TEA PARTY PATRIOTS:
The GOP quandary: How far right without falling over the edge?
“…Wisconsin Gov. Scott Walker, who is at or near the top of most early polls among Republicans, likes to boast how he stuck to conservative principles to win statewide office three times in a centrist state. “To win the center, you don’t have to go to the center, you have to lead,” he said last week during a Tea Party Patriots telephone town hall. Tea party loyalists are still somewhat wary of Walker, though, because of past positions on immigration and government support for ethanol, a big issue in Iowa, site of the nation’s first caucus. In 2006, he said during his gubernatorial campaign that “we as conservatives should oppose” federal ethanol requirements. But at the Iowa Ag Summit this month, he said he was “willing to go forward” with federal standards. During last week’s call, Tea Party Patriots president Jenny Beth Martin asked Walker why he switched his position. Walker said his position was consistent, explaining that he wants the standard phased out but would not end it right away. Immigration is also proving a difficult hurdle. Walker, former Florida Gov. Jeb Bush and Sens. Marco Rubio of Florida and Lindsey Graham of South Carolina are all viewed with suspicion because they have been sympathetic to paths to legalization or citizenship for immigrants living in the United States without documentation…”
http://www.fresnobee.com/2015/03/26/4447954_the-gop-quandary-how-far-right.html?rh=1
The GOP quandary: How far right without falling over the edge?
http://www.thenewstribune.com/2015/03/26/3709861_the-gop-quandary-how-far-right.html
HEALTHCARE:
Republicans see best shot yet at approving ObamaCare repeal as budget plan advances
“Republicans may be divided over the particulars of dueling budget plans, but there is at least one area of agreement among GOP lawmakers: the desire to repeal ObamaCare. And this year’s budget legislation could give them the best chance yet to send repeal legislation to President Obama’s desk. The party — which for the first time in eight years controls both the House and Senate — is using the budget process to inch closer toward a repeal of the controversial health care law, even as Obama hailed it a success on its five-year anniversary this week. The House on Wednesday night narrowly passed its version of a budget blueprint after Republican leaders agreed to tack on extra defense spending over the protest of conservative members who opposed busting the caps imposed by the 2011 Budget Control Act. The Senate, meanwhile, is on track to approve its plan by the end of week following a marathon voting session that starts Thursday. Leaders in both chambers have set a mid-April goal of resolving differences between the two approaches. Why does this matter for ObamaCare? Like many pieces of legislation before it, the proposal calls for undoing the health care law. What’s significant this time is that it’s contained in a budget resolution. While the resolution is not legally binding, it gives Senate leaders a procedural tool by which subsequent legislation — so long as it impacts spending or revenue — can pass the chamber on a simple-majority vote, as opposed to the usual 60-vote threshold. Known as budget “reconciliation,” the tool is critical to GOP hopes of shelving ObamaCare, since Majority Leader Mitch McConnell’s caucus of 54 is six votes short of filibuster-proof. (The budget itself is also subject to special rules and cannot be filibustered.) Five years after the president signed it into law, polls show that ObamaCare — also known as the Affordable Care Act — remains unpopular, with 42 percent of the public approving of it compared with 53 percent who disapprove, according to the Real Clear Politics average. The fact Obama likely would veto a rollback of his signature legislative achievement isn’t stopping Republicans from fulfilling what they describe as a campaign promise…”
http://www.foxnews.com/politics/2015/03/26/republicans-see-best-shot-yet-at-approving-obamacare-repeal-as-budget-plan/
ObamaCare under fire in ‘vote-a-rama’
“Senate Republicans are targeting ObamaCare in the chamber’s marathon session on budget amendments known as a “vote-a-rama” on Thursday. Senators have proposed 85 healthcare-related amendments, including a full repeal of ObamaCare, a ban on any ObamaCare marketing and a shift of Medicaid into states’ control. The symbolic proposals are among more than 600 amendments that the Senate will consider during the “vote-a-rama,” which is expected to last through late Thursday. Senate Democrats used their budget amendments to try to ward off attacks against the Affordable Care Act, which just passed its five-year anniversary. Several Democrats, including Senate Finance Committee ranking member Ron Wyden (D-Ore.), tried to strike a portion of the budget that “makes it easier to address Obamacare,” known as reconciliation. Another proposal from Sen. Dick Durbin (D-Ill.) would increase funding for the cash-strapped IRS to help enforce the healthcare law. This year marks the first time that the newly GOP-controlled Senate will put forward its own budget. While it will not become law under President Obama, the budget process allows lawmakers to make political statements about their priorities.”
http://thehill.com/policy/healthcare/237055-obamacare-under-fire-in-senates-vote-a-rama
Freshman Senator: Pay for Obamacare Replacement With … Obamacare
“Bill Cassidy, the freshman senator from Louisiana and a doctor, has been pushing fellow Republicans in his first few months in the Senate to embrace an alternative to Obamacare — one he predicts will insure more people without mandates. And he even says he has a way to pay for it: Obamacare. At an event attended Monday by fellow GOP freshmen to mark the fifth anniversary of the Affordable Care Act, Cassidy took an unusual tack for a Republican by bemoaning the fact that 30 million people remain uninsured, despite the ACA. He also took aim at the law for leaving pregnancy as “a pre-existing condition.” Asked about that assertion in a hallway interview the following day, Cassidy noted that uninsured pregnant women are only eligible to sign up for Affordable Care Act exchange plans during open enrollment or once their baby is born. “Now if a woman is pregnant, she’s not signed up, she’s not covered until she delivers. She doesn’t get prenatal care! She doesn’t get prenatal care! … Now, is that a good thing? No. But that’s what they left,” he said. More broadly, Cassidy, who noted he treated uninsured people for decades as a doctor in a public hospital, said Obamacare uses a combination of penalties, mandates and “bribes” to get people to submit to the administration’s will. “It’s actually in our nation’s interest for people to have insurance,” but there should be a voluntary approach, Cassidy said. He told CQ Roll Call his plan could cover those pregnant women, and many more, by providing tax credits large enough for people to afford major medical insurance and giving states the ability to auto-enroll people in insurance plans unless they opt out. “That is not a mandate. It is not a penalty, but it is a way, behavioral economics teaches, that will get most people enrolled,” he said. He predicted his approach would insure more people than the Affordable Care Act has. “If you had a system where states could auto-enroll, I think you’d be there. You’re always going to have Theodore Kaczynski, who you don’t know exists, under some hood in Montana.” Women who get pregnant while being uninsured could have a rolling auto-enrollment period, Cassidy suggested. “Somebody who is homeless has now come to the emergency room, didn’t know she had coverage, but we can, in a rolling enrollment, put her in for at least a baseline of coverage,” he said. There could be restrictions on plans purchased mid-year to prevent gaming the system. But even with restrictions, items such as prenatal care could be covered. The tax credits would be at least equal to the tax breaks people get for having employer-sponsored health insurance, Cassidy wrote in a column that ran in The Hill in February. Asked how he would pay for such a bill, Cassidy cited the taxes that finance the president’s health care law and pointed to the upcoming Supreme Court case over the legality of subsidies in states that did not set up their own health exchanges. “King v. Burwell obviously affects only a small scope of Obamacare, and one of the things it does not affect are the revenue streams. So, one thing you can do is basically take those revenue streams and distribute them in a way which is frankly a better plan. It doesn’t have the coercion or the bribes or the penalties or the mandates.” Getting rid of the mandates has broad appeal, he said. “I was with a bunch of college students last night. I said, ‘Everyone raise your hand if you want people telling you what to do?’ Nobody raised their hand.” Of course, the administration and insurers have long contended that without the mandates, the ban on pre-existing conditions would lead to sharply higher premiums as the sickest people get insurance and healthier, younger people opt out…”
http://blogs.rollcall.com/wgdb/bill-cassidy-freshman-senator-obamacare-replacement/?dcz=
Paul Ryan: GOP must have Obamacare replacement by late June
Strategy will tilt with Supreme Court ruling
“House Ways and Means Chairman Paul Ryan says Republicans must have a plan to replace Obamacare by late June, a deadline that coincides with a Supreme Court decision that could blow a huge hole in the controversial law. The Wisconsin Republican is working with other House chairmen to craft the GOP’s long-awaited alternative to President Obama’s health reforms. Their Senate counterparts are meeting, too, ahead of the justices’ ruling at the end of this term. “We have to have a plan in place by then,” Mr. Ryan told reporters. The Supreme Court heard oral arguments in the closely watched case known as King v. Burwell, with challengers saying the administration is breaking the law by paying tax subsidies to customers in states that rely on the federal HealthCare.gov exchange. The law says subsidies can be paid to customers in exchanges “established by the state.” If the subsidies are struck down, the law will be much less attractive to customers in at least 34 states that rely on the federal portal. Plans would no longer be affordable, and premiums could skyrocket if healthier enrollees drop coverage first. Republicans are cheering on the case, as it provides their best opportunity yet to scale down Obamacare and present their own ideas ahead of the 2016 presidential election…”
http://www.washingtontimes.com/news/2015/mar/26/paul-ryan-gop-must-have-obamacare-replacement-late/?utm_source=RSS_Feed&utm_medium=RSS
Obamacare struggling to enroll high-income Americans
“Obamacare isn’t enrolling enough middle-to-high income Americans to remain stable over the long term, according to a new analysis. Over the past few weeks the Obama administration has taken a victory lap touting the 11.7 million enrollees in Obamacare’s health exchanges during the most recent open enrollment, beating administration estimates of 9 million. However, 40 percent of the people who enrolled in healthcare.gov earn up to nearly $18,000 a year and another 25 percent earn nearly $30,000, according to an analysis from the research firm Avalere health. On the other hand, only 8 percent of people who earn up to $44,000 a year signed up through healthcare.gov, which covers 37 states. Only 2 percent of enrollees earn $60,000 and above. The analysis doesn’t examine the enrollees in the 14 state-run exchanges. If Obamacare doesn’t find a way to enroll higher-income consumers, it could jeopardize the healthcare exchanges, Caroline Pearson, senior vice president of Avalere, told the Washington Examiner. If not enough high-income people sign up, enrollment could decline or sputter and health insurers would be less willing to participate in the marketplace, she said. That could happen within the next few years. Obamacare enrollment is supposed to grow every year, with the goal to have 21 million enrolled in health coverage by 2016. However, the administration could run out of higher-income citizens to sign up. Obamacare has already enrolled 76 percent of eligible U.S. citizens who earn up to $17,655 a year, the lowest income bracket, according to Avalere….”
http://www.washingtonexaminer.com/obamacare-struggling-to-enroll-high-income-americans/article/2562082?custom_click=rss
Amid Affordable Care Act Fight, a Health Center Program Struggles to Stay Alive
“Dr. Savita Gopal, a 27-year-old resident physician at the Family Health Center of Harlem, sat in front of a computer last Thursday, peppering Jacob Doble, a 10-year-old from Harlem, with questions for 20 minutes. As Dr. Gopal typed copious notes, Jacob, accompanied by his mother, Mekisha Hawkins, said he had been to the emergency room repeatedly in February for asthma, migraines and hallucinations. “Like what?” Dr. Gopal asked about the visions. “I saw a giant dragon that looked like it was trying to get me,” Jacob replied. Dr. Gopal, who also gave Jacob a physical examination, said she accepted a residency program at the center last year, after studying at Rutgers New Jersey Medical School in Newark, because she wanted to work with patients who did not have access to adequate care. “I wanted to continue working in that environment, in an underserved community,” she said. Dr. Gopal’s residency is supposed to last three years, but its future is uncertain. Her training is paid for by a provision of the Affordable Care Act called the Teaching Health Center Graduate Medical Education program, which is up for renewal this year. The program has allocated $230 million nationwide over five years to try to tackle a worsening shortage of primary care physicians and draw eager young doctors to places where they are sorely needed…”
http://www.nytimes.com/2015/03/26/nyregion/amid-affordable-care-act-fight-a-health-center-program-tries-to-stay-alive.html?_r=0
Jonathan Gruber to face off with Michael Cannon in Obamacare showdown
“Call it an Obamacare showdown. Two leading voices in the controversy over President Obama’s signature healthcare law will face off next week at an event likely to grab widespread attention. One of them contributed to crafting the law. The other is trying to get a major part of it struck down. Jonathan Gruber, an economics professor at the Massachusetts Institute of Technology, will appear side-by-side with Michael Cannon, director of health policy studies at the conservative Cato Institute. The event will take place Wednesday in New York City at a summit hosted by Sun Life Financial. Both men, but especially Gruber, have attracted widespread media attention for their strong stances on the Affordable Care Act. Gruber, who consulted for the White House while the law was being passed in 2010, has been one of its strongest advocates. But he faced a firestorm of criticism last summer when some of his past comments about the law surfaced. On at least one occasion, Gruber suggested the law wouldn’t have passed if not for the “stupidity” of voters. Another time, his comments appeared to uphold arguments by the law’s opponents that its insurance subsidies — which the law’s language says are only available to users of state-run exchanges — can’t go to participants who use the federal exchange website healthcare.gov. That question is currently being considered by the Supreme Court, which is expected to hand down a decision in June. The case, called King v. Burwell, has given Cannon a big platform to air his opposition to the law. Cannon has been King v. Burwell’s loudest champion since it first arose in lower courts and worked its way all the way up to the Supreme Court, which heard oral arguments earlier this month. If the court strikes the subsidies, millions of low and mid-income Americans who have bought health plans on healthcare.gov won’t be able to afford them anymore…”
http://www.washingtonexaminer.com/jonathan-gruber-to-face-off-with-michael-cannon-in-obamacare-showdown/article/2562088?custom_click=rss
How do you define Obamacare success?
“Should you measure Obamacare’s success by how many Americans have gotten health insurance, or by how good that coverage is? It’s evident the health care law’s advocates and opponents hold vastly different views on that question as they mark its fifth birthday. President Obama and Democrats spent this week touting how millions of previously uninsured Americans have gained coverage since the Affordable Care Act was passed half a decade ago — 16.4 million, by their count. Some have become newly eligible for Medicaid while others have bought private health plans at online insurance marketplaces with the help of federal subsidies. Young people have been allowed to remain on their parents’ plans, and many with serious medical conditions have gained coverage, too. “A lot of the attention has been rightly focused on people’s access to care, and that obviously was a huge motivator for us passing the Affordable Care Act — making sure that people who didn’t have health insurance have the security of health insurance,” Obama said Wednesday in a speech celebrating the law’s anniversary…”
http://www.washingtonexaminer.com/how-do-you-define-obamacare-success/article/2562049?custom_click=rss
Gingrich: GOP really doesn’t want to repeal Obamacare
http://www.usatoday.com/story/news/nation/2015/03/26/newt-gingrich-healthcare-reform-obamacare-medicaid-expansion/70448300/
Obama takes stock of health-care law — and presidency
“White House aides insist that, with a year and a half left in his administration, President Obama is not yet talking about his legacy. But this week, the president offered one of his most definitive, bottom-line assessments of his signature health-care law that sounded a lot like he was taking final inventory. “Coverage is up. Cost growth is at a historic low. Deficits have been slashed. Lives have been saved,” Obama said at a White House summit Wednesday, marking the fifth anniversary of the Affordable Care Act. “It’s working better than many of us, including me, anticipated,” he said. Obama likes to remind audiences that a lot can still happen in the final stages of his presidency, and he’s determined to retain his political relevance even as the contest to replace him starts to take center stage. But time is running out on his chances for major new initiatives, especially legislation that requires cooperation with Republicans, who control Congress…”
http://www.washingtonpost.com/politics/obama-takes-stock-of-health-care-law/2015/03/26/06ae534a-d317-11e4-ab77-9646eea6a4c7_story.html?wprss=rss_national
Rarest of victories in House: Bipartisan health bill approved
“The House gave sweeping approval Thursday to a bipartisan plan to alter payment systems for Medicare providers and extend a popular children’s health program, fueling momentum for legislation that could soon reach President Obama’s desk. The vote, 392 to 37, came as Senate Democrats’ resistance to the more than $200 billion health package faded and Obama signaled he would sign the plan. After a first quarter of 2015 marked by gridlock, the legislation provides a modest but important victory that demonstrated congressional leaders have an ability to craft bipartisan deals when they believe it is in their interest. The proposal, negotiated by House Speaker John A. Boehner (R-Ohio) and Minority Leader Nancy Pelosi (D-Calif.), has been embraced by liberals seeking increased funds for programs that are key to advancing Obama’s Affordable Care Act and by conservatives cheering an increased premium charged to wealthy recipients of Medicare. It sets up one of the most rare moments in Obama’s second term, a piece of legislation that meets the approval of the president, the speaker and their respective allies. “As we speak, Congress is working to fix the Medicare physician payment system,” Obama said Wednesday, at a White House ceremony commemorating the fifth year of ACA’s enactment. “I’ve got my pen ready to sign a good, bipartisan bill, which would be really exciting.”…”
http://www.washingtonpost.com/politics/rarest-of-victories-in-house-bipartisan-health-bill-approved/2015/03/26/d77d0f92-d322-11e4-8fce-3941fc548f1c_story.html?wprss=rss_homepage
Pressure’s On Senate To Pass ‘Doc Fix’ In Latest Blow To Fee-For-Service Medicine
“The Republican-led U.S. House of Representatives has joined the Obama administration and private insurance companies in the march away from fee-for-service medicine in passing a repeal to Medicare’s controversial sustainable growth rate formula. The legislation, which overwhelmingly passed by a 392-37 bipartisan vote in the U.S. House, will avert a 21 percent cut in Medicare payments to doctors while at the same time moving future reimbursement to pay-for-performance and away from traditional fee-for-service medicine. Congress has several times for more than a decade now merely made stopgap corrections to avert drastic payment cuts to Medicare payments under SGR, which was created by the Balanced Budget Act of 1997 in an effort to slow the growth of Medicare spending. This time, the legislation, which is supported by the White House, will increase payments 0.5 percent annually through 2019. But it would tie more Medicare payments to quality measures that include clinical care, patient safety and care coordination. “The bill brings about a fundamental change in how Medicare reimburses physicians – moving from a volume-based payment system to value-based where physicians receive payment based on quality, coordination and outcomes,” Mary Grealy, president of the Healthcare Leadership Council, a coalition of chief executive officers from companies like Aetna AET -1.29% (AET), Johnson & Johnson JNJ -0.2% (JNJ), Merck (MRK) and Walgreens Boots Alliance (WBA) said in a statement to Forbes. Health insurance companies led by UnitedHealth Group UNH -0.25% (UNH), Anthem (ANTM), Aetna (AET) and others are shifting billions of dollars in payments to providers away from fee-for-service medicine to value-based care as well. Critics of the fee-for-service approach say it leads to unnecessary medical tests and procedures and results in payments to doctors and hospitals no matter how the care turns out…”
http://www.forbes.com/sites/brucejapsen/2015/03/26/pressures-on-senate-to-pass-doc-fix-in-latest-blow-to-fee-for-service/
Huge House vote pressures Senate
http://thehill.com/policy/healthcare/237084-huge-house-vote-for-doc-fix-puts-pressure-on-senate
Boehner says Senate will act ‘sooner rather than later’ on ‘doc fix’
“House Speaker John Boehner (R-Ohio) is keeping quiet about whether he expects the Senate to pass the House’s bipartisan Medicare bill before this week’s deadline. Minutes before the House overwhelmingly voted to pass the bipartisan measure, Boehner told reporters that he expects the Senate to take up the legislation “sooner rather than later.” But he declined to say when that vote could take place. “All I know is that the House is going to have a very large vote today,” Boehner told reporters. When asked why few in the Senate have publicly embraced the House’s “doc fix” deal, Boehner said he believes the bill will ultimately pass both chambers…”
http://thehill.com/policy/healthcare/237060-boehner-says-senate-will-act-sooner-rather-than-later-on-doc-fix
Fixing the ‘Doc Fix’ for Good
“Today’s Medicare vote is an important step toward reining in costs while protecting patients. President Obama’s debt is hurting our prosperity today and imperiling the American Dream for our children and grandchildren. On his watch, America’s national debt has increased by $7.5 trillion, to more than $18.1 trillion. Virtually everyone agrees: This simply can’t go on forever. Entrusted with a majority in the House of Representatives since the start of 2011, Republicans have worked hard to reduce out-of-control Washington spending. Despite staunch opposition from the White House and Senate Democrats, we have made 99 percent of the Bush tax cuts permanent and we are on track to save taxpayers nearly $2.1 trillion. And every year, we’ve proposed budgets that would balance and set us on a path to pay off our debt. Obviously, we haven’t achieved everything we wanted. The federal government still spends more than it takes in, largely because of mandatory entitlements like Medicare, Medicaid, and Social Security, which account for more than half of the entire budget. These important programs are still scheduled to go bankrupt in just a few years. It will take more work to save them, not to mention a president willing to do the right thing. We can’t put off progress until 2017, though. Our debt grows by the day, robbing our kids and grandkids of promised benefits that they are unlikely ever to see. Social Security Disability Insurance runs out of money next year. And due to what’s called Medicare’s Sustainable Growth Rate (SGR) formula, doctors will be hit with an automatic 21 percent cut to the payments they receive for treating patients on Medicare — unless Congress acts. ADVERTISEMENT We’ve faced this cliff before, nearly 20 times over the past dozen years. And every time, instead of actually addressing the problem with real reforms, Congress has punted with a temporary “doc fix.” But this time can be different. Later today, the House will vote on legislation that will make real progress in strengthening Medicare — a bill that will provide better health care for seniors and real savings for taxpayers. We know that more and more seniors have been losing access to their doctors because of Medicare rules. If enacted, this bill will permanently replace one of Washington’s most infamous budget gimmicks, SGR, with a more stable system that rewards quality and innovation. In doing so, not only will we reassure seniors that they can count on Medicare and continue to see their own doctor, but we will also put in place a stronger Medicare program for Americans who are trying to care for elderly parents…”
http://www.nationalreview.com/article/415965/fixing-doc-fix-good-john-boehner
A Medicare Bill Conservatives Need to Embrace
It’s not perfect, but it will pay huge benefits in the long term.
“The House of Representatives is poised to pass H.R. 2, the Medicare Access and CHIP Reauthorization Act of 2015, today by a wide margin. The Senate is expected to follow suit, again by a wide margin, and President Obama is expected to sign H.R. 2 into law. The major components of this bill are: the permanent avoidance of a long-planned 21 percent payment cut to doctors who take Medicare patients; asking wealthier seniors to pay for more of their own benefit; and requiring that “Medigap” plans have a modest amount of cost sharing in their plan design. The Congressional Budget Office finally came out with a score yesterday afternoon. As a conservative, you can be forgiven if you feel a bit of whiplash. Some conservatives say this plan increases the national debt, is too timid, and is a giveaway of key leverage to extract annual spending cuts. Other conservatives (myself included) think this bill will reduce the unfunded liabilities of Medicare without raising taxes, is a good down payment on even more entitlement reforms, and is well worth supporting. So which is it? Let’s start with the CBO score. Under a “current law” baseline (wherein CBO assumes that physician reimbursements will be cut 21 percent next week and stay cut forever), H.R. 2 is a ten-year spending increase of $141 billion, because the law would do away with that 21 percent cut and the government would have to pay doctors more. Under a more realistic baseline in which doctors don’t face a 21 percent Medicare cut next week (or ever), H.R. 2 is a ten-year spending cut of $1 billion. That’s because in this scenario, elimination of the 21 percent cut is already included in the baseline, so it doesn’t count as new spending. So it really comes down to deciding which starting point (another term for baseline) you think is more reasonable. I think the more reasonable starting point is that Congress won’t let next week’s 21 percent reimbursement cut happen (a safe bet, since they’ve avoided it 17 times since 2003)…”
http://www.nationalreview.com/article/415995/medicare-bill-conservatives-need-embrace-ryan-ellis
The SGR Fix Will Bust the Budget
But hey, if you’re going to be totally fiscally irresponsible, this bill is the way to do it.
“The House is expected to vote today on a bill to eliminate the annual cuts in Medicare payments to doctors that Congress has been postponing for more than a decade — the so-called “sustainable growth rate” (SGR) cuts. (UPDATE: The bill passed the House by a 392–37 margin.) The bill would result in $145 billion in new federal spending, above current law. It would also require wealthier seniors to pay for more of their own Medicare coverage, and would restrict the ability of seniors to buy supplemental coverage that completely shields them from the cost of the medical care they consume. (Such comprehensive “Medicare supplemental” coverage tends to increase overall Medicare spending.) A number of people have asked me what my take on this legislation is. Basically, it is this: If you’re going to be totally fiscally irresponsible, this is the way to do it. Congress created the SGR to limit Medicare spending on physician services. The SGR uses a formula to cut Medicare payments to physicians automatically. The formula works too well: It mandates cuts so deep that Congress decides every year it cannot stand for them. That’s why Congress has postponed those cuts some 17 times since 2003. This legislation would eliminate the cuts permanently, which of course would increase federal spending — by the $145 billion mentioned above (over the next ten years). As a starting point, we should recognize that the ideal amount the federal government should pay doctors is $0.00. So right off the bat, we know this bill is moving in the wrong direction. The bill compounds this error by not paying for all of that new spending by cutting spending elsewhere or increasing revenues. As a result, it increases the federal debt — which is to say, it imposes a tax burden on future generations who cannot vote or have not even been born yet. So this bill is yet another example of the dessert-first-spinach-later approach to fiscal stewardship that is business as usual in Congress. Ryan Ellis of Americans for Tax Reform disagrees. He is the most prominent conservative supporter of this bill’s approach. Ellis argues that if we assume Congress has already spent that $145 billion, then this bill is actually a $1 billion spending cut. Well, yes, but Congress has not already spent that $145 billion. If we assume that in fiscal year 2016, Congress will spend 100 percent of U.S. GDP, then President Obama’s proposed budget will be an even bigger spending cut. (The only difference is in the degree of reasonableness of those two assumptions.) That’s not how we do these things. Current law does not provide for that spending. So if you want Congress to spend that money, it counts as a spending increase. Ellis’s strongest arguments are that the bill increases means-testing in Medicare, prohibits Medicare supplemental plans from providing first-dollar coverage, and — c’mon, folks — this is the best deal we are going to get given current political realities…”
http://www.nationalreview.com/article/416022/sgr-fix-will-bust-budget-michael-f-cannon
The Medicare ‘Doc Fix’ That Isn’t
“As you listen to House Democrats and Republicans sing kumbaya over their bipartisan agreement to fix the Medicare physician payment system, keep one thing in mind: The doc fix doesn’t fix much, and what it does repair likely will add hundreds of billions of dollars to the debt in coming years. The bill would accomplish one big thing: It would repeal a Medicare payment formula that was supposed to cut physician compensation, but which Congress has blocked every year since 2003. This fantastical payment method would result in an impossible 21 percent cut for Medicare docs this year, a threat that is driving congressional action. But beyond repealing that formula, the House’s doc fix is an amalgam of temporary solutions to a host of health policy issues, special interest subsidies, and a promise of better health care for seniors—but not for at least five years. It may improve the way Medicare reimburses docs for the services they provide, but it won’t fix the problem. Equally troubling, the House bill would add $141 billion to the deficit over the next 10 years, according to the official Congressional Budget Office score, and $500 billion by 2035, according to the Committee for a Responsive Federal Budget. And, in reality, it could end up costing much more because it is filled with fiscal gimmicks. It front-loads benefits but delays many offsets for five years or more—a design that will give future Congresses the opportunity to abandon efforts to trim Medicare costs. Which is exactly what lawmakers did when they kept postponing payment cuts under the current formula. Here are a few of the problems, and why the plan would likely end up being far more costly than advertised…”
http://www.forbes.com/sites/beltway/2015/03/26/the-medicare-doc-fix-that-isnt/
Ryan: Medicare deal could be a ‘formula’ for tax reform
“Rep. Paul Ryan joined other congressional Republicans Thursday in arguing that a bipartisan deal to reform Medicare’s formula for paying doctors shows that their party can run Congress and pass big reforms. “I think we’re showing we’re a majority that is working,” the Wisconsin representative said Thursday following the Medicare vote. “And when we see opportunities to find common ground, we’re advancing big reforms.” Ryan spoke to reporters in the Capitol immediately after the House voted overwhelmingly to overhaul the Medicare payment formula. The Senate is working to pass the legislation, and President Obama has said that he would sign it. The bill would end years of congressional patches to prevent steep cuts in doctors’ payments. The legislation, however, was opposed by some fiscal hawks, who argued that it adds to the deficit. The deal was made between Republican and Democratic leaders, bypassing some House conservatives. Ryan, chairman of the powerful Ways and Means Committee that has jurisdiction over taxes and many domestic programs, said the legislation could provide a template for further efforts. House Speaker John Boehner “had a particular impression about how we could get that agreement, he was right on the way we should proceed and we did get the agreement we wanted to get,” Ryan said. “There’s a formula here for getting things done, and we’re going to try to perfect that formula. And maybe tax reform is one of those areas,” Ryan said…”
http://www.washingtonexaminer.com/ryan-medicare-deal-could-be-a-formula-for-tax-reform/article/2562091?custom_click=rss
The 37 lawmakers who opposed Medicare deal
http://thehill.com/blogs/floor-action/house/237116-the-medicare-deal-defectors
Ted Cruz: ‘Zero intention of taking any government subsidy or Obama subsidy’
“Sen. Ted Cruz, Texas Republican, says he’s simply following the law in likely getting health insurance through an Obamacare exchange, accusing the media of playing “gotcha games” with the development. “You know, the mainstream media loves to play gotcha games,” Mr. Cruz said in an interview with CBN News’ David Brody. He said his wife, Heidi, decided to take an unpaid leave of absence from her job when he announced his presidential campaign. Since she’s losing her benefits in the process, he said, they are going to take health insurance from their employer, “so in all likelihood, we’ll go on the exchange.” “And so suddenly, all the media says, ‘Ahahaha, gotcha, because Cruz is now signing up for Obamacare,’ ” he said in the interview, which was posted on The Daily Signal’s website. “Listen, I have zero intention of taking any government subsidy or Obama subsidy. Rather, what I’m going to do is pay in the marketplace for health insurance for my family just like millions of Americans.” Mr. Cruz went on to say that just because he wants to abolish the IRS, for example, doesn’t mean he’s going to stop paying taxes. “Some of these media outlets think that following the law is somehow less than principled,” he said. “I strongly support a flat tax, abolishing the IRS. It doesn’t mean I refuse to pay my taxes today, because the current law isn’t a flat tax. It is my intention to continue to lead the fight to repeal every word of Obamacare so that none of us are burdened by this law. But in the meantime, I and everybody else are bound by the laws that are passed in this country.”
http://www.washingtontimes.com/news/2015/mar/26/ted-cruz-zero-intention-taking-any-government-subs/?utm_source=RSS_Feed&utm_medium=RSS
Does Ted Cruz really need to buy insurance through Obamacare?
“When Sen. Ted Cruz, R-Texas, said Tuesday that he and his family would “presumably” purchase health insurance through an Obamacare exchange, the news sparked cries of hypocrisy from Democrats and progressives. How ironic, they said, that one the fiercest opponents of the Affordable Care Act (ACA) would decide to use a program he’s vowed to overturn. “Ted Cruz: Obamacare for me, but not for thee,” quipped the @SenateDems Twitter feed, which is operated by staffers for Democratic Senate leaders. Now, it turns out, the Cruz family might not purchase their insurance through an ACA exchange after all. Rick Tyler, a spokesman for Cruz’s just-launched presidential bid, told CBS News the senator “is weighing all the available options to choose what’s best for his family.” Cruz’s current coverage, which he receives through his wife Heidi’s job at Goldman-Sachs, will soon expire because Heidi is taking a leave of absence as the senator runs for president. The furor that greeted Cruz’s acknowledgment that he might purchase replacement coverage through an Obamacare exchange, though, raises the question: Does he have any other choice? An amendment to the ACA, which passed in 2010, required lawmakers and some of their staffers to purchase their coverage through the law’s D.C.-based exchange if they want to receive a subsidy. Nebraska Sen. Chuck Grassley, the Republican behind that amendment, said members of Congress “need to go into the exchange so that we would have to go through the same red tape as every other citizen.”…”
http://www.cbsnews.com/news/does-ted-cruz-really-need-to-buy-insurance-through-obamacare/
IMMIGRATION:
DHS secretary says Mayorkas will keep his job amid immigration flap
“Homeland Security Secretary Jeh Johnson said Thursday he won’t fire his deputy despite a scathing internal report that found Alejandro Mayorkas helped several high-profile Democrats get better treatment from an immigration agency. Mr. Johnson acknowledged he has work to do to rebuild trust among the many career staff whistleblowers who said Mr. Mayorkas was playing politics with the immigration system, but insisted Mr. Mayorkas himself did nothing wrong in responding to the requests. “He has been a valuable member of the team, definitely value added, and it would be a big loss to the men and women of our department if he were not full time, fully engaged, occupying his job,” Mr. Johnson said. Homeland Security Inspector General John Roth issued a report Tuesday finding that Mr. Mayorkas, who generally avoided getting involved in investor-visa cases when he was director of U.S. Citizenship and Immigration Services, did take “unprecedented” intervention after being contacted personally by Sen. Harry Reid, former Pennsylvania Gov. Ed Rendell and Virginia Gov. Terry McAuliffe. Mr. Roth said in each case, Mr. Mayorkas overruled career staffers and gave the well-connected Democrats’ concerns special favorable treatment. Mr. Roth also questioned Mr. Mayorkas’s veracity, pointing to a number of instances where he claimed not to have spoken with people when records showed he did, and other instances where Mr. Mayorkas said he was prodded by higher-ups but there was no record of such prodding. Mr. Mayorkas has vehemently rebutted the charges, saying he got involved in the three cases because the system was breaking down, not because he was trying to aid important Democrats…”
http://www.washingtontimes.com/news/2015/mar/26/jeh-johnson-says-mayorkas-will-keep-his-job/?utm_source=RSS_Feed&utm_medium=RSS
Watchdog says senior Homeland official broke no laws
“A senior Obama administration official violated agency ethics policies but did not break any laws when he intervened in three visa cases involving foreign investors with ties to prominent Democrats, a government watchdog told Congress Thursday. The Homeland Security Department’s now deputy secretary used his post as head of the department’s immigration benefits-processing agency to expedite the paperwork in a program long riddled with problems and backlogs, the department’s inspector general, John Roth, said. Alejandro Mayorkas’ interventions in the three cases helped key Democrats whose states and clients stood to benefit from these permits to live and work in the U.S., which pave the way for job creation and economic investments. The visa applications Mayorkas is accused of meddling with were part of the U.S. government’s investor-visa program, known as EB-5. It allows foreigners to obtain visas to live permanently in the U.S. with their spouse and children if they invest $500,000 to $1 million in projects or businesses that create jobs for American citizens. Approved investors can become legal permanent residents after two years and later can become U.S. citizens. The agency, which awards up to 10,000 foreign investor visas every year, is not supposed to give preferential treatment to anyone. Mayorkas drafted the ethics policy himself. “In each of these three instances, but for Mr. Mayorkas’ intervention, the matter would have been decided differently,” Roth told members of the House Homeland Security Committee Thursday…”
http://www.washingtontimes.com/news/2015/mar/26/republicans-looking-for-more-answers-in-visa-progr/?utm_source=RSS_Feed&utm_medium=RSS
DHS Won’t Fire a Top Official Who Did Political Favors for Democrats Because ‘We Need to Move On’
“Homeland Security Secretary Jeh Johnson on Thursday rejected the idea that Deputy DHS Secretary Alejandro Mayorkas should be fired for helping Democrats get visas for their favored companies, and instead argued that DHS should just be allowed to learn from the episode and “move on.” Johnson testified at a House Appropriations subcommittee just one day after the DHS Inspector General said Mayorkas intervened in three decisions on whether to grant visas for certain foreign investors. The report said Mayorkas intervened in cases involving well-known Democrats, and managed to get those visas approved. Mayorkas intervened in one case at the request of Senate Minority Leader Harry Reid (D-Nev.), and another case involved Virginia Gov. Terry McAuliffe (D) and Anthony Rodham, Hillary Clinton’s brother. But while the report said Mayorkas created the appearance of “favoritism and special access,” Johnson said the matter would end there, and indicated he opposed any effort to remove Mayorkas. “I just don’t get it,” Rep. David Young (R-Iowa) said at committee hearing. “You’re not going to do anything with deputy secretary Mayorkas? He’s going to stay where he is?” “Deputy Secretary Mayorkas is a valuable member of our senior leadership team,” Johnson answered. “He is working very, very hard in the public interest. He’s working very hard to reform the management of our organization, improve morale, manage our management action group.” “He has been a valuable member of the team, definitely value added, and it would be a big loss to the men and women of our department if he were not full-time, fully engaged, occupying his job,” he said. “I believe that. I work with him daily,” Johnson concluded. “And I’ve read the report, I’ve read it very carefully. I believe he understands the lessons to be learned from it, and we need to move on.” But Republicans are unlikely to accept that answer. Sen. Chuck Grassley (R-Iowa), who chairs the Senate Judiciary Committee, wrote a letter to Johnson on Thursday demanding that Mayorkas be held accountable somehow. “The Inspector General’s report paints a clear picture of how Mr. Mayorkas, when Director of the agency, used poor judgment and provided preferential treatment to certain petitioners and regional center applicants in the EB-5 immigrant investor program,” Grassley wrote. “You have an obligation to ensure there is accountability.”…”
http://www.theblaze.com/stories/2015/03/26/dhs-wont-fire-a-top-official-who-did-political-favors-for-democrats-because-we-need-to-move-on/
Terry McAuliffe defends pushing for action on stalled visas
“Gov. Terry McAuliffe (D-Va.) was unapologetic Thursday about his aggressive lobbying of the Department of Homeland Security over investor visa applications, despite an agency watchdog report that said a top official’s actions in response to those pleas created the appearance of political favoritism. McAuliffe, who was involved in a business deal with Hillary Clinton’s brother Tony Rodham to seek foreign investors for an electric car venture, insisted his contacts with then-U.S. Citizenship and Immigration Services Director Alejandro Mayorkas between 2011 and 2013 were intended solely to prod officials to make decisions on long-pending petitions in a program that grants green cards to wealthy foreigners who help create U.S. jobs. “They tell you if you get an applicant in they will make a decision [in] six months — on their website,” McAuliffe said in an “Ask the Governor” call-in program on Richmond radio station WRVA. “Well, I got to tell you when you’re sitting there with someone’s deposit, waiting for a year, a year and a half, or two years, you would be angry.” McAuliffe played down the favoritism allegations by saying he didn’t know Mayorkas prior to their dealings over the visa program. Rodham has not responded to phone calls or spoken publicly about the report. “This guy took calls from everybody, I never knew the guy beforehand,” McAuliffe said, referring to Mayorkas….”
http://www.politico.com/story/2015/03/terry-mcauliffe-visas-defends-116421.html
HARRY REID PRESSURED DHS TO EXPEDITE $115 MILLION FOREIGN INVESTORS EB-5 VISA DEAL CRITICAL TO SON’S CASINO CLIENT
“Details in this week’s Department of Homeland Security’s Inspector General’s report reveal only part of the story behind Senate Minority Leader Harry Reid’s (D-NV) abuse of his political office in 2012 and 2013. Through a brazen intervention, Reid ultimately forced the Department of Homeland Security to bend to his will in a way that benefited his political allies and family.
The report concluded that Reid pressured a compliant DHS official to override normal departmental procedures and rush through 230 EB-5 foreign visa applications, thereby freeing up $115 million the applicants invested in the SLS Hotel and Casino in Las Vegas. The report did not, however, reveal the now confirmed fact that the owner of that casino project had hired Reid’s son, Rory Reid, to provide legal representation for the project. “At the request of Senate Majority Leader Harry Reid, [current DHS Deputy Secretary Alejandro] Mayorkas intervened to allow expedited review of investor petitions involved in funding a Las Vegas hotel and casino [SLS], notwithstanding the career staff’s original decision not to do so,” the report found. “The career staff noted that the purported urgency was of the applicant’s [SLS’s] own making and that the decision to expedite fell outside EB-5 program guidelines,” the report stated. “Nevertheless,” the report concluded, “Mr. Mayorkas pressured staff to expedite the review. He also took the extraordinary step of requiring staff to brief Senator Reid’s staff on a weekly basis for several months.”…”
http://www.breitbart.com/big-government/2015/03/26/harry-reid-pressured-dhs-to-expedite-115-million-foreign-investors-eb-5-visa-deal-critical-to-sons-casino-client/
DHS chief: Court should have known part of amnesty was in effect
“A federal judge should have known Homeland Security was carrying out at least part of President Obama’s new deportation amnesty beginning last year, department Secretary Jeh Johnson told Congress on Thursday as the administration continued to struggle with what’s become a thorny legal issue. Justice Department lawyers had to apologize to a court earlier this month after revealing that Mr. Johnson had in fact been approving three-year “deferred action” applications from so-called Dreamers — an enhancement included in Mr. Johnson’s memos designed to carry out Mr. Obama’s new immigration policies. But Judge Andrew S. Hanen is considering imposing sanctions on the administration, saying in a court hearing last week that he felt misled when he learned a part of the amnesty was being carried out. He said the government had led him to believe that none of the amnesty — which grants a stay of deportation and work permits to potentially 4 million illegal immigrants — was in effect. Mr. Johnson said his directive announcing the three-year applications was part of the record submitted in the court case, so the Justice Department and Judge Hanen should have been aware. “Sitting here, I do not know whether the number of renewals that had been granted at the moment of the hearing was known to the court, but it should have been clear because it was in the record of the case that we began issuing three-year renewals effective Nov. 24, 2014,” Mr. Johnson said at a hearing of the House Appropriations Committee on Thursday. “That’s right here on page three of this directive.” The Nov. 20 directive reads that the change “shall apply to all first-time applications as well as all applications for renewal effective November 24, 2014. Beginning on that date, USCIS should issue all work authorization documents valid for three years, including to those individuals who have applied and are awaiting two-year work authorization documents based on the renewal of their [deferred action] status. USCIS should also consider means to extend those two-year renewals already issued to three years.”
http://www.washingtontimes.com/news/2015/mar/26/johnson-court-shouldve-known-part-amnesty-effect/?utm_source=RSS_Feed&utm_medium=RSS
Medi-Cal rolls could swell under Obama’s deportation relief plan
“President Obama’s executive actions on immigration, which have sparked a fierce political backlash nationwide, could also provide an unlikely boost for another of his goals: increasing health insurance signups. Immigrants living in the U.S. without permission can’t enroll in Obamacare, but an unusual policy in California allows those granted temporary relief from deportation to sign up for Medi-Cal. That means up to half a million more Californians could apply for the state’s low-income health program, according to data released Wednesday by UC Berkeley and UCLA…”
http://www.latimes.com/local/countygovernment/la-me-medi-cal-immigrants-20150326-story.html
REP. CARDENAS TELLS ILLEGALS: ‘I REPRESENT ALL OF YOU’ IN CONGRESS
http://www.breitbart.com/big-government/2015/03/26/rep-cardenas-tells-illegals-i-represent-all-of-you-in-congress/
US GENERAL TO SENATE: TERROR GROUPS BENEFITING FROM LATIN AMERICAN DRUG TRADE
“The Iran-backed Lebanese terror group Hezbollah is among the terrorist organizations that are benefiting from the illegal drug trade in Latin America, Lt. Gen. Kenneth Tovo, deputy commander of the U.S. Southern Command (Southcom), told lawmakers. Illegal drug trafficking in Latin American generates at least “tens of millions” for Hezbollah, which uses the funds to fuel its operations in the Middle East, explained the Southcom general. During a hearing this afternoon held by the Senate Homeland Security & Government Affairs Committee, Ron Johnson (R-WI), the panel’s chairman, asked the general to comment on the nexus between drug traffickers and terrorist organizations in Latin America….”
http://www.breitbart.com/big-government/2015/03/26/us-general-to-senate-terror-groups-benefiting-from-latin-american-drug-trade/
Dems grease skids for Obama’s immigration programs
“House Democrats are intensifying their efforts to help undocumented immigrants enroll in President Obama’s new programs easing deportations. The lawmakers, representing districts nationwide, have launched a new outreach campaign designed both to grease the application process and to prevent those eligible from being deported before the programs go into effect. Obama’s initiatives hit a wall last month when a federal judge in Texas, ruling that the administration violated a law governing the establishment of new rules, blocked the programs temporarily while the courts weigh broader challenges to their constitutionality.
Behind Rep. Luis Gutiérrez (D-Ill.), the Democrats are issuing “emergency cards” to potential participants and asking them to present those cards in the event they’re detained by an immigration official before the court issues are resolved. “If you are … put in harm’s way for deportation, tell them you’ve got the documents, tell them you can prove that you’re established,” Gutiérrez said Thursday. “Because if there is one thing I am clear about, it’s that [Homeland Security] Secretary Jeh Johnson and the president of the United States, Barack Obama, don’t want you deported.” The emergency cards are part of a new “toolkit” Gutiérrez and many other Democrats are distributing at outreach forums they’re hosting in their districts, both over the long Easter recess and beyond. The lawmakers emphasize that, in lieu of Obama’s executive actions, they want Congress to consider comprehensive reform legislation. But with House GOP leaders refusing to take up such proposals, Democrats are backing the president’s unilateral moves as a way to keep immigrant families together. “It is time for us to bring a bill to the floor,” Rep. Steny Hoyer (Md.), the Democratic whip, said Thursday. “But in the interim, this packet allows people to understand their rights in this country pursuant to the president’s order. “If Republicans disagree with the president’s immigration policies,” he added, “they have an alternative: bring a bill to the floor to change that.” At issue are a pair of executive actions launched by Obama shortly after last November’s mid-term elections. One, known as DAPA, would halt deportations and offer work permits to the parents of U.S. citizens and permanent legal residents. The other would expand Obama’s 2012 program — the Deferred Action for Childhood Arrivals (DACA) initiative — to a greater number of undocumented immigrants brought to the country as kids…”
http://thehill.com/homenews/house/237156-dems-grease-skids-for-obamas-immigration-programs
Majority of undocumented immigrants work in low-skill jobs, report finds
“Undocumented immigrants hold more white-collar jobs and fewer blue-collar jobs today than they did before the national recession of 2007-2009, but a “solid majority” still work in low-skilled service, construction and production jobs, according to a report released Thursday by the Pew Research Center in the District. The report, based on a five-year study from 2007 to 2012, found that the size of the illegal immigrant workforce has remained about the same — roughly 5.1 per cent of all workers — even though the total number of illegal immigrants has continued to fall since a peak of 12.2 million in 2007 to about 11.2 million in 2012. Overall, it described an undocumented workforce that has stabilized during a period of economic recovery and moved up in some skilled and professional occupations but has remained largely circumscribed by language barriers, poor education and legal status. Within the undocumented workforce, Pew reported, the portion of those in professional jobs grew to 13 percent, while the portion of those in production and construction jobs declined to 29 percent. As in the past, the great majority are concentrated in low-paying jobs including agriculture, cleaning and food service, and production. Critics of illegal immigration often complain that undocumented workers are squeezing out American-born workers by undercutting wage levels. But the Pew center found that far higher percentages of illegal immigrants than U.S.-born workers hold poorly paid jobs with the least desirable or most demanding conditions, such as crop picking, animal slaughter, cleaning and cooking. In certain occupations, such as agriculture, the contrast between undocumented and U.S.-born or legal immigrants is especially dramatic. Only 2 percent of U.S-born workers today are employed in farming, fishing or forestry, while unauthorized workers constitute 26 percent of all agricultural jobs. Although the portion of illegal immigrants in professional occupations remains low, the report noted that, under several existing and proposed policies ordered by the White House, a substantial number of illegal immigrants are obtaining or may obtain temporary legal status, giving them access to better education and professional jobs…”
http://www.washingtonpost.com/local/majority-of-undocumented-immigrants-work-in-low-skill-jobs-report-finds/2015/03/26/dada9f2a-d3bc-11e4-a62f-ee745911a4ff_story.html?wprss=rss_national
One in eight undocumented immigrants in the U.S. now has a white-collar job
“The share of all unauthorized immigrant workers with management and professional jobs grew to 13% in 2012 from 10% in 2007 — an overall increase of 180,000