4 stories that actually mattered this week

Washington’s long summer vacation headed toward a close with a pair of presidential speeches, one delivered formally and from a teleprompter, and the other delivered largely extemporaneously at a major rally. One announced that President Trump would adhere to a longstanding policy status quo on an important national security matter; the other signaled his return to his on-again off-again habit of feuding with members of his own party.

Meanwhile, the lower-key work of policy development continued apace — especially in health care, and especially in the states.

Here’s what you need to know.

Trump announced a “new” strategy for Afghanistan

In his first primetime national security address, Donald Trump unveiled his long-awaited new strategy for Afghanistan — largely a continuation of the existing strategy augmented with a few thousand additional soldiers.

Aamir Qureshi/AFP/Getty Images

• The plan: The core strategy — to use a combination of military pressure on the Taliban and diplomatic pressure on Pakistan to try to force elements of the Taliban to the bargaining table for a political settlement — is broadly similar to the Obama administration’s approach. The news is less the development of a new strategy than Trump abandoning his own history of calling for American troops to leave.
• The difference: The main difference is that while Obama felt that announcing withdrawal schedules in advance helped maintain pressure on the Afghan government to learn to stand on its own feet, Trump (and many in the military) believes an explicitly open-ended commitment puts more pressure on the Taliban.
• Democratic reaction: Congressional Democrats were largely critical of Trump’s approach, but mostly in somewhat unspecific ways. Few are willing to call for outright withdrawal, and few are willing to detail an alternative plan. Instead, criticisms mostly focused on process and the ways in which Trump’s dismantling of the State Department tend to undermine his strategy.

Republicans were consumed with weird infighting

Trump’s renewed commitment to the war in Afghanistan earned him plenty of unflattering coverage in Breitbart, once again helmed by former White House chief strategist Steve Bannon. And that was only one of several fronts on which Republicans spent the week fighting each other.

Nicholas Kamm, Saul Loeb/AFP/Getty Images)

• Breitbart is at war with H.R. McMaster: Breitbart’s criticism of Trump’s Afghanistan approach is part of a larger campaign against National Security Adviser H.R. McMaster, whom the site frequently castigates as a “globalist” who is undermining Trump’s populist philosophy.
• Trump slapped at Senate Republicans: At a rally in Phoenix Tuesday night, Trump criticized both of Arizona’s incumbent Republican senators. On Thursday, he tweeted criticisms of Mitch McConnell and Paul Ryan over their handling of the debt ceiling and health care reform. And new reports surfaced indicating that Trump lashed out at Thom Tillis (R-NC) over legislation that would protect special counsel Robert Mueller from being fired.

Ralph Freso/Getty Images

• Senate Republicans slapped back: McConnell has largely tried to avoid taking the bait, but Jeff Flake (R-AZ) said Trump was “inviting” a primary challenger while Ben Sasse (R-NE) said his constituents are worried about trade wars.

Obamacare’s empty counties all got filled

At a Monday town hall, House Speaker Paul Ryan said that “dozens” of counties had no insurance plans available on Affordable Care Act marketplaces. The actual number at the time was two counties, and over the next three days, both of them got insurance plans. In other words, Obamacare — whatever its flaws — is not imploding.

• Why it matters: One core lesson of the ACA repeal debate is that it’s simply very hard to take a benefit away from people who are using it. Every year the ACA remains in place, it becomes more entrenched — in every county in America.
• ACA marketplaces stabilize: ACA marketplaces have fallen short of their architects’ hopes in a number of ways, but doom-and-gloom predictions of death spirals have proven wrong. Subsidy-eligible consumers want insurance, and the prospect of picking up subsidized customers with little to no competition is invariably good enough to tempt at least one insurer into the mix.
• What’s next? Democrats have plenty of ideas to tweak, improve, expand, or perfect the ACA, but nothing’s going to happen now in Washington without Republican leadership. For now, congressional Republicans don’t seem over the sting of legislative defeat and aren’t quite ready to move on.

Health care at a crossroads

Medicaid, long the unwanted stepchild of the American health care system, took center stage during the ACA repeal debate as a key flashpoint. And it looks set to continue to be at the center of the health care universe as Democrats press ambitious plans for further expansion, while Republican governors seek waivers to transform the ACA in a more conservative direction.

Drew Angerer/Getty Images

• Sen. Brian Schatz wants a big Medicaid expansion: The Hawaii Democrat this week unveiled legislation that would essentially turn Medicaid into a “public option” that states could allow anyone to buy into. That would conceptually transform the program from its longtime status as a safety net for the poorest and most vulnerable into something more like a mainstream fallback option for anyone dissatisfied with the private insurance market.
• Iowa wants to reconfigure the ACA: On the other side of the spectrum, Iowa’s GOP-held state government is seeking a federal waiver to completely transform how the Affordable Care Act works in the state — notably by spreading money more evenly rather than focusing it on the neediest cases.

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