Category Archives: Healthcare

Any thing to do with Healthcare

More on the stuff under the hood in the Sanders Single payer Bill….

The New York Times takes a look at some of the fine print in the Sanders Bill written by other Senators in better attempt address the basic question of HOW a move TOWARDS Universal Healthcare could actually begin….

The bill, introduced this week, has attracted the endorsement of 15 Democratic senators, including several of the party’s most ambitious liberals. But many more Democrats this week said they’d like to pursue more limited steps to expand health insurance coverage and the government’s role in the system. It turns out that the Sanders bill also has provisions along those lines. Taken together, the bill encapsulates much of the coming Democratic debate about the direction of health care.

In the statements of the bill’s co-sponsors, one can detect an openness to less transformational approaches to health reform. “This bill is aspirational, and I’m hopeful that it can serve as a starting point for where we need to go as a country,” Senator Al Franken of Minnesota wrote in a Facebook post. He described the bill as a “marker” and “one way to achieve universal coverage.”

Parts of the Sanders bill help establish a road map for what some other strategies might look like.

The provisions are tucked into Title X of the bill and describe the four-year transition between current policy and the Sanders bill’s goal of a Medicare-for-all system. During that interim, some younger Americans would be able to buy access to the traditional Medicare program, which is now mainly for those 65 and up. The provisions would also establish an option for Americans to buy access to a Medicare-like government plan that would be sold on the Obamacare exchanges.

The Medicare buy-in section comes from Senator Debbie Stabenow of Michigan, who has introduced the provision as a stand-alone bill.

“One part of the bill that I worked with my colleagues to put in was the ability for every American to buy into a nonprofit public option as part of a four-year transition to get to single-payer in this country,” she said during the news conference introducing the bill. “This would create affordable, public health care that is available to any American to purchase in the already available exchanges.”

The idea of mixing public and private insurance in a competitive marketplace was a goal of many Democrats during the writing of the Affordable Care Act. The hope was that a public option would provide more choice to consumers and more pricing discipline for insurers. The idea didn’t have enough support to stay in the final bill, but it has been experiencing a bit of a comeback. Before the 2016 election, both President Obama and Hillary Clinton, the Democratic presidential nominee, endorsed a public option. Mrs. Clinton also endorsed the idea of a Medicare buy-in for older Americans.

Other Democrats are working on similar provisions that would provide more access to public health insurance without upending the existing private system. Senator Chris Murphy of Connecticut, who has not endorsed the Sanders bill, has said he’s developing different legislation to allow Americans to buy into the Medicare program, as Ms. Stabenow’s provision in the Sanders bill does for Americans of certain ages. (A group of House Democrats has already offered one piece of legislation to create such a program.)….

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Some Republicans are giddy about Sanders Single Payer effort….

A Socialist Senator, who hangs with the Democrats,  pushing for something that would cost TRILLONS of dollars in taxes to do, while the existing ‘Obamacare’ healthcare program is having its own issues….

While the GOP has tripped over it’s healthcare pinning to President Obama and the Democrats….

It probably will embark on the same campaign , for a while,  against Nancy Pelosi (who smartly has NOT endorsed the Sanders bill), Democrats and whoever ends up being the 2020 Democratic Presidential nominee , because that person HAS to dance with Bernie Sanders, to get their parties nomination….

As more and more Democrats come out in favor of some form of “Medicare for all” legislation, Republican campaign strategists are salivating.

In much the same way the GOP has tried to tie all Democrats to House Minority Leader Nancy Pelosi in attack ads, they’re planning to tie all Democratic incumbents and challengers to different proposals from Vermont independent Bernie Sanders in the Senate and Michigan Rep. John Conyers Jr. in the House, regardless of whether they’ve personally embraced those policies.

“I’m thrilled,” said Corry Bliss, executive director of the Congressional Leadership Fund, the leadership-backed super PAC that plans to spend $100 million to help Republicans keep their House majority in 2018.

“I love their new policy so much that I’m thinking about taking the $50 or so million I was planning on spending on attacking Nancy Pelosi and putting a small portion toward explaining how single-payer hurts the American people,” Bliss said Tuesday.

That strategy isn’t much different from the GOP strategy of the past seven years, when the party has gone after Democrats on the 2010 health care law. But after months of their own health care legislative failures, Republicans think they finally have an offensive opening on health care again…..

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GOP Obamacare fix’s are being debated…

The Healthcare program WILL be funded by Congress…

But as thes go with Congress….

There is gonna be a ‘give and take’ worked out….

And some Republicans want to cut back the coverage….

After a year of backroom, closed-door, GOP-only meetings on health care, and a bitter, partisan floor fight over repealing the Affordable Care Act that eventually collapsed, senators from both parties came together to hold nearly half-a-dozen public hearings and hammer out a bill to stabilize Obamacare’s vulnerable insurance exchanges by the end of September.

But beneath the bipartisan bonhomie, there is trouble in paradise.

In exchange for funding Obamacare’s subsidies to insurers that cover care of low-income people with severe health needs, Republicans are demanding that some of the ACA’s protections and mandates be waived—and have suggested rolling back the requirement that every insurance plan cover essential health benefits like maternity care and mental health treatment.

This week, Sen. Lamar Alexander (R-TN), the chair of the committee crafting the stabilization bill, mocked the concept of forcing all insurers to offer comprehensive health care plans.

Senate Democrats say they’re open to some increased “flexibility” but worry that allowing too many regulatory rollbacks will lead to more expensive and worse quality health coverage for millions of people. Though many proposals have been tossed onto the table over the past few weeks, the key battle is currently over loosening the rules around Obamacare’s “state innovation” waivers—which states obtain from the federal government to test different health care systems. Some states, including Alaska, have used these waivers to set up reinsurance programs, which have brought down the number of uninsured residents and lowered costs. But other states are seeking waivers for plans that health care experts say would create “barriers to enrollment.”

“Flexibility needs to increase health care for people, not decrease it. If it’s flexibility to take health care away, that’s not something I would support,” Sen. Debbie Stabenow (D-MI) told TPM. “I believe that health care is a basic human right and we’re going to make sure that everyone has health care.”….

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Lindsey Graham floats a last ditch Obamacare Repeal try…

Simple….

He doesn’t have the votes….

And the time….

And the support from Conservatives who don’t think Graham is going far enough….

And?

Trump is talking to Democrats about funding the Obamacare indidvidual insurance substities….

Sens. Lindsey Graham, Bill Cassidy, Dean Heller and Ron Johnson on Wednesday released an Obamacare repeal bill, framing it as the last, best hope to fulfill the GOP’s promise to undo the health law.

“There’s a lot of fight left in the Republican Party” on repeal, Graham said.

The bill faces long odds: Even some of its GOP backers say it would be almost impossible to get a massive rewrite of the health care system through the Senate within 17 days, or before the expiration of fast-track procedural powers Republicans hope to use to bypass the threat of a Democratic filibuster.

President Donald Trump praised the lawmakers for continuing to work on Obamacare repeal, citing the “complete nightmare” the law is for Americans. But he didn’t indicate whether he would press lawmakers to support the measure…..

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Pelosi does NOT join the Sanders Single Payer movement….

The House Minority Democratic Leader Nanacy Pelosi isn’t running for President…..

So she doesn’t have to pass a litmus test on this….

She isn’t doing Sanders dance that she knows won’t fly….She will have to work to do fixes to the existing Affordable Healthcare program also known as Obamacare….

She has carefully walked around Trump’s basic idea….

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House Minority Leader Nancy Pelosi (D-Calif.) declined to back a single-payer health care bill drafted by Sen. Bernie Sanders (I-Vt.) , saying she is instead focused on efforts to shield Obamacare from Republican attempts to rescind it.

“Right now, I’m protecting the Affordable Care Act,” Pelosi told a small group of reporters in her Capitol office Tuesday. “None of these other things … can really prevail unless we have the Affordable Care Act.”

The House’s top Democrat said she would review the legislation, which Sanders is rolling out to much fanfare on Wednesday.

The single-payer bill has quickly attracted support from a flock of Democratic senators in the mix for the 2020 presidential race, suggesting that it is rapidly becoming a litmus test among the liberal grass roots….

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Governors Ask Congress to fund the Individual Health Care Market program…

With an outright Repeal of the nations’s healthcare program Governors  are asking  national lawmakers to get serious about making sure the program’s individual insurance market doesn’t fall apart …

Governors are calling for multiyear funding for cost-sharing payments and for federal assistance to launch reinsurance programs as part of a bipartisan measure to stabilize the individual insurance market.

The conversation among governors and senators in a Sept. 7 hearing before the Senate Health, Education, Labor and Pensions Committee echoed what insurance commissioners told the same panel earlier in the week about how to bring stability to the individual insurance market before the fifth open enrollment period.

The committee’s leaders hope to advance a narrow, bipartisan package before insurance companies finalize contracts with the federal government for the 2018 coverage year on Sept. 27.

HELP Chairman Lamar Alexandersuggested the contours of a package could include funding for the health care law’s cost-sharing reduction payments, which the state officials have pleaded for, and additional restructuring of the law through waivers or through allowing certain consumers to buy basic catastrophic coverage.

The Tennessee Republican has sought to fund the cost-sharing payments through 2018, but state officials told his panel last week they should be funded at least though 2019 to provide additional stability for the marketplace. Alexander said a package would need to include more than just that funding to win support from Republicans….

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What’s next for the Affordable Healthcare Law?

Axios looks at the options , particularly from the US Senate side , which blocked efforts to repeal the law….

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All things considered, the HELP Committee’s hearings this week about stabilizing the Affordable Care Act went incredibly well. Republicans, Democrats, senators, governors and insurance commissioners are more or less on the same page. And, miraculously, nearly every member was on their best behavior, avoiding partisan jabs at the health care law or one another.

But it’s easy to have a good hearing. There’s still a long way to go before the finish line. Here’s what’s ahead, both short-term and longer term.

Committee: The details will be crucial, but it seems highly likely that HELP Chairman Lamar Alexander and ranking Democrat Patty Murray will be able to pull off an agreement.

  • “I wouldn’t bet against Lamar Alexander and Patty Murray,” Sen. Michael Bennet told me, a sentiment echoed throughout the committee.
  • The final package is likely to be pretty simple: Funding for cost-sharing reduction subsidies paired with more flexible state innovation waivers. It’s looking pretty likely that the subsidies will be funded for two years, in exchange for adding a less comprehensive “copper” plan option for people older than 30.
  • But it’s unclear how the process moves forward. Murray said she doesn’t know exactly how it’s going to play out yet, but a senior GOP aide told me they’re skeptical the committee has time to mark up legislation.
Floor: Assuming the committee reaches an agreement, it would seem to stand a good chance of passing — at least in the Senate. The question is when. (The House is a different matter — and President Trump would have to sign it, too.)….
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An argument against Trump JUST playing to his base….

Social scientists have long been familiar with the important concept of the reference group — a group individuals use as the standard against which to compare their own behavior and self-perceptions, whether a part of that group or not.

President Donald Trump has, in recent months, given evidence that his reference group is shifting to the minority of the U.S. population he characterizes as his “base.” In a series of tweets in August, he opined, “Hard to believe that with 24/7 #Fake News … the Trump base is getting stronger!” and, “… Supreme Court pick, economic enthusiasm, deregulation & so much more have driven the Trump base even closer together,” and, “The Trump base is far bigger & stronger than ever before …”

A selective focus on only a portion of the population as one’s reference group is an attractive and tempting alternative for any politician. It reduces the cognitive dissonance that accompanies attempting to deal with the fact that the entire population is more negative than positive (Trump’s current overall job approval rating is 37%), and it produces a stream of positive feedback from that base (as was the case in President Trump’s recent speeches in Phoenix and Springfield, Missouri).

At the same time, a selective choice of a relatively narrow reference group for a president has significant implications. The main consequence stems from the finding that the public, taken as a whole, wants less partisanship, less polarization, and is ultimately not in favor of a strict position of sticking to principles at the cost of getting things done.

Keep in mind that government and the way it operates today is, in the public’s mind, one of the most important problems facing the nation. Although this concern has multiple causes, a good deal of it comes from the belief that government — mainly Congress — is too focused on infighting, bickering, adherence to intransigent partisan allegiances, enslavement to special interests and those with money, and a general lack of willingness to compromise in order to get things done for the public good.

In this sense, Trump’s explicit announcement of the use of his base as the reference group governing his behavior (rather than using the nation as a whole) runs the danger of exacerbating, rather than ameliorating, the public’s concerns…..

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Democrats warn Sanders about his supporters…and his future…

Democratic Senator’s and establishment types are increasingly uneasy with Sanders supporters efforts to co-op the Democratic party itself….

Supporters have increasingly looked to instill THEIR policy views on the party , thus re-running the 2016 Presidential Primary debate…

First…

For the hundredth time?

Bernie Sanders is NOT a Democrat…

Nor does he want to join the party….

He HAS done things to help the party…

But maintains his independence ….

His supporters make NOT bones about wanting to TAKE OVER the party driving it to the hard left, something that would divide the party and be catastrophic for the party in  2018/2020 elections…

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Right now, Kamala Harris , the Democratic Senator for California is the flavor of the month for the national party…. Other Democratic senators are NOT happy that Sanders supporters are knocking her even as she expresses support for Sanders Single-payer health insurance bill that has NO chance of passage…

Prominent Democrats are increasingly riled by attacks from Bernie Sanders’ supporters, whose demands for ideological purity are hurting the party ahead of the 2018 midterms and 2020 presidential election, they say.

But it’s not just the outside agitators that Democratic lawmakers, operatives, and activists are annoyed with: They’re tired of what they see as the senator’s hesitance to confront his own backers, either in public or through back channels.

Tensions boiled over recently when a handful of Sanders loyalists bashed freshman Sen. Kamala Harris — a rising star in the party and potential 2020 hopeful — as an establishment tool. Democrats were also rankled that other prominent Sanders allies said support for single-payer health care should be a litmus test for candidates.

In response, Democratic senators and outside groups have begun telling Sanders and friendly intermediaries that if he wants to be a leading figure for Democrats ahead of 2020’s presidential election, he needs to get his supporters in line — or at least publicly disavow their more incendiary statements.

The confrontations, they insist, threaten party unity ahead of a critical midterm election cycle, when Democrats have a shot at winning the House and several governor’s offices.

“The Democratic Party has treated Senator Sanders exceptionally well. We collectively let him run in our primaries when he declared he wasn’t a Democrat — I count that as a great favor, and an opportunity almost no one else has ever received,” said former Democratic National Committee chairman Don Fowler, who has called for the independent Sanders to formally join the party….

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Note…

Yes …The 2020 Democratic Presidential nomination favorite DOES seem to be Kamala Harris and Bernie Sanders out loud…With Eliaazbeth Warren sitting on the side…Joe Biden offically leads the early polling….Things HAVE already started …

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Sanders Single Payer Medicare litmus test for Democrats…

US Senator Bernie Sanders the guy who ain’t a Democrat  (And IS an independent Socialist ) is fronting a bill for a single payer Medicare health insurance program for America….

It’s counter to the Republicans Repeal Obamacare….

There is NO chance the bill will pass the present GOP majority Congress and White House…

But Kamala Harris , the rising star on the 2020 Democratic Presidential nomination early list has thrown her support behind the Sanders effort, as has Cory Booker….

Democratic nomination basic’s are you run to the left, THEN move back to the middle…A lot of Democrats running in the 2018 Midterms simply cannot support Sanders efforts due the cost factor that would be thrown back at them from a Republican opponent…

It worked for Bill Clinton and Barack Obama…We see what happened to Hillary Clinton….

So one would imagine that Sanders is gonna get some Democratic support on his bill….

For NOW….

Sen. Bernie Sanders’ (I-Vt.) Medicare for all plan has become a key test for Democrats with 2020 presidential ambitions.

Sanders, who energized liberals with his improbable run at the White House last year, is poised to introduce a long-awaited single-payer bill when Congress returns to Washington this month. The liberal icon insists it’s not a litmus test for the Democrats, but he’s actively seeking endorsements. Outside liberal groups are watching closely, with some hinging their own endorsements on a candidate’s support for the Sanders health-care model.

Sen. Kamala Harris (D-Calif.), who’s said to be eying a 2020 run, threw her weight behind Sanders’s bill this week, highlighting the sense that potential candidates want to get on the right side of their base –– and do it early.

The issue poses a dilemma for both Democratic leaders and presidential hopefuls, who are walking a fine line between appeasing their liberal supporters without alienating the more conservative-leaning voters they’ll need to win back power in the House, the Senate and the White House.

Spokesmen for several Democrats with possible presidential ambitions, including Sen. Amy Klobuchar(Minn.), New York Gov. Andrew Cuomo and Virginia Gov. Terry McAuliffe, did not respond to a request for comment on their stance on single-payer.

Sens. Chris Murphy (D-Conn.), Kirsten Gillibrand (D-N.Y.) and Sherrod Brown (D-Ohio), all potential White House contenders who have voiced support for single payer in the past, haven’t said if they’ll endorse Sanders’s bill. Their offices were also silent this week.

A spokeswoman for Sen. Cory Booker (D-N.J.), another possible candidate, referred to Booker’s interview with Vox in April. He said then that “I believe, ultimately, in ideas like single payer or Medicare for all,” while adding that “I don’t know how we get it done in this environment.”

They will face no lack of pressure to try, as liberal groups are already pushing for candidates to get on board….

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Breaking …Trump to give Congress 6 months to legalize ‘Dreamers’ program or it will be gone….

Donald Trump the GOP Presidential candiadte was for keeping the Obama excutive program to allow children of undoucmented parents to remain in the US and not be deported….

His adopted party types in the Republican party want them and all and any undiucumented man, woman or child removed from America….

Trump’s Dept of Homelend Security head, now Chief of Staff John Kelly has held that immigration law should come from Congress, not a President….

It appears that Kellys view has held the day….

The action now moves to Congress, where Trump can now esacape blame….

The president’s expected announcement is likely to shore up his base, which rallied behind his broader campaign message about the importance of enforcing the country’s immigration laws and securing the border. At the same time, the president’s decision is likely to be one of the most contentious of his early administration, opposed by leaders of both parties and by the political establishment more broadly.

The White House and Congress have tried to pass the issue off on each other – with each arguing that the other is responsible for determining the fate of the approximately 800,000 undocumented immigrants who are benefiting from DACA. Though most Republicans believe that rolling back DACA is a solid legal decision, they are conscious of the difficult emotional terrain. Utah Sen. Orrin Hatch joined Ryan in cautioning Trump against rolling back the program.

The president is likely to couch his decision in legalese. Many on the right, even those who support protections for children brought into the country illegally through no fault of their own, argue that DACA is unconstitutional because former President Barack Obama carried it out unilaterally instead of working through Congress.

Some Republican lawmakers, including Florida Sen. Marco Rubio, have said that Congress needs to pass a law to protect the so-called Dreamers.

“My hope is that as part of this process we can work on a way to deal with this issue and solve it through legislation, which is the right way to do it and the constitutional way to do it,” Rubio told CNN in June.

Trump’s expected decision to scrap DACA represents another challenge for Ryan and fellow congressional Republicans….

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Waiting for Another Kennedy to shine…..

While the 2020 Democratic Presidential nomination sweepstakes players start plugging their tickets…. 

Politico takes a look at Rep. Joe Kennedy up in Massachusetts….

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Democrats are in search of new leaders to take on Donald Trump, and Rep. Joe Kennedy could fit the bill. But it’s not clear he wants the job.

In short order, Kennedy has garnered a loyal grass-roots following with a series of viral speeches challenging the president on everything from health care to hate speech, leading some Democrats to believe he could help fill the party’s leadership vacuum.

It’s a shift for someone who, despite his famous last name and wavy red mane, has kept a low profile on the national scene since being elected to the House in 2012. Loath to be seen as a political celebrity, the 36-year-old from the outskirts of Boston has put in the work of a relative back-bencher and focused on delivering for his district.

But the fact is, he’s no ordinary lawmaker. He’s the grandson of the late Robert F. Kennedy, a member of Democratic royalty. And his decimated party could use an infusion of young talent. As Trump continues to undermine the ideals Kennedy holds dearest, he’ll have to decide whether and how to take a larger role in the party and fight back.

Kennedy has already proved he has the ability to harness his star power, after gaining national prominence for blasting GOP efforts to dismantle Obamacare earlier this year.

But the key question for Democrats, including the more than two dozen interviewed for this story, is what’s next for the young lawmaker they say is much more than a notable last name. It’s one — to the quiet frustration of several in the party — that Kennedy seems in no hurry to answer.

“Somewhere down the road, if a Senate seat were to open, yeah, it’s something I’d certainly take a look at,” Kennedy said in an interview in his Capitol Hill office. “But that’s got to be right in time for me and my family.”

Since his attack on Obamacare repeal efforts, Kennedy has been slowly raising his national profile…..

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Minnesota deals will keeping its health rate increase’s modest…

They are proving …IT CAN BE DONE…

Last fall, as consumers in Minnesota were facing health insurance rate increases of 50 percent or more, Gov. Mark Dayton, a Democrat, said the Affordable Care Act was “no longer affordable to increasing numbers of people.” The state’s top insurance regulator said the Minnesota market was “on the verge of collapse.”

The outlook now is much better. Rate increases requested for 2018 are relatively modest, thanks in part to a new program under which the state will help pay the largest claims. The program, known as reinsurance, and the efforts that led to its creation hold lessons for other states where rates are rising rapidly, and for Congress, where lawmakers are considering the introduction of a similar program.

“The individual insurance market is stabilizing under the program here,” said Allison L. O’Toole, the chief executive of Minnesota’s state-run insurance marketplace. “Health plans are very happy about it.”

State officials and insurers say that, as a result of the program, premiums next year will be about 20 percent lower than they would otherwise have been. The program — for which Minnesota has budgeted about $270 million in each of the next two years — potentially benefits all of the 160,000 people buying insurance on their own, not just those with large claims.

But the program will be invisible to consumers. They will not have to file additional paperwork or do anything different from what they would ordinarily do….

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Sen Kamala Harris will join Sanders effort on a single-payer healthcare bill…

She join’s Sen. Cory Booker and others in a doomed effort, under a Republican  majority Congress ,to approve Sanders “Medicare for All”  legislation….

The push has political postives for Democrat going into the 2020 Presidential nomination campaign…

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California Senator Kamala Harris (D) announced during a town hall on Wednesday that she would support Sen. Bernie Sanders‘s (I-Vt.) “Medicare for All” bill, which would institute a single-payer health insurance system.

“I intend to co-sponsor the ‘Medicare for All’ bill because it’s just the right thing to do,” Harris announced Wednesday at a town hall in Oakland.

“It’s not just about what is morally and ethically right, it also makes sense just from a fiscal standpoint,” she said.

The decision to co-sponsor Sanders’s bill is Harris’s first instance of publicly supporting single-payer.

In July, Harris said, “as a concept” she supported single-payer, but that lawmakers still needed to “work out the details.”

Sanders said earlier this week that he was building support for his “Medicare for All” bill.

“You’re seeing more and more movement toward ‘Medicare for All,” Sanders said. “When the people are saying we need healthcare for everyone, as more and more Americans come on board, it will become politically possible.”

The former presidential candidate’s backing for the policy has raised questions about whether he and his supporters might launch primary challenges against Democrats who do not back a single-payer plan.

Sanders on Wednesday tweeted thanking Harris for her announcement as well.

“Thank you Kamala Harris for your support. Let’s make health care a right, not a privilege,” he tweeted….

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Crazy Shit for the Morning….Maine Governor…Call Medicaid… Welfare….

‘Code Word’ politics….

The state is moving to actually EXPAND its Medicaid program…

Is Medicaid “insurance” or is it “welfare”?

The battle taking place in Maine right now over this semantic question could determine whether the state becomes the first in the nation to adopt Obamacare’s Medicaid expansion by popular vote.

Mainers have until Friday to weigh in on the exact wording of a ballot initiative, which if it passes would allow Maine to join the 30-plus states that have expanded Medicaid under the Affordable Care Act.

Conservative groups and state Republicans, led by Maine’s firebrand Gov. Paul LePage (R), are pushing for the Medicaid expansion to be characterized on the ballot as welfare in the hopes that people will then vote it down.

“It’s free health care paid for by the taxpayers, and it’s got to be said that way,” LePage told talk radio hosts at WGAN last Thursday. “It’s pure welfare. If you don’t want to call it welfare, call it an entitlement.”….

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Trump holdover in the VA is a Trump Admin good guy?

Secretary of Veterans Affairs David Shulkin is pictured. | Cliff Owen/AP Photo.

Sure is….

One of the several Obama guys that is still on the job gets kudos from his boss….

VA Secretary David Shulkin has proved to be something unique in President Donald Trump’s Washington: an Obama appointee nominated by Trump who is beloved by almost everyone and getting stuff done.

By tweaking regulations, he has managed to fire hundreds of allegedly incompetent employees, publicized waiting times at Veterans Affairs clinics, gotten money to expand vets’ treatment by private doctors, and expanded care for isolated vets through telemedicine and mobile phones, while promising to close 430 vacant VA buildings and speed up benefit awards. Shulkin also made a bold — and risky — decision to bypass contracting rules to buy a $16 billion digital health record system.

“What motivates me and what motivates Dr. Shulkin is the same, to provide the best care to veterans,” said Rep. Phil Roe (R-Tenn.), chairman of the Veterans Affairs Committee. “I don’t know whether he’s a Republican or Democrat, and I could care less.”

But there’s a reason Shulkin was Trump’s fourth choice for the VA job — or possibly the fifth, or the 10th, depending on whom you ask. The VA, with 350,000 employees and 1,250 health care sites, is a political quagmire. Not many people want to clean up others’ messes with hundreds of people looking over their shoulder.

The VA’s conservative critics are holding their fire now that a GOP administration and Congress control the agency….

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