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At the White House

TRUMP’S PIVOT TO HEALTHCARE: President Trump on Capitol Hill thanked Republican senators for standing by him during special counsel Robert Mueller's investigation -- and then insisted they should focus on health care going into 2020. 

"The Republican Party will become 'The Party of Healthcare!'" he tweeted yesterday. 

  • The timing: The Justice Department on Monday night argued in a new court filing that the entire Affordable Care Act should be thrown out, instead of just its individual mandate to buy coverage
  • That would do away with provisions that are popular among voters, such as protections for pre-existing conditions, access to "essential health benefits," and coverage for young adults on their parent's plans. 
  • As my colleague Isaac Stanley-Becker writes, that "would fulfill Republican promises to undo a prized domestic accomplishment of the previous administration but leave no substitute in place."  
  • By the numbers: If the ACA is struck down, "21 million could lose their health insurance",  "12 million adults could lose Medicaid coverage," "60 million Medicare beneficiaries would face changes to medical care and possibly higher premiums," "Medical care for the uninsured could cost billions more dollars," per The New York Times's Reed Abelson, Abby Goodnough and Robert Pear. 

WHAT'S THE PLAN?: On the Hill, several Republicans did not hold back from expressing their confusion and exasperation: 

  • “Do we have a plan? What’s our plan,” Sen. Lisa Murkowski (R-Alaska), who opposed the party’s repeal efforts two years ago, told Politico’s Adam Cancryn and Burgess Everett“I guess we’ll find out.”
  • “He didn’t offer a plan,” Sen. Marco Rubio (R-Fla.) told Bloomberg's John Tozzi and Erik Wasson after lunch with Trump. “He referred to some of the ideas that have been debated in the past.”
  • “I was extraordinarily disappointed in the position the Justice Department has taken,” said Sen. Susan Collins (R-Maine), Eliana Johnson and Burgess Everett report. “I thought it was bad enough when they didn’t want to defend parts of the law, the parts protecting people with pre-existing conditions. This goes far beyond that and think this was a huge mistake.”

On the other side: Democrats embraced the administration's filings to reinvigorate and united around the debate surrounding the ACA, calling it the latest attempted by Trump to eliminate health insurance. 

  • Key quote: "The Republicans did say during the campaign that they weren’t there to undermine the pre-existing condition benefit, and here they are, right now, saying they’re going to strip the whole Affordable Care Act as the law of the land,” House Speaker Nancy Pelosi (D-Calif.) told reporters Tuesday, adding, “This is actually an opportunity for us to speak to the American people with clarity.”

GET READY: DOJ's "surprise move... thrust the partisan battle over health care into the middle of the 2020 campaign on Tuesday, handing Democrats a potential political gift on an issue that damaged Republicans badly in last year’s midterm elections," my colleagues Toluse Olorunnipa and Seung Min Kim report. 

  • "[By] resurfacing old battles about stripping away popular elements of the current health-care system, Trump is likely to embolden and unite Democrats who seek to make health care a top issue in 2020, said Amy Walter, national editor of the Cook Political Report."
  • "Democrats who have been divided in recent months over proposed Medicare-for-all legislation can now coalesce around the idea of protecting the ACA’s most popular provisions, she said."
  • Pro tip: “If you’re a Republican thinking about 2020 right now, you want to be on offense on health care, not defense,” Walter said. “And the only way to do that is to make the focus on what Democrats want to do — on Medicare-for-all — rather than making it on what the president and the White House are suggesting.”

Trump's right in that health care has consistently polled as a top issue among voters. 

  • CNN's exit polling from the 2018 midterms showed that voters viewed health care as *the* most important issue facing the country and 69% of voters said that healthcare in the U.S. needs "major changes."
  • But: The majority of voters said that Democrats would better protect pre-existing conditions over Republicans. 
  • It's personal: "Trump suggested he wants to revisit the issue, after two unsuccessful efforts in 2017 to undo former president Barack Obama’s signature legislative achievement. Trump has long fumed over those failures, and as recently as last week was attacking the late senator John McCain (R-Ariz.) for his pivotal role in quashing the effort," per Tolu and Seung Min.

NEXT STEPS: "The fate of Obamacare could — once again — hinge on the Supreme Court, which has installed two conservative justices since it voted to uphold the landmark health-care law in 2012," they write.

  • Behind the scenes disputes: Politico's Eliana and Burgess report that the administration's "surprising move to invalidate Obamacare on Monday came despite the opposition of two key cabinet secretaries: Health and Human Services Secretary Alex Azar and Attorney General Bill Barr."
  • "The new challenge to Obamacare follows a heated internal administration debate that began late last year and continued through yesterday's announcement. Azar argued against backing a lawsuit seeking the full repeal of the health care law at a White House meeting in late December, citing the lack of a Republican alternative, according to two sources briefed on internal discussions, while Mulvaney said that taking a bold stance would force Congress into repealing and replacing the law," per Politico. 
 

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PRESIDENTIAL POLICY BY TWEET: Trump's Twitter fingers frequently catch his aides just as off guard as the rest of us. Just last week, the president reversed decades of U.S. foreign policy in a tweet recognizing Israel's control of the Golan Heights. And Bloomberg News came out with a deep dive into his other tweet that week overruling his own Treasury Department on North Korean sanctions

Here's what Saleha Mohsin, Jen Jacobs and Nick Wadhams report happened after Trump tweeted he “ordered the withdrawal of those additional Sanctions” on North Korea:

  • The White House, Treasury and the State Department went silent as reporters pressed for an explanation 
  • Officials then “devised a misleading explanation of his vague tweet” and “sought to explain away the move with a statement — initially requesting no attribution to anyone — that said the penalties against the Chinese companies hadn’t been reversed but the U.S. wouldn’t pursue additional sanctions against North Korea,” per Bloomberg
  • The problem?: “There were no additional North Korea sanctions in the works at the time, according to two people familiar with the matter.” Officials just wanted to save face after they talked Trump down.

The saga is just the latest example when Trump's tweets overtake the traditional policy process. Here are some of the most consequential policy announcements Trump has made on social media and the chaos, clean ups and sometimes success that followed: 

1. Banning transgender service members: In a series of tweets, Trump announces in July 2017 that transgender individuals will not be allowed “to serve in any capacity in the U.S. military,” reversing an Obama administration policy.

  • The chaos: The White House was unable to answer basic questions, including what it meant for active duty transgender troops. Defense Secretary Jim Mattis was informed just a day earlier about Trump's decision. Trump's announcement came as some House conservatives were considering derailing a broader defense policy bill over whether the federal government would pay for gender transition therapies for active service members.
  • Status: More than two years later, new limits on transgender troops are set to go into effect on April 12. 
  • Reuters reported the new rules will “bar most transgender individuals from serving if they require hormone treatments or transition surgery” as the administration prevailed in a court challenge. Trump “later accepted Pentagon recommendations to limit the ban to individuals with a history of gender dysphoria, defined as 'those who may require substantial medical treatment,' and allowing some exceptions.”

2. Withdrawing U.S. troops from Syria: On Dec. 19, 2018, Trump tweeted that “we have defeated ISIS in Syria" and ordered the withdrawal of 2,000 American troops from Syria.

  • The chaos: Mattis resigns a day later, a decision my colleagues reported came after a clash over the withdrawal. Brett McGurk, the U.S.’s top envoy to the intentional coalition fighting the Islamic State, also resigns. Trump’s abrupt move came after a phone call with Turkish Recep Tayyip Erdogan.
  • Status: More than three months later, it is apparent that Trump’s promise to withdrawal all forces is unlikely to become reality. The question now is just how many troops will remain in Syria. The Wall Street Journal reported just over a week ago that as many as 1,000 forces could be left behind.

3. Reauthorizing FISA: Reportedly spurred on by a “Fox and Friends” segment, Trump tweeted on the morning of Jan. 11, 2018 that he is concerned about the House's vote scheduled later that for later that day on the renewal of a major surveillance program.

  • The chaos: House Republicans wonder if Trump’s linking of reauthorizing of the program to surveillance of his campaign may sink a legislation that Trump’s own administration was lobbying to pass. The vote was to "reauthorize the governments' authority to conduct foreign surveillance on U.S. soil."
  • Paul Ryan, my colleagues reported, spent 30 minutes on the phone with Trump “explaining the differences between domestic and foreign surveillance, as many fellow Republicans reacted in disbelief and befuddlement.”
  • Status: Trump flipped. Just over 100 minutes after his panic inducing initial tweet, Trump corrects himself and explicitly endorses the bill via a follow up tweet. The bill passes the House and Senate in short order before Trump signs the reauthorization of what the intelligence community considers to be its "key national security surveillance tool" into law.

Context: Presidential historian and NYU professor Timothy Naftali tells Power Up that it's not unprecedented for presidents to be impatient with the traditional lengthy policy process. But what is unusual about Trump is that he seems to make the exception the rule.

  • "Presidents can make decisions out of ire, exhaustion or frustration, but they don't announce them," Naftali  said. "There's a way for experts and allies to edit, sharpen or smooth presidential passions. But this president doesn't want a filter."
  • In a crisis, the consequences would be even bigger, he said: "The presidency shouldn't be a high wire act without a safety net."

The Investigations

GRAF DU JOUR:  This paragraph from the New York Times's Peter Baker left many wondering about the timeline for the release of the full findings of Mueller's report after the summary of its conclusions from Attorney General William Barr. The House Judiciary Committee has requested access to the report by April 2 -- but it's unclear if it will be released at all: 

  • "Beyond those bottom-line conclusions, Mr. Mueller’s full report has yet to be released, and it remained unclear if it ever would be. House Democrats have demanded that it be sent to them by next Tuesday, but the Justice Department outlined a longer schedule, saying that it will have its own summary ready to send to lawmakers within weeks, though not months," Baker writes. 

In the Agencies

HUD INSPECTOR GENERAL TO PROBE PUERTO RICAN AID: The Trump administration gained another investigation as the Department of Housing and Urban Development's inspector general's office reviews whether the White House interfered with hurricane relief funding for Puerto Rico.

  • Jeremy Kirkland, counsel to the HUD inspector general’s office, told lawmakers yesterday the agency is looking into the matter, as it looks "into broader delays in the spending of federal aid for regions struck by natural disasters, including Texas and Florida," per my colleagues Jeff Stein , Tracy Jan and Josh Dawsey. 

  • "On Monday, the Government Accountability Office published a report finding that the federal government has been 'slow' to get block grants to areas struck by disasters," they write. 

  • "The Trump administration has also recently rejected requests for additional aid to Puerto Rico in particular, with President Trump privately signaling he will not approve help for Puerto Rico beyond $600 million in emergency funding for food stamps."

The timing: The news comes just day after our colleagues filed a lengthy report detailing how Trump last month asked top advisers for ways to limit federal support from going to Puerto Rico, believing it is taking money that should be going to the mainland. But Trump again complained about Puerto Rico at yesterday's lunch with Senate Republicans, Seung Min, Josh, and Paul Kane report

  • "Trump rattled off the amount of aid that had been designated for other disaster-hit states and compared it with the amount allocated for Puerto Rico following the 2017 hurricane, which he said was too high, according to the officials, who spoke on the condition of anonymity to describe the private meeting," they write.
  • "Trump noted to GOP senators that Texas — also battered by a spate of hurricanes — was awarded $29 billion in aid, while South Carolina got $1.5 billion to recover from storms. Trump then questioned why Puerto Rico was getting $91 billion." 
  • "Trump remarked that one could buy Puerto Rico four times over for $91 billion, according to people familiar with his comments."

SPECIAL OLYMPICS?: "What is it that we have a problem with, with children who are in special education?," Rep. Mark Pocan (D-Wisc.) asked Education Secretary Betsy DeVos on Tuesday about her department's proposed cuts to the Special Olympics and other special education programs.

During a hearing before the House Appropriations subcommittee, DeVos "struggled...to defend at least $7 billion in proposed cuts to education programs, including eliminating all $18 million in federal funding for the Special Olympics," NBC News's Doha Madani reports. 

  • "When Pocan asked whether she knew how many children would be affected by the elimination of federal funding to the Special Olympics, DeVos said she did not know."
  • "I’ll answer it for you, that's OK, no problem," Pocan said. "It’s 272,000 kids that are affected."
  • "I still can’t understand why you would go after disabled children in your budget," Rep. Barbara Lee (D-Calif.) told DeVos during the hearing. "You zero that out. It’s appalling.”

PHARMA MAKING BILLIONS, DESPITE GOVERNMENT PATENT: The U.S. government patented the treatment called Truvada that prevents HIV infection but "is not receiving a penny for that use of the drug from Gilead Sciences, Truvada's maker, which earned $3 billion in Truvada sales last year," reports my colleague Christopher Rowland

  • "Gilead argues that the government’s patents for Truvada for PrEP, as the prevention treatment is called, are invalid. And the government has failed to reach a deal for royalties or other concessions from the company — benefits that could be used to distribute the drug more widely," reports Christopher. 
  • Key: "The extraordinary standoff between the CDC and a drug company over patent rights raises a big question for the Trump administration: How aggressively should the government attempt to enforce its patents against an industry partner?"
  • Only 20 percent of the 1.1 million people who should be receiving the treatment are currently receiving the drug. 
  • “The CDC has all these patents and is allowing Gilead to rip off the American people at the expense of public health,’’ James Krellenstein, an HIV/AIDS activist and co-founder of the PrEP4All Collaboration, told Christopher. Instead of enforcing the patent, CDC officials are “twiddling their thumbs," according to Krellenstein.

In the Media