Senate Republicans admit defeat in latest effort to repeal Affordable Care Act

Senate leaders admitted they did not have the votes to pass a bill, hours after Trump railed against certain so-called Republicans for refusing to vote for it

The latest Republican attempt to repeal the Affordable Care Act died on Tuesday as it became obvious they did not have the votes to pass a bill that would leave millions without health insurance.

The admission of defeat received from Senate leader Mitch McConnell and the sponsors of the bill after party debates over lunch on Capitol hill left them in no doubt their slim majority could not survive a revolt.

Republicans were at least one vote short in their effort to repeal Obama’s signature domestic policy accomplishment and were running out of time to force-out the bill through this week before a key procedural deadline.

They confessed defeat on one of their central promises of the past several decades, hours after Donald Trump was left railing against” certain so-called Republican” refusing to vote for the latest bill.

” To be clear, through events that are under our control and not under our control, we don’t have the votes ,” said Louisiana senator Bill Cassidy, one of the authors of the measure.” We’ve attained the decision since we don’t have the votes, we will defer that election. Am I frustrated? Utterly .”

At a press conference after lunch, the bill’s writers insisted that Republicans supported the substance of their proposal, which would direct billions of dollars under the healthcare law to states in the form of block awards, transferring sweeping new discretion over how to deliver healthcare.

” Patience is a virtue ,” co-author Lindsey Graham, of South Carolina, said.” Time is actually on our side. The elections “were in” absence were actually more about process than substance. We can fix the process and we can improve the substance, so that’s why I’m optimistic .”

Addressing conservative voters and donors who helped revive the repeal effort after it failed in a dramatic fashion in July, Graham pledged Republican still had the “fight” left to ensure the law is replaced.

Senator John Thune of South Dakota, a is part of Republican leadership, said he expected voters would be frustrated.” I don’t blame them ,” Thune said.” They have to hold us accountable and we made a commitment. I hope they’ll have a little bit of patience .”

Lindsey
Lindsey Graham with John Barrasso, Bill Cassidy John Cornyn and Mitch McConnell. Photo: Aaron P. Bernstein/ Reuters

On Tuesday, McConnell opened debate in the Senate by assailing the ACA, widely known as Obamacare, but offered no guidance on whether he would hold a election or not. Hours afterwards, he admitted defeat. Later that afternoon, McConnell made clear his caucus was moving on to other legislative priorities.

” We haven’t given up on changing the American healthcare system. We are not going to do that this week but it still lies ahead of us ,” McConnell said.” We do think it’s time to turn to our twin priority: reforming the tax code. We’ve reached significant agreements inside the budget committee to go forward and I’m optimistic that we’ll achieve that .”

Trump has been frustrated by Republican’ repeated failings on healthcare and has expressed displeasure with the senators who have stood in the way of repeal measures.

Asked on Tuesday if he would demand Republican leadership hold a vote on the healthcare bill, Trump replied:” We’ll see what happens .”

He told:” It’s going along and at some phase, there will be a repeal and replace. But we’ll see whether that point is now or whether it will be shortly thereafter. But we are disappointed in certain so-called Republicans .”

His frustration came after the very public opposition of Susan Collins, Rand Paul and John McCain, who made clear they would vote no. That would be enough to sink the bill given the Republican’ narrow 52 -4 8 majority in the Senate.

On Monday, Collins announced her opponent moments after the non-partisan Congressional Budget Office published an analysis that find millions of Americans would lose their health insurance if the bill became law.

During a televised debate on healthcare on Monday night, Cassidy and Graham recognise the setbacks but vowed is to promote with their bill.

” We are going to press on ,” Graham said during the CNN debate.” It’s OK to vote. It’s OK to fall short, if you do, for an idea that you believe in .”

For seven years, Republican have won elections on the promise to repeal the healthcare statute and replace it with a conservative scheme that removes decision-making power from the federal government. Repealing the ACA was also a central thrust of Trump’s campaign, though his fickle expectations for its replacing have complicated Republican attempts to repeal the law.

To overhaul the healthcare system on a party-line election, Republican want to use a process called ” reconciliation” that allows lawmakers to pass bills affecting taxes and spending with a simple majority. But the reconciliation process is time-bound, tied to a budget resolution Congress passed earlier this year, which ends on 30 September.

The analysis followed a frantic try by the bill’s writers to win over reluctant senators, rewriting the bill to deliver more federal funds to countries where the senators were undecided, such as Alaska and Maine.

While Paul opposed the measure because he believed it did not go far enough in repealing the ACA, Collins and McCain, two of the three senators who derailed a repeal try in July, lamented a rushed process and exhorted a return to” regular order”, which includes public hearings and a full CBO analysis.

Reacting to the news, Senate minority leader Chuck Schumer said Americans would” exhale a sigh of relief” and praised the voters and activists who quickly mobilized against the bill.

” Our colleagues got no choice, in the face of opposition from one end of the land to the other, to withdraw their bill ,” Schumer told.” Now we hope that Republicans don’t come back to this bill. It will meet the same fate that it did this time because the people didn’t like it .”

Schumer recommended Republicans to resume the bipartisan negotiations over ways to stabilize the insurance markets.

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Physicians can’t ignore politics. Our patients’ lives are at stake | Farzon Nahvi

Our patients depend on us for their care we must help them get onto, whether that comes in the form of pill or policy

If all politics is local, then Washington’s healthcare debacle has brought politics to the front stoop of every healthcare provider in America. There is no escaping it- debates taking place on Capitol Hill are set to affect the very survival of our patients. Irrespective of political tilts, doctors, nurses and providers of all stripes have ethical and professional obligations to speak up and become engaged in order to protect their patients.

While politics have always affected medicine- obstetricians and gynecologists have long fought for women’s health issues, for example- current political events have pushed this into overdrive. In our current political climate, it no longer even induces sense to distinguish between events in Washington and my patient in front of me.

Earlier this year, Congress put forth a bill that among other things would strip 23 million patients of their health insurance, allow insurance companies to omit people with preexisting conditions, remove essential health benefits such as pediatric services, ambulance rides, and laboratory tests from their plans, and increase expenses, especially to older Americans.

Politicians are speaking frankly- even eagerly- about stripping services away from patients who currently have them. Each patient I insure becomes another example of someone whose life could be at risk should any of the measures debated in Congress pass into statute.

My elderly patient’s infected bedsore, for example, could only worsen, leading to sepsis and even death if she could no longer fill her antibiotic prescription. My patient with breast cancer, if unable to obtain chemotherapy due to her “preexisting condition”, would unavoidably die. And any pediatric patient I assure could abruptly be at risk of entirely preventable maladies if left unimmunized due to the elimination of their essential health benefits.

Suddenly, being a physician and ignoring politics has become a lot like being an airplane pilot and ignoring the fact we are flying with the cabin doors wide open. Patients are about to be whisked into the sky with no parachute- it is just as unethical to dismis politics as it would be to continue flying that plane pretend everything was OK.

The truth is that avoiding politics is not only unethical, but also unprofessional. While many physicians, scientists at heart, find political advocacy uncomfortable, it is in fact a required part of the job.

In order to be allowed to practice independently, physicians must graduate from a residency training program and demonstrate proficiency in six “core competencies”. Most of them, such as medical knowledge and patient care and procedure abilities, are well known. It is the sixth- systems-based practise – that is often overlooked, but equal in important.

To quote the governing body that mandates these requirements: doctors” must demonstrate an awareness of and responsiveness to the larger context and system of healthcare … and are expected to advocate for quality patient care and optimal patient care systems “.

In other terms, to practice independently, we must not only know how to prescribe our medications and perform our procedures, but also work toward improving our entire healthcare system. Our professional governing body builds no distinction between helping patients through syringes, scalpels or ordinances.

As German physician Rudolph Virchow noted in 1848:” Medicine is a social science, and politics is nothing else but medicine on a large scale .”

Importantly, as physicians, we advocate for our patients all the time. We feel wholly at ease when we do this on the day-to-day level. If one of our patients cannot get an appropriate follow-up appointment with functional specialists or their insurance company denies them a specific medication, for example, we eagerly take up arms. We opposed a million reams of red tape on a daily basis to get that one patient what she needs.

We must now embracing this same ethos on a macro level by lobbying our representatives, joining activist groups and even operating for office ourselves. The only change is the outsize impact these efforts could have: working through a single ream of red tape in the form of legislation could positively affect the lives of millions of patients.

Laws affecting human lives should not be drawn along partisan lines, but by evidence-based policy that’s best for constituents. As Washington fails this litmus test, citizens must step up. As healthcare providers, advocating for our patients is both an ethical imperative and a professional requirement. Our patients depend on us for their care- “were supposed to” help them get onto, whether that comes in the form of pill or policy.

Read more: www.theguardian.com

‘ Move fast and break things ‘: Trump’s Obamacare failure and the backlash ahead

Republicans suffered a devastating defeat on Obamacare. But the pulling of the American Health Care Act could be a blessing in disguise for Trump

The James S Brady Press Briefing Room at the White House was crammed as usual but there was an extra frisson of suspense. As the press secretary, Sean Spicer, walked to the lectern, a conversation was unfolding merely 27 paces away in the Oval Office. It would negate almost everything he said.

Paul Ryan, the speaker of the House of Representatives, told Donald Trump the news he did not want to hear. Weeks of cajoling and arm-twisting to win over skeptics of their healthcare reform legislation had failed. Ryan asked the president to trench the bill and avoid the dishonour of putting it to a vote in the House. Trump agreed.

It was a chastening defeat for a president whose electoral campaign was built on his reputation as a negotiator and a win. His book, The Art of the Deal, brags: Deals are my art kind. Other people paint beautifully on canvas or write wonderful verse. I like attaining deals, preferably big deals. Thats how I get my kickings. When it came to his first major legislation as chairman and the question deal or no deal, the answer was, emphatically , no deal.

In a poetic twist, the president who has espoused a rightwing agenda of economic patriotism, law and order and America first was undone by the right wing of his own party. Conservatives said the bill did not go far enough to repeal and replace Barack Obamas signature healthcare policy, the Affordable Care Act( ACA ), also known as Obamacare.

Today was a big win for the president. The 44 th chairperson, Barack Obama, declared Tv host Lawrence ODonnell on MSNBC. And it was, to set it in Trump-speak, a complete catastrophe for the current president.

It came hard on the heels of two legal knock-backs to his attempt to ban travelers from certain Muslim-majority districts. That policy too was imposed with a missionary zeal that masked a lack of competence and grasp of detail. But Trump appears to be playing the role of a chief executive intent on shaking up a business and his chief strategist, Steve Bannon, was reported to admire a creed from the tech sector in Silicon Valley: Move fast and breach things.

But Washington politics are different. Add in the Russia affair the resignation of the presidents national security consultant, groundless claims of wiretapping against Obama and an ongoing FBI investigation into his associates and the first two months of the Trump presidency reek of chaos, crisis and confusion.

Nobody knew healthcare could be this complicated

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Congress returns to face daunting undertakings: avoid a shutdown and an angry Trump

The House and Senate have only days to forestall a government shutdown, while also coping with a chairman impatient to assert victories in his first 100 days

After two weeks away, the 535 members of Congress return to Washington this week facing a critical deadline: they have five days to keep the government from shutting down, on the 100 -day milestone of Donald Trumps presidency.

In a rare show of bipartisanship, Democrats and Republicans are united in their determination to keep the suns on. But its unclear how they will navigate the vying interests of their parties and the White House to find a solution that the three sides can support.

Meanwhile, the president has expressed pained awareness of the first 100 -day mark, used as a benchmark since the first term of Franklin D Roosevelt. On Friday Trump rejected the 100 days as a ridiculous standard which could be used to judge a presidents accomplishments, and predicted that the media wouldnt give him the credit he deems himself owed.

Barring dramatic action, Trump will pass the 100 -day mark next Saturday without a major legislative victory and with a conspicuous failure to guide his party to repeal and replace the Affordable Care Act. White House officials have reportedly pressed Republicans to vote on the healthcare statute next week.

If the threat of a shutdown and a battle over healthcare werent enough to eat lawmakers time in a dizzying week, Trump also announced that he were planning to unveil his tax reform plan on Wednesday.

Healthcare

Although Republican failed to secure support last month for a replacement scheme proposed by House Speaker Paul Ryan, healthcare is back on the orders of the day at the White Houses urging.

Speaking from London on Wednesday, Ryan said his party was in the midst of negotiating sort of finishing touch on a compromise that would bridge the ideological divide within his party, which controls the Senate and the House.

Over the two-week recess, conservatives and moderates came together to hammer out an amendment to Ryans deeply unpopular plan. The proposal, according to a one-page white paperobtained by Politico, would give states the option to opt out of key provisions, including protections for sick people with pre-existing conditions.

The amendment would keep the ACA requirement that insurance plans must cover 10 essential health benefits, such as maternity care and prescription drugs. But states could apply to waive those provisions if they could fulfill certain terms.

While the negotiations played out, Republican lawmakers faced constituents angry about the first replacement and determined to save the ACA at town halls across the country.

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Treasury secretary exhorts Senate to pass Puerto Rico bill before next debt default

Jack Lew alerts debt crisis in US territory will ratchet up if it defaults on$ 2bn pay on Friday as Senate expected to vote on bill afterward this week

The US Senate must take immediate action to address Puerto Ricos $70 bn indebtednes crisis, Treasury secretary Jack Lew said on Monday, days before the near bankrupt territory looks set to default on its debts once more.

In a letter addressed to Senate leadership, Lew called on Congress to pass a bill addressing the issue before the US territory defaults on a$ 2bn debt pay this Friday.

On 1 July only four days from now the crisis in Puerto Rico will ratchet up to an even higher level. Puerto Rico has$ 2bn in debt payments coming due that day, including payments on constitutionally prioritized indebtednes on which Puerto Rico has not previously defaulted, Lew wrote.

He pointed out that the US House of Representatives already passed a bill earlier this month on 9 June that would devote Puerto Rico the tools to recover without any federal spending and exhorted the Senate to vote on it immediately. The Senate is expected to vote on the matter this week before leaving for the 4 July holiday. If the Senate passes the bill but amends it, the House will have to vote on it again next week when it is back in conference, which could be too late for Puerto Rico.

I urge Republicans and Democrat to come together in the Senate as you have before to help our fellow citizens, and get a bipartisan bill to the Chairmen desk before 1 July, Lew pleaded with the US Senate.

Others warned of what might happen if the bill did not pass before the end of the week.

If legislation doesnt pass before 1 July, we are opening the door for vulture funds to exploit Puerto Rico , noted Eric LeCompte, a United Nation indebtednes expert and the executive director of the religion development coalition Jubilee USA. Up to now weve insured very little predatory behavior, but if Puerto Rico defaults without protections, the vultures will swoop in.

Last week Lew met with Senate Democrat urging them to pass the bill , noting that Puerto Rico could not wait any longer. That same day, a group of bondholders filed a suit against Puerto Ricos government as indebtednes negotiations fell apart.

Puerto Ricos governor, Alejandro Garca Padilla, also visited Washington last week to make a example for a quick passageway of the bill.

We need the bill by 1 July. We need the bill yesterday, Garca Padilla said on Thursday. He added that even if he were to shut down the government, a July default would not be averted.

We dont have the money for the payroll, the medical system and the healthcare system and to pay our indebtedness. If I shut down the government on 1 July, I still dont have enough fund to pay, he said. Its merely a reality. We do not have the money. Thats why weve been saying that we will default on 1 July.

In his letter to the Senate, Lew warned that in case of the default or a successful creditor suit, Puerto Rico could be forced to pay creditors instead of using funds on health, education and public safety, which could result in laying off police and shutting down hospitals and public transportation.

The legislation offer critical breathing space, said LeCompte. Before Puerto Ricos next default, it needs the protection of this legislation. The bill in front of the Senate permits Puerto Rico to pay pensions and social services before it pays the debt.

Last week, when the Federal Reserve chair, Janet Yellen, testified before the US Senate, US lawmakers attempted to find out if the Fed would step in at the last minute and provide Puerto Rico organizations with emergency loans as a last resort.

I guess our authority is extremely limited. It would not is suitable for us to give loans to Puerto Rico. We have very limited authority to buy municipal debt and the authority we have, if we were to buy the eligible indebtednes, I dont think it would be helpful to Puerto Rico, Yellen told them, before flinging the ball back in their court by saying: This is inherently a matter for Congress and is not something that is appropriate for the Federal Reserve.

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Obama seems to expand background checks for handguns with executive action

White House tells it is also exploring so-called firearm show loophole as House Democrats push to have federal forbidding on gun violence research funding lifted

Barack Obama has ordered officials to draw up an urgent new plan to strengthen background checks on handgun purchasers without the approval of Congress.

The president has asked his advisers to complete a proposal and submit it for his review, White House adviser Valerie Jarrett said.

The president has directed his team in short order to finalise a set of recommendations on what more the administration can do on its own to save lives from gun violence, and those recommendations will include stimulating sure we do everything we can to keep firearms out of the wrong hands, including those expanded background checks, Jarrett told their own nationals handgun violence vigil in Washington.

After the mass shooting in Roseburg, Oregon in October, Obama indicated he was looking for ways to boost gun laws without a be participating in Congress.

On Thursday, the White House spokesman, Josh Earnest, said the review that Jarrett referred to had been under way for the past couple of months but claimed there was now increased craving for fresh reform attempts among the US public in the recent weeks.

These are basically recommendations that the president has asked for from his personnel based on their review of available executive authority, Earnest told reporters on Thursday.

The running premise of this ongoing review is that Congress hasnt acted and thats been the source of immense frustration on the part of the president, he added. So given the congressional inaction, the question thats been raised is what more can the Obama administration do, and thats the substance of this review.

White House officials have said they are exploring closing the so-called firearm show loophole that allows people to buy weapons at handgun presents and online without a background check.

Earnest also revealed that the vice-president, Joe Biden, had been in dialogue with state and local politicians across the US to encourage them to take more unilateral steps to curb handgun sales too.

We have been actively engaged with leaders across the country about steps they can take to protect their communities from gun violence, he said.

Jarrett told Wednesday nights vigil: Americans are mobilising. Two weeks ago I met at the White House with a group of gun owneds who believe in the need for change. Many were former NRA[ National Rifle Association] members who made clear to me that the NRA no longer represents them, and they assured me that many more gun owners were feeling the same.

Separately on Thursday, Connecticuts governor, Dan Malloy, announced that he would sign an executive order to bar people on the governments terrorism watch lists from buying guns in the country. The move came ahead of next weeks third anniversary of the shooting of 20 young children and six of their adult carers at Sandy Hook elementary school in Newtown, Connecticut.

Meanwhile, House Democrats have launched a fresh great efforts to take over the powerful gun lobby, demanding an objective to a 17 -year ban on government-funded research into violence involving pistols. Nancy Pelosi, the House minority leader, announced the initiative on Thursday at an emotional press conference at Capitol hill in Washington.

Pelosi complained that Americas gun control debate has been skewed for years because of a lack of public data. She told Democrat will insist that the research banning, the work of former Republican congressman Jay Dickey, be removed from law as part of the $1.1 tn omnibus bill that Congress needs to pass by next week to avoid a government shutdown.

The House minority leader, Nancy Pelosi, comforts Melody McFadden and Stacy Hart, holding a photo of her friend Timmy, who was shot to death. Photograph: Allison Shelley/ Getty Images

Dickey himself had now been admitted that he was wrong about the measure, Pelosi told. We must insist that we cannot have a bill leave the station that still has that prohibit on research in it, she added to applause. Our priority is to remove the ban on research on firearm violence. Lets do it today.

Pelosi declined to comment immediately on whether the measure would be a dealbreaker for the crucial budget. This is something that has universal acceptance, so let us take it one step at a time, she responded. The bill has so many problems, they should welcome this as a gift It would be the easiest thing in the world for them to take that piece of legislation out of the bill, and then we could find out. Why would we not want data, why would we not want info, so we can make a judgment about how we move forward?

This bill today would say to the NRA you no longer have a stranglehold on datum, on data, on research, on how we are capable of make the change that you need. Once we have the data, we are better prepared to act upon it.

We face a public health crisis

Three years after Sandy Hook, Democrats have got nowhere with proposed measures to strengthen background checks on gun purchasers, stop people on the FBIs no-fly list from purchasing handguns or create a select committee on the issue, while the same period has assured an estimated 90,000 gun deaths and more than 1,000 mass shootings. The Dickey amendment, they believe, provides a more tangible and achievable target.

Speaking at Thursdays press conference, Senator Richard Blumenthal of Connecticut said: Describing this line and saying this measure and its removal is a priority is profoundly significant. The gun hall has a stranglehold and one of their arguments is, You dont have the facts, you dont have data. The reason theres no data is this prohibition against the United States of America collecting facts and research.

In a public health crisis, the most important rich is facts, knowledge, proof. We face a public health crisis. If the Center for Disease Control were prohibited from collecting information about Ebola, think of the outcry. Thats in effect what we are doing here. We are prohibiting the United States from get information about a lethal menace to the people of America.

Blumenthal added: Thirty thousand people falling sick as a result of a public outbreak, dying as a result, is a public health crisis. We have in this nation, genuinely, an epidemic of gun demises and gun disease that is taking lives 90 of them every day, and should be treated as a public health crisis.

The legislators were joined by dozens of survivors and victims family members holding photos of men, women and children murder by guns. One mom broke down at the rostrum and could then hear anything sobbing in a passageway. Pelosi, clearly moved, placed a comforting hand on her arm.

Along with still raw heartache, families and politicians expressed rising indignation at Congresss failure to pass any legislation three years after Sandy Hook.

Christian Heyne, 29, whose mom was made to beg for her life before being killed by a gunman ten years ago, held a up a picture of her said: This is what gun violence looks like. This is my mother and this is a painting that I gave to her on one of the last trip-ups we took together. Gun violence looks like my bridal day when as Im watching my spouse walk down the aisle, and as its one of the most emotional days of my life, I know that my mama will never know who she is, shell never know my wife.

Gun violence to me is knowing that when I have infants, they will never know their grandmother. Gun violence is just knowing that when I want to hop on the phone and dedicate her a call to tell her how my day want, Ill never have that opportunity again. Thats what gun violence looks like and thats what the costs of inaction is.

Christian Heyne, centre, spoke of his mother, shot dead ten years ago: Gun violence to me is knowing that when I have infants, they will never know their grandmother. Photograph: Kevin Lamarque/ Reuters

Charged with feeling, Senator Chris Murphy, also from Connecticut, said thoughts and prayers are not meaningless, but my religion involves partnering religion with action. What I believe is that it isnt enough any longer to just say we care; you have to do something to show you care. And while we have discrepancies about whether the right answer is a ban on military-style assault weapons or more protections to make sure felons dont get firearms or a fix to our broken mental health system, the one option that we cannot take is to do absolutely nothing, and thats what weve done.

In the wake of the massacre of 20 little first-graders in Newtown, Connecticut, and the slaughter of 80 more every single day, Congress has done absolutely nothing. And thats maybe whats most offensive to me. Behind me are dozens of grieving households, and by this time tomorrow there will be 80 other families who could join them in this room, and 80 more the day after. How cold-hearted is this place to look these families in the eye and do absolutely nothing?

He added: Its day for us to figure out what message we can send that were serious about this and to end a stillnes that has induced Congress complicit in these ongoing murders.

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