Make America Great At Last

(Scott Threlkeld/AP)

A sense of our own greatness has always been part of the American psyche. And not without reason. A fresh start in a new land with unexplored but limitless potential. Manifest destiny leading us across a magnificent continent, brimming with resources– and pesky natives. Development of a robust economic engine, fueled in part by the labor and expendable lives of an enslaved population. The endurance of, and prevailing over: civil war, world wars, economic depression. The status of being the envy of the world for our democratic freedoms, standard of living, and independent, self-sufficient lifestyle.

A sense of this greatness diminishing was the basis for the Trump phenomenon in 2016. Trump identified the genuine and poignant plight of a segment of working Americans whose livelihoods and towns have been deteriorating in the face of advancing technology and world economic forces. He successfully exploited it with the time-tested strategy of scapegoating immigrants with different shade skin.

I first witnessed this strategy in action in January, 2016. My daughter lives in Vermont and has her office in Burlington’s Flynn Center for the Performing Arts. The Trump campaign chose this location, three blocks from Bernie Sanders’s campaign headquarters, for a January 7 rally. Stacy sent me links to coverage of the event, including a phone video that someone attending had recorded.

At that early date, the hallmarks of Trump’s campaign were already appallingly evident: the lies about crowd sizes (“25,000 people are in line outside” when it was actually 2,000); the xenophobic hate speech; the incitement to physical violence (“Get them out! Get them out!” to encourage physical removal of anyone suspected of not being a real supporter); the promise to make America great again.

The campaign unleashed racial resentment and hatred that had never disappeared from our society, but had been suppressed by judicial progress and evolving awareness and conscience among a majority of citizens. The victory in the election validated what the campaign had exposed.

We have seen this resurgence of racism in many forms. The emboldening of white supremacists. Violence and vandalism against Muslims and mosques. Physical and vocal antagonism in schools, north and south. Policies and budgets in Congress and statehouses that disfavor immigrants and the poor.

And it is playing out in the South over the issue of removing Confederate monuments from public spaces.

This is what I’ve been getting at. In an odd way, I wonder if there is a silver lining in the storm clouds. It is difficult to engage with attitudes that lie below the surface. But Trumpism has given “political correctness” a negative connotation, while simultaneously encouraging expression of long suppressed racial resentments. The controversy over the meaning of Confederate monuments is putting those attitudes on open display.

Charlottesville, VA, has faced protests to its recent decision to remove a prominent statue of General Robert E. Lee. State lawmakers have lined up on either side of the issue. About two weeks ago, white supremacist leader, Richard Spencer, led a protest in front of the statue, complete with torches but minus the robes. You may recall that Spencer achieved prominence with his “Hail Trump” appearance at a white nationalist conference in DC shortly after the election. This protest elicited many public denunciations and expressions of support.

Richmond, VA, the capital of the Confederacy, has also revived its previously unsuccessful campaign to remove six Civil War statues from its famed Monument Avenue. Public polls and media commentary abound.

People celebrating the removal of a statue of Robert E. Lee in New Orleans on Tuesday. Credit Edmund D. Fountain for The New York Times
People celebrating the removal of a statue of Robert E. Lee in New Orleans on Tuesday. Credit Edmund D. Fountain for The New York Times

Perhaps New Orleans presents the most interesting example of this public discourse. As you probably know, the city council voted to remove four statues  in different parts of the city and relocate them in a museum to provide historical context. Fearing violent protests, the first three were removed at night. The last, a 16 foot bronze figure of General Lee, was removed in the light of day on May 19. No violence occurred.

Not that some did not think that violence was called for. The next day, state representative Karl Oliver, Republican, made this Facebook post:

The destruction of these monuments, erected in the loving memory of our family and fellow Southern Americans, is both heinous and horrific. If the, and I use this term extremely loosely, “leadership” of Louisiana wishes to, in a Nazi-ish fashion, burn books or destroy historical monuments of OUR HISTORY, they should be LYNCHED! Let it be known, I will do all in my power to prevent this from happening in our State.

Let me restate that, to make sure you got it. A sitting state legislator called for the LYNCHING! of other public officials whose actions he disagreed with. Nicely symbolic form of execution, I’ll give him that.

I’m happy to report that Rep. Oliver has been roundly condemned for his post by members of both parties and stripped of his committee chairmanship. Racism boldly, and baldly, expressed in public is rarely an attractive thing, save to other die-hard racists. That is why I have hope, albeit slim, that the Trump brand of nationalism could result in a greater number of Americans seeing it more clearly and rejecting it.

Mayor Mitch Landrieu’s speech on May 19 regarding the meaning of removal of four Confederate monuments in New Orleans.

How might that look? New Orleans Mayor Mitch Landrieu gave a remarkable speech on the same morning the Lee statue was being removed. The vision he eloquently proposed is both aspirational and attainable. The entire speech is here. If you would like just some of the highlights, try here. But this is the part that best speaks to the point of this post (bolding is mine):

A friend asked me to consider these four monuments from the perspective of an African American mother or father trying to explain to their fifth grade daughter who Robert E. Lee is and why he stands atop of our beautiful city. Can you do it? Can you look into that young girl’s eyes and convince her that Robert E. Lee is there to encourage her? Do you think she will feel inspired and hopeful by that story? Do these monuments help her see a future with limitless potential? Have you ever thought that if her potential is limited, yours and mine are too? We all know the answer to these very simple questions. When you look into this child’s eyes is the moment when the searing truth comes into focus for us. This is the moment when we know what is right and what we must do. We can’t walk away from this truth.

I am aware that in some places and circumstances, I could be pilloried for saying or even implying that America is not great. It’s just that saying it doesn’t make it so. Neither does a slogan on a baseball cap. Neither, it turns out, does electing the first African-American President. If only it were so easy.

No, there are many many things about America that are great. And she has, perhaps more than most if not all other countries, the potential for greatness. But to realize that potential, to become truly great at last, the potential must be equally available to all within her borders. Because when some are denied, oppressed, slighted, or attacked, we all fall short.

This Can’t Continue! Can It?

I cannot believe I’m saying this, but it may be time to start thinking about the 2018 elections. “Sure,” I can hear you thinking, “right after I finish hot waxing myself and listening to a 2-hour compilation of Kellyanne Conway’s most irritating interviews.”

But, any American citizen who is appalled at the spectacle of immense power in the hands of an “infantalist”, as David Brooks called him, needs to think in practical terms about what it is going to take to get Trump out of office. And whether there is anything we can do about it besides wish.

We are starting to see the term “tipping point” appear with some frequency in the “failing” NY Times and the “dishonest” mainstream media in general. The reference is to the question of whether the self-sabotaging president has racked up enough offenses– against ethical standards, the constitution, intelligence protocol, etc.– and exhibited sufficiently shocking, irrational, unhinged behavior to spur Congress to finally fulfill its intended role as a check on an executive branch that is abusing its power.

It is my belief that, if the current avalanche of jaw-dropping events does not push House and Senate Republicans over that tipping point, it is unlikely to happen. Journalists are reporting that those legislators are increasingly expressing their dismay and concern off the record. But only the occasional lone voice, and none of the leadership, will publicly stand against the president.

Why is that? Primarily, you can chalk it up to three factors.

First, Trump voters don’t agree with you. Polls are showing almost no slippage in support on one vital question. Sizable numbers register disapproval for certain traits or actions, resulting in somewhat lower approval ratings since January. But 96% of those who voted for Trump still say they would vote for him now.

Again, why is that?! I expect you know. Read the polls (e.g. something like 85% of Republicans place more trust in Trump to tell the truth than the media) and listen to Trump voters interviewed about their reactions to current events. You find that they buy into the narrative that the president is trying to do what he promised, is being thwarted by (fill in the blank), and is being lied about in the press and by opponents.

Second, as long as this base does not erode, Reps in Congress believe they can’t afford to anger them and end up getting defeated in the primaries next year.

And third, they still have an agenda they know Trump will sign if he doesn’t get in the way of passing it: repeal and replace Obamacare, tax “reform” i.e. cuts, budget cuts, and regulatory cuts.

What it will take

If the current majority party does not act, the 2018 mid-terms become a referendum to elect to Congress those who will defend our democratic institutions and traditions, to say nothing of the constitution.

Every Democratic seat must be defended. Every current Republican incumbent must find him or herself challenged by the highest quality candidate possible. The process of identifying, vetting, and supporting those challengers needs to begin now.

If Democratic infighting can’t be banished, it at least needs to take a vacation. Encourage great local leaders to run. And to run positive primary campaigns that result in a general election candidate that enjoys united support.

There may be places where an Independent candidate emerges as the strongest option. There may even be situations where a moderate Republican who is also appalled at what has become of the party and the presidency turns out to be the smartest vote in order to oust the Trump-enabling incumbent.

The point is this. The portentous possibilities that were forewarned in 2016 of electing a man so unfit and unprepared are materializing with growing speed and impact. It should not be allowed to continue, but it may. If it does, we can shrug, console ourselves with Colbert, and gradually become desensitized to the new normal.

Or, we do what we can do. Support and read a vigilant press, keeping our opposition informed and intelligent rather than partisan. And act locally, while thinking nationally, to help elect a Congress who will be willing to fulfill its responsibility.

I would like my grandchildren to grow up in a great America. But excuse me if I choose Lincoln’s definition over Trump’s. That would be an America where the “government of the people, by the people, and for the people, shall not perish from the earth.”

It survived the Civil War. I think it can survive Trump.

Avoid Difficult End-of-Life Decisions: Make Them Now

It’s been a quiet week in Lake Trumpbegone. Scanning the news of the last week for anything related to the Donald, I just don’t seem to find anything of significance. Well, there was some FBI flap, North Korea shooting missiles toward Japan, a Kissinger sighting and threats of White House “tapes” in case the firing wasn’t Watergate-ish enough already. Oh, and unplanned or not, the big f*** you to the country in the form of Oval Office smiles and back-slapping with the Russian foreign minister and the Russian ambassador. Yes, the same ambassador that was meeting and phoning Trump campaigners during the election and transition. That was the next day after the humiliating purge of the chief investigator into Russia’s attack on our elections! Yada yada yada. Same old, same old.

So, it seemed a good opportunity for a break from the depressing topic of present day politics in America to talk about something marginally less gloomy– present day dying in America. I know. I must have a natural instinct for building readership.

This fun idea did not drop out of the blue. There was a recent article in the NY Times by Dhruv Khullar, M.D., M.P.P., a resident physician at Massachusetts General Hospital and Harvard Medical School, titled “We’re bad at death, can we talk?”  If you are a (SSA) card-carrying boomer, I strongly urge you to read this article. Preferably after finishing this one.

A Personal Perspective

Ann and I made the decision eight or nine years ago to see a family estate attorney in order to prepare documents that included wills, advance health care directives, and durable POAs (power of attorney) for health care decisions and finances/property.

What we thought would be a simple matter of signing some papers drawn from boilerplates turned into several days (our time, not billable hours) of enforced consideration. Given numerous document samples to work with, and the option to add and edit, we faced hypothetical calamities such as cancer, car crash, and Alzheimers. We also acknowledged the certainty of death. Not the someday we really don’t expect, but the one day we know will come.

If you’ve done this already, you understand what I mean when I say it was a positive experience. Assets in a will are easy. Get it done and you can check it off your list and congratulate yourself. But, considering the reality of your own death is major league stuff, as is who will speak for you if you are incapacitated and how you will know they understand what you would choose. First, you will need to know that yourself.

For us, the process I just described was a big part. The consultation with an attorney who specializes in family estate planning helped to broaden our thinking and realize the vital issues at stake. Reading, revising, and choosing what to include and what to exclude in the advance directive required that we confront some of our fundamental beliefs, values, preferences, and fears. For example, near the end, do you want to be kept alive under any circumstances with extraordinary medical intervention? Or, under certain circumstances, at a certain point, would you prefer to be kept as comfortable as possible and have as natural a death as possible? At home or in a hospital? What are those circumstances and what is that point?

Another factor in our thinking was what we observed in the gradual decline and deaths of our own parents, two with Alzheimers or dementia, along with second-hand observations of the same experiences of friends and friends’ loved ones. What we have seen has ranged from refusal to think or do anything about it to orderly and loving preparation. It goes without saying which approach has impressed us as preferable.

We ended up with a portfolio of documents, with paper and electronic copies for our children and medical providers, that are our best effort to come to terms with the later and last stages of our lives.

If you don’t have a similar set of papers already, here is why you should. Not someday, but now:

  1. It is a gift to your loved ones that cannot be overestimated. It is like the credit card commercial: attorney costs for us 8-9 years ago were about $1000, having it accomplished, priceless. (I’m only focusing on the health care directive and POA. The will and the financial/property POA were included and equally important.)
  2. If you don’t start it now, when will you? Answer: someday. That day might come too late.
  3. The choices that must be made when you are in a hospital are usually during either a crisis, when you are least able to think clearly, or you are unconscious. Thinking you will make these decisions “when the time comes” really means you are passing the buck to loved ones who cannot read your mind and who may not be able to think very clearly at that time either.
  4. You may find, like we did, that facing up to your mortality now, and all that implies, is good for the soul and instills the confidence that you will be ready to face it in fact when the time comes.

A National Perspective*

In the last 6 months of life, Americans make an average of 29 visits to the doctor. In the last 30 days, “half of Medicare patients go to an emergency department, one-third are admitted to an I.C.U., and one-fifth will have surgery.” This, in spite of surveys indicating that 80% express a preference to avoid hospitalization, especially intensive care, at the end.

We spend 6 times as much on Medicare patients in the last year of their lives than all other patients over 65 combined, and that last year accounts for 25% of all Medicare spending. That has been true for the past 30 years.

And yet:

Patients who engage in advance care planning are less likely to die in the hospital or to receive futile intensive care. Family members have fewer concerns and experience less emotional trauma if they have the opportunity to talk about their loved one’s wishes. And earlier access to palliative care has consistently been linked to fewer symptoms, less distress, better quality of life — and sometimes longer lives.     -Dhruv Khullar, M.D., NY Times

So, there is mounting evidence that most people want access to palliative (i.e. treating the symptoms, such as pain, of a condition) and hospice care and that such care produces better outcomes, a better quality of life…and death. There seem to be two main reasons it isn’t more prevalent.

The most obvious reason is that many people fail to make that preference known, either in the moment or with an advance directive. The other reason is that the hospital either fails to honor the preference or simply does not have the facility or resources to do so.

I don’t have data, but have read of the reluctance doctors and hospitals have to stop efforts to extend a patient’s life as long as there are any avenues remaining, even if the best that can be hoped for is a few more days at the expense of more suffering and more medical bills. This inclination is likely to become stronger as medical technology continues to advance. Our challenge as a society will be to weigh the benefit of the extended days against the quality of the person’s life and the right of that person to determine how it is lived and how it ends.

The individual’s choice becomes moot when living in a state or rural area where palliative and/or hospice services are restricted or unavailable. For example, nearly 90% of New England hospitals have palliative care services, whereas only about 40% of those in the South do. And, if a hospital does not have a palliative care program, it falls to individual doctors to discuss options with a terminal patient and family. Nearly 70% of doctors say they haven’t been trained in palliative or hospice care, with many uncertain of the distinction between them. And about half of doctors say they are uncomfortable discussing terminal illness.

Most of us can relate to that. It isn’t as much fun as, well, most topics. But that is not an excuse. Not for doctors. Not for boomers. We have lived our entire lives thinking the rules do not apply to us or we should at least get to set the rules ourselves. DT is a boomer, remember? Sorry, Donald. You– we– aren’t going to weasel out of this one. Or buy, bully, or bluster your way out of it.

So, why not make our final curtain a class act? Set it up now. Do it right. Make it a farewell that is an expression of your love and care.

 

*The source for information in this section is the article by Dhruv Khullar, M.D., which was cited and linked above.

Just Turn the Lights Off: A Trumpian Metaphor

If it weren’t happening against the backdrop of a potential Constitutional crisis, it would be humorous. Well, it’s actually kind of humorous anyway. But it is also a perfect metaphor for the Trump administration, as you will see.

On Tuesday, in an apparent attempt to match his boss’s classy behavior in notifying Director Comey of his firing via TV news, Sean Spicer and staff kept trying unsuccessfully to inform the press of the same news via an email statement, according to an article in the Washington Post. Finally giving up, after three hours of technical problems, Spicer stood in his office doorway and shouted an announcement to the reporters who were within shouting range. He then ducked inside and his staff locked the doors.

The White House was reportedly taken aback by the speed and harshness of the blowback, with criticism building from Republicans as well as Democrats. Having previously said there would be no more statements, Spicer and two staffers “were suddenly speed-walking up the White House drive to defend the president on CNN, Fox, and Fox Business,” where their reporters and camera crews did interviews with the White House itself as backdrop. Upon completing those, the intrepid press secretary was facing a conundrum.

It was now after sunset and Spicer found himself hiding in the hedges in the dark, wanting to hightail it back to his office. But between the bushes and the building were “a swarm of reporters wanting to know why President Trump suddenly decided to fire the FBI Director.”

After a few minutes, he sucked it up and emerged, telling the reporters he would answer some questions. But only with the cameras off.

“‘Just turn the lights off. Turn the lights off,’ he ordered. ‘We’ll take care of this. Can you just turn that light off?’ Spicer got his wish and was soon standing in near darkness…with more than a dozen reporters gathered around him.” After ten minutes of Q&A, he abruptly turned and escaped.

See what I mean? Metaphor, ready made. (If I thought the president might read this, however, I would definitely spell it out. You know what I mean if you saw the May Day interview of Trump in the Oval Office by CBS’s John Dickerson. Dickerson commented on the quote by George W. Bush regarding the office being oval and having no corners to hide in. Trump agreed that there are no corners, so the room has a certain openness and anyone outside looking in the windows would be able to see him, but of course no one could get that close. Dickerson started to explain that it was a metaphor, but gave up.)

But, back to Spicer’s metaphor. This anecdote unintentionally encapsulates the Trump administration modus operendi. Everything will be fine if we can just shed a little darkness on it. Fine for Trump. Not so much for our democracy.

Democracy Dies in Darkness

James Comey was just the most recent career law enforcement official to be fired by Trump while engaged in unwelcome investigations. Preet Bharara, the US Attorney for Southern New York, and Sally Yates, the acting US Attorney General, were let go with similarly suspicious timing. They, like Comey, had reputations for independence and integrity and were seen as threats to his independence.

An independent investigation of Russia’s influence on the Trump election by definition would shed much needed light. In spite of his erratic behavior regarding Clinton email, Comey’s FBI effort was seen as the best hope for that light and an honest report. On the other hand, the president and the Republicans on the congressional committees charged with that investigation have made their target anyone who can be found who has leaked information.

If these actions weren’t enough to prove the point, Trump tweets spell it out. With increasing stridency, he broadcasts his demands to stop the Russia investigation and find those who talk to reporters instead.

The battle lines are becoming clear. The Washington Post ran a front page article on Wednesday to give a more complete picture of all that transpired in the previous 24-48 hours. They cited 30 sources from the White House, Justice, and the FBI. Thirty. 3-0. These people don’t like what they are witnessing and want the rest of us to know about it.

Ah, yes. The press. To be fair, it is a thorn in the side, a pain in the neck (and lower) to all administrations. Their job, when they do it well, is to keep the government honest by keeping klieg lights on its activities. No one likes to be that exposed. But that is the price of democracy. And the media isn’t perfect, nor are politicians, so at times we just muddle through and count on checks and balances to keep the country on the rails.

What is brand new in 2017, totally unprecedented, is that this Oval Office occupant has declared war on the press and is waging that war daily. Consider:

  • Trump used his rallies and tweets for months to repeat epithets and slogans to demonize and undermine the press. This message became gospel for his congregation.
  • The ugly language and constant refrain of “fake news” aimed at the media continued and was amplified after assuming office.
  • In this environment, the State Department was stripped of most of its senior officers and staff, and a Secretary of State installed who refuses to engage with the press in any meaningful way.
  • The president’s spokespeople reflect his contempt in their own interactions with the “mainstream” media.
  • Numerous federal departments, under Trump appointees, instituted gag rules, prohibiting staff to communicate with the press or even with Congress. Some but not all of these have been walked back.
  • Access by the press to Spicer’s communications department has been restricted, at times with favorable access rewarding favorable coverage.
  • Updated item on May 12:        

I mentioned the Washington Post earlier. If you have read it in the past couple of months you have probably seen their masthead. Since February, they have added a motto for the first time ever. I was surprised to learn that it has been in the works for about a year, so was not a direct response to the Trump presidency. But it could have been and it resonates.

The executive branch clearly hates the glare of the light. The legislative is in the hands of a party that has shown little interest in flipping the switch yet. Fortunately the judiciary has so far shown a willingness to stand up to the challenges it has received. And the fourth estate is under attack. But, it seems that many in the press see this moment for what it is. A time to stand in the breach. A time to just turn the lights on.

 

Fake Win

I was working on a post for the blog when I read this column today by Maureen Dowd saying much the same thing, only better. I hope you will read it. The thing is, Trump neither knows nor much cares what is actually in the Republican health-care-for-the-young-and-healthy/tax-cut-for-the-wealthy bill. He expects to keep getting away with claiming things are great that aren’t– and selling them. He needed a health bill passed. No matter that it hurts most those who most need help. A win for him is a win, regardless of the lives trampled along the way. That is the art of his deal.

Trump: Hazardous to Our Health – The New York Times, by Maureen Dowd

President Trump sprinkling flimflam dust in the Rose Garden Thursday to deflect attention from the health care bill House Republicans had just passed. Credit Carlos Barria/Reuters

Repeal, Replace, Regurgitate

After several attempts to start this post, I need to give up on trying to be clever or intellectually rigorous, disciplined, or even organized in presentation. I’m just too disgusted and need to get it out of my system. The ongoing spectacle to repeal Obamacare and replace it with We-don’t-care is reaching it’s absurdly noxious climax this week. We are being treated to one of the most nauseating demonstrations of legislative sausage-making I can imagine. Repeal, Replace, Regurgitate.

It looks very possible that an $8 billion ruse is going to persuade enough moderate (what the hell does that mean here?) Republicans to vote for the House bill to pass it.

How did we get here?

After sixty-some safe and symbolic votes over the years to repeal the Affordable Care Act, someone threw the House Republicans a curve in November and delivered all three Houses– Representatives, Senate, White– and a mandate to do it for real. Several problems presented themselves early on.

Republicans, including Trump, had done a smashing job of convincing their base that Obamacare was evil, awful, and a disaster. So much so that a large percentage of those voters entered 2017 not realizing that the health care they had and counted on actually is Obamacare. Once that began to sink in, views on health care became a little less partisan for real people. They liked and needed what it provided.

The new President had been promising for months that he was going to replace it with something better. He had a plan and it was great. Ready any day now. No such plan existed.

Republicans had been saying or implying the same thing for years. But, sorry, no such plan existed.

It turns out that the only thing that has been uniting Congressional Republicans on health care is the political strategy of opposing Obamacare. When it comes to providing health care, their enthusiasm wanes and is scattered all over the map.

Folks like Ryan and his cohort want mostly to get government out of health care and any other entitlement program ASAP. If they could privatize completely, they gladly would but see the need to proceed cautiously. The Freedom Caucus has similar goals but has little interest in compromising or being cautious, even within the party. The so-called moderates see some value in providing actual health care, whether they are motivated politically or sincerely.

So, when the House came up with their first bill, you’ll remember that the Congressional Budget Office scored it and determined 24 million Americans would lose insurance by 2027. Premiums would be 15-20% higher for the first couple years, then about 10% lower by 2026. Medicaid reductions would account for many of the people thrown off care. Tax cuts would result for wealthier people and businesses.

That wasn’t painful enough for the Freedom Caucus, so they voted against and scuttled it.

Recently, with both Trump and the House under extreme pressure to deliver on their promise to repeal Obamacare (or something sorta kinda like a repeal that they can sell), a deal was struck with the hard right members. Several of the popular features of Obamacare– e.g. no refusal or penalty for pre-existing conditions, a list of required provisions for all plans– can now be eliminated by states with a waiver. The states would be required to have a high-risk pool for people who have pre-existing conditions. It is widely understood that these high-risk pools almost always run out of subsidies, resulting in skyrocketing premiums and loss of insurance.

A particularly sensitive and touching explanation for the removal of the guarantee of affordable coverage for families with pre-existing conditions was given by Rep. Mo Brooks (R-AL), who said these people will “contribute more to the insurance pool that helps offset all these costs, thereby reducing the costs to those people who lead good lives, they’re healthy, they’ve done the things to keep their bodies healthy. Right now, those are the people have done things the right way that are seeing their costs skyrocket.”

Contrast that remarkable statement with the one made a couple nights ago by Jimmy Kimmel. If you haven’t watched it, you should.

So, today a couple of the so-called moderates came up with an amendment to the bill that would add $8 billion over 5 years to supplement the insurance of people with pre-existing conditions. That is vastly less than the amount that will be required if, no, when many Red states choose to exempt themselves from full coverage for their people, which is inevitable perhaps for most states since the bill also calls for cutting and then limiting (block granting) money for Medicaid and for subsidies.

Conjecture is that this bandaid could be enough to assuage the consciences of a handful of legislators, enough to pass the bill on to the Senate.

What a hollow victory that would be. What a repulsive accomplishment.