Tag Archives: Dean Heller

The Great Bamboozle: GOP Tax Plan Targeted Right At the Middle Of The Top 1%

There are some amazing feats of verbal legerdemain going on as Republicans try to explain why their Jam It Through Tax Plan isn’t a real bag of snakes.

Oh, don’t worry about our plan…people want to see an improving economy…people want to see more in their paychecks…now 90% of the people can file a simple return…there’s a lot of wishful thinking going on here, and most of it is wrong.  The political advertising is going to write itself in 2018.

Senator Maria Cantwell (D-WA) is correct to say that “haste makes waste,” and in its haste the GOP is about to unload both barrels into their own feet.

The tax cuts will explode the debt.  Remember all the times the GOP told us that debt is a problem?  It certainly can be.  When there was a Democrat in the White House the Heritage Foundation positively screamed about the impact of increasing the national debt:

Current and projected increases in government debt, cutting into future economic growth rates, also mean slower future growth of government revenues. Even as future interest expense rises as taxpayers are called upon to service all this debt, growth in government revenues will slow, leaving less available for other priorities, such as national security and economic security, education, and innovation-driving research.

The only difference now is that the accumulated deficits will be driven by a Republican penchant for rewarding the investor class with amazing tax cuts.  Now the argument is reversed: there will supposedly be More revenue, More innovation, More funds for national security and research.  No there won’t. And we don’t need to kid ourselves, because the same basic economic elements are going to underpin the new tax/budget structure that are girding the current one. 

Nothing in the tax bill reverses the current emphasis on short term gains. The GOP is fond of pointing to gains in the stock market as “proof” of its stewardship of economic growth.  There’s an obvious problem with this, as noted by the Chicago Tribune:

Nearly half of country has $0 invested in the market, according to the Federal Reserve and numerous surveys by groups such as Gallup and Bankrate. That means people have no money in pension funds, 401(k) retirement plans, IRAs, mutual funds or ETFs. They certainly don’t own individual stocks such as Facebook or Apple.

So, nearly half the population has Zilch invested in The Market. What about the others?  While people don’t generally have elephantine memories, 2008 isn’t that far in the rear view mirror, and that’s part of the reason about 54% of Americans have some sort of investments, as opposed to the 62% prior to the Big Crash of 2007-08.

Further,  there’s some recent research indicating the decline isn’t over.

Rosenthal and Austin’s main focus was the precipitous decline of taxable investment accounts. In 50 years, the amount of stock owned by individual investors and funds outside retirement and nontaxable accounts such as 529 college-savings plans has dropped off a cliff — to about 25% in 2015 from over 80% in 1965.

But wait, there’s more:

The other startling finding was the growth in foreign investment in the US stock market. What was once a small sliver of the makeup now accounts for a quarter of all stock ownership at $5.5 trillion. Part of this may be due to increasing wealth in foreign countries, but, as the researchers noted, it could also be influenced by corporate inversions, in which foreign-domiciled firms have large direct holdings of US-based stock.

So, we have a structural situation in which the percentage of individual investors is declining precipitously, the percentage of institutional investors is increasing, as is the percentage of foreign investors.   It doesn’t take much effort to perceive that the produce of stock market gains aren’t going to benefit most Americans, but should assist institutional and foreign investors.

But surely those institutional investors will be looking for long term investment prospects and will act as a curb on short term pursuits as exemplified by hedge fund operations?  Nupe.  That part of the structure hasn’t changed either.  It’s not happening:

Across the world, a clamor is rising against corporate short-termism—the undue attention to quarterly earnings at the expense of long-term sustainable growth. In one survey of chief financial officers, the majority of respondents reported that they would forgo current spending on profitable long-term projects to avoid missing earnings estimates for the upcoming quarter.1

Critics of short-termism have singled out a set of culprits—activist hedge funds that acquire 1% or 2% of a company’s stock and then push hard for measures designed to boost the stock price quickly but unsustainably. 2 The typical activist program involves raising dividends, increasing stock buybacks, or spinning off corporate divisions—usually accompanied by a request for board seats.

If corporations increase profitability I am hearing, “raising dividends, increasing stock buybacks, and mergers, acquisitions, and spin offs.  I am NOT hearing investment in plant expansion, workers’ wages, and company benefits.  And, I’m certainly not hearing anything about encouraging the promotion of taxable investment accounts, the kind that  puts revenue into the Nation’s coffers.

Nothing in the tax bill addresses wage stagnation.   And, no, this is not a myth:

“After adjusting for inflation, wages are only 10 percent higher in 2017 than they were in 1973, with annual real wage growth just below 0.2 percent.[1] The U.S. economy has experienced long-term real wage stagnation and a persistent lack of economic progress for many workers.” […] ” The portion of national income received by workers fell from 64.5 percent in 1974 Q3 to 56.8 percent in 2017 Q2.”

Ouch.  Somehow, the Growth Fairy is supposed to be so enamored of tax cuts for corporations and wealthy individuals that more greenbacks will float down and squirm into the pay packets of average American workers.  Probably not, and putting more dollars into the pockets of institutional investors — foreign and domestic — isn’t going to be all that helpful either.  So, not only does the tax plan not address short term-ism, it doesn’t really address paycheck issues either.

But Wait! How about increasing the child tax credits and standard deductions?  It’s no secret that those people earning $75,000 or less aren’t going to be the big winners in this tax bill.  “The tax bill Senate Republicans are championing would give large tax cuts to the rich while raising taxes on American families earning $10,000 to $75,000 over the next decade, according to a report released Thursday by the Joint Committee on Taxation, Congress’s official nonpartisan analysts.” [WaPo]

But, but, but…Your tax filings will be simpler!  Simple doesn’t matter if you aren’t getting your taxes cut.  And, if the tax preparation deduction is eliminated then there are going to be some mom and pop franchises in serious straits — those just happen to be local small businesses as well.

But, but, but…jobs won’t go overseas!  You can only dream.  The arguments get a bit into the economic weeds, into territorial taxation, but the bottom line is clear:

This might seem like a small difference, but the design of their global minimum tax creates perverse incentives for companies to offshore jobs and shift profits to tax havens—outcomes that a per-country minimum tax would avoid.

Perverse indeed, especially if one expects the new tax plan to provides incentives for companies to expand operations domestically.  Nothing in this plan actually and directly promotes domestic expansion in the economy — it’s all indirect and absolutely hopeful, perhaps even illusory if not downright delusional.

In the meantime, Medicare will be facing cuts of about $25 billion.  There will be calls to “reform” Social Security” in order to reduce the debt — translation: Higher requirements for fewer benefits.  There will be calls to cut SNAP programs — not a drop in the bucket needed to fill the debt hole; and, educational funding — another squeeze on programs that actually help people eventually earn higher wages.

This won’t prevent Republicans like Nevada’s Senator Dean Heller from enjoying the passage of a “great tax cut,” while he hopes to high Heaven no one in the state notices cuts to Medicare, Medicaid, Childrens’ Health Insurance, and no one talks about increased premiums in the individual health insurance market.  Perhaps no one will notice that graduate students at UNR and UNLV are supposed to pay taxes on tuition waivers while they’re actually earning minimum wages for part time jobs?  No one will notice the reduction in home mortgage interest deductions?  No one will observe the reduction or elimination of deductions for major medical expenses — much of which will be out of the pockets of the elderly.

My guess is that Nevadans will notice.  The political ads may, indeed, write themselves.

 

 

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Filed under health insurance, Heller, Nevada economy, Nevada politics, Politics, Taxation

Senator Heller’s Second Shot at Slashing Medicare and Medicaid

“This morning, the Senate Budget Committee will consider a resolution that instructs lawmakers to find ways to reduce Medicaid spending by $1 trillion (and Medicare spending by $473 billion) over the next decade, according to supporting documentation that Democrats are publicizing.” [WaPo]

Here’s the strategy: “A fast-track “reconciliation” process that would allow for tax cuts costing $1.5 trillion over ten years that require only a simple majority to pass.  The $1.5 trillion cost would not have to be offset by closing tax loopholes or ending unproductive tax breaks, and thus would add to the nation’s deficits, which are already growing as the baby boomers retire.  In addition, the resolution would allow the Senate Finance Committee to cut critical programs under its jurisdiction, including Medicaid, Medicare, and basic assistance for poor seniors and people with disabilities, and then use those savings to make the tax cuts even larger (so that the net cost of the tax cuts and the budget cuts combined equaled $1.5 trillion).  The reconciliation process is the same process that Congress tried to use to repeal the ACA and requires only a simple majority to enact law.”  [CBPP] (emphasis added)

And, there we have it: (1) If it’s a Republican budget, then adding to the federal deficit doesn’t matter; (2) in order to provide for tax cuts to the top 1% of income earners in the United States, the Committee can slash funding for Medicaid, Medicare, basic assistance for senior citizens, and people with disabilities.

The trick is that the Senate Republicans have to pass a “budget” slashing spending for those aforementioned Medicare and Medicaid beneficiaries, elderly people in poverty, and disabled people, in order to create ‘space’ for the “reforms” in their tax legislation.  The buck slashing needs to stop here.

Please contact Senator Dean Heller, and let him know that these are not Nevada priorities.

202-224-6244

702-388-6605

775-686-5770

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Filed under Health Care, Heller, Medicaid, Medicare, Nevada politics, Politics

Deflection, Distraction, and Destruction: Trump & the GOP

“…this is exactly what Trump does when he’s in trouble. He finds an enemy and punches as hard as he can.”  [WaPo]

Now, why is he in trouble? And,  what will happen today in Reno at the American Legion convention?  Additionally, who will be standing with the President at the closed to the public event?  The Nevada Independent, which if you’ve not already bookmarked you should, reports: (1) Adam Laxalt, Tea Party Darling will gleefully meet the President and has wrangled radical right wing VP Pence to his Basque food-fest; (2) Dean Heller, maybe not so much but then he won’t say — so what is new about the Heller rope-a-dope strategy? (3) Mark Amodei (R-NV2) showed up Tuesday and may have skedaddled? “A spokeswoman for Amodei did not respond to a follow up question as to whether or not the congressman would meet with Trump while the president is in Reno.” (4) Governor Sandoval appears to be adopting the Republican Gubernatorial Avoidance Strategy — meet him at the airport and then scamper off out of sight thereafter.  If the crowd is thinning, then why the Great Counter Punch?

What makes the President go into full attack mode?  What sends him off on tangents about white supremacy, statues of CSA ‘heroes,’ and “the Media?”  There’s a pattern, the deflection and distraction flare as the investigation of his connections to the Russians progress.

Why did he fire former FBI Director James Comey? Why was he upset with A.G. Jeff Sessions?  Why did he hammer Sen. Mitch McConnell? — Why the “profane shouting match?

“During the call, which Mr. Trump initiated on Aug. 9 from his New Jersey golf club, the president accused Mr. McConnell of bungling the health care issue. He was even more animated about what he intimated was the Senate leader’s refusal to protect him from investigations of Russian interference in the 2016 election, according to Republicans briefed on the conversation.”

What happened prior to August 9, 2017 that’s increased the need for deflection and distraction?

On August 1, 2017 PBS reported that the President dictated the message delivered by his son concerning the meeting at Trump Tower during the campaign with a small host of Russians who were very interested in “adoptions” (read: getting rid of the Magnitsky Act sanctions.)  The President’s assertions that the investigation is fake news and a witch hunt cracks a bit when it’s known that HE was aware of the trouble his son was in for taking and arranging that meeting.  On August 3, 2017 the President grudgingly signed the new Russian sanctions bill dictated by Congress. No fanfare, no ceremony, and two explanations or signing statements.  That was the same day the Wall Street Journal reported that Special Counsel Robert Mueller had impaneled a grand jury in the District of Columbia.

Senator Richard Blumenthal (D-CT) spoke out in support of the Grand Jury, and Mr. Mueller’s continuing investigation of all matters related to Russian interference, and thereafter was rewarded by a “tweet storm” of abuse from the President, reported on August 7th.  The Special Counsel investigators raided the home of former Trump Campaign manager Paul Manafort on August 9.  They were looking for tax documents and foreign banking records, and since they didn’t merely ask Manafort’s legal team for them we can safely assume Mr. Manafort was (a) not as cooperative as his press comments made him out to be, and (b) in possession of things he might very well want to destroy before they landed in Mr. Mueller’s hands.

Events in Charlottesville, VA on August 12 and 13, 2017 intervened to capture public attention as Neo-Nazis and white supremacists took center stage, and as the President waffled about who might have been “responsible.”  Presidential commentary about “history” and “heritage” as if they are synonymous deflected and distracted from the continuing Russia probe.

Fast forward to August 22, 2017 on which it is revealed that the “Trump Dossier” re-emerges into the public consciousness.  Spokespersons for the President have tagged the dossier as “unsubstantiated,” “debunked,” or “unproven” as a general matter, without noting that individual contentions within the document are still under investigation.  The president of the company underwriting the dossier has now spent an entire working day with the staff of the Senate Judiciary Committee.    Interestingly enough, the President chose to spend a significant amount of his time during a campaign rally in Phoenix on August 22nd railing about “fake news” and the “unfair media.”

Those dismissing the dossier as “debunked” may be a bit premature.  The origin of the dossier investigation lies within the “never Trump” wing of the GOP, and after Trump secured the GOP nomination the Clinton Campaign was interested in the contents.  For a “debunked” piece of investigation it’s certainly had an impact, and the FBI now has information from the author about his sources, again as of August 22nd.  If some of the allegations in the Steele Dossier can be sourced, investigated, and substantiated, then the generalized “debunking” portion of the President’s defense can start to crack.  And, we wonder why he spent an inordinate amount of time denouncing the media on the evening of August 22, 2017?  Deflection and Distraction?

Perhaps now this paragraph concerning the cracks reported by the New York Times in the McConnell/Trump relationship makes more sense:

“During the call, which Mr. Trump initiated on Aug. 9 from his New Jersey golf club, the president accused Mr. McConnell of bungling the health care issue. He was even more animated about what he intimated was the Senate leader’s refusal to protect him from investigations of Russian interference in the 2016 election, according to Republicans briefed on the conversation.”

Why would the President become “more animated” about Senator McConnell’s purported failure to “protect” him?  Does the President demand Senator McConnell “protect” the President from the Senate Judiciary and the Senate Select Committee on Intelligence?

Protect him from What?  Destruction?  The gamble for Republicans — from reluctant Senator Heller to enthusiastic Adam Laxalt — is whether to hitch their political futures to the distraction/deflection tactics of the current administration or cut loose and hope he doesn’t lead them to destruction.

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Filed under Amodei, Heller, nevada taxation, Politics, Republicans

The Eternal Sunshine of a Perpetual Gadfly Candidate’s Mind: Tarkanian takes on Heller

The son of a former UNLV basketball coach, and leading candidate for the Sharron Angle Perpetual Campaigner award, Danny Tarkanian — Trump supporter and right winger has decided to give Senator Dean Heller a primary.  This may allow Senator Heller room to reprise his “I’m a moderate” role — well, yes, if one is compared to the Perpetual Candidate who says on his Facebook Page: (Let’s add some commentary– in red)

“Over the past several weeks, I have been inundated with text, emails, and phone calls from people of all walks of life across the state of Nevada who are upset with Dean Heller for campaigning one way in Nevada and voting the exact opposite in Washington DC. [This is interesting since Senator Heller has voted with Trump 89.6% of the time.]The refrain is the same: he turned his back on us.
Today, after much thought and discussion with my family and friends, I have decided to run for the United States Senate. [Here’s guessing he was waiting by the phone for the first call?] I am running for United States Senate because Nevada deserves a Senator who will keep his word and vote in Washington DC the same way he campaigns here in Nevada.  [Interesting since Heller tends to campaign as a moderate and vote as a conservative.]
I am a conservative Republican who supports the policies of President Trump to repeal Obamacare [And can we trust you have a PLAN to replace the ACA?] and end illegal immigration.  [Nothing like a flippant tip of the hat to gratuitous racism.] I will continue to support President Trump’s policies that have led to a 20% increase in the stock market in just six months. [continuing a market trend for the last umpteen quarters] I will join Senator Lee, Senator Cruz, and Senator Paul fighting for real reforms against the liberals in our party. [or, I intend to join the diehard purists in Congress who have contributed to gridlock; defining ‘liberal’ as anyone who isn’t carefully tucked into some corporate pocket…]
I look forward to campaigning across the state of Nevada [in perpetuity] and earning your support. It is time to take a stand. Together, we will make our state, and our country, proud.”

There’s more in the Nevada Independent.  <— well worth a click and read.

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Filed under Heller, Nevada, Nevada politics, Politics

The Moderate Heller Myth: Health Insurance Edition

Senator Dean Heller (R-NV) has cultivated his “moderate” image to the point that this adjective is attached to him with remarkable consistency — when if a person does even a perfunctory piece of research on his actual voting record what emerges is the model of a hard line conservative.  There is a pattern.  The Senator expresses “concerns” with a bill; then announces with ranging degrees of fanfare his opposition to a bill “in its current form,” then when the rubber grinds on the road surface the Senator votes along with the Republican leadership.

Why would anyone seriously believe he would support fixing the Affordable Care Act’s problems and not ultimately support what is now being called the “skinny repeal” version in the Senate based on the following voting record:

In 2007 then Representative Heller voted against the Medicare Prescription Drug Price Negotiation Act (HR 4).  Then on August 1, 2007 he voted against HR 3162, the State Children’s Health Insurance Program reauthorization.  The next day he voted against HR 734, the Prescription Drug Imports bill.  On March 5, 2008 he voted against HR 1424, the Mental Health Coverage bill.  Further into 2008 he voted “no” on HR 5501, the bill to fund programs fighting AIDS, Malaria, and Tuberculosis, and “no” again on the concurrence version of the bill in July.   If he had a ‘flash’ of moderation during this period it happened in the summer of 2008 when he voted in favor of HR 5613 (Medicaid extensions and changes), HR 6631 (Medicare), the latter including a vote to override the President’s veto.  By November 2009 he was back in full Conservative mode.

He voted against HR 3962 (Health Care and Insurance Law amendments) on November 8, 2009, and HR 3961 (Revising Medicare Physician Fee Schedules and re-establishing PAYGO) on November 19, 2009.

In March 2010 Heller voted against HR 4872 (Health Care Reconciliation Act), and HR 3590 (Patient Protection and Affordable Care Act).  He also voted against the concurrence bills.

January 19, 2011 he voted in favor of the Repealing the Health Care bill (HR 2).  He also signaled his stance on Planned Parenthood when he voted in favor of H.Amdt. 95 (Prohibiting the use of Federal funds for Planned Parenthood) on February 18, 2011.    He was in favor of repealing the individual mandate (HR 4), of repealing the Prevention and Public Health Fund (HR 1217).  May 4, 2011 he voted to repeal funding of the construction of school based health centers (HR 1214).

There was another “soft” period in some of his initial Senate votes in 2011, especially concerning the importation of medication from Canada (interesting since many prescription drugs are manufactured in other overseas sites).  See S. Amdt 769, S. Amdt 2111, and S. Amdt 2107 in May 2012.  On March 31, 2014 he voted in favor of HR 4302 (Protecting Access to Medicare).

He was back riding the Republican rails in September 2015, supporting an amendment to defund Planned Parenthood, (S. Amdt 2669) which failed a cloture vote.   Then on December 3, 2015 he voted in favor of another ACA repeal bill (HR 3762).    If we’re looking for patterns in this record they aren’t too difficult to discern. (1) Senator Heller can be relied upon to vote in favor of any legislation which deprives Planned Parenthood of funding for health care services, (2) Senator Heller can be relied upon to vote in favor of repealing the Affordable Care Act, and (3) Senator Heller’s voting record, if it illustrates any ‘moderation’ at all, comes in the form of dealing with prescription drug prices, but even that is a mixed bag of votes.

Thus, when he makes comments like the following:

“Obamacare isn’t the answer, but doing nothing to try to solve the problems it has created isn’t the answer either,” the statement read. “That is why I will vote to move forward and give us a chance to address the unworkable aspects of the law that have left many Nevadans — particularly those living in rural areas — with dwindling or no choices.

“Whether it’s my ideas to protect Nevadans who depend on Medicaid or the Graham-Cassidy proposal that empowers states and repeals the individual and employer mandates, there are commonsense solutions that could improve our health care system and today’s vote gives us the opportunity to fight for them. If the final product isn’t improved for the state of Nevada, then I will not vote for it; if it is improved, I will support it.”

We should examine them with some caution.   If he is referring to rural Nevada voters as ‘victims’ of the Affordable Care Act he might want to note that before the ACA there was one insurer in the northern Nevada rural market and if there is only one now that’s really not much of a change, much less a “nightmare.”  Nor is he mentioning that the proposed cuts to Medicaid will have a profoundly negative effect on rural Nevada hospitals. [DB previous]

That Graham-Cassidy proposal isn’t exactly a winner either:

“The new plan released Thursday morning and written by Republican Sens. Lindsey Graham (S.C.) and Bill Cassidy (La.) would block grant about $500 billion of federal spending to the states over 10 years to either repeal, repair or keep their ObamaCare programs.”

We have no idea if the number is an accurate estimate of what would keep the health care systems of all 50 states afloat — no one seems to want to ‘score’ anything these days.  Additionally, Americans should be aware by now that when Republicans chant “Block Grant” they mean “dump it on the states, wash our hands, and walk away” while the states struggle to keep up with demands to meet needs and provide services, operating on budgets which cannot function on deficits.

Then, there’s that perfectly typical Hellerian comment: “If it is improved, I will support it,” leaving the issue entirely up to Senator Heller’s subjective assessment if “it” has improved his re-election chances enough to go along with it while not upsetting his very conservative base.  Meanwhile, the media persists in repeating the “Moderate Heller” mythology, and we haven’t even begun to speak of his actions to thwart and later repeal any common sense regulations on the financial sector.

 

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Filed under conservatism, Health Care, health insurance, Heller, Medicaid, Medicare, Nevada Test Site, Politics, public health, Republicans, Rural Nevada, SCHIP

Heller at the President’s Right: Lunch Time At The White House

Nothing like watching Senator Dean Heller (R-NV) sitting next to POTUS, smiling and applauding as the remarks from the President replicate every standard talking point made by every Republican since the passage of the Affordable Care Act.  Including such wonderful clichés as:

You’ll pay lower premiums (Oh, such lower premiums you won’t believe) — Any fool can sell low premium policies, the ones with high deductibles and co-pays, limited benefits, and caps.  Worse still, these junk policies will be sold across state lines so that consumer standards and protections of the worst level of protection will be the standard.

The states will have control over Medicaid (smaller units will be better for individual needs)  Nothing like blowing a big wide ‘beautiful’ hole in the Nevada budget!  Cutting $770B from Medicaid will have effects far beyond Nevada’s capacity to support its elderly, its children, its rural health care facilities, its support for low income working families.  That was the point of Medicaid — expenses far beyond the capacity of individual states could be shared nationwide, allowing medical care and services for the greatest good for the greatest number.

Some counties only have one insurance corporation offering policies in the individual market.  Did the president recall that before the ACA there were some counties that had no insurance corporations offering policies in the individual market.  There’s a solution to this problem — one the president didn’t mention — establish a public option.

Then there flowed the usual barrel of platitudes and campaign rhetoric, freedom and flexibility, low cost with high coverage,  everyone can get better insurance, reduce burdensome taxation, burdensome regulation….

And there was Senator Dean Heller, smiling as though siding with the president isn’t going to be a major political problem for him in the 2018 campaign season.  It makes a person wonder.

Senator Heller can be reached at 202-224-6244, 775-686-5770; 702-388-6605

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Filed under Health Care, health insurance, Heller, Politics

Embattled Bill Entangled Senator

While the Russians are in, or not in, meetings which are, or aren’t important, and which do or don’t offer trade-craft dangles — there’s a Senate version of the health insurance bill as egregious as its predecessors.  The hold music of the morning on Senator Dean Heller’s DC office phone is a static infused version of The Battle Hymn of the Republic while a person waits for an opportunity for leave a message for the Senator urging opposition to the health care insurance bill.

There’s a reason no one likes this bill — it puts insurance corporations back into the bifurcated market  with high premiums for those older and lower premiums (with higher co-payment and deductible out of pocket expenses) for younger, or less affluent, customers.  It puts state budgets at extreme risk. It slashes Medicaid funding (in conjunction with the proposed budget), thus placing services for children and the elderly in peril.

Senator Heller is described as being wedged into a hard place — between the desires of the hard right (and perhaps the bounteous coffers of Sheldon Adelson) and the hopes of his constituents and the Governor who want reasonable access to affordable health care insurance.

“Heller, in other words, has backed himself into a corner. Either he honors the concerns he raised just a few weeks ago, or reverses course and completes a very public betrayal – the year before his re-election campaign.” [NBC]

It’s time to offer Senator Heller a way out of this box — encouraging his continued opposition to the health insurance bill — call 202-224-6244; or 702-388-6605; or 775-686-5770.

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Filed under Health Care, health insurance, Heller, Politics