Of Course Russian Trolls Used Obamacare Repeal to Divide Americans

Full disclosure: I am not a Russian troll.

On Wednesday, the Wall Street Journal published an analysis of nearly 10,000 tweets published by accounts linked to the Internet Research Agency (IRA), a Russian-backed organization that Special Counsel Robert Mueller indicted for its attempts to interfere with the American electoral process.

It should go without saying, but no one should support efforts to interfere with, or otherwise corrupt, the American democratic process. Particularly given the way in which Russia’s authoritarian regime has stifled dissent and dismantled the country’s free and independent media, the IRA and Russian President Vladimir Putin have little business trying to lecture the United States on how to run a government.

That said, it seems unsurprising that the Russian government would attempt to use health care as a “wedge” issue to divide groups of Americans. The Journal article notes that “health policy [was a] natural target for the [Russian] provocateurs.”

In 2010, Democrats passed their health-care law through Congress on strict party lines, with not a single Republican vote. Health care in general, and Obamacare in particular, have remained polarizing issues ever since. The Journal also noted that the trolls’ Obamacare-related activity spiked last spring and summer, during the heat of the debate over “repeal-and-replace” legislation in Congress.

Health care, unlike most other issues, remains intensely personal to each American. Whereas many Americans might not care much about energy policy, or see how the North Atlantic Treaty Organization affects their daily lives, people have frequent and personal interactions with the health care system, whether for themselves or someone close to them. Everyone has a story and an opinion about health care.

Health care also has become a flashpoint for long-simmering political debates over the size and scope of government. Conservatives and libertarians oppose Obamacare because they view it as “big government” overreach. They would repeal the law, and scale back the involvement of government in general, and the federal government in particular, over the health care system.

By contrast, liberals want to go even further to expand government’s scope and reach—hence the renewed push for a single-payer health system. The Left views health care as a right, the number of uninsured and underinsured people as a scandal, and health concerns as a moral imperative that only government can address. Likewise, the vaccine debate plays to similar questions about the extent to which government can and should involve itself in health choices.

Almost one year ago, I wrote that “wisdom does not always lie with the loudest and the strongest. It requires us to listen to discern its voice.” A medium that attempts to digest “news” into a 280-character format seems tailor-made for the type of instant, emotional reactions that the IRA desires as a means to foment discord and dissent.

Combating Russian trolls requires actions by law enforcement and social media companies, yes, but it also requires some level of introspection by each one of us. Instead of simply “Amusing Ourselves to Death,” a phenomenon Neil Postman first described more than three decades ago, we should spend less time passively consuming media and more time thinking about what we consume. As I wrote last October:

At times, the cacophony of voices on Twitter, cable news, and in myriad other cultural venues might prompt us to wonder if anyone can make sense of it all, and maintain that inner peace. The story of Elijah on Horeb reminds us that wisdom and understanding remain always present in our lives—if only we search hard enough to find them.

This post was originally published at The Federalist.

Does the Heritage Health Plan Include Taxpayer Funding of Abortion?

When lawmakers write legislation, little details matter—a lot. In the case of a health plan that the Heritage Foundation and former Sen. Rick Santorum (R-PA) are reportedly preparing to release in the coming days, a few words indicate the plan has not considered critically important details—like how Senate procedure intertwines with abortion policy—necessary to any substantive policy endeavor.

A few short words in a summary of the Heritage plan leave the real possibility that the plan, if enacted as described, could lead to taxpayer funding of abortion coverage. Either Heritage and Santorum—both known opponents of abortion—have undertaken dramatic changes in their pro-life positions over the past few months, or they have failed to think through the full import of the policies they will release very shortly.

However, multiple individuals participating in the Heritage meetings told me that the concepts and policies Spiro’s document discusses align with Heritage discussions. Spiro may have created that document based on verbal descriptions given to him of the Heritage plan (just as the New York Times’ list of questions Robert Mueller wants to ask President Trump likely came via Trump’s attorneys and not Mueller). But regardless of who created it, people in the Heritage group told me it accurately outlined the policy proposals under discussion.

What Cost-Sharing Reductions Do

The summary describes many policies, but one in particular stands out: Under “Short-term stabilization/premium relief,” the plan “Adopts the [Lamar] Alexander and [Susan] Collins appropriation for CSRs [cost-sharing reductions] and state reinsurance/high risk pool programs for 2019 and 2020.”

On one level, this development should not come as a surprise. Party leaders often incorporate recalcitrant members’ pet projects (or, in the old days, earmarks) into a bill to obtain their votes: “See, we included the language that you wanted—you have to vote for our bill now!” Given that Collins as of last week had not even heard about the Heritage-led effort, one might think she would need some incentive to support the measure, which attaching her “stability” language might provide.

About the Hyde Amendment and Byrd Rule

The reference to CSRs takes on more importance because of the way Congress would consider Heritage’s plan. As with the Graham-Cassidy bill and other “repeal-and-replace” bills considered last year, the Senate would enact them using expedited budget reconciliation procedures.

Those procedures theoretically allow all 51 Senate Republicans to circumvent a Democratic filibuster and pass a reconciliation bill on a party-line vote. However, as I outlined last year, the reconciliation process comes with procedural restrictions (i.e., the “Byrd rule”) to prevent senators from attaching “extraneous” and non-budgetary matter to a bill that cannot be filibustered.

“Hyde amendment” restrictions—which prevent federal funding of abortion coverage, except in the cases of rape, incest, or to save the life of the mother—represent a textbook example of the “Byrd rule,” because they have a fiscal impact “merely incidental” to the policy changes proposed. Former Senate Parliamentarian Bob Dove said as much about abortion restrictions Congress considered in 1995:

The Congressional Budget Office determined that it was going to save money. But it was my view that the provision was not there in order to save money. It was there to implement social policy. Therefore I ruled that it was not in order and it was stricken.

After pushing for a vote for months, Collins suddenly backed off and didn’t force the issue on the Senate floor. She knew she didn’t have the votes—everyone knew she didn’t have the votes—because Democrats wouldn’t support a measure that restricted taxpayer funding of abortion coverage. Exactly nothing has changed that dynamic since Congress considered the issue in March.

Why We Can’t Fund CSRs

Republicans recognize the problems the abortion funding issue creates, and the Graham-Cassidy bill attempted to solve them by providing subsidies via a block grant to states. Graham-Cassidy funneled the block grant through the State Children’s Health Insurance Program (SCHIP), largely because the SCHIP statute includes the following language: “Funds provided to a state under this title shall only be used to carry out the purposes of this title, and any health insurance coverage provided with such funds may include coverage of abortion only if necessary to save the life of the mother or if the pregnancy is the result of an act of rape or incest.”

Because SCHIP already contains full Hyde protections on taxpayer funding of abortion, Graham-Cassidy ran the block grant program through SCHIP. Put another way, Graham-Cassidy borrowed existing Hyde amendment protections because any new protections would get in a budget reconciliation bill. It did the same thing for a “stability” fund for reinsurance or other mechanisms intended to lower premiums by subsidizing insurers, also referred to in Spiro’s document.

Creating a pot of money elsewhere in law—for instance, through the SCHIP statute, which does contain Hyde protections—and using that money to compensate insurers for reducing cost-sharing would prove just as unrealistic. The CSR payments reimburse insurers for discrete, specific discounts provided to discrete, specific low-income individuals.

If the subsidy pool gave money to all insurers equally, regardless of the number of low-income enrollees they reduced cost-sharing for, then insurers would have a ready-built incentive to avoid attracting poor people, because enrolling low-income individuals would saddle them with an unfunded (or only partially funded) mandate. If the subsidy pool gave money to insurers based on their specific obligations under the Obamacare cost-sharing reduction requirements, then the parliamentarian would likely view this language as an attempt to circumvent the Byrd rule restrictions and strike it down.

Not Ready for Prime Time

Four participants in the Heritage meetings told me the group has discussed appropriating funds for CSR payments to insurers as part of the plan. Not a single individual said the Senate’s “Byrd rule” restrictions—which make enacting pro-life protections for such CSR payments all-but-impossible—came up when discussing an appropriation for cost-sharing payments to insurers.

That silence signals one or more potential problems: A lack of regard for pro-life policy; an ignorance of Senate procedure, and its potential ramifications on the policies being considered; or a willingness to fudge details—allowing people to believe what they want to believe. Regardless, it speaks to the unformed nature of the proposal, despite meetings that have continued since the last time “repeal-and-replace” collapsed” nearly eight months ago.

Earlier this month, Santorum claimed in an interview that while the original “Graham-Cassidy was a rush…this time we have the opportunity to get the policy better.” But any serious attempt to “get the policy better” wouldn’t have major lingering questions about tens of billions of dollars in “stability” funding, and whether such funds would subsidize abortion coverage, mere days before its public release. In this case, eight months of deliberations may not lead to a deliberative and coherent policy product.

This post was originally published at The Federalist.

Michael Cohen and “The Swamp”

Recent revelations surrounding the business clients of Michael Cohen, Donald Trump’s personal attorney, demonstrate the seedy underbelly of the lobbying business in Washington. At least one company that hired Cohen admitted that it got suckered by someone who couldn’t deliver what he promised. Many companies consider these types of expenditures the cost of doing business.

Last Tuesday, attorney Michael Avenatti released a report claiming that Cohen’s firm, Essential Consultants, received millions of dollars in payments from various companies, including one linked to a Russian oligarch. Avenatti, a Trump critic, represents onscreen prostitute Stormy Daniels in a lawsuit seeking to nullify a non-disclosure agreement Daniels and Cohen reached regarding the former’s alleged affair with Trump.

While Avenatti’s original report claimed Novartis paid Cohen just under $400,000, the company later confirmed payments totaling three times that amount, or $1.2 million. In an interview, an unnamed Novartis employee gave commentary into what amounts to a corporate comedy of errors:

He [Cohen] reached out to us…With a new Administration coming in, basically, all the traditional contacts disappeared and they were all new players. We were trying to find an inroad into the Administration. Cohen promised access to not just Trump, but also the circle around him. It was almost as if we were hiring him as a lobbyist.

To paraphrase the British phrase used when a new sovereign assumes the throne: “The (Old) Swamp is dead! Long live The (New) Swamp!”

Unfortunately for Novartis, however, the firm locked itself in to a one-year agreement at a $100,000 monthly retainer—ridiculously high by most Washington lobbying standards—only to discover that Cohen could not deliver. According to the Novartis employee, it took but one meeting for the bloom to come off of the rose: “At first it all sounded impressive, but toward the end of the meeting, everyone realized this was probably a slippery slope to engage him. So they decided not to really engage Cohen for any activities after that.”

AT&T and Novartis admitted on Wednesday that the office of special counsel Robert Mueller contacted both about their relationships with Cohen. In analyzing their behavior, assume that both companies acted legally—that their payments to Cohen were solely for consulting services, and not as part of some quid pro quo scheme directly tied to an official act, whether by Cohen, Trump, or anyone else.

On one hand, the companies exercised exceedingly poor judgment. Novartis CEO Vas Narasimhan (who was not running the company when Novartis signed its 2017 agreement with Cohen) admitted on Thursday that the company “made a mistake in entering into this engagement,” signing away more than a million dollars in shareholder money to someone without undertaking any due diligence as to whether he could deliver what he had promised.

Novartis also vastly overpaid Cohen, even if it had engaged him for more activities than a single meeting. As I noted on Twitter, I could have cautioned them about the dim chances for Obamacare repeal for half the $1.2 million they paid Cohen. (If they had asked nicely, I might have done so for even one-quarter that sum.) Very few if any Washington lobbying firms can command a six-figure monthly retainer from one client, yet Novartis paid that much to a single individual.

As Politico noted, Trump’s “2016 victory rattled corporations enough that clients were eager to pay top dollar to anyone who could help them understand the Administration in its first months.” Because no one thought Trump could win—and therefore spent little time reaching out to him or his campaign in the summer and fall of 2016— after the election corporations felt the need to overcompensate, throwing money at anyone with a connection to Trump, in the hopes of ingratiating themselves with the new administration. I saw some of this myself in late 2016 and early 2017, when companies and financial firms came out of the woodwork asking me to predict what the new Congress and administration would do on health care. (Trust me: My offers didn’t come anywhere close to $1.2 million.)

Firms often spend sizable sums on lobbying. Novartis has “nearly a dozen lobbying firms on retainer,” for which it paid $8.6 million last year. In some cases, companies or industries have so many lobbying firms on retainer that the ineffective ones often attempt to take credit for the “wins” achieved by the effective ones. However, given how federal policy initiatives can affect both a company’s revenue and its stock price—witness the market volatility surrounding President Trump’s proposals on drug pricing—companies have little choice but to play the K Street game.

It seems ridiculous to pay $1.2 million to an individual for a single meeting, and it is. But only a smaller role for the federal government—in taxing, spending, and regulations—would bring an end to the types of influence-peddling stories like those surrounding Cohen this week. Unfortunately, it’s the price of doing business for many companies—and a symptom of a government run amok.

This post was originally published at The Federalist.