Friday, July 28, 2017

The Russians Were Involved. But It Wasn’t About Collusion.

Russians are fond of a proverb, “besplatniy sir biyvaet tol’ko v mishelovke”: “Free cheese can be found only in a mousetrap.”

Having long considered the United States its main enemy, the Kremlin deploys a full quiver of intelligence weapons against America and its national security agencies, political parties and defense contractors. Its intelligence services, though best known for clandestine operations to recruit spies, also run covert “influence operations” that often use disinformation to try to affect decisions or events in rival countries. A central tool of those operations is “kompromat,” “compromising material”: things of seemingly great value that are dangled, at what appears to be no cost, before unwitting targets. This is the “free cheese” that ensnares victims in a trap.

I know all this from having spent much of my 30-year government career, including with the C.I.A., observing Soviet, and then Russian, intelligence operations. I came to realize that President Vladimir Putin, who spent his formative years in the K.G.B., the Soviet Union’s main intelligence agency, and served as director of its successor agency, the F.S.B., wants, as much as anything, to destabilize the American political process. For all his talk of desiring friendly relations, Mr. Putin favors a state of animosity between our two nations. By characterizing the United States and NATO as Russia’s enemies, he can attack within his own borders what threatens him the most — the ideals of liberty, freedom and democracy, of which the United States has been a defender.

This background is necessary for understanding the real meaning of the June 2016 meeting in Trump Tower between Kremlin-connected Russians and three representatives of Donald Trump’s campaign: his son, Donald Trump Jr., his son-in-law, Jared Kushner, and Paul Manafort, then the campaign manager. The evidence that has emerged from this meeting strongly suggests that this was not an effort to establish a secure back channel for collusion between Moscow and the Trump campaign but an influence operation with one simple objective: to undermine the presidential election.

No conclusive proof has yet emerged that the Kremlin arranged this meeting, and the Russians involved have asserted they were not working for the Putin government. Mr. Kushner himself told Senate investigators that there was no collusion between the Trump campaign and Moscow. But to me, the clearest evidence that this was a Russian influence operation is the trail of bread crumbs the Kremlin seemed to have deliberately left leading from Trump Tower to the Kremlin. This operation was meant to be discovered.

I can’t say how news of the meeting broke, but once it did, Mr. Putin achieved one of his goals: throwing the American government into greater turmoil amid the frenzied media coverage, escalating F.B.I. and congressional investigations and intensified political conflict. And with the revelation that Russia was behind the meddling, Mr. Putin achieved another objective: to allow Russia, despite its economic and military inferiority, to claim that it could rival the United States on the global playing field. He could do all this while denying, with a wink and a nod, any involvement.

If this all sounds far-fetched, consider that the Russians have a long history of these kinds of operations, including in the United States. In the 1968 presidential campaign, Soviet Ambassador Anatoly Dobrynin unsuccessfully offered financial assistance to the Democratic candidate, Hubert Humphrey, according to a K.G.B. archivist, Vasili Mitrokhin. Mr. Mitrokhin also uncovered a Soviet intelligence campaign to spread vicious attacks in 1976 against Senator Henry Jackson, a Democratic presidential candidate known for his anti-Soviet views. Russia’s active-measures operations slowed during the 1990s under President Boris Yeltsin, but Mr. Putin has resurrected the art of covert influence often in conjunction with cyberwarfare, particularly against Georgia, Ukraine and the United States.

The most effective method to combat Russia’s intrusions into our political process is to be clear, transparent and honest with ourselves about how the Kremlin operates and what it hopes to achieve. The Trump campaign did not need to collude with the Kremlin for Russia’s cyber and covert influence campaign to be considered a serious breach of our electoral process, and hence our national security. The Trump administration and both parties in Congress need to speak with one voice against Russia’s attack on our democratic institutions. If they do not, Mr. Putin will have won.

Continue reading the main story

Fate of Ancient Canaanites Seen in DNA Analysis: They Survived

Remnants from an ancient Canaanite found in the Sidon excavation site. A genetic analysis found that the Canaanites survived a divine call for their extinction and that their descendants live in Lebanon. Credit Claude Doumet-Serhal/Sidon Excavation

There is a story in the Hebrew Bible that tells of God’s call for the annihilation of the Canaanites, a people who lived in what are now Jordan, Lebanon, Syria, Israel and the Palestinian territories thousands of years ago.

“You shall not leave alive anything that breathes,” God said in the passage. “But you shall utterly destroy them.”

But a genetic analysis published on Thursday has found that the ancient population survived that divine call for their extinction, and their descendants live in modern Lebanon.

Dr. Tyler-Smith and an international team of geneticists and archaeologists recovered ancient DNA from bones belonging to five Canaanites retrieved from an excavation site in Sidon, Lebanon, that were 3,650 to 3,750 years old. The team then compared the ancient DNA with the genomes of 99 living people from Lebanon that the group had sequenced. It found that the modern Lebanese people shared about 93 percent of their ancestry with the Bronze Age Sidon samples.

The Sidon excavation site in Lebanon. Archaeologists retrieved bones from five Canaanites that were 3,650 to 3,750 years old. Credit Claude Doumet-Serhal/Sidon Excavation

The team published its results in The American Journal of Human Genetics.

“The conclusion is clear,” said Iosif Lazaridis, a geneticist at Harvard who was not involved in the study. “Based on this study it turns out that people who lived in Lebanon almost 4,000 years ago were quite similar to people who lived there today, to the modern Lebanese.”

Marc Haber, a postdoctoral fellow at the Wellcome Trust Sanger Institute in England and lead author on the study, said that compared with other Bronze Age civilizations, not much is known about the Canaanites.

“We know about ancient Egyptians and ancient Greeks, but we know very little about the ancient Canaanites because their records didn’t survive,” he said. Their writings may have been kept on papyrus, which did not stand the test of time as clay did. What is known about the Canaanites is that they lived and traded along the eastern coast of the present-day Mediterranean, a region that was known as the Levant.

“What we see is that since the Bronze Age, this ancestry, or the genetics of the people there, didn’t change much,” Dr. Haber said. “It changed a little, but it didn’t change much and that is what surprised me.”

At first the team was not sure if it would be able to retrieve DNA from the ancient skeletons, which were recovered from the hot and humid excavation site within the last 19 years. Dr. Haber had chosen more than two dozen bones from the site that looked promising and had them investigated for genetic material. It turned out that only five contained ancient DNA. All of those came from the petrous part of the temporal bone, which is the tough part of the skull behind the ear, from five different individuals.

Ancient DNA recovered from bones in the excavation site was sequenced for a new study. Credit Claude Doumet-Serhal/Sidon Excavation

After extracting that DNA, the team members compared it with a database that contained genetic information from hundreds of human populations. They then further compared their results with the genomes of the modern-day Lebanese population sample, which revealed what happened to the ancient Canaanite population.

He said researchers thought that migrations, conquests and the intermixing of Eurasian people — like the Assyrians, Persians or Macedonians — with the Canaanites 3,800 to 2,200 years ago might have contributed to the slight genetic changes seen in modern Lebanese populations. Still, the Lebanese retain most of their ancestral DNA from the Canaanites.

“It confirms the continuity of occupation and rooted tradition we have seen on-site, which was occupied from the 4th millennium B.C. right to the Crusader period,” Claude Doumet-Serhal, an archaeologist and director of the Sidon Excavation who is a co-author on the paper, said in an email.

She said that the archaeologists had found about 160 burials to date at their excavation site, which is in the heart of modern Sidon. They include graves and burials where a person was placed in a large jar, and they date to between 1900 and 1550 B.C. The genetic results further support the archaeological findings.

“We were delighted by the findings,” Dr. Doumet-Serhal said. “We are looking at the Canaanite society through 160 burials and at the same time uncovering a common past for all the people of Lebanon, whatever religion they belong to.”

Senate Rejects Slimmed-Down Obamacare Repeal as McCain Votes No

WASHINGTON — The Senate in the early hours of Friday morning rejected a new, scaled-down Republican plan to repeal parts of the Affordable Care Act, derailing the Republicans’ seven-year campaign to dismantle President Barack Obama’s signature health care law and dealing a huge political setback to President Trump.

Senator John McCain of Arizona, who just this week returned to the Senate after receiving a diagnosis of brain cancer, cast the decisive vote to defeat the proposal, joining two other Republicans, Susan Collins of Maine and Lisa Murkowski of Alaska, in opposing it.

The 49-to-51 vote was also a humiliating setback for the Senate majority leader, Mitch McConnell of Kentucky, who has nurtured his reputation as a master tactician and spent the last three months trying to devise a repeal bill that could win support from members of his caucus.

As the clock ticked toward the final vote, which took place around 1:30 a.m., suspense built on the Senate floor. Mr. McCain was engaged in a lengthy, animated conversation with Vice President Mike Pence, who had come to the Capitol expecting to cast the tiebreaking vote for the bill. A few minutes later, when Mr. McCain ambled over to the Democratic side of the chamber, he was embraced by Senator Dianne Feinstein, Democrat of California. A little later Senator Amy Klobuchar, Democrat of Minnesota, put her arm around Mr. McCain.

The roll had yet to be called, but the body language suggested that the Trump administration had failed in its effort to flip the Arizona senator whom President Trump hailed on Tuesday as an “American hero.’’

After the tally was final, Mr. Trump tweeted:

The truncated Republican plan that ultimately fell was far less than what Republicans once envisioned. Republican leaders, unable to overcome complaints from both moderate and conservative members of their caucus, said the skeletal plan was just a vehicle to permit negotiations with the House, which passed a much more ambitious repeal bill in early May.

The “skinny repeal” bill, as it became known at the Capitol this week, would still have had broad effects on health care. The bill would have increased the number of people who are uninsured by 15 million next year compared with current law, according to the nonpartisan Congressional Budget Office. Premiums for people buying insurance on their own would have increased roughly 20 percent, the budget office said.

Senator John McCain of Arizona leaving the Senate chamber early Friday after casting the vote that ensured the measure’s defeat. Credit Gabriella Demczuk for The New York Times

Unlike previous setbacks, Friday morning’s health care defeat had the ring of finality. After the result was announced, the Senate quickly moved on to routine business. Mr. McConnell canceled a session scheduled for Friday and announced that the Senate would take up the nomination of a federal circuit judge on Monday afternoon.

With so many senators in both parties railing against the fast-track procedures that Republican leaders used, a return to health care seemed certain to go through the committees, where bipartisanship and deliberation are more likely.

“We are not celebrating,” said the Senate Democratic leader, Chuck Schumer of New York. “We are relieved that millions and millions of people who would have been so drastically hurt by the three proposals put forward will at least retain their health care, be able to deal with pre-existing conditions.”

Mr. McConnell said he was proud of his vote to start unwinding the Affordable Care Act. “What we tried to accomplish for the American people was the right thing for the country,” Mr. McConnell said. “And our only regret tonight, our only regret, is that we didn’t achieve what we had hoped to accomplish.”

Vice President Mike Pence arriving at the Capitol late Thursday. He was not able to save the measure with a tiebreaking vote. Credit Zach Gibson/Getty Images

The new, eight-page Senate bill, called the Health Care Freedom Act, was unveiled just hours before the vote. It would have ended the requirement that most people have health coverage, known as the individual mandate. But it would not have put in place other incentives for people to obtain coverage — a situation that insurers say would leave them with a pool of sicker, costlier customers. It would also have ended the requirement that large employers offer coverage to their workers.

The “skinny repeal” would have delayed a tax on medical devices. It would also have cut off federal funds for Planned Parenthood for one year and increased federal grants to community health centers. And it would have increased the limit on contributions to tax-favored health savings accounts.

Before rolling out the new legislation, Senate leaders had to deal with a rebellion from Republican senators who demanded ironclad assurances that the legislation would never become law.

Yes No
Republicans 49 3
Democrats 0 48
Total 49 51

Mr. McCain and Senators Lindsey Graham of South Carolina and Ron Johnson of Wisconsin insisted that House leaders promise that the bill would not be enacted.

“I’m not going to vote for a bill that is terrible policy and horrible politics just because we have to get something done,” Mr. Graham said at a news conference, calling the stripped-down bill a “disaster” and a “fraud” as a replacement for the health law.

Mr. Graham eventually voted for the bill after receiving an assurance from the House speaker, Paul D. Ryan, that the two chambers would negotiate their differences if the Senate passed the legislation.

“If moving forward requires a conference committee, that is something the House is willing to do,” Mr. Ryan said in a statement. “The reality, however, is that repealing and replacing Obamacare still ultimately requires the Senate to produce 51 votes for an actual plan.”

From left, Senators Lindsey Graham of South Carolina, Ron Johnson of Wisconsin and John McCain of Arizona, all Republicans, spoke about the “skinny repeal” bill on Thursday. Credit Gabriella Demczuk for The New York Times

But Mr. Ryan left open the possibility that if a compromise measure had failed in the Senate, the House could still pass the stripped-down Senate health bill. That helped push Mr. McCain to “no.”

Republican senators found themselves in the strange position of hoping their bill would never be approved by the House.

Two influential House conservatives made clear that they did not want to simply pass the Senate bill. Representative Mark Walker, Republican of North Carolina and the chairman of the conservative Republican Study Committee, said he favored a conference, calling the bill “ugly to the bone.”

OPEN Document

Document: Read the Senate ‘Skinny Repeal’ Bill

And Representative Mark Meadows, Republican of North Carolina and the chairman of the hard-line Freedom Caucus, said that for many conservatives, it would be a “nonstarter” to send President Trump a bill that has “gotten so skinny that it doesn’t resemble a repeal.”

But senators had at least some reason to be nervous. The House majority leader, Kevin McCarthy of California, notified House members that “pending Senate action on health care,” the House schedule could change, and that “all members should remain flexible in their travel plans over the next few days.” That did not sound like a man preparing for protracted House-Senate negotiations.

Representative Chris Collins, Republican of New York and a key ally of Mr. Trump, said the stripped-down bill would be “better than nothing” if it became apparent that the Senate did not have the votes for a more ambitious bill.

“It becomes a binary choice,” he said. “If it’s this or nothing, who wants to go home and say I did nothing?”

Mr. Graham, right, called the Senate bill a “disaster,” and Mr. Johnson, left, said it “doesn’t even come close to honoring our promise of repealing Obamacare.” Credit Gabriella Demczuk for The New York Times

“No one can guarantee anything,” he added, sending a message to senators wanting assurances.

Even some senators who voted for the bill Friday conceded that its enactment could have been disastrous. It would have repealed the mandate that most Americans have insurance, without another mechanism to push Americans to maintain insurance coverage. Under those circumstances, healthy people could wait to buy insurance until they are sick. The insurance markets would become dominated by the chronically ill, and premiums would soar, insurers warned.

America’s Health Insurance Plans, the Blue Cross Blue Shield Association and the American Medical Association all expressed similar concerns.
On the other side, the Trump administration twisted arms. Mr. Trump directed Interior Secretary Ryan Zinke to call Ms. Murkowski, the Alaska senator, to remind her of issues affecting her state that are controlled by the Interior Department, according to people familiar with the call, who requested anonymity because they were not authorized to speak to the press.

Ms. Murkowski confirmed to reporters that she had received a call from Mr. Zinke, but she declined to describe the details. However, people familiar with the call described her reaction to it as “furious.”

Wednesday, July 26, 2017

Allies Warn Trump of Conservative Revolt Unless He Backs Off Sessions

WASHINGTON — For a week, some of President Trump’s top aides have tried to talk him down from his public campaign against Attorney General Jeff Sessions. Not only was it exposing tensions within the administration, it was stirring consternation with the conservative base and setting off a major revolt among Senate Republicans incensed over the treatment of a former colleague.

By Wednesday afternoon, just hours after the president’s latest broadside against the attorney general, several officials said they thought the storm had passed: Mr. Trump would let Mr. Sessions stay in office, at least for now. If he was going to fire the attorney general, they said, he would have already done so. But his anger was deep, they added, and nothing was certain when it came to the volatile president.

Among those urging Mr. Trump to spare Mr. Sessions have been Reince Priebus, the White House chief of staff; Stephen K. Bannon, the president’s chief strategist; and Donald F. McGahn II, the White House counsel, according to officials who asked not to be named describing internal deliberations. Sharing the president’s frustration have been people in his family, some of whom have come under scrutiny in the Russia investigation.

For the White House, the attacks on the attorney general have touched off a serious problem on Capitol Hill when it did not need any others. Senate Republicans who almost never link arms in unison against a president from their party formed a cordon around Mr. Sessions, making it clear that they neither concurred with nor would tolerate Mr. Trump’s repeated threats to the attorney general’s tenure. Senate leaders made clear they would block Mr. Trump from replacing Mr. Sessions if he tried to do so during the coming recess.
“I would hope the public discussion of that would end immediately,” said Senator Bob Corker, Republican of Tennessee, who said he delivered the message directly to the White House. Those sentiments were echoed publicly by at least a dozen Republican senators, including their top two leaders, Mitch McConnell of Kentucky, the majority leader, and John Cornyn of Texas. Mr. Sessions’s removal, Mr. Cornyn said, would be “incredibly disruptive.”

The persistent presidential barrage against Mr. Sessions “says more about President Trump than it does Attorney General Sessions, and to me, it’s a sign of great weakness on the part of President Trump,” said Senator Lindsey Graham, Republican of South Carolina. “I hope Jeff Sessions doesn’t give in to this humiliation campaign.”

The president’s pique at Mr. Sessions stems from the attorney general’s decision to step aside from overseeing the investigation into Russia’s interference in last year’s election and any possible ties to Mr. Trump’s campaign team because he had been a top campaign surrogate and met with the Russian ambassador himself. After Mr. Sessions’s recusal, his deputy appointed a special counsel, Robert S. Mueller III, to lead the investigation. A new attorney general could in theory fire Mr. Mueller.

Mr. Trump has not spoken with Mr. Sessions since the president’s public complaints began a week ago. The attorney general was in the White House on Wednesday for a meeting of cabinet-level officials but did not see the president, officials said. Even as he was visiting, Mr. Trump launched a new fusillade against him.

“Why didn’t A.G. Sessions replace Acting FBI Director Andrew McCabe, a Comey friend who was in charge of Clinton investigation but got big dollars ($700,000) for his wife’s political run from Hillary Clinton and her representatives,” Mr. Trump wrote on Twitter. “Drain the Swamp!”

Andrew G. McCabe, a career law enforcement official, took over the F.B.I. after Mr. Trump fired James B. Comey, the bureau director, in May. Mr. McCabe’s wife, Jill, received contributions in 2015 for a State Senate run in Virginia from the state Democratic Party and a political action committee affiliated with Gov. Terry McAuliffe, who is close friends with Hillary and Bill Clinton. Ms. McCabe lost the race.

By the afternoon, however, the White House seemed to have subtly moderated the tone, shifting to a more moving-forward message.

“He’s obviously disappointed but also wants the attorney general to continue to focus on the things that the attorney general does,” Sarah Huckabee Sanders, the White House press secretary, said, referring to the president. “He wants him to lead the Department of Justice. He wants to do that strongly. He wants him to focus on things like immigration, leaks and a number of other issues, and I think that’s what his focus is at this point.”

Asked why the president would criticize Mr. Sessions without firing him or asking for his resignation, Ms. Sanders said, “Look, you can be disappointed in someone but still want them to continue to do their job.”
Mr. Sessions, who has remained silent since the weekend, seemed to get the message. Anthony Scaramucci, the new White House communications director, said the attorney general was close to announcing an investigation into the intelligence leaks that have so angered Mr. Trump.

“I think he’s got a plan that he’s put together, and at some point, I don’t know if it’d be today, tomorrow or next week, he’ll announce that plan,” Mr. Scaramucci said on Fox News.

Mr. Trump began his sustained attack on Mr. Sessions in an interview with The New York Times a week ago. While it was known that he was angry about the recusal, Mr. Sessions made the decision months ago, and it remained unclear why it suddenly came up again. Some advisers said they believed that Mr. Trump’s anger grew as the Russia investigation touched more on his family, and he blamed Mr. Sessions for not protecting him.

The Times reported that Donald Trump Jr. met with Russians during the campaign as part of what he was told was an effort by the Russian government to help his father’s candidacy. Jared Kushner, Mr. Trump’s son-in-law and now a senior White House adviser, spent two days this week being interviewed in private about his contacts with Russians by the Senate and House intelligence committees.

Although Mr. Trump often publicly criticizes people in his own circle, Mr. Sessions is someone with a powerful base of support in the Senate. This is partly because Mr. Sessions, a former senator from Alabama, is a well-liked former colleague with whom many senators remain close. He endured a brutal confirmation in which many of them were forced to vigorously defend him at the behest of Mr. Trump.

But Republicans also fear that the firing of an attorney general in the middle of the Russia investigations would send the country into a political and constitutional tailspin, making it extremely difficult to confirm anyone Mr. Trump nominated to replace him. And they argued that Mr. Trump was jeopardizing his own agenda.

“If you look at so much of what the president of the United States wants to accomplish on his agenda, Sessions is critical to that,” Senator Charles E. Grassley of Iowa, chairman of the Senate Judiciary Committee, which would consider any replacement, said in a television interview this week. “And Sessions should remain in office.”

Senator James M. Inhofe of Oklahoma agreed, even as he noted that he supports Mr. Trump. “The only area where I disagree with him is he’s got this fight going with Jeff Sessions,” he said, “but let me just say this: There is no one I hold in higher regard. He’s about the most knowledgeable person, compassionate person and honorable person we can have in that job.”

And almost every Republican who has ventured an opinion also agrees that Mr. Sessions was correct in recusing himself. “I think the attorney general is doing a fine job,” Mr. McConnell, whose wife, Elaine Chao, the transportation secretary, serves in the cabinet with Mr. Sessions, said on Tuesday. 

“And I think he made the right decision to recuse himself from the Russia matter.”



The Great Health Care Coverup By Paul Krugman

Like many people, I have a sick sense of anger over what just happened in the Senate, which just voted to proceed on a health care bill without any information on what will be in the bill. There’s still hope that in the next few hours, moderates who just caved in will balk at the horrible things they’re being asked to vote for. And I do mean hours: there will be no time for reflection or serious debate.

But nobody should have any confidence that they will. And I think we can almost take it for granted that John McCain will first vote for something terrible, then give a grandstanding speech about making our politics better.

The important thing to realize is WHY the Senate is doing this — rushing to pass legislation that will have a vast impact on American lives, the economy, and more without a single hearing, without time for a proper analysis of the bill, and with crucial votes taken on behalf of legislation yet to be determined. It’s not some arbitrary failure of procedure: it’s a coverup.

The fact is that Republicans have no good ideas on health; everything they want to do will make huge numbers of people worse off, to the benefit of a wealthy few. And they know this. They know that the campaign against Obamacare was based on lies from the beginning, that all their complaints about things like high deductibles were hypocritical. They know that what they’re about to do is terrible. But they’re trying to do it anyway — and the only way they have a chance is by breaking every rule of good governance, by making the process so rushed and secretive that nobody has a chance to say “Wait a minute– what are we doing?”

At a deep level McConnell’s determination to pass a health bill by breaking all norms is quite similar to Trump’s determination to shut down an investigation into his own corruption and possible collusion. Both men are trying to cover up what they know would outrage voters if they knew about it, and they don’t care what rules get broken along the way.

And the Senators who caved on health today are pretty much the same people who are enabling Trump’s abuse of his office. The moral rot in the Republican party runs wide as well as deep. All we need to save America is a few good men — but apparently all we have are two decent women. And that’s not enough.


Health Care Vote: Senate Rejects Repeal Without Replace

• The Senate on Wednesday afternoon rejected a proposal to repeal major parts of the Affordable Care Act without providing a replacement. Follow the live vote tracker to see how each senator voted.
• President Trump lashed out Wednesday morning at Senator Lisa Murkowski of Alaska, one of two Republicans who voted on Tuesday against beginning debate on repealing the health law.
• Blue Cross Blue Shield warns senators against repealing the mandate that almost everyone have insurance without something to take its place.

How Each Senator Voted on Obamacare Repeal Proposals

Republican leaders are bringing the second of several expected amendments to a vote on Wednesday.

Senate rejects ‘repeal only’ measure

The Senate on Wednesday rejected a measure that would have repealed major parts of the Affordable Care Act but would not have provided a replacement, signaling that the “clean repeal” bill that conservatives have embraced cannot get through Congress.

The vote, 45-55, underscored the bind that Republican leaders have found themselves in. Seven Republicans voted against the measure — Senators Shelley Moore Capito of West Virginia, Susan Collins of Maine, Dean Heller of Nevada, John McCain of Arizona, Rob Portman of Ohio, Lamar Alexander of Tennessee and Lisa Murkowski of Alaska — showing that repealing the health law without an immediate replacement lacks crucial support among Republicans.

With neither approach viable, Senate Republican leaders may have no choice but to fall back on a third choice: Push a far more limited measure that repeals parts of the Affordable Care Act, such as its mandate that most people have insurance and a tax on medical devices, but leaves most of President Barack Obama’s signature health law in place. Senators would then take their narrow bill into negotiations with the House, which passed a comprehensive measure to repeal and replace the Affordable Care Act.

Where did everything leave off Tuesday night?

Understandably, confusion is rife over what the heck is happening on the Senate floor: What was that vote Tuesday night? Why did Senator John McCain, Republican of Arizona, give that impassioned speech saying he would not vote for the Senate health care bill as it stands, then turn around and cast a yes vote on Tuesday night?

An explainer:

When the Senate voted 51-50 to begin debating the repeal of the Affordable Care Act, technically senators were bringing the repeal bill that was passed in the House to the Senate floor. For now, that 
is the bill that senators are trying to reshape.

On Tuesday night, Senate Republican leaders brought to the floor their most complete version of a plan to repeal and replace the Affordable Care Act. That measure had been worked out behind closed doors by the majority leader, Senator Mitch McConnell of Kentucky, and it would dismantle major parts of the current health care law, including the requirement that most people have health insurance.

But it also included an overture to Senate conservatives, a measure championed by Senator Ted Cruz, Republican of Texas, that would allow insurance companies to sell stripped down, low-cost insurance plans as long as they also offer insurance policies that comply with federal standards, including the requirement that plans cover “essential” services like maternity care, mental health treatment and prescription drugs.


Republicans Are Voting This Week to Repeal or Replace Obamacare. Here Are Their Proposals.

Three major proposals are being discussed.
OPEN Graphic

For moderates, the legislation includes $100 billion to help pay out-of-pocket medical costs for low-income people.

Because that broad version of the Senate health care measure had not yet been assessed by the nonpartisan Congressional Budget Office, it needed 60 votes to overcome a Democratic objection that it violated Senate rules.

Mr. McCain had previously made clear that he wanted to secure amendments to that broad repeal-and-replace bill. The vote on Tuesday night could be interpreted as a sign of support for that general approach.

The debate goes on.


John McCain to Senate: ‘We’re Getting Nothing Done’

Senator John McCain, who was recently diagnosed with brain cancer, spoke to the Senate after casting his vote to begin debating legislation to repeal the Affordable Care Act.
By THE ASSOCIATED PRESS. Photo by Gabriella Demczuk for The New York Times. Watch in Times Video »

And what does McCain actually want?

On Wednesday, the Arizona Republican let his leaders know what he wants. Mr. McCain’s office said he had filed three amendments meant to address concerns from leaders in his home state of Arizona, including the governor, Doug Ducey, a Republican.

Arizona is one of 31 states that expanded Medicaid under the Affordable Care Act, and the amendments would all address Medicaid. One of them would extend the phase out of the Medicaid expansion to 10 years, considerably longer than the bills under consideration. Another would increase the growth rate for Medicaid payments to states to better reflect health care inflation.


The G.O.P.’s Health Care Hail Mary: ‘Skinny Repeal’

Margot Sanger-Katz, a New York Times correspondent, explains the implications of a new, more modest health care bill Republicans are working on.
By ROBIN STEIN, NATALIE RENEAU and ROBIN LINDSAY on Publish Date July 26, 2017. Photo by Gabriella Demczuk for The New York Times. Watch in Times Video »

“Any reform to our health care system must reward states like Arizona that are responsibly managing their health care services and controlling costs — not penalize them,” Mr. McCain said in a statement, adding that the amendments would “ensure our citizens who are most in need do not have the rug pulled out from under them.”

What’s happened so far on Wednesday?

Mr. Trump opened the day by attacking Ms. Murkowski.

But Mr. Trump’s public shaming is not an effective strategy for Ms. Murkowski, who has dealt with worse from her party. In 2010, Ms. Murkowski retained her Senate seat in a historic win as a write-in candidate. She had lost Alaska’s Republican primary that year to a Tea Party challenger and was largely abandoned by Republican leadership. Since then, she has not felt beholden to her party.

Blue Cross Blue Shield warns the Senate

The Blue Cross Blue Shield Association warned senators on Wednesday that repealing the Affordable Care Act’s mandate that nearly everyone have health insurance would be disastrous if Congress fails to replace it with another measure that ensures that people get and maintain insurance coverage.
“If there is no longer a requirement for everyone to purchase coverage, it is critical that any legislation include strong incentives for people to obtain health insurance and keep it year-round. A system that allows people to purchase coverage only when they need it drives up costs for everyone. Immediate funding for the cost-sharing reduction program also is essential to help those individuals most in need with their out-of-pocket costs, so they can access medical services. And dedicated funds must be provided to help pay for the care of those with significant medical conditions.

In order to ensure a stable individual insurance marketplace, any final legislation must include these crucial elements to avoid steep premium increases and diminished choices that would make coverage unaffordable and inaccessible.”
The association appeared to be worried about a so-called skinny repeal bill that would do away with the Affordable Care Act’s individual mandate and require that most employers offer insurance to their workers, but would include little else. Republican leaders believe that such a narrow bill may be the only measure that can get through the Senate.

The Senate majority leader, Mitch McConnell of Kentucky, on Tuesday at the Capitol. Credit Gabriella Demczuk for The New York Times

Senators are set to consider a different repeal measure on Wednesday.

This measure would repeal major parts of the health law but would not provide a replacement. The legislation resembles a bill that passed the Senate in 2015 but was vetoed by President Barack Obama in early 2016.

Senator Rand Paul, Republican of Kentucky, supports that approach. But some Republicans worry that repealing the law without providing a replacement would leave many Americans without health care coverage. Such a “repeal only” measure is not expected to garner enough votes for passage.

The vote for this measure had been expected to take place around midday Wednesday, but it has now been delayed until later in the afternoon.

Then what happens?

Republicans are using special budget rules to try to pass a repeal bill, so the debate is limited to 20 hours, and Democrats cannot delay it with a filibuster. Later this week, the Senate will hold what is known as a vote-a-rama, an exhausting marathon of amendment votes.

The nine Republicans who voted against the comprehensive replacement measure on Tuesday night are an indication of the problem that Senate Republican leaders continue to confront: The party caucus still does not agree on what should be in a health care repeal bill that would have enough support to win Senate approval.

One solution might be to pass a pared-down health plan that has support from at least 50 of the 52 Republican senators, and then turn to working out a compromise with the House.


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