Collins Will Vote Against Healthcare Bill

Yesterday Sen. Susan Collins (R-ME), a key Senate centrist, said that she will not vote for the healthcare bill being proposed by Speaker Paul Ryan (R-WI) in its current form. Sen. Rand Paul (R-KY) has previously said he will not vote for it either. If one more Republican senator defects, the bill will not be able to pass the Senate.

Collins' objection was straightforward: "This bill doesn't come close to achieving the goal of allowing low-income seniors to purchase health insurance." This remark suggests that she has no ideological objection to the bill, but just wants the tax credits to be bigger. The trouble with increasing them is that the House Freedom Caucus doesn't want tax credits at all. Ryan is going to have to thread a needle to get the Freedom Caucus and Collins on the same page.

Oops. It just got worse. Now four Republican governors have come out against Ryan's plan. They are the governors of Arkansas, Michigan, Nevada, and Ohio. In a letter to Senate Majority Leader Mitch McConnell (R-KY), the governors said that the plan does not meet President Trump's goal of covering everyone and shifts too much responsibility and not enough money to the states. It is likely that the second part of that is the key to their opposition. Note that the letter went to McConnell, not Ryan. The governors understand that there is a better chance of blocking the bill in the Senate than in the House.

However, before the bill even gets to the Senate, it has to first pass the House. A vote is scheduled for next Thursday, so Trump and Ryan have less than a week to get all their ducks lined up (but see below). One has to assume that Ryan would not have scheduled a vote unless he was fairly sure he has 216 votes (two fewer than normal due to House vacancies). (V)

Trump and House Conservatives Agree on Key New Provisions to Healthcare Bill

Donald Trump is starting to show his stuff as a dealmaker. Yesterday, he made a deal with House conservatives that may be enough to get some of their votes, which are crucial to passing the AHCA next Thursday. What he offered them are two provisions they very much want. To understand why these are important, you have to realize that if there is one thing conservatives hate more than "ObamaCare" it is Medicaid, a program that provides free medical care to poor people. Their first objection is that in their view poor people are lazy and undeserving and shouldn't be given freebies that everyone else has to pay for. Their second objection is that it is an entitlement program, meaning that the recipients are legally entitled to care and there is no way for Congress to control the costs. The third objection is that it is a very expensive program, costing over $500 billion/year. The changes Trump has offered adress all three of these points.

The first change allows governors to require able-bodied Medicaid recipients to have a job before receiving any medical care. The catch here is that many Medicaid recipients can't work until their illness has been cured. If they can't get medical help, they won't be cured so they can't work so they can't get Medicaid. The net result for the conservatives is fewer people on Medicaid, which is what they want.

The second concession relates to how much each recipient costs. Under current policy, it costs whatever it costs to give the Medicaid patients the treatment their doctors call for. The second change the conservatives got from Trump is that instead of having the federal government pay the bills as they come in, each state would get a lump-sum of money once a year and the governor would determine how to spend it. If it runs out in, say, August, then no Medicaid recipient would get care until the following January. This scheme limits the amount of money Congress has to spend on Medicaid to a number Congress can determine every year. Effectively, this provision eliminates Medicaid as an entitlement, something conservatives care very much about.

If there are fewer people on Medicaid and each one gets a fixed (and fairly small) amount of money, the cost of the whole program can be reduced, which addresses the conservatives' third objection to it.

With these changes, the bill stands a better chance of passing the House—and a much worse chance of passing the Senate. But right now Trump and Ryan are focused on getting the bill passed in the House. They will worry about the Senate later.

As we have pointed out before, one possible strategy is to have the Senate modify the bill and pass the modified bill. Then a conference committee will come up with a compromise and all Republicans will have a gun put to their heads and be told: "It's this or nothing." That might just do the job. (V)

Healthcare Nomenclature Keeps Changing

The Republicans plan to change the healthcare system keep changing, and the sales effort to go with it keeps changing as well. At first they just promised to "repeal ObamaCare." Later that became "repeal and delay." Next up was "repeal and replace." Then it was "access to coverage." Currently it is the "three-bucket strategy."

The first bucket is passing Ryan's AHCA bill. The second bucket is having Secretary of HHS Tom Price change the thousands of regulations associated with the ACA. The third bucket is passing a bill that would eliminate those parts of the ACA that can't be done using the budget reconciliation process. Bucket three requires at least eight Democrats to vote for the final bill. Rep. Raul Labrador (R-ID) described the strategy thusly: "Anybody who believes the three-step process is believing in a fantasy." Sen. Tom Cotton (R-AR) was kinder. He said: "That is just political talk." Clearly neither Labrador not Cotton thinks there is any chance at all of signing up eight Democrats in the Senate to invoke cloture, so the three-step process is really a two-step process. (V)

Freedom Caucus Looks to Bannon for Support

Members of the House Freedom Caucus, who oppose the ACA replacement bill being pushed hard by Speaker Paul Ryan (R-WI), have found a new ally in a strange place: the White House. Officially, President Donald Trump supports Ryan's bill as it currently stands (with yesterday's patches). However, top presidential adviser Steve Bannon seems sympathetic to their concerns, and is more than willing to talk to them. This allows the Freedom Caucus members to bypass Chief-of-Staff Reince Priebus, who is close to fellow Wisconsinite Ryan. To some extent, this puts Bannon on the opposite side of the fight from Trump. Most presidents would never tolerate this kind of disloyalty, but Trump has to put up with Bannon for a very good reason.

The good reason is money. With all the usual big Republican megadonors sitting out the election, Trump became extremely dependent on the reclusive billionaire Robert Mercer and his politically active daughter, Rebekah, who is extremely close to her good friend Steve Bannon. Rebekah Mercer, who runs the Mercers' political operation, has a short fuse and was very upset when her favorite foreign policy choice, the hard-liner John Bolton, wasn't chosen for any position. If Trump were to dump or even sideline Bannon, she would go ballistic and use her father's billions in a way Trump surely would not like. So Trump has to put up with Bannon conspiring with the Freedom Caucus to defeat a bill that he (at least nominally) supports. Of course, there is little evidence that he cares about the actual bill one way or another. If it turns out that it can't pass, then he will simply accept that and start blaming the Democrats for keeping the horrible, failing ObamaCare. (V)

What Has Trump Accomplished So Far?

Donald Trump promised a tremendous number of things on his first day in office, his first month, and his first 100 days. We are now more than half way through the first 100 days, so we can take a peek at how well he is doing:

• Nominate a new Supreme Justice. Status: accomplished
• Withdraw from the TPP. Status: accomplished
• Crack down on immigration. Status: he tried, but the courts don't seem to like it
• Defund foreign health providers that even discuss abortion. Status: accomplished
• Drain the swamp. Status: he did sign a lobbying ban but many alligators are still swimming around
• Impose a hiring freeze on civilian government employees. Status: accomplished
• Authorize the Keystone and Dakota Access pipelines. Status: in progress

So the bottom line is that he has made a serious effort to grab the low-hanging fruit and succeeded at much of it. Wall building will take a bit longer. (V)

Trump Voters Among the Biggest Losers in the Trump Budget

The proposed budget the White House released yesterday hits Trump voters, especially older and rural ones, especially hard. Funding for rural airports, rural Amtrak stations, and rural water and sewer projects will all be cut sharply. The federal program to help poor people heat their homes in the winter (which is especially prized in cold states), will be axed. One estimate puts the number of especially vulnerable people in New England getting heating assistance to be 70%, meaning that most of the recipients are elderly, disabled, or poor families with young children. Many have to choose between heat or food. The Center for American Progress estimates that up to 1/3 of the people in rural counties that Trump won are living paycheck to paycheck, and will miss these forms of assistance and many others that will be slashed if Trump gets his way.

Budget Director Mick Mulvaney responded to these criticism by saying:

One of the questions we asked was can we really continue to ask a coal miner in West Virginia, or a single mom in Detroit to pay for these programs; the answer was no. We can ask them to pay for defense and we will, but we can't ask them to continue to pay for the Corporation for Public Broadcasting.

However, the proposed budget is far from a sure thing. The representatives and senators from poor counties and states, most of whom hate pork in the abstract, like pork very much when it affects their constituents, so these cuts may not make it into the final budget. For example, Sen. Shelley Moore Capito (R-WV) had this to say about the elimination of the Appalachian Regional Commission:

[It] is essential to redeveloping economically distressed regions of West Virginia, especially the coal communities that have been devastated by years of regulatory overreach. The commission also plays an important role in Senator Capito's efforts to expand critical broadband infrastructure.

Can Trump count on her vote for this budget? Not until the Commission's funding is put back. What about the Delta Regional Authority, which helps poor people in the Mississippi delta region? What about the Northern Border Regional Commission? These three agencies provide services in 698 counties from Maine to Mississippi, as shown below.

The services they provide include fixing roads and sewer systems, funding health clinics, encouraging entrepreneurs, and training displaced workers, among many others. The people in the 698 counties covered by the commissions may not be aware of them, but the representatives and senators from those counties most certainly are. There is no way they will let Trump just kill off commissions so important to their constituents. Trump will soon learn that everything in the federal budget is there because some senators and representatives want it there. (V)

U.S. To Appeal Judge's Order on Muslim Ban v2.0

Yesterday the Dept. of Justice announced that it would appeal the ruling of a Maryland federal judge to the U.S. Court of Appeals for the 4th Circuit. The district court judge issued a temporary restraining order on Donald Trump's second attempt at an order banning entry into the U.S. of people from six majority-Muslim countries and the Dept. of Justice wants the appeals court to overturn the judge's order. A federal judge in Hawaii issued a similar order, but the Dept. of Justice wants to try its luck first in the 4th Circuit rather than the more liberal 9th Circuit, which includes Hawaii. (V)

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---The Votemaster and Zenger