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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

8:15 AM PT:

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

U.S. Senate Minority Leader Mitch McConnell (R-KY) speaks to the media on Capitol Hill in Washington June 17, 2014. REUTERS/Yuri Gripas (UNITED STATES - Tags: POLITICS) - RTR3UAWO
The House did something productive this week. Well, semi-productive. They managed to pass a short-term highway funding bill. So that they can come back again in two months and do it all over again.
The U.S. House voted to keep federal money flowing for highways and mass-transit programs for two more months, through the end of July.

Lawmakers voted 387-35 on Tuesday for the short-term measure to give themselves time to negotiate toward a longer extension. The Senate also plans to vote on the measure this week before Congress leaves Washington for a week-long Memorial Day recess. […]

The two-month extension “was not our preferred path forward,” Transportation and Infrastructure Committee Chairman Bill Shuster, a Pennsylvania Republican, said on the House floor before the vote. He said he would have preferred to extend the program through at least the end of the year.

“Unfortunately, we were unable to reach an agreement on a seven-month extension, so we are left with a two-month patch,” Shuster said.

The Senate, of course, can ruin all that if Majority Leader Mitch McConnell continues his foot-dragging as the House moves toward leaving for Memorial Day recess midday Thursday. As of Wednesday afternoon, the pending legislation on the floor was Trade Promotion Authority with a fight over process as McConnell tries to prevent Democrats from offering amendments. At the same time, Sen. Rand Paul was conducting an extended speech (not really a "filibuster" as he calls it) to try to prevent McConnell from moving forward with extending the PATRIOT Act's bulk metadata provision. McConnell's ploy has been to play out the clock to the last minute to try to force that vote, leaving the highway funding more or less hanging in the balance.

Not well played, Mr. McConnell.

President Barack Obama smiling and holding
Charles Gaba calls it: 12 million people have signed up for health insurance through the Obamacare exchanges. Over 9 million, according to his calculus, signed up through the federal site, And there's probably about 12.4 million in Medicaid expansion. All in all, we're talking about 7 percent of the population getting some kind of coverage through the law, private or Medicaid. That means bad news for Republicans on a couple of fronts—how in the hell do you repeal that? And what in the hell are you going to do for 9 million people if the Supreme Court takes away their subsidies? Now it's possible that the numbers won't be quite so huge, but we're still talking millions of people. Add in the Medicaid enrollees, and 7 percent of the population.
The caveat? Not all of the people who sign up for a plan end up with Obamacare coverage. Last year, 88 percent of people paid at least their first month's premium; if that holds, about 11 million people will have paid for their coverage. But once you factor in policy changes, he assumes that the number of people with actual coverage—effectuated plans, in the parlance—will be about 10.1 million through the summer.
People come and go out of insurance because people have big life changes—jobs, moves, marriage, divorce, death—but 10 million people who would love private insurance under repeal are 10 million people likely to be rather unhappy to know that the Republicans were taking it away from them in exchange for a vague promise of "patient-centered" something. Also, too, the whole insurance industry would not be too happy about losing 10 million customers! Of course, they could just be blowing smoke on that whole repeal thing, and they probably are.

That doesn't get them off the hook, though, if the Supreme Court challenge they've been egging on prevails. In that case, there's as many as 9 million people, mostly living in Republican-run states, who will have their insurance yanked immediately, even without repeal. And as of yet, no Republican help in sight. Now would not be a fun time to be a Republican healthcare policy wonk.

U.S. House Speaker John Boehner (R-OH) (L) and Senate Minority Leader Mitch McConnell (R-KY) speak at a news conference about the U.S. debt ceiling crisis at the U.S. Capitol in Washington July 30, 2011. REUTERS/Jonathan Ernst  
Senate Majority Leader Mitch McConnell still insists that the PATRIOT Act provision that the NSA has used to illegally collect cell phone metadata from every American with a cell phone must be continued. The provision is set to expire, along with a couple of others, on May 31. McConnell is running down the clock to that expiration, hoping to exploit the imminent end of the program to scare members into going along with his plan. His end game, however, isn't clear because so far the House is still refusing go along with his plan.
[T]op House Republicans insist their bill is the only option for the Senate, with the House set to leave town on Thursday, and Speaker John Boehner (R-Ohio) giving no indication Tuesday that he is willing to bail out Senate Republicans with a short-term lifeline for the expiring PATRIOT Act provisions. […]

Senate Republicans are increasingly raising concerns about the House measure and say they need more time to be assured that the USA Freedom Act—which passed the House with 338 votes last week—actually would work. The House bill would end the NSA's bulk collection program and call on phone companies to retain the data. Investigators then could later tap the information in smaller amounts for terrorism probes.

McConnell and Senate leadership say that the USA Freedom Act will not meet a 60-vote threshold, which McConnell will insist the bill must reach. That's why he's willing to put the bill on the floor. His idea is then that the Senate will have to pass his two-month extension or let the provisions expire. But that's problematic as well. The House is intent on leaving town Thursday and as of now it doesn't look like the Senate will get to this vote until Friday. If McConnell and House Speaker John Boehner somehow work out the scheduling difficulties, there's still the major question of whether the House passing that extension—Goodlatte says that's not likely. And if that were to happen, there's still the Second Circuit Court of Appeals ruling that threatens that the court will step in to stop the program if Congress doesn't.

A bipartisan group of 60 members of the House, headed up by Reps. John Lewis (D-GA) and Justin Amash (R-MI) have written to Senate leadership, opposing the short-term extension and arguing that the Senate should take up last year's much stronger USA Freedom Act. It's a big enough group to challenge leadership's ability—if they even wish to try it—to pass a short-term extension. What's McConnell's alternative? Let it expire and come back to try again.

Tell Congress to let bulk collection of our metadata and other PATRIOT Act provisions expire.

1:27 PM PT: Sen. Rand Paul began what he's calling a filibuster early Wednesday afternoon, and has been joined by Sen. Ron Wyden (D-OR) and Sen. Mike Lee (R-UT). It's not really a filibuster, because the extension that he is opposing isn't actually on the floor, but it is eating up time. If the House does end up leaving for Memorial Day recess midday Thursday as planned, Paul's delay could achieve the expiration of the PATRIOT Act provisions.

2:31 PM PT: Developments:

Rep Amash: Hse GOP leaders "made a commitment to us that they will not pass a re-authorization of the PATRIOT Act by UC or by voice vote"
Which would mean if House leaves on Thursday, and Senate passes a short-term clean extension after, it's not getting a vote until June 1
Which means McConnell's only choice is let it expire or vote on/pass the USA Freedom Act w/out amendments.
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