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This NYT editorial on June 26, 2015, says the arguments of the plaintiffs before the U.S. Supreme Court for the Affordable Care Act were specious, based as they were on a reading of four words phrase in the Act leaving ambiguity about what exchanges were covered by health care subsidies. It says the plaintiffs with strong emotions on the subject decided to pull their argument out of thin air. That only one Justice acted as the swing vote, Justice Anthony Kennedy, shows the Supreme Court like the rest of the nation is not above emotion- Justice Scalia called the 6-4 decision based on "jiggery-pokery" and not "honest jurisprudence"- and needed Chief Justice Roberts to provide the larger view in 2015 as he did in 2012.

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The U.S. Senate passes a motion that allows the chamber to proceed with a debate on a health care bill. The motion passed 51-50 with Vice President Mike Pence casting the deciding vote. Republican Senators Collins and Murkowski voted against the motion. This report in the WSJ says this sets in motion a process in which debate will take place and amendments will be made. It is not clear what shape the bill will take. Under the process used only a simple majority is needed in the Senate, yet this allows for many amendments to be made.  Only hours after this motion passed by one vote, a bill replacing major parts of the Affordable Care Act failed to pass 57 votes against and 43 in favor. Senator John McCain who arrived in Washington from Arizona following brain tumor surgery, delivered strong criticism of the way the Republican healthcare bill was rushed through allowing very little debate. Experts have commented on the way the bill was rushed through with a thin majority for passage, with very little debate, first by Democrats in 2009 and now in the House by Republicans. With the same pattern now followed in the Senate by Mitch McConnell, the Republican leader in the Senate. A backup bill would remove just the individual and employer mandates and a tax on medical devices- the elements Republicans agree on, if no majority can be put together for the healthcare bill. ...

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US is shutting down 10% of airport traffic because of government shutdown in November 2025. Democrats are holding up the passing of the new budget till Obama's Affordable Care Act healthcare subsidies for low income Americans are restored. Republicans who control both houses of Congress are unwilling to restore these subsidies saying it will cost $350 billion over 10 years. Editorials in the Washington Post in November see Obama's Affordable Care Act as a bandaid approach for a broken healthcare system in the US. Public opinion in the US supports this assessment. Trade unions and labor have called for an end to the government shutdown. Democrats are acting as though the party is for low income Americans and labor yet this is not the party of FDR who fought hard for labor over vested interests, Democrats today are the vested interests whether from Tech which is taking a disproportionate share of the Nation's wealth and resources and pouring it into projects that do not reduce the cost of living or rebuild crumbling obsolete infrastructure, or from Banks which were not sanctioned for their part in the 2009 financial crisis, or from healthcare interests that oppose restructuring the entire healthcare system for fairness in insurance, pharmaceutical pricing and wellness. Republicans are making an effort to displace Democrats in the role of FDR and Lincoln under newcomer DJT who rejects both the incompetent Bush (Republican) and Obama (Democrat) administrations that wasted money and resources in foreign wars while overlooking America's many challenges and strengthening foreign powers including China, while weakening the US. The US government is cutting airport traffic to relieve unpaid traffic controllers. Also at risk are SNAP benefits which are for the loew income Americans. The US president is asking the Senate to drop the filibuster rule which requires 60 votes in the Senate for the biudget to pass it and pass it by majority vote. The Senate Majority Leader Republican Thune wants to keep the filibuster because it acts as a brake for hasty legislation passed by whichever party is in government. ...

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There are about 181,000 homeless in California one third of the total in the US. This $6.4 billion bond issuance for borrowing funds was approved by just over 50% of the vote. It will go to create more affordable housing so badly needed in California's out of control housing prices. People tended to think nothing works and out of apathy did not vote. But the scale of the problem required effort at the state level or federal level with funding in the tens of billions of dollars for affordable housing. This is the first time that this has happened even though Silicon Valley and capital markets have wasted hundreds of billions of dollars in dubious companies and projects that have contributed little to the standard of living and ease of living of the American people, including essential infrastructure and health, education services. The dilapidated and crumbling infrastructure, of subways, streets and bridges in New York City is another aspect of the same problem of serious, serious lack of affordable housing in California. It also creates the kind of class divisions in society that FDR-Truman-Kennedy sought to remove since the 1930's. ...

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Both candidates Mr. Trump and Mr Biden put forward their positions on immigration, the coronavirus response, the economy, and racial justice, in the final debate of 2020. This was a calmer debate with policy details and the candidates delivered their points without the sharp attacks of the earlier debates. At some points in the debate the discussion turned to Mr. Biden and dealings of son Hunter Biden with a Ukrainian company. Mr. Biden raised the issue of Mr. Trump's tax returns not being disclosed. The Affordable Care Act and coverage for Americans lacking health care, immigration and the wall with Mexico, and the oil industry were other issues in the debate.

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This editorial in the WSJ describes the sharp increase in premiums under the Affordable Care Act of president Obama. The average premium increase is about 24.2% according to a Barclay's analysis, and as high as 43.9% in states such as Illinois. Bill Clinton calls it the craziest thing with small business affected, and some premiums doubling. Of the 17 million people in the individual market eight million buy without subsidies. One in five enrollees cannot qualify for subsidies. Democrats say subsidies are too small. Hillary Clinton has proposed to have a Medicare "buy-in" for people ages 55-65, and a "public option" government run plan. Republicans want to rewrite the law. But this depends on which party wins the Senate, with the election in Missouri giving Democrats an opportunity to maintain a Senate majority.

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NY Times analysis shows upper and middle income groups support 33 year old Zohran Mamdani,  black and Hispanic residents support Cuomo for NYC Mayor. Mamdani has a good ground presence with 50,000 volunteers knocking on 1.6 million doors in an unprecedented effort in one American city as it became less and less affordable (WSJ). Paradoxically large numbers of higher income resident and middle income residents favored Mamdani over Cuomo, and Cuomo did better in black and minority neighborhoods. Mamdani promised better housing, freezing stabilized housing rents and going after landlords who do not fix rental properties, free buses, and city run lower cost grocery stores, free child care. For the funding Mamdani says $5 billion by making corporate tax 11.5% similar to New Jersey, and by a wealth tax of 2% on incomes over $1 million (which at $20,000 would not affect their standard of living), as the property owners supported Mamdani. Mamdani is a immigrant who came to America from Kampala, Uganda at the age of 7 with Indian parents. His father taught at Columbia University, Mamdani attended Bowdoin College in Maine. ...

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Congressional Budget Office analysis that shows 14 million more people uninsured in 2018 under the Republican House health care plan, this increases to 24 million by 2026.

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Questions being addressed to get health care to the uninsured and to all Americans at an affordable level.

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Summit County median rents in the towns of Breckenridge, Dillon, Frisco, in the Rocky Mountains near Denver, Colorado now exceed $4000. This pushes low paid workers making $36,000 a year serving tourist visitors to the state further away to longer commutes along stretches of rural highway. This NYT report looks at the different lives in the state with 70% of homes vacant or rented out in Summit County as second homes, and the two different worlds based on family wealth and the workers serving these communities. The lack of affordable housing near resorts. Breckenridge and other communities in the Rocky mountains are giving homeowners thousands of dollars to add deed restrictions to limit renting to local residents.

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This NYT editorial points out that the cuts to Medicaid amount to taking out a fourth of its budget and are sure to hurt low income Americans. The cuts are about $880 billion over 10 years for Medicaid. The $300 billion less in subsidies over ten years is likely to hurt the elderly. It also points out that removing the individual mandate will make it harder to reduce premiums as fewer healthy adults offset the costs of sick patients.

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India is piuoneering and innovating in the field of lowcost health care. The Indians say state of the art is not what they aspire to but world class, which means coming up with solutions in tech and health care that are affordable in a poor country.

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WSJ reporter Monica Langley provides a glimpse behind the scenes of how Donald Trump comes up with his attacks on rivals, and statements on immigration, terrorism, refugees. Trump pays close attention to what is riling voters on any particular week, but other rival politicians are not willing to say. He looks for what resonates with the public, and in today's environment where politicians are cautious, careful and plodding, this strategy works. Donald usually puts down a few points on his private plane, looks at reports from campaign staff, yet makes all the decisions himself on what and how to say it. His memory helps, he says. And he has a flair for words, sounding uncouth at times, but yet choosing words carefully enough to sound reasoanble to his audience. In Jan 2016 this approach has worked for Trump in the Iowa and New Hampshire primaries, stalling progress by rival Ted Cruz, and holding back other rivals. Yet this approach has its risks as the primary season progresses. One of the changes in the Republican party politics in 2016 is the emergence of two candidates Donald Trump representing the white working class, and Ted Cruz representing evangelicals, who are both strident and willing to take strong positions on issues in striking contrast to leading Democrats. Trump on China, immigration, refugees, and Cruz on taxes, cultural issues for evangelicals, IRS, Affordable Health Care Act, and both candidates on terrorism. ...

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Samuelson shows why the Ryan Plan needs serious consideration because it brings in competition from the private sector to control medical costs. The Obama plan does not reduce Medicare costs he says because it merely transfers the costs to mandated Affordable Care Act spending. And the Independent Advisory Board of 15 experts given the job of reducing Medicare spending if it exceeds a certain amount is ineffective- it cannot increase patient cost-sharing, restrict benefits or modify eligibility or cut spending by more than 1.5% in any particular year according to the Kaiser Family Foundation. Important points to remember about health care are: 1) sustainable Medicare for current and future generations can only be on the basis of sound finances 2) sound finances mean first and foremost controlling health care costs 3) private sector competition is the better way to control health care costs in todays environment where cost reduction needs to be large enough to make Medicare sustainable especially when competition shifts health care delivery away from the cost increasing fee-for-service system 5) Obama Affordable Health Care Act does little to change the costly fee for service system and the basic mechanism of cost escalation in U.S. health care. The Ryan plan's voucher option injects this dose of competition into the system and only for those who choose this option, it was also drafted with the help of Democrat Ron Wyden, and is cautious because it does'nt start this till 2023- giving time for discussion and improvement, and therefore a constructive effort to look at serious ways to control uncontrolled fee-for-service spending....

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The major provisions of the Republican House healthcare bill that passed by a vote of 217-213 are- 1. To help people buy insurance coverage the bill offers $2000 to $4000 a year, upto $14,000 a year in credits based mainly on age, reducing them for families making $150,000, individuals making $75,000. 2.  Under the Affordable Care Act insurers cannot charge older Americans more than 3 times for same coverage they offer to younger people, the new bill makes this 5 times. This would increase premiums for older Americans and reduce it for younger Americans. This is the most controversial part of the bill. Older Americans supported the Republican party in the presidential election. 3. The new bill ends Medicaid as an open ended entitlement and places this on a budget with cuts of $880 billion over 10 years. 4. To mollify conservative Republicans a provision allows state to opt out some provisions of the ACA that requires minimum benefits such as maternity care and emergency services. It retains coverage for pre-existing conditions to mollify moderate Republicans. The bill provides states with $138 billion over 10 years to subsidize premiums, provide coverage for pre-existing conditions, mental healthcare and drug addiction. 5. The bill removes the taxes imposed under the Affordable Care Act (ACA) on high income people of about $300 billion over 10 years by repealing a payroll tax increase and tax on investment income. This bill and the ACA offer 2 competing visions on healthcare, both bills passed only by a margin of 4-5 votes in the House. The ACA overlooked the impact on premiums causing discontent among middle income Americans. The new bill lets premiums rise for older Americans in order to keep premiums down for other Americans. This shows the many tradeoffs involved and choices being made, and the lack of a consensus on the issue of healthcare in the U.S., becoming a highly politicized issue instead of the way it is treated in western Europe.     ...

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With the rushed approach adopted by the Trump administration not enough consideration was given to winning support in the House from 25 conservatives in the Freedom Caucus. Without their support the bill cannot be passed in the House of Representatives. The fight also includes one over what are essential health benefits including whether  maternity care would be included. As a result some moderate Republicans are also expressing opposition on the grounds that less people will be covered and fewer benefits will be provided under the Republican House plan called AHCA. President Trump has not involved himself in the details, and the bill comes very early in the first 100 days, leading to the perception that health care has become a partisan conflict without really grappling with the problems of high cost of health care and creating a solution that all can support. Democrats are seen as having made the same error early in Obama administration's first term. President Trump sees this as a much needed win with a drop in his approval ratings, making this even less of an effort to come out with a good plan.  ...