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The latest news on Obamacare from Business Insider

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    generation opportunity screenshot

    Update: A key aspect of Obamacare I'd missed here: Unlike today's individual insurance markets, signup for insurance exchanges will be limited to a specific annual enrollment period. So while going without insurance will be less risky under Obamacare than it is today (you'll eventually be able to get a plan that covers your pre-existing condition at a fixed price) it still entails a major risk: You might have to wait months to sign up for insurance. That greatly reduces the appeal of paying the penalty and waiting to see if you get sick. My apologies for the error.

    Update 2:Aaron Carroll raises some further objections: "The first is that there is still a waiting period after you decide you want insurance until you can get it. That could still be long enough to bankrupt someone. The other is that even if there wasn’t, you’re still at risk. Get in a car accident? You’re not getting insurance for whatever it takes to fix you from that hospitalization, and – again – that could be enough to bankrupt you."

    Original post:

    A new series of creepy videos attack Obamacare as a government overreach. As the above screengrab shows, the argument is that Obamacare is like Uncle Sam trying to personally inspect your prostate.

    But is a privacy/liberty argument really the best tack to take in selling the young on avoiding Obamacare?

    There's actually a good cost reason for some young people not to sign up for health plans under Obamacare. If you're 23 and healthy and rarely go to the doctor, you can pay a penalty of $95 in 2014 or a few hundred dollars in years after that and effectively have an option on health coverage if you ever need it in the future.

    Obamacare provides a big advantage to people who don't have health insurance: a rule called "guaranteed issue" that forces insurers to sell you a health plan that covers your illness even if you're already sick. But if enough healthy people decide they might as well wait until they get sick to buy insurance, it could become a significant problem for the health insurance exchanges, as the pool of insurance buyers becomes sicker and therefore more expensive to cover.

    The individual mandate is supposed to stop that from happening, but the penalty associated with the mandate is so low that some people may find it advantageous to forego insurance even if they have to pay it.

    Generation Opportunity, the group behind these videos, focuses its cost message instead on the idea that insurance from the Obamacare exchanges is a bad deal for young people, because rate-setting rules limit how much of a price break insurers can give to the young and healthy. That leaves out the fact that a lot of young people are eligible for subsidies that will reduce the effective premiums they pay, even if the sticker price is high.

    But it also misses the other big value issue for young people: Obamacare makes not having insurance a significantly less risky option than it is today, even if the available insurance is reasonably priced.

    Generation Opportunity can't make its "opt out" pitch around option value because that's like highlighting a feature of Obamacare: It will make sure you can get insurance when you need it. So instead they're left weaker arguments.

    Instead, the first argument against signing up for Obamacare on Generation Opportunity's website is that giving the government your information might expose you to identity theft. They note that, in the wake of the IRS scandal, who can really trust the government with data?

    That seems like a message more calibrated to your retired aunt who still uses AOL and forwards you chain emails than to my generation, which is broadly comfortable sharing its intimate details not just with the government but with anybody else who has a Facebook account.

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    Ted Cruz

    Conservatives in the Senate spent weeks building grassroots support for a plan that would strip funding from the Affordable Care Act in a bill that keeps the government funded beyond Sept. 30.

    And now that it's finally here, they don't appear to know what to do with it.

    This has been the contention of House Republicans for some time — that Cruz was willing to say what he thought people wanted to hear, but he didn't have a plan to get it through the Senate. It was a long con, House Republican aides said, unless he actually expected President Barack Obama to sign a rollback of his signature legislative achievement in a grand, Rose Garden ceremony.

    In reality, it was always going to be nearly impossible for Cruz to get any bill that defunds Obamacare through the Senate. Now, it's becoming even clearer why. 

    The House bill that continues funding for the government is expected to pass on Friday. It will go to the Senate, where Senate Majority Leader Harry Reid (R-Nev.) will face two potential filibusters of the legislation. 

    One is on the vote to begin debate — which is not likely to produce a fight. The language will enter the Senate with the House language, so there's no reason for conservatives in the Senate to vote against opening debate on the bill. 

    The key procedural movement will come next. A Democratic Senate aide said that it's likely Democrats will introduce an amendment to strip the House language defunding Obamacare after the vote to end debate occurs. Because of Senate rules, they can do so by a simple majority vote.

    That makes the second cloture vote the one to watch. That's when Cruz, along with Sens. Mike Lee (R-Utah) and Marco Rubio (R-Fla.), can argue that voting to end debate will enable Reid to get rid of the House language that defunds Obamacare — "which is true," the Democratic aide said.

    Here's why that's a problem: Reid needs 60 votes to end debate. He can count on all 52 Democrats (including himself), as well as the Senate's two Independents, to vote to end debate and strip the language defunding Obamacare. 

    That means he needs only six Republicans to vote to end debate. And 14 Senate Republicans have already expressed their dismay with the strategy — mostly because doing so involves the possibility of shutting down the government. 

    House Speaker John Boehner put Cruz in check on Wednesday. And whether Cruz lays down — like he signaled he was going to do Wednesday— or drags out the "defund" movement as long as he can will tell a lot about how serious he was about it in the first place. 

    In a press conference on Thursday, Cruz shifted tone and hinted that he might participate in a filibuster to block a Senate bill that includes funding for Obamacare. 

    "I will do everything necessary and anything possible to defund Obamacare," Cruz said, adding that a talking-style filibuster was also possible.

    SEE ALSO: The GOP Civil War Just Exploded Messily Into The Public

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    With the coming implementation of Obamacare, many Americans believe that all of our health-care needs will soon be taken care of. But the coverage mandated by the Patient Protection and Affordable Care Act doesn't address one critical type of health-care cost -- and could leaving you with a huge and expensive challenge to deal with on your own.

    Many people don't realize that traditional forms of health-care insurance coverage don't typically pay for long-term care, and long-term care is increasingly becoming a key financial issue for the aging U.S. population. According to the RAND Corporation, 15 percent of those over age 70 have dementia, and dementia-care costs alone are expected to rise to $1 trillion annually by the year 2030.

    To address the lack of knowledge about long-term care, the Department of Health and Human Services created a website with information on getting the care you need and protecting yourself from the financial impact of paying for that care.

    Let's look at four key facts you need to know about long-term care.

    1. Long-Term Care Isn't Just Nursing Home Coverage.

    Decades ago, when people needed help with basic daily tasks like bathing or getting in and out of bed, they had relatively few options. If they couldn't get family members to take care of them, they often had to go to a nursing home to get the help they needed.

    Now, though, a wide variety of different options are available. Home-care aides and other non-medical personnel can help you with many of your basic needs, letting you keep living in your home. Adult day services can give vital relief to family caregivers who can't provide 24-hour care. Moreover, a wide array of long-term care facilities, including assisted-living and continuing-care retirement communities, provide the services you need without the overkill of comprehensive nursing-home care.

    2. Medicare Doesn't Usually Pay For Long-Term Care.

    Medicare coverage is limited to very specific types of long-term care. To qualify, you must establish a need for skilled services or rehabilitative care. Even then, Medicare only pays for a maximum of 100 days of skilled-nursing care in nursing homes. Other types of covered care, including physical therapy and part-time skilled-nursing care, have their own limits on how long benefits will last.

    Most private insurance options have the same coverage limitations as Medicare, leaving Medicaid as the biggest payer for long-term care services. But Medicaid is only available to those with low incomes and assets, making it a payer of last resort for many families.

    3. Most People Have Multiple Options to Pay For Care.

    In order to cover long-term care expenses through insurance, you'll need to buy a specialized long-term care insurance policy. Such policies provide comprehensive coverage of most types of long-term care needs, although they have different coverage limits and eligibility requirements.

    Costs can vary greatly among different types of long-term care policies, so it's important to match up your financial resources with your anticipated needs.

    But insurance isn't the only way to cover costs. Reverse mortgages can help provide funding for care, although most reverse mortgages require that you continue to live in your home and so don't work well if you need to relocate to receive out-of-home care. Various types of specialized trusts can also help, such as Medicaid disability trusts that can provide money for supplemental needs beyond what Medicaid benefits cover.

    4. Planning In Advance Is the Best Way to Have Your Wishes Met.

    Many families face the challenge of having to guess what family members would want after a tragic health event leaves them unable to express their wishes. Doing advance planning can help avoid the uncertainties and ensure that your wishes will be respected and followed.

    A strong advance care plan includes a living will or advance health care directive that tells medical professionals what types of life-sustaining care you want or don't want, such as whether to resuscitate you if you stop breathing or your heart stops beating, or whether to use mechanical ventilators or tube-feeding.

    You should also choose someone to act on your behalf under a health-care power of attorney, letting a trusted individual make decisions about the specific medical situation you face. Financial provisions like establishing a trust and a durable power of attorney can make it easier for others to care for your money matters as well.

    You Can Get the Care You Need

    Needing long-term care is a scary proposition for anyone. By taking steps in advance, though, you can handle your long-term medical challenges much better than if you let things go until you actually need care.

    You can follow Motley Fool contributor Dan Caplinger on Twitter @DanCaplinger or on Google+.

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    Sean Duffy

    Republican Congressmen are continuing to rail against Sen. Ted Cruz (R-Texas) on the push to defund the Affordable Care Act through the government spending bill. 

    Thursday night, Rep. Peter King (R-N.Y.) said Cruz should "keep quiet" about House matters. And on Friday, Rep. Sean Duffy (R-Wis.) continued his blistering criticism of Cruz, complaining that he "abused" and "bullied" House conservatives into a strategy that's going nowhere.

    "I have to tell you what," Duffy told "Morning Joe's" Joe Scarborough Friday, "You should have been on the floor back in the cloak room. There was so much anger, so much frustration. Because, again, we've been abused by these guys for so long. What I see happening now is people coming out and calling them out for the hypocrisy of these big, tough conservatives who know how to fight but will never get in the ring."

    House Republicans have been angry — publicly — at Cruz since Wednesday, when he released a statement that Duffy said then was akin to "waving the white flag" and surrendering on Obamacare defunding. Cruz — along with Sens. Mike Lee (R-Utah), Rand Paul (R-Ky.), and Marco Rubio (R-Fla.) have been the leaders of the "defund" scheme that most Republicans agree has no chance of passing the Senate. 

    With 10 days until a possible government shutdown, Republicans are worried they'll get heaped with the blame for a no-end strategy.

    The House is voting Friday on its bill to keep the government funded, which includes language to strip funding for Obamacare. It is expected to pass, but the language will be stripped when it heads to the Senate — something Cruz acknowledged, finally, on Wednesday.

    King told CNN's Wolf Blitzer Thursday that the episode proved Cruz and other Republican senators should stay out of the House's business. He said that Republicans could "not let a government shutdown happen." And he said that if the GOP's image makes it through this "crisis," it would be because of House Speaker John Boehner's leadership.

    "If anything good comes from all of this, when Ted Cruz and Rand Paul and Mike Lee fail in the Senate next week, maybe finally we Republicans will have ended their influence," King said.

    "We as House Republicans should stop letting Ted Cruz set our agenda for us," King added. "He should stay in the Senate, keep quiet."

    "If he can deliver on this — fine. If he can't, he should keep quiet from now on and we shouldn't listen to him."

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    House vote Obamacare

    The House of Representatives Friday morning passed a spending bill that would keep the government funded past Sept. 30 — and would also strip funding for the Affordable Care Act.

    The bill passed by a 230-189 vote. All but one Republican voted in favor of the bill. All but two Democrats opposed it.  

    The continuing resolution will head to the Democratic-controlled Senate, where Democrats are expected to have enough votes to strip the language that defunds Obamacare from the bill. The government will shut down Oct. 1 if Republicans and Democrats cannot agree on a consensus bill.

    The vote in the House came after two weeks of House leadership struggling to find a strategy that avoids a government shutdown but also appeases the ultra-conservative wing of the party who want to use the threat of a shutdown as a last-ditch effort to stop Obamacare, the implementation of whose main provisions starts next month.

    Wednesday, House Speaker John Boehner gave in to the demands of his party's conservative wing and announced that he would bring to the floor a continuing resolution that includes the language defunding Obamacare. The bill keeps the government funded only through Dec. 15. 

    The bill has caused a significant amount of division between House and Senate Republicans this week. Most of House Republicans' ire has been directed at Sen. Ted Cruz (R-Texas), who has pushed the House to take up the cause of defunding Obamacare but admitted Wednesday that his gambit was not likely to succeed in the Senate.

    Friday morning, Rep. Sean Duffy (R-Wis.) said Cruz and other Senate Republicans had "bullied" and "abused" House Republicans into a failed approach.

    "You should have been on the floor back in the cloak room," Duffy said on MSNBC's "Morning Joe."

    "There was so much anger, so much frustration. Because, again, we've been abused by these guys for so long. What I see happening now is people coming out and calling them out for the hypocrisy of these big, tough conservatives who know how to fight but will never get in the ring."

    The one Republican who voted against the bill was Rep. Scott Rigell (Va.), who said Thursday that he would do so because of a desire to return to regular budget order.

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    senate must act boehner

    Earlier Friday, the House voted for a bill that keeps the government open while defunding Obamacare.

    This was Sen. Ted Cruz's (R-Texas) idea, and all but one House Republican ended up voting for it, even as House Republicans complain openly about Cruz's meddling in their business.

    After the vote, House Republican leadership had a clear message: Your problem now, Senate. Top Republican officials spoke behind a podium with the hashtag "#SenateMustAct." 

    House Republican Conference Chairwoman Cathy McMorris Rogers urged outside groups to "push the Senate to have this important debate on the floor of the Senate." Of course, pressure from outside groups to defund Obamacare has been a major headache for House Republicans in the last two weeks.

    The move to put pressure on the Senate is pushback against Cruz, who infuriated many House Republicans by suggesting that Senate Majority Leader Harry Reid (D-Nev.) won't have much trouble stripping the Obamacare defunding provision from the bill in his chamber.

    SEE ALSO: House Republicans Vote To Cut Food Stamps By $39 Billion

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    Ted Cruz

    At the urging of Sen. Ted Cruz (R-Texas), House Republicans voted overwhelmingly Friday for a bill that funds the government while de-funding Obamacare.

    Now, Cruz is urging his colleagues to filibuster the House bill as soon as it reaches the Senate.

    It makes a little more sense than it sounds like.

    Cruz argued that a filibuster is necessary to keep Senate Majority Leader Harry Reid (D-Nev.) from using what he called "procedural gimmicks" to strip language defunding the Affordable Care Act. 

    "If Reid pursues this plan — if he insists on using a 50-vote threshold to fund Obamacare with a partisan vote of only Democrats — then I hope that every Senate Republican will stand together and oppose cloture on the bill in order to keep the House bill intact and not let Harry Reid add Obamacare funding back in," Cruz said in a statement.

    "Now is a time for party unity; Senate Republicans should stand side-by-side with courageous House Republicans."

    Cruz's statement will put pressure on moderate Republicans — and the 14 Republicans who have gone on-record as opposing his strategy — to stand with him. 

    But the statement also reflects how difficult it will be to actually carry out his plan in the Senate. He acknowledged on Wednesday that Reid will likely succeed in stripping the Obamacare defunding langauge from the bill. But by saying as much, he infuriated House Republicans who accused him of waving a white flag. 

    The "procedural gimmicks" Cruz objects to are in keeping with normal Senate rules.

    According to a Democratic Senate aide, Democrats will introduce an amendment to strip the House language defunding Obamacare after securing 60 votes to limit debate. Because of Senate rules, they can then strip the language by a simple majority vote. Republicans' only opportunity to filibuster will come before the stripping amendment has passed.

    The irony in this situation is that if Republican senators do filibuster, they would be blocking passage of a bill that still would include the language to strip Obamacare funding. It was a scenario Reid seemed keenly aware of when releasing a statement Friday afternoon reacting to the House vote. 

    "Republicans are simply postponing for a few days the inevitable choice they must face: pass a clean bill to fund the government, or force a shutdown," Reid said in the statement.

    "I am glad to see more and more of my moderate Republican colleagues speaking up against the vocal, irrational minority within their ranks. But only time will tell if common sense will prevail."

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    House vote Obamacare

    There wasn't much surprise in the House of Representatives' vote to avoid a government shutdown while stripping all discretionary funding for the Affordable Care Act. 

    But three Congressmen did buck party lines in the vote. One Republican voted against the bill, and two Democrats voted in favor of it.

    Rep. Scott Rigell (R-Va.) was the lone Republican to vote against the bill (four Republicans did not vote). But his objection didn't really relate to Obamacare.

    He voted no because he opposes continuing resolutions, stopgap bills like this one that fund the whole government for a period of months. He wants to get back to regular budget order: funding the government through 12 separate, year-long bills for different functional areas. Rigell also represents a military-heavy district, and he decried the continuing resolution's failure to address sequestration cuts.

    "This CR fails to address the sequester that is negatively impacting those who wear our nation’s uniform and is the result of Congress’ inability to pass the 12 appropriations bills necessary to properly fund the government on time. What is needed is a comprehensive solution to our nation’s fiscal challenges, including a replacement for sequestration," Rigell said in a statement. 

    The two Democrats who defied most of their party were Reps. Jim Matheson (D-Utah) and Mike McIntyre (D-N.C.). They both represent conservative districts and voted against the Affordable Care Act when it first passed in 2010.

    Both Congressmen said in statements that they felt it irresponsible to let the government shut down, though Matheson made it clear that he opposed the inclusion of the language that defunds Obamacare. 

    McIntyre, though, has voted dozens of times to repeal Obamacare in its entirety or in certain portions. And he said that's why he voted to defund it on Friday. 

    “My record on the health care law has been crystal clear – I voted against it when it was first considered, have voted to repeal it dozens of times, and today voted to defund it," McIntyre said. "The need for health care reform is clear, but this law is not the right approach for our citizens, communities, and businesses.”     

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    Ted Cruz

    It's happening again. The clock is ticking amid yet another fiscal showdown between President Obama and Congress, which is making noises about shutting down the government, or not raising the debt ceiling unless some concession is made.

    The most famous of these showdowns came in the summer of 2011, when the Tea Party-infused GOP took the debt ceiling fight down to the wire, only to relent once Obama and the Democrats agreed to automatic future spending cuts (which we now call the sequester).

    This time we're getting a fiscal two-step: At the end of September, the government will shut down unless a "Continuing Resolution" is passed. A little bit after that the U.S. will hit the debt ceiling.

    Not only do we have two "events" in rapid succession, but there's a twist:

    Texas Senator Ted Cruz and a band of fellow travelers are promising to block the continuing resolution (in other words shut down the government) unless somehow the Congress passes (and Obama signs) a bill that would defund Obamacare.

    Now if you think there's any chance that Obama will sign a bill to defund his signature program, on the eve of it going into effect, you're probably living on another planet. But on the other hand, Republicans in the age of Obama are not known for being compromisy. It's smash-nose politics all the way down.

    Except, oddly, the Republican party is pissed off at Ted Cruz.

    See, Cruz has been making life kind of miserable for a lot of House Republicans all summer by holding rallies, and pressuring them to vote to defund Obamacare. Essentially he's being an interloper from the Senate, getting in the House's business. Eventually, this week they did successfully hold a vote that would keep the government funded at current levels of spending, with the exception of Obamacare.

    But after that it all went downhill for Cruz and the GOP because now the bill has no chance to pass in the Senate. House Republicans (and also conservative pundits) are flipping out at Cruz because they see only bad options from here. Either conservatives surrender on the issue, or there's a government shutdown.

    And it's this government shutdown possibility that has everyone freaking the hell out.

    Charles Krauthammer declared that the Republican party will end up as "sushi" if this fight to defund Obamacare ends up shutting down the government. The conservative WSJ editorial page calls this a "kamikaze" mission that will play right into Obama's hands.

    None of the arguments we've seen actually say that a government shutdown would be bad for the country (although it would depress government spending) ... all the arguments are about how bad a shutdown would be for the GOP and how it would be good for Obama.

    And this gets to the nut of why Republicans are so upset. For the first time since the Tea Party had its big win in 2010, a wing of the party is actually engaging in a fight that puts the party at risk.

    In the 2011 debt ceiling fight, the GOP was essentially free-rolling (meaning playing risk-free). They could threaten to not raise the debt ceiling knowing that Obama could not afford to actually let that happen. And they knew that the public didn't understand what the debt ceiling was (the public still doesn't), which is why polls show the public not in favor of raising the debt ceiling, even though the consequences of not raising it would be quite severe (far more than a government shutdown, which can be done in an orderly manner, and which doesn't put the service of U.S. debt at risk).

    Obama can afford to let a government shutdown happen (at least for a few days). The GOP would have to live with what it wrought, and the public would understand exactly what was going on. Threatening to shut down the government over Obamacare is not free-rolling. It's a threat with real consequences. It's a principled threat. That's why your Krauthammers and your WSJs and your Jonah Goldbergs (who says Cruz is engaged in a "long con") are screaming bloody murder.

    Unlike the debt ceiling battlers, Cruz is putting principles over his party. And that has people apoplectic.

    Even the CEO of conservative outside group Heritage Action agrees that the anger here is that Cruz is doing something that might hurt the GOP.

    Screen Shot 2013 09 21 at 3.19.44 PM

    Ezra Klein makes the correct point at Wonkblog that it's John Boehner who is being more irresponsible than Cruz, because Boehner actually is promising a fight over the debt ceiling (which will come up later) and with the debt ceiling you have the threat of a default and financial calamity.

    Defenders of the Boehner/debt ceiling approach say that such a fight isn't bad for the country because ultimately the debt ceiling will get raised somehow.

    But this is crap. First of all, it's logically inconsistent to threaten to not raise the debt ceiling (unless some demands are met) and then argue that such a threat is harmless because ultimately you're going to not follow through with it. Either you're making the threat or not. And if you're making the threat, then you're threatening for the U.S. to not pay some of its bills.

    But furthermore, just the debt ceiling fight itself has consequences. Summer 2011 showed a collapse in consumer confidence (red line) and what might be characterized as a crash in the stock market (blue line).


    Bottom line: There are two possible battles for a fiscal fight.

    One hurts America, but leaves the Republican party looking okay. That's fighting over the debt ceiling, which most people don't grasp.

    The other causes a brief government shutdown, while making the GOP look terrible on an issue that people grasp.

    Cruz is launching his fight on the one that makes the party look bad, and that's why conservatives are flipping out at him.

    It's too much to ask that Washington not have these dumb fights. But if you're going to have one, it should be the one that doesn't pose major systemic risk to the system. Cruz is fighting the right one.

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    rand paul

    MACKINAC ISLAND, Mich. (AP) — Republican Sen. Rand Paul says President Barack Obama's health care law probably can't be defeated or gotten rid of. And he's suggesting there is little he and other congressional Republicans can do to stop the law from taking effect.

    Speaking to reporters Saturday at a gathering of Michigan Republicans, Paul says Republicans could use votes on measures in the House and in the Senate to come up with compromise legislation. But the Kentucky Republican says that time for that is running out.

    An opponent of the law many call "Obamacare," Paul says he's acknowledging that, in his words, "we probably can't defeat or get rid of Obamacare." He says that working from the position of not funding the health care law might help render it, quote, "less bad."

    Copyright (2013) Associated Press. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.

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    Ted Cruz Fox News

    Sen. Ted Cruz (R-Texas) has infuriated Republicans, again— this time in the Senate — by saying that any vote to advance debate on a government spending bill is akin to supporting the Affordable Care Act.

    Senate rules make it difficult for Cruz's plan to "defund Obamacare" through the continuing resolution to get through the Democratic-controlled Senate, as it did through the Republican-led House of Representatives last Friday.

    Cruz calls them "procedural gimmicks" by Senate Majority Leader Harry Reid, but they are in keeping with normal Senate rules. A Republican filibuster would have to come before Democrats introduce an amendment to strip the language in the House-passed bill that defunds Obamacare.

    So to build pressure on the Senate, Cruz said on "Fox News Sunday" that any GOP senator who does not filibuster is supporting Obamacare — even though, in filibustering, they would essentially be endorsing a government shutdown.

    "Any vote to allow Harry Reid to add funding — a vote for cloture is a vote for Obamacare," Cruz told Fox News' Chris Wallace. "And I think they will stand side by side and listen to the people and stop this train wreck that is Obamacare."

    Like House Republicans did last week, Senate Republicans brushed back at Cruz on Sunday.

    Sen. Tom Coburn (R-Okla.) said the debate over a shutdown had to be based in "reality"— and the reality, he said, is that Republicans don't have the votes in the Senate. Sen. John McCain (R-Ariz.) threw shade at Cruz by lauding Coburn's comments afterward.

    And according to National Review's Robert Costa, GOP Senate aides are now fuming at the position Cruz has put them in:

    Then again, the aide Costa spoke with said he couldn't go on record for fear of being fired for putting distance between GOP senators and Cruz.

    Amanda Carpenter, a senior communications adviser and Cruz speechwriter, pushed back on the attacks against Cruz on Twitter:

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    Chris Wallace Ted Cruz

    As soon as "Fox News Sunday" booked Sen. Ted Cruz (R-Texas) as a guest for its program on Sunday, host Chris Wallace began receiving "unsolicited" research against Cruz. 

    For Wallace, it was one of the strangest experiences he's ever had in Washington. Not because the research was being peddled to him — but because he was receiving it from not Democrats, but fellow Republicans. 

    "This has been one of the strangest weeks I've ever had in Washington," a flabbergasted Wallace said during the panel segment of the show that included GOP strategist Karl Rove, a Cruz critic.

    "And I say that because, as soon as we listed Ted Cruz as our featured guest this week, I got unsolicited research and questions — not from Democrats, but from top Republicans — to hammer Cruz. Why are Republicans so angry at Ted Cruz?"

    "Well, because this was a strategy laid out by [Sens.] Mike Lee and Ted Cruz without any consultation with their colleagues," Rove said. 

    Rove and other establishment Republicans have been critical of Cruz's strategy on tying the "defund Obamacare" fight to the continuing resolution to keep the government funded, arguing that Cruz has no end game.

    Senate GOP aides complained Sunday after Cruz went on Fox News and said that any senator who votes for a procedural step to move along consideration of the continuing resolution is "vot[ing] for Obamacare."

    Senate Republicans also brushed back at Cruz. Sen. Tom Coburn (R-Okla.) said the debate over a shutdown had to be based in "reality"— and the reality, he said, is that Republicans don't have the votes in the Senate. Sen. John McCain (R-Ariz.) threw shade at Cruz by lauding Coburn's comments afterward.

    Here's the video of Wallace, via Mediaite:

    SEE ALSO: Ted Cruz And John McCain Really Hate Each Other

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    Obama sad frown

    You can just feel conservatives' glee as they await the "implosion" of Obamacare.

    Whether it's technical problems with the health care exchange websites or low participation in the insurance pools, they see big problems on the horizon that will doom Obamacare, and they are psyched.

    Tom Miller has a "reality check" for conservatives in the current issue of National Affairs: While Obamacare is going to cause big problems, it's not going to explode in a fireball of health care disaster. Conservatives can only defeat it with a plausible plan to replace it, says the health policy scholar from the conservative American Enterprise Institute.

    Unintentionally, Miller's "reality check" explains why conservatives can't come up with an approach to health care other than waiting for Obamacare to fail.

    Though Miller spends 6,000 words laying out his health policy vision, he never explicitly notes two facts about his approach: It would cost a lot of taxpayer money to implement, and it wouldn't achieve universal health coverage. The former makes the approach a nonstarter for so many conservatives that no Republican Congress would ever implement it. The latter makes it unsaleable to the broader electorate.

    For example, here's what Miller says about high-risk pools, or government entities that subsidize coverage for people with costly chronic medical conditions:

    We should be more generous in targeting persistent, condition-based problems and vulnerabilities. Subsidizing access to health-care choices in a competitive marketplace (through high-risk pools, for instance) is preferable to directly providing services through government channels, although markets alone do not and cannot meet every medical need.

    High risk pools already exist in most states but they don't work very well because subsidizing care for the chronically sick is expensive and states don't tend to fund the pools very well. Miller and Jim Capretta wrote another article for National Affairs in 2010 with a solution to that problem: federally funding high-risk pools, which they estimated would cost $15 to $20 billion a year.

    And some Republicans are down with the federally-funded high risk pool approach. In April, in an effort to show that Republicans have an alternative vision for health care reform, House Majority Leader Eric Cantor (R-Va.) brought forward a plan to divert $3.7 billion over four years from Obamacare into high risk pool subsidies.

    That's about 5% of the amount the Capretta-Miller plan would cost, but it would be a start. Yet, Cantor had to pull the bill from the floor because Republicans were unwilling to spend even that much money on the high risk pool approach.

    Rep. Raul Labrador (R-Idaho) told Talking Points Memo that "subsidizing health care is not what Republicans should be about."

    In 2010, when Rep. Paul Ryan (R-Wisc.) and Sen. Tom Coburn (R-Okla.) advanced their alternative to Obamacare, one argument they made in favor of their plan was that it did not spend any federal money on high-risk pools, unlike a plan previously advanced by Sen. John McCain (R-Ariz.) which they complained would have "[cost] the taxpayers hundreds of billions of dollars over a projected budget window."

    The problem for Miller is not that conservatives are too busy opposing Obamacare to sign on to his approach to fixing health care. It's that conservatives oppose his approach to fixing health care.

    At the same time Miller asks for money for the sick that Republicans won't give him, he's also calling for rolling back coverage in a way the broader public won't appreciate. Most plans for health reform focus on reducing uninsurance and improving access to coverage. Miller actually calls for shrinking Medicaid coverage for healthy adults—but he makes the call in a convoluted way that you might miss if you're not paying attention. Emphasis added:

    Income-based financial support from taxpayers to address health-care vulnerabilities should distinguish better between short-term emergency assistance and longer-term arrangements for those suffering from chronic or permanent conditions. Reformers need to have in mind a socially conscious "floor" for the former — both in dollar amounts and eligibility duration for catastrophic coverage— while avoiding the danger of setting a ceiling on personal responsibility, economic initiative, and social mobility. Short-term assistance can provide stability and opportunity to rebound from health-related misfortune, but it should not dull the incentives to regain more self-sufficiency after the crisis is over.

    In other words: Reduce Medicaid for healthy adults to "catastrophic" coverage covering major health events instead of the broad coverage it is today, and impose a time limit on its use, so that healthy people who end up long-term unemployed with almost no income also end up uninsured.

    If you explained Miller's plan in clear language to the public ("we're going to spend a bunch of money and we're going to take health insurance away from people who have it now") it wouldn't go very far. If this is the available policy alternative, it's pretty easy to understand why Republicans have ditched it for a facile "defund Obamacare" message.

    Other parts of the article reflect how shallow conservative thinking on health policy tends to be, including Miller's. In a section on delivery reforms, he bemoans conservatives' failure to advance alternatives to Obamacare's "science-fair of medical-delivery experiments and untested vaporware," such as bundled payments and accountable care organizations. But then three of the four principles he lays out for such alternatives are exactly the same ones underlying the Obamacare approach:

    First, they must redesign payments so they reward results rather than try to micromanage processes as they do now. Second, they should better measure what matters to patients and other private payers. Third, they need to remember that favoring competition is not the same as (and indeed must be at times the opposite of) protecting incumbent business interests.

    This is what liberal health policy wonks have been working on for the last five years while conservatives have invested their energy in trying to undermine and tear down Obamacare.

    Miller is right that conservatives are being undone by their unseriousness on health policy. But the patient can only get better if he wants to.

    The failure of conservative politicians and think tanks to advance serious alternatives on health policy reflects their complete lack of interest in fixing health policy: They don't want to spend money, they don't want to change Medicare in ways that affect elderly Republican base voters, they don't want to cut the incomes of Republican-voting doctors, and they don't want to change the (often overly expensive) health coverage situations of the overwhelmingly insured Republican electorate.

    They do want to stop Democrats from having legislative accomplishments. Sometimes, conservative health care "plans" are useful as a concern trolling exercise to interfere with Democratic legislating on health care. But Republicans are not about to let their own side's plans get anywhere near the implementation stage, lest they do any of the things I listed in the above paragraph.

    I understand Miller's frustration. It's tough to sell a product that nobody wants to buy. But he should try harder to understand why he's not making the sale.

    SEE ALSO: In Defense Of The Obamacare Defunders

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    The top-two ranking Senate Republicans on Monday came out against Sen. Ted Cruz's (R-Texas) plan to defund the Affordable Care Act by filibustering the continuing resolution that keeps the government funded. 

    Both Senate Minority Leader Mitch McConnell and Sen. John Cornyn, the other Republican senator from Texas, did so in a roundabout way that signals how Republicans are going to approach their discontent with Cruz's plan

    Here's Cornyn's tweet:

    John Cornyn Ted Cruz

    McConnell will also not participate in a GOP filibuster. Like Cornyn, he will oppose an amendment to restore Obamacare funding in the continuing resolution, but he will not block the House-passed bill. 

    Here's the full statement from McConnell spokesman Don Stewart: 

    Senator McConnell supports the House Republicans’ bill and will not vote to block it, since it defunds Obamacare and funds the government without increasing spending by a penny.  He will also vote against any amendment that attempts to add Obamacare funding back into the House Republicans’ bill. If and when the Majority Leader goes down that path, Washington Democrats will have to decide—without hiding behind a procedural vote—whether or not to split with their leadership and join Republicans and their constituents in opposing the re-insertion of Obamacare funding into the House-passed bill.

    Cornyn and McConnell's statements are more complicated than they look.

    Senate rules will make things a little awkward for Cruz as the House-passed bill moves through the upper chamber. They make it possible for Senate Majority Leader Harry Reid to introduce an amendment to strip language in the House bill defunding Obamacare — after the Senate has voted to end debate on the bill.

    Votes to cut off debate require 60 votes (and therefore at least six Republican votes) but the vote on the amendment and on final passage will only require a simple majority, meaning Reid can get his way with only Democratic support on those votes.

    Cruz calls this approach a series of "procedural gimmicks" by Reid, but it's in keeping with normal Senate rules. A Republican filibuster would have to come before Democrats introduce an amendment to strip the language in the House-passed bill that defunds Obamacare.

    So, somewhat ironically, Cruz has signaled plans to filibuster the House-passed bill that includes language to defund Obamacare. 

    In their statements, McConnell and Cornyn are saying that they will support the House bill that defunds Obamacare, but they hint that they will not go along with a plan to filibuster that same bill. That could be how other moderate GOP senators follow suit and allow a "clean" continuing resolution that doesn't defund Obamacare to pass the Senate.

    This post has been updated.

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    Dave Weigel sent an interesting Tweet this afternoon.

    Screen Shot 2013 09 23 at 5.24.05 PM

    It's been a tough couple of months for labor unions and the Affordable Care Act. The AFL-CIO passed a resolution at its convention earlier this month complaining about several of the law's provisions. The head of the Laborers International Union of North America said the law should be repealed if it isn't modified to the unions' liking.

    Most of the Democratic Party's liberal coalition is quite eager for implementation of the new health care law, and Obamacare is pretty clearly beneficial to the sort of people who join labor unions: low- and middle-income workers who stand to gain bigger subsidies and better access to health insurance under the law.

    But the unions are resistant. Here are five reasons why:

    • Obamacare discourages the sort of high-end health plans some unions have negotiated. Starting in 2018, the law imposes an excise tax on the most expensive health plans, as a way to both discourage high health care spending and raise revenue to finance the law. A lot of the "Cadillac" plans that will be subject to this tax are high-end ones that labor unions have negotiated for their members.
    • Obamacare is financed in part through taxes on health insurance premiums. Officially, these are three new "fees" on group health insurance plans, but substantively they are taxes. TriNet, which provides health benefit services for Business Insider's employees (including me) estimates that these taxes are adding 2.8% to their average health plan premium next year. So, if you already have a health plan, you have reason to worry that Obamacare could make it more expensive.
    • Obamacare will undermine union-run Taft-Hartley multiemployer plans. This is at the center of LIUNA's complaint: Employers who currently participate in these plans are likely to drop out and give their employees cash to buy plans in the Obamacare exchanges instead. The unions claim that this is bad for the workers who currently enroll in Taft-Hartley plans. I don't buy that; the reason Taft-Hartley plans are expected to fall out of favor is that many current participants in those plans will become eligible for much larger subsidies if they buy in the exchanges. But whatever the impact on union members, the demise of Taft-Hartley plans is clearly bad for the union leaders who run them.
    • Obamacare will make non-union workers better off. Access to exchange subsidies is good for union workers, but it's even better for non-union workers, who are more likely to lack access to health care through work currently. This win-win for workers will make it harder for unions to organize workplaces. As Avik Roy points out, access to a Taft-Hartley health plan is a key selling point to workers considering affiliating with certain unions. Losing that advantage of union membership may make workers less keen on joining a union.
    • Universal health care will reduce the importance of collective bargaining. I noted last week that decoupling health insurance from work will reduce employers' power over workers, by making it easier to demand a raise or quit your job without fear of losing your health insurance. Since a key purpose of collective bargaining is to press employers to make good on obligations to their workers, shifting some of those obligations away from employers toward the government makes unions less important and powerful.

    While these are rational reasons for unions (or at least union leaders) to be wary of Obamacare, none are really good substantive policy objections to the law. The best objection is to the taxes on plan premiums, but the new benefits the law provides have to be financed somehow. Don't confuse some unions' parochial concerns about Obamacare for a reason to think the law is a problem for workers broadly.

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    Ted Cruz

    The conservative editorial board of the Wall Street Journal blasted Sen. Ted Cruz's (R-Texas) strategy to strip funding of the Affordable Care Act through the continuing resolution to keep the government funded.

    The board cast Cruz as a "general" sending his troops out to battle in a losing fight — a "charge into the fixed bayonets." It also blasted Cruz for the main problem with his strategy — calling on House Republicans to "stand firm" in the face of sure losses in the Senate

    From the editorial:

    When Mr. Cruz demands that House Republicans "hold firm," he means they should keep trying to defund ObamaCare even if it results in a shutdown that President Obama will blame on Republicans. It's nice of him to volunteer House Republicans for duty. The supposedly intrepid General Cruz can view the battle from the comfort of HQ while the enlisted troops take any casualties.

    The Lee-Cruz strategy, to the extent it's about more than fund-raising lists or getting face time on cable TV, seems to be that if the House holds "firm" amid a shutdown, then the public will eventually blame Mr. Obama and the Democrats, who will then fold and defund ObamaCare. Or, short of that, Democrats might agree to delay the health-care law for another year past its launch date on October 1.

    Miracles happen, but it would rank as one for the ages if Mr. Obama agreed to defund his signature Presidential achievement. A year's delay would also be a victory, but Mr. Obama knows that punting the law past the 2014 election is risky if Republicans regain a Senate majority.

    The WSJ edit board has been one of the leading critics of Sens. Cruz and Mike Lee (R-Utah) in a fight that has divided conservative groups.

    In its editorial, the WSJ took shots at the Heritage Foundation — which, it pointed out, was an architect and proponent of "Romneycare," on which Obamacare's individual mandate is based.

    "These columns opposed ObamaCare before it was known by that name, and we may have even been the first to call it by that name," the editorial reads.

    "We also don't need any lectures about principle from the Heritage Foundation that promoted RomneyCare and the individual mandate that is part of ObamaCare. Or from cable TV pundits who sold Republicans on Mitt Romney despite RomneyCare."

    A better strategy, the editorial board argued, would be to seek a one-year delay in the individual mandate, pointing out that President Barack Obama has already agreed to delay the so-called employer mandate. But the board noted that the only "real way" to fully repeal the law is to "win elections."

    SEE ALSO: Inside The GOP Civil War That Could Turn Into A Debt Ceiling Or Government Shutdown Disaster

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    emergency room

    A non-blogging friend points me to this new article at Forbes by Chris Conover purporting to show that the "typical family of 4" will see its health care spending rise by $7450. He quotes the Center for Medicare and Medicaid Services (CMS), saying "in its first ten years, Obamacare will boost health spending by 'roughly $621 billion' [that's the CMS quote]  above the amounts Americans would have spent without this misguided law." How stupid is this? Let us count the ways.

    First of all, this is not $7450 per year, but over the entire 10-year (or more likely 9-year; he usually refers to 2014-22) period. So the he's hyping shock value that isn't there. As he explains, he divides the $621 billion by total population over the period to give a per capita cost, which he then multiplies by 4 to get the cost to his "typical family of 4." So what we're actually looking at, before we start tearing up his calculation, is ($7450/9)/4 = $207 per capita higher spending per year on average. Recall that in 2011 the United States spent $8174.90 per person on health care (see link on how to navigate to the ultimate source for this data,

    Second, Conover doesn't understand present value. He writes, "Of course, all these figures are in nominal dollars. In terms of today’s purchasing power, this annual amount will rise steadily." Of course, it is just the opposite. A dollar in 2022 is worth less than a dollar today. In 2013 dollars, the amount is less than $207 per person per year (how much less depends on what you consider an appropriate discount rate). How does an editor not catch this? I have a screen shot to memorialize the error after it eventually gets fixed.

    Third, Think Progress's Igor Volsky is completely right when he quotes Paul van der Water of the Center on Budget and Policy Priorities that none of this will apply to the "typical American family" because that family gets its insurance at work. More money will obviously be spent over time, but it won't be spent at the center of the health insurance distribution, if you want to look at it that way. But Conover can't see this point. Instead, he points the finger at President Obama for promising that the ACA would reduce premiums for the typical family by $2500 per year. Not only do two wrong not make a right, but

    Point four is that what he says is impossible just isn't: "It’s simply not possible for national health spending to rise by $621 billion and for the “typical” family to expect a $2500 (per year!!!!) premium reduction." I don't know if it will happen, but it certainly isn't impossible. Conover is overlooking the fact that the increase in health spending is being funded in ways that don't come out of individual health care spending.

    High-income taxpayers ($200,000 single, $250,000 filing jointly) are paying 0.9% points more in Medicare tax and an extra 3.8% on investment income. According to Robert Pear of the New York Times, "The new taxes on wages and investment income are expected to raise $318 billion over 10 years, or about half of all the new revenue collected under the health care law."The medical device tax will raise $29 billion over 10 years, over $100 billion will come from insurance companies, $34 billion from drug companies, and $150 billion from the "Cadillac" tax, according to the Obama administration. (We can debate the wisdom of this tax, but it doesn't fall on the "typical" family.) We're already at $631 billion over 10 years. If we increased these taxes more, yes, we could use the money to fund premium reductions, most plausibly by increasing the income levels eligible for subsidies.

    Then, there's the little matter of the newly insured. By 2022, according to the CMS report Conover cites, 30 million more people will have insurance than would be the case without Obamacare. While many of those people will be receiving subsidies, a lot of them will be paying something for their insurance, adding even further to the sources of income that don't come out of what the "typical family" will pay. 

    Finally, the new 30 million people will be covered very efficiently. $621 billion divided by 9 years is $69 billion per year, divided by 30 million people is $2300 per person per year. While that figure is too low because we won't be insuring all 30 million immediately, remember that 2011 U.S. health spending per capita was $8174.90. Any way you look at it, the newly insured will be costing far less per person than those currently in the insurance system.

    There you have it. Forbes' most-read story of the day (with over 26,000 Facebook shares and 3400 tweets as I write this) is simply false. Between all the new taxes and the premiums from the newly insured, you can cover the total increase in health care spending. The typical, already insured family isn't going to see increases due to the rise in overall health care spending. You add 30 million new insured at a far lower cost than what we currently spend per person. And the editors didn't catch a blatant error on present value.

    Read more posts on Middle Class Political Economist »

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    John Boehner smile

    By all indications, the conservative gambit led by Sen. Ted Cruz (R-Texas) on defunding the Affordable Care Act through the continuing resolution is doomed to fail.

    But Cruz's battle has diverted attention away from another battle that Democrats wanted to fight through the continuing resolution — sequestration. It's something that House Speaker John Boehner has taken advantage of, masterfully putting Republicans in position to come out of the government-funding fight with a win and with future leverage on the sequester.

    Last week, the House of Representatives passed a bill to avert a government shutdown. Boehner gave into demands from the conservative wing of his caucus, and the bill included the stripping of funding for Obamacare. 

    But the bill also funds the government through Dec. 15 at a spending level of approximately $986 billion. This locks in another temporary round of spending cuts, as it funds the government at levels under sequestration. According to the liberal Center for American Progress, it keeps 100% of the non-defense sequester cuts and 60% of the cuts to defense.

    But sequestration has become such an afterthought that Democrats have barely put up a fight in this round of fiscal talks. The White House has refused to take the step of issuing a veto threat against a bill that includes sequester-level spending. And Senate Democrats also look prepared to cave.

    A senior Democratic Senate aide told Business Insider that it's not likely the Senate will amend the House's bill to include higher-spending levels. Democratic aides say this is because they are worried about having the votes to push through anything higher than the House level.

    And they say that Boehner hasn't provided them enough time to fight on the sequester. If they do, they fear they'll be blamed in the event of a shutdown. But the aides stressed that there are still a few days and possibly two Democratic caucus meetings before any strategy is set in stone. 

    It's likely, however, that the Senate will send back to Boehner a "clean" continuing resolution without the language to strip funding for Obamacare and that maintains the $986 billion spending level.

    At that point, House Democrats will be pressed to support the Senate-passed bill when it comes back to the House. Even though House Minority Leader Nancy Pelosi (D-Calif.) and Minority Whip Steny Hoyer (D-Md.) have railed against a $986 billion-level bill, the Senate will have given them no cover. They would risk being blamed for a government shutdown if they oppose the bill that passed the Senate with substantially Democratic votes.

    For Boehner, the real test will come in convincing a majority of his caucus to also support the bill, considering many conservatives will be disappointed that it no longer includes language to defund Obamacare. 

    This doesn't mean that Republicans will come out of this fiscal debate unscathed. Polls show that the majority of Americans oppose defunding Obamacare if it means a government shutdown or debt default.

    But if Boehner can get enough of his caucus on board to avoid breaking the "Hastert Rule" and avoid a shutdown, Republicans will have won another significant battle on spending. That's plausible, considering that only a minority of 80 Republicans in the House signed a letter urging Boehner to defund Obamacare.

    It also means that Republicans will continue to hold important leverage on something Democrats — and President Obama — desperately want to eliminate.

    SEE ALSO: This Is How The Top Two Senate Republicans Got Out Of Ted Cruz's Plan To Defund Obamacare

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    TEd Cruz filibuster

    Just less than a half hour into his speech in opposition to Obamacare on the Senate floor, Sen. Ted Cruz (R-Texas) compared his fight to defund it to the fight against Nazi Germany in the 1940s. 

    Cruz said that acceptance of Obamacare implementation is like 1930s appeasement of Nazi Germany. 

    He also compared his fight to standing up to the British during the Revolutionary War, and standing up to the Soviet Union during the space race.

    "So, we get to Obamacare," Cruz said. "What do all those voices say? Can't be stopped. You can't win. Cannot defund it.

    "By any measure, Obamacare is a far less intimidating foe than those that I have discussed, with the possible exception of the moon. The moon might be as intimidating as Obamacare."

    SEE ALSO: Full coverage of Ted Cruz's speech

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    Ted Cruz

    When Sen. Ted Cruz (R-Texas) took the Senate floor at 2:41 PM Tuesday, he declared his intention to talk "until I cannot stand anymore."

    He's not going to do that.

    That's because what Cruz is doing isn't really a filibuster, where you can hold the Senate floor as long as you want so long as you keep talking. Cruz is subject to a time limit. At most, he can talk until noon Wednesday.

    Senate rules don't always allow unlimited debate. In this instance, the Senate is scheduled to adjourn tomorrow at noon, at which point Cruz will have to stop talking.

    At that point, the Senate will immediately reconvene to vote on cloture, which moves the continuing resolution that Cruz is trying to stop toward passage with further time limits. If most of the Senate's Republicans line up with Cruz and vote against cloture, then he'll be able to filibuster; cloture requires 60 votes, so it needs at least 6 Republican votes to pass.

    But many Republicans, including Minority Leader Mitch McConnell (R-Ky.) have indicated that they will vote yes, meaning the 60 vote threshold will be achieved. That will set up the bill for a limited, 30 hours of debate, of which only 15 will be allocated to the Republicans.

    That means Cruz has no chance at breaking the record for the longest speech on the Senate floor, which Strom Thurmond, then a Democrat from South Carolina, set when he spoke against a civil rights bill for just over 24 hours in 1957.

    Indeed, Cruz might not even speak as long as he is allowed. A Republican leadership aide told ABC News that Cruz might speak just long enough to appear in prime time on Fox News, which would only require talking for a bit more than eight hours.

    An earlier version of this story incorrectly described Senate procedures and stated that Cruz would have to stop talking by 5 a.m. Wednesday.

    SEE ALSO: It Took Ted Cruz 25 Minutes To Compare Defunding Obamacare To Nazi Germany, And The Moon

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