The Dictatorship
Democrats need to start thinking beyond Obamacare
The government shutdown is over, and Democrats have failed to obtain an extension of subsidies for plans under the Affordable Care Act. That means premiums will skyrocket for the tens of millions of Americans who get their insurance through the ACA marketplaces. While Democrats look for other ways to save the subsidies, though, the party also needs to lay the groundwork for a bigger fix to America’s broken health care system.
It’s been a decade and a half since President Barack Obama signed the ACA into law, which in turn came a decade and a half after Bill Clinton’s failed attempt at health care reform early in his presidency. For the last 15 years, Democrats have said the same thing about the Affordable Care Act: The law has done a tremendous amount of good, but it’s far from perfect. Despite the ACA’s successes, our health care system is still a failure in multiple ways, and only one party wants to fix it. The time is now to start planning for the next phase.
Every Democratic president in the 80 years since Truman made at least some attempt to move toward universal coverage and containing costs.
In 1945, President Harry Truman proposed that the federal government provide health insurance to all. “Millions of our citizens do not now have a full measure of opportunity to achieve and enjoy good health,” he said. “Millions do not now have protection or security against the economic effects of sickness. The time has arrived for action to help them attain that opportunity and that protection.”
That time, in fact, kept arriving; every Democratic president in the 80 years since Truman made at least some attempt to move toward universal coverage and containing costs. There were successes along the way, including Medicare, Medicaid and the ACA itself. But most Americans are unhappy with the U.S. health care system as a whole, even if many are happy with their own insurance.
Although health care is typically one of the party’s strongest issues, Democrats have largely been on the defensive since the ACA was passed in 2010. They’ve worked hard, mostly with success, to beat back Republican attempts to repeal or undermine it. This has been a necessary and noble effort: Since the ACA’s passage, the share of Americans without health insurance has been cut in halffrom 16% to 8%. But 27 million Americans are still without coverage. That number is expected to increase dramaticallyboth because of the expiration of enhanced subsidies and because Trump’s “big, beautiful bill” includes massive Medicaid cuts and restricts access to ACA marketplaces.
That means Democrats have no choice but to come up with a new plan they can present to the public for health reform — and it has to be more than just reinforcing the ACA.
This will require both policy work and political advocacy, which was exactly what the party did after Clinton’s reform failed. Health policy experts spent years researching and developing ideas, and by the time the 2008 election arrived, the party had coalesced around an outline of what would become the ACA — a combination of subsidies for people in the middle to buy insurance, an expansion of Medicaid and a mandate for everyone to get covered. While Obama, Hillary Clinton and John Edwards argued about the details in that year’s presidential primary, their differences were minor because they were working from a policy consensus that had already taken shape.
Twelve years later, there was another intense debate over health care in a Democratic presidential primary. And though it seemed in 2020 that there was a gulf between the ideas from progressives, such as Sen. Bernie Sanders’ proposal for a single-payer system, and those from the more moderate candidates, including Joe Biden, in truth the whole party had moved left. Even Biden’s plan, which centered on a public option, was far more progressive than the ACA.
Opponents of health care reforms count on Americans believing that we can’t have anything better.
But once he took office, Biden essentially put that plan in a drawer and never spoke of it again. You can argue that he wouldn’t have been able to pass it through a closely divided Congress, but he never tried to build the support that would have made it possible.
So what should Democrats do now? The answer is that they should spend the next couple of years debating it among themselves. Task the policy experts with devising a menu of options, talk to voters, begin advocacy for real reform and see where support builds. Then, when 2028 comes, have the debate during the presidential campaign when the largest number of Americans are paying attention.
My own preference would be to model our next reform on the combination of public and private insurance that’s used successfully in various forms in countries such as Australia, Canada, France and Denmark. In this system, the government provides basic insurance that covers everyone, and people are free to buy supplementary private insurance if they want more benefits. Liberals like it because of the universal coverage, and conservatives like it because rich people can still buy all the benefits they want.
We could get there by expanding Medicaid — which already covers more than 77 million Americans — to everyone under 65, while allowing seniors to keep Medicare. Yes, there would be many details to work out. And powerful forces will array themselves against meaningful reform — not just the GOP, but the many people, organizations and companies that benefit handsomely from the current system.
Opponents of health care reforms count on Americans believing that we can’t have anything better, or at the very least that it can only be a little bit better. But we know that isn’t true, because every other industrialized country on Earth has a national system that is far less expensive than ours, yet still insures all or virtually all residents.
Last weekend, President Donald Trump proposed sending money to Americans instead of to insurance companies. He later said that people will “feel like entrepreneurs” when they’re “able to go out and negotiate their own health insurance.” It’s an incoherent and nonsensical idea that will only make health care expensive. But Republican lawmakers quickly signaled support, with Sen. Rick Scott of Florida saying he was “writing the bill right now.”
Unlike their opponents, Democrats need to be serious about health care. And that means finding the next big proposal to get closer to a system that all Americans can actually count on and afford. It won’t be an easy process, and it won’t be quick. But that makes it all the more important to start now.
BATON ROUGE, La. — With his political future hanging in the balance and President Donald Trump looming large over Louisiana’s Republican Senate primary, Sen. Bill Cassidy spent the campaign’s final hours trying to hit a moving target.
During a campaign stop at a gun range on Friday, the incumbent senator — fighting for his political life against two Trump-aligned candidates — said his primary “is not me versus Donald Trump.”
“This is me fighting for the people of Louisiana,” he said.
When MS NOW asked if he regretted his vote to convict Trump following the president’s impeachment after the Jan. 6, 2021, attack on the Capitol — a vote that set into motion the primary fight currently threatening his political career — Cassidy said he doesn’t sit around and think about what happened five years ago. “I’m focused on the future,” he said.
And when MS NOW pressed Cassidy on whether there’s room in the GOP for a Republican willing to cross Trump, he shot down the question.
“I’m gonna let you hold on that because I think you got a theme there,” Cassidy said, turning from reporters and walking toward the gun range. “So let me go shoot.”
In a race defined by Trump, closely watched by Trump, and playing out in a state that voted for Trump three times, Cassidy is choosing his words carefully. But instead of avoiding the topic entirely, he’s embracing it in his own way.
The Louisiana Republican said he’s the only candidate in the race “who’s ever had Donald Trump sign a bill into law,” pointing to his sponsorship of a measure that reclassified fentanyl as a schedule 1 drug and a separate bill that aimed to combat the opioid crisis.
“My opponent, she has never had a single piece of legislation signed into law,” Cassidy said. “I’ve had dozens.”
The strategy is a risky gamble for the incumbent senator, who’s fending off two Trump-affiliated candidates in a state that voted for the president by more than 18 percentage points in the 2024, 2020 and 2016 presidential elections. The race has taken on national interest, with onlookers across the country watching to see if a Republican can cross Trump and survive.
With his congressional career on the line, Cassidy is confident in the wager.
“I plan on winning,” Cassidy said. “It may go to a runoff. If it goes to a runoff, I’ll win in the runoff.”
He went on to shoot an AR-15 and a 9mm pistol, highlighting the suppressors on the guns after he championed a bill that eliminated a tax on silencers. He admired his target sheet showing five shots hitting the bullseye and one in the innermost ring.
“I wanted them all like right there, but that’s not too bad — I’m pretty pleased with that,” he told reporters, pointing to the bullseye. “You know what I’m saying? I’m real pleased with that.”
Whether Cassidy will be just as pleased when results begin to roll in on Saturday is another question.
Primary polls show Cassidy trailing both his Trump-associated opponents — Rep. Julia Letlow and former Rep. John Fleming — spelling trouble for Cassidy’s chances at a third term in Congress. If none of the candidates reach a majority vote, the top two vote-getters will head to a runoff.
Letlow, a second-term congresswoman whom Trump hand-picked to challenge Cassidy, is a relative newcomer, after arriving on Capitol Hill in 2021 to succeed her late husband. But Letlow’s political fortunes have since skyrocketed since she secured Trump’s endorsement
“Highly Respected America First Congresswoman, Julia Letlow, of the wonderful State of Louisiana, is a Great Star, has been from the very beginning, and only gets better!” Trump wrote on Truth Social Friday.
But there’s also Fleming, the former congressman and Louisiana State Treasurer, who is a founding member of the conservative House Freedom Caucus and deputy chief of staff during Trump’s first administration. Despite not having the coveted endorsement, the MAGA loyalist has stressed his Trump credentials.
“I served in the Trump administration for four years. I was Trump’s deputy chief of staff for the last 10 months of his administration, his first one. And also, I was there Jan. 6,” Fleming said at a primary debate last week. “And you know what? There were a lot of resignations in that White House on Jan. 6. I stood there, stayed there, and did not leave my post in the White House. I was there to the very end.”
Trump has had his sights set on Cassidy since shortly after Jan. 6, when the Louisiana lawmaker was one of seven Senate Republicans who voted to convict Trump following his impeachment after the Capitol attack. Of that group, just three remain.
The tensions continued into last year, when Cassidy — a doctor by trade — raised doubts about Robert F. Kennedy Jr. and his vaccine skepticism after Trump nominated him to lead the Department of Health and Human Services.
If Cassidy — the chairman of the Senate Health, Education, Labor and Pensions Committee — had voted against Kennedy for a preliminary committee vote, he would’ve been blocked. In the end, Cassidy supported Kennedy, but noted to Kennedy that he was “struggling with your nomination.”
Last month, Trump unleashed on Cassidy as the president’s pick to be the next surgeon general, Casey Means, stalled amid GOP opposition from Cassidy and others. Trump called Cassidy “a very disloyal person” and urged Louisiana residents to vote him “OUT OF OFFICE in the upcoming Republican Primary.”
The recent opposition comes back to Cassidy’s core identity: A doctor. During his outing at the gun range on Friday, donning protective earmuffs and glasses, the physician-turned-politician spoke about the physics of the suppressors and how they protect people’s hearing.
Minutes after dodging a question about whether he regrets his vote to convict Trump, Cassidy said his experience as a doctor — gathering information, making decisions, and not looking back — guides everything he does.
“When you graduate from med school in 1983 and you’ve been a doctor ever since, that is the prism through which you use things, which is really good,” he told reporters. “As a doctor, you’re taught to serve people. You’re taught to listen to them, figure out what the issue is, digest it, observe, and then come up with an answer.”
“You make the answer, you live with it, you move on,” he continued. “You learn from a mistake, but you move on. And so, in one sense that’s insightful. You could probably look at like almost everything I do, and you can say there’s a doctor in him.”
Mychael Schnell is a reporter for MS NOW.
Syedah Asghar
Syedah Asghar covers Congress for MS NOW.
In the Supreme Court’s latest action that helps Republicans ahead of the midterms, the justices rejected Virginia Democrats’ emergency bid to save the state’s redistricting effort that voters approved last month.
Friday’s order follows the GOP-appointed majority’s recent Voting Rights Act ruling in Louisiana v. Callaiswhich prompted Republican-led states to try to make their maps redder ahead of November’s elections. Earlier this week, the high court majority granted emergency relief to Alabama Republicans who cited Callais as justification to use a congressional map that was previously deemed discriminatory.
The justices didn’t explain their decision in their unsigned order Friday, as is typical for emergency appeals. None of the justices noted any dissent.
The rejection of Virginia’s appeal is another court win for Republicans in this election season because the state’s voters had approved a process for new congressional districts that were poised to deliver more seats to Democrats. At President Donald Trump’s urging, Texas set off a wave of mid-decade redistricting last year that led other states, including Virginia, to follow suit. In prior orders affecting congressional maps, the Supreme Court approved the Texas effort as well as a Democratic countermeasure in California while also helping New York Republicans hold onto a seat.
The GOP-appointed majority said in a 2019 ruling that federal courts can’t do anything about partisan gerrymandering. Combined with Callais, that set the stage for Republicans to erase districts across the South that have been led by Black representatives and supported by Black voters, under the legal guise of partisanship rather than race. The Callais ruling makes it even more difficult to prove that map-makers are motivated by improper racial considerations rather than the partisan ones that the high court majority has effectively approved.
The Virginia rejection was expected because, although the Supreme Court can hear appeals from state high courts, this case posed a challenge for Virginia officials. That’s because the state court ruling they challenged was based largely on Virginia jurists’ interpretation of their state’s constitution, and the Supreme Court gets involved when there are federal issues to resolve. The Virginia case didn’t squarely call into question the Voting Rights Act or other federal matters of the sort the justices have been ruling on in election cases.
Still, in their emergency appealVirginia Democrats maintained that their case presented federal issues warranting the justices’ attention. The NAACP supported that position in an amicus briefwriting that invalidating Virginians’ votes “constitutes a deprivation of constitutional due process that requires this Court’s immediate intervention.”
Opposing the application, state Republicans arguedamong other things, that the state high court’s ruling rested on “pure state-law grounds” and so “no federal issue is present” for the justices to take up.
The meaning of ‘election’
In the state court ruling that struck down the measure, Virginia’s justices split 4-3 in deciding that the process that put it on the ballot had violated Virginia’s Constitution.
The state’s amendment procedures are, per the state court majority, admittedly “laborious” and “slow-walk[ed]” to “guard against hasty changes.” With that in mind, the majority explained that the process gives voters two chances to weigh in on a proposed amendment, the first time indirectly and the second time directly. The first, indirect time is after legislators initially propose the amendment, when voters can choose to retain those representatives based on their position on the amendment. The second, direct time occurs if it gets on the ballot, as this one did when voters approved itin April.
To get an amendment on the ballot, it actually needs to be approved twice by the state legislature before it goes to the voters. In this case, the proposed amendment first passed the legislature on Oct. 31 and then in January before voters backed it at the ballot box last month.
The legal issue in the ruling centered on the first step in late October when the legislature voted after early voting began but before Election Day on Nov. 4. That timing turned out to be crucial because the state constitution says the second approval must happen “after the next general election.” So the case raised the question of whether the first vote technically happened prior to the November election.
The state court majority said it did not, reasoning that the phrase “general election” in this context included early voting. The majority rejected what it called the state’s “thesis” that early voters “unknowingly forfeited their constitutionally protected opportunity” to base their November election votes on whether their representatives supported the amendment.
The dissent said the majority’s reading was an unnatural one that “broadened the meaning of the word ‘election’” and was “in direct conflict with how both Virginia and federal law define an election.”
As for why the court didn’t rule until after voters approved the measure, the majority said that’s a “fair” question to ask but that Virginia officials have no right to complain because, the majority recalled, they insisted that the court couldn’t rule prior to the vote.
Jordan Rubin is the Deadline: Legal Blog writer. He was a prosecutor for the New York County District Attorney’s Office in Manhattan and is the author of “Bizarro,” a book about the secret war on synthetic drugs. Before he joined MS NOW, he was a legal reporter for Bloomberg Law.
Israeli Prime Minister Benjamin Netanyahu on Thursday threatened to sue The New York Times over its publication of an opinion column detailing allegations of sexual abuse against Palestinians by Israeli forces and settlers.
The Times’ articlewritten by Nicholas Kristof and published Monday, was based on conversations the Pulitzer Prize-winning journalist said he had with 14 men and women who alleged they had been sexually assaulted in what Kristof described as “a pattern of widespread Israeli sexual violence against men, women and even children — by soldiers, settlers, interrogators in the Shin Bet internal security agency and, above all, prison guards.”
In one account, a Palestinian freelance journalist told Kristof that when he was detained in 2024, a group of guards threw him to the ground, pulled down his pants and underwear and that one guard raped him with a rubber baton. A Palestinian woman separately told Kristof she was repeatedly stripped naked, beaten and groped after she was arrested following the Oct. 7, 2023, attacks on Israel.
Kristof also cited a 49-page United Nations report alleging sexual violence has become one of Israel’s “standard operating procedures” and “a major element in the ill treatment of Palestinians” since the Hamas-led attacks that became the deadliest day in Israeli history.
Israeli leaders have denied the allegations. Netanyahu wrote in a social media post Thursday that he asked his legal advisers to consider “the harshest legal action” against Kristof and The New York Times.
“They defamed the soldiers of Israel and perpetuated a blood libel about rape, trying to create a false symmetry between the genocidal terrorists of Hamas and Israel’s valiant soldiers,” Netanyahu said.
The Israeli prime minister’s statement and his threat to sue the Times falls against the backdrop of the war against Iran that he is waging jointly with President Donald Trump, who has separately threatened to sue the same news organization over its Iran war coverage.
Israel’s foreign ministry called Kristof’s article “one of the most hideous and distorted lies ever published against the State of Israel in the modern press.”
The Times said in a statement posted on X that the allegations detailed in Kristof’s article “were extensively fact-checked, with accounts further cross-referenced with news reporting, independent research from human-rights groups, surveys and in one case, with U.N. testimony.”
Asked for comment, New York Times spokesperson Danielle Rhoades Ha said Netanyahu’s threat to file a lawsuit “is part of a well-worn political playbook that aims to undermine independent reporting and stifle journalism that does not fit a specific narrative.”
“Any such legal action would be without merit,” she said in a statement to MS NOW, adding, “Nick has covered sexual violence for decades, and is widely regarded as one of the world’s best on-the-ground journalists in documenting and bearing witness to sexual abuse experienced by women and men in war and conflict zones.”
The statement continued:
“The accounts of the men and women he interviewed were corroborated with witnesses, whenever possible, and with people the victims confided in, including family members and lawyers. Details were extensively fact-checked, with accounts further cross-referenced with news reporting, independent research from human-rights groups, surveys and in one case, with U.N. testimony. Independent experts were consulted on the assertions in the piece throughout reporting and fact-checking.”
This story has been updated to include additional comment from The New York Times.
Erum Salam is a breaking news reporter for MS NOW, with a focus on how global events and foreign policy shape U.S. politics. She previously was a breaking news reporter for The Guardian.
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