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Vox Sentences: CBOh that's another very bad health care score

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New health care bill, same as the old health care bill.

CBOh man

JANESVILLE, WI - AUGUST 09: House Speaker Paul Ryan (R-WI) speaks at his Primary Night press conference, August 9, 2016 in Janesville, Wisconsin. Ryan defeated Republican challenger, Paul Nehlen for the first district primary election. Darren Hauck/Getty Images
  • Nearly three weeks after the House voted to pass it, the Congressional Budget Office finally has estimates for how many people will lose insurance under the latest version of the American Health Care Act, and how much it will cut the deficit. [CBO]
  • Whereas the first version of the bill, which the CBO examined in March, would cost 24 million people health care, the new version only denies coverage to … 23 million people.
  • Since the first version, the bill has been changed to include a large ($117 billion over 10 years) subsidy so that states can set up “high-risk pools” that subsidize insurance for very sick people with very large medical bills. It also added an amendment allowing states to waive certain protections for people with preexisting conditions, and to allow insurance plans to cover fewer services now deemed essential. [Vox / Sarah Kliff]
  • Those two provisions combined to make the bill cost more (it now only cuts the deficit by $119 billion over 10 years, versus $337 billion in the first bill), but that dramatically higher cost doesn’t seem to translate into much more coverage. The changes cost about $20,800 per new person covered, per year. By contrast, Obamacare’s Medicaid expansion costs about $6,365 per newly eligible adult. [Center for Medicare & Medicaid Services]
  • Rather than using Medicaid to cheaply expand access to health care, the bill cuts it dramatically, to the tune of $834 billion over 10 years. That’s a cut of nearly a quarter, and will deny 14 million people health insurance. [Vox / Dylan Scott]
  • So are Republicans going to back away? It doesn’t look likely. In a statement, House Speaker Paul Ryan declared, “This CBO report again confirms that the American Health Care Act achieves our mission: lowering premiums and lowering the deficit.” (It doesn't achieve this for everyone. The report finds that low-income 64-year-olds will see premiums go up by more than 800 percent.) [Paul Ryan​]
  • Health and Human Services Secretary Tom Price, by contrast, disputed the score: "The CBO was wrong when they analyzed Obamacare's effect on cost and coverage, and they are wrong again." [Phil Mattingly]
  • That said, the ball is now in the Senate's court. And many Senate Republicans in states that expanded Medicaid appear to oppose the sweeping cuts in the AHCA. Then again, Ted Cruz and Mike Lee want even bigger cuts. So who knows which faction will win the internal fight. [Politico / Burgess Everett and Adam Cancryn]

A big win for the Taiwanese LGBTQ rights lobby

SAM YEH/AFP/Getty Images
  • The Constitutional Court of Taiwan — the island’s highest court — ruled Wednesday that the federal law preventing same-sex marriage is unconstitutional and must be changed. [Vox / Sarah Wildman]
  • The ruling gives the legislature two years to pass a bill providing for same-sex marriage; otherwise, same-sex couples will simply be allowed by default to marry in the same way heterosexual couples can.
  • Such a bill, as it happens, is waiting in the legislature, where it was debated last fall (though it stalled before Wednesday’s ruling) amid spirited protests both for and against it, featuring the occasional physical altercation between protesters. [CNA / Chen Chih-chung, Justin Su and Lilian Wu]
  • The dual strategy of legislation and litigation might sound familiar to Americans. And like the US — but unlike other countries in Asia — Taiwan has a relatively well-established and organized LGBTQ rights movement. [AP]
  • Indeed, to some in Taiwan the fight over marriage has become a symbol of the island’s leadership on democratization in the region. [The Economist]
  • But the push for same-sex marriage has also galvanized Taiwan’s Christians — only 5 percent of the population — into an organized political opposition force. [The Japan Times / Jeff Kingston]
  • Now the fight shifts back to the legislature — with LGBTQ rights advocates pushing for same-sex couples to simply be included in the existing civil code and Christian opponents pushing for a new, separate institution. [BBC / Cindy Sui​]

Principled dealism

President Trump Attends Summit With Arab Nations Photo by Thaer Ghanaim/PPO via Getty Images
  • In Saudi Arabia over the weekend, President Trump outlined a policy of “principled realism” in the Middle East. Now, after he’s left, the dust is beginning to settle and we’re beginning to see what that means. [Washington Post / Quinn Mecham]
  • On one level, Trump was siding forcefully with the region’s Sunni powers (led by Saudi Arabia) over its Shiite ones (led by Iran). [Slate / Fred Kaplan]
  • The power struggle between the Saudi and Iranian governments (which is at least as geopolitical as it is religious) has been going on for decades, and has arguably served to destabilize the region (with, for example, both sides aiding factions in the current Yemeni civil war). [NYT / Max Fisher]
  • The US has traditionally sided with the Saudis — even Barack Obama, who made overtures to Iran, wasn’t quite neutral. But Trump appears to be pursuing a different strategy from his predecessor: giving Sunni countries victories first, and hoping they’re inspired to listen to the US later. [Washington Post / Marc Lynch]
  • Instead, some leaders are taking it as an endorsement of their current (often less-than-democratic) regimes. In Bahrain, for example, the government launched a raid on an opposition stronghold just days after Trump’s speech. [AP / Jon Grambell]
  • But it’s also emboldening some Sunni countries against other Sunni countries. On Wednesday, Saudi Arabia and the United Arab Emirates started criticizing the government of Qatar over comments supposedly made by its emir — even after the Qatari government stated that the comments were fake news. [Reuters / William Maclean]
  • Qatar has had a hot-and-cold relationship with other Sunni countries for a few years, in part because it’s wary of going too hard against Iran — or Islamist groups other countries consider extremist. [FT / Simeon Kerr]
  • To some observers, this is a sign that Trump is doing good things for the region, and that by characterizing Sunni countries as bulwarks against extremism, he’s inspiring them to act the part. [Foreign Policy / John Hannah]
  • But it’s a slightly awkward characterization when Saudi Arabia has started lobbying the president for a change to a US law that allows American victims of 9/11 to sue the Saudi government for sponsoring terrorism. [McClatchy / Anita Kumar​]


  • Ivanka Trump wants to combat human trafficking, and is consulting countless lobbyists and sex work prohibitionists. But she isn't consulting any actual sex workers. That’s a problem. [Pacific Standard / Melissa Gira Grant]
  • Pittsburgh was promised free driverless car rides from Uber. Now it turns out they're not free, the project is not creating the jobs it promised, and Pittsburgh is souring on the whole idea. [NYT / Cecilia Kang]
  • Mexico’s deadliness has been greatly exaggerated. I mean, it’s not great, but it’s not a war zone. [Washington Post / Brian Phillips]
  • What it's like to write AI software that puts your dad out of a job. [Snips / Rand Hindi]
  • Pulling carbon dioxide out of the atmosphere would be an elegant way to help tackle global warming. But many scientists believe it's impossible to make that strategy cost-effective. [Washington Post / Chelsea Harvey]


  • "'Say, Ted,' I smiled. 'I did a rewrite of Amy's joke, and I think it's a lot better. Want to hear it?' … Ted was still smiling. 'Sure!' 'Okay. Here it is: "When most people think of a cruise that's full of shit, they think of Carnival. But we think of Ted."' And there went Ted's smile. For once, he had no words." [Al Franken via Jonathan Tilove]
  • “Each vlogging channel is like a miniature Truman Show, filmed and edited by Truman himself.” [A.V. Club / Caroline Siede]
  • “It is no longer acceptable to have the mass media react to [terrorist attacks] again and again as if the killers were the shadow producers of a reprehensible reality show on TV.” [BuzzFeed / Zeynep Tufekci]
  • “At the checked bag line we told the ticketing agent that our cat was one of our carry-ons. We were charged the American Airlines one-time domestic carry-on pet travel fee of $125. We got a ticket for her, too, but it did not say ‘Reggie’ like I had hoped.” [The Billfold / Ali Kelley]
  • “Steve Jobs and Mark Zuckerberg are associated with signature outfits — a black, mock turtleneck for the former and a gray T-shirt and hoodie for the latter. Zuckerberg explained: ‘I really want to clear my life to make it so that I have to make as few decisions as possible about anything except how to best serve [Facebook’s] community.’ So, fashion and formality are frivolous? That’s the same logic that killed off the lavish ensembles of the French court and made way for the post-Revolution sack suit, a change that set a standard for menswear for nearly two centuries.” [The Atlantic / Deirdre Clemente]

Watch this: Scientists really aren’t the best champions of climate change

Facts and data alone won’t inspire people to take action in the fight against global warming. So what will? [University of California, Vox]

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