Contributor Post Created with Sketch. Get It Together, Senators

 

Good news: Republican members of the US Senate are excited to repeal and replace ObamaCare. Bad news: Even at this late date, they can’t decide on how to do so.

Via the WSJ, one plan comes from Senators Susan Collins (R-ME) and Bill Cassidy (R-LA), who describe it as an “an off-ramp” for the GOP and, likely, amenable enough to Democrats to overcome a filibuster:

The bill would take major decisions out of the hands of Congress and let states choose whether to keep the current law’s core insurance structure, with the promise that if a state opts out it will get the federal funding it would have received to enact its own ideas instead. […] The senators’ proposal, called The Patient Freedom Act of 2017, would effectively allow states to opt out of many of the provisions that form Title I of the Affordable Care Act, known as Obamacare, including the requirement that everyone must obtain health coverage or pay a penalty and an edict that insurers cannot charge older people significantly more than younger people.

States that do choose to drop the ACA would have to keep a handful of the requirements it imposes on insurance companies: that they allow parents to cover children as dependents up to age 26, pay claims without annual or lifetime limits, and issue policies to people with pre-existing conditions.

Those states could also choose to collect federal funds that, under the law, would have gone toward tax credits and the expansion of Medicaid eligibility, and use the money to give other health-care assistance to residents instead.

Another, bolder plan comes from Senator Rand Paul (R-KY). Via Reason:

Replaces the existing open-ended tax exclusion for employer-provided health insurance with a universal deduction on both income and payroll taxes that would provide the same level of benefit regardless of how an individual obtains their health insurance. […] The bill will also give “individuals the option of a tax credit of up to $5,000 per taxpayer for contributions to an HSA…. Removes the maximum allowable annual contribution, so that individuals may make unlimited contributions to an HSA….[and] Eliminates the requirement that a participant in an HSA be enrolled in a high deductible health care plan.”

[…] Paul’s bill also wants to make it easier for individuals “to pool together for the purposes of purchasing insurance” and thus “Amends the Public Health Service Act (PHSA) to allow individuals to pool together to provide for health benefits coverage through Individual Health Pools (IHPs). These can include nonprofit organizations (including churches, alumni associations, trade associations, other civic groups, or entities formed strictly for establishing an IHP) so long as the organization does not condition membership on any health status-related factor.”

To my mind, it’s embarrassing that the GOP hasn’t settled on something that would have been, more or less, ready to go last Friday. For reasons that I imagine are largely shared here, Paul’s plan strikes me as vastly superior: besides pushing federal health policy toward something that resembles an actual insurance market, anything that ends the tax discrimination against buying insurance directly immediately gets my attention. (“You had me at ‘universal deduction.'”) On the other hand, majorities are slim and Collins and Cassidy are likely right that we’ll need some Democratic defections.

Details on the Collins-Cassidy Plan here and Paul’s here.

Thoughts, Ricochet?

There are 35 comments.

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  1. Columbo Member

    If Susan Collin’s name is attached to it … just say NO!

    • #1
    • January 26, 2017, at 7:00 AM PST
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  2. KC Mulville Inactive

    That was the opportunity cost of Obamacare … in their rush to push through a healthcare policy for political reasons, the Democrats by-passed and short-circuited the required vetting of different ideas. As it stands, in reality, there are so many moving parts in a healthcare policy that it should take a prudent amount of time to sort them out.

    Healthcare is another proof of Sowell’s dictum: there are only tradeoffs. Settling on the best mixture of tradeoffs is something that you can’t do behind closed doors, as Hillarycare and Obamacare tried to do.

    I hate to say it, but if you really want to do justice to the topic, you’re going to need a lot of time and a lot of debate. That won’t be politically attractive, but it will be honest.

    • #2
    • January 26, 2017, at 7:06 AM PST
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  3. MarciN Member

    It was a difficult and complicated problem eight years ago, and today it is much more so because of the addition of the ACA complications.

    The feds should get out of healthcare altogether. Human services is one economic sector where economies of scale completely fall apart.

    • #3
    • January 26, 2017, at 7:08 AM PST
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  4. The (apathetic) King Prawn Member

    As my kids are reaching the end of their usefulness as tax deductions I think the Paul plan looks better. Anything I can do to keep more of my income shielded from the IRS will win my support.

    • #4
    • January 26, 2017, at 7:12 AM PST
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  5. Seawriter Member

    Folks seem to forget it took over a year to pass Obamacare. The idea it could be repealed and replaced in January 2017 always struck me as . . . well . . . overoptimistic.

    Seawriter

    • #5
    • January 26, 2017, at 7:29 AM PST
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  6. dittoheadadt Inactive

    If it’s “amenable enough to Democrats,” y’know, the same folks who gave us the craptastic Obamacare, then IMO it should be DOA.

    • #6
    • January 26, 2017, at 7:39 AM PST
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  7. Jager Coolidge
    Jager Joined in the first year of Ricochet Ricochet Charter Member

    Seawriter (View Comment):
    Folks seem to forget it took over a year to pass Obamacare. The idea it could be repealed and replaced in January 2017 always struck me as . . . well . . . overoptimistic.

    Seawriter

    It does not strike me as overoptimisic. It frankly depresses me to no end.

    Obamacare has been the law since March 2010. No Republican voted for it and they have wanted to get rid of it for 6 years. How is it that in 6 years of opposing this law Republicans have not put together a useful replacement plan?

    So yeah, it should be easy to replace January 2017 because they have had 6 years, not just a couple months, to create the major framework for the replacement plan.

    • #7
    • January 26, 2017, at 8:41 AM PST
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  8. Vance Richards Member
    Vance Richards Joined in the first year of Ricochet Ricochet Charter Member

    Tom Meyer, Ed.: To my mind, it’s embarrassing that the GOP hasn’t settled on something that would have been, more or less, ready to go last Friday.

    Yeah, they had a few years to prepare something. I guess they didn’t really expect to win on election day (but then that was a couple of months ago).

    • #8
    • January 26, 2017, at 8:50 AM PST
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  9. Bob Thompson Member

    Tom Meyer, Ed.: To my mind, it’s embarrassing that the GOP hasn’t settled on something that would have been, more or less, ready to go last Friday

    Don’t be embarrassed, it is unrealistic to think that a group needing to come together would do so before circumstances enabled them to actually pass a bill. Unless, of course, you favor the approach used by Pelosi/Reid in the passage of the ACA where you had to pass the bill to know what was in it and pity the poor Democrat who rose in opposition to anything the leadership was putting on the table. I support total repeal of ACA and let a market-based solution form. Preservation of employer participation group plans and an equalization of tax benefits for individuals, which I think is in Paul’s approach, is needed

    • #9
    • January 26, 2017, at 8:56 AM PST
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  10. Aaron Miller Member
    Aaron Miller Joined in the first year of Ricochet Ricochet Charter Member

    KC Mulville (View Comment):
    I hate to say it, but if you really want to do justice to the topic, you’re going to need a lot of time and a lot of debate. That won’t be politically attractive, but it will be honest.

    So repeal now and take their sweet time on replacement. Why do Republicans concede the fantasy that circumstances were worse before Obamacare?

    Of course, Obamacare has messed up many things so repeal would not reset us to those same circumstances. Even so.

    • #10
    • January 26, 2017, at 9:06 AM PST
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  11. Jager Coolidge
    Jager Joined in the first year of Ricochet Ricochet Charter Member

    Bob Thompson (View Comment):
    Unless, of course, you favor the approach used by Pelosi/Reid in the passage of the ACA where you had to pass the bill to know what was in it and pity the poor Democrat who rose in opposition to anything the leadership was putting on the table

    I think about this differently. I don’t want to pass a bill to know what is in it. I think there has been plenty of time since ACA was enacted for us to know exactly what is in the replacement plan.

    We have been told the Republicans oppose the ACA. The Republican House has taken multiple votes to repeal. These Congressmen should have be curious about what happens next.

    Senators have stated that Repeal would not work, that they needed to Repeal and Replace. Ok great, they should have taken that next step. Replace with what?

    There could have been a vigorous debate over the last four years. They could have hashed out a plan. This would help them now, but it would have helped before to inoculate them against the constant Democrat/Media line that the Republicans who want to Repeal Obamacare have no plan on healthcare.

    • #11
    • January 26, 2017, at 9:11 AM PST
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  12. KC Mulville Inactive

    Aaron Miller (View Comment):So repeal now and take their sweet time on replacement. Why do Republicans concede the fantasy that circumstances were worse before Obamacare?

    Of course, Obamacare has messed up many things so repeal would not reset us to those same circumstances. Even so.

    The pre-Obamacare period was a mix of private sector dysfunction and heavy regulation; the Obamacare period was public sector dysfunction. If you repeal without a replacement, all you get is dysfunction in both forms. Without regulation in this environment, for instance, insurance companies have no incentive to pay for anyone with pre-existing conditions. The current costs aren’t going to drop, but all those pre-existers will be left out.

    I’m hoping that opening up the ability buy across state lines will happen quickly, and that should ease the transition into what’s coming next.

    • #12
    • January 26, 2017, at 9:31 AM PST
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  13. JcTPatriot Inactive

    First of all, I am having more and more difficulty accepting anything that comes out of the mouths of the people at WSJ. But ignoring that…

    I am fine with multiple plans and debating the merits of each. Obamacare from the beginning was one huge behemoth of a plan, no you can’t read it, no we won’t change it, no we won’t debate it, just shut your pie-holes and vote on it, yes or no. The only “debating” that was done was done by Obama pulling in his “moderates” and telling them what would happen to their families if they voted against it, the last one being a 45-minute plane ride with Kucinich to “convince him” to vote yes.

    We’ve waited 8 years for this. We can stand a couple months of debate, Tom. Patience will be rewarded.

    • #13
    • January 26, 2017, at 9:41 AM PST
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  14. Robert McReynolds Inactive

    Nope not good enough Senators Collin and Cassidy. Opting out of the mandate will basically mean that the mandate still exists because no state is going to opt out, particularly if you are a Blue state. Who receives the money collected from the fine/tax?

    Once again we see the GOP in a position to act on behalf of freedom and instead they act on behalf of themselves and their damned chairmanships. Repeal the damned thing or be honest with your voters in that you were lying the whole time you said you wanted to repeal. Quit jerking us around. #NoLongerVotingForYou #GOPisGuttlessOldPeople

    • #14
    • January 26, 2017, at 9:53 AM PST
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  15. Bob Thompson Member

    Jager (View Comment):
    I think about this differently. I don’t want to pass a bill to know what is in it. I think there has been plenty of time since ACA was enacted for us to know exactly what is in the replacement plan.

    I don’t know this stuff in great detail but if Obamacare is repealed it seems at that point there are many plans in existence already that insurers can begin to modify and tailor to fit classes of insured since all the baggage they had to include in every plan to meet the ACA are no longer applicable. There are clearly a few things that require some legislative replacement action but nothing like what was in the ACA. Between Tom Price and those who worked with him in the House and the Senators who have worked on this, they can do it quickly. Nothing will be perfect and as the competitive market begins creating things new challenges will arise but that’s ok. It’s not like 2009 when the Democrats were doing all they could to make things as bad as possible pointing toward nationalizing all healthcare.

    • #15
    • January 26, 2017, at 10:00 AM PST
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  16. Mike H Coolidge

    Seawriter (View Comment):
    Folks seem to forget it took over a year to pass Obamacare. The idea it could be repealed and replaced in January 2017 always struck me as . . . well . . . overoptimistic.

    Seawriter

    Well, they’ve had 7 years to come up with something.

    • #16
    • January 26, 2017, at 10:22 AM PST
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  17. Bob Thompson Member

    Mike H (View Comment):

    Seawriter (View Comment):
    Folks seem to forget it took over a year to pass Obamacare. The idea it could be repealed and replaced in January 2017 always struck me as . . . well . . . overoptimistic.

    Seawriter

    Well, they’ve had 7 years to come up with something.

    You write this as if the organization is static with the same people in all the key spots. And the ACA has not been operating even half of 7 years. And a couple of major pieces may be significantly different, interstate insurance, coverage for pre-existing conditions, and tax treatment. Not to mention that no serious debate occurred when repeal bills were presented and there was no reason to have such debates, Now there is.

    • #17
    • January 26, 2017, at 10:30 AM PST
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  18. JcTPatriot Inactive

    Robert McReynolds (View Comment):
    Nope not good enough Senators Collin and Cassidy. Opting out of the mandate will basically mean that the mandate still exists because no state is going to opt out, particularly if you are a Blue state. Who receives the money collected from the fine/tax?

    Once again we see the GOP in a position to act on behalf of freedom and instead they act on behalf of themselves and their damned chairmanships. Repeal the damned thing or be honest with your voters in that you were lying the whole time you said you wanted to repeal. Quit jerking us around. #NoLongerVotingForYou #GOPisGuttlessOldPeople

    Great idea. Let’s just all throw in the towel and give up on everything, before the first week of Trump’s Presidency is over. It’s been a whole week and nothing has changed, screw it I’m moving to Canada.

    • #18
    • January 26, 2017, at 10:31 AM PST
    • Like
  19. Umbra Fractus Coolidge
    Umbra Fractus Joined in the first year of Ricochet Ricochet Charter Member

    Collins/Cassidy is DOA for me because it keeps the pre-existing conditions mandate. That’s what’s driving costs up in the first place.

    I like the Paul plan (based solely on Tom’s blurb,) but I’m not sure it could get past a filibuster.

    • #19
    • January 26, 2017, at 10:39 AM PST
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  20. Jager Coolidge
    Jager Joined in the first year of Ricochet Ricochet Charter Member

    JcTPatriot (View Comment):
    Great idea. Let’s just all throw in the towel and give up on everything, before the first week of Trump’s Presidency is over. It’s been a whole week and nothing has changed, screw it I’m moving to Canada.

    I don’t think that is entirely fair. Robert panned one of the two Senate plans in this OP, that represents one of a dozen different GOP plans out there. Hating the Collins plan is not really the same as giving up on everything because the world is not perfect a week into a new Presidency.

    • #20
    • January 26, 2017, at 10:45 AM PST
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  21. The (apathetic) King Prawn Member

    Umbra Fractus (View Comment):
    Collins/Cassidy is DOA for me because it keeps the pre-existing conditions mandate. That’s what’s driving costs up in the first place.

    That’s the most popular part of OCare. People really want people to not be turned away from getting “insurance” simply because they need it. Of course, this makes it a collectivist payment scheme rather than actual insurance, but that is what people want. What they don’t like is being forced to participate, but collectivism only works if everyone is forced to participate. People want it both ways. Republicans really only have two choices here: be right or be liked.

    • #21
    • January 26, 2017, at 11:18 AM PST
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  22. Bob Thompson Member

    The King Prawn (View Comment):

    Umbra Fractus (View Comment):
    Collins/Cassidy is DOA for me because it keeps the pre-existing conditions mandate. That’s what’s driving costs up in the first place.

    That’s the most popular part of OCare. People really want people to not be turned away from getting “insurance” simply because they need it. Of course, this makes it a collectivist payment scheme rather than actual insurance, but that is what people want. What they don’t like is being forced to participate, but collectivism only works if everyone is forced to participate. People want it both ways. Republicans really only have two choices here: be right or be liked.

    Whoa. Who says there cannot be a market based approach to all except those with pre-existing conditions and then some state-based programs to assist those with pre-existing conditions in some ways similar to what different states now have for uninsurable drivers? There’s a need to get even this piece away from Washington.

    • #22
    • January 26, 2017, at 11:48 AM PST
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  23. iWe Reagan
    iWe Joined in the first year of Ricochet Ricochet Charter Member

    Why not just pass Mark Price’s bill that the house passed when there was no chance of the President signing it?

    • #23
    • January 26, 2017, at 11:49 AM PST
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  24. Jager Coolidge
    Jager Joined in the first year of Ricochet Ricochet Charter Member

    Bob Thompson (View Comment):

    The King Prawn (View Comment):

    Umbra Fractus (View Comment):
    Collins/Cassidy is DOA for me because it keeps the pre-existing conditions mandate. That’s what’s driving costs up in the first place.

    That’s the most popular part of OCare. People really want people to not be turned away from getting “insurance” simply because they need it. Of course, this makes it a collectivist payment scheme rather than actual insurance, but that is what people want. What they don’t like is being forced to participate, but collectivism only works if everyone is forced to participate. People want it both ways. Republicans really only have two choices here: be right or be liked.

    Whoa. Who says there cannot be a market based approach to all except those with pre-existing conditions and then some state-based programs to assist those with pre-existing conditions in some ways similar to what different states now have for uninsurable drivers? There’s a need to get even this piece away from Washington.

    This system existed in 30 some states. They are called high risk pools. Many of these systems closed because of the ACA.

    • #24
    • January 26, 2017, at 12:37 PM PST
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  25. Leigh Member

    Mike H (View Comment):

    Seawriter (View Comment):
    Folks seem to forget it took over a year to pass Obamacare. The idea it could be repealed and replaced in January 2017 always struck me as . . . well . . . overoptimistic.

    Seawriter

    Well, they’ve had 7 years to come up with something.

    But to be fair, seven years ago they had no idea what the Senate would look like in January 2017.

    In fact, three months ago they had no idea what it would look like. There’s some margin for error but not a lot — flip a couple senate seats in either direction and the whole debate changes.

    • #25
    • January 26, 2017, at 4:34 PM PST
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  26. Bob Thompson Member

    Leigh (View Comment):

    Mike H (View Comment):

    Seawriter (View Comment):
    Folks seem to forget it took over a year to pass Obamacare. The idea it could be repealed and replaced in January 2017 always struck me as . . . well . . . overoptimistic.

    Seawriter

    Well, they’ve had 7 years to come up with something.

    But to be fair, seven years ago they had no idea what the Senate would look like in January 2017.

    In fact, three months ago they had no idea what it would look like. There’s some margin for error but not a lot — flip a couple senate seats in either direction and the whole debate changes.

    And the legislators may talk about alternatives but not seriously debate those during a period when they have no possibility of enacting anything. Now the can debate and then legislate.

    • #26
    • January 26, 2017, at 5:40 PM PST
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  27. Robert McReynolds Inactive

    Jager (View Comment):

    JcTPatriot (View Comment):
    Great idea. Let’s just all throw in the towel and give up on everything, before the first week of Trump’s Presidency is over. It’s been a whole week and nothing has changed, screw it I’m moving to Canada.

    I don’t think that is entirely fair. Robert panned one of the two Senate plans in this OP, that represents one of a dozen different GOP plans out there. Hating the Collins plan is not really the same as giving up on everything because the world is not perfect a week into a new Presidency.

    Yeah this is kind of my point. Any plan that leaves any semblance of the mandate validates Obama, so why bother replacing it if you agree that the general government can coerce you into commerce you might not want to engage in? If the GOP thinks that they can punt removing the mandate to the states and claim success, then they are going to lose me as a supporter.

    • #27
    • January 27, 2017, at 6:48 AM PST
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  28. Mike H Coolidge

    Leigh (View Comment):

    Mike H (View Comment):

    Seawriter (View Comment):
    Folks seem to forget it took over a year to pass Obamacare. The idea it could be repealed and replaced in January 2017 always struck me as . . . well . . . overoptimistic.

    Seawriter

    Well, they’ve had 7 years to come up with something.

    But to be fair, seven years ago they had no idea what the Senate would look like in January 2017.

    In fact, three months ago they had no idea what it would look like. There’s some margin for error but not a lot — flip a couple senate seats in either direction and the whole debate changes.

    Shouldn’t they have been ready for it from day 1? You don’t need to know the makeup of Congress to come up with a framework that is amenable to the vast majority of Republicans. Seriously, defending them on this is just ridiculous. You would never give the other party that kind of slack.

    • #28
    • January 27, 2017, at 8:30 AM PST
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  29. Duane Oyen Member
    Duane Oyen Joined in the first year of Ricochet Ricochet Charter Member

    The fundamental problem for the GOP is unchanged- a significant group of perfectionist “conservatives” and “libertarians” (the Constitutional perfectionist smallest-government-possible “Baptists“) still wants to eliminate- not reform- all federal health care programs, and now sees the golden opportunity to do so. They will try to block all replacement attempts, regardless of content or mechanism. The Dems (the “Bootleggers“) will be happy to cooperate, helping the GOP commit political suicide- to hasten the advent of Single Payer.

    James Capretta discussed this in his recent Ricochet podcast appearance with James Pethokoukis. He pointed put that fashioning an adequate position to the Repeal and Replace quandary will require a lot of Hill Republicans to accept some ideas and spending in the form of subsidies that will be uncomfortable given historic positions. I believe that the problem is with persons who reflexively identify GW Bush as a big government liberal because of Medicare Part D, and Romney as a traitor because of the Massachusetts plan. Actual contextual understanding of both programs shows both men to have been solidly conservative and maximally pragmatic in what they accepted, in order to prevent far worse inevitabilities.

    The federal and state governments have screwed up the health care market in ways that will require drastic changes and interim transition costs in order to fix. Shakespeare pointed out, the “fault lies not in our stars, but in ourselves, that we are underlings.” We need to stop complaining and fashion market-friendly, consumer-driven federally-enabled health care.

    • #29
    • January 27, 2017, at 8:33 AM PST
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  30. Jager Coolidge
    Jager Joined in the first year of Ricochet Ricochet Charter Member

    Bob Thompson (View Comment):

    Leigh (View Comment):

    Mike H (View Comment):

    Seawriter (View Comment):
    Folks seem to forget it took over a year to pass Obamacare. The idea it could be repealed and replaced in January 2017 always struck me as . . . well . . . overoptimistic.

    Seawriter

    Well, they’ve had 7 years to come up with something.

    But to be fair, seven years ago they had no idea what the Senate would look like in January 2017.

    In fact, three months ago they had no idea what it would look like. There’s some margin for error but not a lot — flip a couple senate seats in either direction and the whole debate changes.

    And the legislators may talk about alternatives but not seriously debate those during a period when they have no possibility of enacting anything. Now the can debate and then legislate.

    That just isn’t my experience at least at the State Level. A lot of the “serious debate” happens before the bill is drafted. The idea is to introduce a bill that has a good chance of succeeding. You know who your supporters are, your sponsors and co-sponsors before a bill is drafted. You address the concerns of people nominally on your side of the issue before there is a a debate on anything. When a bill is introduced you already know who supports you, who opposes you and who you can convenience.

    Frankly there should be 3-4 plans ready to go and ready to be debated.

    • #30
    • January 27, 2017, at 8:47 AM PST
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