Sahil Kapur

Sahil Kapur is TPM's senior congressional reporter and Supreme Court correspondent. His articles have been published in the Huffington Post, The Guardian and The New Republic. Email him at sahil@talkingpointsmemo.com and follow him on Twitter at @sahilkapur.

Articles by Sahil

The Affordable Care Act will insure fewer people and cost $51 billion less over 10 years than was projected last March, the Congressional Budget Office announced Tuesday in a revised estimate.

As of 2016, the law's insurane exchanges are expected to insure 2 million fewer people overall than had been estimated. The ACA is poised to raise Medicaid and CHIP enrollment while decreasing coverage by more in other areas like employer-sponsored insurance, CBO said.

Here's an excerpt from the CBO report highlighting the budgetary changes to 2012-2021 projections, which it attributes to new legislation, adjustments in the economic outlook and updated forecasts regarding insurance premium growth.

  • An increase of $168 billion in projected outlays for Medicaid and CHIP;

  • A decrease of $97 billion in projected costs for exchange subsidies and related spending;

  • A decrease of $20 billion in the cost of tax credits for small employers; and

  • An additional $99 billion in net deficit reductions from penalty payments, the excise tax on high-premium insurance plans, and other effects on tax revenues and outlays—with most of those effects reflecting changes in revenues. 


Senate leaders dug in Tuesday afternoon on a standoff involving the bipartisan JOBS Act and stalled judicial nominees.

In a press conference at the Capitol, Minority Leader Mitch McConnell (R) argued that the 17 stalled federal district court nominees should be dealt with in the coming months and that he's more concerned with moving the small-business JOBS Act the moment the highway bill is passed.

"We hope the Senate Democratic majority will not obstruct our ability to go forward and actually accomplish good things for the American people," McConnell told reporters. "I assume these 17 people already have a job... What we're worried about is all the people who don't currently have a job."

His fellow Senate GOP leaders, standing alongside him, sought to drive home the same message.

Majority Leader Harry Reid (D) countered that there's no legitimate reason for the GOP to continue blocking the nominees, noting that McConnell has already conceded that most are noncontroversial and will ultimately be confirmed. Reid told reporters that it'll take "five minutes" to clear the prospective judges once Republicans drop their filibuster, at which point he'll move on to JOBS.

As to the charge that Dems are trying to gum up the works on the JOBS Act, Reid said, "I don't know logically what in the world they're talking about."

Senate Majority Leader Harry Reid has a message for the Republicans: Stand in the way of confirming over a dozen judicial nominees, as you've threatened to, and the country can watch for weeks as you hold up the bipartisan JOBS Act. I dare you.

Ever since President Obama used his recess appointment power to install the director of a powerful consumer protection agency, and members of the National Labor Relations Board, Senate Republicans have threatened to hold up all of his other pending nominees. Including judges.

Normally, there's little a majority leader can do to thwart a determined minority bent on grinding the Senate to a halt. But Reid believes he's found the leverage he needs.

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Republicans have had no luck convincing Democrats to adopt their controversial plan to convert Medicare into a subsidized private insurance system. But they have had some success convincing Democrats to abandon President Obama and his plan for making Medicare spending sustainable. At least until now.

With help from some Democrats, House committees last week cleared legislation that would repeal the Independent Payment Advisory Board (IPAB), the Medicare cost-saving board created by Obama's health care law, and the GOP-led chamber is poised to pass it next week. But their new plan to pay for the bill with a medical malpractice reform measure is already costing them Democratic votes -- and thus weakening their claim that Obama's vision for Medicare faces bipartisan opposition.

It's the latest jab in the congressional shadowboxing over Medicare's future.

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Rep. Barney Frank (D-MA) told TPM the that House GOP has lost his vote for their bill repealing the Medicare cost-cutting Independent Payment Advisory Board after proposing to offset it with medical malpractice reform.

Frank is one of some 20 Democrats cosponsor of the IPAB-repeal bill, but said the GOP's medmal offset is a bridge too far that will alienate other Dems as well. Asked whether he'll vote for it now, Frank said, "Of course not."

"It's typical of their irresponsible approach. They talk about wanting to have bipartisan cooperation but they don't want it," Frank told TPM on Monday. "They have a lot of Democratic support to repeal [IPAB] and they know it. They were dangerously close to having some bipartisanship and they couldn't accept that."

"They're taking two very different issues and putting them together in an effort to coerce Democrats," he added. "This is nothing more than an overreach to appease the right wing."

Frank said he opposes IPAB because he believes other federal programs, most notably the military, should be cut to balance the budget, as opposed Medicare providers. He emphasized that hospitals, which could face cuts under IPAB, are "major sources of employment" and shouldn't be on the hook.

He added that he supports some cost-cutting policies in Medicare such as asking wealthier seniors to pay higher premiums.

Rep. Allyson Schwartz (PA), the most outspoken Democratic supporter of the GOP's effort to repeal the Medicare cost-cutting Independent Payment Advisory Board, tore into Republicans on Monday for proposing to pay for it with medical malpractice reform.

In a statement to TPM sent via a spokesperson, she warned that the "partisan" pay-for will cost the GOP Dem vote and guarantee defeat.

"Unfortunately, Republican Leadership is manipulating the dialogue on this issue for political purposes, which will undoubtedly lead many Democratic Members to vote against the bill – despite support for the underlying policy from House Democrats across the ideological spectrum," Schwartz told TPM. "By unnecessarily tying repeal of IPAB to a partisan malpractice bill, House Republicans have effectively ensured that this bill is dead. This is deeply disappointing."

Medical malpractice reform has long been a poison bill for Democrats and even some Republicans who want to leave malpractice damage caps to states.



House Republican leadership has opted to offset the $3.1 billion cost of repealing the Medicare cost-cutting Independent Payment Advisory Board (IPAB) with Rep. Phil Gingrey's (R-GA) medical malpractice reform bill, an aide confirms.

The House is poised to vote on the bill next week.

The move runs the risk of alienating some of the Democrats -- and perhaps 10th Amendment Republicans -- who want to repeal IPAB but oppose federal caps on malpractice damage awards. But the legislation is widely expected to fail in the Democratic-led Senate either way.

What if "Obamacare" not only helped save Medicare from fiscal doom, but also quashed the GOP's longstanding goal of privatizing the program? It's too early to know what will ultimately happen, but new evidence suggests that nightmare scenario for conservatives is within the realm of possibility.

In a development with potentially profound implications -- both for Medicare itself and for the broader ideological fight between the two parties over the role of government -- researchers writing in the New England Journal of Medicine believe that the growth in per patient Medicare costs has slowed, contra earlier projections that spending would soar at an unsustainable rate. More importantly, the researchers believe this trend will hold over time, thanks largely to the Affordable Care Act's sweeping cost-control policies.

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Even as the jobs picture continues to improve steadily, the rise in gas prices is taking a toll on President Obama's approval rating on the economy, according to a new ABC/Washington Post poll.

Thirty-eight percent approve of his handling of the economy while 59 percent disapprove, the survey found. The same poll's numbers last month were 44 and 53, respectively.

Tellingly, the public said it disapproves of his handling of the "situation with gas prices" by a 65-26 margin.

A president cannot materially sway gas prices, which are set on the world market, but Americans tend to blame their president anyway when costs rise. Republicans have seized on this as a political weapon, and the White House is eager to fight back and make the case for Obama's energy policy.

Former Rep. Alan Grayson (D-FL), who's running for his old House seat this year, crashed into a bus Saturday, according to the local WESH Orlando TV station.

Grayson, the local newscaster reported, was driving his Mercedes when he "ran a red light and slammed into [a] bus." Two passengers on the bus were injured and taken to the hospital, but are expected to recover, WESH reported, adding that police deemed Grayson at fault for the incident and will cite him. Grayson's car was significantly damaged.

The Orlando Sentinel adds that the passengers' injuries were "slight."