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You are here: Home / Anderson On Health Insurance / Speed of Legislation vs Executive Action

Speed of Legislation vs Executive Action

by David Anderson|  November 12, 20247:28 am| 52 Comments

This post is in: Anderson On Health Insurance

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In comments yesterday, Ohio Mom raised a good question:

We were really looking forward to that $2,000 cap on drug purchases for people on Medicare. And idea David how that might shake out?

We had vague plans to replace the washer and dryer. Well, we know they have to be replaced, we were putting off thinking about the sequence of basement renovations. But with the threat of tariffs, time to get started comparison shopping.

She brings up a really important distinction.

Some things that could change need legislation. The $2000 Medicare Part D out of pocket limit is a creature of legislation. That could change if there are 218 votes in the House, 51 in the Senate and 1 signature in the White House. That will take time. It is not a January 21st problem.

There are many things in the health space that are legislative problems. A lot of them (most particularly Medicaid) will likely be sacrificed at the altar of upper income tax cuts but all of that needs legislation Nand that will give pressure points in a House with a 4 to 6 seat majority where the functional majority will be less as Trump raids safe GOP seats for staffing.

Tariffs are an executive action problem. These are things that can change on the stroke of a sharpie. The price structure of the US economy could be radically different on the morning of January 21st relative to the morning of January 20th.

Keep this distinction in mind — what needs Congress? What needs a Sharpie?

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52Comments

  1. 1.

    Chris Johnson

    November 12, 2024 at 7:40 am

    What’s happening is wild to see. In theory it’s within the parameters of what you’re talking about, and that’s the only way to keep ALL the ‘soft’ Trump voters on side. Things have to go in the direction they’ve been conditioned to expect, and the country has to prosper, and everything has to remain basically the same but better.

    In PRACTICE, what I see is scrambling in the ‘sharpie’ direction, a smash-and-grab. Except it’s really not about making Americans of any stripe wealthy. What I’m seeing is attempts to follow through on the worst of what Trump represents, if possible by freaking people out so bad everything blows up, and rather than the cruelty being the point (that represents a smaller group who aren’t fun to be around, and they’re the secret police now), the aftermath is the point.

    Russia has formally acknowledged they gave Trump his win and stated he owes them. Publically. It is bait, and it’s the simple truth (no tricky hacking, simply Musk-assisted, NYT-assisted manipulation over years).

    That means Russia runs us, and their only purpose is vengeance: America is to be reduced to a state lower than them. That takes some doing! It also requires that all Americans abandon everything else they’re doing, everything productive, and fall to fighting each other in blind rage.

    I’m sorry, I’m washing my hair that day. I’m carrying some cast-off clothes to the church to clothe the underprivileged. How’s the fifth of never work for ya, Russia? How about I turn to fighting my Trump-voting friends on the 357th of Noturday?

  2. 2.

    hrprogressive

    November 12, 2024 at 7:46 am

    Yeah I think the bigger worry is that if these people (from the Convicted Felon on down) just decide “To hell with laws and legislation, we’re just going to do what we want by fiat and dare anyone to stop us”.

    In such a scenario, everything becomes a sharpie.

    So in theory, things that aren’t “Jan 21st Problems” could become such problems.

    Of course, if that scenario actually plays out, we’ll all be worried about lot more than just things like Medicare out of pocket caps or whether or not to buy an appliance.

    Hopefully, you are right about the relative timing of these problems.

  3. 3.

    Suzanne

    November 12, 2024 at 7:49 am

    @Chris Johnson:

    It also requires that all Americans abandon everything else they’re doing, everything productive, and fall to fighting each other in blind rage. 

    Agree with you.
    I get the feeling that a lot of the Trumpies feel purposeless and directionless, and essentially want a big, defining struggle. But, like…. I’m not here for that.

    Watched an interesting TikTok video by a white MAGA guy talking about how he lies about his politics to get with liberal women. He says liberal women are hotter and nag less than conservative women. I LOLed. Dude may now be single forever.

  4. 4.

    Barry

    November 12, 2024 at 7:52 am

    IMHO, what will happen is that many, if not most things which theoretically require legislation could be shut down simply by blocking things.

  5. 5.

    Peale

    November 12, 2024 at 7:53 am

    Yeah. Was at the grocery store yesterday and looked at items that I might want to buy for Christmas that are likely to go up in price. Light bulbs, pens, printer toner. Oh and batteries. So I don’t know how well they store, but if you have medical device that requires a specialized battery, you might want to ask for that as a stocking stuffer.

  6. 6.

    TBone

    November 12, 2024 at 7:54 am

    This was eye-opening about Trump and Congress (he has already told them to go into Recess on Day One):

    https://www.msn.com/en-us/news/politics/maddow-trump-already-consolidating-power-despite-almost-guaranteed-obedience-from-gop-in-congress/vi-AA1tVgMs

  7. 7.

    TBone

    November 12, 2024 at 8:00 am

    @TBone: he wants to avoid ANY voting by the Senate so he can just proceed to make recess appointments, unilaterally.

    Unitary Executive.

  8. 8.

    Baud

    November 12, 2024 at 8:13 am

    @TBone:

    I believe they’ll have to jettison the filibuster to do it.

  9. 9.

    TBone

    November 12, 2024 at 8:17 am

    @Baud: to go into recess “just following orders” mode?

    He is already in the “bypassing Congress” stance and he’s still just “-elect.” (I will never refer to him in his soon to be official capacity, I just can’t.)

  10. 10.

    Ohio Mom

    November 12, 2024 at 8:18 am

    Would the nursing home industry go along with axing Medicaid? AARP would put up a fight too.

    As I’ve said too many times already, Medicaid and its Waivers are essential to the disability community. Medicaid Waivers pay for everything from group home staffing, transportation, day programs, etc., and oh yeah, health coverage. Which for disabled people with complex medical needs is what is keeping them alive.

    Of course, the lobbyists for the national disability community don’t have much leverage other than evoking pity and calls to do the right thing.

  11. 11.

    Baud

    November 12, 2024 at 8:19 am

    @TBone:

    Yes. I think they have to vote on recess so Dems can filibuster it. But I haven’t researched the point.

  12. 12.

    BritinChicago

    November 12, 2024 at 8:20 am

    The fact that tariffs are a matter for executive action rather than legislation means that we may see very soon after Inauguration Day how much of the bluster about them is real. (If I had to bet I’d bet no “not much”, but I’m not at all confident about that.) It may also mean that the administration becomes quite unpopular quite soon.

  13. 13.

    TBone

    November 12, 2024 at 8:21 am

    @Baud: good to know, I will look it up!

  14. 14.

    Baud

    November 12, 2024 at 8:22 am

    @Ohio Mom:

    Republicans don’t need anyone’s consent.

  15. 15.

    lowtechcyclist

    November 12, 2024 at 8:22 am

    @Baud:

    I believe they’ll have to jettison the filibuster to do it.

    If it’s something Trump wants, they’ll kill the filibuster to make it happen.  Or carve out a ‘just for this one kind of thing’ exception each time.  From their POV, the main purpose of the filibuster is to strangle the Dems with it if they ever regain control of Congress.

  16. 16.

    Baud

    November 12, 2024 at 8:24 am

    @lowtechcyclist:

    Sure. It’s their choice.

  17. 17.

    WereBear

    November 12, 2024 at 8:24 am

    Actually, if we deported the MAGAs to their country of genetic origin, and only let in new immigrants who had to study civics like naturalized citizens…

  18. 18.

    WereBear

    November 12, 2024 at 8:28 am

    @Ohio Mom: The nursing home industry will be bribed with another lucrative racket. Probably loot Medicare next, of course.

    The AARP is a glossy marketing organization, roping in all the seniors for direct mail solicitations.

    No, we’ll have to charge those Rascals and head for Washington ourselves.

    The Million Gray Hairs march.

  19. 19.

    JMG

    November 12, 2024 at 8:30 am

    @lowtechcyclist: Maybe Senate Republicans will kill the filibuster but maybe not. It serves to protect the majority as well as the minority, because it allows them to vote for unpopular legislation without the consequence of having it go into law.

  20. 20.

    TBone

    November 12, 2024 at 8:32 am

    @Baud: you are, as usual, correct – gah, concurrent resolution required and if we lose the House…

    My eyes glazed over a bit while reading up…starting on page 11, then in detail on page 15.  This is a .PDF so I don’t recommend clicking unless you don’t have to download:

    https://crsreports.congress.gov/product/pdf/R/R42977

  21. 21.

    Baud

    November 12, 2024 at 8:34 am

    @TBone:

    They’ll probably get the house. The question is whether a concurrent resolution can be filibustered. I think it can because I think the Republicans did this with Obama.

  22. 22.

    TBone

    November 12, 2024 at 8:34 am

    @Baud: 👍

    I guess I know just about as much of The Rules as Donold does.  I wasn’t interested in looking into it much before now.

    Seems like Calvinball.

  23. 23.

    Central Planning

    November 12, 2024 at 8:35 am

    My only hope (and I’m somewhat confident in this) is that the Johnson-led house continues to be disfunctional even with Groper Cleveland (I love that) in the whitehouse.

  24. 24.

    WereBear

    November 12, 2024 at 8:39 am

    @Central Planning: He only adds dysfunction.

    Maybe we should add something to all the recreational drugs in the White House pharmacy before we go. That seems to be the first place they would head to.

  25. 25.

    TBone

    November 12, 2024 at 8:40 am

    @WereBear: 😆👍

  26. 26.

    TBone

    November 12, 2024 at 8:42 am

    I’ma start calling them Quagmire.

    Giggity.

  27. 27.

    sixthdoctor

    November 12, 2024 at 8:43 am

    @Central Planning: I definitely think there are chaos and choke points that the non-Trump coalition can exploit that could help mitigate the damage around the margins. All of the worst people are in charge but a lot of them have different priorities so we might have a Mr. Burns’s diseases situation where the conflict could slow down damage in instances.

    Unfortunately it could only mean the difference between existentially terrible and very, very bad.

  28. 28.

    Suzanne

    November 12, 2024 at 8:47 am

    @Ohio Mom: Mr. Suzanne and I were discussing this yesterday. He is a special educator. Disability is one of those things that affects a lot of GOP people and their families. 20% of students have an IEP. Almost everyone has a relative who needs or needed long-term care.

    I don’t know if IGMFY, sparrows and curtain rods, etc. is powerful enough that people are going to give that up.

    More likely they find some way to convince themselves that TFG saved Medicaid and Special Education!

  29. 29.

    Central Planning

    November 12, 2024 at 8:48 am

    @sixthdoctor: ​
      I agree. I don’t think that this will make anything better, just less horrible (but still horrible)

  30. 30.

    Kristine

    November 12, 2024 at 8:49 am

    Thinking about Rachel’s point that the Senate would confirm his appointments anyway so why should they shut themselves down? We know they would roll over in private, but he’s now asking them to make it public and permanent. Senators have egos, too—some can be seen from space. Will they go along with that?

  31. 31.

    cmorenc

    November 12, 2024 at 8:49 am

    OT, but is Casey making up enough ground in the remaining uncounted Pa vote to have any realistic chance of pulling it out?  Or is the race still “uncalled” because technically there are enough outstanding votes for him to still narrowly win, but the % margin among them he’d need is unrealistic to expect?

  32. 32.

    Mai Naem mobile ¹

    November 12, 2024 at 8:51 am

    I just heard on the hourly news blurb that dog killer Kristi Noem is going to be the DHS secretary. I am thinking TFG is not hiring the best people.

  33. 33.

    Suzanne

    November 12, 2024 at 8:51 am

    @cmorenc: The second thing.

  34. 34.

    Kristine

    November 12, 2024 at 8:56 am

    @Mai Naem mobile ¹: Wondering if the overall incompetence can help mitigate the damage. And by “wondering,” I mean “hoping.”

    Dammit, some of my tax dollars will go toward their salaries. Another blow upon the bruises.

  35. 35.

    Mai Naem mobile ¹

    November 12, 2024 at 9:02 am

    @Central Planning: i think Johnson will keep the House people in line because POTUS is a GOPr and probably even easier  for him that there are so many MAGat Reps. Your only hope is that the numbers are so close that losing Stefanik or Walsz evens it up for 2-3 months. After that you can hope you’ve got some illnesses, family emergencies or deaths but that can happy to either party. It’s the Senate which can help mitigate some of the damage.

  36. 36.

    WereBear

    November 12, 2024 at 9:11 am

    @sixthdoctor: My rule is to dodge the existentially terrible, that’s just me.

  37. 37.

    WereBear

    November 12, 2024 at 9:13 am

    @Mai Naem mobile ¹: I believe the qualifications were, in the old SS, “will you kill your puppy?”

    She and the Huckabees are already there.

  38. 38.

    Mai Naem mobile ¹

    November 12, 2024 at 9:15 am

    @Kristine: I’m hoping that there’s enough electoral self preservation in the ‘moderate’ congress critters that they won’t go along with  everything tfg and his minions want. Ofcourse they might end up having to decide between being threatened by MAGats or being given some cushy gig on the wingnut welfare gig.

  39. 39.

    comrade scotts agenda of rage

    November 12, 2024 at 9:19 am

    @JMG:

    Maybe Senate Republicans will kill the filibuster but maybe not…

    I’m pretty sure Mitch “The Gravedigger of Democracy” said sometime after the election that the filibuster will remain.

    Of course I always believe everything he says. /s

  40. 40.

    azlib

    November 12, 2024 at 9:20 am

    One point is Trump does not give a crap about policy. He only ran to keep from going to prison. Also, under our Federal system there are many power points who will not want to give up their power. I predict there will be a lot of infighting and back stabbing. Just like his first administration, his second will be unpredictable and chaotic.

  41. 41.

    Kristine

    November 12, 2024 at 9:26 am

    @azlib: That’s my hope as well. So many of these personalities do not play well with others even when they’re on the same team.

  42. 42.

    Ohio Mom

    November 12, 2024 at 9:32 am

    @Suzanne: I am hazy on the details but I think I remember that Medicaid is a funding source for public school interventionists like SLPs and OTs. Or maybe that’s just Ohio — not every state provides disabled children with Medicaid Waivers but Ohio does.

    Somewhat off topic, Medicaid is a joint Federal-State program. The Feds set the broad parameters, within which each state fashioned their Medicaid Waiver program (services for disabled). Covering adults is mandatory, children are optional.

    The Feds match every dollar the State puts in, dollar for dollar. Unless it’s a poor Red (Taker) state, then the Feds put in a $1.50 or more for every dollar the state puts in.

    School-age interventions surely save money in the long run but I don’t have those statistics.

  43. 43.

    Ohio Mom

    November 12, 2024 at 9:36 am

    @Suzanne: And about: “Disability is one of those things that affects a lot of GOP people and their families. 20% of students have an IEP. Almost everyone has a relative who needs or needed long-term care.”

    I’ve had this discussion with this Republican parents of IEP kids before, they all believe that “They wouldn’t do that to *our* kids.” Leopards, meet faces.

  44. 44.

    BritinChicago

    November 12, 2024 at 9:43 am

    @JMG: That’s a good point, but some of us worry that these Republicans will pass the most damaging laws, even if they are very unpopular.

  45. 45.

    Suzanne

    November 12, 2024 at 10:02 am

    @Ohio Mom:

    I am hazy on the details but I think I remember that Medicaid is a funding source for public school interventionists like SLPs and OTs. 

    I think that’s the case in every state. Mr. Suzanne has to do a lot of Medicaid billing paperwork.

  46. 46.

    comrade scotts agenda of rage

    November 12, 2024 at 10:12 am

    @Ohio Mom:

    One of the guys in my gaming group is a middle-school special ed teacher in Estes Park.  I’ve spent the last four years being “regaled” with stories about his job.  He doesn’t get paid enough and the school district is already over-burdened (I don’t mean that the way it sounds) in terms of special ed teachers to students with IEPs.

    I’ve never asked him about funding, process, etc.  Sounds like that’ll be on the chit-chat agenda on Wednesday.  If they do get some kind of Federal dollars thru whatever mechanism and that gets cut, based on what he says, that particular district simply won’t have a program any more.

  47. 47.

    Chris Johnson

    November 12, 2024 at 10:15 am

    @Kristine: That’s fundamental.

    How long the regime lasts, depends on how successfully they can get the ‘enemies of the state’ to rise up, and how well they can keep the siloes insulated from each other.

    Pretty much at all costs they have to keep each side adamantly refusing to talk, and if possible, believing the other side is subhuman and can’t remotely be reasoned with. Only that will work.

    It’s very easy to see the messaging from within our silo (note: not one we chose, but it was constructed for us). We’ve been getting told every last enemy represents everything about the worst of them, even while they avoided even looking at their guy during the campaign. We’re told they worship and love him, yet look at the fucking crowd sizes.

    They’re of course being told we’re madmen wanting to murder them all. Lot of effort goes into all this. I think it falters if it’s too hard to keep up that level of silo-age. it’s got to be complicated to orchestrate, though it’s part of human nature, too.

  48. 48.

    Anonymous At Work

    November 12, 2024 at 10:17 am

    The point of Day 1 recess is to install Cabinet Secretaries without going through Senate confirmation procedures.  Last time, the Senate questioned Jefferson [Davis] Sessions III on his Russian contacts, leading to Mueller being run by Rosenstein, not Sessions.

    However, Democrats could, should, and have previously filibuster “recesses” to stop this from happening.  By 2018, The Convicted Felon’s appointees were dropping like flies and he was having trouble finding self-abasing toadies to replace them who could also survive Senate confirmation and background checks.  So, he started double-appointing the already confirmed members.

    Now, Senate Republicans can end the filibuster but probably won’t.  There’s too much long-term downside for them.  Everything they want is largely, or almost exclusively, a majority vote at this time: tax-cuts via budget reconciliation and judicial appointments.  It’s the Democrats’ agenda that gets stymied by the super-majority threshold.  There are a handful of Democrats that were fearful or protective of their privileges that kept Democrats from undoing the filibuster previously who would be empowered if Republicans did it first.

    Finally, let’s not forget that the filibuster largely protects “moderates” and radical centrists from taking difficult votes.  False-faced “moderates” like Suzie C from Maine can “support” something, knowing it won’t come to a vote.  Senate Republicans will now own everything The Convicted Felon does leading up to 2026 and 2028 elections (where I suspect the primary will devolve to DeSantis vs. Vance, determined by whose supporters can stop vomiting in disgust long enough to vote).

    CODA: A reminder that even Executive Action has to be enacted and regulations/SOPs promulgated before anything happens.  An Executive Action requiring the expulsion of all non-legal immigrants including asylum seekers and lawful refugees will take a long time to separate out binding treaty obligations, set up a process for review of cases, etc. for those whose status was changed.  For everyone else who already was undocumented, the Executive Action is literally meaningless, an excuse to sign a paper and hang it on the wall.  So, most Executive Actions will have delays.

  49. 49.

    Ohio Mom

    November 12, 2024 at 10:26 am

    @comrade scotts agenda of rage: It is a federal law that children with disability receive a “free and appropriate public education.” Parents already sue schools all the time when they think their child is not receiving an appropriate enough education.

    That law also mandates that the federal government help fund special ed, though they have never fully funded their promise. You friend is correct in that special ed is underfunded and undersupported even as their responsibilities have steadily increaesed.

    Anyway, how this all reconciled — the law requiring spec ed vs the dismantling of the government — remains to be seen. That’s true of just about every federal program and agency.

  50. 50.

    Anonymous At Work

    November 12, 2024 at 10:52 am

    @Ohio Mom: Undoing the Department of Education isn’t the same as zeroing out Special Education funding.  I think there’s enough Republicans either concerned about their districts in 2026 or concerned about the optics that the funding might end up moved to HHS.  It won’t be as efficiently administered but it won’t go away.  Same with Pell Grants.

  51. 51.

    Smiling Happy Guy (aka boatboy_srq)

    November 12, 2024 at 11:00 am

    I have a semi-related question. Does anyone think that pricing this holiday season will taken into account future tariffs? As in “no sales this Black Friday, but prices will be higher next year – so buy at retail now because things will be much more expensive later”?

    I am looking at a couple semi-discretionary purchases, and watching the discounts just fall off over the last week. I am imagining retailers pricing tariff premiums into 2025 stickers and counting on consumers not to notice.

    Wondering whether 2024 will be the last consumer spending binge, or a retail catastrophe own-goal.

  52. 52.

    artem1s

    November 12, 2024 at 3:35 pm

    @Suzanne: He says liberal women are hotter and nag less than conservative women. I LOLed. Dude may now be single forever.

    Wait. What? We were told liberal women were all ugly un-fuckable harpies. With canckles. And shrill voices. Who wouldn’t make me sammiches and force them to like cats.

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