reactions to the media that didn’t sound like they had been convinced by the changes in the bill. If McConnell loses another Republican vote, the bill can’t pass.

One reason for the 2-week August recess delay is to catch up on the backlog of stalled Trump nominees. Senate GOP leaders blamed delays on foot-dragging Democrats. Data suggests part of the problem is the failure of the Trump administration to send formal nominations to Capitol Hill.

One reason for the 2-week August recess delay is to catch up on the backlog of stalled Trump nominees. Senate GOP leaders blamed delays on foot-dragging Democrats. Data suggests part of the problem is the failure of the Trump administration to send formal nominations to Capitol Hill.

Democrats, including Oregon Senator Ron Wyden, have urged McConnell to ditch the current GOP approach and engage in bipartisan negotiations. Wyden expressed willigness to find ways to bolster the individual health insurance market and the health exchanges. He also said pressure on insurance premiums could be relieved by pursuing strategies to curb the price of prescription drugs. Trump and, later, Vice President Mike Pence have suggested repealing Obamacare now with an effective date in 2020 to allow more time to reach a consensus on how to replace it.

GOP leaders signaled their FY18 budget will contain funding for Trump’s controversial border wall. Before the July 4 congressional break, conservative Republican lawmakers threaten to vote against any budget without funding for the wall. Now the political calculus may change with Democrats refusing to back a budget containing wall funding.

Nobody mentioned voting to raise the debt ceiling, which was breached in March. Instead, McConnell and other GOP Senate leaders deplored Democratic foot-dragging on confirming Trump administration nominees. According to The Washington Post, there are 145 formally submitted Trump nominations pending in the Senate. Only 48 Trump nominees have been confirmed, but Trump’s team has failed to submit a nominee for 382 of 564 key federal appointed positions.

President Obama by the same time in his first year in office had 200 of his nominees confirmed, with another 151 awaiting confirmation by the Senate. The average confirmation time for Obama nominees was 37 days, compared to an average of 44 days for Trump nominees.

The big news of the week, however, will probably be the release of an email string by Donald Trump Jr. that shows he agreed to meet last June with a Russian attorney after being lured by the promise of sensitive material detrimental to Hillary Clinton’s presidential campaign. The emails indicate the material was from the Russian government and was intended to boost Trump’s candidacy.

Trump Jr. says no material was transmitted at the meeting, which Jared Kushner and Paul Manafort also attended, but critics and some legal experts say that may be irrelevant. They noted it is illegal to solicit or accept items of value from foreign nationals, which presumably would include politically embarrassing dirt on an opponent. Some of the reactions on Capitol Hill ranged from calling the younger Trump’s behavior “problematic” to stronger references that included “treason.” Wyden, who sits on the Senate Intelligence Committee, said the emails remove any question about whether there was collusion between Trump and Russian officials and leave it to all Members of Congress to find out the extent of the collusion.

Hanging over congressional Republicans is the nightmarish possibility of heading home later this summer with no major legislative victories, little progress on priorities such as tax cuts and infrastructure investment and a president under siege. Trump officials said they won’t submit a tax proposal until September and details of an infrastructure package until next year.

'Obamacare’s Kindest Critic'

Obamacare has been assailed from the political right and left, but its namesake took an unusual step in publishing a critique that suggested ways his legacy achievement could be perfected and expanded.

Obamacare has been assailed from the political right and left, but its namesake took an unusual step in publishing a critique that suggested ways his legacy achievement could be perfected and expanded.

Republicans are convening in Cleveland this week and can be expected to bash Obamacare nonstop, but constructive criticism of the Affordable Care Act came last week from an unanticipated quarter – Barack Obama.

Signing his critique as Barack Obama, J.D., the President described how his legacy achievement could be perfected by adding a public health insurance option and allowing Medicare to negotiate prescription drug rates, which is currently prohibited.

The New York Times called Obama “Obamacare’s kindest critic” and said his suggestions have the appearance of a memo to his hoped-for Democratic presidential successor, Hillary Clinton.

“Presidents usually wait until their memoirs to review their work,” the Times editorialized, but in this case Obama used the sixth anniversary of the act to make observations about his handiwork in the Journal of the American Medical Association. "Health care costs are still too high, he wrote, and 29 million people still lack coverage.”

One of Obamacare’s “failings” is an incomplete expansion of Medicaid in 19 states that chose not to accept federal financial assistance to pay for expanded coverage.

But Obama points to the actual failure of providing coverage for 9.1 percent of the U.S. population. Obamacare reduced that total from 16 percent, but there are still people who can’t afford health care, often because they lack the money for co-pays and deductibles in addition to health insurance premiums.

Unsuccessful Democratic presidential candidate Bernie Sanders campaigned hard on a Medicare-for-all health insurance plan that captured a lot of attention and rekindled interest in a single-payer system. Obama’s recommendation to add a public option to the health insurance exchange is a more targeted version of the idea, which possibly could win bipartisan support if aimed at rural areas with few private-sector health insurance choices, the Times said.

Clinton has expressed support for a public option. The Times notes Clinton has also voiced interest in allowing Americans between the ages of 55 and 64 to enroll in Medicare.

The Obama view on Obamacare is that it isn’t going away any time soon, but it should be improved and perfected as part of a continuing drive to put a blanket of health insurance coverage over all Americans.

Not everyone agrees. Leading Republicans continue to call for repeal of Obamacare and replacing it with something else, which has largely been ill-defined. The Obamacare health care exchanges are under pressure as costs continue to rise and some insurers lose money. Efforts in Oregon and elsewhere to promote coordinated care and integration of physical and mental health care have registered some positive results, but are still in an extended trial stage. Employers have largely retained private health insurance coverage for employees, but have blunted cost increases by opting for plans with higher deductibles and co-pays and trimmer provider networks.

“What Mr. Obama has done is unusual – asking someone else to burnish a legacy of which he is personally proud,” the Times said. “If the candidates (and Congress) pay attention, his request may also do a world of good for millions of Americans for whom decent health care remains out of reach."

The Search for an Obamacare Alternative

Congressional Republicans have failed so far to offer a comprehensive alternative to Obamacare, but there is a surge of support on the campaign trail to look at a single-payer health care system.

Congressional Republicans have failed so far to offer a comprehensive alternative to Obamacare, but there is a surge of support on the campaign trail to look at a single-payer health care system.

While congressional Republicans continue to look for an Obamacare replacement, others are stepping up with alternatives they may like even less but may appeal to a significant segment of the U.S. population.

Democratic presidential candidate Bernie Sanders has been a consistent voice for a single-payer national health care system, which could be a simple as having everyone enrolled in Medicare. His support for a single-payer health care system is credited by some political observers for his strong showing in early Democratic presidential polls as he challenges Hillary Clinton, who also has a reputation for health care reform.

The single-payer system Sanders has supported on the presidential stump is estimated to cost $15 trillion over 10 years. But Sanders and like-minded supporters say a single-payer system would eliminate $5 trillion in “administrative waste" in that same period. The plan would be paid for by what is described as a “progressive” payroll tax

A Colorado group has placed Initiative 20 on that state's 2016 general election ballot to create ColoradoCare. Under this universal health care coverage proposal, people who live or earn money in Colorado could choose their providers, but medical bills would be paid by the state.

Backers of the Colorado initiative would pay for ColoradoCare through a 10 percent payroll tax, which would generate an estimated $25 billion per year. Under the plan, employers would pay two-thirds of the 10 percent payroll tax and employees the remaining one-third. Self-employed individuals would pay the entire 10 percent on their net income, according to The Denver Post.

The concept of a national single-payer health care system has been floated before and generally beaten back because of fears of an even larger federal bureaucracy, increased health care costs and higher taxes. Hillary Clinton’s proposed health care reform measure stopped short of a single-payer system, as does the Affordable Care Act, which tries to reduce the number of people without health insurance by creating a government-managed marketplace.

While it is easy to point at warts in Obamacare, it is much harder to come up with a plan to replace it, which is why congressional Republicans have voted scores of times on repeal and zero times on a substitute. One reason for the difficulty is that the U.S. health care system has lots of parts. There is the part where workers and their families receive health insurance offered through their employer. Then there is Medicare, Medicaid, the Veterans Administration, Indian Health, federally funded clinics, school clinics, psychiatric care and alternative care such as naturopathy and chiropractic.

The complex health care system and health insurance coverage only partially overlap, which sometimes leads to awkward and expensive health care delivery, such as children from low-income families being forced to seek care in a hospital emergency room instead of a school clinic or people suffering from mental illness receiving prescriptions for psychotropic drugs from primary care physicians.

One of the underlying appeals of a single-payer system is its promise to consolidate the silos in the health care delivery system and eliminate (or at least shrink) the disparity between health care delivery and health insurance.

Skeptics question whether a single-payer health care system would live up to its promise in the United States, where many people are accustomed to a broad range of choices in providers and some providers decline to serve patients in a public health program because of lower fees. Skeptics also doubt Americans are willing to pay higher taxes and hand over more control of their lives to the federal government.

While those arguments have prevailed in the past, progressives such as Sanders and the Initiative 20 backers in Colorado are saying that tinkering with the health care system is not enough to stem rising health care costs and ballooning insurance premiums. They say if you want an alternative to Obamacare, here’s one to consider.

In the absence of another comprehensive alternative, the single-payer system appears to be gaining some momentum as a policy option.

Congress Reaches $1 Trillion Spending, Tax Deal

New House Speaker Paul Ryan turned a "crap sandwich" into a $1.1 trillion spending and tax deal that both Republicans and Democrats can point to with provisions they support.

New House Speaker Paul Ryan turned a "crap sandwich" into a $1.1 trillion spending and tax deal that both Republicans and Democrats can point to with provisions they support.

Congressional negotiators have reached an agreement on a $1.15 trillion federal spending bill that will carry through until Sept. 30, 2016. Most of the contentious policy "riders" were dropped in the final package.

The House is expected to vote Friday on the 2,009-page measure. Senate action will follow. Because the short-term spending extension expires tonight, Congress is expected to rush through another extension until Dec. 22 to allow time for the in the House and Senate on the omnibus package, which consists of 12 appropriations bills.

The deal also involves a 233-page bill that extends various tax provisions, including a five-year extension of tax credits for the wind and solar industries and a two-year delay of the so-called "Cadillac" tax on health insurance plans. The measure locks the research and development credit and Section 179 small business expensing deduction into law.

Reaching a spending agreement was a heavy lift for new House Speaker Paul Ryan, who called the job a "crap sandwich."

To reach a deal, Ryan and Senate Majority Leader Mitch McConnell were forced to drop provisions Democrats opposed to defund Planned Parenthood, block funding for the 10,000 Syrian refugees that President Obama has agreed to accept, blunt an Obama administration clean water rule and peel back portions of the Dodd-Frank financial overhaul legislation.

Ryan and McConnell hope to attract as many Republican votes as possible through tax extenders, an end to a 40-year ban on U.S. oil exports and a reformed visa waiver program that no longer will apply to anyone who has travelled to Iraq or Syria. The omnibus package also stops what GOP critics call an Obamacare "bailout" of health insurers.

Democrats mostly played defense on the spending bill, but achieved policy goals on the tax measure, including expansion of the child, earned income college tuition tax credits. The measure also indefinitely extends state and local sales tax deductions and a deduction for teachers' out-of-pocket expenses. New York Senator Charles Schumer successfully inserted a provision to provide a tax benefit to mass transit riders that parallels an existing exclusion for employer-paid parking.

Provisions of particular interest to CFM clients include the following:

•  CDBG: $3 billion (equal to FY15 enacted level)

•  HOME: $950 million ($50 million increase over FY15 enacted levels)

•  Byrne Memorial Justice Assistance Grants: $347 million (slight increase over FY15 enacted levels)

•  Economic Development Administration, Public Works Programs: $100 million (increase over FY15 enacted levels)

•  FEMA Assistance to Firefighter Grants: $690 million — $345 million for AFG and $345 for SAFER (increase over FY15 enacted levels)

•  TIGER: $500 million (equal to FY15 enacted level), although the bill does not provide funds for planning grants. 

While the omnibus spending and tax extender bills are expected to pass, most likely with bipartisan support, there is sure to be sniping about items buried in the bowels of the mammoth legislation, especially given the little amount of time Members of Congress will have before votes begin.

The Vermont Health Care Option

Pretty much everyone agrees the political battlefront in 2014 and stretching into 2016 will be the future of Obamacare. Democrats want to preserve it. Republicans want to repeal and replace it, though with what isn't certain.

However, looming just over the 2016 horizon is another alternative — the Vermont experiment with a single-payer health care system that could go into effect in 2017.

The Affordable Care Act moves toward universal access to health insurance by trying to fill the gaps in the previous system of employer-provided health insurance, individually purchased self insurance, Medicare and Medicaid. And that doesn't include the health insurance available to military personnel and their families.

Yet gaps remain. There is an entire network of public health clinics serving the homeless, rural poor, low-income children in schools and Native Americans on reservations. And there is gap between those who qualify for Medicaid and who can afford to buy their own insurance under the Affordable Care Act's state health insurance exchanges.

Even sympathetic critics of the current hodge-podge system of health insurance and health care delivery say it is inefficient, doesn't address cost control and fails to establish a reliable pricing system to allow health care to operate in any semblance as a market.

To bridge that final gap requires imposing an entire new system. There aren't a lot of choices.

Connecting Between the Ferns

In ministerial school, you are taught to talk to the people in the front row differently than those in the rear pew. Marketers call that knowing your audience and talking to them where they are at.

President Obama showed the deft touch of a marketer this week when he appeared on the online comedy show "Between the Ferns" to connect with young adults who are the program's main demographic.

Obama is trying to convince a larger number of young adults without health insurance to enroll for Obamacare. After his appearance on the mock celebrity interview show where he traded barbs with host Zach Galifianakis, the Obamacare website showed a spike in traffic.

The funny exchange also earned media coverage on national television and publications such as The New York Times, which may have the byproduct of coaxing older adults to check out the Obamacare website.

The enrollment deadline for Obamacare is March 31, so some may question why the President and his fellow supporters waited so long. The truth is, they have tried a lot of ideas – such as ads aimed at young adults. But that turned out largely to be a case of the right message in the wrong channel.

Obamacare to Command Continuing Headlines

Obamacare faced a rough 2013, but it could be a walk in the park compared what lies ahead in 2014.

Elise Viebeck, writing for The Hill, identifies five significant stories to watch for in the coming year.

The most obvious is an analysis of how many people and who enrolled in the new health insurance exchanges. Chances are good the total will be less than the Obama administration's target of 7 million enrollees. Who signs up will be followed with intense interest. Will healthy young adults enroll? Will people desert employer-sponsored plans to shop on the exchange? How many people will be covered by the Medicaid expansion? Answers to these and similar questions will have an impact on rates, which also will earn close scrutiny.

President Obama has shown a willingness to postpone deadlines. Viebeck says he pushed back 10 separate deadlines in 2013. One of the biggest pressure points is the individual health care insurance mandate, a critical lynchpin to the overall success of Obamacare. Viebeck speculates Obama could look for more workarounds to entice broad participation.

The requirement that most employers provide birth control in their plans will go before the Supreme Court in two challenges. The issue arrives on the top court's docket after split decisions by appellate courts.

Another area the media will sniff out is further cancellations of existing health plans. While many of the cancelled plans may not have been a great value, the cancellation undermined Obama's claim that no one would be forced to change their health care plan, which in turn eroded political trust in the President and Obamacare itself. Short of plan cancellations, there will be careful analysis of whether newly offered plans trim costs by narrowing patient choices of doctors and hospitals. The Wall Street Journal already has published an initial analysis. But some patients accelerated elective surgeries before the end of the year to take advantage of their existing coverage.

The Changing Face of Industry and Policy Concerns

Not long ago, when the President of the United States sat down with industry leaders, he met with steel magnates, carmakers and machine tool manufacturers. Today, President Obama huddled with the heads of Yahoo, Google and Twitter. 

That says volumes about the changing face of "industry" in America, not to mention the profile of the nation's most pressing issues.

Steel, car and machine tool tycoons rode into Washington, DC to talk about foreign competition, excessive regulation and the minimum wage. The 15 high tech CEOs who met with Obama came to discuss the bungled HealthCare.gov website and their concerns about excessive government data-mining, sometimes through unsuspected backdoors into their data warehouses. 

Many captains of industry have identified with the Republican Party. This new breed of corporate leader tends to side with the Democrats and have especially close ties to Obama. The Sunlight Foundation says employees at the 15 companies represented at today's meeting contributed an average of $356,000 per company to Obama's campaign.

Despite the political comity between Internet giants and the President, they find themselves in a strained position over the government's performance in the digital world. They see the HealthCare.gov website fiasco as a major stumbling block to Obama's leadership on other major policy aspirations they share. And they find government spies in their data closets disconcerting.

Arguably, the topics at today's presidential parlay affect more Americans than those of yesteryear involving tariffs and government rule-making. The implementation of Obamacare, including introduction of health care exchanges, will have a broad impact across the nation's economy. And the thought of government snoops sifting through emails, phone records and people's digital footprints has a large segment of the American public on edge.

The Politics and Facts of Obamacare

The bungled rollout of the Affordable Care Act, coupled with a tide of canceled health insurance policies, has put a dozen Democratic senators, including Oregon's Jeff Merkley, in a defensive position a year ahead of the 2014 election.

Merkley has joined other Senate Democrats in supporting legislation to allow people to retain their health insurance plans that have been canceled because they fail to meet the minimum requirements under the Affordable Care Act.

The balky federal Affordable Care Act website is blamed for embarrassingly sluggish sign-ups for health insurance coverage, which totaled only slightly more than 106,000 in October. However, the political panic button has been pushed because the existing health care plan cancellations undercut President Obama's oft-repeated promise than no one would be forced to give up their health plan. No less than former President Bill Clinton says action is needed to make the promise whole.

Republicans have dubbed 12 Democratic senators up for re-election in 2014 the Obamacare Dozen. North Carolina Senator Kay Hagan is already the target of attack ads, which have eroded her poll numbers so she now finds herself in a dead heat with potential GOP challengers.

Several of the 12 Democrats, including senators who just months ago were viewed as invincible in 2014, are pivoting to separate themselves from Obamacare by supporting a fix to the canceled policy problem, advocating for a longer period to enroll in a new health plan or demanding an investigation on why the website rollout tanked.

For his part, Obama has tried to absorb some of the frustration by apologizing for the poor website rollout and admitting "we fumbled the rollout on this health care law," as he unveiled his own fix to allow people to retain current health care plans.

Senator Cruz Does Custer

You know something must be wrong when a U.S. senator threatens to filibuster the bill he supports to win. That's exactly what Senator Ted Cruz, R-Texas, proposes to do to block implementation of Obamacare.

Cruz has been barnstorming the country to put the fear of God in his fellow Republicans to make one last stand to block the Affordable Care Act, President Obama's signature first-term achievement, before it goes fully into effect.

The vehicle for this derailment of a three-year-old law, which has been upheld by the U.S. Supreme Court, is something called a Continuing Resolution, essentially a catch-all funding bill that will allow the federal government to continue to operate when its new fiscal year begins October 1.

Last week, the GOP-controlled House muscled through a Continuing Resolution that would defund Obamacare. Senate Democrats, who control the upper chamber, scoffed at the idea and plan simply to amend the House-passed Continuing Resolution by deleting the Obamacare defunding provision. No problem, you say, since Democrats hold 54 seats and the amendment only requires 51 votes to pass.

Here is where Senate procedures come into play. Senators reserve the right to filibuster. A filibuster can be halted by a cloture vote, which requires 60 votes. Cruz is gambling he can round up 41 of the 45 Senate Republicans to join him in blocking cloture. He believes Senate Democrats will have little choice but to yield and ultimately agree to the House-passed Continuing Resolution.

Inaction Response to Navy Yard Shooting

The latest mass shooting, this time perilously close to the U.S. Capitol, has produced the same thud of silence in Congress.

Senate Majority Leader Harry Reid told reporters he still lacks the votes to pass any significant gun control legislation. And if the Democratically controlled Senate is stymied, you can imagine the challenge in the GOP-controlled House.

Perhaps it is one of those telling yet cruel coincidences that two Colorado state senators who voted for legislation requiring universal background checks were just recalled in special elections. And this is in a state that has experienced two recent mass shootings. The alleged Navy Yard shooter had been arrested in Seattle for firing three pistol shots into the tires of a man who angered him. The Navy contractor in DC said he never would have hired the shooter if he had known. But the message in the Colorado election left a deeper impression. 

The shooting spree Monday at the Navy Yard, which is at the edge of Capitol Hill in Washington, DC, sent shudders down a lot of backs across America, including those of men and women in the military. Despite their security, military bases have become ready-made targets for shooters with nobody in particular to kill, but with the ability to walk into a gun shop and legally buy a shotgun.

There was huge irony in the White House Rose Garden as President Obama, trying to put the Syrian chemical weapons episode in the rearview mirror, held a press conference to refocus national attention — and the attention of House GOP leaders — on the still-flagging U.S. economy. While he spoke, Congress and other government offices were in lock-down while authorities searched for potential additional shooting suspects in the neighborhood.

Full Plate Greets Returning Congress

After five weeks back home, Congress returns to what shapes up as an issue-busting fall, starting with a charged debate over U.S. military action in Syria. But not far behind are titanic battles over the federal debt ceiling, a Continuing Resolution, immigration reform and the farm bill.

Even before President Obama lobbed his political grenade over military action in Syrian into the halls of Congress, the House and Senate faced a daunting schedule, including an effort by some conservative Republicans to stage a final showdown over funding for Obamacare. 

The political fireworks start Tuesday when Obama addresses the nation to make his case for targeted military strikes in retaliation for the use of chemical weapons by Bashar al-Assad's Syrian regime. It will take every ounce of communication wizardry by Obama to convince a war-weary nation and a skeptical Congress to authorize use of military force. He may have the necessary votes in the Senate, but not in the House, where both liberal Democrats and conservative Republicans may combine to block a majority.

Key votes on Syria are expected this week. It is unclear whether Obama will blast away with or without congressional approval. But it also is possible that new developments could occur. For example, Russia said it would push Syria to turn over control of its chemical weapons to international authorities.

One positive from the divisiveness over Syria is that House GOP leaders have soured on the idea of a contentious fight over a Continuing Resolution, at least right now while the nation's attention is diverted. This could lead to a short-term extension of federal spending authority until later in the fall when Republican strategists believe they will have more political leverage.

Even though the House and Senate Appropriations committees have acted on nearly all spending measures, the Senate hasn't passed any of them and the House has only passed four. That could lead to an omnibus appropriations measure or measures to catch up. 

Converging Fiscal Policy Dilemmas

Conservative Republicans want to force a final showdown over Obamacare, which coincides with another vote on the federal debt ceiling and unraveling inequities caused by across-the-board spending cuts ordered by sequestration.When Congress returns after its August recess, another financial crisis looms as conservative Republicans threaten to shut down the federal government unless Obamacare is defunded.

Shutting down the federal government is probably never a good things, but it may be especially bad timing this fall in light of new leaks showing privacy abuses by the National Security Agency and smoldering trouble in the Middle East as Egypt tips back to a dictatorships. Even Greece is making noises it needs another bailout, which in the past has put a damper on international economic recovery.

Egged on by groups such as the Heritage Foundation and former House GOP rabble-rouser Jim DeMint, conservative Republicans are demanding a final political showdown on the Affordable Care Act. They say they are willing to risk a government shutdown and the economic and political consequences to block the signature achievement of President Obama in his first term. Many are out on the political hustings encouraging voters to pressure their representatives to sign the defund-Obamacare petition.

Wyden Talk in a Tweet

Oregon Senator Ron Wyden covered a wide range of topics at his speech today, but none drew closer attention than his remarks about how to secure privacy from government surveillance. With Congress in recess before a tumultuous fall session dealing with the budget, senators and representatives are hitting the hustings to reconnect with their constituents. Oregon Senator Ron Wyden spoke at a luncheon meeting of the Westside Economic Alliance.

His comments and answers to questions covered the federal budget, Medicare, taxation, international trade, energy exports, national security and Obamacare, as well as more local issues. Here is the essence of what he said in a series of tweets:

  • Sen. Wyden promises new bipartisan Medicare plan to preserve its guarantee and financial integrity as 10K people turn 65 daily for 20 yrs.

  • Sen. Wyden says simplified federal tax code can unleash ton of corporate cash sitting on the sidelines for job-creating investment.

  • Wyden predicts congressional revision of Patriot Act's "relevance" standard and a privacy advocate before FISA court.

  • Wyden says choice between safety and privacy is false in the face of continuing terrorist threats. Both are critical and can co-exist.

Confusion Undermines Health Reform Understanding

Is the Affordable Care Act good or bad for small business? Political chatter says it's bad, but a careful read of its provisions may change your mind.Since passage of the Affordable Care Act (ACA) in 2010, President Obama’s problem hasn’t been the law itself; it has been selling the law to the public, health care providers and especially small businesses.

Most business owners agree the key to business planning is predictability and clarity. While the ACA attempts to provide a clear framework that would allow small business to flourish under the law, many of those benefits are buried underneath the weight of 1,100 pages of text.

Should small business owners be out pounding the payment in support of Mitt Romney and repeal of Obamacare or will the market reforms in the ACA provide small business owners a respite from the notoriously dysfunctional and expensive small group health insurance market?

To date, discussion of this question has been fueled more by politics than facts.

Opponents of Obamacare contend the rising cost of excessive government regulation will force millions of employers to drop coverage for their employees, while also hindering job creation and economic growth. However, this contention overlooks substantial small business benefits contained in the law.

The Commerce Clause Yellow Brick Road

The Commerce Clause has been used over time by the Supreme Court to enable and block economic regulation. Now a new watershed case involving an individual health care mandate is sitting on the high court's docket.The Commerce Clause in the U.S. Constitution has been a source of strong disagreement since the time of Thomas Jefferson. Arguments over this clause, which on its face controls what economic activity Congress can and cannot regulate, has intertwined with New Deal legislation, the ability to ship wine directly to consumers and, now, the Affordable Care Act.

Nina Totenberg, the encyclopedic NPR reporter who covers the U.S. Supreme Court, delivered a brief history lesson on the Commerce Clause this week, as anticipation builds for the high court's decision on what detractors sneeringly call ObamaCare.

Thomas Jefferson was one of the first to question how far the Commerce Clause could be stretched after the Supreme Court, led by Jefferson nemesis John Marshall, ruled in 1824 that the Constitution gave Congress broad powers.

Totenberg says the argument picked up with intensity 70 years later when the federal government tried to limit the antitrust actions of emerging large corporations. Federal officials suffered a setback in an 1895 ruling involving a sugar company when the court said the government lacked jurisdiction to regulate its activities because most refining was conducted within a state.