Email #313: “Americans will be hurt”

Last Friday, the attorney generals of 18 states filed a joint suit requesting a temporary restraining order and later permanent injunction preventing the Trump administration from halting ACA subsidy payments.

Those attorney generals have the support of their governors, Republicans included. Republican Gov. Sandoval says the President’s stopping payment is “going to hurt kids. It’s going to hurt families. It’s going to hurt individuals. It’s going to hurt people with mental health issues. It’s going to hurt veterans. It’s going to hurt everybody.” The bipartisan National Governors Association agrees: “We are deeply concerned that the administration has declined to continue these payments, further increasing uncertainty for state marketplaces.”

Doctors oppose the President too. The American Medical Association says: “Our patients will ultimately pay the price. We urge Congress to accelerate its efforts to reinstate these payments before further damage is done.” The American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Physicians, the American Congress of Obstetricians and Gynecologists, the American Osteopathic Association, and the American Psychiatric Association are all urging the subsidies to continue too, saying in a group statement: “This action will make it harder for patients to access the care they need. Costs will go up and choices will be restricted.”

Even many Republican law-makers agree. Republican Rep. Reed, co-chair of the bipartisan Problem Solvers Caucus, says: “It’s only going to get worse as this marketplace continues to destabilize. If we stay where we are and do nothing, I think this is going to be a pox on all of our houses.” Republican Senator Alexander said in August: “Without payment of these cost-sharing reductions, Americans will be hurt.”

You, however, have said nothing. I know many Republicans have argued that the subsidies are unconstitutional because Congress never appropriated money. A lower court agreed, but the appeal has not been settled, and until it is, the ACA and its subsidies remain the law. The Supreme Court has heard three different ACA challenges in the past, and three times it ruled in favor of the ACA. Even Bush-appointed Chief Justice Roberts declared: “Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them. If at all possible we must interpret the Act in a way that is consistent with the former, and avoids the latter.”

If the Court rules that the ACA subsidies are unconstitutional, so be it. But until then, they are the law, and the Trump administration has the Constitutional and moral responsibility of continuing them. You and all of Congress have the moral responsibility of passing legislation that stabilizes healthcare for millions of Americans. Since all of the GOP’s attempts to repeal and replace the ACA failed, that means working within the framework of the ACA. It means crossing the aisle and compromising. Cutting off subsidies only harms Americans who need them.

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Email #312: “the very core of our system of government”?

You praised President Trump’s elimination of Deferred Action for Childhood Arrivals because you said it was an “unlawfully-contrived program.” You said President Obama had “used his ‘pen and phone’ to overstep his authority and unilaterally rewrite our nation’s laws” in a manner that was “wholly unconstitutional” and compromised “the rule of law.”

Obama created DACA in 2012 after the nearly identical DREAM Act failed to pass in the Senate. The administration stopped deporting illegal immigrants who matched the proposed DREAM Act criteria anyway. You responded with the Preventing Executive Overreach on Immigration Act, saying: “President Obama declared war against the Constitution by changing our immigration laws on his own and Congress today began its fight against this unprecedented power grab.”

When the courts blocked Obama’s immigration order, you applauded: “The case of United States v. Texas is fundamentally about preserving the separation of powers and its outcome will have drastic implications for our Republic… I am hopeful that the Supreme Court will stop President Obama’s lawlessness so that we protect the Constitution and the intent of the Founding Fathers that the legislative branch, which reflects the will of and is accountable to the American people, makes the laws, not the President.” Due to the death of Justice Scalia, the Court deadlocked in a 4-4 decision.

But you demonstrated your continuing commitment to this issue by creating the House Judiciary Committee’s Task Force on Executive Overreach last January, correctly noting that “presidents of both parties have aggrandized their power and usurped Congress to legislate from the Oval Office. This is not a Republican or Democratic issue; it’s an American issue and touches the very core of our system of government.” You said the Task Force “will study this troubling trend and also look for solutions to prevent the executive branch from exceeding its constitutional authority. The separation of powers and its checks and balances are designed to protect individual liberty and we must ensure that it is preserved for future generations.”

And now President Trump has given the Task Force a lot more to study.

The President tweeted last week: “Since Congress can’t get its act together on HealthCare, I will be using the power of the pen to give great HealthCare to many people – FAST.” He then used that power to issue executive orders that violate provisions of the Affordable Care Act. He said during the signing: “I just keep hearing repeal-replace, repeal-replace. Well, we’re starting that process.”

But as you have so forcefully argued in the past, no President has the power to create legislation and no President has the power to alter or repeal legislation once it’s been created by Congress–including in this case the Affordable Care Act. By the standards you applied to President Obama, President Trump’s “lawlessness” and “power grab” is usurping Congress too.

Fox News reported: “President Donald Trump is taking his first steps to fulfill his vow to dismantle Obamacare on Thursday, signing an executive order that … would allow consumers to buy short-term policies, which don’t have to comply with Obamacare’s protections for those with pre-existing conditions.”

The Wall Street Journal says the executive orders “initiate the unwinding of the Affordable Care Act, paving the way for sweeping changes to health-insurance regulations by instructing agencies to allow the sale of less-comprehensive health plans to expand.” The newspaper also said the President was “using his authority to accomplish some of what Republicans failed to achieve with their stalled congressional health-care overhaul.”

President Trump’s “Obamacare relief” orders follow the same steps and executive abuses that you so vigilantly opposed under President Obama. After his party failed to pass the legislation he wanted, the President is using his pen to overstep his authority and unilaterally rewrite our nation’s healthcare laws. According to you past arguments, President Trump’s directives to bypass ACA provisions and create unlawfully-contrived healthcare associations are wholly unconstitutional and compromise the rule of law.

The only difference is political. You opposed the DREAM Act, and so it was simple for you to oppose DACA. But you supported ACA repeal bills, and so you agree with the goals of the President’s executive orders. While I empathize with the difficulty and irony of your position, anything short of a condemnation of President Trump with the same vigilance and vigour that you condemned President Obama’s “war against the Constitution” will expose you as an unprincipled hypocrite.

As much as I have disagreed with so many of your past actions, I am sincerely hopeful that you will rise to this situation and place the Constitution before your political party. As you said, the very core of our system of government is at stake.

Email #306: “a great HealthCare Bill”?

President Trump tweeted Saturday:

“I called Chuck Schumer yesterday to see if the Dems want to do a great HealthCare Bill. ObamaCare is badly broken, big premiums. Who knows!”

Schumer responded:

“The president wanted to make another run at repeal and replace and I told the president that’s off the table. If he wants to work together to improve the existing health care system, we Democrats are open to his suggestions. A good place to start might be the Alexander-Murray negotiations that would stabilize the system and lower costs.”

I wrote to you about the Alexander-Murray bill last month, predicting that if it passes:

“the President will describe it as ‘essentially’ a repeal of the ACA anyway and so claim to have accomplished a campaign promise.”

His phone call to Senator Schumer on Friday is the first tangible step to that increasingly likely outcome. If the President makes a deal with Democrat leaders, moderate Republicans will join, and the country will get a law that will “increase access to care and deliver affordable health insurance options.” Those are the two goals you emphasized in July, and so I assume you still prioritize them.

You also said last December that you were “working towards a bi-partisan solution to solve the problem of unaffordable health care.” So you must be pleased that the President is now working towards a bi-partisan solution too. Since a majority of your constituents will applaud any legislation that President Trump calls “a great HealthCare Bill,” are you prepared to cross the aisle and pass a Trump-ObamaCare bill that improves but does not repeal the ACA?

Since partisan repeals have proven impossible, the only other alternative is a permanent but increasingly ineffective ACA. The Congressional Budget Office’s original projections were based on the assumption that over 20 million people would enter the ACA market, but less than half as many actually did. As long as enrolments remain low, the ACA will remain affordable only for those receiving subsidies. But those subsidies will also prevent a complete collapse, locking the system in permanent dysfunction.

Despite this, the Trump administration is cutting the next ACA sign-up period from twelve weeks to only six, and the sign-up website will be shut down on all but one of those Sundays, even though Sunday is one of the most popular sign-up days. The administration has also cut funding to enrollment assistance groups by 40% and the advertising budget by 90%, even though many Americans are unaware that the ACA is still available or that they need to re-up to maintain their coverage. The end result will be even fewer enrollees and so even higher premiums.

If President Trump has a strategy it must be to further weaken the ACA so greatly that a bipartisan repair bill will so drastically improve the system that the result will “essentially” be a repeal and replacement. If that’s the President idea of “a great HealthCare Bill,” I’ll grudgingly support it. Will you?

Email #298: “bi-partisan solution”?

You said last December: “I am working towards a bi-partisan solution to solve the problem of unaffordable health care.” That was ten months ago. Have you made any progress on that solution? For it to be bi-partisan, you must have been working with at least one Democrat. Could you name who that was?

After the Senate failed to pass the AHCA in July, you said: “I will keep working towards a solution to increase access to care and deliver affordable health insurance options.” What happened to the “bi-partisan” part? Did you abandon what you had been working on before supporting the highly partisan AHCA?

Now the GOP has again failed to pass a partisan healthcare bill. Despite controlling 52 seats in the Senate, they could not reach even a 50-vote majority, let alone the 60 votes needed without the procedural manipulation of so-called reconciliation. According to the Congressional Budget Office, that latest partisan bill would have cut Medicaid by a $1 trillion, raised the number of uninsured Americans by millions, and eliminated federal protections for pre-existing conditions by turning over all control to the states. Little wonder it didn’t attract a single non-GOP vote and even lost at least three key Republican senators.

Now that the September 30 reconciliation deadline passed yesterday, will the GOP move to a centrist position on healthcare? If so, this would be a great moment to reprise that “bi-partisan solution” you were “working towards” last fall. Can you describe anything about that bill? Or, if it was only something still in its earliest stage, can you describe some of the process? What specific steps had you taken? Who else was involved that made the process “bi-partisan”? Or what aspects of the bill were designed to attract Democrats?

If you can’t answer any of these questions, then there’s no sense in which the solution could be called “bi-partisan.” Except perhaps in a Orwellian sense. George Orwell defines his 1984 term “doublethink” as telling “deliberate lies while genuinely believing in them.” Were you aware that you were lying when you claimed to be “working towards” a “bi-partisan solution” on healthcare or is your rhetoric so empty that you don’t register your own fabrications?

Email #291: “the indignity of it all”?

Some think that the majority party in Congress should be required to involve the minority party before taking any major legislative action. One Congressman expressed particular outrage when a bill was rushed to a vote without hearings or minority input simply because the party in charge was facing a deadline:

“Now, the indignity of it all is that here in the closing days of the Congress, when this bill has been brought forward in this urgent manner, we are not even given the opportunity, as the minority is always given, to offer a motion to recommit, no opportunity to amend this bill in any way, shape or form, as though this was perfectly drawn and perfectly brought here, and that anybody who was not in the small room where the final version of this, totally without the inspection of the American people, totally without the opportunity for anybody to participate, brought here in some perfect manner; and now, of course, we are going to pass it without even the opportunity for the minority to offer changes to the bill.”

That was in 2010. The bill was the DREAM Act, which became the blueprint for President Obama’s DACA program. The majority party was the Democrats, and the outraged Republican Congressman was you.

Now the GOP-controlled Congress is facing its own deadline. After September 30th, the so-called “reconciliation” process can no longer be used to avoid the Senate requirement that legislation have 60 votes to pass. Since the GOP only controls 52 seats, that means compromise will be the only path forward. But instead of embracing bipartisanship, the GOP is attempting to hurry through an ACA repeal bill.

Given the “indignity” you felt in 2010, I would expect you to oppose the Senate bill out of principle. The Graham-Cassidy repeal has been brought forward in a far more urgent manner than the DREAM Act was seven years ago, and, since not even the CBO has had a chance to calculate its repercussions, it is being pushed through totally without the inspection of the American people and totally without the opportunity for anybody but a handful of Republican Senators to participate.

But not all Republican Senators are accepting this process. Three have rejected it, including Senator McCain who said on Friday:

“I believe we could do better working together, Republicans and Democrats, and have not yet really tried. Nor could I support it without knowing how much it will cost, how it will affect insurance premiums, and how many people will be helped or hurt by it. We should not be content to pass health care legislation on a party-line basis, as Democrats did when they rammed Obamacare through Congress in 2009. If we do so, our success could be as short-lived as theirs when the political winds shift, as they regularly do.’’

When the first ACA repeal bill failed last summer, McCain said:

“Let’s return to regular order. We’ve been spinning our wheels on too many important issues because we keep trying to find a way to win without help from across the aisle. That’s an approach that’s been employed by both sides, mandating legislation from the top down, without any support from the other side, with all the parliamentary maneuvers that requires.”

This sounds like you in 2010. Except you were in the minority then, and McCain is in the majority now. Was your “indignity” sincere? Was your appeal for a fair process based on principle? Or were your complaints only political posturing that you ignore now out of hypocritical convenience?

Email #289: “working towards a solution”?

The latest version of an ACA repeal, the Senate’s Graham-Cassidy bill, would eliminate the individual mandate, eliminate essential health benefits, convert ACA market and Medicaid funds into state block grants, cap and reduce those funds over ten years, and eliminate those funds completely by 2027.

A group of eleven governors–five Republicans, five Democrats, and one Independent—condemned the bill. The Blue Cross Blue Shield Association, America’s Health Insurance Plans, the American Medical Association, the American Hospital Association, AARP, and the American Cancer Society are condemning it too.

The CEO of Blue Cross Blue Shield said:

“The bill contains provisions that would allow states to waive key consumer protections, as well as undermine safeguards for those with pre-existing medical conditions. The legislation reduces funding for many states significantly and would increase uncertainty in the marketplace, making coverage more expensive and jeopardizing Americans’ choice of health plans.”

The CEO of Alaska State Hospital and Nursing Home Association said:

“The cuts could be devastating to our health care system, including rural and frontier hospitals that operate on razor-thin margins. These hospitals are often accessible only by airplane or ferry, so the loss of a hospital means an expensive and disruptive medical evacuation out of the community. Ultimately, patients will bear the consequences, through reduced access to health care and lost insurance coverage.”

The Congressional Budget Office has estimated that the previous, similar repeal bills would have resulted in 15 to 18 million fewer people having healthcare the following year, a fact that doomed those bills in the Senate. The CBO does not have enough time to score the Graham-Cassidy bill before the September 30th deadline for a “reconciliation” vote, but preliminary calculations suggest a decrease of at least 15 million and as many as 30 million people.

You said in July: “I will keep working towards a solution to increase access to care and deliver affordable health insurance options.” But Graham-Cassidy and its predecessors would decrease access and decrease affordable options. Even if you’re right that “Obamacare does not work,” these repeals are not solutions. When will you start working for a bill that, like the ACA, is at least trying to achieve the goals you claim to support?

The AHCA, like Graham-Cassidy, would decrease access to care, but you voted for it because you said the AHCA would increase access to care. How can your constituents understand your position as anything other than Orwellian doublethink?

Email #286: “health insurance in 2018”?

Last month, Anthem announced it would be leaving the Virginia ACA market because the President would not guarantee the federal subsidies that let poor enrollees afford deductibles. As a result, 70,000 Virginians were going to lose their health insurance next year, over 30,000 in your own district.

Fortunately, Anthem changed its mind, announcing last week: “Since learning that 63 counties and cities would not have access to individual health plans, Anthem has been engaged in further evaluation and discussion with regulators to ensure that no bare counties or cities exist in Virginia.”

Your Republican colleague Rep. Griffith expressed thanks: “I am appreciative that Anthem re-entered the market, ensuring that Southwest Virginians will have an option to purchase health insurance in 2018.” Griffith’s congressional district borders yours, and so you share the 40,000 residents of Roanoke and New River valleys who would have lost their insurance.

You, however, did not express thanks. Would you prefer that Anthem not provide healthcare for your neediest constituents? Do you want the ACA market to collapse regardless of the human price?

Last week the Senate Health Committee held its fourth and final hearing on a bipartisan bill to stabilize the ACA insurance markets. Republican Committee chair Senator Alexander and Democrat Committee member Senator Murray hope to introduce a new healthcare bill for a vote this month. It would fund the subsidies that Anthem needs to remain in Virginia. It would create a catastrophe-only coverage option for enrollees. And it would give states more freedom to control rates and plans.

Personally, I think catastrophe-only coverage is a terrible idea, but I understand that many conservatives feel it’s essential for any bipartisan deal. I therefore support it. I also fear that states will have the “freedom” to strip away protections for pre-existing conditions and other essential needs. Still, if the measure brings Democrats and Republicans together, I support it. I assume many conservatives will dislike the cost of subsidies. But that’s the nature of compromise. Both sides must move to the center.

Unfortunately, these bipartisan efforts are being halted by the GOP’s latest and last attempt to repeal the ACA before September 30th, the deadline for the filibuster-preventing reconciliation process. Senator Murray said yesterday: “Republican leaders have decided to freeze this bipartisan approach and are trying to jam through a partisan Trumpcare bill.”

I know you would prefer to repeal the ACA. But if the repeal fails and the Senate passes the Health Committee’s bipartisan bill instead, will you vote for it? I predict the President will describe it as “essentially” a repeal of the ACA anyway and so claim to have accomplished a campaign promise. As long as it gets insurance to the people who need it, I don’t care who takes credit. Do you?