• AHCA: At A Crossroads
• Veterans Affairs: Fixes Vs. Cures
• How Special Are Those Elections?
• Staying Secure

The Senate’s radical take on healthcare, which finally saw the light of day last week, dominated voter attention -- and apprehension. We also take a look at special elections, plus our congressman’s e-News items on veterans and national security.

AHCA: At A Crossroads, And How We Got Here

This week U.S. Senators will vote on what they call the Better Care Reconciliation Act (BRCA), their version of the House bill known as AHCA, or, in yet another shorthand, Trumpcare.

This measure would displace an estimated $1 trillion over the next decade from healthcare funding to bankroll tax cuts for the benefit of the richest U.S. citizens. That is a brutal statement, we know. But then, this is a brutal bill, which:

• Deepens cuts to Medicaid funding, putting poor children, those with mental-health issues, and those with disabilities firmly in the bull’s-eye.
• Would leave 22 million more people without health insurance by 2026, the Congressional Budget Office said today.
• Decimates protections for pre-existing conditions by loosening the rules under which states can waive coverage requirements, and allowing states greater latitude in defining what “essential health coverage” means.
• Throws even those of us in large employer-sponsored plans under the bus – since under current regulations, such plans can choose the rules of any state in the country (loosened rules, remember) as their basis for defining coverage. 

Today, the American Medical Association officially added its own letter to a growing swell of opposing voices: "Medicine has long operated under the precept of Primum non nocere, or 'first do no harm.' This legislation violates that standard on many levels." 

From 2013 to 2015, New Jersey saw a 35% decrease in the rate of uninsured residents, largely due to ACA. The Senate’s plan squarely targets the health of the most vulnerable in our state: 

• The 42 percent of births, the third of all children, and three out of five nursing-home residents who are covered by Medicaid;
• The whopping 1.2 million New Jerseyans under the age of 64 who have a declinable pre-existing condition.  

Both the Senate and the House versions of AHCA deliver another significant result: that $1 trillion tax cut. As CNBC reported, the Senate’s version sends even more of the cut to the wealthiest Americans – 40 percent for the top 1 percent of earners, the rest to the top 20 percent.

So here we are. Here are the “big improvements”  Rep. Rodney Frelinghuysen hoped for when he changed his vote to help the House’s version of AHCA to pass in May. Now the Senate will vote, and should it vote yes, the bill goes back to Frelinghuysen and his House colleagues for another vote, another crack at improving the “improvements.”

“I'm anxious to see and study the provisions of the final legislation,” Frelinghuysen said in March, as the House crafted the first version of its bill. He also said: “I can assure you we're trying to make sure people that are receiving Medicaid,” and “I think we're headed in the right direction.”

We consider the crossroads to which Frelinghuysen’s direction ultimately led us, just as we consider that perhaps more than anyone else in Congress, two New Jersey GOP representatives made the crossroads possible. One was NJ-3’s Tom MacArthur, who crafted the amendment weakening pre-existing protections that proved crucial to the House passage. And the other was Frelinghuysen, whose justified his pivotal flip vote by assuring us that the Senate would surely fix this bill.

Here we are at our country’s health-care crossroads, and -- vitally for us in NJ 11th For Change - here is our representative. Talk to him. Ask him what he is thinking now.

Veterans Affairs: Fixes Vs. Cures

This week Frelinghuysen highlighted the passage of the Veterans Affairs Accountability and Whistleblower Act, saying it will “help deliver the kind of fundamental change” required to solve longstanding problems. He also declared: “It will help our veterans get the world-class care and treatment that they deserve, and that they have earned.”

An efficiently functioning VA is important, but it’s not clear that this legislation is a cure-all. On paper, it would help administrators address issues quickly by allowing them to fire bad employees more easily. Veterans Affairs secretary David Shulkin indicated he wants “to run this organization the way that the private sector runs organizations.” The new legislation has implications beyond the VA, portending significant civil service changes across the board for the federal workforce.

The legislation does not address serious understaffing issues at the VA, where over 5000 administrator positions and over 50,000 overall positions remain unfilled, many left over from the Trump administration’s government-wide hiring freeze from earlier this year.

Multiple studies and investigations have outlined the challenges at the VA: a failure to recruit and retain a talented workforce, budget shortfalls, and an operating environment that favored efficiency over premium health care.

Another wrinkle: About 340,000 veterans nationally receive coverage through the Affordable Care Act’s Medicaid expansion. Most of these veterans stand to lose such coverage should Congress pass GOP proposals to slash funding for Medicaid. In New Jersey alone, 27,000 veterans are covered by Medicaid, with a 25% increase in veterans under age 65 covered by Medicaid from 2013 to 2015.

If our congressman truly cares about our veterans, he will do everything in his power to fight his party’s ongoing attacks on Medicaid funding.

How Special Are Those Elections?

In a tumultuous political landscape, special elections in Kansas, Montana, and now Georgia and South Carolina, took on a heightened significance as a preview of the 2018 midterms. As a vehicle for resisting the Trump administration, results from South Carolina and especially Georgia could be called disappointments. In much media coverage, Georgia’s 6th District was portrayed as the first battle of the 2018 midterm season.  The fact that it was the most expensive Congressional election in history was one reason (or possibly, a result).

Additionally, Georgia’s 6th, HHS Secretary Tom Price’s former district, was said to be full of “reluctant” Trump voters – i.e., better-educated and wealthy moderate Republicans who only supported Trump in the later stages of Election 2016, and in smaller margins. The Georgia 6th election was heavily sold as a reflection of the country’s mood and a referendum on the President. So to opponents of the status quo, the 4-point GOP win was a huge let-down, even as the other side of the aisle talked it up as a ringing endorsement. In the cacophony of after-the-fact analysis, it’s important to separate facts from hype.

Wins matter of course, but in gauging what can be expected from the midterms, numbers matter, too. Picking up an additional House seat or two counts for something, but 2018 is the real window for change and for that, it’s important to look at vote margins. In Kansas’ 4th District Republican Ron Estes won by 6.8 points, compared to a 24.6 and 29.3 GOP lean in the House and Presidential 2016 elections. In Montana, Republican Greg Gianforte had a 6.1-point win margin, versus 8.8- and 22.7-point GOP leans for the House and the President in 2016. For South Carolina’s 5th, GOP candidate Ralph Norman won by 3.2 points, relative to 13.3- and 20.6-point GOP leans in 2016 House and President elections. And finally in Georgia, Karen Handel beat Democrat Jon Ossoff by 3.7 points, against 16.2 and 3.6 for the House and President in 2016. Averaged together, the numbers for the Congressional special elections in 2017 showed a 5-point Republican lean compared to 15.7 and 19.1 points in those districts for 2016 House and Presidential elections, respectively.

There are a few big takeaways from these numbers. There is some variety among the special election districts – Georgia’s 6th district only went to Trump by 3.6 in 2016, for instance. So while it’s possible to infer some national trends, there will always be district-specific quirks, and some strategies will work better or worse in different areas. Even with those differences, Democrats are significantly overperforming. An average of 11- to 14-point improvement over the most recent elections, which increases to 12 to 17 points when the 2014 midterms and 2012 presidential elections are considered, is an undeniably large Democratic swing. The central reason none of these special elections resulted in a Democratic win is that the districts are deeply Republican to begin with. The picture could change even more in 2018, with more moderate districts in play such as NJ 11th. Should grassroots organizing continue to energize and engage voters, the events of last week could prove to be the start of a swell of change, not its crest.

The 2017 special election results are therefore a telling sign, but whether the trend continues will depend on whether the grassroots forces that have driven it continue to forge ahead. Groups across the country like NJ 11th For Change are taking the game to the ground, changing conversations and reshaping the country’s political landscape one neighborhood voter at a time. Next stop, 2018. Hope to see you out there with us.

Staying Secure

We would not want to leave you without reflecting briefly upon Frelinghuysen’s e-newsletter item headlined “Congress’ Top Job: Ensuring National Security.”

It’s an interesting thought – Congress’ top job. Article I, Section 8 of the Constitution doesn’t really name a principal responsibility in the impressive list of jobs it gives Congress to do. Absolutely, provisions regarding national defense are there, after nine other things are named. (We're counting the part about piracy as security. Seriously, take a look at Article I, section 8 sometime. You’d be amazed at all the things Congress is supposed to be doing besides figuring out more tax cuts for billionaires.)

We agree, though, that ensuring the nation’s security is very important. And given that Frelinghuysen is taking Congress’ role in that seriously, we hope to hear more of his thoughts on the ongoing investigations into a foreign power’s cyberattacks on the nation’s electoral systems in 2016. That's a pretty important security issue, too.

 -- By Liz Lynch, Mara Novak, Liz Jarit and Adam Tucker