From the day President Obama signed the Affordable Care Act in April of 2010, the Republicans in Congress started a drumbeat of promises to repeal it.

You can read an excellent timeline here. It was published in 2014 and chronicles only the first four years of their attempt.

Republicans in both the House of Representatives and the Senate introduced bills to repeal the ACA. But by the next month they were already backpedaling; Tennessee Senator Bob Corker said this: “The fact is that’s [a repeal] not going to happen, OK?” There were parts of the ACA that everyone liked, (e.g. allowing children to remain on their parents’ policy until age 26 and preventing insurers from denying coverage for preexisting conditions).

The 2010 Congressional elections broke heavily Republican; they gained 63 seats in the House and 6 seats in the Senate. Republicans ran on a platform of repealing the ACA and they saw this victory as a mandate and vindication. Instead of looking for bipartisan ways to improve the ACA they elected to do nothing legislatively and instead keep beating the drum to repeal.

But as long as Barack Obama was President they could freely call for the ACA to be repealed, safe in the recognition that it wouldn’t happen and they wouldn’t be responsible for its consequences. As matter of fact, they passed a repeal bill that President Obama vetoed in January of 2016. At the time House Speaker Paul Ryan said this: “It’s no surprise that someone named Obama vetoed a bill repealing Obamacare. The idea that Obamacare is the law of the land for good is a myth. We have now shown that there is a clear path to repealing Obamacare without 60 votes in the Senate. So, next year, if we’re sending this bill to a Republican president, it will get signed into law.”

But on November 7, 2016 they found themselves in the spotlight. On that night the Republican party won the House, the Senate, and the Presidency. Suddenly they found themselves in a position where they needed to deliver on a promise they never expected to have to keep: repeal (and replace) something the American people had grown to love.

Candidate Trump promised to repeal and replace and made it sound easy. But it never occurred to him (or any of his allies) that it wouldn’t be easy.

Simply put, while the Republicans spent seven years promising to repeal the ACA, the rest of the country spent those years recognizing its value. By late 2016 6,400,000 Americans knew their health wasn’t in danger because they purchased insurance through the ACA.

And it surprised nobody but President Trump that health care reform is complicated.

Meanwhile, the ACA kept growing in popularity. In June we learned that 41% of Americans supported it while only 38% didn’t (presumably 21% weren’t certain). On the same poll only 16% supported the plan the House passed in April. In fairness, President Trump weighed in and called the House plan mean.

All during this time both Congress and the White House steamed on, determined to keep this promise regardless of its damage. In early May the House passed the American Health Care Act by a vote of 217-213. They took this vote before hearing from the nonpartisan Congressional Budget Office (CBO); when their report did come out the CBO predicted 24,000,000 would lose their health insurance over the next 10 years. Several members voted for the AHCA knowing it would not pass the Senate.

The Senate indicated they weren’t going to vote on the AHCA and drew up their own version that they called the Better Care Reconciliation Act (BCRA). The CBO determined that only 22,000,000 people would lose coverage in the next 10 years.

Like the House, several moderate Republicans voiced concerns. Majority Leader Mitch McConnell attempted to pressure his members to vote for this bill by essentially saying “we need to get something done.” When it became clear that it couldn’t pass, they came up with “skinny repeal”. This also failed, but only by one vote.

Their actions are both dishonest and irresponsible. Moderate Republicans have been bullied into voting for legislation they don’t support by being told “we’ll fix it later.”

What they need to do now is the thing they’ve refused for the last 7 years: work with Democrats. Nobody believes the ACA was perfect on its first try but it’s far from doomed. They need to put the health of the nation ahead of their political ambitions.

President Trump ran (and won) on the platform that he wasn’t a politician. Nobody disputed that. Since moving into the White House he has surrounded himself with others who were equally naive about how government works.

In previous posts I’ve created a subcategory of the Trump Chronicles I’ve called “Amateur Hour.” Previous winners included Kellyanne Conway, President Trump, Stephen Miller, and Sean Spicer.

Next up is Sean Spicer’s successor, Anthony Scaramucci. He took the job promising to end leaks to the press (which reminds many of us of President Nixon’s attempt to stop leaks in his administration through the use of operatives that we know as plumbers).

Wednesday night Mr. Scarmucci called the journalist Ryan Lizza demanding to know how he (Mr. Lizza) knew about who attended a White House dinner. Of course Mr. Lizza refused to give his source.

Mr. Scarmucci then began a tirade, accusing (then) White House Chief of Staff Reince Priebus of leaking the information.

He then falsely claimed that the public disclosure of his finances was a felony even though it was published by Politico after they made a public records request.

If that weren’t enough he then made increasingly vulgar attacks on Mr. Priebus and White House Strategist Steve Bannon. You can read about it here.

I’m not a politician but I recognize that any conversation I have with a journalist is “on the record” unless I ask that it be “off the record.” An “off the record” conversation is understood by both parties to be kept confidential. The reporter may use the information to continue to investigate but he can’t directly quote anything he is told.

I guess Mr. Scarmucci didn’t get the memo. When Mr. Lizza quoted him in an excellent article in The Atlantic, Mr. Scarmucci claimed he made a mistake in trusting a reporter and that it won’t happen again.

Only a rank amateur would speak to a reporter on the record and then complain that his words were quoted.

Tony, welcome to the club currently occupied by Kellyanne Conway, President Trump, Stephen Miller, and Sean Spicer. Fear not, the club will get bigger.

Dear Mr. President:

Yes, it’s been six months since you took the oath of office and gave an inaugural address that can only be called dark and dystopian.

I have to confess that six months later my fears for your presidency are vindicated, though I did have some initial hope. During the campaign you promised to be so presidential that we would be bored. I prayed that this campaign promise would be honored.

It didn’t take long to see that you lied about this too. On your second day in office you did something so disrespectful that it still takes my breath away. In case you don’t remember (or wish to claim it’s fake news) you appeared at the Central Intelligence Agency and stood in front of the Memorial Wall.

Perhaps you didn’t know this, but each of the 125 stars behind you commemorate a CIA employee who died in service to his country. But unlike most memorials to those who paid the ultimate price, there are no names with the stars. We know who some of them are but some died in circumstances that are still classified to ensure the safety of others who continue to serve us. This wall is a sacred place.

And not to put too fine a point on this, we don’t memorialize these 125 martyrs anywhere. We don’t remember them with streets, or parks, or schools. They don’t live on in memorial runs or hospital wings. Our only recognition of their sacrifice, and even their existence, lies in those 125 stars most of us will never see.

So did you honor their memory? Did you tell their families that while they may never know how their loved ones died, their country’s gratitude knows no bounds? Or did you instead use this opportunity to complain that “the press” cheated you by reporting that your inauguration was poorly attended?

Were this not sufficiently offensive, you later claimed to have been given a standing ovation. Really? So here’s the thing: when the President walks into a room everyone stands, and nobody sits until the President tells them to. You didn’t. Not only that, but you planted the room with your own people who were instructed to laugh and clap on cue. You were given an alleged standing ovation only because nobody was allowed to sit and your own people clapped.

I weep for those whose memory you disrespected.

But I hope you listen me now: it’s not too late. You still have 3 1/2 years left in your term (1208 days but who’s counting). Here’s what I suggest:

• Stop trying to make yourself look better by denying health care to the poor and the sick. The Affordable Care Act is, while necessary, not perfect. If you work with Democrats and make it better you can claim to have “fixed” it. We’ll give you that.
• Come clean about how you worked with Russia to win the election. Admittedly this won’t make you more popular, but full disclosure is your only way to take this off the front page of the daily news cycle. Much of the reason you’ve not been able to get much done lies in the fact that you’ve consistently cared more about your image than the nation you lead.
• Stop listening to those who are the most loyal and start listening to those who are the most intelligent. Those who bring you bad news aren’t currying favor, they’re looking out for your (and our) best interest. Be cautious about those who tell you want to hear and listen carefully to those who tell you what you need to hear.
• Admit that you have a hard job. This won’t be a hard sell but you ran on a platform of “I’m smart enough to make this job easy.” When you mused that nobody knew that healthcare could be so complicated you looked stupid. Every President before you understood that they needed to learn how to do the job. It’s your turn to recognize that.

I’ll have more later. Call me.

When I was a teenager I served on a committee at my church. After a long and painful meeting another member told me: “When all is said and done, a great deal more is said than done.” I still laugh when I think of it

I’ve written several posts on the Republican promise to “repeal and replace” the Affordable Care Act. Perhaps it’s time to take a step back and look at how we got here.

From the 2nd half of the 20th Century different Presidential administrations have sought to make health care available to everyone. As far back as 1945 we’ve been hearing about this. In November of 1945, Democratic President Harry Truman (seven months into his first term) said this: “The health of American children, like their education, should be recognized as a definite public responsibility.”

Alas, he was not able to make this happen. But 20 years later Democratic President Lyndon Johnson signed into law Medicare (health care for those 65 and older) and Medicaid (health care for the poor).

It’s worth noting that the Republican Party fought hard against all three. You can read an excellent article here.

From his first days in office in 2009 President Obama pledged to provide health care to those who had previously been left out because they had pre-existing conditions, or worked for employers who didn’t offer health insurance, or couldn’t work. You can find an excellent timeline here. It wasn’t easy, but he signed the ACA bill on March 23, 2010.

When Social Security, Medicare, and Medicaid became the law of the land the Republicans soon learned that these programs were both popular and permanent. Both parties then learned to cooperate and make regular updates that benefited the American people.

Not so with the ACA. Republicans who wanted nothing other than President Obama’s defeat latched onto this as a path to destroy his Presidency. You can read about it here. Simply put, while they failed in the courts, they found moderate success in frightening insurance companies away from entering markets in states that declined the Medicaid expansion (and threw overboard their poorest citizens in favor of settling political scores).

Meanwhile they’ve spent the last seven years promising to replace the ACA with something “better and cheaper.” Five days before his inauguration President Trump promised insurance for everybody. But if we’ve learned anything from the last six months, we’ve learned that while the Republicans pledged to replace the ACA they’ve spent not one minute figuring out how to do it. No plan, no framework, no work at all.

In fairness they’ve enjoyed the luxury of making promises they never expected to have to keep. That all changed in November.

So here’s the problem: these Republicans now have to choose between a moral compass and their job security. I don’t envy them because it’s not a fair fight. They continue to claim that they serve their constituents but the latest national poll shows that most Americans support the ACA and only 12% of counties who voted for President Trump support the ACA’s replacement. This morning we learned that a group called the Senate Conservatives Fund are already targeting Republican Senators who didn’t support the latest Senate bill to replace the ACA.

In my last few posts I’ve talked about the Senate Healthcare Bill, also known as the Better Care Reconciliation Act of 2017. My last post centered on its effect on Medicaid.

Today I wish to focus on another aspect: the Affordable Care Act (Obamacare) listed 10 things that all health insurance were required to provide:

Ambulatory patient services. [outpatient care]
Emergency services.
Hospitalization. [inpatient care]
Maternity and newborn care
Mental health and substance use disorder services, including behavioral health treatment.
Prescription drugs.
Rehabilitative and habilitative services and devices.
Laboratory services
Preventive and wellness services and chronic disease management;
Pediatric services, including oral and vision care.

These were chosen because several of them are exactly the benefits that are denied when times get tough. You can find an excellent article from National Public Radio that compares Obamacare, the House bill, and the Senate bill.

For the purposes of this post I’m going to drill down on just one: mental health and substance use disorder services, including behavioral health treatment. With Obamacare your health insurance required them to pay for mental health services, but both the House and Senate bills allow states to apply for waivers that would not require them to pay for this.

We’ve been hearing more and more about this, but opioid addiction has skyrocketed in the last few years. In fact, in March Mr. Trump appointed former New Jersey Governor Chris Christie to lead a new commission to battle opiod abuse.

Thing is, many addicts who seek treatment are able to pay for it through Medicaid. The percentage varies from from state to state. States that are hardest hit by addiction rely heavily on Medicaid to pay for this treatment. In Ohio it’s 49%, West Virginia it’s 45%, Kentucky it’s 44%.

The GOP plan will decimate Medicaid and make it harder for those who seek sobriety. We’ve been reading in the last few days that the Senate is looking at adding $45 billion for drug treatment but this isn’t nearly enough.

I’ll be writing more about how we all benefit from Medicaid, but healing addiction helps everyone.