Wednesday, March 29, 2017

It's Not Happenstance That Americans Pay So Much For Prescription Drugs


A few weeks ago Digby and I went to dinner with Ted Lieu and Ro Khanna, two of Congress' most dedicated legislators-- guys actually looking for ways to make people's lives better. We asked David Dayen to come as well so he could explain the intense research he has been engrossed in involving pharmacy benefit managers. His piece, "The Hidden Monopolies That Raise Drug Prices," is running in the new issue of the American Prospect and it's worth reading in its entirety. But first a 101 definition for those who may not have heard of a pharmacy benefit manager (PBM), simply "a third-party administrator of prescription drug programs for commercial health plans, self-insured employer plans, Medicare Part D plans, the Federal Employees Health Benefits Program, and state government employee plans. 266 million Americans are dependent on them doing a good job, which the American Pharmacists Association says includes "contracting with pharmacies, negotiating discounts and rebates with drug manufacturers, and processing and paying prescription drug claims.. striving to maintain or reduce the pharmacy expenditures of the plan while concurrently trying to improve health care outcomes." Sounds powerful, right? And that kind of power inevitably leads to abuse including lawsuits involving fraud, deception and antitrust claims.

Dayen pointed out that most people blame insurance companies and/or pharmaceutical companies for raising costs in the health-care system. He wants you to know how the PBMs have "morphed from processors to predators... Over the past 30 years, PBMs have evolved from paper-pushers to significant controllers of the drug pricing system, a black box understood by almost no one. Lack of transparency, unjustifiable fees, and massive market consolidations have made PBMs among the most profitable corporations you’ve never heard about."
Americans pay the highest health-care prices in the world, including the highest for drugs, medical devices, and other health-care services and products. Our fragmented system produces many opportunities for excessive charges. But one lesser-known reason for those high prices is the stranglehold that a few giant intermediaries have secured over distribution. The antitrust laws are supposed to provide protection against just this kind of concentrated economic power. But in one area after another in today’s economy, federal antitrust authorities and the courts have failed to intervene. In this case, PBMs are sucking money out of the health-care system-- and our wallets-- with hardly any public awareness of what they are doing.

Even some Republicans criticize PBMs for pursuing profit at the public’s expense. “They show no interest in playing fair, no interest in the end user,” says Representative Doug Collins of Georgia, one of the industry’s loudest critics. “They act as monopolistic terrorists on this market.” Collins and a bipartisan group in Congress want to rein in the PBM industry, setting up a titanic battle between competing corporate interests. The question is whether President Donald Trump will join that effort to fulfill his frequent promises to bring down drug prices.

Dr. David Gill is a policy-driven progressive candidate running for Congress against a backbench garden variety Republican incumbent, Rodney Davis, in a central Illinois swing district, IL-13. (Blue America has endorsed him and you can contribute to his campaign here.) This morning, after reading Dayen's article, he told us that as an emergency department physician he doesn't have direct dealings with pharmacy benefit managers. "However," he added, "it comes as no surprise to me that such abuses take place. Given that the benefit managers are subcontractors of insurance companies whose primary mission is to maximize their profit, it should be no surprise to anyone that these benefit managers are also largely focused on maximizing their own profit, and that the well-being of patients is of secondary importance. Until we finally adopt a single-payer healthcare system administered by the federal government ('Medicare for all'), such abuses will continue within many different layers of healthcare here in America. Uncle Sam does not run Medicare in order to make money; if only the rest of our healthcare system was run with such noble intentions."

Jason Westin is a first time candidate, a cancer researcher specialist and physician in Houston, who's running against reactionary GOP incumbent John Culberson, a long-time-corporate puppet. We turned to Jason immediately when Dayen made us aware of the PBM problem. He told us that as a cancer doctor he has "seen first hand the hard choices that patients are often forced to make when it comes to medications. Many of the newest and most promising new anti-cancer medications are also the most expensive due to unregulated pricing by Pharma and by the hidden charges of the pharmacy benefit managers (PBM). This predatory pricing puts desperate and vulnerable patients between a rock and a hard place. If they purchase the drug and it works, they will need to decide if they can continue to pay for it longterm and face financial ruin, or quit after a while and take their chances. If they do not purchase the drug, their families may long wonder 'what if?' As PBMs no longer provide any real benefit to patients, loosening their stranglehold on prescription medications should be a bipartisan issue. Many uninformed GOP members of Congress, like John Culberson of TX-07, think drug pricing would be solved if we could 'open up purchasing across state lines' (actual quote from 3/25/17 Town Hall). Their ignorance on the insidious effects of PBMs on drug pricing means they are completely incapable of regulating them: how can you fix what you do not understand?"

Like David Gill and Jason Westin, progressive candidates Tom Guild in Oklahoma and Kim Weaver in Iowa are running against extreme right wing incumbents, respectively Steve Russell and Steve King. Both had the same reaction to the GOP attack on Americans' privacy yesterday. "It's disappointing and disgusting that Big Corporate donations of nearly $100 million doled out  to members of Congress," said Tom, "including my opponent incumbent Clyde 'Steve' Russell, carried the day. Russell joined the list of U.S. House Members who were all but bribed to vote to take away Americans internet privacy, to the extent that even our browsing history can be peddled to the highest bidder, like a cyber-Snickers bar. As they say about Clyde and other career politicians who voted for this outrageous legislation, they can’t be bought but they can be rented for long periods of time. I’m looking forward to defeating Wall Street lackey Russell in November of 2018, and taking back our rights and freedoms, including the right to privacy, that Clyde blithely sells to the highest Wall Street and Big Corporate Bidder. Has he no shame? Apparently, not!"

"Once again Steve King showed that his loyalty rests with his corporate sponsors rather than with the people of Iowa," Kim told us. "I'm appalled that he thinks it's okay for cable and internet companies should have the right to sell our private information. The people of this district will be outraged when they see this vote-- American's privacy should not be for sale!"

Back to Dayen's piece, which doesn't end quite as bleakly as it starts. He's looking for a way to solve this mess:
Amid frustration on all sides of the market, some private-sector actors are attempting to break the PBM stranglehold. A group of 20 large employers representing four million patients, including Coca-Cola, Marriott, and Verizon, have formed the Health Transformation Alliance, seeking to break away from the “patchwork of complicated, expensive, and wasteful systems” in modern health care, including the pharmaceutical supply chain.

The alliance has expressed interest in a “transparent PBM” model, which takes a flat administrative fee on each prescription, with all rebates and discounts fully disclosed and no hidden spreads. Transparent PBMs only have a sliver of the market, but they can get results: A hospital nonprofit network named Meridian Health Systems claimed to Fortune magazine that a transparent PBM saved it $2 million in the first year, about one-sixth of its total drug costs.

But many employers don’t know enough about the system to go outside the Big Three, says Susan Hayes. “They’re trying to manage something they don’t understand. If you put blinders on, and hire one of the Big Three, you won’t get in trouble with the boss.”

Another model would empower pharmacies. A 2016 report from the Institute for Local Self-Reliance highlights a quirk of law in North Dakota, which only allows drugstores to operate if owned by pharmacists (similar laws exist in Europe). The law prohibits chain pharmacies from entering the state. Not surprisingly, North Dakota’s independents deliver among the lowest prescription drug prices in the country, along with better health outcomes and more drugstores per capita than any other state. This flies in the face of industry claims that big chains and giant conglomerates save consumers money or improve services.

Why can’t this successful model be replicated elsewhere? “The answer is PBMs,” says Stacy Mitchell, the report’s author. “Because in North Dakota, independents are the only game in town, PBMs have to negotiate with them. In other states, they have no leverage.” Unsurprisingly, PBMs and chains want the North Dakota law overturned rather than adopted in other states.

For a more immediate impact, we must turn to Washington. And there, solutions often emerge when one large industry starts pointing the finger at another. Under fire for their many drug-pricing scandals, from Martin Shkreli to Valeant, the pharmaceutical industry has tried to deflect blame by citing PBMs. GlaxoSmithKline CEO Andrew Witty said in a February conference call that so much of the list price on the company’s drugs went to “non-innovators in a system which thinks it’s paying high prices for innovation,” a veiled reference to PBMs. An industry-funded report in January asserted that manufacturers took only 63 percent of gross drug revenues, attributing the decline to discounts and rebates paid to PBMs. (Of course, this hasn’t stopped pharmaceutical companies from earning higher profit margins than any other industry.)

For their part, PBMs insist that drug prices would be even higher without them, arguing that they deliver broad access to medications and 90 percent customer satisfaction rates. But in an industry-on-industry arms race, the millions of dollars that leading PBMs and their trade groups spend each year on lobbying would be no match for the pharmaceutical industry. That creates opportunities for longtime PBM opponents in Washington, which include several Republicans representing rural districts, where independent pharmacies are getting crushed.

Doug Collins, a third-term House member, experienced the PBM issue personally, when his mother couldn’t get her regular medications and her plan had no substitute on the formulary. “I am a free-market person, as conservative as they come,” Collins says. “When dealing with this, it’s not a free market.” Buddy Carter, his colleague, has worked in independent pharmacies since 1980, and sees himself as their voice in Congress. I asked him if he had difficulty explaining the PBM market and its problems to his colleagues. “Heck, it’s difficult for me to understand and I’ve worked in the industry over 35 years!” Carter says.

Watch some hearing soundbites from these two and you’d think you’re seeing the second coming of William Jennings Bryan. “Who will my folks in my district of Georgia call, when they need someone at night and their local pharmacist is the one they trust?” Collins asked two PBM representatives in 2015. “They’re going to try and find their local pharmacist, who has been closed because of the anti-competitive nature of this field.” Carter grilled top PBM lobbyist Mark Merritt in 2016: “I notice that the profits of the PBMs have increased enormously over the past few years. In fact, almost doubled. And I find that very disturbing.” These are conservative Republicans!

What can Congress do to reform PBMs? More than 20 states have passed laws to require more frequent MAC list updates, so PBMs can’t drag their feet and generate large pricing spreads. But PBMs started to circumvent the laws, in one case by eliminating the term “maximum allowable cost” from contracts. Collins’s bill, the MAC Transparency Act, would take care of this at a federal level, to stop the game-playing.

Other bills in the House and Senate would prohibit retroactive DIR fees on Medicare Part D plans, stopping the after-the-fact clawbacks on pharmacy reimbursements. A separate bill would allow any willing pharmacy to participate in a PBM’s preferred pharmacy networks if they agree to the terms, increasing access in communities without chains. All of these bills would add transparency to the system, and reduce the incentives to constantly jack up prices. And they all have bipartisan cosponsors.

...The wild card in all this is Donald Trump. At his one and only pre-inauguration press conference, Trump singled out drug companies for “getting away with murder,” vowing to create “new bidding procedures” for Medicare and earning praise from the likes of Bernie Sanders. But when Trump met with pharmaceutical executives two weeks into his presidency, he focused more on speeding up new drug approvals from the FDA and cutting regulations than on reducing industry profits. This lines up with the perspective of a key aide, Silicon Valley billionaire Peter Thiel, who wants to overhaul the FDA process. (In fact, the Republican Congress just overhauled the FDA process in one of the last bills signed by Barack Obama.) Trump doesn’t appear to understand the cost excesses in the supply chain.

Trump did say in his address to a joint session of Congress that he would “bring down the artificially high price of drugs.” And in his confirmation hearing, Health and Human Services Secretary Tom Price, discussing Trump’s idea for competitive bidding in Medicare, said that “right now the PBMs are doing that negotiation… I think it is important to have a conversation and look at whether there is a better way to do that.”

But where Trump’s team will ultimately land is unknown. “We need to get to a point of clarity about whether the administration is serious,” says the NCPA’s John Norton. Furthermore, any attempt to move forward legislatively on any part of health-care policy will run headlong into the deeply polarized debate over the Affordable Care Act. While a bipartisan alliance appears possible on the PBM issue in isolation, it will be difficult to separate anything health-related from the Obamacare vortex.

The PBM industry’s leading trade group isn’t sleeping on the possibility of an attack. Days after Trump met with pharma execs, the Pharmaceutical Care Management Association issued an internal memo leaked by Buzzfeed, stressing the need for “building a political firewall” in Congress to stop any legislative action.

Frightened about drug manufacturers highlighting a “bloated supply chain,” PCMA CEO Merritt laid out a six-point strategy that included meetings with White House staff and key members of Congress, a digital ad campaign targeting congressional leaders, partnerships with right-wing think tanks like the American Action Forum, and working groups to shape regulatory changes that make PBMs the savior instead of a villain. “We will continue to show how competition—not government intervention-- is the way to manage high drug costs,” Merritt wrote, apparently without irony. Merritt even scheduled a meeting with the main health insurance lobby, AHIP, “to make sure the payer community is aligned and coordinated.”

With drug companies on one side and PBMs and insurers on the other, both camps will have plenty of resources. In that environment, is bipartisan action possible to break up a powerful monopoly? “My answer would be absolutely,” says Representative Carter. “Everyone is impacted by prescription drug prices.”

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The Will Of The Voters Be Damned-- Republicans Still Aren't Done Trying To Kill The Affordable Care Act


Republicans are hoping voters already forgot this

Kansas has mostly been a one-party state in contemporary politics. Their entire congressional delegation is Republican. All 6 statewide elected officers are Republicans and the state legislature-- blood red. Of the 125 House members, only 40 are Democrats and in the state Senate-- 40 members and just 9 lonely Democrats. And yet... Monday's Kansas City Star reported that the legislature is moving towards expanding Medicaid along Affordable Care Act lines. This is Sam Brownback and Kris Kobach's state. The legislature is ignoring Brownback in this battle. Tuesday morning he state Senate voted for expansion of KanCare-- 25-14 (two votes shy of a veto override if Brownback blocks the bill).
“I can’t believe it took this long to do it,” said Sen. John Doll, a Garden City Republican... “This is something that’s long overdue.”

House Bill 2044 would expand health care coverage to an estimated 150,000 people in Kansas. Moderate Republicans and Democrats helped push the bill through the Legislature this session in a stark contrast from past years where expansion efforts failed to gain much traction in either chamber.

David Jordan, the executive director of the Alliance for a Healthy Kansas, one of the main advocacy groups pushing the bill, said he thinks the “level of support in both chambers reflects the fact that a majority of Kansans support expanding KanCare… They understand what this means for keeping their local hospital open.”

Conservative Republicans tried repeatedly to change the Senate legislation before it came to a vote. All of those efforts failed, however, with moderate Republicans frequently siding with Senate Democrats in opposition to the changes.

“It’s very gratifying that people had the sense to see that we needed to not be distracted by the political games that are being played in Washington, D.C., and we needed to try to help our own people,” said Senate Minority Leader Anthony Hensley, a Topeka Democrat.

Opponents of the bill have spent much of the 2017 session downplaying the legislation’s chances because of uncertainty over how health care would change under President Donald Trump’s administration.

“We’re standing at an amusement park ride that’s closed,” said Sen. Ty Masterson, an Andover Republican who voted against expansion. “It’s broken. And we’re saying we want to go ahead and get on the ride. There’s a reason there’s nobody in line behind us.”

But the opponents’ argument faded slightly after U.S. House Speaker Paul Ryan, a Wisconsin Republican, canceled a vote on a bill that would have repealed the Affordable Care Act and effectively barred states from expanding Medicaid beyond March 1, due to a lack of GOP support.

The Affordable Care Act enabled states to expand Medicaid, which provides health coverage to the disabled and low-income families, to cover people who earn too little to buy insurance through the federal health care exchange but also earn too much to otherwise qualify for Medicaid.

...If Brownback vetoes the bill, it would take 84 votes in the House and 27 in the Senate to override his opposition.

Once he gets the bill, the governor has 10 days to either sign the bill, veto it, or let it become law without his signature.

Conservative lawmakers have said they hope that Brownback vetoes the bill, while moderates and Democrats fear he’ll do just that.
Kansas is one of only 19 states that haven't expanded Medicaid to benefit their citizens. What's interesting about what happened in Kansas yesterday is that the NY Times was reporting at the same time that Trump and Ryan are being pressured by the hard right of the party to go for a Obamacare repeal (with no replacement). Ryan won't tell anyone what's in the new iteration of the repeal he has in mind-- presumably more than the one-sentence bill Alabama crackpot Mo Brooks already introduced. "Just days after President Trump said he was moving on to other issues, senior White House officials are now saying they have hope that they can still score the kind of big legislative victory that has so far eluded Mr. Trump. Vice President Mike Pence was dispatched to Capitol Hill on Tuesday for lunchtime talks."

Brooks' bill: "Effective as of Dec. 31, 2017, the Patient Protection and Affordable Care Act is repealed, and the provisions of law amended or repealed by such Act are restored or revived as if such Act had not been enacted."
The new talks, which have been going on quietly this week, involve Stephen K. Bannon, the president’s chief strategist, and members of the two Republican factions that helped sink the bill last week, the hard-right Freedom Caucus and the more centrist Tuesday Group.

Any deal would require overcoming significant differences about how to rework a law that covers about one-fifth of the American economy, differences that were so sharp they led Mr. Trump and Mr. Ryan to pull the bill from consideration just as the House was scheduled to vote on Friday.

Still, Republican members of Congress said they hoped that revisiting the issue would lead this time to a solution and a vote in the House.

“I think everyone wants to get to yes and support President Trump,” said Representative Dave Brat, Republican of Virginia and a Freedom Caucus member. “There is a package in there that is a win-win.”

Representative Raúl Labrador of Idaho, another Freedom Caucus member, said he hoped the discussions would yield a compromise that brings the party together after a divisive debate that revealed deep fissures. “I think we will have a better, stronger product that will unify the conference,” Mr. Labrador said.

Mr. Trump has sent mixed signals in recent days, at times blaming the Freedom Caucus, outside groups and even, it appeared, Mr. Ryan. On Monday, for instance, he said in a late-night Twitter post that the Freedom Caucus was able to “snatch defeat from the jaws of victory” over the health care repeal. “After so many bad years they were ready for a win!”

But then he suggested that he could also cut a deal with Democrats, a move that would almost certainly make more conservative members of the House balk. “Don’t worry,” he tweeted later Monday night, “we are in very good shape!”

Mr. Ryan said House Republicans were determined to use the next version of the repeal bill, like the first version, as a vehicle to cut off federal funds for Planned Parenthood clinics.
So, this is already headed in the same dumpster fire direction as the first two failed attempts.

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Tuesday, March 28, 2017

Trump's More Like Journey Or Confected Nashville Crap Than Like Punk Rock


When they were younger, music fans of a certain age had to choose-- Beatles or Stones. The next generation had a similar choice-- Pistols or Clash. I liked the Beatles-- a lot. I used to take acid when a new Beatles album came out so I could really get into it fully. But, like Trump, I was a Stones guy. By the time punk rock got going I was a dj on KSAN in San Francisco and KSJO in San Jose. Many people in the Bay Area will tell you that the first time they heard Anarchy In the U.K. or God Save the Queen was on one of my radio shows. Maybe other American DJs did live interviews with the Pistols as well but one of the ones I did with them wound up on an album, Big Tits Over America. I got fired from KSJO over that one. Anyway, I always preferred the Clash-- more coherent, more melodic... truth be told, easier.

Johnny Rotten was in the "news" yesterday-- "backing" Trump and Brexit:
Godfather of punk, anarchist and former Sex Pistol John Lydon, AKA Johnny Rotten, was on the show this morning promoting his limited edition new book Mr Rotten's Songbook. Having built a career on his anti-establishment views, he didn't shy away from talking about todays political landscape.

Lydon came out in support of Brexit claiming the working class had spoken and that he would stand by them. He also claimed he could see a possible friendship in Trump, praising his ability to terrify politicians. Rotten himself inspired a generation of anarchists.
This alt-right character Paul Watson is a real dirt-bag-- and is either incredibly stupid about what punk rock is or is just trying to deceive the simpleminded people likely to care what he has to say. Worth watching though:

In late January, his former bandmate, L.A. resident Steve Jones, also flogging a book Lonely Boy: Tales From a Sex Pistol, was asked about Brexit and Trump. Being more of an American these days, he went right for the Trumpy part of the question:
So we’re living in crazy times, obviously. You’ve probably been asked this but in the wake of Brexit and also Trump’s presidency, do you feel like we need another Sex Pistols right now?

Well, to be honest with you, I think Donald Trump is the modern-day Johnny Rotten.

Wow. What? Why?

Well, they have the same color hair, and he’s basically come out of left field, with no experience of anything, and he’s just doing it. Like, not in the normal way that all the others do it. It kind of is a bit like Sex Pistols-like, if you want to look at it like that. You know, it’s an odd one.

You’re not trying to say that Donald Trump is punk rock, I hope?

No. I’m not saying that, but as far as politics goes, he’s about as knowledgeable about politics as we was in playing rock music when we first started. Don’t misquote me, though!
I'm not sure who the first person was to mislabel Trump a punk, but we tried explaining why that's embarrassing earlier this month. Kyle Smith made the assertion, derogatorily, on Nov. 9 in the NY Post.
Donald Trump may favor stodgy blue suits and boring red ties and wear his hair in a strange double combover, but don’t be fooled. That’s how he looks, not who he is. Who he is is a guy with a safety pin through his nose and a purple mohawk. He just pulled off the most punk act in American history.

If you’re a Hillary Clinton voter, or a member of the average media outlet, observing the Trump phenomenon to you was like watching Frank Sinatra in the 1970s: has-been, used-up, going through the motions appealing to a rapidly disappearing demographic, relying entirely on crusty oldies like “My Way.”

Yet the version of “My Way” Trump actually represented was the one gargled by Sid Vicious, the short-lived Sex Pistol, over the closing credits of Goodfellas-- crude, sneering, shocking, postmodern. None of us could believe what Trump was doing-- because no one had ever seen anyone do it that way before.

Remember when somebody mentioned the sainted war hero John McCain and Trump wisecracked that he couldn’t be that much of a hero if he got caught? Punk!

Remember when he promised a big announcement that he was ready to concede that President Obama was actually born in the United States and every news hound covered it as if it were the Super Bowl? He turned it into an infomercial for his new Trump hotel in the Old Post Office building on Pennsylvania Avenue in DC.

Hey, what’s more punk than shameless love of filthy lucre?

Remember when Hillary Clinton, Lisa Simpson-like, was busily organizing a landslide?

She did everything by the book. She amassed a prim little army of do-gooders, covering her bases by opening proper little field offices in every burg in America, even in Dallas and Houston. Trump scoffed, and sent out some 3 a.m. tweets. (Hillary, we learned from WikiLeaks, once needed 12 staffers and 12 hours of deliberation to craft a single tweet.)

Even Trump himself often seemed so ambivalent about the position he found himself in that the most seasoned political reporters openly wondered if he even wanted to win.

Just not giving a flying fig is the quintessence of punk.

Trump didn’t just throw out the playbook, he set fire to it. And America loved it. Not releasing his taxes? Fine, said America-- can you help us game the system too? So antagonizing the media that major news outlets dropped all pretense of neutrality and openly campaigned against him? Not a problem, said America-- we hate those sons of bitches too, and the enemy of our enemy is our friend.

Punk is the art of taking the stage with no preparation whatsoever and screaming: It’s me against the world, and what the freak are you gonna do about it?

The last year-and-a-half it was Trump against the world, and the world lost.

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A Military Perspective On Border Security And Terrorism-- Learning Lessons From Military Service


-by Kevin Lenau,
National Security Advisor to the Tom Wakely for Congress Campaign

As an officer in training for the Marine Corps, I recall many days and nights spent running through the woods, digging fox holes, and sitting in rain and mud, watching a small opening in the trees. At the time, I could barely see how these skills were applicable for the job I was then training for, let alone predict how they could be of use to me in civilian life. Yet, it’s been seven years since my time training in Virginia, and even today I am able to take wisdom I earned then, and apply it today to make the best decisions I can. I only wish I could say the same about the decisions that are being made by our current administration.

Building a wall, the travel ban, and conducting indiscriminate ICE raids are mostly symbolic gestures meant to consolidate political support at home, but from a practical point of view, violate basic military concepts and actually put America in a less secure position. These political gestures of power in fact have very limited benefits for national security, and in actuality have a number of wide-ranging risks. From a basic military perspective, specifically one concerned with antiterrorism goals, these measures are entirely misdirected.

Let’s start with the wall. On its surface, this idea sounds strong and decisive, one meant to directly curtail issues of drug flow and illegal immigration that America has been dealing with for decades. Yet, beyond this visceral symbolism, a basic understanding of security and defense shows us that such a wall will actually have far more negative implications for the American people. In the military, there exists a core tenant in the planning of defensive positions called “defense in depth.” This is the idea of having overlapping tactics that use geography, technology, and human behavior in sync with each other in order to create high level security and safety. Think of using ground radar to detect foot traffic at a border crossing and using UAVs (drones) as a quick response force. Building the proposed wall along the Mexico-U.S. border would drain resources from this proven multi-layered strategy in order to implement an idea with only one layer instead. The opposite of sitting in the rain staring at a specific spot based on intelligence, terrain and strategy.

Further flaws that will create more problems than solutions for the USA include messaging and prioritization. The message being perpetuated is one of hostility and fear, the same type of language used by the Soviets in their explanation for the construction of the Berlin Wall. This is important to note due to the importance of messaging and civil affairs to modern military operations, a lesson which has been learned over the last 50 years of military history. In this case, the best message to send out is that the United States is monitoring the most desolate and dangerous crossing areas, thereby decreasing the number of migrants and smugglers using these most hazardous routes, which would result in overall decreases in these types of illegal activities.

On prioritization, the wall challenges all illegal crossings indiscriminately. While this may sound good at first, what this really means is resources would be evenly spread to stop drug traffickers, terrorists, and migrant workers, all of which clearly do not pose the same level of risk to America. This is an insane idea; no military commander would ever tell their forces to spend equal time and resources across an entire geographical area or population group.

In short, the idea of building a wall is antiquated and outdated. Suggesting a wall as a solution is the equivalent of saying “to fix our transportation system I am building a transcontinental canal, but don't worry-- it will be big and beautiful.” A “Smart Border” using defense in depth principles would be more efficient, flexible, and cost-effective.

Moving on from the wall, next we must discuss the mighty travel ban. Quick, decisive, and powerful, once said “I come in peace. I didn't bring artillery. But I'm pleading with you, with tears in my eyes: If you f*ck with me, I'll kill you all.” The General was known for showing up in combat theatres without body armor on, not because it was the safest thing to do, but because he is well aware of the powerful tools of both messaging and optics.

Mattis, along with his Marines and countless other services members (past and current) know the effects that either good or bad communications and visuals can have. We all know that a full shutdown of our borders to all foreign countries could possibly prevent a terror attack, but the outsized negative impacts, including on the outside perception of America, would cause irrevocable harm to our National Security interests. Military members know that building trust in communities that you work with is indispensable to gather intelligence and to protect our “six” the same is applied to foreign relations.

A military perspective shows us a better way to stop potential terror threats from entering our country. Rather than an all-out ban, which does nothing to actually identify threats to U.S. soil, we should increase wait times for visas to people from countries that are unwilling or unable to share intelligence information with us. From there, we can build our relationships with other countries based on a clear understanding of we require for our security, which would enable the U.S. to engage in bilateral negotiations with countries that are not able to track terrorism within their borders. This type of strategy was recently demonstrated with the laptop ban, targeted, intelligence based, and multi-lateral. In short, we can stop threats abroad before they even try to set foot on our land.

Lastly, when I think about basic military principles the generalized ICE raids make my skin crawl. Such a generalized mission does not allow for proper prioritization and allocation of resources. Resources have not been increased by the legislature, the natural conclusion of which sees resources moving from a targeted approach on violent offenders meaning more violent criminals will be left on the streets. Quite an effective crackdown wouldn’t you say?

A more sensible approach would be for more joint task forces between the DEA and ICE using ICE arrests to weaken cartel influence in the United States. In conjuncture, universal background checks for gun purchases would further increase our ability to find the most dangerous criminals who have managed to make it to America as these checks would immediately criminalize gun ownership by any immigrants without the proper authorization. Seen this way, universal background checks could be a serious check on criminal elements of the undocumented community.

These are just a few alternatives that both the current administration and Congress should be considering. They are evidence based, supported by years of military experience and the data to go along with it. When I was assigned to logistical or support functions in the Marine Corps, I was not absolved of understanding the strategy of the Marines I was supporting. This same principal applies to Congress, which must take responsibility for the strategies imposed by the agencies they are funding. Evidence, logic, holistic strategy, and data can only be ignored for so long before the everyone notices and policies fall apart.

I am not the only Marine who was an anti-terrorism officer, or who sat in the snowy hills of Quantico, freezing, digging holes to learn the basic military principles that are being ignored by our highest leadership. Thus, I know there are many out in our country who are as concerned as I am about the type of thinking being employed by our government. If you’re one of those people, Marine, Soldier, Airman, or Sailor, Military or Civilian, I urge you not to let our country fall under the idea appearing strong rather than actually being strong.

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GA-06 Special Election Is 3 Weeks From Today-- And Ossoff Leads Either GOP Front-Runner


DEADLY for GOP candidates

The first round of voting to replace Trump's HHS Secretary Tom Price-- the man who bears a great deal of responsibility for TrumpCare-- is exactly 3 weeks from today, April 18. Georgia's 6th congressional district isn't a district the DCCC ever looks at. They never recruit candidates there and never back local Democrats who run-- NEVER (like in not ever). However, voters in the suburban and exurban parts of Fulton, Cobb and DeKalb counties north of Atlanta that make up GA-06 proved to be unenamoured of Trump-- first in the primary, where he didn't come close to Rubio (while winng statewide) and then in the general, where he barely came out ahead of Hillary Clinton. Last week a Republican firm's poll showed voters in the district unimpressed by Trump's stint in the White House. His negatives (49.7%) outweighed his positives 49.1%)-- in district with an R+14 PVI! The same poll showed these voters blaming the mess over healthcare on the Republicans (61.4%) not the Democrats (26.4%).

Yesterday a new poll was released by Opinion Savvy and it offers the GOP even worse news. Despite right-wing SuperPACs directed by Paul Ryan having poured over $2 million into negative advertising against Ossoff, he's leading the top two GOP contenders COMBINED.

When Nate Silver mentioned on Twitter Monday morning that "voters didn't elect Trump to get Paul Ryan's agenda [and] that's why GOP health care bill was so spectacularly unpopular," he was referring to the whole country. But his diagnosis works in GA-06 as well. Voters there oppose TrumpCare-- the bill their own congressman helped Ryan and the insurance companies write-- 49.7-46.8%. As if that isn't bad enough for the Republicans, these same educated GOP-leaning voters also prefer Ossoff 39.8% to 30.3% over Handel and Gray (together), the two top Republican contenders. No wonder Ryan just sent another million dollars in negative ads down to Atlanta!

And in second round June 20 head-to-head match-ups, it's more bad news for the TrumpCare Party:
Ossoff 42.4%, Handel 41.0%
Ossoff 44.3%, Gray 42.3%
Yesterday was the first day of in-person early voting and Ossoff was looking good. 60 Democrats voted as opposed to 28 Republicans. In 2016, the first day saw 46 Republicans and just 23 Democrats. So... despite Paul Ryan's barrage of negative attack ads, something is going on in GA-06 for Jon Ossoff.

According to the polling Dan Moody appears to be a GOP also-ran in this race. The latest poll shows him with just 8% support-- 5th place (4th among Republicans). But this morning the Atlanta Journal-Constitution reported that Georgia Senator David Perdue endorsed him, in effect, throwing a monkey wrench into the messy-- and increasingly desperate-- Republican effort to find someone who can credibly stand up to Jon Ossoff in June. Perdue cut a 30-second TV spot that has started airing on Atlanta TV today. In an attack on the Republican front-runner, Karen Handel, Perdue said, "Trust me, we don’t need another career politician up here." (Moody, though, is a former state senator himself.) Meanwhile Gingrich and Marco Rubio have endorsed another ex-state senator, Judson Hill, and former U.S. Senator Saxby Chambliss is backing Handel, the very controversial anti-choice maniac and extremist.

Goal Thermometer If the Republicans lose GA-06, the message will loud and clear-- namely that even Republican-inclined voters want Trump to slow down and move away from the extreme right-wing agenda Ryan, Pence and Price have sold him on. Republican members of Congress will see him as an anchor around the own reelection chances and distance themselves from him, from his kleptocratic regime and from his toxic agenda. And if voters in Montana do the same thing there in June-- which looks more and more possible-- Trump will be forced to start working with a different governing coalition, one that's more centrist and more bipartisan. If you'd like to help Jon Ossoff pull this off, please consider contributing directly to his campaign by tapping the ActBlue thermometer on the right. This race will be won because of get out the vote efforts. It's all up to Ossoff's own campaign. An atrophied Democratic Party has long since lost the ability to do field in districts like this one. Contributing to the DCCC doesn't do Ossoff any good at all. If you want to help him win, please contribute to him, not to the DCCC which only knows how to spend money on things their favorite consultants can commission, like pointless and wasteful TV ads. Ossify knows how to spend the money to win, not to enrich Beltway consultants. the way the DCCC and Paul Ryan do.

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Are Sessions And Trump Orchestrating A Cover Up? What Caused Nunes To Cancel Sally Yates' Testimony?


People aren't asking me "if" Trump is going to be impeached any longer. They're asking me "when." Chris Christie's disapproval is at 72% now. Trump's disapproval-- historically high-- isn't even in the 60's yet. The political will to impeach him-- especially among Republicans and among careerist conservative Democrats as well-- won't begin 'til he's at least where Christie is. That's what it takes for that kind of wrenching move.

Last night I had dinner with one of the most successful big-time, house-hold name attorneys in America and he told me he's working on collecting evidence against Trump, evidence that will eventually be used in cases against him. Those will come even before impeachment proceedings do. The big news about Nunes canceling the Intelligence Committee that would have included former Acting Attorney General Sally Yates, broken by the Washington Post this morning, is leading towards the eventual impeachment case. What are Trump and Sessions hiding that caused the White House to have Nunes-- a sad and pathetic little lap dog-- cancel the testimony? The Post's first paragraph was absolutely devastating:
The Trump administration sought to block former acting attorney general Sally Yates from testifying to Congress in the House investigation of links between Russian officials and Donald Trump’s presidential campaign, the Washington Post has learned, a position that is likely to further anger Democrats who have accused Republicans of trying to damage the inquiry.
Sessions demanded Yates not testify before Congress but she went ahead and agreed to come before the House Intelligence Committee this week anyway. Nunes "abrupt canceled" the hearing. Intelligence Committee Committee member Eric Swalwell (D-CA) was in Morning Joe today and said "this is what a cover-up to a crime looks like. We are watching it play out right now." Watch:

An independent commission is an absolute "must" at this point. When Joe Scarborough asked Bill Kristol, "They're going to have to have a Select Committee, right?," Kristen responded matter of factly, "You'd think they'd have to, but in Trump's Washington [i.e.- the swampiest swamp in the history of swamps] things that we think 'have to happen,' don't have to happen." Trump and Bannon and their regime are counting on that attitude of surrender.
As acting attorney general, Yates played a key part in the investigation surrounding Michael T. Flynn, a Trump campaign aide who became national security adviser before revelations that he had discussed sanctions with the Russian ambassador to the United States in late December led to his ouster.

Yates and another witness at the planned hearing, former CIA director John Brennan, had made clear to government officials by Thursday that their testimony to the committee probably would contradict some statements that White House officials had made, according to a person familiar with the matter who spoke on the condition of anonymity. The following day, when Yates’s lawyer sent a letter to the White House indicating that she still wanted to testify, the hearing was canceled.

A White House spokesperson called the Post article “entirely false” and said, “The White House has taken no action to prevent Sally Yates from testifying and the Department of Justice specifically told her that it would not stop her and to suggest otherwise is completely irresponsible.”

The Justice Department had no immediate comment.

Rep. Adam B. Schiff (Calif.), the ranking Democrat on the Intelligence Committee, said the panel was aware that Yates “sought permission to testify from the White House. Whether the White House’s desire to avoid a public claim of executive privilege to keep her from providing the full truth on what happened contributed to the decision to cancel today’s hearing, we do not know. But we would urge that the open hearing be rescheduled without delay and that Ms. Yates be permitted to testify freely and openly."

In January, Yates warned White House counsel Donald McGahn that statements White House officials made about Flynn’s contact with the ambassador were incorrect, and could therefore expose the national security adviser to future blackmail by the Russians.
Pelosi has been demanding Nunes be fired as Intelligence Committee head-- or at the minimum, be forced to recuse himself from this investigation. If Pelosi is so outraged about Nunes' behavior-- and she should be-- why does' t she order her DCCC to do something they've never done before-- mount an election challenge against Nunes. Funny thing how that works: members of Congress who have to answer to their constituents in contested elections tend to be less arrogant in the way they do their jobs. As we've mentioned over and over again, the DCCC has given Nunes a free-pass to reelection in 100% of his reelection battles. Allow me to reiterate:

The DCCC has always dismissed it as "too conservative" and has never run a candidate against Nunes-- never. He skates to reelection without serious opposition. Last year his unsupported Democratic opponent, Louie Campos, didn't even raise the $5,000 that would have triggered an FEC report, while Nunes raised $2,459,235, almost entirely from special interests; only about 1% of his contributions ($25,038) coming from small donors. The bulk of his money came in the form of outright bribes from PACs ($1,623,714). He's widely considered one of the most corrupt characters in Congress and today he's sitting on a formidable $3,177,900 war-chest, interesting in a district that the DCCC has never looked at. He beat Campos 143,333 (68.2%) to 66,802 (31.8). Yes, Campos did terribly but he took 66,802 votes spending no money and with no DCCC help. One district west and south-- CA-21-- saw the DCCC and Pelosi's House Majority PAC spend $94,400 in 2014 and $1,778,846 in 2016 (primarily on ineffective-- and commissionable-- mass media) and the two Democrats who ran spend $1,690,530 (2014) and $648,918 (2016). Now remember how Campos, with his grassroots field operation turned out 66,802 Democratic voters against Nunes? In CA-21 there were just 33,470 Democratic voters in 2014 and just 49,643 in 2016. Even with money, you only win if you know what you're doing. The DCCC has absolutely no idea and local Democrats are-- at best-- out of practice, everything atrophied from lack of use.

The district is minority-white now. Ethnically, it is 45.9% Latino, 41.9% white, 7.0% Asian and 2.5% black. McCain and Romney both beat Obama with just over 56%. Last year Trump beat Hillary 52.1-42.6%. According to the old CBO report, if TrumpCare becomes law, 87,694 Nunes constituents will lose their health insurance. That number, with the changes Ryan put through to placate extremists, is probably closer to 100,000. Now. Remember, Nunes only netted 143,333 votes in 2016, not that many more than the people who are liable tol lose their health care. The DCCC should be working on organizing and registering those voters now. They aren't.

This is on Pelosi. As Ted Lieu tweeted early this morning, "Since Rep Nunes is acting like a Trump appointee, he should apply for a White House position. There are lots of openings." The DCCC should do it's part-- even if the atrophied local party takes 2 cycles to accomplish it-- and take on Nunes electorally.

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Does Jeff Merkley Have The Magic Key To Break The Partisan Deadlock Over Healthcare Reform?


Blue America first met Jeff Merkley almost a decade ago when he was Speaker of Oregon's state House. There seemed so much promise in his candidacy for the U.S. Senate and we endorsed him-- and have never regretted it for a moment. At the time, we introduced him as someone who had been an outstanding and accomplished statewide leader who not only had good ideas, but translated this ideas into legislation. Merkley comes from humble rural Oregon origins and was the first in his family to go to college. He led Habitat for Humanity in Oregin and worked to help families work their way into the middle class by purchasing a home, starting a business, or saving for college. One of the reasons Blue America was so enthusiastic about him-- despite his being the choice of Chuck Schumer and the DSCC-- was that he loudly and unambiguously vowed to take on the special interests, like the big insurance companies and big drug companies who underwrite Schumer's power. And that's the kind of Senator he's been since winning that first election in 2008. He was reelected in 2014 and his seat isn't up again until 2020 but he's working as hard as most senators do when they're up for reelection-- but working on the people's business, not his career.

Over the weekend, Daniel Marans, writing for Huff Po about Bernie's push for Medicare for All. Progressives-- like Merkley and Bernie-- have always talked about the need to correct some of the Affordable Care Act flaws. In the final stages of passage, there was a big debate among progressive activists whether to back passage or not, the compromises with corporate greed and that flaws that brought being so transparent. The thought was always that the ACA would be a step towards single payer-- in effect, Medicare for All.

On Friday Bernie was on Chris Hayes show and explained to the viewers that "We have got to have the guts to take on the insurance companies and the drug companies and move forward toward a ‘Medicare for all,’ single-payer program."
“The problem is the insurance companies, Big Pharma-- they’re gonna come back and use the chaos to their advantage,” predicted Social Security Works executive director Alex Lawson. “If Democrats go with a half-a-loaf policy, Republicans are going to blame them for the failures of Big Pharma. They have to immediately pivot to expanding Medicare.”

Notwithstanding the support of the influential groups for the proposal and-- according to a May 2016 Gallup poll-- even a majority of the American people, Medicare-for-all legislation is a non-starter in the current Congress. Single-payer health insurance still lacks support from many, if not most, Democrats, let alone from the Republican lawmakers who control both chambers.

But the proactive strategy speaks to increasing confidence among progressives that if they stick to their ideals and build a grassroots movement around them, they will ultimately move the political spectrum in their direction.

...In the meantime, a potential benefit of this ambitious approach is what’s known as shifting the “Overton Window,” a political science term for the narrow range of acceptable political views at a given moment in time.

By adopting a position that is considered extreme by contemporary standards, politicians and activists can make more attainable policy goals start to seem reasonable by comparison.

That phenomenon already seems to be working in progressives’ favor.

Sen. Jeff Merkley (D-Ore.), the only one of Sanders’ Senate colleagues to endorse his presidential bid, discussed the possibility of lowering the Medicare eligibility age or empowering Medicare to negotiate drug prices in his statement on the Republican bill’s collapse.

“There are plenty of ideas already on the table that would make health care more affordable for working families, from a public option, to prescription drug negotiations, to offering older Americans the chance to buy into Medicare,” Merkley said on Friday. “I’m happy to work with anyone, from either side of the aisle, to explore these or any other ideas that would improve health care for working Americans.”

Lowering the Medicare eligibility age from its current level of 65 is a “very interesting” idea, because of the positive financial effect it would have on the Obamacare insurance exchanges, said Austin Frakt, a health economist for the Department of Veterans Affairs.

By allowing the oldest exchange participants to enroll in Medicare, lowering the Medicare age would relieve the health insurance marketplaces of some of their costliest customers, said Frakt, who also has academic posts at Boston University and Harvard.

“It would reduce the premiums in those markets,” he predicted. (Frakt noted, however, that absent measures to offset the cost of the additional beneficiaries, the change would increase Medicare’s financial burden.)

Social Security Works’ Lawson praised the idea as an incremental step toward Medicare for all.

“Start by lowering the age to 62 and get it down to zero,” he said.
With Bernie about to offer a full-on Medicare for All bill, which he announced he would do Sunday on State of the Union, Merkley's idea might get traction among mainstream Republicans who aren't ready to go all the way but who are serious about correcting some of the Obamacare defects. Although Bernie invited Señor Trumpanzee to hop on board, it's not likely the Regime would get anywhere near a full-on Medicare for All plan. Can you imagine the reaction from HHS Secretary Price? Sure, Bernie said "President Trump, come on board. Let's work together. Let's end the absurdity of Americans paying by far the highest prices in the world for prescription drugs." But, this isn't something Trump would/could embrace. But Merkley's plan... I'm betting that is. I mean who wouldn't want to see premiums come down across all age levels? What Merkley's bill is, in effect, just an extension of a system that already works and is universally popular across the country and with all Democrats, all independents and even most Republicans. If people started joining Medicare at 50 instead of 65, it wouldn't just be the biggest imaginable boon for them, it would, by taking a less healthy cohort out of the general population insurance pools, lower premiums for everyone under the age of 50 as well. It sounds like something Trump could understand and get behind.

UPDATE: Bannon's Evil As Well

Please watch Ted Lieu on MSNBC with Lawrence O'Donnell (last night). And remember-- the most effective voices in Congress for the resistance can all use some help with their reelection efforts.

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Monday, March 27, 2017

Some Republicans Are Trying To Deny They Were Backing The TrumpCare Catastrophe


Sunday, Texas conservative Ted Poe resigned from the Freedom Caucus because of TrumpCare. He was for it. The Caucus was, by and large, against it. Maybe Poe was afraid of Trump's wrath but that is odd in a Houston area district that wasn't especially pro-Trump. Romney won Poe's district with 63%, around the same that McCain won it with. Trump only managed 52.4%. And had Trumpcare been enacted into law-- and Poe never made any bones about voting for it-- 26,054 of his constituents would have found themselves without health insurance. His district includes Montrose, one of the biggest and most vibrant LGBT communities in America, but the DCCC has never once given Poe a serious challenge to reelection. So he knows he can behave like a dirt-bag with alacrity. So far he has no opponent for 2018.

Over the weekend, conservative columnist Andrew Sullivan speculated that Trump has-- finally-- had it... or rather the American public has had it with Trump and his vile kakistocracy. "Trump still shows alarming potential as a would-be tyrant, contemptuous of constitutional proprieties, and prone to trashing every last norm of liberal democracy," he warned. "But he is also beginning to appear simultaneously as a rather weak chief executive, uninterested in competent management or follow-through, bedeviled by divisions within his own party, transfixed by cable news, and swiftly discrediting himself by an endless stream of lies, delusions, and conspiracy theories." And with no credibility left, at least not, according to Sullivan, "among sane people." Sullivan also warned the Republicans that the midterms aren't going to be kind to them in 2018.
A president hobbled domestically by his own party’s divisions and the opposition’s new energy may be tempted-- Putin-like-- to change the subject in a way that vaults him back to popularity. A foreign altercation from which he will not back down? A trade war? A smidge likelier, I’d say, is an over-the-top response to an inevitable jihadist terror attack in a major American city. A demagogue loses much of his power when he tries to wrestle complicated legislation through various political factions, in the way our gloriously inefficient Constitution requires. He regains it with rank fear, polarization, and a raw show of force. Heaven knows what the Constitution will look like once he’s finished.

The other possibility is that Trump really does at some point realize he’s sinking fast and decides on a hard pivot. He wants to win and be loved, and if he keeps losing and becomes more widely loathed with his current strategy, it’s by no means out of character for him to recalibrate. He could use the possible failure of Trumpcare to feed Paul Ryan to the Breitbartians, and reach out to Democrats on a tweaked Obamacare and infrastructure package. He could dump Bannon the way he dumped Manafort and bullshit his way through all the inconsistencies (the one thing he remains rather good at). He could wrest himself like Kong on Skull Island from the giant lizards and become the tribune of the forgotten men and women he wants to be, and combine nationalism and protectionism with, er, socialism, like his heroine Marine Le Pen. He could finally realize the potential he has thrown away so far, and become an American Perón.

The only snag with this strategy, of course, is that he could hard-pivot only to find himself a Kong who’s alienated from the GOP and obstructed by the emboldened Dems, a rogue, bleeding president without a party, marooned on his own island of polarized irrelevance.
The Times' Alexander Burns reported over the weekend that the ignominious collapse of TrumpCare amidst disastrous polling numbers and internal Republican Party in-fighting is leaving the bill's supporters "in a political jam back home". He mentioned, as examples, two very vulnerable Republicans. "John Faso of New York negotiated a side deal for his state in exchange for backing it. Mike Coffman was the lone Colorado lawmaker to endorse the bill, while his Republican neighbors agonized and stalled."
But with the collapse of the legislation on Friday, such Republican representatives now have nothing to show for their trouble. They ventured far out on a political limb, only to watch it disintegrate behind them. And when they run for re-election next year, they may have to defend their support for a politically explosive bill that many Republicans backed only reluctantly, and that never came close to reaching the president’s desk.

The fiasco in Washington is already rippling at home: Back in their districts, there are early signs of backlash against these lawmakers, including from constituents who voted Republican last November.

...National Republicans, still reeling from their unexpected defeat, expressed hope that health care might fade as an issue before the congressional elections in 2018. With more than a year and a half until voters next pass judgment on the Republican-controlled Congress, party leaders say they have plenty of time to record victories on issues like a tax code overhaul and infrastructure spending. Mr. Trump and Speaker Paul D. Ryan indicated on Friday that they did not intend to revisit health care in the near future.

But Republican strategists also acknowledged that they would probably have to give extra help to vulnerable members of Congress who supported the health care bill. Corry Bliss, the chief strategist for the Congressional Leadership Fund, a “super PAC” backed by Mr. Ryan, said the group would go out of its way to protect lawmakers who backed the bill. “We are committed to helping advance the legislative agenda of House leadership,” Mr. Bliss said on Saturday. “Of course we are going to give preferential treatment to friends and allies.”

By contrast, Mr. Bliss noted that the group had cut off funding to Representative David Young of Iowa, a Republican who opposed the health care bill.

It is unclear whether voters’ anger over health care will be enough help Democrats win a majority in the House next year.
The Democratic candidates we talked to since the bill imploded last week don't seem unclear at all. Katie Hill, for example, is running against a wishy-washy, scared-of-his-own-shadow Republican, Steve Knight. Last cycle, the DCCC forced some guy from outside the district on local Democrats and while Hillary won the blue-leaning district 50.3% to 43.6%, Knight won reelection over the hapless DCCC shill, 112,768 (54.2%) to 95,296 (45.8%). Katie is working on doing a lot better. We asked her how to characterize the differences between herself and Knight on Ryan's health care plan. "From my perspective, it was a terrible plan right from the start," she told us. "Out of party loyalty and an apparent lack of concern for his constituents who would lose coverage, Knight acted like the proposal had merit. He refused to take a real public stand one way or the other, so the fact that he didn't have to actually vote on it must have been a huge relief to him. Nonetheless, we know that he has not been standing up to say that all of his constituents deserve and need affordable health care. I promise to do that if I'm elected to replace him. Even though the ACA is still intact, we have a long way to go to really fix our health care system. I'm ready to fight for that in Congress. True leaders are more than just people who vote for or against what their party leadership tells them to. Unfortunately, Congressman Knight has not demonstrated his own core values that are not dependent on party lines. Folks in the Antelope Valley, Simi Valley and Santa Clarita expect and deserve real leadership, not someone who is afraid of standing up to the party establishment and special interests that back them. I will make the district I grew up in proud that they sent a local woman to Congress to make real change happen for the people in our communities and our country."

Darrell Issa and his most important constituent

Doug Applegate nearly beat Darrell Issa in the San Diego area last year. He's determined to finish the job in 2018. It didn't help Issa any that he kept wavering on the bill every time he got tugged in one direction or another. "It was an embarrassing week for Congressional Republicans," Applegate told us, "but it was even more embarrassing for Darrell Issa. When TrumpCare was first written, protests erupted at Issa’s office and Issa said he would vote no. But when Donald Trump sat down with Issa and asked him to support a bill that would cause 24 million Americans to lose health insurance, Issa flip flopped and supported it. I guess we know where Darrell’s true loyalty lies."

Voters on the South Shore of Long Island are trying to persuade DuWayne Gregory to run against Peter King again this year. King's dilly-dallying around the whole healthcare issue didn't endear him to anyone on either side of the contentious issue. DuWayne, who's the Presiding Officer of the Suffolk County Legislature told us that "King did the politically cowardly thing in regard TrumpCare; he tried to conceal his position from his own constituents. He instructed his staff to tell any callers that he was leaning no then after hundreds of calls, he changed that to "undecided." And yet, it was reported that during President Trump's visit to Capitol Hill to meet with GOP lawmakers he pointed out King saying they had grown up near each other in Queens. King was quoted afterwards as saying that "it would be difficult to vote no" after being singled out like that. Peter King's district was slated to be one of the worse affected by the AHCA with nearly 82,000 constituents to have lost insurance. Trumpcare was a disaster for those on Medicaid, also allowing insurers off the hook for providing maternity care, prescription drugs, mental health and more egregious provisions. Look at this; it's what they wanted to deny coverage for:

"Peter King and the New York State Republican delegation had negotiated an added bonus for New York State county governments by attempting to shift the cost of Medicaid to the state. This provision was labeled an attack on New York by Governor Cuomo. Worse yet, preliminary estimates of this, New York only, provision would have cost Suffolk County over $100 million. To think Peter King would have voted against the interests of millions of Americans and thousands of his own constituents simply because Trump recognized him is embarrassing and failure as a leader."

We introduced you to Dr. Jason Westin early in the month. He's a progressive candidate-- and a cancer specialist-- running against John Culberson in a district Hillary won 48.5% to 47.1% (after Romney beat Obama there 59.9% to 38.6%. He told me today that "Congressman Culberson knows that his district (TX-07) will be targeted by the DCCC and other groups as a pickup opportunity if the right candidate emerges for 2018. As a savvy career politician, he recognized that taking a position on the TrumpCare bill would open him up to criticism from his left or his right. He showed his true colors by taking no public position, despite his having co-sponsored H.R. 277 on January 4th, 2017, a much harsher 'root and branch' repeal of the Affordable Care Act. Surprising no one, he told local press after the bill was withdrawn that he 'absolutely' was supporting TrumpCare. The voters of TX-07 deserve a representative who will be honest, explain and not hide their vote, and be open to feedback. As my team says, we will 'Repeal and Replace' Culberson on 11/06/18."

You want to be sure a Republican was sincere about not supporting Ryan's horrific TrumpCare mess, look at the records. For example, mainstream, libertarian-leaning North Carolina conservative Walter Jones wrote a long piece for his constituents on his official house website where he explains why he would vote against TrumpCare. "Over the past two and half weeks," he wrote, "over 1,000 Eastern North Carolinians of all political stripes have contacted my office. Well over 90 percent are opposed to the bill. I asked for this job to represent the people of Eastern North Carolina, and they have spoken clearly. Furthermore, there are many aspects of the bill that deeply trouble me because of their potential effects on Eastern North Carolina and rural America. For example, the bill discriminates against as many as 7 million American veterans by making them ineligible to receive tax credits provided in the bill. It would also result in low-to-middle income seniors paying dramatically higher premiums. For instance, a 64-year old making $26,500 a year would see their annual premium jump from $1,700 to $14,600. It’s time to scrap this flawed bill and start over. Go out across the country, gather people’s input, and use an open, public process to thoughtfully craft a bill that delivers the relief the American people need." 

Compare Jones' clear, forthright, well-reasoned statement of opposition to the deceitful mumbo-jumbo that spewed out of crooks like Issa, King, Culberson and Knight.

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