[AMV] President Trump #280 Make America Sick Again

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Op woensdag 15 maart 2017 00:17 schreef ExtraWaskracht het volgende:
Het lekken van de tape waarop Ryan zegt Trump nooit te steunen vind ik wel echt heel opvallend.

twitter:

RawStory twitterde op dinsdag 14-03-2017 om 22:00:25 Top Trump backer: It's time to throw Paul Ryan and his health care 'death wish' under the bus... https://t.co/UV62Mn0BFW reageer retweet

twitter:

RawStory twitterde op woensdag 15-03-2017 om 00:32:22 Bannon behind Ryan audio so Trump can throw Ryan's health care flop under the bus: conservative pundit... https://t.co/0A7UmSeY1Q reageer retweet

twitter:

LouDobbs twitterde op woensdag 15-03-2017 om 00:00:00 Speaker Ryan a disgrace - Leaked audio shows shameful disloyalty to @POTUS. Join #Dobbs Now #MAGA #TrumpTrain reageer retweet

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LouDobbs twitterde op woensdag 15-03-2017 om 00:14:18 #LDTPoll Should the GOP remove Paul Ryan as Speaker of the House? reageer retweet

twitter:

LouDobbs twitterde op dinsdag 14-03-2017 om 21:30:00 RyanCare could die on Thursday - Will House Budget Cmte derail O'Care replacement bill? @RepChrisCollins joins #Dobbs FBN7p #MAGA reageer retweet

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BREAKING: We've got Trump tax returns. Tonight, 9pm ET. MSNBC.

(Seriously).

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Op woensdag 15 maart 2017 00:42 schreef Stabiel het volgende:

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JAAAHAA WE GOT HIM

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Op woensdag 15 maart 2017 00:42 schreef Stabiel het volgende:

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https://twitter.com/maddow/status/841795163664089089

JAAAHAA WE GOT HIM

Ladies and gentlemen we got him

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Op woensdag 15 maart 2017 00:33 schreef Nintex het volgende:

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Ook de reden dat het White House niet wil dat het bekend staat als Trumpcare.

Overigens pushed conservative talk radio op dit moment single player healthcare ipv Ryan's plan en dan zonder de Freedom Caucus lijkt erop dat Team Trump een power play doet tegen het R establishment.

twitter:

RawStory twitterde op dinsdag 14-03-2017 om 22:00:25 Top Trump backer: It's time to throw Paul Ryan and his health care 'death wish' under the bus... https://t.co/UV62Mn0BFW reageer retweet

twitter:

RawStory twitterde op woensdag 15-03-2017 om 00:32:22 Bannon behind Ryan audio so Trump can throw Ryan's health care flop under the bus: conservative pundit... https://t.co/0A7UmSeY1Q reageer retweet

Ook Fox News doet mee:

twitter:

LouDobbs twitterde op woensdag 15-03-2017 om 00:00:00 Speaker Ryan a disgrace - Leaked audio shows shameful disloyalty to @POTUS. Join #Dobbs Now #MAGA #TrumpTrain reageer retweet

twitter:

LouDobbs twitterde op woensdag 15-03-2017 om 00:14:18 #LDTPoll Should the GOP remove Paul Ryan as Speaker of the House? reageer retweet

twitter:

LouDobbs twitterde op dinsdag 14-03-2017 om 21:30:00 RyanCare could die on Thursday - Will House Budget Cmte derail O'Care replacement bill? @RepChrisCollins joins #Dobbs FBN7p #MAGA reageer retweet

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Op woensdag 15 maart 2017 00:45 schreef Nintex het volgende:
Feit dat Maddow het in haar show gaat presenteren en niet direct naar bijv. de FBI of CIA is gegaan toont aan dat er weinig boeiends in zal staan. Trump betaald geen belasting door een loophole bijv. (wisten wel al schept hij over op)

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Op woensdag 15 maart 2017 00:45 schreef Nintex het volgende:
Feit dat Maddow het in haar show gaat presenteren en niet direct naar bijv. de FBI of CIA is gegaan toont aan dat er weinig boeiends in zal staan. Trump betaald geen belasting door een loophole bijv. (wisten wel al schept hij over op)

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Op woensdag 15 maart 2017 00:45 schreef Nintex het volgende:
Feit dat Maddow het in haar show gaat presenteren en niet direct naar bijv. de FBI of CIA is gegaan toont aan dat er weinig boeiends in zal staan. Trump betaald geen belasting door een loophole bijv. (wisten wel al schept hij over op)

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Op woensdag 15 maart 2017 00:49 schreef Tijger_m het volgende:

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Wat heeft de FBI of CIA te maken met belasting aangiftes? Daar is de IRS voor.

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Op woensdag 15 maart 2017 00:51 schreef Nintex het volgende:

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Critici van Trump zijn vooral op zoek naar bewijzen voor zijn banden met Rusland. De tax returns zouden daar bijv. een bewijs van kunnen zijn (bepaalde Russische investeringen of Assets).

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It's almost as though Republicans are tired of having President Trump's evidence-free allegations laid at their feet. Almost.

Late Monday, a spokesman for House Intelligence Committee Chairman Devin Nunes (R-Calif.) threatened to subpoena the Trump administration to produce evidence of Trump's claim that President Barack Obama wiretapped Trump Tower during the campaign. The White House has declined to produce this evidence publicly, offering various excuses, including the Constitution's separation of powers and — most recently on Monday — arguing that Trump wasn't speaking literally when he made the claim.

The Justice Department missed Nunes's deadline to provide evidence Monday, which drew Nunes's subpoena threat.

“If the committee does not receive a response, the committee will ask for this information during the March 20 hearing and may resort to a compulsory process if our questions continue to go unanswered,” Nunes spokesman Jack Langer said.

Then, on Tuesday, Sen. Lindsey O. Graham (R-S.C.) made his own threat. Last week, Graham — who is clearly skeptical of the wiretapping claim and chairs a subcommittee looking into it — asked the Justice Department and the FBI to provide copies of any warrants or court orders related to the alleged wiretapping. Having not received anything, Graham said Tuesday that he would announce his next steps Wednesday and may push for a special committee.

“They're about to screw up big time if they keep running to the intel committee and not answer that letter,” Graham said, according to CBS's Alan He. He added: “If they don't honor this request and give us an answer, then I would say that we need a joint select committee because regular order is not working.”

twitter:

alanhe twitterde op dinsdag 14-03-2017 om 17:57:21 Senator Graham warns that the FBI is "about to screw up big time" by not responding to the letter from his subcommi… https://t.co/VyWbUDXC7X reageer retweet

It's clear as day what's going on here.

The White House's reactions to Trump's evidence-free claims — be it this one or the one about millions of illegal votes in 2016 — is to call for investigations. That has the triple benefit of putting the onus on someone else to look into it, to buy some time and hope people forget that the president is making such wild allegations, and, in this case, to give themselves an excuse to clam up. The White House initially said it wouldn't comment on Trump's wiretapping claim while it was being investigated and then it said it couldn't provide evidence because of separation of powers — another claim that strained credulity.

But that also puts Republicans such as Nunes and Graham in the position of having to account for these claims — and calling on Trump and his team to put up or shut up. By pushing the administration to produce evidence — or else — they are effectively putting the ball back in the executive branch's court. The subtext: You can't just make these claims and then ask us to deal with the fallout.

Nunes in particular has faced some very tough questions from reporters, and he must feel as though he's being hung out to dry. Graham's angle is slightly different, in that he clearly doesn't think Trump's claim is accurate and wants to prove it. “If there is no warrant, then we’ll have solved this problem: There was no wiretapping,” he said this week.

Whether this will actually give Trump any pause in the future when making such allegations is an open question. But these members want to make sure he and the people around him at least think twice before saddling them and their GOP colleagues with another evidence-free Trump claim.

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BREAKING: Trump to nominate Goldman Sachs managing director James Donovan as deputy Treasury secretary - White House

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What we've got is from 2005... the President's 1040 form... details to come tonight 9PM ET, MSNBC.

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Before being elected President, Mr. Trump was one of the most successful businessmen in the world with a responsibility to his company, his family and his employees to pay no more tax than legally required. That being said, Mr. Trump paid $38 million dollars even after taking into account large scale depreciation for construction, on an income of more than $150 million dollars, as well as paying tens of millions of dollars in other taxes such as sales and excise taxes and employment taxes and this illegally published return proves just that. Despite this substantial income figure and tax paid, it is totally illegal to steal and publish tax returns. The dishonest media can continue to make this part of their agenda, while the President will focus on his, which includes tax reform that will benefit all Americans.

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Op woensdag 15 maart 2017 00:33 schreef Nintex het volgende:

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Overigens pushed conservative talk radio op dit moment single player healthcare ipv Ryan's plan en dan zonder de Freedom Caucus lijkt erop dat Team Trump een power play doet tegen het R establishment.

SPOILER

Om spoilers te kunnen lezen moet je zijn ingelogd. Je moet je daarvoor eerst gratis Registreren. Ook kun je spoilers niet lezen als je een ban hebt.

twitter:

realDonaldTrump twitterde op woensdag 15-03-2017 om 12:02:40 Can you imagine what the outcry would be if @SnoopDogg, failing career and all, had aimed and fired the gun at President Obama? Jail time! reageer retweet

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Op woensdag 15 maart 2017 12:05 schreef Mani89 het volgende:
Genoeg inhoud, nu weer even randzaken.

twitter:

realDonaldTrump twitterde op woensdag 15-03-2017 om 12:02:40 Can you imagine what the outcry would be if @SnoopDogg, failing career and all, had aimed and fired the gun at President Obama? Jail time! reageer retweet

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Op woensdag 15 maart 2017 13:03 schreef Re het volgende:
ik snap niet dat een single payer insuranceer zo makkelijk doorheen komt, zelfs de democraten zijn het niet unaniem eens met zo'n systeem

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Op woensdag 15 maart 2017 13:07 schreef Ludachrist het volgende:

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Gaat het ook nooit worden natuurlijk.

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Op woensdag 15 maart 2017 13:08 schreef Re het volgende:

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het is alleen de enige manier dat Trump zijn nummer 1 speerpunt kan waarmaken

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Op woensdag 15 maart 2017 13:10 schreef Ludachrist het volgende:

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Punt is dat dat hele nummer 1 speerpunt van Trump niet waar te maken is, in ieder geval niet binnen de huidige Republikeinse partij.

Ik wil verder niet te veel spoileren voor de komende jaren, maar er zijn wel meer speerpunten van Trump die met dit euvel kampen.

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'People are scared’: Paranoia seizes Trump’s White House
Staffers are leaving their phones at home, using secret apps and monitoring each other’s social media.

A culture of paranoia is consuming the Trump administration, with staffers increasingly preoccupied with perceived enemies—inside their own government.

In interviews, nearly a dozen White House aides and federal agency staffers described a litany of suspicions: that rival factions in the administration are trying to embarrass them, that civil servants opposed to President Donald Trump are trying to undermine him, and even that a “deep state” of career military and intelligence officials is out to destroy them.

Aides are going to great lengths to protect themselves. They’re turning off work-issued smartphones and putting them in drawers when they arrive home from work out of fear that they could be used to eavesdrop. They’re staying mum in meetings out of concern that their comments could be leaked to the press by foes.

Many are using encrypted apps that automatically delete messages once they’ve been read, or are leaving their personal cell phones at home in case their bosses initiate phone checks of the sort that press secretary Sean Spicer deployed last month to identify leakers on his team.

It’s an environment of fear that has hamstrung the routine functioning of the executive branch. Senior advisers are spending much of their time trying to protect turf, key positions have remained vacant due to a reluctance to hire people deemed insufficiently loyal, and Trump’s ambitious agenda has been eclipsed by headlines surrounding his unproven claim that former President Barack Obama tapped his phone lines.

One senior administration aide, who like most others interviewed for this story spoke on the condition of anonymity, said the degree of suspicion had created a toxicity that was unsustainable.

“People are scared,” he said, adding that the Trump White House had become “a pretty hostile environment to work in.”

A White House official rejected the notion that there’s a culture of paranoia.

Spicer on Tuesday emphasized that cell phone checks are not White House policy, and said that neither he nor others are still conducting them. “The only incident in which that occurred was limited to the one involving myself,” he said.

Trump has a history of overseeing pressure-cooker organizations rife with suspicion, setting up sophisticated surveillance partly to monitor employees at his properties, including at his campaign headquarters, where some campaign aides suspected their offices were bugged.

One widespread concern in the Trump White House: That career intelligence operatives are working to undermine the new president through a series of leaks of classified information.

Much of the suspicion is directed at the Central Intelligence Agency, which many Trump loyalists believe is targeting CIA skeptics who sit on the National Security Council. Some of them allege that the CIA was behind the damaging leaks to the press that culminated in the resignation of National Security Adviser Michael Flynn in February, and that the agency has pushed for the removal of other staffers.

They also believe the CIA exaggerated security clearance concerns that led to the removal of a top Flynn deputy, Robin Townley, from the NSC. Last week, another top NSC staffer who had drawn opposition from some within the CIA, intelligence director Ezra Cohen-Watnick, was told he was being removed, only to have Trump overrule the decision, after Trump advisers Steve Bannon and Jared Kushner intervened, two people familiar with the episode said.

Some rank-and-file White House aides, meanwhile, have become convinced that intelligence agents may be monitoring their phone calls, emails, and text messages. Those fears intensified last week when WikiLeaks released a trove of CIA documents outlining how the agency can break into phones and computers.

In an interview, one White House aide described the elaborate steps he was taking to shield himself. Once he gets home in the evening, he turns off his work phone and stores it in a drawer because, he said, he believes it could be used to listen to him even when it’s off. If he makes a call during off-hours, he uses a separate, personal phone in an adjoining room, where the stowed work device wouldn’t be able to pick up his voice as clearly.

The fact that so much sensitive information from the White House was making its way to news outlets, he said, had raised suspicions that national security officials were listening in.

“I’m paranoid,” said the aide. “Anything significant seems to be on the front page the next day.”

One prominent Republican strategist who is close to the administration marveled at the amount of sensitivity over phones. “It’s always a, ’you never know who’s listening’ kind of thing,” this person said. “It’s a general concern that people have over there.”

Some staffers have even expressed concern about messages that appear on digital faces of the White House’s landline phones, indicating that calls could be monitored. The White House official, however, said those messages have been a feature of the building’s phone system for years.

Yet the perception among some staff that monitoring is widespread has engendered even greater suspicion and anxiety. “We’ve got strict instructions not to talk to talk to the press,” said one White House aide. “I assume I would get fired immediately.”

One senior aide said staffers have become almost obsessed by daily palace intrigue news accounts, spending hours dissecting in the office in hopes of deciphering who is dishing — and who is trying to hurt whom.

Another Republican who is close to the White House said junior-level staffers were simply “mimicking what they’re seeing at the top … Everyone at the top is so suspicious that it trickles down the org chart, so everyone has become paranoid and suspicious.”

The distrust, some contend, isn’t unfounded.

“I wouldn't call it paranoia under the circumstances,” said a Republican who communicates with many administration aides through encrypted apps. “It’s not paranoia if people really are out to get you, and everybody actually is out to get everyone else.”

Many staffers say they don’t like the idea that supervisors – or anyone else – could have access to their emails. Some have taken to using secure messengers like Confide and Signal in order to communicate on their personal phones. One program gaining popularity within the administration is Wickr, which allows users to set an expiration time on how long an unread message can remain in a recipient’s inbox before it self-destructs.

The encryption programs can’t be accessed from White House-issued phones, which prevent users from downloading most apps. There are no restrictions on employees using encrypted apps on their personal phones, the White House official said, as long as they’re not being used to conduct official business.

The most stress, however, may be outside the West Wing, in executive branch agencies, where staffers worry about career bureaucrats who are hostile to Trump.

Fears grew on Friday, when Sid Bowdidge, a Trump appointee to the Department of Energy who worked on the campaign, was ousted amid reports that he’d expressed anti-Muslim views and argued that Obama had relatives who were terrorists in Twitter posts from over a year ago.

In an interview, Bowdidge blamed the disclosure on an anti-Trump department staffer who had picked through his background. He called the incident “character assassination” and said that Obama allies were sending a warning shot to Trump loyalists in agencies.

“A lot of these career folks were put in there over the last eight years, they’re Obama supporters,” he said. “By and large, they hate Trump.”

Spokespeople for the Department of Energy did not respond to a request for comment.

To inoculate themselves, staffers at agencies have begun scrubbing their social media accounts for anything that could be perceived as controversial. They are also operating on the assumption that anything they say in the office could be leaked.

One agency aide said he had become particularly circumspect in meetings and was taking additional steps to protect himself, like keeping his office door closed during the day. He has used his off-time to catalogue the Twitter and Facebook postings of co-workers who he suspects harbor anti-Trump views and could be a threat.

“I do think there’s a concerted effort to disrupt us," the aide said. “We’re professional, we’re courteous. But it’s a one-way street. The [anti-Trump staffers] out to hurt the administration, and you have to handle yourself accordingly.”

In recent days, the administration has given credence to the idea that Obama loyalists are working against them. When Spicer was asked during a briefing last week about the idea that a deep state is working to undermine the president, he did not reject the premise.

“I don’t think it should come as any surprise that there are people that burrowed into government during eight years of the last administration, and may have believed in that agenda and what to continue to seek it,” he said.

Obama White House veterans are skeptical.

Tommy Vietor, who was an NSC spokesman during the Obama years, rejected the current administration’s deep state concerns as “overstated and ridiculous.”

“The idea that there are career officials who are holdovers who may not agree with Trump is neither new nor remarkable,” he said. “That’s not the deep state.”

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Op woensdag 15 maart 2017 13:13 schreef Re het volgende:

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nee dat was wel duidelijk, maar dit raakt de amerikaan wel het hardst denk ik

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Op woensdag 15 maart 2017 13:10 schreef Ludachrist het volgende:

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Punt is dat dat hele nummer 1 speerpunt van Trump niet waar te maken is, in ieder geval niet binnen de huidige Republikeinse partij.

Ik wil verder niet te veel spoileren voor de komende jaren, maar er zijn wel meer speerpunten van Trump die met dit euvel kampen.

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Op woensdag 15 maart 2017 13:51 schreef ExtraWaskracht het volgende:
Wel opvallend van Mattis: US Defence Secretary James Mattis says climate change is already destabilising the world

Althans, op zichzelf natuurlijk niet heel opvallend, maar in het licht van Trump en de rest van zijn administration wel.

twitter:

BraddJaffy twitterde op woensdag 15-03-2017 om 13:49:43 Paul Ryan moments ago on the GOP health plan: “This is something we wrote with President Trump...” https://t.co/NRDwJbuIL9 reageer retweet

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Op woensdag 15 maart 2017 13:23 schreef Monolith het volgende:

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Zoals ik voor de verkiezingen al zei, met Trump in het Witte Huis krijg je gewoon hoofdzakelijk doorsnee Republikeins beleid. Hij kan hier en daar wat blaffen met EOs, maar het daadwerkelijke werk vereist medewerking van het congres. En dan zie je al dat zo'n zorgplan redelijk haaks staat op alles wat hij toezegde in de campagne.

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Obamacare is a disaster. We are going to come up with a new plan ideally not an amended plan because right now if you look at the pages they're this high. We're gonna come up with a new plan that's going to be better health care for more people at a lesser cost.

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Op woensdag 15 maart 2017 10:47 schreef antiderivative het volgende:
dagelijks hoekje Trump personeelszaken

Nieuwe nominaties voor de Treasury Department :

Deputy Secretary of the Treasury:
James Donovan
* Partner and Managing Director of the Private Wealth Management division at Goldman Sachs
* Adjunct Professor at the University of Virginia School of Law
* Director at the Foundation for the National Institutes of Health
* Member of the Corporation Development Committee at MIT
* Founder of the MIT Scholarship Fund for incoming students from financially disadvantaged backgrounds
* B.Sc. in Chemical Engineering from the Massachusetts Institute of Technology (MIT), MBA from the Massachusetts Institute of Technology (MIT), J.D. from Harvard Law School

andere namen op de shortlist waren:

SPOILER

Om spoilers te kunnen lezen moet je zijn ingelogd. Je moet je daarvoor eerst gratis Registreren. Ook kun je spoilers niet lezen als je een ban hebt.

Undersecretary of the Treasury for Terrorism and Financial Intelligence:
Sigal Mandelker
* Partner, Attorney in Litigation Department and White Collar Defense & Investigations Group at Proskauer
* Fmr. Deputy Assistant Attorney General for Computer Crime and Intellectual Property Section, the Domestic Security Section, the Child Exploitation and Obscenity Section, and the Office of Special Investigations in the Criminal Division at the Department of Justice
* Fmr. Counsel to the Secretary of Homeland Security
* Fmr. Counsel to the Deputy Attorney General at the Department of Justice
* Fmr. Special Assistant on counter-terrorism and national security to the Assistant Attorney General for the Criminal Division of the Department of Justice
* Fmr. Assistant United States Attorney in the Southern District of New York
* Fmr. Deputy Committee Liaison to the U.S. House Majority Leader
* Fmr. Law Clerk at the U.S. Supreme Court and the and U.S. Court of Appeals for the Fifth Circuit
* B.A. from the University of Michigan, J.D. from the University of Pennsylvania Law School

Assistant Secretary of the Treasury for International Finance:
Dr. Adam Lerrick
* Visiting Scholar on International Economic and Financial issues, Sovereign debt restructuring and International Capital Markets at the American Enterprise Institute
* Fmr. Chaired Professor of Economics at the Tepper School of Business at Carnegie Mellon University
* Fmr. Chairman of Sovereign Debt Solutions Limited
* Fmr. Advisor to the majority leader of the House of Representatives
* Fmr. Advisor to the Joint Economic Committee of the US Congress
* Fmr. Senior Advisor to the Chair of the International Financial Institution Advisory Commission
* Fmr. Partner at Voute Coats Stuart & O'Grady
* Fmr. Investment Banker and Head of Capital Markets Product Development at Credit Suisse First Boston
* Fmr. Investment Banker and Head of Capital Markets International Product Development at Salomon Brothers
* A.B. in Economics from Princeton University, Mathematics at Ecole Alsacienne in Paris, France, Ph.D. in Economics from the Massachusetts Institute of Technology (MIT)

Assistant Secretary of the Treasury for Legislative Affairs:
Andrew Maloney
* VP for Government Affairs and Public Policy at Hess Corp.
* Fmr. CEO of Ogilvy Government Relations
* Fmr. Senior Advisor to the Republican National Committee
* Fmr. Administrative Assistant and Legislative Director for Republican House Majority Whip
* B.Sc. in Political Science from Randolph-Macon College, J.D. from Catholic University's Columbus School of Law

en wat eerder was er al:

Under Secretary of the Treasury for International Affairs:
David Malpass
* Founder and President of Encima Global Marco-economic Research
* Fmr. Chief Economist at Bear Stearns
* Fmr. Deputy Assistant Secretary of the Treasury for Developing Nations
* Fmr. Deputy Assistant Secretary of State for Latin American economic affairs
* Fmr. Staff Director of Congress's Joint Economic Committee
* Fmr. Senior Analyst for Taxes and Trade at the Senate Budget Committee
* Fmr. Director of The National Committee on United States-China Relations
* Fmr. Director of The Council of the Americas
* Fmr. Director of The Economic Club of New York
* Fmr. Accountant at Arthur Andersen
* B.A. in Physics from Colorado College, MBA from the University of Denver, Doc. Cand. in International Economics at Georgetown University

---------------
geinstalleerd:

Legislative Affairs Advisor at the White House Office of Management and Budget
Neal Patel
* Counsel & Deputy Communications Director at the Office of the Representative from Nevada
* Fmr. Counsel & Communications Director at the Office of the Representative from Louisiana
* Fmr. Associate at the Hudson Legal Group
* B.Sc. in Business Administration from the University of North Carolina-Chapel Hill, J.D. from Charleston School of Law

Special Assistant at the Department of the Treasury
Jon Perdue
* Senior Fellow for Strategic Research at the Center for a Secure Free Society
* Member of the Board of the Americas Forum
* Member of the Board of the Fundación Democracia y Mercado in Chile
* Fmr. International election observer with the Washington Senior Observer Group
* Fmr. Director of Latin America Programs at The Fund for American Studies
* Founding Director of the Institute for Leadership in the Americas
* Founder of Salud sin Fronteras, non-profit medical clinics in Latin America
* Fmr. VP of Business Development at Infectech Biotechnology
* Fmr. Education Policy Research Associate at the Mackinac Center for Public Policy
* Recipient of the the International Young Leader Award by Jovenes Lideres Internacional in Buenos Aires, Argentina
* Recipient of the the Global Leadership Award by the Bow Group in London, England
* B.Sc. in Finance from from the University of North Georgia

Special Assistant to the Secretary of Labor
Byron Anderson
* Vice President of Federal Affairs at Transamerica
* Fmr. Associate Administrator of the Risk Management Agency at the Department of Agriculture
* Fmr. Senior VP for Government Affairs at American General Corporation
* Fmr. Legislative Assistant at US Congress and Senate
* B.A. in Political Science and Government from the University of Pittsburgh, J.D. from Antioch School of Law

Advisor at the Department of Health and Human Services
Alexandra Campau
* Fmr. Health Policy Advisor and Counsel at the House Budget Committee
* Fmr. Healthcare Associate at Cozen O'Connor
* B.A. from Tufts University, MPP from the Georgetown University Public Policy Institute, J.D. from Georgetown University Law Center

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How the American Health Care Act Leaves Near-Elderly People Behind
The bill cuts the deficit and lowers premiums for the wealthy and healthy by squeezing the poor, old, and sick out of health-care markets and government-benefit programs.

The numbers are in, and they aren’t great for some of the sickest people in the country.

On Monday, the Congressional Budget Office scored the American Health Care Act, projecting that the new Republican health reform would make dramatic changes to the American health-care landscape. On the one hand, the law would cut the deficit by over $300 billion over 10 years and reduce average premiums after an initial two-year increase. On the other, the office projected that 24 million additional people would either lose health insurance or choose to go without it in the next decade.

Proportionally, the group of people that would see the most coverage losses under the AHCA is the population of people aged 50 and older. Although they’re more likely to have coverage in the first place, owing to more stable employment and a higher likelihood of public-insurance coverage, CBO estimates show the uninsured rate of people over 50 would skyrocket from around 13 percent currently to just under 30 percent by 2026. Included in that number are near-elderly adults with low incomes, a group that’s most likely among all non-Medicare enrollees to be sick, and one of the most expensive groups to cover in American health markets today.

Essentially, the AHCA works by abandoning a key goal of health reform altogether, and carving out some of the most expensive people to cover—while simply not offering them a more affordable coverage option. The CBO report suggests that while the Republican plan includes an age-adjusted tax credit to purchase health insurance and a fund for establishing reinsurance and cost-sharing programs for states’ riskiest potential enrollees, for low-income near-elderly people those cost-reductions would not be enough to offset the elimination of the Medicaid expansion, the establishment of per-capita caps on Medicaid, the loss of the ACA’s cost-and-income-based premium tax credits, and a new age-rating scheme that allows insurers to charge older people much more for coverage relative to younger people.

Table 4 of the CBO report shows just how this dynamic plays out:



Currently, a 64 year old person who makes 175 percent of the federal poverty line ($26,500—about a $13 per hour wage in a full-time job) but doesn’t receive insurance from an employer or public coverage pays around $1,700 per year on average in the exchanges for a health-insurance plan. But that person’s actual premiums are much higher because of age, although Obamacare hides that amount with a premium tax credit that adjusts with cost. Obamacare’s cost-sharing subsidies paid directly to insurers increase the average actuarial value of their coverage to 87 percent—meaning the plan covers 87 percent of health-care costs. Even under Obamacare, that final amount of $1,700 is steep for a person who makes less than the $28,000 average cost of living in the United States.

Under the AHCA, the new age-rating structure actually increases the total premium, while substantially decreasing the amount of federal assistance for paying that premium. It also eliminates Obamacare’s cost-sharing reductions and allows exchange plans to cover fewer services, meaning the same person under AHCA rules will have to pay almost nine times as much for a health-insurance plan that pays for only about two-thirds of health-care services. Put a different way, this hypothetical person would have to pay 55 percent of their pre-tax income just to have inferior insurance. It’s pretty safe to say that nobody in this situation in real life would actually be able to afford health care.

The specific circumstances of 64-year-olds in the exchanges may seem unrepresentative, but note the table shows premium increases for 40-year-olds as well. After age 40, able-bodied people unlucky enough to not have employer coverage will face a steadily worsening affordability curve. Also, as the AHCA defunds enhanced federal rates for the Medicaid expansion and incentivizes states to reduce Medicaid coverage and services, more and more near-elderly people who are close to, or below, the poverty line will lose public-coverage guarantees, and will be forced to choose between paying half or more of their yearly incomes or going without.

As my colleague Olga Khazan notes, even near-elderly people who have employer-based coverage are at risk, because without an employer mandate and with exchange tax credits, some employers will drop their insurance plans. And of course the employers with the greatest incentive to drop coverage will be those with the most expensive employees to cover—including near-elderly low-wage workers.

Republicans behind the AHCA have known about these challenges for a while, and have done their best to spin them as positives. House Speaker Paul Ryan has defended the plan against criticism of the CBO’s estimates of coverage losses, saying that “this report confirms that the American Health Care Act will lower premiums and improve access to quality, affordable care. CBO also finds that this legislation will provide massive tax relief, dramatically reduce the deficit, and make the most fundamental entitlement reform in more than a generation.” Ryan acknowledges the concerns about coverage losses, but recasts the losses as an expansion of choices that reduces cost.

It’s tempting to buy Ryan’s optimistic spin, or temper it by writing off huge premium spikes as uncharacteristic bits of collateral damage for an otherwise useful plan to control costs.The truth of the CBO report, however, is that the entire mechanism of the AHCA’s savings and premium reductions for healthier and wealthier people lies in making coverage too expensive for older, sicker people with less money. Most of the budgetary savings come from cuts to Medicaid funding and the replacement of the Obamacare premium tax credit with a much less generous credit, both of which will lead to less coverage among this older population. And most of the out-of-pocket savings for people who can afford coverage by 2026 rely on expensive enrollees just disappearing from health-care markets. Attrition among near-elderly people with low incomes isn’t an ancillary effect of Republican policy here; rather it is the engine that makes the rest of the bill work.

The irony is that the mid-aughts health-reform momentum that gave the country the Affordable Care Act put the plight of near-elderly people at its center. For decades, researchers have noted that one of the key turning points in a person’s health-care experience is when they turn 65 and are guaranteed Medicare coverage. For many people, that age arrives as an oasis in a health-care desert. In 2004, almost a quarter of all people between 55 and 64 who made less than 200 percent of the federal poverty line were uninsured, a statistic that led Urban Institute and Kaiser Family Foundation researchers to reach the following conclusion 13 years ago: "Extending coverage to this group could be done either through providing access to Medicare, or creating a new group purchasing arrangement. Expanding Medicaid to even subgroups of the near elderly seems less feasible at this time given that the near elderly are a high-cost population and states are struggling to maintain their programs’ coverage in the face of unparalleled fiscal crises. Alternatively, tax credits for the purchase of non-group health insurance are unlikely to help many of the near elderly unless the value of the credit is substantially adjusted for age or health status."

Without employing some of the options outlined in that report—the Affordable Care Act focused on Medicaid expansion and an adjustable tax credit—the AHCA will likely increase mortality among near-elderly people. Researchers have found that people between 55 and 64 who are uninsured are significantly more likely to die than their insured peers. That much should be obvious, as 65 is a somewhat arbitrary age for health purposes, and often the advance of age-linked disorders comes earlier. The median age of several cancer diagnoses—especially for people of color—often comes in the near-elderly range, and heart disease, diabetes, and hypertension often first manifest themselves during this range. And as the opioid epidemic grips the country, the risk of death from overdose is increasingly rapidly among the near-elderly.

Again, those risks are not simply collateral damage or unintended consequences of the AHCA; they are the ultimate endpoint of all its constituent policies. Republicans could fix these consequences, but that might mean risking some of the more positive reports of effects on the budget and premiums, and in essence really creating the “Obamacare lite” kind of program so dreaded around the Capitol. And if whispers of Republican plans to raise the Medicare age or reform that program have any amount of truth to them, the AHCA could land as the first blow of a one-two punch. It would deeply weaken health-care coverage and health for near-elderly people even as future policies delay the promise of guaranteed care past the age of 65. The end result of that system would be—simply—more deaths.

Politically, the AHCA faces risks because it tends to negatively affect the kinds of people who voted for President Trump and the new Republican majorities in the first place: rural, older Americans with higher health costs and more health problems. But beyond the politics, if any American health reform should be judged on how much it betters the health of the sickest people and how much it lowers the costs of the most expensive people, the AHCA fails on just about all the merits.

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Op woensdag 15 maart 2017 17:25 schreef Knipoogje het volgende:
Worden eindelijk zijn tax returns geleaked...

Zijn het 2 pagina's
Uit 2005

Waarschijnlijk heeft ie ze zelf gelekt, zegt de journalist die ze kreeg

Anders was heel 2005 wel gelekt, of latere jaren.
Die Donald ook

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Op woensdag 15 maart 2017 17:51 schreef Kijkertje het volgende:

[..]

Dat was ook mijn eerste gedachte

quote:

Op woensdag 15 maart 2017 18:21 schreef Knipoogje het volgende:

[..]

NOS journaal zegt gewoon letterlijk 'Trump heeft zijn belastingen uit 2005 vrijgegeven '. Faalhazen 😂

Of ze hebben gelijk 😄