In the early-morning hours after Senate Republicans’ last-ditch attempt to repeal Obamacare failed, a common narrative began to emerge: that while three “no” votes from Republicans killed the bill, only Sen. John McCain (R-AZ) saved the day.
To be sure, McCain’s vote against the bill was dramatic and decisive. He flew back to Washington from Arizona less than two weeks after he was diagnosed with brain cancer, after having surgery to remove a blood clot from above his eye. He made a sweeping speechabout returning Senate procedure to a time of bipartisan, transparent cooperation. Then he proceeded to briefly horrify ACA proponents by voting yes on a motion to proceed vote, and yes again on the Republican Better Care Reconciliation Act.
So when McCain cast a performative last-minute vote against “skinny repeal,” it immediately overshadowed the two women Republican senators who did far more to halt Republicans’ reckless efforts to repeal Obamacare. Sens. Lisa Murkowski (AK) and Susan Collins (ME) repeatedly stood their ground against the three health bills their colleagues tried to ram through the Senate.
Murkowski and Collins were the only Republicans to vote against a motion to proceed with the health care bill debate. Both women cast votes against the Better Care Reconciliation Act, which could have led to 22 million more uninsured Americans. They both also voted against the Obamacare Reconciliation Act — repeal and delay — which could have led to 32 million more uninsured Americans.
Both senators said they could not support bills that would leave millions of people without health insurance. They also opposed provisions to defund planned parenthood. When skinny repeal — seemingly the last shot for the GOP — came down, they stood their ground and voted no again.
Through all of this, the backlash against these two women senators was severe. Two House Republicans threatened them with violence.
President Trump publicly shamed Murkowski on Twitter:
Senator @lisamurkowski of the Great State of Alaska really let the Republicans, and our country, down yesterday. Too bad!
Murkowski then got a call from Interior Secretary Ryan Zinke, who reportedly threatened to punish Alaska’s economy based on her health care vote, according to the Alaska Dispatch News.
McCain’s vote was crucial in ending the latest health care repeal effort — but no more so than the votes of Murkowski and Collins, which were consistently courageous in the face of threats and suggestions of retaliation.
It was the most dramatic night in the United States Senate in recent history. Just ask the senators who witnessed it.
A seven-year quest to undo the Affordable Care Act collapsed — at least for now — as Sen. John McCain (R-Ariz.) kept his colleagues and the press corps in suspense over a little more than two hours late Thursday into early Friday.
Not since September 2008, when the House of Representatives rejected the Troubled Asset Relief Program — causing the Dow Jones industrial average to plunge nearly 800 points in a single afternoon — had such an unexpected vote caused such a striking twist.
The bold move by the nation’s most famous senator stunned his colleagues and possibly put the Senate on the verge of protracted bipartisan talks that McCain is unlikely to witness as he begins treatment for an aggressive form of brain cancer.
“I’ve stated time and time again that one of the major failures of Obamacare was that it was rammed through Congress by Democrats on a strict party-line basis without a single Republican vote,” he said in a statement explaining his vote. “We should not make the mistakes of the past.”
Rumors swirled late Thursday that the Arizona Republican, who had captured the nation’s sympathy this week after delaying his cancer treatment in order to return to Washington, might vote against the GOP’s “skinny repeal” plan — a watered-down version of earlier Republican proposals to repeal the 2010 health-care law.
McCain warned at a hastily arranged news conference Thursday afternoon that he was leaning against supporting the legislation unless House Speaker Paul D. Ryan (R-Wis.) assured GOP senators that the House would not move to quickly approve the bill in its current form. McCain and Sens. Lindsey O. Graham (R-S.C.) and Ron Johnson (R-Wis.) wanted Ryan to launch broad House-Senate negotiations for a wider rollback of the law. Two hours later, Ryan issued a statement signaling he would launch negotiations, and Graham and Johnson announced their support.
McCain headed for the stage — the Senate floor — around midnight, emerging from his office in the Russell Senate Office Building for the subway ride to the U.S. Capitol.
When he arrived, he held a brief conversation with Senate Minority Leader Charles E. Schumer ( D-N.Y.), an exchange that left the New Yorker smiling.
“I knew it when he walked on the floor,” Schumer later recounted, explaining that McCain had already called to share his plans.
But few, if any, of his Republican colleagues realized what was about to transpire.
Two votes were called just after midnight. The first was on a Democratic proposal to refer the “skinny repeal” bill back to a committee. The second vote was to pass “skinny repeal,” which would have repealed the Affordable Care Act’s individual mandate and rolled back a tax on medical devices.
“Let’s vote against skinny repeal,” Schumer told his colleagues before the votes as he once again derided the rushed nature of the health-care debate.
McCain stood on the Republican side of the room nodding in agreement.
With Sens. Susan Collins (R-Maine) and Lisa Murkowski (R-Alaska) already planning to vote against the plan, Republicans could not afford to lose McCain. Vice President Pence was already at the Capitol prepared to break a tie. Instead, he launched a last-ditch effort to win McCain’s support.
As the first vote began, McCain took his seat next to Graham, his closest friend in the Senate. The South Carolinian mostly nodded as McCain gesticulated, and signaled — through his body language — that he was likely to vote no. When Murkowski walked over to join the conversation, McCain winked and gave her a thumbs down — signaling his intentions.
Collins joined the group as another clutch of Republican senators formed in the well of the Senate Chamber. Sen. Jeff Flake (R-Ariz.), who operates in McCain’s long shadow, stood next to Senate Majority Leader Mitch McConnell (R-Ky.), Sen. John Cornyn (R-Tex.), who counts GOP votes, and Pence. Eventually, Flake was dispatched to talk to McCain.
He obliged, walked over to McCain and asked Graham to move over one seat. But McCain did not acknowledge Flake, focusing instead on Murkowski and Collins.
That left Flake, one of the most polite members of the Senate, leaning into the conversation uncomfortably with a pained look on his face, as if he had to tell his father that he had run over the family dog with his car.
Seeing that Flake was not making progress, Pence walked over at 12:44 a.m. McCain smiled, pointed at Collins and Murkowski, said something about “marching orders,” and stood up.
“Mr. Vice President,” he said, greeting Pence. For the next 21 minutes, the vice president cajoled McCain, Collins and Murkowski. Twice during the conversation, a Pence aide came to whisper in the vice president’s ear — other reporters learned it was the White House calling. Pence finally left to take a call, but later returned to speak with McCain.
By then, other senators around the room realized what was happening.
“You could see the body language in the entire chamber change in two hours,” Sen. David Perdue (R-Ga.) recalled. “One side was kind of ebullient, moving around and talking and the other side was subdued, and all of a sudden it began to change. There was an instinctive reaction that maybe this thing wasn’t going to pass. Nobody knew for sure.”
“It was pretty somber,” added Sen. Amy Klobuchar (D-Minn.).
At 1:10 a.m., McCain crossed the Senate Chamber to talk to Schumer, Klobuchar and other Democrats, including Sens. Richard J. Durbin (Ill.), Dianne Feinstein (Calif.) and Elizabeth Warren (Mass.). As he approached, McCain told them he worried that reporters watching from the gallery above could read his lips. When he realized that the press was indeed watching, he looked up at the ceiling and shouted, “No!” as senators and reporters laughed. Then, Democrats beamed when McCain shared his news. Feinstein gave him a hug.
Walking back to the Republican side of the room, McCain was stopped by Sen. Orrin Hatch (R-Utah) who also offered a hug.
“I love John McCain. He’s one of the great heroes of this country,” Hatch explained later. “Whether we agree or not, I still love the guy.”
The vote on “skinny repeal” began at 1:24 a.m., but McCain was out in the lobby once again conferring with Pence. In his absence, Collins and Murkowski cast their “no” votes along with the 48 members of the Democratic caucus.
McCain returned at 1:29 a.m. without Pence, approached the Senate clerk and gave a thumbs down — the third “no” vote.
Several people gasped. Others applauded. Reporters dashed out to report the news.
McCain returned to his seat, walking past Cornyn and Sens. John Thune (R-S.D.) and Bill Cassidy (R-La.), who stood grim-faced and despondent. Cassidy rubbed his face several times with his hands. Thune’s face contorted. The color in Cornyn’s face seemed to drain.
“Certainly Senator McCain knows how to improve the drama,” Cassidy recalled later.
The vote concluded, and the results were announced — the bill was voted down, 51 to 49. Just days before, McCain had fired a warning shot with a lengthy floor speech that criticized the rushed, secretive process that led to “skinny repeal.” Early Friday morning, McCain, Collins and Murkowski delivered the fatal blow.
McConnell, humiliated by the results, stood to address his colleagues. The color of his face now matched the pink in his necktie.
“This is clearly a disappointing moment,” he said.
Senator John McCain returned to the Senate Chamber on Tuesday to cast a deciding vote allowing the legislative body to begin debating a bill put together behind closed doors by Republicans that would repeal and replace the Affordable Care Act.
Health industry professionals have overwhelmingly supported Republicans seeking federal office, and one could imagine McCain and others who benefit from that support might push policy that would be more financially beneficial to their benefactors.
Healthcare providers are among the top 5 contributors by industry to McCain’s campaign coffers, having given $7,184,854 since 1989, according to OpenSecrets.org.
A full list of donors in the health and insurance industries provided by FollowTheMoney.org reveals that USAA, Humana, Liberty Mutual, American Association of Orthopaedic Surgeons, Cigna Corp, American Society of Anesthesiologists, American Society of Plastic Surgeons, National Association of Insurance & Financial Advisors and others have been top donors to McCain throughout his career, providing as much as $20,000 (USAA’s contribution) each to his campaigns.
Selecting just for health industry contributions, here are some of the top donors to McCain ranked by contribution amount, from the Institute for Money in State Politics:
The Pentagon spent $84 million on erectile disfunction medications in 2014, 10 times the estimated annual medical costs for transgender services.
Military Times reported in 2015 that the military spent $84 million on erectile disfunction medications such as Viagra and Cialis the year before. Meanwhile, a 2016 Rand Corporation study estimated that the maximum annual medical costs for transgender military members would be around $8.4 million, Business Insider reports.
“You’re talking about .000001% of the military budget,” being spent on transgender services, Navy SEAL veteran Kristin Beck, who is transgender, told Business Insider.
President Trump announced Wednesday on Twitter his decision to ban transgender people from serving in the military “in any capacity.” He cited the “tremendous” costs for providing medical services for transgender troops.
“Our military must be focused on decisive and overwhelming victory and cannot be burdened with the tremendous medical costs and disruption that transgender in the military would entail. Thank you,” Trump tweeted.
His announcement sparked widespread condemnation from members of both parties, including Republicans who broke with the president to speak out against the ban.
El republicano sigue siendo un presidente de excepción, apoyado por un núcleo duro, pero rechazado por el resto.
Donald Trump en su reunión con senadores republicanos tras el fracaso de la reforma sanitaria. REUTERS
Donald Trump sigue solo. Tras seis meses en el poder y una agenda en agitación permanente, el multimillonario neoyorquino no ha sido capaz de romper con la maldición de su mandato. Continúa siendo un presidente de excepción, apoyado por un núcleo duro de votantes, pero rechazado por el resto. Una fractura, cristalizada en su bajísima valoración en las encuestas, que el fracaso en la aprobación reforma sanitaria ha dejado en evidencia. Ni siquiera en el proyecto más emblemático y anhelado de la derecha ha logrado unir a su propio partido.
La división republicana ha dejado el liderazgo de Trump por los suelos. El legado de Barack Obama ha mostrado mucha más resistencia de la que se suponía y ha permitido que las carencias del multimillonario afloren. Las encuestas lo han señalado desde el primer día. Su valoración es la más débil de un presidente a esta altura del mandato, y su vertiginosa gestión solo polariza más. Pero esta limitación no implica que haya perdido el apoyo de sus bases. Los sondeos, como indica a este periódico el profesor Larry Sabato, director del Centro para la Política de la Universidad de Virginia, se elaboran sobre población general pero a efectos electorales solo importan los votantes registrados, y ahí Trump permanece incólume. Sin otros aliados, pero fuerte.
Con este bagaje, Trump ha entrado en el laberinto. Fracasado su plan de liquidar el Obamacare y aprobar al mismo tiempo un proyecto propio, está tratando de hallar una nueva salida: votar la eliminación del actual sistema y dejar para una discusión posterior su alternativa. El plan es de alto riesgo. Tres republicanos moderados ya han alertado de que no piensan dar ese paso y que sumaran sus votos a los demócratas. Dada la exigua mayoría republicana en el Senado (52 escaños frente a 48), es casi imposible que la iniciativa prospere.
Pero Trump no ha tirado la toalla. Ha pedido al líder de la mayoría republicana en el Senado, Mitch McConnell, que someta a votación el fin del Obamacare la semana que viene, y paralelamente él mismo ha convocado una serie de reuniones con los senadores, la primera este miércoles, con el objetivo de recuperar terreno perdido y taponar una fuga irreversible en su presidencia. “La inacción no es solución. Tengo una pluma en la mano lista para firmar. No deberíamos dejar la ciudad hasta tener un plan y sacarlo adelante”, les dijo.
La Casa Blanca es consciente de que sin una mayoría estable en el Senado no sólo la reforma sanitaria, sino su plan fiscal y los presupuestos del año próximo corren peligro. Ante este espectro, Trump, el antisistema que venía a drenar el pantano, ha empezado a buscar su apoyo. No será tarea fácil.
Los republicanos tienen la mayoría en las dos Cámaras, pero forman un universo fractal que hizo de la obstrucción un arma mortal contra Obama y cuyo aguijón sigue vivo. Irredentos, centrados en sus intereses de circunscripción y ultrasensibles a las elecciones de 2018 (renovación total en la Cámara de Representantes y un tercio en el Senado), usan su poder hasta la extenuación y no perdonan los deslices. Trump lo ha sentido en carne propia.
El líder que se presentaba como el gran hacedor de pactos ha cometido en la tramitación de la reforma sanitaria graves errores de estrategia. El primero se vio en marzo cuando intentó forzar la votación de una primera versión en la Cámara de Representantes sin tener mayoría asegurada. In extremis tuvo que retirarla y volver a negociar a puerta cerrada.
El bochorno se ha repetido ahora. En esta segunda fase, obligó al líder de la mayoría republicana en el Senado, Mitch McConell a imponer un doble juego:eliminar el Obamacare y aprobar un proyecto alternativo al mismo tiempo. McConnell y otros senadores le advirtieron de la complejidad de la jugada. Demasiado ambiciosa para lograrla de una sola tacada. Trump insistió. Y la fractura volvió a emerger.
Para los moderados, el plan presentado era excesivamente duro en sus recortes a los más desfavorecidos y hacía prever un colapso en la cifra de asegurados de clase trabajadora (unos 15 millones menos en dos años). Y para los radicales, la ley dejaba escapar con vida el Obamacare. El descontento era evidente. Y Trump no supo manejarlo.
El mismo lunes el presidente cenó con un nutrido grupo de senadores y dedicó la mayor parte de la reunión a recordar sus viajes. “No habló más que de Francia y del Día de la Bastilla”, señaló con sorna un senador republicano. Poco después, la rebelión tomó cuerpo y con la oposición de solo cuatro legisladores la ley se hundió.
JUGANDO CONTRA LAS ENCUESTAS
Donald Trump ha jugado contra las encuestas en la reforma sanitaria. La última elaborada por The Washington Post-ABC y publicada este domingo pasado ya revelaba la falta de confianza en su proyecto. Aunque es cierto que el Obamacare no gusta del todo (sólo el 37% lo apoya con fuerza), aún gusta menos el proyecto alternativo auspiciado por la Casa Blanca (sólo 17% lo apoya con fuerza). Un resultado que se repite incluso entre los trabajadores blancos sin estudios superiores, el sector de voto duro de Trump.
A este factor se suma la propia polaridad del presidente. Excepto en el área económica, donde el 43% aprueba su gestión frente 41% que la rechaza, en el resto de baremos el mandatario suspende. Así el 58% es contrario a su gestión presidencial (36% a favor) y el 55% considera que no ha logrado avances significativos, frente al 38% que sí.
MÁS DE 30 MILLONES DE PERSONAS MÁS SIN SEGURO CON LA DEROGACIÓN DE OBAMACARE
En pleno debate interno, el Partido Republicano sufrió un nuevo jarro de agua fría. La Oficina Presupuestaria del Congreso, un organismo independiente, pronosticó este miércoles que derogar partes de la ley sanitaria actual sin sustituirlas por una alternativa dispararía el número de personas sin seguro médico en EE UU: 17 millones más en 2018 y 32 millones en 2026. Es una cifra muy superior a los 22 millones de personas más sin seguro en nueve años que había calculado el organismo ante la primera propuesta de reforma republicana.
Ante la incapacidad de sumar los votos republicanos necesarios para avanzar con su propia reforma, Donald Trump ha instado a los senadores a derogar primero Obamacare y luego votar por una propuesta que lo sustituya. Pero esa estrategia parece contar con aún menos apoyos entre los legisladores, lo que posiblemente se acentuará con el pronóstico de la Oficina Presupuestaria.
¿Se ha preguntado sobre qué trata el debate sobre el Seguro de Salud en los Estados Unidos? o ¿por qué un seguro de accidentes o por enfermedad funciona de la manera en que lo hace? El sistema de salud de los Estados Unidos puede ser difícil de entender, y la palabra “sistema” en sí puede ser engañosa ya que diferentes áreas de ella están dirigidas por cientos de organizaciones individuales, incluyendo el gobierno y las organizaciones con y sin fines de lucro.
Historia del Servicio de Salud en los Estados Unidos
La atención médica era de difícil acceso en los primeros días de Las Colonias ya que pocos médicos británicos entrenados habían llegado a Norteamérica. Sin embargo, a mediados del siglo XVIII, Nueva Orleans, Filadelfia y Nueva York fundaron los primeros grandes hospitales, en ese contexto las primeras escuelas de medicina también abrieron sus puertas. El primer hospital, el Royal Hospital de Nueva Orleans, era demasiado caro para una gran parte de los residentes del área, por lo que se decidió construir un segundo hospital, The Charity Hospital, que atendería a la población con fines caritativos. A lo largo de la historia de los Estados Unidos y aún hoy, muchos hospitales están dirigidos por organizaciones religiosas, las que tradicionalmente se han inclinado por atender las dolencias y enfermedades de los más pobres.
Durante la Guerra Civil en los Estados Unidos, el Gobierno Federal y los Estados individuales comenzaron a construir hospitales en cada Estado para la atención de los soldados enfermos o que caían heridos. El gobierno también inició las primeras disposiciones sobre salud pública relacionadas con el servicio de agua potable, saneamiento y control de la tuberculosis, las cuales comenzaron a tener efectos significativos a principios del siglo XX. Desde entonces, la atención de la salud en los Estados Unidos se convirtió en un gigantesco sistema dirigido por múltiples grupos.
En 1965, el Presidente Lyndon B. Johnson promulgó los sistemas Medicare y Medicaid, que aseguraban a los jubilados y a las personas cuyos ingresos se encontraban bajo la línea de pobreza. Esto significó la creación de un gran sistema de salud federal que cubre a millones de estadounidenses. Sin embargo, resultaba difícil expandir estos programas para cubrir a más personas, porque se trataba de un tema muy polémico y que la mayoría de los políticos no querían abordar.
El Debate sobre la Atención de Salud en los Estados Unidos
El debate sobre si el gobierno debía proporcionar financiamiento a los servicios de salud y cuánto debería proporcionarse, es de larga data. La primera legislación, propuesta por la activista Dorthea Dix, fue el Proyecto de Ley de 1854 para el beneficio de indigentes con problemas mentales. A pesar de haber sido aprobada en ambas cámaras del Congreso, el proyecto de ley fue vetado por el presidente Franklin Pierce, quien argumentó que el bienestar social no debía descansar en manos del gobierno federal.
En 1910, cuando muchos países europeos aprobaban legislación para estatizar la atención médica para sus ciudadanos, el presidente Theodore Roosevelt trató de promover el mismo tipo de legislación en los EE.UU. Sin embargo, fue derrotado en el intento por los políticos de ambos partidos políticos. Los principales argumentos del debate en la actualidad siguen basándose en ideas similares en ese tiempo.
Los que apoyan la idea de la atención universal de la salud en los Estados Unidos afirman que sólo el Gobierno Federal puede garantizar que todos los ciudadanos estén cubiertos. Asimismo, el dinero que el gobierno federal gasta ahora para cubrir la atención de emergencia para aquellos sin seguro es tan alto que sería más eficiente si ellos pudieran tener un sistema formal que cubra a todos. Un sistema unificado tendría una mayor capacidad de negociación para concertar con compañías farmacéuticas, hospitales y proveedores de equipos permitiéndoles reducir los costos de la atención.
Sin embargo, en los Estados Unidos existe una larga historia de recelo por parte del poder federal. Los EE.UU. fueron diseñados originalmente con un gobierno federal débil y gobiernos estatales fuertes como una garantía de protección contra la tiranía. Aunque ese equilibrio ha cambiado dramáticamente a través de los años, aún muchos estadounidenses prefieren limitar el poder del gobierno federal. Estos argumentan que si el gobierno administra el servicio de salud, este sería más burocrático y tendría que tomar decisiones sin participación de los pacientes. Sienten que su cuidado sería más regulado y menos individualizado. También temen que un sistema de salud grande implique un alto costo y contribuya a impuestos significativamente más altos.
Sistema Estadounidense de Aseguramiento en Salud
Aunque hay varios tipos de cobertura y los Estados a menudo tienen sus propias regulaciones sobre seguro de salud, hay algunos aspectos del sistema que son similares en todo EE.UU. Hospitales, clínicas, consultorios médicos y otras instalaciones de atención de salud son propiedad de una gran variedad de entidades públicas y privadas. Los proveedores de seguros de salud (health insurance providers) son generalmente empresas separadas de aquellas y tratan con una amplia gama proveedores de atención médica (healt care providers).
Los pacientes pagan cuotas de seguro de salud mensuales para asegurarse de que estarán cubiertos cuando tengan que ir al médico, clínica u hospital. Los proveedores de seguros cubren a miles de pacientes, por lo que son capaces de negociar con los proveedores de atención médica por precios reducidos y el pago por los servicios. El seguro de Medicare o Medicaid funciona de la misma manera, pero a mayor escala. Dado que necesitan ser capaces de negociar, los proveedores de seguros generalmente tienen una red de médicos con los que tienen acuerdos y los pacientes están cubiertos por visitas a los médicos dentro de esa red, pero puede que no esten cubiertos o totalmente cubiertos, por visitas a doctores que están fuera de esa red. Los proveedores de seguros por lo general cubren los servicios que los médicos consideran necesarios, pero a menudo no cubren los servicios que se consideran “electivos”. Las compañías de seguros tienen como objetivo mantener sus costos bajos mientras siguen cubriendo los cuidados de salud necesarios.
La Ley de Cuidado de Salud Asequible (Afordable Care Act, A.C.A. u “Obamacare”)
La Ley de Protección al Paciente y Asistencia Asequible (PPACA), comúnmente conocida como “Obamacare”, fue una ley aprobada en el año 2010. Como las compañías de seguros son sociedades privadas con fines de lucro, muchos estadounidenses quedaron sin seguro porque no podían pagarlo, no querían el seguro, o porque fueron rechazados debido a condiciones preexistentes. El gobierno de Obama trató de abordar varios de estos temas con la Ley de Protección al Paciente y Asistencia Asequible (ACA). Estas son algunas de las principales disposiciones de la Ley:
No se permite a los aseguradores rechazar la cobertura debido a condiciones preexistentes.
Se establecieron patrones mínimos para las pólizas de seguro de salud.
La elegibilidad para Medicaid se expandió.
Medicare se sometió a reformas orientadas a una mayor eficiencia.
Las personas sin seguro proporcionado por el empleador están obligadas a comprar un seguro de salud.
Los Health Exchange (o Health Insurance Marketplace) se crearon para ofrecer a los consumidores una forma eficaz de encontrar un seguro de salud adecuado y proporcionar subsidios a quienes lo necesitan.
Bajo la Ley de Protección al Paciente y Asistencia Asequible (ACA), 11 millones más de estadounidenses están asegurados en comparación con periodos anteriores. Sin embargo, esta legislación fue criticada por los republicanos a pesar de que fue aprobada por ambas cámaras del Congreso. Los intentos repetidos por detener la legislación a través de los tribunales han fracasado en su mayoría, aunque ha habido algunas resoluciones parcialmente en su favor. Es muy probable que el debate sobre la atención sanitaria continúe como ha ocurrido durante los últimos cien años.
President Trump either has no idea about what just happened in the health-care debate, or he’s really good at pretending.
Trump was asked a few questions about the just-imploded Senate GOP health-care bill on Tuesday afternoon at the White House, and his answers at once suggested he didn’t really grasp the strategy at all and he hadn’t paid much attention to the senators he needed to persuade. He even suggested that only four GOP senators would have opposed it — which is highly doubtful in the first place — and called that “a pretty impressive vote.”
Below are his answers, with our annotations in yellow.
On whether he is disappointed:
I’m disappointed — very disappointed. I don’t know, but I’m certainly disappointed. For seven years, I’ve been hearing “repeal and replace” from Congress. I’ve been hearing it loud and strong, and when we finally get a chance to repeal and replace, they don’t take advantage of it. So that’s disappointing. So I would say I’m disappointed in what took place, and it will go on. And we’re going to win on taxes, we’re going to win on infrastructure and lots of other things that we’re doing. We’ve won and are winning the war on the border. We are very much decimating ISIS — you can see that, you can see that better than anybody see it, the soldiers that are here today. We’ve had a lot of victories but haven’t had a victory on health care. We are disappointed. I am very disappointed because, again, even as a civilian for seven years on health care, I’ve been hearing about repeal and replace, and Obamacare is a total disaster. Some states had over a 200 percent increase, 200 percent increase in their premiums, and their deductibles are through the roof. It’s an absolute disaster. And you’ll also agree that I’ve been saying for a very long time “Let Obamacare fail, and then everybody is going to have to come together and fix it.” And come up with a new plan and a plan that is really good for the people with much lower premiums, much lower costs, much better protection. I’ve been saying that — Mike, I know you’ll agree — let Obamacare fail, and it will be a lot easier. And I think we’re probably in that position where we’ll let Obamacare fail. We’re not going to own it. I’m not going to own it. I can tell you the Republicans are not going to own it. We’ll let Obamacare fail, and then the Democrats are going to come to us, and they are going to say, “How do we fix it, how do we fix it?” or “How do we come up with a new plan?” We’ll see what happens, but I am disappointed, because for so many years, I’ve been hearing “repeal and replace.” I’m sitting in the Oval Office, right next door, pen in hand, waiting to sign something and I’ll be waiting. And, eventually, we’re going to get something done, and it’s gonna be very good. But Obamacare is a big failure. It has to be changed. We have to go to a plan that works. We have to go to a much less expensive plan in terms of premiums. Something will happen, and it will be good. It may not be as quick as we had hoped, but it is going to happen.
On Sens. Mike Lee (R-Utah) and Jerry Moran (R-Kan.) announcing their opposition Monday night:
They had their own reasons. I was very surprised when the two folks came out last night, because we thought they were in fairly good shape, but they did. You know, everybody has their own reason. If you really think about it, you look at it, we have 52 people, we have no Democrat support, which is really something that should be said. You should have Democrats voting for a great plan for a lot of people. We had no Democrat support. You had 52 people, you had 4 nos. No we might have had another one someone in there. But the vote would have been if you look at it, 48-4. That’s a pretty impressive vote by any standard, and yet you have a vote of 48-4 or something like that and you need more.That’s pretty tough. So the way I look at it is in ’18, we’re going to have to get some more people elected. We have to go out and get more people elected that are Republicans. And we have to probably pull in those few people who voted against it. They’ll have to explain to you why they did, and I’m sure they’ll have very fine reasons. But we have to get more Republicans because if we get it passed in the House, we would have gotten it very much — you know you can’t use his head as a stand, we don’t want that to happen. You’re messing with the wrong guy here — I think we’re doing very well actually in ’18. I would be not surprised if something is done long before that. In any case, because the margin is so small, the majority margin is so small, we’re going to have to go out and get more Republicans elected in ’18. I’ll be working very hard for that to happen. It would be nice to get Democrat support, but really they are obstructionists. They have no ideas. They have no thought process. All they want to do is obstruct government and obstruct period. In this case, think of it, so many good things we didn’t get one vote and their plan has failed. And, by the way, Obamacare isn’t failing. It’s failed. Done.
On whether he blames Mitch McConnell:
No.
Aaron Blake is senior political reporter for The Fix. Follow @aaronblake
Hospital Regional de Tumbes fue construido hace tres años y recomiendan que sea demolido.
El sótano del hospital en Tumbesestá inundado, tiene carteles de peligro y cientos de rajaduras en sus paredes. El Hospital Regional de Tumbes fue construido solo hace tres años y necesita ser demolido por poner en peligro la vida los usuarios y trabajadores.
Existe una parte del hospital que no es usado porque no está en condiciones. Las losetas del las recepción se sale con solo agarrarlas con las manos. No existe ningún responsable de la mala construcción.
El Hospital Regional de Tumbes fue construido en el gobierno de Ollanta Humala. El Consorcio Hospitalario Tumbes, con capital peruanos y argentinos, fue el encargado de la construcción del hospital y manifiesta que la culpa de este desastre lo tienen las lluvias.
Los trabajos del hospital se iniciaron en el 2011. El presidente regional de ese entonces era Gerardo Viñas Dioses,ahora en prisión por corrupción. Toda el hospital luce grietas en paredes y pisos. El muro de contención también colapsó.
“Podemos observar que existe un hundimiento. Tenemos una zona que está cerrada por que puede colapsar”, manifiesta el Director del Hospital Regional de Tumbes, Salvador Zelaya.
Manuel Boggio, ingeniero especialista en gestión de riesgo, manifestó: “Las construcción se está hundiendo producto de una mala cimentación. Esto es muy grave…esta construcción debe de demolerse”.
Se limpias las manos
Manuel Sullón, representante del Consorcio Hospitalario Tumbes, manifestó lo siguiente: “El hospital se ha hecho conforme a lo que manda los planos. Lo que mandan todas las especificaciones técnicas”.
Las justificaciones son tan abundantes como las grietas que siguen apareciendo en el hospital de Tumbes. Los especialistas aconsejan que lo mejor es demoler la construcción.
By Cheryl Wetzstein – The Washington Times – Thursday, June 20, 2013
An anti-prostitution provision in a federal AIDS funding program created under the George W. Bush administration was struck down as unconstitutional by the U.S. Supreme Court on Thursday
The decision is a victory for private aid organizations that believe the provision, which required them to explicitly oppose prostitution and sex trafficking as a condition for getting federal dollars, has blocked them from serving at-risk AIDS populations, such as sex workers.
The 6-2 decision, written by Chief Justice John G. Roberts Jr., said it is a violation of the First Amendment to require people “to pledge allegiance to the government’s policy of eradicating prostitution” as a funding condition.
Associate Justice Elena Kagan, who was the Obama administration’s solicitor general before joining the court in 2010, recused herself from the case. Associates Justice Antonin Scalia and Associate Justice Clarence Thomas dissented.
The provision — sometimes called the “prostitution pledge” — was part of the U.S. Global Leadership Against HIV/AIDS, Tuberculosis and Malaria Act of 2003. The act includes the $4.5 billion President’s Emergency Plan for AIDS Relief (PEPFAR).
The law says its funds cannot be used “to promote or advocate the legalization or practice of prostitution or sex trafficking.” But it went further, asking that grant recipients adopt that same viewpoint and sign a pledge that they “explicitly” opposed prostitution and sex trafficking.
That requirement “to profess a specific belief” went too far, the majority wrote, affirming a 2011 decision by the 2nd Circuit Court of Appeals that struck down the pledge.
Rep. Christopher H. Smith, New Jersey Republican, called the ruling “extremely disappointing and tragic for all victims of sexual exploitation, including sex trafficking.”
He and other lawmakers had put the pledge into the PEPFAR program as a way to ensure that the U.S. government didn’t unwittingly fund or promote commercial sex activities — “pimps and brothel owners” — as part of the battle to stop the spread of HIV/AIDS.
“The U.S. taxpayer may well now legitimately question whether U.S. assistance being given for laudable purposes is being administered by hands that undermine those very goals,” said Mr. Smith, chairman of the global human rights panel on the House Foreign Affairs Committee.
Senate Judiciary Committee Chairman Patrick J. Leahy, Vermont Democrat, praised the ruling, saying, “I have noted time and again that we cannot successfully combat HIV/AIDS by ignoring commercial sex workers who transmit the disease.”
The Alliance for Open Society International (AOSI) and three other AIDS-fighting groups challenged the law as an unconstitutional violation of free speech.
“Today’s ruling is an important victory toward lifting the taboo that has plagued HIV prevention programs since the anti-prostitution pledge began,” said Marine Buissonniere, director of the Open Society Public Health Program.
“It is critical to work in concert with sex workers and their advocates in the fight against HIV and AIDS. Condemnation and alienation are not public health strategies,” she said.
The U.S. Agency for International Development, which oversees PEPFAR, was sued in the case.
In April, when the high court heard arguments on the case, Deputy Solicitor General Sri Srinivasan defended the law, saying Congress placed rational limitations on the use of its HIV/AIDS funds.
The government can and does set restrictions on its funding programs to find the best “partners” for its efforts, and it is reasonable to ask groups receiving funds to fight AIDS to also oppose prostitution and sex trafficking, said Mr. Srinivasan, who represented the Agency for International Development, the Department of Health and Human Services, and the Centers for Disease Control and Prevention. He has since been confirmed to join the D.C. federal appeals court.
On the other side, David W. Bowker, who represented AOSI, a group funded by billionaire George Soros, said the pledge was unconstitutional and hobbles AIDS-fighting efforts with one of the very populations that needs services.
The pledge makes funding recipients go through “an ideological purity test” and then forces them “to adopt and express the government’s viewpoint as their own,” the AOSI, Pathfinder International, the Global Health Council and InterAction said in their brief. The pledge does not even apply to other government-funded public health programs, they noted.
In their dissent, Justices Scalia and Thomas said “a central part of the government’s HIV/AIDS strategy is the suppression of prostitution, by which HIV is transmitted. It is entirely reasonable to admit to participation in the program only those who believe in that goal.”
The AOSI runs a program in Central Asia to reduce drug use and prevent the spread of HIV/AIDS, while Pathfinder International offers family planning and reproductive health care in more than 20 countries. The two other groups, the Global Health Council and InterAction, are involved in fighting AIDS through public health and collaborative efforts of nongovernmental organizations.
