Obamacare Repeal, Thought Dead in July, May Be Revived in Senate
September 19, 2017 by admin
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“I think the odds have improved,” said Senator John Thune of South Dakota, a member of the Republican leadership. “I just told Bill Cassidy he’s kind of the grave robber. This thing was six feet under, and I think he’s revived it.”
It is still too early for Republican leaders to celebrate. Mr. McCain said he would pay attention to the views of his governor, but he also insisted that Republicans should hold hearings and consider amendments, rather than ramming the bill through the Senate.
Later Monday, the Senate Finance Committee announced it would hold a hearing on the Graham-Cassidy bill early next week. The Senate Homeland Security and Governmental Affairs Committee also plans a hearing.
“I’m not interested in only having an up-or-down vote on what’s one-fifth of the gross national product,” Mr. McCain said.
Ms. Collins was similarly skeptical.
“I’m concerned about what the effect would be on coverage; on Medicaid spending in my state; on the fundamental changes in Medicaid that would be made without the Senate holding a single hearing to evaluate them; and also on what the effect would be on premiums, particularly for older Americans between 50 and 64,” she said.
Graphic
The Latest Health Care Repeal Plan Would Give States Sweeping Discretion
A comparison of the latest bill released by Senate Republicans with the Affordable Care Act.
In the latest fight, unlike the July showdown, repeal advocates must overcome one “no” vote from the right: Senator Rand Paul, Republican of Kentucky, who said the new bill would leave too much of the Affordable Care Act in place.
Keeping 90% of Obamacare is not ok and it’s not what we ran on. Conservatives should say no.
—
Senator Rand Paul (@RandPaul)
Sept. 18, 2017
“This bill keeps 90 percent of the spending of Obamacare and reshuffles it,’’ Mr. Paul said on Monday. “Really, when you look at how it reshuffles it, it does it just to take money from the Democrat states and give it to Republican states.’’
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Ms. Murkowski said she was still considering her vote.
If the Senate does not vote by the end of next week, it will become nearly impossible to repeal the health law because the drive to kill the Affordable Care Act will lose the procedural protections that allow it to pass the Senate with a simple majority, rather than the 60 votes that would otherwise be needed.
Democrats sounded the alarm Monday, and the Senate Democratic leader, Chuck Schumer of New York, geared up for an all-out effort to block the Graham-Cassidy bill, which has support from President Trump.
“After a few weeks of lying dormant, Trumpcare is back, and its meaner than ever,’’ Mr. Schumer said, adding: “This is so outrageous and so harmful that we’re going to look at every possible way to slow the bill down.’’
Democrats said the Senate should not vote on the bill before receiving a full analysis from the Congressional Budget Office. The budget office said it was aiming to provide a preliminary fiscal analysis by early next week, but would not have estimates of the bill’s effects on insurance coverage and premiums “for at least several weeks.”
Mr. Schumer said it would be much better for Congress to advance a bipartisan bill being drafted by Senators Lamar Alexander, Republican of Tennessee, and Patty Murray, Democrat of Washington. That bill would provide money to insurers to compensate them for reducing out-of-pocket costs for low-income people. Without those payments, insurers say, they will sharply increase premiums or withdraw from additional markets next year.
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The House passed an Affordable Care Act repeal in early May, by a vote of 217-213. But the movement appeared to reach a dead end in July, when multiple versions of repeal legislation failed to gain even a simple majority in the Senate.
Refusing to accept defeat, Mr. Graham and Mr. Cassidy took another tack. The Graham-Cassidy bill has two major elements, one that is new and one that was found in many other Republican repeal bills this year.
The new element is a block grant. Mr. Graham and Mr. Cassidy would give each state a fixed amount of federal money for health care and health insurance each year from 2020 to 2026. The allotments total $1.2 trillion over the seven years. That is slightly less than what the federal government is expected to spend under the Affordable Care Act on the expansion of Medicaid, on premium tax credits and on the “cost-sharing reduction” payments to insurers on behalf of low-income consumers.
States would have sweeping new discretion over how to use the money, and they could receive federal block grant funds without putting up state money.
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Tom Brenner/The New York Times
In addition, the Graham-Cassidy bill would make deep cuts in Medicaid. It would end the expansion of eligibility under the Affordable Care Act, which has extended coverage to 13 million people. And it would put the entire program, which serves more than 70 million people, on a budget, ending the open-ended entitlement that now exists. States would receive a per-beneficiary allotment of federal money.
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The Congressional Budget Office has estimated that 15 million fewer people would have Medicaid as a result of similar proposals in other Republican bills.
Mr. Graham and Mr. Cassidy would distribute federal block grant funds to the states using a complex formula that, like any such formula, creates winners and losers. It is difficult for any state to be sure how much it would receive. The authors of the bill say they intend to reduce expected federal payments to high-cost states like Massachusetts and increase federal payments to states that have not expanded Medicaid.
“Right now, 37 percent of the revenue from the Affordable Care Act goes to Americans in four states” — California, New York, Massachusetts and Maryland, Mr. Cassidy said. “That is frankly not fair.”
Mr. Graham and Mr. Cassidy said that their bill would also enhance the ability of states to waive “Obamacare regulations.” Insurers would still have to offer insurance to anyone who applied, but states could obtain federal waivers allowing insurers to charge higher premiums to sick people or to omit some of the benefits they are now required to provide, like maternity care, mental health care or treatment for drug addiction.
Coverage, while theoretically available, could become unaffordable for some people with costly conditions like cancer or AIDS, health policy experts say. “Less-healthy people would face extremely high premiums” in states that obtained waivers involving both benefits and premiums, the Congressional Budget Office said in analyzing a similar provision of the bill passed by the House.
Mr. Cassidy played down that concern. Under the Graham-Cassidy bill, he noted, a state seeking a waiver would have to describe how it intends to “maintain access to adequate and affordable health insurance coverage for individuals with pre-existing conditions.”
But critics have taken notice. Sixteen groups representing patients and heath care providers came out Monday in opposition to the bill. Among those who issued a joint statement opposing it were the American Heart Association, the American Diabetes Association, the March of Dimes and the lobbying arm of the American Cancer Society.
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“Much of the proposal just repackages the problematic provisions of the Better Care Reconciliation Act,” which the Senate rejected in July, the groups said.
The Graham-Cassidy bill would eliminate the requirement for most Americans to have health insurance and for larger employers to offer it to employees. Like prior Republican bills, it would also cut off federal funds for Planned Parenthood for a year — a provision opposed by Ms. Collins and Ms. Murkowski.
The outlook for the Senate bill in the House is unclear. Some Republicans from states that lose money under the block grant could balk. But House Republicans would be under immense pressure to support the bill and fulfill their longtime promise to dismantle the law, which was passed seven years ago.
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With a Picked Lock and a Threatened Indictment, Mueller’s Inquiry Sets a Tone
September 19, 2017 by admin
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A spokesman for Mr. Mueller declined to comment. Lawyers and a spokesman for Mr. Manafort also declined to comment.
Few people can upend Washington like a federal prosecutor rooting around a presidential administration, and Mr. Mueller, a former F.B.I. director, is known to dislike meandering investigations that languish for years. At the same time, he appears to be taking a broad view of his mandate: examining not just the Russian disruption campaign and whether any of Mr. Trump’s associates assisted in the effort, but also any financial entanglements with Russians going back several years. He is also investigating whether Mr. Trump tried to obstruct justice when he fired James B. Comey, the F.B.I. director.
Mr. Manafort is under investigation for possible violations of tax laws, money-laundering prohibitions and requirements to disclose foreign lobbying. Michael T. Flynn, the former national security adviser, is being scrutinized for foreign lobbying work as well as for conversations he had last year with Russia’s ambassador to the United States. On Monday, Mr. Flynn’s siblings announced the creation of a legal-defense fund to help cover their brother’s “enormous” legal fees.
The wide-ranging nature of Mr. Mueller’s investigation could put him on a collision course with Mr. Trump, who has said publicly that Mr. Mueller should keep his investigation narrowly focused on last year’s presidential campaign. In an interview with The New York Times, Mr. Trump said Mr. Mueller would be overstepping his boundaries if he investigated his family’s finances unrelated to Russia.
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For the moment, Mr. Mueller’s team has shown a measure of deference to White House officials, sparing them grand jury subpoenas and allowing them to appear for voluntary interviews. Those sessions are expected to begin soon. Ty Cobb, a lawyer brought in to manage the White House response to the inquiry, has told administration officials that he wants to avoid any subpoenas from the special prosecutor.
Staff members have been working long hours answering Mr. Mueller’s request for 13 categories of documents, including records related to Mr. Comey’s firing and Mr. Trump’s role in drafting a misleading statement about a June 2016 meeting between campaign officials and Russian-born visitors. Nonetheless, the demand for documents has provoked at least one angry confrontation between Mr. Cobb and Donald F. McGahn II, the White House counsel, over whether certain documents should be withheld to protect the president’s right to confidentiality.
But associates of both Mr. Manafort and Mr. Flynn have received more peremptory treatment. Instead of invitations to the prosecutor’s office, they have been presented with grand jury subpoenas, forcing them to either testify or take the Fifth Amendment and raise suspicions that they had something to hide. At least three witnesses have recently been subpoenaed to testify about Mr. Manafort: Jason Maloni, a spokesman who appeared before the grand jury for more than two hours on Friday, and the heads of two consulting firms — Mercury Public Affairs and the Podesta Group — who worked with Mr. Manafort on behalf of Viktor F. Yanukovych, the pro-Russia former president of Ukraine.
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Mr. Mueller’s team also took the unusual step of issuing a subpoena to Melissa Laurenza, a specialist in lobbying law who formerly represented Mr. Manafort, according to people familiar with the subpoena. Conversations between lawyers and their clients are normally considered bound by attorney-client privilege, but there are exceptions when lawyers prepare public documents that are filed on behalf of their client.
Mr. Mueller took over the Russia investigation in May, after the F.B.I. had already spent nearly a year looking into connections between Mr. Trump’s associates and Russians. His team has occasionally been caught by surprise, hearing of possibly important information only when it is revealed in the news media.
This was the case in July, when Mr. Mueller’s prosecutors learned about email exchanges between Donald Trump Jr. and an emissary for a Kremlin-connected Russian oligarch only after they were disclosed in The New York Times, according to a law enforcement official who spoke on condition of anonymity. Donald Trump Jr., the president’s son, set up the Trump Tower meeting to receive what he was told would be damaging information about Hillary Clinton from the Russian government.
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Soon after his name surfaced, one of the Russian-born participants at the meeting, Rinat Akhmetshin, was ordered to testify before the grand jury, according to one of Mr. Akhmetshin’s associates.
“They seem to be pursuing this more aggressively, taking a much harder line, than you’d expect to see in a typical white collar case,” said Jimmy Gurulé, a Notre Dame law professor and former federal prosecutor. “This is more consistent with how you’d go after an organized crime syndicate.”
The tactics reflect some of the hard-charging — and polarizing — personalities of Mr. Mueller’s team, seasoned prosecutors with experience investigating financial fraud, money laundering and organized crime.
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Admirers of Andrew Weissmann, one of the team’s senior prosecutors, describe him as relentless and uncompromising, while his detractors say his scorched earth tactics have backfired in some previous cases. Greg B. Andres, another one of Mr. Mueller’s prosecutors, once ran an investigation into a Mafia kingpin. Zainab N. Ahmad made her name as a prosecutor pursing high-profile terrorism cases.
Some lawyers defending people who have been caught up in Mr. Mueller’s investigation privately complain that the special counsel’s team is unwilling to engage in the usual back-and-forth that precedes — or substitutes for — grand jury testimony. They argue that the team’s more aggressive tactics might end up being counterproductive, especially if some grand jury witnesses turn out to be more guarded than they would have been in a more informal setting or invoke the Fifth Amendment.
The longer Mr. Mueller’s investigation goes on, the more vulnerable he will be to allegations that he is on a fishing expedition, said Katy Harriger, a professor of politics at Wake Forest University and the author of a book on special prosecutors. Such accusations dogged the investigation of Kenneth W. Starr, the independent counsel whose investigation of Mr. Clinton stretched on for years.
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To a degree, Mr. Mueller is in a race against three congressional committees that are interviewing some of same people who are of interest to the special prosecutor’s team. Even if the committees refuse to grant them immunity, congressional testimony that becomes public can give other witnesses a chance to line up their stories.
Rep. Adam Schiff of California, the top Democrat on the House Intelligence Committee, said committee staff members were going to great lengths not to get in Mr. Mueller’s way. But Senator Charles E. Grassley, the chairman of the Senate Judiciary Committee, indicated last week that his committee might subpoena witnesses to testify about the circumstances of Mr. Comey’s firing even over Mr. Mueller’s objections.
Mr. Mueller’s need to navigate this complex landscape could explain the timing of the raid on Mr. Manafort’s house, which took place in the early hours of July 26. The raid came one day after Mr. Manafort was interviewed by staff members of the Senate Intelligence Committee.
On the day of the raid, Mr. Manafort was scheduled to talk to the Senate Judiciary Committee, an interview that was eventually canceled.
It is unusual for a prosecutor to seek a search warrant against someone who, like Mr. Manafort, had already put his lawyer in contact with the Justice Department. No search warrants were executed during the investigations by Mr. Starr or Patrick J. Fitzgerald, a special counsel appointed during the George W. Bush administration to investigate the leak of the name of a C.I.A. officer.
To get the warrant, Mr. Mueller’s team had to show probable cause that Mr. Manafort’s home contained evidence of a crime. To be allowed to pick the lock and enter the home unannounced, prosecutors had to persuade a federal judge that Mr. Manafort was likely to destroy evidence.
Said Mr. Gurulé, the former federal prosecutor, “Clearly they didn’t trust him.”
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