Finally Accountability at the VA

The Department of Veterans Affairs has fired 526 employees, demoted another 27 employees and temporarily suspended an additional 194 for longer than two weeks, since President Donald J. Trump took office on January 20. That information is contained in the Adverse Actions accountability report posted on the agency’s website. The report doesn’t include the employees’ names, but shows their positions.

CBS reports that in an effort for more transparency and accountability within the VA, Secretary of Veterans Affairs David J. Shulkin announced that the list “accountability actions” will be posted  and updated online weekly.

President Trump signed his Executive Order “Improving Accountability and Whistleblower Protection at the Department of Veterans Affairs” in April. Then in June President Trump signed the “Department of Veterans Affairs Accountability and Whistleblower Protection Act of 2017.” Those two actions allowed Trump to claim he kept his campaign promise to reform veterans’ health care and other services.

The President pointed out that getting this Accountability Act passed was no small accomplishment. Referring to union opposition, Trump said “this was not an easy one”:

We got it done. It’s a reform that I campaigned on, and now I am thrilled to be able to sign that promise into law.

The VA is the government’s second-largest Cabinet agency, with approximately 350,000 employees. VA Secretary David Shulkin has complained that the current disciplinary process has averaged 51 days to remove an employee, primarily due to a 30-day notice period. The new law cuts the 30-day notice to 10 days and speeds up the appeal process. It also lowers the evidentiary standards required to fire an employee, and allows the VA secretary to rescind employee bonuses and relocation expenses in some cases.

President Trump has vowed to rid the VA of officials who misbehave or fail to meet agency standards. This is a yuge departure from President Obama. Obama insisted his administration was scandal free, despite the horrific 2014 scandal during which veterans died waiting for doctor’s appointments, as officials falsified records hiding the amount of time that veterans had to wait for medical appointments. According to an inspector general’s report, 1,700 veterans were kept on such waiting lists and veterans waited an average of 115 days for an initial primary care appointment.

During Obama’s presidency only nine employees (out of 57 targeted for disciplinary actions) were fired. And then, in June 2016, the Obama administration abandoned the 2014 law’s streamlined firing process after deciding it was unconstitutional.

Obamacare Reform Is Looking Doubtful This Year

If you’re wondering whatever happened to the Republican health care reform bill, you are not alone. When we last heard from the American Health Care Act, House Republican leaders were waiting on the Congressional Budget Office to score the bill before submitting the legislation passed in the House to the Senate. The CBO scored the bill in late May, but the silence from the Republican ranks has been deafening. The congressional website does not show any action on the bill since it passed the House on May 4.

Readers of The Resurgent are aware that the Republican health care bill falls short of full repeal. Senate rules require 60 votes for cloture on a repeal bill and Republicans would not be able to find eight Democrats to join them in ending a Democrat filibuster. Even if Republicans eliminated the filibuster entirely, they would not have enough votes for full repeal because at least four Republicans have pledged to oppose a repeal bill that does not provide for a phase out of the Obamacare Medicaid expansion.

Now some Republicans are saying that it is doubtful that they will be able to pass even an incomplete health care reform bill. “I don’t see a comprehensive health care plan this year,” Senator Richard Burr (R-N.C.) said in Politico. “It’s unlikely that we will get a health care deal, which means that most of my time has been spent trying to figure out solutions to Iowa losing all of its insurers.” Burr serves on the Senate Heath, Education, Labor and Pensions Committee.

In the Wisconsin State Journal, Senator Ron Johnson (R-Wisc.) agreed that the first priority to would probably be to act to preserve the health insurance markets in their current form. Johnson said that a short-term “market stabilization” bill could be passed that would fund the Obamacare exchanges with billions of dollars to help prevent insurers from exiting the marketplaces. Such an approach would reduce volatility in the Obamacare markets and buy time for Republicans to agree on a reform bill.

“To me, this may be a two-part process. I would admit that’s probably a minority view in the Republican Senate right now,” Johnson said.

Senator Jeff Flake (R-Ariz.) also tried to tamp down expectations. “There are some still saying that we’ll vote before the August break,” he told the Washington Post. “I have a hard time believing that.”

The fundamental problem is that conservative and moderate Republicans do not agree how to handle various aspects of the health care issue. Although Republicans have been united in their desire to repeal and replace Obamacare since the day it was passed, they disagree on the details of what should come next.

In the eight years since Obamacare became law, Republicans such as Tom Price, formerly a Georgia congressman and now Secretary of Health and Human Services, have written legislation to repeal Obamacare and reform the health insurance industry, but the party has not coalesced around any single bill. When Donald Trump eked out a squeaker of a victory in the Electoral College, Republicans were caught flat-footed and did not have a plan for how to exploit his victory. Indications were that, as late as early February, Republicans had not even started writing an Obamacare reform bill. The Senate considers the House bill dead on arrival and is writing its own version of health care reform, which may be available as early as this week.

President Trump’s antics are also hurting the possibility of passing a health care bill. The investigation into the Trump campaign’s possible connections with Russia and the firing of FBI Director James Comey are distractions that make it even more difficult to find a compromise that is acceptable to all GOP factions. The president showed leadership in the fight to pass the AHCA in the House, but has largely been missing-in-action on the issue in the month since the House vote.

Not all Republicans are pessimistic on health care. Senator John Cornyn (R-Texas) was quoted in The Hill as saying, “We do need to take care of our business, and I think you mentioned healthcare, and that’s certainly front and center in the United States Senate — something we’re going to have to get resolved here in the next few weeks.” Cornyn said that he thought a Senate bill would be “done by the end of July at the latest.”

Repeal of Obamacare has been the centerpiece of the Republican platform since 2010. The fact that repeal is not possible, even with Republican majorities in Congress and a Republican president, is not going to please most Republican voters. If the new Republican administration leaves Obamacare completely intact, it may well face a mutiny from the grass roots.

House May Have to Vote on Health Care Bill Again

If you are wondering why the Senate hasn’t started working on the American Health Care Act two weeks after the House passed the bill, you aren’t alone. Bloomberg reports that the measure is stalled with the House leadership after being approved by a four-vote margin earlier this month.

According to Bloomberg, the holdup is a series of last minute amendments that were made before the vote in order to garner more support. The late changes have not been scored by the Congressional Budget Office and Republican leaders are waiting for the CBO numbers before sending the bill to the Senate.

If the CBO numbers don’t show at least $2 billion reduction in the deficit, it would doom the bill in the Senate because it would not qualify for the budget reconciliation process that avoids a Democrat filibuster. The GOP would be forced to start the process again with a new budget resolution in the House. Before the changes, the bill was projected to save about $150 billion over 10 years.

“We’ve got to wait for the CBO score to prove that you meet the reconciliation test,” said Rep. Greg Walden (R-Oreg.), chairman of the House Energy and Commerce Committee.

A Republican aide told Business Insider that Republicans expected positive results from the CBO, but were waiting for the report to be sure. “Based on the previous two scores, we believe we’ll hit our target deficit reduction number but we’re holding out of an abundance of caution,” the aide said.

If the House has to vote on the bill again, passage would not be a slam dunk. In the first vote, 20 Republicans joined every House Democrat in voting against the bill. The current version of the bill was specifically crafted to gain enough support from disparate Republican factions to pass. If the bill has to be changed to satisfy budget reconciliation requirements, the fragile balancing act may be upset and changes may cost too many Republican votes to pass the bill a second time.

The CBO report is expected next week.

New Cruz? Texas Senator Works For Health Care Compromise

Texas Senator Ted Cruz has developed a reputation as a firebrand. Cruz has made refusal to compromise a trademark of his career in Congress and has often had strong words for fellow Republicans who disagreed with him on strategy. Now a new behind-the-scenes report by the Wall Street Journal reports that Cruz may be turning over a new leaf.

The Journal reports that Cruz began working quietly with moderate Republicans to find a consensus on health care reform that has a realistic chance of becoming law. Cruz was instrumental in forming a working group of 13 Senators that had its origin in a February steak dinner with Sen. Lamar Alexander (R-Tenn.). The group includes Republicans concerned about the effect of an outright repeal of Obamacare’s Medicaid expansion and pre-existing conditions rules such as Rob Portman (R-Ohio), Tom Cotton (R-Ark.), Cory Gardner (R-Col.) and Mike Lee (R-Utah). Cruz has reportedly been working with House Freedom Caucus Chairman Mike Meadows (R-N.C.) for the past month.

Senators on both sides of the aisle expressed surprise at Cruz’s new strategy. “It’s a ‘you live long enough, anything can happen’ moment,” said Lindsey Graham (R-S.C.).

“It would be a first for Sen. Cruz,” noted Chris Murphy (D-Conn.).

The GOP’s 52-vote majority in the Senate means that Republicans can lose no more than two votes and still be able to pass an Obamacare replacement. A defection of two Republicans would require Vice President Mike Pence to cast the tie-breaking vote. At least five Republican moderates are considered to be doubtful in their support for the American Health Care Act.

The working group is expected to be vital in bringing various Republican factions in the Senate together to forge a compromise that can replace as much of Obamacare as possible. Cruz’s participation and support may help bring other conservatives such as Mike Lee and Rand Paul (R-Ky.) on board with the Republican reform effort.

In the past, Cruz has had difficulty with consensus building and passing legislation. He is perhaps most well-known for his role in the 2013 government shutdown and attempt to defund Obamacare. With Republicans outnumbered by Democrats, the shutdown failed to halt the implementation of President Obama’s namesake health bill. Cruz was also known for failed attempts to prevent an increase in the debt ceiling and compromise spending bills under the Obama Administration.

Cruz may be realizing that the role of majority party senator is very different from that of one who serves in the opposition. When a party is in power, it is expected to deliver results in the form of advancing its legislative agenda. It is not enough to just say “no” when your party controls both houses of Congress and the White House.

“They’re giving him a leadership role and he’s going to have to make the most of if it,” said Rick Tyler, who served with Cruz’s presidential campaign. “If he can pull it off it’s a huge victory. But it’s fraught with danger.”

The upside for Cruz would be an enormous amount of prestige and notoriety if he shows an ability to build a coalition to pass a landmark reform bill. The boost for Cruz could potentially reach beyond his normal conservative base and lay the groundwork for a second presidential campaign in 2020.

Without the support of Cruz and other Senate conservatives, a reform effort would necessarily have to reach across the aisle to Senate Democrats. That would mean fewer conservative reforms in a watered-down bill. The alternative would be to delay reform until after the 2018 elections or until health insurance markets become so dysfunctional that the public demands action.

A potential pitfall would be alienating the conservative base whose expectations are for a full repeal of Obamacare. Even though Republicans do not have the votes for a full repeal, Mr. Cruz has helped stoke those expectations over the past few years. Many conservatives view anything short of full repeal to be a betrayal. Cruz must help the party overcome that view and sell the reform bill to the conservative base.

Health care reform gives Ted Cruz an opportunity to break out of his stereotypical role as a roadblock in the Senate. If Cruz can prove that he has the ability reach out and build a working majority with senators who don’t share his views, it would represent a major milestone in his career make him an even greater force in the Senate.


AHCA May Be Best Chance to Replace Obamacare In Our Lifetime

The House of Representatives finally passed a bill to gut Obamacare and many conservatives are upset. Admittedly the bill is not full repeal. It is far from perfect. If I was going to write a health care reform plan, the American Health Care Act would not be it. Still, I’m very glad that the House passed the bill and I fervently hope that the Senate moves the legislation forward. Why? Because it is the only health care reform that has any chance of passing.

Many myths have grown up around Obamacare and the Republican repeal and replace effort. Over time, we have forgotten that Obamacare was not passed by a budget reconciliation. “HR 3590, the Patient Protection and Affordable Care Act,” was passed on Christmas Eve 2009 after a cloture vote by 60 Democrats ended a Republican filibuster. It was a traditional bill that requires a traditional bill to repeal.

So, what was the controversy about the budget reconciliation? After Scott Brown (R-Mass.) was elected to the Senate, the Democrats could no longer break Republican filibusters. If the Democrat-controlled House amended the ACA, it would be subject to another cloture vote, which the Democrats would lose. The answer was to have the House pass the bill unchanged and use the budget reconciliation process to pass a second bill, “HR 4872, The Healthcare and Education Reconciliation Act,” by a simple majority vote. This bill was subject to the same limitations that the GOP now faces in passing their own budget reconciliation.

Even though Republicans hold the presidency and control both houses of Congress, they were not granted a blank check by voters. A full repeal would require 60 votes for cloture in the Senate and there are only 52 Republicans. The mathematical problem is obvious.

But what about the 2015 repeal bill that was vetoed by President Obama, you may ask. Republicans didn’t have 60 votes in 2015 either, but they passed a repeal bill then. Why can’t they do it now?

The answer is that the 2015 repeal bill was not a full repeal either. The 2015 bill, was also a reconciliation bill that carried the unwieldy title, “HR 3762 To Provide for Reconciliation Pursuant to Section 2002 of the Concurrent Resolution on the Budget for Fiscal Year 2016.” The text of the bill states in Section 102 that the ACA “is amended,” not repealed.

If the 2015 bill was better that the AHCA of 2017, it is for two reasons. First, there were 54 Republicans in the 114th Congress where there are only 52 now. The GOP could afford to lose more votes in the Senate in 2015 that it can today.

Second, four Republican senators who voted for the 2015 bill now say that they won’t vote for a bill that does not provide for a phase out of the Medicaid expansion. Sens. Rob Portman (Ohio,) Shelley Moore Capito (W.Va.), Cory Gardner (Colo.) and Lisa Murkowski (Alaska) refuse to back the same bill that they voted for two years ago. Sen. Susan Collins (R-Maine) voted against the 2015 bill and would presumably do so again. Other Republicans are reluctant to repeal the popular provision concerning pre-existing conditions. It is these five senators and House moderates, not the Republican leadership or President Trump that are forcing a more watered-down version of the bill.

Some conservatives suggest that Republicans should get rid of the filibuster to pass a repeal. We wouldn’t need 60 votes then and the Democrats will probably kill it anyway the next time they have a majority, they argue.

The problem with this strategy is that full repeal could not even win a simple majority vote. The five Republican defectors in the Congress and the Tuesday Group of 50 Republican moderates in the House would kill it.

Removing the filibuster would also mean that Democrats would only need simple majorities to replace Republican health care reform with a national single-payer system the next time they control both houses of Congress and the presidency. It would also usher in a host of other bad ideas from gun control to a higher minimum wage to higher taxes to onerous regulations on practically everything. It is true that Democrats might one day choose to remove the filibuster, but it is certain that if Republicans remove it now, for no strategic reason, Democrats will have a field day when they return to power.

What, then, are the options for Republicans on Obamacare? One option is to wait and hope for a filibuster-proof majority. If you favor this option, be aware that the last time that Republicans had a 60-vote majority was the 61st Congress from 1909 to 1911. It is extremely likely that before the Republicans get a supermajority, Obamacare will implode, health insurance premiums will skyrocket, insurance companies will cancel policies and hell will freeze over. I have little doubt that if Republicans hold out for the perfect, full repeal bill that I will die of old age with Obamacare still intact. (I’m only 45.)

Waiting until 2018 might give the Republicans a few more votes to craft a better compromise. It is also possible that two years into the Trump Administration, voters might deliver a rebuke to Republicans in the form of Democrat majority in either the House or Senate that makes any sort of conservative impossible. In any event, it is doubtful that the numbers would change enough in the GOP’s favor to justify putting off a cornerstone promise of the campaign for two years. The longer Republicans wait to take action, the more entrenched Obamacare will become.

A better option is to take baby steps toward the full repeal of Obamacare starting now with the AHCA. The current bill has the support of moderates as well as the Freedom Caucus and has decent chance of becoming law. While far from ideal, it is a reasonable bill that can hopefully be improved further in its journey through the Senate. Even if it became law in its current form it would mark a vast improvement over Obamacare.

The Republican reform bill should not be viewed as a final step, but as a first step toward total repeal. Without a supermajority, it may take years of nibbling at the edges of Obamacare to fully repeal the behemoth, but conservatives have to start somewhere. The logical place to start is the bill that has the support of the two disparate factions of the GOP. The only bill that has a chance of becoming law.

Conservatives must decide whether it is worth trading a chance to gut Obamacare now to wait for a perfect bill in the distant future. The answer should be obvious. We should not allow the perfect to be the enemy of good and the possible.

Seize the day and start saving American healthcare!




GOP Sets Its Sights On Regulatory Reform With A Slew Of Bills

Regulatory reform was an important rallying cry for Republicans in 2016. Then-candidate Donald Trump promised to cut 75 percent of federal regulations, and now the GOP is starting to work on helping the president keep his promises to lessen the regulatory burden on Americans with a series of pieces of legislation.

One of the top priorities on this wish list of bills is the Regulatory Accountability Act, which looks to eliminate costly regulations. The way this bill works is that all regulations would be subject to cost-benefit analysis, which would determine whether authorities should choose a “reasonable alternative” to the regulation. Senator Rob Portman (R-OH) plans on introducing the measure after the Easter recess. A House version passed in January.

Supporters of the Regulatory Accountability Act say it would keep federal agencies on a tight leash and prevent the sort of regulatory overreach that Republicans complained about during the Obama administration.

But critics say it would lead to toothless regulations.

Even left-leaning critics of the bill say that it’s the one most likely to attract bipartisan support.

Another bill, the Small Business Regulatory Flexibility Improvements Act, requires agencies to take into account the impact a regulation has on small businesses. The idea, of course, is to limit red tape and rethink regulations that put too much of a burden on small businesses. A House version of this one passed earlier in the year, but the GOP will need to pull a few Democrats into the fold to prevent a filibuster.

The Searching for and Cutting Regulations that are Unnecessarily Burdensome (SCRUB) Act seeks to eliminate up to 15 percent of regulations by cutting duplicate and redundant regulations. It too passed the House in January but may have an uphill battle in the Senate.

One of the most daring bills on the table is the Regulations from the Executive in Need of Scrutiny (REINS) Act. This measure requires federal agencies to consult Congress before enacting major regulations.

Critics say it would allow Republicans to kill regulations much more easily, even if they just control one branch of Congress.

Currently, Republicans have the Congressional Review Act, which lets Congress strike down some regulations on the books. But it’s only effective when the same party controls both chambers and the White House.

As its name implies, the All Economic Regulations are Transparent Act (ALERT) Act seeks to bring more transparency to the regulatory process by requiring agencies to send reports to Congress, which would then be make public for six months before the regulations can go into effect, while another optional measure, the Early Participation in Regulations Act, would allow more options for public comment on potential regulations.

Like the other bills, the REINS and ALERT Acts have already passed the House but likely face a tougher fight in the Senate, while the Early Participation in Regulations Act may have some bipartisan support.

It’ll be interesting to see if these new bills have any chance of becoming law and what effect they’ll have on the regulatory state. Here’s hoping the GOP can make a dent in the burden with these measures.

Trump: Health Care Reform Before Tax Reform

After the failure of the Republican health care reform bill, there were indications that the Trump Administration intended to put health care on the back burner and move along to tax reform. Treasury Secretary Steven Mnuchin set an August deadline for passing tax reform, but now President Trump has apparently changed his mind, telling Fox Business that health care reform must come first.

“I have to do healthcare first, I want to do it first to really do it right,” Trump said in an interview Tuesday on the cable channel.

“We’re saving tremendous amounts of money on health care when we get this done, number one, and most importantly … we’re going to have great healthcare, and all of that savings goes into the tax,” Trump said. “If you don’t do that you can’t put any of the savings into the tax cuts and the tax reform.”

The change in priorities may be due to Trump’s decision to scrap the tax reform plan from his campaign and start over from scratch. Fox News reported that White House aides say that the goal is to cut tax rates to spur growth, but alternative ways of raising revenue have not been decided. Two options reportedly being considered are a border adjustment tax on imports and modified version of the border adjustment that would cut corporate taxes and eliminate much of the payroll tax. The resulting plan is similar to a value-added tax that would be in line with WTO rules. Eliminating payroll taxes would require creating a new source of funding for Social Security.

In reality, health care reform and tax reform share the same obstacles. Both are hampered by a divided Republican Party that holds a razor-thin majority in the Senate. Unless Senate Republicans go nuclear again to eliminate the remainder of the filibuster rule, at least eight Democrats will need to vote for cloture to advance any bill. If any Republican faction splits off from the rest of the party on a bill, the number of required Democrat votes increases.

The requirement for Democrat votes limits the extent of conservative reform that can go into a bill. If a bill goes far enough right to please the Freedom Caucus and Tea Party Republicans, then it loses support from moderate Republicans and is almost certain to be filibustered by Senate Democrats. On the other hand, if a bill isn’t conservative enough, it loses support of Congress’s conservative reformers.

There are stark differences between Republicans and Democrats on both reform packages, but ultimately compromise will be needed to get enough votes to pass any bill. While some elements of health care and tax reform can be packed into a reconciliation bill that is not subject to filibuster, full reform or repeal of Obamacare requires 60 votes for cloture in the Senate.

A possible solution is to simply eliminate the filibuster entirely. Republicans could pass their wish list relatively easily if bills were not subject to cloture votes. There are two obvious problems with this strategy.

First, the Republicans only have a two-vote majority in the Senate. There would be tremendous pressure on moderate Republicans like Susan Collins (R-Maine), Rob Portman (R-Ohio) and Lisa Murkowski (R-Alaska) to break ranks and vote with the Democrats. Bills would have to be watered down to prevent their defections.

Second, if Republicans eliminate the filibuster, they will get a taste of their own medicine the next time the Democrats have a majority. One day soon, the filibuster might be all that stands between a Democrat majority and gun control, single-payer health care, a $15 minimum wage and the rest of the liberal wish list.

The filibuster puts the brakes on legislation, conservative and liberal, Democrat and Republican. That’s a good thing and Republicans should learn to deal with it. The resulting bills may not be everything that conservatives want, but incremental change in the right direction is better than risking a full-court liberal press four years from now.

For now, it seems that no health care reform or tax reform is on the immediate horizon. It may be months before either the second attempt at health care or tax reform is ready. After eight years in the wilderness, conservative voters are unlikely to be very patient.



Republicans Still Divided on Health Care Reform After Late Night Meeting

A meeting of Republicans with Vice President Mike Pence that went into the wee hours resulted in no agreement between Republican factions on the next attempt at reforming the Affordable Care Act. Even though Republicans represent a majority in both houses of Congress, disagreement on some aspects of the reform legislation resulted in House Speaker Paul Ryan (R-Wisc.) withdrawing the American Health Care Act from consideration last month.

Last night’s meeting included leaders of several of the various Republican factions. Rep. Mark Meadows (R-N.C.) of the Freedom Caucus, Republican Study Committee Chairman Mark Walker (R-N.C.), and moderate Tuesday Group co-chairman Tom MacArthur (R-N.J.), House Energy and Commerce Committee Chairman Greg Walden (R-Ore.) and Ways and Means Committee Chairman Kevin Brady (R-Texas) were also in attendance at the meeting.

“We’re basically working on the concepts where the differences have been. We found a lot of common ground,” said Rep. Jeff Duncan (R-S.C.) in The Hill. “You find common ground, you set that aside, and then you start working on some of the differences.”

The first Republican attempt at health care reform had several problems that eventually drove many conservatives to oppose the bill. The AHCA kept two popular Obamacare provisions that require insurance companies to cover pre-existing conditions and keep children on their parents’ policies up to age 26. The bill also continued to subsidize health insurance premiums although it restructured the subsidies as refundable tax credits. The bill also would have left Obamacare’s Medicaid expansion in place through 2020.

“Even though we have a high-risk pool that deals with this, I think there’s probably a lot more concern over the guaranteed issue [of insurance for people with pre-existing conditions] portion of that and what that may mean,” said Rep. Meadows.

Rep. Walker said that there was “great consensus” among Republicans on high-risk pools for people with pre-existing conditions, but did not provide detail.

Under the high-risk pool concept, the states would set up an alternative insurance plan for people with pre-existing conditions who would otherwise be uninsurable. High-risk pools typically cost more for the policy holder, but some of the cost is subsidized by taxes on other insurance premiums. High-risk pools for people who are uninsurable have been utilized by states for years.

Several Republicans said that the meetings will continue Wednesday as the caucus tries to find a consensus that can pass the House. New legislation will also ultimately have to meet the requirements of moderates in the Senate where four Republicans have promised to oppose any bill that guts the Medicaid expansion.