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Senate Republican leader Mitch McConnell turns to Sen. John Cornyn, R-TX after speaking to reporters after the Republican party policy luncheon in the Capitol in Washington September 16, 2014.  At left is Sen. John Barasso, R-WY. The U.S. House of Represe
The Senate provided a scene of remarkable drama in the early hours of Saturday morning, as Mitch McConnell's ploy to force his colleagues into a panic-inspired and last minute vote to extend the Patriot Act without modification failed. Spectacularly. With Section 215 of the Patriot Act, the provision that the government has used to justify dragnet surveillance on Americans, set to expire on May 31st and Congress planning to recess until June 1, McConnell was attempting to force the Senate into extending the programs using the threat of "national security" by waiting until the last minute to hold the vote. His bullying backfired.
In a tense vote after midnight, the Senate failed to move forward on the House-passed USA Freedom Act, legislation that would end the National Security Agency's bulk collection of call data. The vote was 57-42, just short of the 60-vote threshold needed after stiff opposition and last-minute whipping Friday night into Saturday from Majority Leader Mitch McConnell and other GOP defense hawks. Senators then easily rejected a motion to move ahead on a McConnell backed two-month extension of the Patriot Act's spying authorities.

If the two high-stakes votes at 1 a.m. weren't enough, the dramatic scene that followed showed how tense things are in the Senate. […]

McConnell proposed an even shorter-term extension of the surveillance authorities—from their current June 1 expiration date through June 8, giving the Senate time to take its Memorial Day recess before returning to take up the issue once again. Sen. Rand Paul objected on grounds he wanted up-or-down votes on his amendments to the Freedom Act, and what followed was an unusual exchange between McConnell and pro-reform senators that resulted, where much of the night did, in no solution.

McConnell suggested putting off the debate until June 5, earning objection from Sen. Ron Wyden of Oregon. Then McConnell tried for June 3, to the objection of Sen. Martin Heinrich of New Mexico. Finally the majority leader asked for an extension through June 2. Paul objected again, and the Senate took another short break.

Flustered, defeated, McConnell huddled with senators and eventually determined that the Senate would return on Sunday, May 31st to give the Senate "one more opportunity to act responsibly" before the the bulk collection program officially expires. Senate Minority Leader pointed out that it was McConnell's own intransigence in trying to manipulate the Senate that led to this outcome. "'That's what happens when you try to jam everything in just a short period of time,' Reid said. When asked if anything would change next Sunday, Reid said, 'I don't know, you'll have to ask Rand Paul [and] the Republicans.'"

McConnell forcefully whipped against the House-passed USA Freedom Act, and according to one Republican aide, told senators "that a vote for USA Freedom was a vote to cancel recess." But the close initial vote on USA Freedom—a bipartisan majority of 57—suggests that without the pressure from leadership, the House reform bill could pass. The question now is whether McConnell will allow the vote, and if he'll allow the amendments Paul is insisting upon. Proponents of real reform have an actual opportunity now to come back to structure a strong reform bill. It's largely up to McConnell, who should have gotten the idea by now that he's not going to get his way.

Former Governor Jeb Bush (R-FL) addresses the National Review Institute's 2015 Ideas Summit in Washington, April 30, 2015. REUTERS/Jonathan Ernst - RTX1B18W

The chair of the Federal Elections Commission has crying "uncle" in the face of a deadlocked commission. Which is really too bad, because 2016 is shaping up to be one long exercise in candidates skirting the edge of campaign finance laws, such as they are.

As the 2016 campaign unfolds, Hillary Rodham Clinton will benefit from one rapid-response team working out of a war room in her Brooklyn headquarters—and another one working out of a "super PAC" in Washington.

Jeb Bush has hired a campaign manager, press aides and fund-raisers—yet insists he is not running for president, just exploring the possibility of maybe running.

And Senator Marco Rubio’s chance of winning his party’s nomination may hinge on the support of an "independent" group financed by a billionaire who has bankrolled Mr. Rubio’s past campaigns, paid his salary teaching at a university and employed his wife.

Bush, though, is the one who is stretching the bounds of the law—and credulity—to the stretching point, with his "if I'm running" routine. Since he's not actually declared officially, by his advisers' reasoning anyway, he hasn't had to register with the FEC and thus can go all around the country soliciting as much money as he wants for his allied Super PAC and for the "non-profit" organization also affiliated with him, and he can coordinate with them. That includes paying all the people who are advising him in his "not yet" campaign.
All share some variation of the name "Right to Rise," and Mr. Bush has headlined fund-raisers for the groups, even putting his name on invitations to more than 300 donors who attended a Right to Rise conference in Miami in April.

Technically, however, the super PAC is controlled by a Republican campaign lawyer in Washington. The regular PAC is run by a Florida accountant who has also prepared Mr. Bush's taxes. (Mr. Bush is merely the PAC's "honorary chairman.") And the nonprofit group is controlled by a former Bush aide who is widely described as the head of Mr. Bush’s policy team, but who has said the nonprofit will merely be "engaged in policy generation that is consistent with Governor Bush's optimistic, conservative message."

Oh, so he's just the chairman. The chairman who has an "optimistic, conservative message" that the whole country must hear, starting with Iowa and New Hampshire. But don't call it Bush's campaign. It's more like a hobby. An extremely lucrative hobby.
Doctors for the 99 Percent march from Zuccotti Park to St. Vincent's Hospital to demand its reopening and health care for all. October 26, 2011
Healthcare reform is not done. Not by a long shot. While Obamacare has gone a very long way toward getting people insured, and in creating some good reforms and regulations on private insurance, private health insurance can still be pretty sucky. And according to a new report from the Commonwealth Fund it's pretty sucky for nearly a quarter of the population which has private insurance.
The Commonwealth Fund counts adults as underinsured if they meet one of two conditions: their out-of-pocket costs totaled 10 percent or more of their income or if their deductible was 5 percent or more of total income. And they found that 23 percent of Americans with insurance fit into this category—up from 12 percent in 2003.

Underinsurance matters because it appears to deter people from seeking care. Underinsured people are far more likely to not go to the doctor when they have a medical problem; a quarter of the underinsured report doing this, compared with 12 percent of those with more robust coverage. They skip prescriptions, follow-up tests, and specialist visits at a rate that's inching closer to the uninsured —people with no coverage at all.

That's a very large group of people and they have been hit very hard financially: "47 percent of respondents said they exhausted their savings to pay medical bills, 23 percent were dealing with collection agencies and 7 percent had to declare bankruptcy." The major problem is deductibles, which just keep growing.
The share of privately insured adults who had a health plan without a deductible fell from 40 percent in 2003 to 25 percent in 2014
That chart shows the shrinking number of health plans that don't include deductibles—from 40 percent in 2003 to 25 percent in 2014 at the same time that deductibles are growing. Now more than in 10 people with private insurance has a deductible of $3,000 or more, up from just 1 percent in 2003. Wages and salaries are not keeping up with those increases, and in fact employee compensation has largely stagnated because health insurance costs are growing so fast for employers.

It does help that Obamacare includes essential benefits, including basic physical exams, cancer screenings, etc. But if one of those screenings requires specialized care, or follow-up testing or expensive prescriptions, co-pays and deductibles can put that follow-up care in jeopardy for too many people—44 percent in this study. That's how many "reported not getting needed care because of cost in the past year, including not going to the doctor when sick, not filling a prescription, skipping a test or treatment recommended by a doctor, or not seeing a specialist."

Having health insurance is better than not having health insurance. But if you can't afford to actually use that insurance without risking financial disaster, then it's clearly not much of a safety net. These costs have to come down. The best way yet demonstrated for healthcare spending to be controlled is through single-payer systems. So healthcare reform in this country is going to have to take the next step and expand Medicare.

Chairman of the House Financial Services Committee, Jeb Hensarling (R-TX) questions financial regulators about the effects of the Volcker Rule on employment in Washington on February 5, 2014.      REUTERS/Joshua Roberts    (UNITED STATES - Tags: POLITICS
Rep. Jeb Hensarling (R-TX)
Sen. Maria Cantwell's very dubious trade for her "fast track" vote Thursday to allow the Trade Promotion Authority legislation to go forward. She demanded from leadership, and got, votes in both chambers to extend the Export-Import Bank, the federally backed lender that helps corporations sell products overseas. One upside of Cantwell's deal is that it is at least going to create a headache for House Republicans.
It gives the bank’s staunchest opponent — House Financial Services Committee Chairman Jeb Hensarling of Texas — the opportunity to show his influence in the Capitol. If he musters the votes to shut down the bank, it would end one of the longest-running fights within the Republican Party.

But if Hensarling fails, and Congress keeps the bank’s government-backed loans flowing to buyers of American exports, the issue is sure to continue dividing the GOP—and its leaders. […]

Hensarling will square off against other Republicans, who will offer amendments to reform the bank—but not shut it down. Tennessee Republican Rep. Stephen Fincher will play a key role in the fight. He has penned a plan with what many consider serious reforms to the institution. […]

Idaho Republican Rep. Raúl Labrador argued that Boehner shouldn’t allow a vote on the bank without having it go through committee—which it never will, due to Hensarling’s opposition.

"I don't know if it makes it harder [to kill the bank]," he said of Boehner’s move. "I think he should not be doing that. I think he should allow the chairman of the committee of jurisdiction to work on this issue. What really matters is what the majority of the Republican conference wants. If the majority is not OK with it, it shouldn't be coming to the floor."

If the Republican House isn't going to be actually doing anything important about actually legislating stuff to help the nation, than they might as well be spending their energy on internecine warfare and tearing one another to shreds. And given the general bent of the current congressional majority, we're all probably better off if they're not governing.
Screenshot from HHS billboard marketing health insurance exchanges
Running health insurance exchanges, states have found, is a complicated and expensive proposition. For a handful of states, that meant opting to use the federal Obamacare exchange, which is now threatened by the Supreme Court in the King v. Burwell case, the challenge that says Congress intended to only allow subsidies to go to people buying insurance on exchanges established by states. The prospect of losing those subsidies, as well as the fact that federal support to states to maintain the exchanges ends next year, is leading states to explore merging exchanges, a provision that is allowed under the law.
The idea is still only in the infancy stage. It’s unclear whether a California-Oregon or New York-Connecticut health exchange is on the horizon.

But a shared marketplace—an option buried in a little-known clause of the Affordable Care Act—has become an increasingly attractive option for states desperate to slash costs. If state exchanges are not financially self-sufficient by 2016, they will be forced to join the federal system,

"What is happening is states are figuring out the money is running out," said Jim Wadleigh, the director of Connecticut’s exchange, hailed as one of the most successful in the country. "At the end of 2016, everyone has to be self sustaining." […]

"In the last seven business days, I've probably had seven to 10 states contact me about contingency plans," Wadleigh said, though he declined to disclose the names of states he's been talking to. "You can imagine the political backlash that would be if the names got out."

And, of course, King. Some states actually do care about the tens of thousands of their residents who could lose subsidies and believe merging with states that have their own is a viable solution, since they sure as hell can't count on a Republican Congress to come up with one. How far states can go in combining systems is the big question. States are still responsible for regulating health insurers operating within them, and many insurers don't operate across state lines, complicating any regulatory aspect that they have to deal with.

But they could share technology and things like call centers and navigators. States would still have to work out things like cost-sharing and divvying up administrative responsibilities. But it could be the best solution available barring congressional action.

Governor Rick Scott speaking at CPAC FL in Orlando, Florida. September, 2011
The Obama administration has offered Florida Gov. Rick Scott a partial compromise in Scott's ongoing fight to get federal money for health care that's not Obamacare Medicaid expansion money. Scott has asked the administration to reverse its decision—made and communicated to the state a year ago—to end a demonstration program that funded a Low Income Pool, funds that went to hospitals providing charity care. The administration is coming part way.
On Thursday, it proposed cutting more than $1.6 billion over two years in funding for Medicaid's Low-Income Pool in Florida. The offer, made in a letter from the Centers for Medicare and Medicaid Services to state officials, signals public progress in the negotiations that have been ongoing for months in that there actually is something on paper.

The LIP program has been the linchpin of the administration's fight with the state over Obamacare. It would be getting cut whether the state expands Medicaid or not, but CMS reminded Florida yet again Thursday that expansion would help make up the revenue it's about to lose through LIP—about $2 billion annually, by some estimates—while covering hundreds of thousands of poorer residents.

"We believe that Medicaid expansion as evidenced by experience in other states would bring significant benefits to low income Floridians and the Florida health care system," the agency wrote.

That's a 55 percent cut to the LIP for next year, from $2.16 billion funding this year to $1 billion next year and then to $600 million the following year. From 2006-13 the state got $1 billion a year, then got the big bump up last year. CMS is clearly letting Florida know that they can't count on this money to bail them out in their next budget crisis. It's also a signal to other states, including Texas, whose LIP money will be up for renewal in the near future. This funding was never intended to be a permanent healthcare solution, especially so after Medicaid expansion passed with Obamacare.

What this means for Scott's bogus lawsuit against the administration isn't immediately clear, but House Speaker Steve Crisafulli told his caucus that he believes this funding could resolve the current budget crisis. The legislature reconvenes next month to try to come up with a budget and stave off the government shutdown Scott has been threatening.

Screenshot of Tweet showing Chris Murphy's Senate floor appearance with poster.
That's Sen. Chris Murphy (D-CT) on the Senate floor Thursday, summing up the Republican plan for the millions of Americans who could lose health insurance with the Supreme Court's King v. Burwell decision. Nailed it.
Photo of Rep. Jackie Speier posing with poster of sage grouse armed with rocket-propelled grenade launcher.
Rep. Jackie Speier (D-CA) was not impressed.
The House passed the National Defense Authorization Act this week, and while much of the attention was on the anti-immigration aspects of the legislation, Republican lawmakers also hit the administration on the Endangered Species Act and the endangered sage grouse.
But a Republican maneuver on the $612 billion military bill to block the Interior Department from adding the bird to the endangered species list has set off a major congressional skirmish that has spilled over into Western states, where the sage grouse is revered, and among environmental groups that fear a steady erosion of the Endangered Species Act. […]

House Republicans, in advance of a legal deadline for final determination of the sage grouse status, have gone at it in several forms, most recently in the military bill. There they argued that giving the bird special status would put military training operations in peril because the birds’ habitat—which stretches across an array of Western training areas—would be essentially off limits. […]

House Democrats were not amused by these efforts. Armed with a large poster of the lesser prairie chicken wielding a rocket-propelled grenade launcher, Representative Jackie Speier, Democrat of California, accused Republicans of treating the birds as "a sort of feathery sleeper cell."

That's the excuse for adding this prohibition to the bill, but it's not reality.
Management of the bird has not "resulted in unacceptable limits on our military readiness activities," said Mark E. Wright, a Defense Department spokesman.

"Because we have already undertaken these actions voluntarily, and expect to need to manage for the sage grouse indefinitely, we do not believe the listing decision—regardless of the outcome—will affect our mission activities to any great degree," he said.

Who is really opposed to the listing, of course, is the oil and gas industry. Sage grouse habitat is also drilling and fracking ground. Groups like the Western Energy Alliance, the Independent Petroleum Association of America and the Domestic Energy Producers Alliance have been lobbying hard to prevent this listing, and they and their member organizations "are among the top donors to election campaigns of major players in Congress who have pushed legislation that would block Interior’s actions." Of course.
Senator Orrin Hatch (R-UT) talks to reporters during a series of votes in Washington December 17, 2011. The U.S. Senate voted on Saturday to extend a payroll tax cut for two months in legislation that also attempts to force President Barack Obama to appro
Thursday morning, the Senate voted to advance Trade Promotion Authority for the Trans-Pacific Partnership, but getting to cloture was a challenge. Ultimately, the price for some Democratic lawmakers to give their support was a promise from Republican leadership that they would forward an extension of the Export-Import Bank, the federally backed bank that provides assistance to U.S. corporations selling their goods abroad. They got that assurance, including from House Speaker John Boehner.
Speaker John Boehner said if the Senate passes an extension of the Export-Import Bank he would allow the bill to come to the House floor under an "open amendment process."

The plan, which Boehner said he laid out for House Financial Services Chairman Jeb Hensarling of Texas, would test support for the government-backed institution. There are sure to be amendments to end, wind down and reform the bank, which guarantees loans for companies doing business overseas.

Meanwhile, the Club for Growth is stepping up with attack ads against House Republicans who support the extension of the Ex-Im Bank.
The ads will begin Friday in the home districts of Reps. David McKinley of West Virginia, Rob Bishop and Chris Stewart of Utah, and Bill Shuster of Pennsylvania, a spokesman for the group said Wednesday.

The spots, which will air on both broadcast and cable networks, are part of $1 million campaign from the Club timed to coincide with Congress's debate over reauthorizing the Ex-Im Bank. (The bank is better described as a government credit agency that backs loans to foreign entities as incentive to sign deals with U.S. companies. The Club sees this as corporate welfare.) […]

In the TV spots, the lawmakers are criticized for supporting a "petri dish of corruption and graft." In Bishop and Stewart's case, they are compared unfavorably to fellow Republican colleagues Sens. Mike Lee and Orrin Hatch. In West Virginia, the Club said McKinley supported a program backed by Hillary Clinton and Barack Obama.

That last bit is pretty funny, the comparison with Orrin Hatch. Because the TPA bill is being managed in the Senate by Hatch, who had to have agreed with having this Ex-Im Bank vote to move TPA forward. Nonetheless, tea party Republicans in the House will probably tank the Ex-Im Bank extension, making this demand from Democrats to support TPA look pretty pointless.
U.S. Senate Minority Leader Mitch McConnell (R-KY) at the U.S. Capitol in Washington, June 27, 2013. REUTERS/Jonathan Ernst
The administration has sent dire warnings about NSA having to shut down its dragnet surveillance system of phone metadata which will expire in 10 days unless Congress acts.
"After May 22, 2015, the National Security Agency will need to begin taking steps to wind down the bulk-telephone-metadata program in anticipation of a possible sunset in order to ensure that it does not engage in any unauthorized collection or use of the metadata," the memo states.
Never mind that the Second Circuit Court of Appeals has ruled that the ongoing collection of metadata is currently unauthorized, operating illegally and subject to a constitutional challenge. Without a change in the law, the court will in all likelihood shut the program down. So that takes us to the Senate, where Majority Leader Mitch McConnell has set up Saturday cloture votes on the program. One vote is on the USA Freedom Act as passed overwhelmingly in the House. The other is on McConnell's preferred choice, a two-month extension of the program as is.

It's not clear that either bill actually has 60 votes to pass cloture. It's also not clear what happens if they do pass cloture, extending debate into next week and Memorial Day. In the case of a short extension, the House has made it pretty clear that it will reject it, and at any rate is scheduled to leave for recess on Thursday. Additionally, House leadership has committed to not trying to pass a short-term extension by voice vote or unanimous consent while the House is in pro forma sessions during recess.

So at this point, the only way the program will continue would be for the Senate to accept the USA Freedom Act without amendments. Sen. Rand Paul's not-really-a-filibuster filibuster Wednesday raises the question of whether that's a possibility. The likeliest outcome at this point is that these programs sunset, at least for a while, until the Congress comes back next month and McConnell restarts the fight between straight reauthorization and reform.

Jeb Bush
Jeb Bush apparently thinks the "compassionate conservative" idea that his brother so cynically ran on will work for him, too. He's using his Medicaid experience in Florida as evidence that he really cared about the poors, that he was reforming Medicaid to give them "more power to choose from more choices." Of course, it was really just about privatization, but that's not how Bush is going to frame it in his attacks on Obamacare. Which, by the way, he says he would repeal.
On the campaign trail, Bush describes how his Empowered Care pilot program tamed runaway costs. He said recently in New Hampshire, “We need to reform Medicaid, and there’s a plan to do that in Florida that’s a pretty good one.”

But while Bush’s plan, enacted while he was governor, did promote greater choice among private managed-care options, it also sparked a backlash among activists who charged that the very low-income Medicaid population often ended up with less care than under traditional Medicaid.

Rather than allowing more choice to improve upon traditional Medicaid, Bush's liberal critics say he gave private managed-care plans too much leeway to design the benefits, which allowed them to "cherry-pick" the healthiest, lowest-cost beneficiaries. Networks of hospitals and doctors were limited. And consumers found the lack of standard benefits confusing; some ended up with inadequate coverage that didn't give them the health care they needed.

The facts actually back up "liberal critics" on the failures of Bush's experiment, particularly for children. For example, a federal judge ruled early this year that the plan, continued under Gov. Rick Scott, neglects needy children and doesn't comply with federal law. The reimbursement rates, the judge ruled, are set so low that providers opt out and have created a shortage of pediatricians serving the neediest children. In fact, in 2013, "almost half the children covered by Florida's Medicaid program didn't get the recommended number of doctor visits in their first 15 months, putting Florida in the bottom quarter of Medicaid plans nationwide."

That's a drop in the bucket of failures. Again, in 2013, nearly one-third of pregnant women didn't get health care in their first trimester, and only half had a postpartum visit within two-months of giving birth. Among adults age 46 to 85, only half who were diagnosed with high blood pressure got adequate treatment, and more than half of them who were diagnosed with diabetes did not get eye exams to check for and treat glaucoma. Only 45 percent of the diabetes patients had their blood-glucose levels adequately controlled.

Sure, maybe Bush's plan was able to reduce costs, but it did it through reducing care, all in the name of "patient choice." And, as usual with Republican plans, it was about transferring public money to private care and the hell with the patient. And never forget that Bush's grand experiment didn't do a thing about Florida's uninsured rate, which has been second only to Texas. All of which Bush calls a complete success. Echoes of his brother and "mission accomplished."

Senate Minority Leader Harry Reid (L) and Senator Majority Leader Mitch McConnell stand together during a ceremony to present Golf legend Jack Nicklaus with the Congressional Gold Medal “in recognition of his many contributions to the game of golf and his
The Senate voted 62-38 Thursday morning to advance the Trade Promotion Authority (TPA) bill, cutting off a Democratic filibuster. Senators Patty Murray (D-WA), Maria Cantwell (D-WA), Heidi Heitkamp (D-ND), Lindsey Graham (R-SC) and Chris Coons (D-DE) were among the holdouts, voting to filibuster the last time around, and holding out on this vote until late, after much on-the-floor negotiating with leadership.
The holdouts included senators who had demanded a path forward for the extension of the Export-Import Bank. It wasn’t immediately clear if a deal was struck on that issue. […]

Sens. Maria Cantwell, D-Wash., one of the pro-trade Democrats, and Lindsey Graham, R-S.C., threatened to vote against the trade legislation without some concession for reauthorizing the Export-Import Bank beyond the end of next month, an effort Stabenow said she supported.

“Being able to get financing, and know they’re going to get paid when they export is absolutely critical,” Stabenow said earlier in the week. “For the life of me, I can’t understand why people who are promoting a free-trade agreement would want to make sure that our businesses could actually use it.”

Negotiations continued on the floor following the vote, while the Senate was in a quorum call. Barring a deal cut for unanimous consent to dispense with the bill sooner, which seems unlikely given the very large Democratic opposition to this bill, this cloture vote sets up a vote on Saturday.

8:15 AM PT:

Murray says McConnell promised her a vote in June on renewing Ex-Im Bank.

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