The mock heroics of the Never Trump performance artists in the Congress continue apace. Every now and again, they throw another vote to keep the Affordable Care Act alive, but they do nothing to stop the ongoing sabotage deliberately designed to make the Act fail out in the country. This is true even in states with two Republican senators—like, say, Iowa. From The Washington Post:

For months, officials in Republican-controlled Iowa had sought federal permission to revitalize their ailing health-insurance marketplace. Then President Trump read about the request in a newspaper story and called the federal director weighing the application. Trump's message in late August was clear, according to individuals who spoke on the condition of anonymity to discuss private conversations: Tell Iowa no.

Hey, Senator Chuck? Senator Joni? He's playing you like he played all those landscapers and designers he stiffed through the years. Good morning, suckers.

HHS has told its regional administrators not to even meet with on-the-ground organizations about enrollment. The late decision, which department spokesman Matt Lloyd said was made because such groups organize and implement events "with their own agenda," left leaders of grass-roots organizations feeling stranded.



"I don't think it's too much to ask the agency tasked with outreach and enrollment to be involved with that," said Roy Mitchell, executive director for the Mississippi Health Advocacy Program, which receives no federal funding for its ACA efforts. "There's money for HHS to fly around on private jets, but there's not money and resources to do outreach in Mississippi."

Well-played, Roy Mitchell.

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And I would note to young master Lloyd: It is not an "agenda" to try and make sure a duly enacted statute actually works. In fact, it's what your boss swore to do. Honest. I was standing right there and the Hugest Crowd In Recorded History heard him, too. Of course, he is still an Angry Toddler. (H/T Quinn Cummings.)

It was a Wall Street Journal article about Iowa's request that provoked Trump's ire, according to an individual briefed on the exchange. The story detailed how officials had just submitted the application for a Section 1332 waiver — a provision that allows states to adjust how they are implementing the ACA as long as they can prove it would not translate into lost or less-affordable coverage. Iowa's aim was to foster more competition and better prices. The story said other states hoping to stabilize their situations were watching closely. Trump first tried to reach Price, the individual recounted, but the secretary was traveling in Asia and unavailable. The president then called Seema Verma, administrator of the Centers for Medicare and Medicaid Services, the agency charged with authorizing or rejecting Section 1332 applications. CMS had been working closely with Iowa as it fine-tuned its submission. State Insurance Commissioner Doug Ommen has repeatedly described the "Iowa Stopgap Measure" as critical to expanding marketplace options there. The plan would abolish the ACA exchange there and convert consumer subsidies into a type of GOP-styled tax credit. New financial buffers would help insurers handle customers with particularly high medical expenses. Without the measure, "over 20,000 middle class farmers, early retirees and self-employed Iowans will likely either go uninsured or leave Iowa," Ommen warned in a Sept. 19 statement.

They're screwing Oklahoma this way, too. Rubes.

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Charles P. Pierce Charles P Pierce is the author of four books, most recently Idiot America, and has been a working journalist since 1976.

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