Tag Archives: repeal

New Congress sees mandate to undo Obama’s agenda

Republicans’ grip on all levers of power stands as a mandate to the GOP-led Congress, which will move swiftly to try to undo eight years of outgoing President Barack Obama’s agenda.

With Republican President-elect Donald Trump weeks away from assuming office, GOP lawmakers plan to open the 115th Congress on Tuesday and immediately take steps to repeal Obama’s health care law. Beyond that, they’ll look at a tax overhaul, reversing Obama-era environmental regulations and other conservative priorities.

Republicans will face some obstacles. House Minority Leader Nancy Pelosi says Democrats “stand ready to fight vigorously” to protect health care and other priorities, and Republicans will have to compromise with Senate Democrats to move major legislation through that chamber.

A look at what the 115th Congress will be up to in 2017:

NEW MEMBERS

New members of the House and Senate will be sworn in on Tuesday, the first day of the new Congress.

In the Senate, five Democrats and two Republicans will be sworn in for the first time, joined by returning members who won re-election in 2016. After those members are sworn in, there will be 52 Republicans, 46 Democrats and two independents who caucus with the Democrats.

The House will have 52 new members — 27 Republicans and 25 Democrats. There will be 241 Republicans in the House and 194 Democrats.

CONFIRMING A NEW CABINET

Trump is sworn in on Jan. 20, and Republicans in the Senate will spend the first days and weeks of his presidency pushing to confirm his Cabinet picks. Democrats changed the rules and curbed the filibuster in 2013, making it easier for Republicans to move nominations. But even though they won’t be able to block Trump’s nominees, Democrats have pledged to fight many of them anyway, highlighting what they say is the hypocrisy of Trump’s populist message and his wealthy, corporate-favoring nominees for several posts.

REPEALING OBAMA’S HEALTH CARE LAW

The Senate plans to begin repealing Obama’s health care law on Tuesday, Congress’ very first day, with consideration of a procedural measure that will shield from Democratic filibusters legislation annulling much of that statute.

Lawmakers will then spend the next few months working on legislation canceling broad swaths of the law. Likely to go are its mandate that people buy health insurance or face IRS fines, and its expansion of Medicaid coverage to more lower-earning Americans. Some elements of the repeal likely wouldn’t go into effect for two to four years.

Republicans will then begin the more complicated task of building a new system. The GOP will have to craft new programs for the nation’s $3 trillion health care system and make sure insurance markets don’t collapse while the transition is under way.

TAX OVERHAUL

Senate Majority Leader Mitch McConnell, R-Ky., and Speaker Paul Ryan, R-Wis., want a massive overhaul of the tax system with the goal of simplifying a complicated tax code that rewards wealthy people with smart accountants as well as corporations that can easily shift profits and jobs overseas.

It would be the first major tax overhaul in 30 years. Trump has also advocated a tax overhaul, but with fewer details. He promises a tax cut for every income level, with more low-income families paying no income tax at all.

SUPREME COURT

Supreme Court Justice Antonin Scalia died 11 months ago, but the Senate still hasn’t considered a replacement. That’s because McConnell blocked consideration of Obama’s nominee, Judge Merrick Garland, saying the next president should make the pick. The strategy paid off, and the Republican Senate will consider whomever Trump nominates.

MEDICARE CHANGES

Ryan is the most powerful advocate in Washington for an overhaul of Medicare and a premium-support approach that would, over time, remake it into a voucher-like program that could force some seniors entering the program to buy health insurance on the open market instead of getting coverage through the traditional open-ended program.

But his ideas likely will run into a political reality. Trump said on the campaign trail that he wouldn’t cut the program, and Senate Republicans haven’t been as enthusiastic either.

Candidate Trump also initially promised not to cut Medicaid — the federal-state health insurance program for low-income and severely disabled people. During the campaign, Trump seemed to shift, backing “block grants” that limit federal funding.

SOCIAL SECURITY

Like Medicare, some House conservatives have said they want to overhaul Social Security and slow the program’s growth to curb spending. But Trump has said he doesn’t want to touch those programs, and Ryan told CBS’ “60 Minutes” in December that he has no plans to change Social Security.

REVERSING REGULATIONS

Republican leaders have complained throughout Obama’s presidency about burdensome regulations, a theme Trump used frequently during the campaign as well. GOP lawmakers now want to undo some of Obama’s regulations and executive orders using the Congressional Review Act, a rarely invoked procedure.

Many of the regulations they are targeting are environmental rules put in place by the Environmental Protection Agency, including the Clean Power Plan to cut carbon pollution from coal-fired power plants, a clean water rule that has drawn the ire of farmers and another rule imposed in December to protect nearby streams from coal-mining debris.

INFRASTRUCTURE

Trump made rebuilding the nation’s aging roads, bridges and airports a major part of his job-creation strategy in the presidential race. But those plans appear to have fizzled, somewhat, as GOP leaders have questioned the spending.

 

If Republicans repeal health law, how will they pay for replacement?

Leading Republicans have vowed that even if they repeal most of the Affordable Care Act early in 2017, a replacement will not hurt those currently receiving benefits.

Republicans will seek to ensure that “no one is worse off,” said House Speaker Paul Ryan, R-Wis., in an interview with a Wisconsin newspaper earlier this month. “The purpose here is to bring relief to people who are suffering from Obamacare so that they can get something better.”

But that may be difficult for one big reason — Republicans have also pledged to repeal the taxes that Democrats used to pay for their health law. Without that funding, Republicans will have far less money to spend on whatever they opt for as a replacement.

“It will be hard to have comparable coverage if they start with less money,” Gail Wilensky, a health economist who ran the Medicare and Medicaid programs under President George H.W. Bush, said in an interview.

“Repealing all the ACA’s taxes as part of repeal and delay only makes a true replacement harder,” wrote Loren Adler and Paul Ginsburg of the Brookings Institution in a white paper out this week. It “would make it much more difficult to achieve a sustainable replacement plan that provides meaningful coverage without increasing deficits.”

The health law’s subsidies to individuals buying insurance and the Medicaid expansion are funded by two big pots of money.

The first is a series of taxes, including levies on individuals with incomes greater than $200,000, health insurers, makers of medical devices, brand-name drugmakers, people who use tanning salons, and employer plans that are so generous they trigger the much-maligned “Cadillac Tax.” Some of those measures have not yet taken effect.

However, the Congressional Budget Office estimated in early 2016 that repealing those provisions would reduce taxes by an estimated $1 trillion over the decade from 2016-2025.

The other big pot of money that funds the benefits in the health law comes from reductions in federal spending for Medicare (and to a lesser extent, Medicaid). Those include trims in the scheduled payments to hospitals, insurance companies and other health care providers, as well as increased premiums for higher-income Medicare beneficiaries.

CBO estimated in 2015 that cancelling the cuts would boost federal spending by $879 billion from 2016 to 2025.

The GOP, in the partial repeal bill that passed in January and was vetoed by President Barack Obama, proposed to cancel the tax increases in the health law, as well as the health premium subsidies and Medicaid expansion. But it would have kept the Medicare and Medicaid payment reductions. Because the benefits that would be repealed cost more than the revenue being lost through the repeal of the taxes, the result would have been net savings to the federal government — to the tune of about $317.5 billion over 10 years, said CBO.

But those savings — even if Republicans could find a way to apply them to a new bill — would not be enough to fund the broad expansion of coverage offered under the ACA.

If Republicans follow that playbook again, their plans for replacement could be hampered because they will still lose access to tax revenues. That means they cannot fund equivalent benefits unless they find some other source of revenue.

Some analysts fear those dollars may come from still more cuts to Medicare and Medicaid.

“Medicare and Medicaid face fundamental threats, perhaps the most since they were established in the 1960s,” said Edwin Park of the liberal Center on Budget and Policy Priorities, in a webinar last week.

Republicans in the House, however, have identified one other potential source of funding. “Our plan caps the open-ended tax break on employer-based premiums,” said their proposal, called “A Better Way.”

House Republicans say that would be preferable to the Cadillac Tax in the ACA, which is scheduled to go into effect in 2020 and taxes only the most generous plans.

But health policy analysts say ending the employer tax break could be even more controversial.

Capping the amount of health benefits that workers can accept tax-free “would reduce incentives for employers to continue to offer coverage,” said Georgetown University’s Sabrina Corlette.

James Klein, president of the American Benefits Council, which represents large employers, said they would look on such a proposal as potentially more damaging to the future of employer-provided insurance than the Cadillac Tax, which his group has lobbied hard against.

“This is not a time one wants to disrupt the employer marketplace,” said Klein in an interview. “It seems perplexing to think that if the ACA is going to be repealed, either in large part or altogether, it would be succeeded by a proposal imposing a tax on people who get health coverage from their employer.”

Wilensky said that as an economist, getting rid of the tax exclusion for employer-provided health insurance would put her “and all the other economists in seventh heaven.” Economists have argued for years that having the tax code favor benefits over cash wages encourages overly generous insurance and overuse of health services.

But at the same time, she added, “I am painfully aware of how unpopular my most favored change would be.”

Republicans will have one other option if and when they try to replace the ACA’s benefits — not paying for them at all, thus adding to the federal deficit.

While that sounds unlikely for a party dedicated to fiscal responsibility, it wouldn’t be unprecedented. In 2003 the huge Medicare prescription drug law was passed by a Republican Congress — with no specified funding to pay for the benefits.

Republished under a creative commons license via Kaiser Health News.

Trump action on health care could cost Planned Parenthood

One of President-elect Donald Trump’s first, and defining, acts next year could come on Republican legislation to cut off taxpayer money from Planned Parenthood.

Trump sent mixed signals during the campaign about the 100-year-old organization, which provides birth control, abortions and various women’s health services. Trump said “millions of women are helped by Planned Parenthood,” but he also endorsed efforts to defund it. Trump once described himself as “very pro-choice.” Now he’s in the anti-abortion camp.

The Republican also has been steadfast in calling for repeal of President Barack Obama’s health care law and the GOP-led Congress is eager to comply.

One of the first pieces of legislation will be a repeal measure that’s paired with cutting off money for Planned Parenthood.

While the GOP may delay the impact of scuttling the law for almost four years, denying Planned Parenthood roughly $400 million in Medicaid funds would take effect immediately.

“We’ve already shown what we believe with respect to funding of Planned Parenthood,” House Speaker Paul Ryan, R-Wis., told reporters last month. “Our position has not changed.”

Legislation to both repeal the law and cut Planned Parenthood funds for services to low-income women moved through Congress along party lines last year. Obama vetoed it; Trump’s win removes any obstacle.

Cutting off Planned Parenthood from taxpayer money is a long-sought dream of social conservatives, but it’s a loser in the minds of some GOP strategists.

Planned Parenthood is loathed by anti-abortion activists who are the backbone of the GOP coalition. Polls, however, show that the group is favorably viewed by a sizable majority of Americans — 59 percent in a Gallup survey last year, including more than one-third of Republicans.

“Defunding Planned Parenthood as one of their first acts in the New Year would be devastating for millions of families and a huge mistake by Republicans,” said incoming Senate Minority Leader Charles Schumer, D-N.Y.

Democrats pledge to defend the group and they point to the issue of birth control and women’s health as helping them win Senate races in New Hampshire and Nevada this year. They argue that Trump would be leading off with a political loser.

But if he were to have second thoughts and if the Planned Parenthood provision were to be dropped from the health law repeal, then social conservatives probably would erupt.

“They may well be able to succeed, but the women of America are going to know what that means,” said Rep. Diana DeGette, D-Colo., citing reduced access to services Planned Parenthood clinics provide. “And we’re going to call Republicans on the carpet for that.”

At least one Republican senator, Susan Collins of Maine, may oppose the effort.

Collins has defended Planned Parenthood, saying it “provides important family planning, cancer screening, and basic preventive health care services to millions of women across the country.” She voted against the health overhaul repeal last year as a result.

Continued opposition from Collins, which appears likely, would put the repeal measure on a knife’s edge in the Senate, where Republicans will have a 52-48 majority next year.

Senate GOP leaders could afford to lose just one other Republican.

Anti-abortion conservatives have long tried to cut Planned Parenthood funds, arguing that reimbursements for nonabortion services such as gynecological exams help subsidize abortions. Though Planned Parenthood says it performed 324,000 abortions in 2014, the most recent year tallied, the vast majority of women seek out contraception, testing and treatment of sexually transmitted diseases, and other services including cancer screenings.

The defunding measure would take away roughly $400 million in Medicaid money from the group in the year after enactment, according to the nonpartisan Congressional Budget Office, and would result in roughly 400,000 women losing access to care.

One factor is that being enrolled in Medicaid doesn’t guarantee access to a doctor, so women denied Medicaid services from Planned Parenthood may not be able to find replacement care.

Planned Parenthood says private contributions are way up since the election, but that they are not a permanent replacement for federal reimbursements. “We’re going to fight like hell to make sure our doors stay open,” said Planned Parenthood spokeswoman Erica Sackin.

For Trump and GOP, ‘Obamacare’ repeal is complex and risky

Here’s the idea: Swiftly pass a repeal of President Barack Obama’s health care law, perhaps soon enough for Donald Trump to sign it the day he takes the presidential oath.

Then approve legislation restructuring the nation’s huge and convoluted health care system — despite Republican divisions, Democratic opposition and millions of jittery constituents.

What could go wrong?

With Republicans controlling the White House and Congress in January, they’re faced with delivering on their long-time promise to repeal and replace “Obamacare.”

Here are hurdles they’ll face:

SPEED VS DELIBERATION

Trump and congressional Republicans will be under intense pressure from their core conservative supporters to repeal Obama’s 2010 health care law — and fast. After all, Congress already sent Obama a repeal bill last January, which he vetoed, and many GOP voters will see no reason for delays this time.

But there probably won’t be anything fast about Congress’ effort to replace Obama’s law, which is likely to take many months.

While the replacement effort is underway, Republicans will risk aggravating up to 30 million people who are covered by the law or buy policies with prices affected by its insurance marketplace. Democrats will be sure to accuse the GOP of threatening the health care of millions.

A SOLUTION

Nothing’s been decided, but here’s one likely scenario:

The new Congress, which convenes Jan. 3, tries to quickly approve legislation repealing Obama’s health care law, maybe completing it by Trump’s Jan. 20 inauguration or soon after. But the repeal would not take effect until the future, perhaps a year later, to give lawmakers time to fashion a replacement. The version Obama vetoed had a two-year delay.

Seemingly acknowledging that two-step process, Vice President-elect Mike Pence said Sunday on “Fox News Sunday” that Trump “wants to focus out of the gate on repealing Obamacare and beginning the process of replacing Obamacare.”

Because Republicans will control the Senate by just 52-48, Congress will first have to approve special budget procedures to prevent Democrats from stopping repeal legislation by filibuster. Bill-killing filibusters require 60 votes to end.

But those special rules would apply only to items that affect the federal budget. Republicans, for example, would need a simple Senate majority to end IRS penalties against people who don’t buy insurance but would still need 60 votes — requiring Democratic support — for other changes such as raising limits on older people’s premiums.

House Budget Committee Chairman Tom Price, R-Ga., says that will restrain Republicans’ ability to ram a “lock, stock and barrel” repeal through Congress.

GOP RISKS

One GOP danger: Congress and Trump might repeal Obama’s law, but while they’re laboring on a replacement, nervous insurance companies begin pulling out of markets and raising premiums. Insurers have been doing that under Obama, but now it would occur under a Republican government.

Another hazard: Congress’ work could spill into the 2018 campaign season, when the entire House and a third of the Senate face re-election. Republicans will grow increasingly timid about anything that might anger voters.

“We want to be the rescue party instead of the party that pushes millions of Americans who are hanging by the edge of their fingernails over the cliff,” says Sen. Lamar Alexander, R-Tenn., who chairs the Senate Health committee.

GOP PATHWAYS

Virtually all Republicans want to get rid of the health law’s mandates that individuals buy coverage or risk IRS fines, and that large employers insure workers.

They also want to erase taxes on higher-earning people and the health care sector. And they’d like to retain parts of the law guaranteeing coverage for people with pre-existing medical problems and keeping children under age 26 on family plans.

Unifying Republicans much beyond that is a work in progress.

Trump’s health care views have varied and lack detail. His campaign website touts tax deductions for health insurance premiums and permitting policies to be sold across state lines. He’d also revamp Medicaid, which subsidizes health coverage for low-income people, directing fixed amounts of money to states and letting them structure benefits.

House Speaker Paul Ryan, R-Wis., last summer unveiled an outline of the House GOP’s solution, though it lacked cost estimates and details. It would provide tax credits, impose taxes on the most generous employer-provided health care plans, revamp Medicaid and let Medicare beneficiaries pick private plans instead of today’s fee-for-service coverage.

Senate Finance Committee Chairman Orrin Hatch, R-Utah, has also advanced a framework relying heavily on tax credits.

REMAINING QUESTIONS

Thirty-one states — including Pence’s Indiana, where he is governor — plus the District of Columbia have expanded Medicaid coverage to 9 million additional people under Obama’s law. Curtailing that program will divide Republicans.

Taxing the value of some employer-provided health plans, aimed at curbing the growth of costs, is “a political land mine,” says GOP economist Douglas Holtz-Eakin. Republicans have long resisted tax increases.

Obama’s law mandates coverage for individuals because without that requirement many healthy people would forgo policies, driving up costs for everyone else and destabilizing insurance markets. Ryan has proposed shielding people from higher premiums if they’ve had “continuous coverage,” allowing higher rates for people who have not had policies, but Republicans have yet to decide how to keep insurance markets viable.

Newtown families’ lawsuit against gun maker dismissed

A judge has dismissed a wrongful-death lawsuit by Newtown, Connecticut, families against the maker of the rifle used in the Sandy Hook Elementary School shooting massacre.

The judge cited an embattled federal law that shields gun manufacturers from most lawsuits over criminal use of their products.

State Superior Court Judge Barbara Bellis granted a motion by Remington Arms to strike the lawsuit by the families of nine children and adults killed and a teacher who survived the Dec. 14, 2012, school attack, in which a gunman killed 20 first-graders and six educators with a Bushmaster AR-15-style rifle made by Remington.

The families were seeking to hold Remington accountable for selling what their lawyers called a semi-automatic rifle that is too dangerous for the public because it was designed as a military killing machine. Their lawyer vowed an immediate appeal of the ruling.

The judge agreed with attorneys for Madison, North Carolina-based Remington that the lawsuit should be dismissed under the federal Protection of Lawful Commerce in Arms Act, which was passed by Congress in 2005 and shields gun makers from liability when their firearms are used in crimes.

Advocates for gun control and against gun violence have criticized the law as special protection for gun makers.

It became an issue in the presidential campaign this year when Hillary Clinton, now the Democratic nominee, criticized then-challenger Bernie Sanders for his support of the law in 2005.

Sanders, a Vermont U.S. senator, is now backing a bill to repeal the law.

Lawyers for Remington said Congress passed the act after determining such lawsuits were an abuse of the legal system.

But the families’ attorneys argued the lawsuit was allowed under an exception in the federal law that allows litigation against companies that know, or should know, that their weapons are likely to be used in a way that risks injury to others, and the judge disagreed.

“While the families are obviously disappointed with the judge’s decision, this is not the end of the fight,” said Joshua Koskoff, a lawyer for the families. “We will appeal this decision immediately and continue our work to help prevent the next Sandy Hook from happening.”

Jonathan Whitcomb, an attorney for Remington Arms, declined to comment.

The company recently had been fighting to keep internal documents requested by the families from public view. The judge issued an order in August allowing certain documents containing trade secrets and other information to be kept from public view, but she said the order did not apply to all other documents in the case.

Besides Remington, other defendants in the lawsuit include firearms distributor Camfour and Riverview Gun Sales, the now-closed East Windsor store where the Newtown gunman’s mother legally bought the Bushmaster XM15-E2S rifle used in the shooting.

Gunman Adam Lanza, who was 20 years old, shot his mother to death at their Newtown home before driving to the school, where he killed 26 other people. He killed himself as police arrived.

GOP bill to repeal health care law pointless political theater, say Dems

The GOP-led Congress sent legislation to President Barack Obama on Jan. 6 repealing his signature health law, fulfilling a promise to Republican voters in a presidential election year but inviting a certain veto.

The nearly party-line vote in the House was 240-181. The legislation had already passed the Senate last year under special rules protecting it from Democratic obstruction, so it goes straight to the White House.

Republicans boasted of a signal achievement, saying they were forcing Obama to face up to the failures of his law while illustrating the stark political choices voters face.

“We are confronting the president with the hard, honest truth,” said Speaker Paul Ryan of Wisconsin. “Obamacare doesn’t work.”

Democrats called it pointless political theater that will have the same ultimate outcome as the 61 previous repeal votes that were blocked in the Senate, since Obama will veto the legislation.

“A bill that is going to the White House, that will get the fastest veto we’ve ever seen happen in this country, is a monumental vote?” said Rep. Jim McGovern, D-Mass. “This is just a waste of everyone’s time.”

Democratic presidential front-runner Hillary Clinton has decried the repeal legislation while leading GOP candidates applauded it. Ryan and other GOP leaders acknowledged it will take a Republican president to get rid of the law. But they said that is the point.

“It is our opportunity as Republicans to lay out the choice for the American people,” said Rep. Cathy McMorris Rodgers of Washington.

Majority Leader Kevin McCarthy of California predicted that a Republican president will be in the White House next year and Congress will pass the repeal legislation again, “but we won’t have to worry about a veto from the White House.”

For maximum visibility Republican leaders made the legislation, which also cuts federal funding for Planned Parenthood, their first major vote of 2016. Although they don’t command sufficient votes to override a presidential veto, they hope to schedule the override vote to coincide with the Jan. 22 March for Life in Washington commemorating the anniversary of the Supreme Court decision legalizing abortion.

Yet Ryan hedged when asked whether the House will ever vote on a GOP replacement to Obamacare. Ryan has pledged that the House will come up with its own plan this year, something the GOP has repeatedly promised but failed to do in the nearly six years since the law’s enactment. But he said details such as whether this plan will actually come to a vote have not been determined.

“Nothing’s been decided yet,” Ryan said. “Just wait.”

Three Republicans joined Democrats in voting against the repeal bill: Reps. Robert Dold of Illinois, and Richard Hanna and John Katko of New York. One Democrat voted for it: Rep. Collin Peterson of Minnesota.

The bill would dismantle the health law’s key pillars, including requirements that most people obtain coverage and larger employers offer it to workers.

It would eliminate the expansion of Medicaid coverage to additional lower-income people and the government’s subsidies for many who buy policies on newly created insurance marketplaces. And it would end taxes the law imposed to cover its costs.

More than 16 million Americans have gained health coverage since the law was enacted, according to government figures. They could risk losing it under the GOP approach. Republicans argue the health law has driven up costs and hurt consumers, and they promise “patient-centered” solutions in its place.

The bill would also terminate the roughly $450 million yearly in federal dollars that go to Planned Parenthood, about a third of its budget. A perennial target of conservatives, the group came under intensified GOP pressure last year over providing fetal tissue for research.

Planned Parenthood officials and Democratic lawmakers accused Republicans in floor debate of attacking women’s health. Republicans, in turn, took to the floor to critique Planned Parenthood in graphic terms, accusing the group of killing babies.

Health care repeal vote to open a political year in Congress

It’s been like a long-delayed New Year’s resolution for Republicans. But 2016 will be the year when they put legislation on President Barack Obama’s desk calling for the repeal of his health care law.

The president, of course, will veto the measure.

The bill undoing the president’s prized overhaul will be the first order of business when the House reconvenes this coming week, marking a sharply partisan start on Capitol Hill to a congressional year in which legislating may take a back seat to politics.

There are few areas of potential compromise between Obama and the GOP majority in the House and Senate in this election year, but plenty of opportunities for political haymaking during the presidential campaign season.

Obama will veto the health law repeal bill, which also would cut money for Planned Parenthood. The measure already has passed the Senate under special rules protecting it from Democratic obstruction. But that’s the point for Republicans, who intend to schedule a veto override vote for Jan. 22, when anti-abortion activists hold their annual march in Washington to mark the anniversary of the Supreme Court decision in 1973 that legalized abortion.

Despite dozens of past votes to repeal the health law in full or in part, Republicans never before have succeeded in sending a full repeal bill to the White House. They insist that doing so will fulfill promises to their constituents while highlighting the clear choice facing voters in the November presidential election.

Every Republican candidate has pledged to undo the health law. The Democrats running for president would keep it in place.

“You’re going to see us put a bill on the president’s desk going after Obamacare and Planned Parenthood so we’ll finally get a bill on his desk to veto,” House Speaker Paul Ryan, R-Wis., told conservative talk host Bill Bennett over the holidays.

“Then you’re going to see the House Republican Conference, working with our senators, coming out with a bold agenda that we’re going to lay out for the country, to say how we would do things very differently,” Ryan said.

In the Senate, which reconvenes Jan. 11, a week later than the House, early action will include a vote on a proposal by Sen. Rand Paul, the Kentucky Republican who is running for president, for an “audit” of the Federal Reserve. Democrats are likely to block it. But, like the health repeal bill in the House, the vote will answer conservative demands in an election year.

Also expected early in the Senate’s year is legislation dealing with Syrian refugees, following House passage of a bill clamping down on the refugee program. Conservatives were angry when the year ended without the bill advancing. Senate Republican leader Mitch McConnell of Kentucky promised a vote, though without specifying whether it would be the House bill or something else.

The House Benghazi committee will continue its investigation of the attacks that killed four Americans in Libya in 2012, with an interview of former CIA Director David Petraeus on Jan. 6. That comes amid new Democratic accusations of political motives aimed at Hillary Clinton after the committee chairman, Rep. Trey Gowdy, R-S.C., endorsed Sen. Marco Rubio, R-Fla. for president. Clinton, the front-runner for the Democratic presidential nomination, was secretary of state at the time of the Benghazi attacks.

The agenda promised by Ryan after succeeding former Rep. John Boehner, R-Ohio, as speaker last fall will begin to take shape at a House-Senate GOP retreat this month in Baltimore. Thus far Ryan has pledged efforts to overhaul the tax system and offer a Republican alternative to the health overhaul.

In the Senate, McConnell’s primary focus is protecting the handful of vulnerable Republican senators whose seats are at risk as Democrats fight to regain the Senate majority they lost a year ago. That means weighing the political risks and benefits of every potential vote to endangered incumbents in Ohio, Illinois, Wisconsin, Pennsylvania and New Hampshire.

That could determine whether McConnell allows criminal justice overhaul legislation _ the one issue cited by Obama and lawmakers of both parties as ripe for compromise _ to come to the floor.

McConnell already has suggested that prospects for approval of Obama’s long-sought Asia trade pact are dim, and the senator has ruled out major tax overhaul legislation as long as Obama is president.

McConnell could try to put his thumb on the scales of the presidential race with two GOP senators having emerged as leading contenders.

Sen. Ted Cruz of Texas has been a thorn in McConnell’s side, once calling the GOP leader a liar, and has frosty relations with his fellow senators. Rubio is on good terms with fellow lawmakers and has been endorsed by several of them. McConnell could schedule debate on an issue with the potential to favor Rubio politically over Cruz, such as National Security Agency wiretapping authority.

But McConnell insists he is staying out of it.

“We all have a big stake in having a nominee for president who can win, and that means carrying purple states, and I’m sure pulling for a nominee who can do that,” McConnell told The Associated Press, refusing to elaborate on who might fit that description.

Democrats push health care reform, GOP pushes repeal

Americans filled 4.3 billion prescriptions last year, and they’re still ailing from the skyrocketing cost of drugs.

Democratic presidential candidates Bernie Sanders and Hillary Rodham Clinton gave voice to patient problems and consumer complaints this fall, with both issuing plans to rein in outrageous prices for prescription medicine.

“The pharmaceutical industry has become a health hazard for the American people,” said Sanders, an independent senator from Vermont. “We now pay, by far, the highest prices in the world for prescription drugs and one in five Americans … cannot afford to fill the prescriptions their doctors write.”

In 2014, an estimated 34 million people could not fill their prescriptions because of costs. Surveys now show that about 70 percent of Americans believe drug costs are unreasonable and that drug companies put profits before people.

Those polls were conducted before Turing Pharmaceuticals CEO Martin Shkreli made headlines in September for raising by more than 5,000 percent the price of Daraprim, a medication used to treat toxoplasmosis in AIDS patients. 

Within hours of Turing purchasing the right to retail Daraprim, the price for a pill that’s been sold for $13.50  went to $750.

“For Turing to charge insurance companies and self-pay individuals with a cost (so much) greater for the same drug is unconscionable,” said Scott Caruthers, chief pharmacy officer of the AIDS Healthcare Foundation, the largest global AIDS group.

AHF president Michael Weinstein said Turing’s greed “is likely to go down in history as the straw that broke the camel’s back on drug pricing.”

Shkreli announced in late September that he would lower the cost “in response to the anger.”

Sanders, an advocate of universal health care, in mid-September released a prescription drug plan that said the federal government should use its bargaining power to negotiate with companies for better prices; allow imports from licensed Canadian pharmacies; prohibit deals that keep generics off the market; and require drug companies to report information affecting pricing.

Clinton, as first lady, led an effort blocked by congressional Republicans that would have provided comprehensive, universal health care. She responded to Turing’s price-gouging almost immediately, pledging on Twitter a plan to reform the prescription drug market that would “both protect consumers and promote innovation — while putting an end to profiteering.”

Clinton has since issued a series of proposals to address rising drug costs, including a monthly $250 cap on out-of-pocket drugs to help patients with chronic or serious health conditions.

The candidate also proposed requiring that health insurance plans provide for three sick visits per year without counting toward a patient’s annual deductible and offering a refundable tax credit of up to $5,000 for families for excessive out-of-pocket care costs.

“When Americans get sick, high costs shouldn’t prevent them from getting better,” Clinton said in a statement. “With deductibles rising so much faster than incomes, we must act to reduce the out-of-pocket costs families face.”

A survey recently released by the Henry J. Kaiser Family Foundation found that employer-sponsored health insurance premiums rose about 4 percent in 2015, considered a moderate increase. But since 2010, both the share of workers with deductibles and the size of the deductibles have increased sharply — about seven times over the rise in worker wages.

A recent Kaiser analysis found comparable countries outperforming the United States on life expectancy at birth, cost-related barriers to health care access and the burden of disease, which takes into account years of lost life due to premature death and years of life lost to poor health.

The Obama administration expects to see improvements as more people have greater access to care under the five-year-old Affordable Care Act, which mandated insurance coverage, expanded eligibility for Medicaid, prohibited insurers from denying coverage for pre-existing conditions, provided for preventative care and lifted lifetime health benefit caps.

New data from the U.S. Census Bureau shows that the national uninsured rate dropped to a historic low of 9.2 percent in early 2015, with 15.8 million people gaining coverage since the health care marketplaces opened in 2013.

Still, the GOP focus in the health care debate is almost solely on repealing the Affordable Care Act. Congressional Republicans have voted more than 50 times to repeal all or parts of the law and, on Sept. 29, they voted again to advance legislation that would dismantle the ACA.

The House Ways and Means Committee chaired by Wisconsin Congressman Paul Ryan voted along party lines to repeal the mandate requiring Americans to get health insurance and also the mandate requiring larger companies to provide health benefits to employees.

Ryan, in a statement, said, “This bill is a big step toward dismantling Obamacare. … By tearing down many of the worst parts of the law — like forcing people to buy insurance only to later tax them for it — we would stop Obamacare in its tracks and start working toward a more affordable, higher-quality, patient-centered system.”

Wisconsin Gov. Scott Walker also wants the Affordable Care Act repealed, although health care advocates in the state maintain provisions have mostly benefited Wisconsinites.

“The ACA has dramatically reduced the number of uninsured in Wisconsin and improved access to preventive health care,” said Jon Peacock, research director for the nonprofit Wisconsin Council on Children and Families.

The WCCF said by the end of June, more than 230,000 Wisconsinites had signed up for a marketplace plan under the ACA and about 90 percent were eligible for tax credits to offset costs.

Respect for Marriage bill reintroduced in Congress

The sunny day Floridians Joe Williams and Peter Rostenkowski skipped down the steps of their county courthouse with a marriage license in hand, a Florida congresswoman reintroduced legislation aimed at guaranteeing them access to full marriage benefits.

Same-sex couples began marrying in much of the Sunshine State at the stroke of midnight on Jan. 6.

Also that day, a Republican from Miami-Dade, U.S. Rep. Ileana Ros-Lehtinen, joined U.S. Rep. Jerrold Nadler, D-N.Y., in reintroducing the Respect for Marriage Act, legislation aimed at fully repealing the 1996 Defense of Marriage Act.

The Supreme Court partially overturned DOMA in 2013, but still in place is Section 2, which allows states to refuse to recognize valid legal marriages of same-sex couples. Also, there is no uniform standard on marriage for federal purposes.

“We must finish the job begun by the Supreme Court by passing the Respect for Marriage Act,” Nadler said. “The Supreme Court has ruled that Section 3 of DOMA is unconstitutional, but Congress still must repeal the law in its entirety.”

U.S. Sen. Dianne Feinstein of California introduced a companion bill, which would provide a uniform rule for recognizing couples under federal law, ensuring benefits and rights of marriage regardless of where lawfully married couples reside

In June 2014, a year after the Supreme Court ruling on DOMA, the U.S. Justice Department issued a finding that without legislation repealing DOMA, married same-sex couples still may be denied critical federal benefits, specifically Social Security and veterans benefits that are issued based on the law of the state in which a married couple resides or resided. Currently under the law, if a same-sex couple married in Wisconsin then moved to Texas, where a marriage ban remains, and one spouse died, the widow or widower likely would be denied Social Security spousal survivor benefits.

“The Respect for Marriage Act would ensure equal treatment under federal law and finally put to rest the awful consequences of DOMA,” said U.S. Rep. Mark Pocan of Wisconsin, a co-sponsor of RMA.

U.S. Rep. Gwen Moore of Wisconsin also is a co-sponsor.

Back in Florida, Williams and Rostenkowski, who’ve been together 33 years,  wanted to get their license the first day possible. But they don’t plan to marry until Valentine’s Day.

“We’ve waited decades for this,” Williams said. “We can wait long enough to plan a marvelous wedding.”

Florida, whose 19.9 million people make it the nation’s third-largest state, became the 36th where same-sex couples could marry. It likely will become a mecca for gay couples seeking destination weddings.

Florida Attorney General Pam Bondi, however, continues to defend the marriage ban and wants final rulings on the issue from state and federal courts.

Her position led clerks in some conservative counties to shut down marriage ceremonies at the courthouses on Jan. 6.

Elsewhere, mass weddings took place at courthouses and city halls, including in Broward and Palm Beach counties and Orlando. 

In Miami-Dade County, more than 100 same-sex couples received marriage licenses on Jan. 6 and more than 20 married at the courthouse.

Push to repeal law protecting transgender students fails in California

Opponents of a new California law that provides transgender students certain rights in public schools failed to gather enough voter signatures to place a referendum to repeal the law on the November ballot.

At least 504,760 signatures were required to force a public vote on the statute approved by the California Legislature and signed by Gov. Jerry Brown last year. The law’s opponents submitted 619,387, but county election officers determined that just 487,484 of them were valid, according to a final count posted on the secretary of state’s website on Feb. 24.

The law took effect Jan. 1. It guarantees students in grades K-12 the right to use the school restrooms and to participate in the sex-segregated activities that correspond with their expressed genders instead of their school records.

The coalition of religious conservative groups behind the repeal effort said it violates the privacy of youngsters who may be uncomfortable sharing facilities with classmates of the opposite biological sex. The law’s supporters said it is needed to provide statewide consistency and to improve the school experiences of young people who decide to live by a gender different from the one they had at birth.

If the referendum had made the ballot, the law would have been put on hold until after the election as its supporters and opponents mounted a campaign that promised to be as bitterly fought as the one over Proposition 8, the 2008 constitutional amendment that banned same-sex marriage in California until last year.

Karen England of the Privacy for All Students coalition said the proposed referendum’s backers are not conceding defeat. They plan to review the disqualified signatures and, depending what they find, go to court to try to get enough of them added to the final tally so the measure would have to go before voters.

“We are preparing for the next stage of the battle,” England said in a statement. “After months of waiting, we now get to see why so many signatures were thrown out. Certainly some signers were not registered to vote or had moved without changing their address. But it is also certain that many of those signatures were rejected based on reasons that will not survive a legal challenge.”

California is the first state to detail the rights of transgender students in schools by statute.

Some school districts around California, as well as the education departments in Massachusetts and Connecticut, have implemented similar policies by regulation.

Although the law’s opponents have focused on potential abuses and awkward encounters in bathrooms and locker rooms, school districts have taken it as a mandate to evaluate yearbook photo dress codes, sleeping arrangements for overnight field trips and activities such as choirs and recreational sports where girls and boys are often separated.

Some have also given students who object to using restrooms or locker rooms with transgender classmates the option of using staff restrooms.

“This law gives schools the guidelines and flexibility to create an environment where all kids have the opportunity to learn. We need to focus on creating an environment where every student is able to do well and graduate. This law is about doing what’s best for all students,” said Masen Davis, executive director of the Transgender Law Center in Oakland.