News, Straight to the Point

In the weeks since the unwieldy and politically unpopular task of dismantling the Affordable Care Act fell to the GOP Senate, Republican senators have been able to punt on some of the tough decisions in writing their repeal legislation until after they saw what the CBO said about the House Obamacare repeal bill.

That CBO report has now landed, and it doesn’t make GOP senators’ lives any easier. Wednesday’s report reinforced the many problems and ugly trade-offs in the House bill that Senate Republicans have been struggling with for months. It also dropped in their laps a new problem that was a result of an amendment added to the House bill that was scored for the first time in Wednesday’s CBO report: What to do about people with pre-existing conditions, whose protections under the ACA are significantly rolled back in a provision that allow states to opt out of Obamacare’s insurer mandates?

Here are five points on how the CBO score puts the big squeeze on Senate Republicans:

The waivers make pre-existing conditions protections very messy, if not impossible.

The big question for the CBO was the impact of a major, last-minute addition of a waiver provision to the House bill, which stands to violate GOP promises to protect those with pre-existing conditions.

The CBO found that one-sixth of Americans would live in states that would seek waivers so aggressive that it would create a wide variation in premiums for which the CBO did not even provide an estimate average. In those places, the individual market would grow increasingly unstable over time, as healthy people flocked to less generous plans that were allowed to medically underwrite based on health status. People with pre-existing conditions would in turn see premiums rise until some were priced out of coverage entirely. The extra $8 billion funding added to the House bill to subsidize them would not be “sufficient to substantially reduce” their “large increases” in premiums, the CBO said.

Senate Republicans have been generally open to a waiver idea, but many have insisted they want people with pre-existing conditions protected. So cleaning up that mess will be a top priority.

There’s no escaping 23 million people losing coverage.

The CBO’s top line coverage number was bad the first time the AHCA was scored and it hasn’t budged much since. Twenty-three million fewer Americans will have insurance by 2026 under the House-approved bill, which is hardly better than the 24 million in coverage losses predicted under the initial version. That downward tick in coverage losses comes in part, the CBO said, because the individual marketplace will be less attractive and more employers will thus continue to offer coverage than was projected in the March version of the legislation.

The first time around some Republicans cast doubt on the CBO’s predictive abilities and that strategy is already in play now. Nevertheless, some GOP senators have recognized those coverages numbers are far from ideal and floated more robust tax credits or a softer cushion to the Medicaid cuts as a way to improve them. The problem there, however, is that those tweaks will likely require more funding, and the Senate’s bill will still have to reduce the deficit by $119 billion over 10 years.

Medicaid remains the elephant in the room.

One of the biggest challenges in the Senate is an aspect of the House bill that hasn’t changed since the March CBO score: its massive cuts to Medicaid, which is at the heart of the legislation.

Of the 23 million fewer covered Americans under the GOP House plan, 14 million lose coverage due to the House bill’s phaseout of the Medicaid expansion and its overhaul of the larger program from an unlimited match rate to a capped system that limits funding on a per enrollee basis.

This gutting of Medicaid saves the government $834 billion, which in turn finances the $664 billion in tax cuts to industry and high earners under the House bill. But the Medicaid cuts also pits expansion state senators against non-expansion state senators. And the formula used to cap the traditional program hits different states in different ways, also complicating the bill’s path to 51 votes for Senate passage.

Older people and poor people lose out under the GOP’s tax credits.

Wednesday’s CBO report reinforced a point made in its analysis of the original version. AHCA’s tax credit scheme severely shortchanges lower income consumers and older people, the latter a key GOP constituency. That constituency is hit a second time by a provision in the bill that allows insurers to charge older consumers more than young people, when compared to the ratio allowed under current law.

A 64-year-old at 175 percent of the poverty level who lives in a non-waiver state will pay eight times more in net premiums than under the current law.

Senate Republicans, led by the conference’s No. 3 Sen. John Thune (R-SD) have promised that they will rework the tax credits so the burden on older and lower-income people is less pronounced. But doing so may require shifting some of the tax benefit away from young and healthy people, who Republicans want to incentivize into buying insurance to make the risk pool less expensive.

Premiums in some places drop, but the costs are picked up elsewhere.

There was one number in the CBO report Republicans are likely to tout. The CBO predicted that about one-in-three Americans will live in states that seek waivers for “moderate” changes to the ACA’s insurer rules that would bring average premiums down by 20 percent by 2026 while maintaining relatively stable marketplace.

But those tweaks come with their downsides.

“Although premiums would decline, on average, in states that chose to narrow the scope of EHBs, some people enrolled in nongroup insurance would experience substantial increases in what they would spend on health care,” the CBO said, referring to the ACA’s 10 Essential Health Benefits, that states would be able to opt out of or rewrite under the GOP plan.

For years, Republicans have bashed Obamacare for how deductibles have increased under its implementation. Senators will now be contemplating a plan that will even further raise out-of-pocket costs.

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Just in time to serve as a prebuttal to a much-anticipated CBO House GOP Obamacare repeal bill score, the U.S. Health and Human Services Department released a study showing, in the words of its spokesperson, that under the Affordable Care Act, “the status quo is unsustainable”

The study, conducted by the Office of the Assistant Secretary for Planning and Evaluation, found that average premiums in the 2017 exchanges used by 39 states were about double the average premiums in the entire, pre-ACA 2013 individual market.

Not surprisingly, the study made its way onto the Twitter feeds and into the floors speeches of the GOP lawmakers currently seeking to dismantle the Affordable Care Act.

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National Security Adviser H.R. McMaster on Tuesday morning marched in lockstep with the larger Trump administration narrative on reports that the President disclosed highly classified information to Russian officials, insisting during a press briefing that nothing inappropriate was shared and that the “real issue” was leaks to the press.

Yet even as he defended the White House, McMaster revealed some telling details.

He did not deny that Trump shared classified information with senior Russian diplomats, and he divulged that Trump spontaneously shared details about an Islamic State threat with a country that the U.S. intelligence community agrees intervened in the 2016 presidential election to Trump’s benefit.

These are the key takeaways from McMaster’s turn at the briefing podium.

Trump made snap decision to share info

McMaster said that President Donald Trump made a spontaneous decision to share “code-word” information, the highest level of classification, during his conversation with Russian Foreign Minister Sergey Lavrov and Russian Ambassador Sergey Kislyak.

“When was the decision made to share that information with the Russians?” a reporter asked McMaster. “Did the President spontaneously, on the spot, decide to give that information over?”

“He made the decision in the context of the conversation,” McMaster said during the White House daily briefing, which he took over from Press Secretary Sean Spicer.

He called Trump’s remarks “wholly appropriate.”

“In the moment then, during the context of that conversation?” the reporter pressed.

McMaster declined to clarify further.

He also would not confirm or deny whether the information Trump shared with the Russian diplomats was classified, saying, “I will not be the one to confirm that information that could jeopardize our security.”

The CIA and NSA were warned about what Trump divulged

McMaster confirmed the Washington Post’s reporting that the CIA and NSA were contacted following the meeting, although he would not comment on why.

“If there was nothing the President shared that he shouldn’t have shared, why did they contact the NSA and CIA?” a reporter asked.

“I would say an overabundance of caution but I’m not sure,” McMaster said. “I’ve not talked to him about that. About why he reached out.”

The Post reported that Thomas Bossert, assistant to the President for homeland security and counterterrorism, called those agencies to try to contain the damage of Trump’s revelations. Bossert’s aide also requested that section of their conversation be stricken from internal memos, and that the full transcript of the meeting be shown only to a small circle of senior staffers, according to the Post.

Asked again why the NSA or CIA would be contacted, McMaster told reporters that he, Secretary of State Rex Tillerson and Deputy Adviser for National Security Dina Powell were in the room and did not feel that the conversation “was inappropriate.”

Trump was never briefed on where the info came from

The White House has repeatedly insisted that no “intelligence sources or methods” were divulged during the Oval Office meeting, offering a defense that goes beyond what the Post, CNN, New York Times and other outlets have reported. The stories instead allege that Trump’s disclosure of highly classified information, apparently without permission from the ally that provided it, could jeopardize a key source on the Islamic State and provide Russia insight into U.S. intelligence capabilities.

McMaster argued Tuesday that Trump could not have divulged such information even if he wanted to—because the President was never briefed on the sourcing.

“The President wasn’t even aware where this information came from,” McMaster told reporters. “He wasn’t briefed on the source or method of the information either.”

McMaster stands by his statement that WaPo’s story is “false”

The national security adviser has mostly avoided the spotlight since assuming his role, working behind the scenes to bring discipline to the administration’s unruly foreign policy apparatus. This came to an end Monday night, when he was sent out to give an on-camera statement in the White House driveway calling the Post story “false” and defending the President’s right to discuss terrorist threats with foreign countries.

When a reporter offered him the chance to clarify or correct that statement after Trump said on Twitter early Tuesday morning that he did indeed share “facts” with his Russian visitors, McMaster didn’t change course.

“I stand by my statement,” he replied. “The premise of that article is false.”

Leaks are the ‘real issue’ here!

In the clearest indication that McMaster had subsumed himself into the White House communications machine, the highly-respected general argued that the leaking of classified information to the press posed a graver danger to national security than whatever Trump discussed with Russian diplomats.

“The real issue, what I would like to see debated more, is national security has been put at risk by those violating confidentiality and those releasing information to the press that can be used connected with other information available to make American citizens and others more vulnerable,” McMaster told reporters.

In response to months of damaging stories about turmoil amid White House staff, Trump’s conversations with foreign leaders, and the ongoing investigation into whether Trump campaign staffers colluded with Russian officials who interfered in the U.S. election, the President has insisted that those leaks themselves are the “real news.”

As Trump infamously put it in February, “The leaks are real; the news is fake.”

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The people who professionally study election protocols are very worried about the commission President Trump has created to ostensibly study election protocols. The so-called “Presidential Commission on Election Integrity,” which was unveiled in an executive order last week, is being viewed with deep skepticism in the voting rights community.

That is in no small part due to Trump’s outlandish and unsubstantiated claims that millions of people voted illegally in the 2016 election; the commission appears to be the result of Trump’s promises of a “major investigation” into voter fraud.

But there are also other hints, tells and coded language signaling that the aims of the commission are less concerned with nonpartisan study of election protocols and more likely to be seeking to trumpet allegations of voter fraud, which has historically been used as an excuse to enact restrictive voting laws.

Here are five points on what Trump’s bogus ‘Elections Integrity’ commission is really about:

Beware the heavy emphasis on voter fraud.

Voter “fraud” or “fraudulent” voting is mentioned five times in the executive order, which goes on to define four types of alleged illegal voting that will be within the purview of the commission. Prospective commissioners floated for the commission—and especially its vice chair, Kansas Secretary of State Kris Kobach—have made careers out of fanning the flames around flimsy fears of voter fraud and advocating for stricter voter laws.

Study after study has found voter fraud—and particularly the types of fraud prevented by a voter ID—to be extremely rare. Yet Kobach said that it was “a very large number” that was “ probably in excess of a million,” when defending Trump’s baseless allegation that millions of illegal voters where the reason he lost the popular vote.

What these stricter laws end up doing is making it harder for certain groups, particularly low income voters and minorities, to vote. One of the two Democrats reportedly tapped for the commission, Maine Secretary of State told TPM last week he would “walk away” if the commission was used as a “trojan horse” to impede access to the ballot box.

The who is as important as the what.

The Trump administration is stressing that commission will be bipartisan, but the lack of participation to this point by any moderate, widely-respected Republican election officials is notable. Instead the GOPers tapped so far for the commission are on the fringe when it comes to voting issues.

Vice President Mike Pence is chairing the commission and joining him in serving on it is Indiana’s Secretary of State Connie Lawson (R). Indiana authorities, under both their watch, launched a sketchy raid of a voter registration drive last fall, and the two Republicans have been accused of overhyping the results. Lawson has since purged Indiana’s voter rolls of nearly half-million names ahead of the next election. Previously, as a state legislator, Lawson was an original sponsor of the state’s 2005 voter ID law, which was upheld in a seminal Supreme Court case.

Former Ohio Secretary of State Ken Blackwell has also been tapped for Trump’s commission. Blackwell was at the forefront of the initial push to implement voter ID laws in the mid-aughts. As Ohio’s top elections official, he was investigated by Democrats on the House Judiciary Committee for his handling of the 2004 elections in the state. He imposed stringent requirements on voter registration drives, including a directive to ignore registrations not printed out on 80-pound stock paper.

Maine Secretary of State Matt Dunlap (D) stands out among the group, for being skeptical of voter restrictions and instead, as he described himself to TPM last week, as a “strong advocate for voter access” who was skeptical of restrictive laws. The other Democrat so far named, New Hampshire Secretary of State Bill Gardner has some—let’s say—unique views on administering elections and once said that early voting, which is used disproportionately by minority voters, “cheapens the value” of election day. He is also supportive of a Republican bill in the state that adds new requirements for certain voters to prove they live in the state, a move critics say is to make it harder for students to vote.

Red flag: No mention in the order of voter suppression.

Reports leading up to the formal unveiling of the commission suggested looking at voter suppression would also be among its charges, as a way to get Democrats to sign on.

The executive order makes no such reference in the commission’s mission, suggesting that the study of voter suppression is not actually a priority of the commission.

Kobach has continued to claim that voter suppression will also be studied. But it’s hard to take that seriously, given that voter suppression is not defined, nor even mentioned in the entire executive order text and many of the people floated to be on the commission have played it down as an issue.

Telltale sign: A peculiar focus on “confidence” in the election system.

The main focus of commission, the order says, is to study whether the public’s “confidence’ is being “undermined” or “enhanced” by certain election protocols. The emphasis on confidence reflects a broader shift in the legal defense of restrictive voting laws: in the absence of legitimate cases of voter fraud to justify the new laws, proponents have argued that because people believe there is a prevalence of voter fraud, the laws are necessary.

“All of us who work in this area know that measuring confidence in electoral rules is something that is both easy to do and amenable to gross manipulation,” Nate Persily, who served as a senior research director for President Obama’s Presidential Commission on Election Administration, told TPM over email.

Persily, an election law expert at Stanford Law, has worked on studies that showed factors like partisanship, education and one’s trust in government influence confidence in an election, beyond actual instances of fraud or restrictions placed on voting ostensibly meant to prevent fraud.

The order is fixated on voter registration issues.

The order mentions time and again the commission’s interest in instances of “fraudulent” or “improper” voter registration. This is no coincidence. Overblown concern about non-citizens being registered to vote is the latest frontier in the campaign to enact stricter laws.

Kobach has been seeking to implement a proof-of-citizenship registration requirement, while elsewhere organizations that conduct voter registration have been targeted by GOP lawmakers.

Election experts and voting rights advocates acknowledge that yes, occasionally mistakes are made and people such as felons or non-citizens are accidentally registered to vote, for instance, while getting a driver’s license. But oftentimes, the ineligible voter never casts a ballot, and doesn’t even realize he or she was registered, and thus prosecutions have been rare.

Furthermore, the order disregards the importance of intent in the commission’s investigation of irregularities.

The commission will study acts conducted “regardless of the state of mind or intent of that individual,” the order says in its definition of “improper voting” and “improper voter registration.”

“They seem to want to reach even those individuals and elections administrators who make an honest mistake or in the course of administering an election to hundreds of millions of Americans,” said Janai Nelson, Associate Director-Counsel of the NAACP-LDF.

Nelson worried that those instances “may be manipulated to paint a picture of voter fraud that really is not existent.”

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In the wake of their razor-thin vote to repeal the Affordable Care Act, House Republicans and President Trump have trotted out a number of misleading and outright false claims about their bill’s provisions and its potential impact on millions of Americans.

These talking points are aimed at obscuring the bill’s most unpopular provisions, including massive cuts to Medicaid, the shrinking of tax credits for low-income and older Americans, and the waiver of some insurance market reforms designed to protect people with pre-existing conditions.

Here are five of the biggest whoppers Republicans are telling about the American Health Care Act:

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Despite immense pressure this week from GOP leadership and the White House—which desperately wanted their Obamacare repeal bill to pass within President Trump’s first 100 days in office—moderate Republicans held out. Trumpcare 3.0 met the same fate as its previous iterations, and everyone promised to try again later.

Rep. Charlie Dent (R-PA), the co-chair of the centrist Tuesday Group, says he and his colleagues have so many concerns about the core policies in the plan that Republicans should consider starting over. “We need to change the paradigm,” he told reporters Friday. “I think the bill has got too many problems, and they need to rework it from the center out.” Specifically, Dent and other holdouts cite the bill’s deep cuts to Medicaid, rate hikes for older Americans, and insufficient protections for people with pre-existing conditions.

But GOP leaders are not heeding his advice, and are instead vowing to keep trying to get the same Obamacare repeal bill to President Trump’s desk in the weeks to come. These are the not-yet-addressed concerns that will come back to haunt them.

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There was always a sense that in some states, Republicans’ refusal to expand Medicaid under the Affordable Care Act was at least somewhat rooted in resistance to the President who lent the law its nickname.

Yet one presidential election, a Republican administration and a failed Obamacare repeal bill later, it’s unclear whether the dynamics that have kept 19 states from opting into Medicaid expansion have truly shifted.

The expansion increases eligibility for the program up to 138 percent of the federal poverty line, with the federal government paying for the bulk of the expanded program; it will phase its contribution down slightly to 90 percent by 2020, however. A 2012 Supreme Court decision made states’ participation in Medicaid expansion optional, so even in states where Republican governors have sought to expand the program, GOP legislators have resisted tooth and nail, citing concerns of fiscal responsibility and state sovereignty.

Here are five points on what fundamentals underlying Medicaid politics stand to change under President Donald Trump and whether more states will be encouraged to expand:

Some states renewed their expansion efforts amid Congress’ Obamacare repeal push

As national Republicans considered—and ultimately pulled—Obamacare repeal legislation that would have scaled back Medicaid expansion, policymakers in a handful of non-expansion states revived their efforts to opt into the program. In Kansas, state legislators were just three votes short of overriding Gov. Sam Brownback’s (R) veto of an expansion bill. Virginia Gov. Terry McAuliffe (D) amped up the public pressure to expand Medicaid there, but was ultimately stymied by a GOP-controlled legislature.

A handful of Republican lawmakers in North Carolina also introduced their own expansion proposal, a first coming from any GOP legislator in the state, as their newly-elected Gov. Roy Cooper (D) continues a court battle to enact expansion without the help of the state legislature. Utah Gov. Gary Herbert (R) met with the Trump administration last month to talk about getting waiver approval for a limited version of Medicaid expansion. And voters in Maine will get to weigh in on the issue with a ballot initiative this November.

At least in the case of Virginia, McAuliffe’s push to expand Medicaid appeared to be in reaction to the prospect of U.S. House legislation to repeal Obamacare and the renewed progressive energy around defeating repeal. Elsewhere, the timing may have been coincidental.

The political landscape didn’t drastically change as renewed expansion efforts fell short

That flurry of activity was not necessarily a sign of national momentum toward growing the Medicaid expansion map, health policy experts and consultants who work with states seeking to expand the program told TPM.

In places like Virginia, the renewed effort to expand was a rehash of old fights.

“Unfortunately, because politics are so strong in the states that haven’t expanded yet, I don’t know if we are actually going to see a whole lot of states make it across the [finish] line in the next six months, potentially the next year or two,” said Laura Summers, senior director of the Medicaid practice at the health care consulting firm Leavitt Partners.

In other places like Utah and Idaho, Medicaid expansion appears stuck in a political middle ground: Always on the burner but unable to to be brought to a full boil.

“Politically its just very difficult to do, particularly in the states sort of on the fence. They have been no the fence for a long time, and so getting them to get over the fence, they just don’t have that push just yet,” Summers said.

Uncertainty around the future of Medicaid expansion is a double-edged sword

For some expansion crusaders, the prospect of Republicans eliminating the program down the road has been a motivating factor. North Carolina’s Cooper, for instance, rushed though an expansion application in the final days of the Obama administration in hopes that it would get done before Trump’s inauguration, but state GOP lawmakers sued and had initial success in blocking him from expanding unilaterally under Obama.

In other states, the uncertainty about Medicaid expansion’s fate may be a reason to hold back, according to Diane Rowland, executive vice president at the Kaiser Family Foundation.

“Repeal and replace has put kind of a cautionary damper on, ‘Oh but should we get in before the window closes or if we get in are we stuck before the window closes?’” she said.

Trump loosening the standards around waivers for states may not do the trick

Early on after being confirmed as Health and Human Services Secretary, Tom Price, along with Seema Verma, Trump’s administrator of the Centers for Medicare & Medicaid Services, sent a letter to governors signaling that they would be far more amenable than their predecessors to allowing conservatives to impose extra obstacles, like work requirements or cost sharing, on Medicaid recipients.

“On the surface you would think that that would maybe lower the barriers a little bit or make the idea of expanding Medicaid seem a little more palatable,” Kathy Hempstead, a senior advisor at the Robert Wood Johnson Foundation, told TPM. “That being said, when I talk to people in those states, they don’t sound like they think the fundamentals have changed that much.”

Instead, red states that have already expanded Medicaid may be the ones who take advantage of this new flexibility, according to Summers.

“I do think you will see states that have already expanded resubmit waivers to get more of those elements included,” she said.

State-level political shifts are likely to play biggest role in moving the dial

State elections matter when it comes to Medicaid expansion. The election of Gov. John Bel Edwards (D), who replaced Obamacare-hater Bobby Jindal (R), allowed to that state to expand Medicaid even in the face of a GOP legislature resistant to the move.

In states where the legislature has to give their approval in order to expand Medicaid, more nuanced shifts in state politics is what ultimately moves the dial. Kansas only came as close as it did to expanding the program after the state’s distaste for Brownback—a deeply unpopular, far-right governor—resulted in many of his allies in the legislature being voted out of office last year in favor of Democrats and more moderate Republicans.

“Certainly in Kansas, they shifted to be slightly more moderate than previously, so obviously state legislative elections matter,” Rowland said. “We see in Virginia that the legislature is still resistant, though the governor has tried one again to [expand.]”

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Embattled Alabama Gov. Robert Bentley (R) may finally be giving up. reported that the governor, for whom impeachment hearings started Monday, is expected to step down this week over his elaborate efforts to conceal an alleged affair with a former aide that investigators say misappropriated state resources and ran afoul of ethics laws.

Bentley’s lawyers are now reportedly trying to ease his departure from the governor’s mansion. Sources told that those attorneys are engaged in negotiations to allow Bentley to resign from office and plead to lesser charges. The Alabama Ethics Commission last week determined that there was probable cause to believe the governor committed four felony violations of state ethics and campaign finance laws while carrying out the alleged dalliance with his former top advisor, Rebekah Mason (both have denied having a physical affair).

While Bentley maintained as recently as Friday that he has “done nothing illegal,” his attorneys failed to block the release of a damning, 131-page state House Judiciary Committee report laying out the state’s evidence.

Here are five wild, revelatory details TPM pulled out of the lengthy so-called "impeachment report" and its supporting exhibits.

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You could call it “scoremeggedon” or you could call it #cbOMG!" Either way, the Congressional Budget Office dropped a giant, 24-million-person bomb on Republicans’ Obamacare repeal effort Monday.

The agency found that the GOP’s leading legislation, the House’s American Health Care Act, would prompt 14 million people to lose their coverage next year, and by 2026, there would 24 million more people uninsured compared to the current projections under the Affordable Care Act.

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President Donald Trump on Monday morning signed a new executive order temporarily barring travelers from a list of predominantly Muslim countries, replacing the widely-criticized order that he signed in January and that sparked nationwide protests.

The previous travel ban had been stayed in the courts, prompting the Trump administration to issue a new order rather than continue to fight for its previous one in court.

This replacement includes several substantive changes, including eliminating Iraq from the list of countries from which travelers will be banned. But the rollout of the new order was also handled in a drastically different manner, suggesting a different public relations strategy for Trump's second swing at a travel ban.

Below are five key takeaways from the new order:

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