House Narrowly Passes a Bill to Repeal the ACA

After months of horse trading and sausage making, yesterday the House passed a bill to replace the Affordable Care Act. The bill would radically change health care for millions of Americans. It passed 217 to 213, which protects members from accusations of: "You could have prevented this bill from passing." This is a major victory for Speaker Paul Ryan (R-WI) and for President Donald Trump, who likes to chalk up wins.

The vote was rushed through before members had a chance to read the bill or the nonpartisan Congressional Budget Office had a chance to score it. No doubt both will happen in the days ahead. It is likely that at least 20 million people will lose their health insurance if the bill is enacted into law. On the other hand, people who are subject to the 3.8% net investment income tax, nearly all of them quite wealthy, will see their taxes reduced if the bill becomes law. So there are winners and losers, only they are different people.

Fortunately/unfortunately for those people, there is zero chance the bill will be enacted into law. In fact, the Senate isn't going to even bother voting on it. It has no chance whatsoever of passing the Senate and all the senators know this. Instead, the Senate will craft its own bill to repeal and replace the ACA. The chairmen of the Senate Finance, Budget, and HELP committees will take the lead on this. These are Sen. Orrin Hatch (R-UT), Sen. Mike Enzi (R-WY), and Sen. Lamar Alexander (R-TN), respectively. The Senate leadership, represented by Sen. Roy Blunt (R-MO), will also play a key role. They have their work cut out for them because there is no way they can get 60 votes on any bill, so they have to use the Senate's budget reconciliation process, which limits the contents of the bill to items that affect the federal budget. Also, because the Republicans can afford to lose only two votes in the Senate, getting everyone on board on a single bill won't be easy.

If the Senate can find 50 votes for its own bill, the Republicans are still not home free, because then the House and Senate bills have to go to a joint conference committee that will be charged with coming up with a single bill that can pass both chambers. That could prove very difficult because provisions that Senate moderates want are anathema to the House Freedom Caucus. (V)

Fourteen Vulnerable House Republicans Voted for the AHCA Bill

Quite a few vulnerable Republicans voted for the ACA repeal bill yesterday, and some of them may pay a price for their party loyalty come 2018. Currently there are 23 Republicans that represent congressional districts that Hillary Clinton won in 2016. Fourteen of them voted for the repeal bill and nine voted against it. The fourteen who voted for it have just promoted themselves to the Democrats' top targets in 2018. Depending on how a number of special elections this Spring go, Democrats need to flip about 22 seats to take control of the House in 2019. Here is the list of Republicans in seats Hillary Clinton won who voted for the bill:

Representative	District	Clinton margin
Carlos Curbelo	FL-26	16.1%
David Valadao	CA-21	15.5%
Erik Paulsen	MN-07	9.4%
Ed Royce	CA-39	8.6%
Darrell Issa	CA-49	7.5%
Peter Roskam	IL-06	7.0%
Steve Knight	CA-25	6.7%
Mimi Walters	CA-45	5.4%
Martha McSally	AZ-02	4.9%
Jeff Denham	CA-10	3.0%
Pete Sessions	TX-32	1.9%
Dana Rohrabacher	CA-48	1.7%
John Culberson	TX-07	1.4%
Kevin Yoder	KS-03	1.2%

Clearly Curbelo and Valadao have big targets now painted on their backs, but Paulsen, Royce, Issa, Roskam, Knight, and Walters are also going to have a hard time explaining their vote to their constituents.

Especially noteworthy is that fully half of the 14 are from California, a state where Donald Trump is detested and where the Democrats are well entrenched, well organized, and well funded. These members helped their party when it needed it, but it may cost all of them their jobs next year. (V)

The Woman Who Could Decide the Future of Health Care for Millions of People

Do you recognize this woman?

It is Elizabeth MacDonough, the Senate parliamentarian since 2012. She is the person who will rule on whether the Senate healthcare bill can be passed using the budget reconciliation process. If it can't, it may need to be changed to get her approval. Theoretically, the Senate can override her judgment, but there could be political costs to doing so as MacDonough is widely seen as a person with great knowledge of the Senate rules and a fair and impartial arbiter of them.

The biggest issue is that reconciliation bills may only contain items that affect the federal budget. Eliminating the mandate for people to have insurance and pay a tax if they don't is clearly a budget issue, since it affects a tax. However, whether insurance policies must cover contraception is probably not a budget issue. (V)

House Bill Could Affect All Health Plans

While the ACA and AHCA directly affect only people buying health insurance on the individual market, the House's AHCA bill could have a major effect on the insurance plans companies offer to their employees as well. Current law allows large companies that operate in many states to buy their insurance in any state they operate in. Under the ACA, all insurance companies in all states must offer the same essential health benefits, so it doesn't matter which state a company uses to get its insurance plan.

However, the ACHA bill the House passed yesterday allows states to opt out of the national essential health benefits and create their own lists. Imagine, for example, that Arkansas opts out and creates its own list that mandates care for hangnails and ingrown toenails, but nothing else, leaving additional coverage to the insurance company. Walmart could opt for the Arkansas rules, thus covering only those items the insurance company was interested in covering. If it left out maternity coverage, mental health coverage, and medicine, so be it. In effect, the House bill creates a backdoor to gutting huge numbers of insurance plans, not just those on the individual market. (V)

GOP Representatives Go off Script

Getting the votes necessary to pass the AHCA was undoubtedly like herding cats. And while Paul Ryan and his whips managed to get most of the red team on the same page for long enough to hold a vote, the party discipline did not extend much beyond that. In fact, numerous GOP congressmen said some rather impolitic things on Thursday afternoon that will make for excellent commercials for the Democrats in 2018.

To start, there's little question that many of the 217 "yea" votes came from representatives who never actually read the bill. However, at least two of them actually came out and admitted it. Rep. Chris Collins (NY) was on CNN to celebrate the bill, and was asked by Wolf Blitzer: "Did you actually sit down and read the entire bill plus all of the amendments?" Collins said, "I will fully admit, Wolf, I did not. But I can also assure you my staff did." Rep. Thomas Garrett (VA) was on MSNBC for the same purpose, and said the same in response to an identical question from Stephanie Ruhle: "Oh, gosh. Let's put it this way: people in my office have read all the parts of the bill. I don't think any individual has read the whole bill, but that's why we have staff." Garrett also doubled down; when asked about the people whose lives were saved by Obamacare, and who were protesting the new bill, he said he was unconcerned because "none of those people did vote for me." In case the Democrats needed ironclad evidence of the GOP's thought process, now they have it.

Perhaps the most damaging words, however, came from a Republican who was never on board with the new bill in the first place, Pat Meehan of Pennsylvania. Appearing on a Philadelphia radio show to explain his "no" vote, he said:

We're doing some of the very things that we criticized the Democrats for doing with Obamacare. Here we have a bill that is going to touch one-fifth of the US economy and as you said the health and welfare of a lot of people, particularly our sickest people and we don't even have a score for it. We don't even know what the CBO is gonna say it actually costs or will do of the form of who's gonna get covered and who's not covered.

Each day that goes by, the Democrats grow more hopeful that they can retake the House, and maybe even the Senate. And the GOP is certainly doing their part to help make that happen. (Z)

Trump Signs Meaningless Executive Order

Flanked by some nuns, cardinals, and ministers—since Christianity, of course, is the only religion in America—Donald Trump participated in a high-profile ceremony at which he signed an executive order that ostensibly allows religious leaders to engage in political campaigning without fear of recrimination—in particular, fear of losing their tex-exempt status.

In the end, however, Thursday's ceremony was little more than a dog and pony show. Across the political spectrum, experts agree that the new order doesn't actually do anything. Princeton professor Robert P. George, a conservative and an expert on religious liberty, declared, "The religious liberty executive order is meaningless. No substantive protections for conscience. A betrayal. Ivanka and Jared won." Ryan T. Anderson, of the very conservative Heritage Fund, concurred: "Today's executive order is woefully inadequate." From the other side of issue, the ACLU announced that, "We thought we'd have to sue Trump today. But it turned out the order signing was an elaborate photo-op with no discernible policy outcome."

There are two reasons that the executive order is toothless. The first is that the law governing religious leaders' political activity, 1954's Johnson Amendment, cannot be overturned by the president. That would require an act of Congress. The second is that the law is flouted all the time, and is almost never enforced. If anything, Trump's order has—somewhat counter-productively, from the religious folks' point of view—drawn attention to that fact.

Needless to say, the fact that the order is meaningless did not stop Trump from taking a victory tour. And because he tends to know even less about religion than he does about Andrew Jackson, he managed to step in it quite a few times. For example, there was noticeable discomfort when—in his remarks after the signing—he referred to the Catholic cardinals who serve in the United States as "my cardinals." He also said that the new order would be a blessing for HUD Secretary Ben Carson. While it is true that Carson often promotes his religion, and that he also engages in political campaigning, the order does not apply to him since HUD is not a non-profit, and doesn't pay taxes. Perhaps Trump will realize his mistake if he ever gets around to reading the document he signed.

For all the attention paid to the comments about cardinals and Carson, however, the real head-scratcher came when Trump turned his attention to the U.S. military. He said:

People were forbidden from giving or receiving religious items at a military hospital where our brave service members were being treated, and when they wanted those religious items. These were great, great people. These are great soldiers. They wanted those items. They were precluded from getting them.

The president, like any politician, takes any and every opportunity to compliment soldiers. However, the "policy" he ostensibly overturned doesn't actually exist. As far as anyone can tell—and the White House has declined to clarify—Trump was referencing a 2011 DoD policy that forbade proselytizing in military hospitals. However, the policy did not bar soldiers from receiving any religious item or service they actually wanted. Further, because the document was poorly written, it was withdrawn and replaced with a clearer statement. So, it would appear Trump was responding to a six-year-old regulation that didn't actually say what he thinks, and doesn't actually exist any more. There are some very legitimate concerns to be raised about the medical care that soldiers and ex-soldiers get, but talking about those might bring up some uncomfortable questions about, say, the AHCA or Trump's budget. So, he goes with the imaginary concerns instead. (Z)

Can Rosenstein Rein in Sessions?

Attorney General Jeff Sessions and Deputy AG Rod Rosenstein are about as different as two Justice Dept. officials can be. Sessions has been a politician for decades and is a very partisan one at that. Rosenstein is a Harvard-educated prosecutor who is known for being apolitical and very impartial during his 12 years as U.S. attorney in Maryland. In fact, Rosenstein is so apolitical that although he was appointed by George W. Bush, Barack Obama asked him to stay on. He is principled and independent.

Rosenstein is nearly certain to get into conflicts with his bosses, Sessions and Donald Trump, and fairly soon if they try to use the Justice Dept.'s powers for political goals. Unlike other executive departments, which are expected to carry out the president's program, the Justice Dept. is not supposed to do that. It is supposed to enforce the law fairly, without regard to the president's goals or any harm that the president may suffer as a result of its investigations. In particular, since Sessions has recused himself from investigating Trump's ties to Russia, Rosenstein will be in charge of the investigation. The problem is that the investigation may uncover things that Trump absolutely does not want uncovered. Then it will be up to Rosenstein handle the situation. What will he do if Sessions insists on inserting himself into the investigation? What will he do it Sessions wants weekly reports on how things are going? It will put Rosenstein in a more difficult position than he has ever been in before, and it is hard to predict how he will handle it.

But even on more routine matters, such as whether do go after undocumented immigrants or Wall Street bankers who have broken the law, Rosenstein may often find himself in conflict with Sessions' political agenda. He probably will know what is right and what is wrong, but will he have the ability to rein in Sessions? (V)

French Head to the Polls Sunday

Because the French forbid both political reporting and campaigning in the 24 hours prior to an election, the race to decide who will be the next president of France is effectively over, as voters will be heading to the polls starting Saturday (in French territories) and concluding Sunday (in France itself).

The race isn't just over chronologically; the outcome is so little in doubt that French pundits are calling the vote a "non-event." Since the runoff election on April 23, polls have consistently given center-left candidate Emmanuel Macron a 20-point lead. This week, he's pushed it to nearly 25 points—after he, ironically enough, denounced the voters who support the far-right Marine Le Pen as "deplorables." So, she is headed for a defeat of Biblical proportions. The only real question is how many Macron-friendly members will be elected to the French parliament. Since he does not come from one of the country's major political parties, it will be an uphill climb for him to build a functional government. (Z)

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---The Votemaster and Zenger