The comical cult of Paul Ryan

Not since LeBron James announced “The Decision” to “take my talents to South Beach” have so many Americans waited with bated breath for one man to declare his intentions. Hoping for white smoke from the chimney of his Jaynesville, Wisconsin home, most Republicans and even some Democrats are hoping that Paul Ryan will decide to run for Speaker of the House of Representatives and thus save the GOP from itself.
While Mitt Romney’s 2012 running mate and current House Ways and Means Committee chairman remains huddled with family in his Badger State conclave, politicians and pundits sing Paul Ryan’s praises in almost hagiographic terms. Josh Marshall noted that “a defining principle of modern Republican ideology is that ‘Paul Ryan is awesome.'” Jonathan Chait argued that Ryan “is already the president of Republican America” because “no other figure within the party combines Ryan’s philosophical radicalism and tactical pragmatism.” While

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After more than five years, GOP is ‘coalescing around the outlines of a plan’ to replace Obamacare

Elderly woman in bed asleep

Hang on, grandma, Republican help is on the way!

Well, this is exciting news. After more than five years, more than 50 votes to repeal, along with endless predictions of Obamacare bringing about the End Times, and finally, finally, Republicans have come up with the replacement plan they’ve been talking about since 2010:

After years of trying, Republicans are coalescing around the outlines of a plan to repeal and replace ObamaCare.

Oh. Never mind. They still haven’t come up with a replacement plan as much as they’ve agreed to a general idea that “seems to reflect an emerging consensus among Republicans” on what that plan should be. So, when will the bill that will at last end our long national nightmare of millions of Americans having access to health care be introduced in Congress?

But despite the general agreement on the outlines of a plan, Republicans are a long way

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Between Holocaust and slavery analogies, Republicans choose both

Former neurosurgeon-turned-2016 GOP White House hopeful Ben Carson raised some eyebrows last week with his declaration that gun control enabled the rise of Adolf Hitler and the annihilation of European Jewry in the Holocaust. But no one who has followed “the biggest fan of Nazi metaphors in politics” should have been surprised by Carson’s grotesque talking point. Besides, Dr. Carson has plenty of company among conservatives playing the Holocaust card against gun control, the national debt, Obamacare, taxing the wealthy, marriage equality and just about every other public policy and societal trend they detest.
But the incendiary all-Auschwitz, all-the-time rhetoric of the right isn’t just a disgusting assault on decency and the truth. As it turns out, many of the same Republican sound bite regurgitators have already vomited up American slavery as their go-to slander for all they hate about the Age of Obama.

Consider, for example, how

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Medicaid expansion reducing uninsured rate, where political leadership is allowing it

2013 Medicaid Matters Rally 7, Texas, March 5, 2013

Huffington Post looks at the most recent data available from Gallup’s ongoing health insurance survey to see what the state of Medicaid expansion—and thus the rate of uninsurance—is two years after the full implementation of Obamacare. Not surprisingly, the divide between expansion and non-expansion states has grown.

The states that expanded Medicaid already had a lower combined uninsured rate than the states that didn’t, and the gap has widened since then. States that undertook the expansion experienced significantly larger increases in the share of their residents with health coverage, compared to states that rejected the expansion and relied only on federally subsidized private health insurance from the exchange marketplaces to expand coverage.

Chart showing rate of insurance pre-and post-Obamacare and by expansion vs. non-expansion of Medicaid

The highest rate of uninsurance is in Texas, at 20.8 percent, and Texas Republicans are damned proud of it.

House Republicans about to dump a real awkward issue on vulnerable senators

Illinois Sen, Mark Kirk talks on the telephone

Sen. Mark Kirk (R-IL)

House Republicans are putting Senate Republicans in a difficult spot with their plan to use reconciliation to defund Planned Parenthood and repeal chunks of Obamacare. Those are the kind of politically risky votes that Republicans in the heavily gerrymandered House can embrace, but senators have to be a little more careful about. Senators facing tough races in 2016, for instance, and those who like to be seen as sane moderates.

Sen. Mark Kirk (Ill.), one of the most vulnerable Republicans in next year’s elections, twice voted against procedural motions on legislation to block the healthcare group’s funding.
Sen. Susan Collins (Maine) has spoken on the Senate floor against defunding the group, though she did back a procedural motion in August that could have led to an up-or-down vote on defunding. She said she only did so on assurances from leadership that it would lead to

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House Republicans about to dump a real awkward issue on vulnerable senators

Illinois Sen, Mark Kirk talks on the telephone

Sen. Mark Kirk (R-IL)

House Republicans are putting Senate Republicans in a difficult spot with their plan to use reconciliation to defund Planned Parenthood and repeal chunks of Obamacare. Those are the kind of politically risky votes that Republicans in the heavily gerrymandered House can embrace, but senators have to be a little more careful about. Senators facing tough races in 2016, for instance, and those who like to be seen as sane moderates.

Sen. Mark Kirk (Ill.), one of the most vulnerable Republicans in next year’s elections, twice voted against procedural motions on legislation to block the healthcare group’s funding.
Sen. Susan Collins (Maine) has spoken on the Senate floor against defunding the group, though she did back a procedural motion in August that could have led to an up-or-down vote on defunding. She said she only did so on assurances from leadership that it would lead to

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Donald Trump proposes replacing Obamacare with something that sounds a lot like Obamacare

Republican U.S. presidential candidate businessman Donald Trump speaks during the second official Republican presidential candidates debate of the 2016 U.S. presidential campaign at the Ronald Reagan Presidential Library in Simi Valley, California, United

Donald Trump got more media attention over the weekend, with a feature on CBS’s 60 Minutes, interviewed by Scott Pelley. In a vain attempt to get some policy specifics out of Trump (and seriously, they’re still trying to get policy specifics out of him?), Pelley pushed him on what he’d do about Obamacare and got a response that has conservative healthcare wonk Avik Roy very frustrated.
Here’s the exchange that set off Roy:

Pelley: How do you fix it?
Trump: There’s many different ways, by the way. Everybody’s got to be covered. This is an un-Republican thing for me to say because a lot of times they say, “No, no, the lower 25 percent that can’t afford private. But–”

Pelley: Universal health care.

Trump: I am going to take care of everybody. I don’t care if it costs me votes or not. Everybody’s going to be taken care

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‘Death panels’ hugely popular with American public

Elderly patient sitting beside empty hospital bed.

The Centers for Medicare & Medicaid Services is now finalizing the rules to start paying for doctors discussing end of life care with their Medicare patients. That would be what Republicans used to call “death panels” and what the American public strongly supports, according to this month’s Kaiser Family Foundation survey.

Poll results from KFF on whether end of life discussion should be covered by insurance

There is broad support (81 percent) for requiring Medicare to cover discussions between doctors and patients about end-of-life treatment options. Similarly, the public supports private health insurance covering these discussions as well (83 percent).
About 9 in 10 (89 percent) say doctors should discuss end-of-life care issues with their patients. But, relatively few (17 percent) say they’ve had such discussions with a doctor or other health care provider, including 34 percent of people age 75 or more, 23 percent of people age 65-74, 19 percent of those age 50-64 and 12 percent of those age 18-49. In addition, those

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Cartoon: Kneejerkin’ (health care edition)


(Click to enlarge)

It takes a lot to make my head explode these days, but reading about Martin Shkreli, the hedge fund brat who bought the drug used to treat toxoplasmosis and raised the price from $13.50 a pill to $750, accomplished exactly that. While the Times piece on Shkreli rightly generated a groundswell of outrage, it made me think of all the previous injustices in our health care system that didn’t. All the abuses of private health insurance companies prior to the ACA — the dropping of sick patients, the exorbitant premiums for those with pre-existing conditions, the flat-out denials of coverage dooming people to death or financial ruin — were just as evil, yet not as easily located in the scandalous behavior of one unsavory person. Remember this article about hospitals charging $137 for a $1 IV drip bag? In a sense, Shkreli simply puts a

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Are primary care docs overwhelmed with new Obamacare patients? Nope.

Patient Thomas West speaks to Dr. Lisa Vinci during his check up at University of Chicago Medicine Primary Care Clinic in Chicago June 28, 2012. A sharply divided U.S. Supreme Court on Thursday upheld the centerpiece of President Barack Obama's signature healthcare overhaul law that requires that most Americans get insurance by 2014 or pay a financial penalty.  REUTERS/Jim Young (UNITED STATES - Tags: POLITICS HEALTH) - RTR34B4B

All of the terrible, no good, horrible things that were going to happen under Obamacare still don’t seem to be happening. Here’s another one that’s not happening: primary care doctors aren’t overwhelmed with new patients, forcing everyone else to wait to get appointments say the Kaiser Family Foundation and the Commonwealth Fund.

Overall, primary-care physicians did report increased demand for services under the ACA. Four in 10 (44%) said the total number of patients they see had increased since January 2014, and six in ten (59%) reported an increase in the number of patients who were newly insured or covered by Medicaid. But providers did not report that this increased demand was swamping their practices.
[M]ost primary-care physicians (59%) said their ability to provide high-quality care to all their patients had stayed about the same since the ACA went into effect, with equal shares (20%) saying it had improved and

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Obama administration forced to revise Obamacare enrollments. They’re up by 1.2 million!

Photos in front of the Supreme Court of the United States, on the day of the King v Burwell Decision. June 25, 2015

Obamacare hasn’t covered 16.4 million people in the past five years, the Obama administration now says. It’s covered 17.6 million, beating expectations and Congressional Budget Office projections.

The revised total includes 15.3 million people who gained coverage through the individual marketplace or through Medicaid. It also includes 2.3 million young adults who gained coverage because they were able to remain on a parent’s plan until they turn 26.
The new data also puts the Obama administration ahead of the health insurance gains estimated by the Congressional Budget Office for 2015. The CBO had predicted roughly 17 million people would gain coverage by 2015, with the gains about equally split between the exchanges and Medicaid.

Health and Human Services (HHS) chief Sylvia Mathews Burwell announced the new figure Tuesday during a speech at Howard University Hospital, where she also highlighted the law’s impact on black and Hispanic

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Hillary Clinton releases plan to hold down prescription drug price gouging

U.S. Democratic presidential candidate Hillary Clinton speaks to a grassroots organizing meeting at the Louisiana Leadership Institute in Baton Rouge, Louisiana, September 21, 2015.  REUTERS/Lee Celano - RTX1RRCZ

Hillary Clinton followed up on her tweeted vow Monday to do something about price-gouging by pharmaceutical companies if she becomes president. As promised, she released her plan to build on Obamacare and start bringing down the cost of prescription drugs.

The Democratic presidential candidate’s proposal would place a monthly cap of $250 on covered out-of-pocket prescription drug costs to help patients with chronic or serious health conditions. It would also deny tax breaks for televised direct-to-consumer advertising and require drug companies that receive taxpayers’ support to invest in research and development.
“We will start by capping how much you have to pay out of pocket for prescription drugs each month. And we’re going to hold drug companies accountable as we work to drive down prices,” Clinton said at a campaign event Monday in Louisiana. […]

Clinton’s campaign said a typical senior on Medicare spends more than $500 annually on out-of-pocket

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Obamacare Medicare provision penalizing hospitals that take care of the sickest, poorest

Elderly patient sitting beside empty hospital bed.

An Obamacare provision intended to—and succeeding at—save Medicare dollars and ensure quality of care could be hurting the safety net and teaching hospitals that disproportionately care for the sickest and poorest patients. The law reduces Medicare reimbursements for hospitals that experience high readmission rates—patients returning in the weeks after treatment. Some of these hospitals have been complaining about being unfairly targeted for the fines, and a new study shows that they have good reason.

Researchers at Harvard Medical School found that hospitals are being penalized to a large extent based on the patients they serve. The researchers found that nearly two dozen variables, such as patients’ education, income and ability to bathe, dress and feed themselves, explain nearly half of the difference in readmission rates between the best- and worst-performing hospitals.
The worst performing hospitals, for example, have 50 percent more patients with less than a high school education than

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CBO: Repeal the Obamacare individual mandate and 14 million become uninsured

Patients wait for their wristband number to be called at the Remote Area Medical clinic in Los Angeles, April 29, 2010.  Organizers hope to bring free medical, dental and vision care to more than 8,000 uninsured and underinsured people in the week they ar

People lining up for healthcare at a Remote Area Clinic in 2010, the GOP’s idea of a healthcare system.

Congressional Republicans are kicking around the idea of using budget reconciliation to repeal the individual mandate (and maybe Planned Parenthood defunding and whatever else they are pissed about at the moment). So they asked the Congressional Budget Office what that would mean. The response has good news and bad news for Republicans. While it would save about $311 billion over the next ten years ($3 billion a year? Peanuts.) it would have some pretty bad side effects.

[T]he GOP would have to deal with a bout of bad news from the report: Repealing the mandate would increase the price of premiums in the individual market by 20 percent.
If a repeal is passed, 14 million people would no longer have health insurance if they were not required to by law,

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John Boehner’s deputies trying to put down rebellion. It’s not working.

Newly elected House Majority Leader Kevin McCarthy (R) joins new Republican Whip Steve Scalise (L) and Speaker of the House John Boehner (C) for a news conference after House Republican leadership elections in the Longworth House Office Building on Capito

House Speaker John Boehner is the target of open revolt in the House, with the extremists in his party continuously threatening a coup. The latest kerfuffle is over whether the House will allow the government to shut down on October 1 over the extremists’ desire to defund Planned Parenthood. Now, Boehner loyalists and members of leadership are having to make public statements of support of Boehner to try to put down the rebellion.

In a pair of statements to POLITICO, House Majority Leader Kevin McCarthy (R-Calif.) and Ways and Means Chairman Paul Ryan (R-Wis.) forcefully backed Boehner and called for an end to the intraparty warfare crippling the House Republican Conference as it faces a possible government shutdown on Oct. 1.
“I support John Boehner as speaker,” McCarthy told POLITICO in a statement. “We should be spending all of our time and energy confronting this administration’s disastrous policies,”

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Appeals court turns back Obamacare birth control mandate for non-profit employers, schools

Members of Planned Parenthood, NARAL Pro-Choice America and more than 20 other organizations hold a

If the Supreme Court wants to expand its Hobby Lobby decision to charities and non-profit operators of businesses, colleges, and schools it now has what it needs—a split among Appeals courts. The U.S. Court of Appeals for the Eighth Circuit issued two decisions on Thursday barring the government from enforcing the mandate with the charities and non-profits, splitting from six other appeals courts.

When the Obama administration filed its first response in the Supreme Court to the new group of non-profit cases, in mid-August, it relied upon the unanimous views of appeals courts up to then as an argument against Supreme Court review. That situation has now changed.
The Eighth Circuit became the first appeals court to accept the non-profits’ argument that it would violate their religious beliefs if they had a role in the process of making birth-control pills and devices available, free of charge, to their employees

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Senate spends last business day of the week voting on Iran. Again. With Republicans losing. Again.

U.S. Senate Majority Leader Mitch McConnell (R-KY) holds a news conference after the weekly party caucus policy luncheons at the U.S. Capitol in Washington, March 10, 2015.  REUTERS/Jonathan Ernst    (UNITED STATES - Tags: POLITICS HEADSHOT) - RTR4STHJ

The third time wasn’t the charm for Senate Majority Leader Mitch McConnell on his Iran agreement disapproval resolution, not by a long shot. For the third time, Senate Democrats blocked the resolution with a vote of 56-42. Not only did McConnell’s tactic of trying to set up Democrats with “painful” political revotes fail, with no Democrat changing positions, it backfired. In addition to the disapproval resolution, he set up a vote on Thursday that he really thought would be a gotcha for Democrats. It wasn’t.

Senators voted 53-45 on an amendment from Majority Leader Mitch McConnell (R-Ky.) that would have prevented President Obama from lifting sanctions on Iran until the country releases American prisoners and publicly recognizes Israel’s right to exist. Sixty votes were needed to move forward. […]
While the amendment vote Thursday was intended to be politically tough for Democrats, the 42 Dems who are in favor

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Have Republicans moved on from Obamacare? Judging by the debates, yes

Republican U.S. presidential candidates including (L-R) Dr. Ben Carson, businessman Donald Trump, former Florida Governor Jeb Bush and Wisconsin Governor Scott Walker pose for a group photo before the start of the second official Republican presidential candidates debate of the 2016 U.S. presidential campaign at the Ronald Reagan Presidential Library in Simi Valley, California, September 16, 2015.   REUTERS/Mario Anzuoni - RTS1HJJ

What had been a central issue in Republican debates in 2012 has barely registered in the first two debates of the 2016 election: Obamacare. There were no specific questions about it, no talk about replacement plans—it was discussed only in asides.

Donald Trump made a quick reference to it during his introductory remarks, and Ted Cruz made his usual promise to repeal the law. But the only sustained discussion came in response to a question about the summer Supreme Court decision rejecting an anti-Obamacare lawsuit. And that was a conversation about Chief Justice John Roberts, his supposed act of heresy, and what kind of justices the Republicans would appoint to serve on the Court. Health care policy didn’t come up.

That was largely true of the Fox debate as well. Obamacare repeal got the kind of lip service you would expect, but no real focus. But here’s where healthcare policy

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New Census data confirms major drop in uninsured in 2014

Bar chart showing dropped in uninsured rates from 2013 to 2014, using census data

The uninsured population fell dramatically from 13.3 percent in 2013 to 10.4 percent in 2014, new data from the Census Bureau shows.

The coverage gains reflect growth in both Medicaid and private health coverage, and they occurred across population groups. These are the first Census estimates showing the effects of health reform’s major coverage expansions, which took full effect on January 1, 2014. […]
The share of Americans enrolled in Medicaid rose from 17.5 percent in 2013 to 19.5 percent in 2014, while the share with private coverage rose from 64.1 percent to 66.0 percent. Thus, 2014 is the first year since 2000 in which both Medicaid and private coverage grew by statistically significant amounts. That’s because health reform expanded Medicaid to more low-income adults and it provides subsidies to help people with modest incomes purchase private coverage through the health insurance marketplaces.

That’s

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Having lost in Iran, again, McConnell sets up another Iran vote

Senate Republican leader Mitch McConnell turns to Sen. John Cornyn, R-TX after speaking to reporters after the Republican party policy luncheon in the Capitol in Washington September 16, 2014.  At left is Sen. John Barasso, R-WY. The U.S. House of Represe

A peevish Mitch McConnell forced the Senate to vote Tuesday evening, again, to begin debate on the Iran disapproval resolution. He lost, again. But true to form, he promised there would be even more Iran votes and set one up for Thursday, this time a procedural vote—which again requires 60 votes—to prevent President Obama from lifting sanctions on Iran under the deal until Iran publicly supports Israel.
As Democratic leader Harry Reid said, “The Republican leader has threatened to us, ‘we lost and we’re going to make you suffer.’ […] The Republicans have lost. They lost this measure, and we should move on to something else.” But they won’t move on to something else, not until McConnell feels he has adequately “shamed” Democrats, as Politico puts it. The problem is, Democrats haven’t been shamed, on any of the votes McConnell has tried this on.

For the

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