Smart. Sharp. Funny. Fearless.

Monday, December 09, 2019 {{ new Date().getDay() }}

Senator Susan Collins: Difficult To Envision Yes Vote On Cassidy-Graham Bill

Reprinted with permission from AlterNet.

In an interview on “State of the Union” with Jake Tapper, Senator Susan Collins (R-Maine) explained:

“Jake, it’s very difficult for me to envision a scenario where I would end up voting for this bill. I have a number of serious reservations about it. I’m concerned about the impact on the Medicare program, which has been on the books for more than 50 years.”

Collins went on to suggest she is “very concerned about the erosion of protections for people with pre-existing conditions.” Senator Collins will wait for the CBO results on Monday, but can’t imagine how the CBO can score the bill, since Cassidy-Graham has continued to morph over the past few days.

When the Senate first took up the repeal-and-replace bill passed by the House, conventional wisdom suggested the Senate would modify the bill and create a more acceptable version. Instead, each Senate version has become more draconian, ending promised protections for pre-existing conditions and Medicare.

The bottom line is simple.

The ACA grand bargain, struck between the insurance companies and Democrats, is impossible to unravel without tens of millions of Americans losing their coverage. The Democrats agreed to keep the private insurance infrastructure and mandate insurance coverage for all Americans nationwide, in exchange for a dramatic improvement in plans: 10 Essential Benefits, no lifetime caps, no difference in prices for people with pre-existing conditions and scores of other protections for consumers.

Health care is now significantly better for millions of Americans. The Republicans’ starting point—an insistence on eliminating coverage mandates—drops healthy young people from the rolls and requires the reduction of guaranteed protections for the math to work for insurers.

Their plans unravel as a result. But they will not stop.

John McCain’s days are numbered. There will be a new reconciliation period established in 2018—and the battle will re-engage.

Watch the full interview below:

 

Dear John McCain: Your Health Care Vote Could Kill More Americans Than The Vietnam War

Reprinted with permission from AlterNet.

Dear John McCain,

John, I lost my mom to the same aggressive disease you are facing, so we both know there is not much time.

Your vote on the last-ditch effort to repeal and replace the ACA, the Graham-Cassidy Bill, proposed by your pal Sen. Lindsey Graham (R-SC) and Bill Cassidy (R-La), Dean Heller (R-NV) and Ron Johnson (R-WI) could be the last and most consequential vote of your entire career. Sure, there have been other big votes, but none where you were twice the “decider”—with the long-term wellbeing of so many Americans in your hands.

Will your July 25 “Role of the Senate” speech, upon returning to the senate floor after brain surgery, be remembered as the dramatic, moral-marker of a legendary maverick of the Senate? Or Exhibit A when studying political hypocrisy and a vote that would make Trump look honest by comparison?

John, if America returns to the bad old days of coverage caps, medical bankruptcy, rejection for pre-existing conditions, substance abuse, maternity and other benefits no longer required, along with a mammoth reduction in Medicaid funds for the poor and most vulnerable, your vote could result in more U.S. deaths than the Vietnam war.

John, let’s revisit some of the words you delivered so emotionally on the Senate floor only a few weeks ago:

Our responsibilities are important, vitally important, to the continued success of our Republic. Our arcane rules and customs are deliberatively intended to require broad cooperation to function well at all. The most revered Members of this institution accepted the necessity of compromise in order to make incremental progress on solving America’s problems and to defend her from her adversaries.

John, Cassidy-Graham isn’t a compromise, and you know it. Are you ready to bet the CBO is wrong by a factor of 30 million?

I hope we can again rely on humility, on our need to cooperate, on our dependence on each other to learn how to trust each other again and, by so doing, better serve the people who elected us. Stop listening to the bombastic loudmouths on the radio and television and the internet. To hell with them. They don’t want anything done for the public good. Our incapacity is their livelihood.

John, are you listening to the American Medical Association? Are you listening to AARP? Are you listening to Blue Cross and Blue Shield, which cover 106 million Americans today with both business and ACA plans? Are you listening to the American Hospital Association? Are you listening to the pediatricians, psychiatrists, obstetricians, gynecologists, and probably the doctors who have been treating you? Is it possible the leading associations representing seniors, hospitals, nurses, doctors and the country’s largest insurer are all wrong? And Donald Trump and Tom Price are right?

Let’s trust each other. Let’s return to regular order.

John, does this rushed process, without hearings, without a CBO score, feel like regular order to you?

We have tried to do this by coming up with a proposal behind closed doors in consultation with the administration, then springing it on skeptical Members, trying to convince them it is better than nothing—that it is better than nothing—asking us to swallow our doubts and force it past a unified opposition. I don’t think that is going to work in the end and probably shouldn’t.

John, is it even remotely possible to speak these words and vote for Cassidy-Graham without being exposed as an epic hypocrite?

Why don’t we try the old way of legislating in the Senate—the way our rules and customs encourage us to act. Let’s see if we can pass something that will be imperfect, full of compromises, and not very pleasing to implacable partisans on either side, but that might provide workable solutions to problems Americans are struggling with today.

John, you know damn well Sen. Lamar Alexander (R-Tenn) and Sen. Patty Murphy (D-Washington) have been working together these past months to find a bipartisan senate solution before being derailed yesterday by Cassidy-Graham. You know damn well 40 House members, calling themselves the Problem Solvers Caucus, have been working toward bipartisan health care solutions. Who are you listening to, John?

And the times when I was involved, even in a modest way with working on a bipartisan response to a national problem or threat, are the proudest moments of my career and by far the most satisfying.

John, reread your speech, every day, morning, noon and night, until the vote next week. Think about your legacy, and the “role of the Senate” you so eloquently defended. Make the proudest moment of your career a no-vote on Cassidy-Graham. Hold your ground, and be remembered as a maverick of the Senate and a man of his word.

America’s Real Health Care Debate: How To Stop Insurers From Robbing Us Blind

Reprinted with permission from AlterNet.

Previously, I argued that Democrats must reclaim and reframe Congress’ healthcare debate to make Dems the party protecting freedom.

In brief, freedom is coverage, we need to move beyond Congressional Budget Office scores and frame other critical components of the Affordable Care Act.

Remember, freedom is coverage. Now, repeat after me…

Caps matter

With passion!

Caps matter

Maximum out-of-pocket caps.

Caps matter

No more lifetime caps.

Caps matter

Because you don’t choose to get sick, you just do.

Why It’s Important

Because your maximum “out of pocket” caps are the key to good insurance.

Because Republicans juggle the numbers and avoid discussing the bottom line. Insurance is not just monthly premiums or deductibles, it is the total level of exposure in each plan.

What does the Swampcare team Say?

It’s always about choice.

Senator Ted Cruz, on Sunday’s This Week with George Stephanopoulos promoted his Consumer Freedom Option, saying, “If you want to buy a plan with all the bells and whistles, with all of the mandates under Title One, you can buy that plan. Those plans will be on the market, those plans will have significant taxpayer money behind them. But on the other hand, if you can’t afford a full Cadillac plan, you should be able to buy another plan that meets your needs. So, the Consumer Freedom Option gives you the consumer choice, whether to go with the full Cadillac or a skinnier plan that is a lot more affordable” and later “If we lower premiums, that’s a win/win for everybody.”

Lots of choices, lower premiums, backed up with some significant taxpayer dollar.

What’s not to like?

What Happens In Real Life?

In real life, no one wants to believe tragedy will strike them.

Life is hard enough without walking around thinking today is the day you’re getting hit by a truck or diagnosed with MS. One of the big protections introduced by the ACA was the elimination of lifetime caps on coverage under the 10 Essential Benefits.

It is an option people would gamble away. And as one would imagine, it is also coverage many insurers would eliminate in the new “skinnier” plans.

What Republicans don’t discuss much is what happens when someone goes “skinny” and bets wrong. It goes without saying the patient will probably go bankrupt and maybe even die. U.S. hospitals nationwide already carry mountains of patient debt, and the re-introduction of lifetime caps will force them to provide health care for more people who can’t pay.

As Amanda Marcotte of Salon recently pointed out, lifetime caps were eliminated under the ACA for the 10 Essential Benefits only. So, if gone, even consumers in employer plans may find themselves facing more limited coverage and more bankruptcies. And Marcotte notes employers can choose whatever state they do business in to create their plan. Where does your company have offices?

When it comes to insurance, no lifetime caps matter.

In real life, everyone faces mundane, commonplace but expensive procedures like knee surgery.

And again, the ACA provides annual maximum out-of-pocket caps, which rise every year for inflation, for individuals and families. This year, the maximum out-of-pocket cap for an individual is $7,150 and the maximum out-of-pocket cap for a family of four is $14,300. Sure, that’s a lot of money, but again, it’s a cap that can prevent bankruptcy or financial ruin.

We all like some choice, and ACA coverage includes Bronze, Silver, Gold and Platinum plans, ranging from 60% to 90% of costs covered. In all the plans, these annual maximum out-of-pocket caps act as a critical backstop. You bet a little, but not the house—literally. And the insurance company pays 100% after you hit those out-of-pocket caps.

When it comes to insurance, annual out of pocket caps matter.

In real life, Americans allocate a higher percentage of GDP to healthcare than any industrial nation.

One of the more humane principles created in the ACA is the sliding “cap” on percentage of personal income going to healthcare. For individuals and families making 100% to 400% of the federal poverty level, the cap ranges from 2% of income for someone making very little money to 9.5% of income for those at the top of the range. If your monthly premium was above the income cap, the government covered the gap.

Known as the premium tax credit, this “income cap” principal guides the calculation of the subsidy people receive each year to supplement their costs. In 2017, the subsidies range was $11,880 to $47,520 for an individual and for a family of four it was $24,300 to $97,200.

Think about it again. The ACA basically says, for any family of four living on less than $90,000 a year, you shouldn’t spend more than 10% of your income on health care. And we will offer assistance to keep it below that cap.

Pretty damn good.

When it comes to insurance, annual percentage of income caps matters.

In real life, old people get a lot sicker than young people and everyone gets old.

Social Security, Medicare and the nursing home elements of Medicaid ease the journey. And the ACA added a “cap” on the maximum spread of premium costs based on age at 3 to 1. The current Senate and House plans shift the ratio to 5 to 1, but who knows what would happen in new state-created plans without restrictions. The CBO reports this one change will make health care unaffordable for millions of elderly Americans.

Just one more cap in a long list of ACA caps (they call them rules and regulations) that stabilize people’s lives economically.

When it comes to insurance, a 3-to-1 age cap matters.

What Should Dems Say?

Talk more about the ACA effect on the middle class.

Media coverage has rightfully been focused on the devastating effects the Senate and House plans will have on the poor, elderly and disabled. But the ACA helps middle-class individuals living on $40,000 a year and a family of four living on less than $90,000 a year too.

Democrats need to give specific examples of families and individuals with middle-class incomes and drive home how the removal of coverage and caps will affect them.

The ACA protects everyone, even people in employer plans.

The 10 Essential Benefits cover all health care plans nationwide and insure every employer plan and every state exchange plan cover essential benefits including substance abuse, mental health and maternity. The ACA elimination of lifetime caps applies to every plan nationwide. Ditto the maximum out-of-pocket costs for individuals and families.

Democrats need to hammer home the potential effects of Swampcare on employer plans, too.

Who covers the costs when someone goes “skinny” and has a very bad health day?

In their brave new world of infinite plan options, what happens when someone bets wrong?

When someone picks a cheaper plan with a reinstated lifetime cap, and has a Steve Scalise moment, we can assume bankruptcy at a minimum and millions in unpaid bills. From 2010 to 2016, personal bankruptcies have been cut in half. This trend would reverse. Will states pick up the slack? Will more people slide into poverty and end up in Medicaid? Will hospitals take on even more debt?

Democrats need to engage Republicans and their pundits with specific examples, walking through the step-by-step reality of a skinny plan. Instead of allowing Tom Price to bloviate, get specific and talk about one person and one scenario at a time. Joe Blow takes a skinny plan with a lifetime cap, has an accident and is disabled for life. What happens? Joan Blow takes a plan without adequate mental health coverage and her kid tries to commit suicide. What does she do?

Under the ACA the insurance company paid—now who does? And why is that better?

The Bottom Line

The Republican solution—free markets and choice—is a return to the bad old days. When you scratch below the surface, it doesn’t add up. Insurance works best with a large pool (mandate), core coverage (10 Essential Benefits) and a limit on maximum out-of-pocket costs (caps).

Caps matter. A lot.

Democrats, Reframe Health Care Debate So Americans Know You’re On Their Side

Reprinted with permission from AlterNet.

For those of us who support the Affordable Care Act and health care as a right, we need to bolster messaging for politicians and mainstream media in the face of unprecedented lies and misinformation.

I get why you may think Congressional Budget Office scores are enough. As the defense lawyer for the ACA, you’d look the jury in the eye and say, “Swampcare is of the Swamp, for the Swamp and decidedly written by the Swamp. Swampcare will cause 22 million people to lose coverage, the death of tens of thousands and a doubling of personal bankruptcies across the nation. The defense rests.”

But we live in a world where these plain truths may not be enough.

 

Good old-fashioned greed propped up by the old standbys—lower taxes and free markets that will reduce premiums, increase choice and spur growth—may still win the day.

Solid reporting on these fallacies is abundant, from the Kaiser Foundation to the Washington Post to AlterNet. But on mainstream and cable news, it’s a different story, where protocols permit unchallenged lies and favor the repetition of simple talking points, true or not.

While admittedly not a marketing maven, I’m going to take a shot at framing some of the critical elements in the ACA that are not receiving the attention they deserve. OK, repeat after me:

Freedom is coverage.

Say it louder!

Freedom is coverage.

You too, Perez, Ellison, Schumer, Sanders and Warren.

Freedom is coverage.

Yes, repetition matters. A lot. Ask Larry Bird.

Freedom is coverage.

Because you don’t choose to get sick, you just do.

Why is it important? Because we can’t cede a concept as basic as freedom to the opposition—and we have.

Because the 10 Essential Benefits truly are essential.

 

Freedom and choice, freedom and choice, freedom and choice, is their mantra.

Tom Price, as Secretary of Health and Human Service is the message lead and champion of health care “freedom,” helping citizens “to select the kind of coverage that’s right for them and their families, not that Washington forces them to buy.” Tom Price wants to turn back the “tide of all the rules and regulations that decrease choices that increase costs.”

Libertarian wingman Senator Rand Paul says, “perhaps we should try freedom.”

From their perspective, the mandate reduces freedom, the 10 Essential Health Benefits limit freedom, the caps restrict freedom and yes, even the pre-existing conditions requirements interferes with free markets, choice and personal freedom.

They want citizens to have freedom of choice and to save money. And for the states to decide on their plans. Who doesn’t like choice? And freedom?

What’s not to like?

 

In real life, people really hate paying a premium every freaking month for 10 years and then when they need the insurance, discovering there was a loophole, disclaimer or exclusion for an “act of god.”

You have a car accident, and want the policy to cover the cost of repair with a modest deductible. A tree falls on your house, and you expect the homeowner’s policy to cover the cost of repair with a modest deductible. If your business has errors and omissions, you expect it to cover the legal costs when you or your company make an error or omission.

When it comes to insurance, what people hate is no coverage.

In real life, 69 percent of U.S. adults have less than $1,000 in savings.

Most Americans are living close to the edge, paying bills month to month and watching every penny. They would easily fall prey to cheaper plans that did not cover essential benefits. It’s human nature. They need to feed their kids, pay the rent or fix the car to get to work.

They will roll the dice, and pray.

When it comes to insurance, what people really want is coverage.

In real life, no one knows when they are going to get sick, or have a Steve Scalise moment.

According to the CDC in 2014, the “number of medically attended injury and poisoning episodes in the population: 39.5 million. Episodes per 1,000 population: 126.3. Number of emergency department visits for unintentional injuries: 28.1 million.”

Translation—your chances of a medically attended injury each year is over one in 10.

And sadly, Steve Scalise is not alone; in 2016, according to the Gun Violence Archive, there were 30,616 gun-related injuries. I doubt any of them were planned for.

You won’t need more than a million dollars in coverage this year and would rather save $200? Bam. Bankruptcy.

When it comes to insurance, what people really need is coverage.

In real life, most businesses and families want to lock into monthly fixed costs.

A CFO will tell you it is better for planning to have monthly costs to avoid fluctuations in expenses whenever possible. If you are a family with the income and luxury to budget, you pay for the security of insurance. And if you are at the lower rung, even a modest expense can throw your life into a panic.

It is the conservative, prudent and more business-like approach. Which one would expect Republicans to embrace. Instead, we have conservatives, Republicans and libertarians ignoring common sense and suggesting the American public play Russian roulette with their health to save a short-term buck.

When it comes to insurance, what people really expect is coverage.

What Should Dems Say?

Drop the qualifier. Democrats—please stop leading with “we know it could be better” and “we are ready to work with Republicans.” You think it makes us sound less partisan, but it makes us sound weak, like we don’t even believe in the bill we fought for.

Try this…

The ACA is the greatest piece of legislation in this generation.

Nine out of 10 Americans live with the freedom afforded by full coverage, the freedom to change jobs, the freedom to live without bankruptcy, the freedom to choose plans in an open market.

 

Isn’t it telling that male Republicans use maternity leave as an example of a benefit that is not “essential?” They don’t want to pay for it, ladies.

So what else is new?

 

Dems, Berniacs, Indivisible groups, everyone on point for 10 days, asking the same question: Why shouldn’t every plan provide coverage for_______?

Day One is ambulatory, Day Two is emergency services. Etc. By the time we get to hospitalization, Republicans will look ridiculous. Let’s ask them to list the coverage they will skip in their family plans.

As a reminder, the 10 Essential Benefits are:

  • Ambulatory patient services (Outpatient care)
  • Emergency Services (Trips to the emergency room)
  • Hospitalization (Treatment in the hospital for inpatient care)
  • Maternity and newborn care
  • Mental health services and addiction treatment
  • Prescription drugs
  • Rehabilitative services
  • Laboratory services
  • Preventive and wellness services, including chronic disease management
  • Pediatric services

 

When Republicans talk about freedom and choice, they repeat two points about Obamacare—the insurers are leaving rural counties (46 without plans) and Obama didn’t let you keep your doctor, reducing choice.

The Senate and House bills only offer the “free market” as a solution.

Both problems are driven by insurance profits. Insurers leave rural counties because they can’t make as much money—so “skinny” plans will be the cure. As anyone who has ever wrestled with the “in-network” search tools on a health care site knows, it is the insurers who pick your doctors—even in employer plans.

When Republicans talk about “freedom,” it’s freedom for insurers and doctors they are mostly talking about. So here are some amendments to solve the rural and doctor problem that insurers and doctors will hate, but will stir the freedom and choice discussion.

 

Insurance companies offering insurance in a state must offer insurance in all counties in the state. Doctors who accept insurance in a state must accept insurance from all providers in the state.

Want to talk about real patient freedom? Rural problem is solved. Throw away those thick “in-network” books forever—if you have insurance, just go to the doctor.

 

Government employees, including congresspersons and the executive branch, will purchase the least costly health plan offered in the state in which they permanently reside.

Republicans would never offer their constituents a plan that was unsafe that they would not take themselves—would they? Do unto others…what is good for the goose is good for gander. And so on.

I am certain good Republicans throughout the government, devoted to saving their fellow taxpayers money wherever they can, will embrace the cheapest plan being offered in their home states, along with fellow constituents.

 

Freedom is coverage. And lots of protections in the Affordable Care Act are worth fighting for.

Remember These Numbers When Republicans Accuse Democrats Of Obstruction

Reprinted with permission from AlterNet.

Donald Trump has selected Federal Appeals Court Judge Neil Gorsuch to take a seat that constitutionally was President Barack Obama’s to fill.

The Senate should have seated Obama’s nominee, Judge Merrick Garland, and then turned to Trump’s nominees as vacancies occurred. But that does not appear to be the political world America lives in, where Senate Republicans, led by Majority Leader Mitch McConnell, have stolen an open seat that would have tilted the court’s balance away from a right-wing majority.

In their article, “The Garland Affair: What History and the Constitution Really Say About President Obama’s Powers to Appoint A Replacement for Justice Scalia,” Robin Bradley Kar and Jason Mazzone comprehensively review virtually every past Supreme Court nominations in our history and compile the data cited below.

“There have been 103 prior cases in which—like the case of President Obama’s nomination of Judge Garland—an elected President has faced an actual vacancy on the Supreme Court and began an appointment process prior to the election of a successor,” they write. “In all 103 cases, the President was able to both nominate and appoint a replacement Justice.”

Let’s get down to some numbers that put Senate Republicans’ judicial coup in context.

293: Number of days Republicans stonewalled President Barack Obama’s nomination of Merrick Garland to the Supreme Court before the Senate term expired.

103: Number of Supreme Court vacancies filled by elected presidents. That’s right, 103 in a row.

8: Vacancies filled during election year. Eight times in our history, Supreme Court vacancies occurred during an election year and the elected presidents’ nominees were approved.

6: Number of unelected presidential Supreme Court vacancy nominations denied. Supreme Court vacancies were denied when the sitting president was not elected: Vice President John Tyler’s nominations after death of President William Henry Harrison; VP Millard Fillmore’s nominations after the death of President Zachary Taylor; and VP Andrew Johnson’s nominations after the assassination of Abraham Lincoln. President Obama was elected by the people, twice.

3: Lame-duck nominations denied. There were also three nominations made by sitting presidents post-election day, after the new president had been elected. John Quincy Adams tried after Andrew Jackson was elected; James Buchanan tried after Lincoln was elected; and President Hayes tried after James Garfield was elected. All were denied. President Obama made his nomination of Garland long before the election of Donald Trump.

84: Years since last election-year nomination. The last time there was a Supreme Court vacancy during an election year, President Hoover’s nomination was approved.

9,498: Average days in the tenure of recent Supreme Court justices (since 1970). That’s right, since 1970, Supreme Court justices who have retired, had tenures averaging 26.1 years. So, this is a quarter-century: a big time decision.

1,461: The number of days Democrats should be willing to wait for the Senate to approve President Obama’s rightful nomination of Merrick Garland to the Supreme Court.

1,151: Number of days Democrats will have to wait during Trump’s term for Republicans to respect history and the right of every elected president to fill vacancies to the Supreme Court that occur during their term. Since Republicans have invented a new, first-time-ever, no-election-year approval precedent, Democrats will only be waiting 1,151 days

2: Number of balls and ovaries most Republicans have when it comes to something as important as the next Supreme Court vacancy. Precedent be dammed, they simply were not going to allow President Obama to appoint another Supreme Court judge that could shift the court. Period. Republicans have basically said to Democrats, when we are in charge, let’s play by the rules, and when you are in charge, all is fair in love and war. Translation: our way or the highway.

Unknown: Democrat Senators with balls and ovaries. Senator Minority Leader Chuck Schumer suggested to MSNBC’s Rachel Maddow, when asked about the stolen Supreme Court seat, there would be some opposition to Republican nominations, but nothing near the absolute resolve expressed by Republicans.

Will Elizabeth Warren, Bernie Sanders, Corey Booker, Al Franken, and the Gang of 49 step up and start the fight for our country on the steps of the Supreme Court? Will they show the toughness that Americans respect from their leaders? (Voters care a lot more about conviction than facts and policy.) Will they say enough is enough?

The Big Picture: Judicial Coup

The Senate should approve Obama’s rightful nominee, and respect 200 years of history and the last 103 nominations and the rightful balance of powers. When the next Supreme Court vacancy occurs, it becomes fair to approve one of your nominees. To be clear, Democrats are not refusing to approve Republican Supreme Court vacancies, but they are now out of sequence – and when they approve ours, we will approve theirs.

And waiting an extra 1,000 days, for a decision that will last 26 years, is not a problem. We’ll wait. The importance of this decision cannot be overstated.

Short of devastating Obamacare, climate legislation, or World War III, this quite simply may be the biggest decision Democrats make during the Trump term. Republicans ignore history, put their boots on Democrats’ necks, and stall a rightful nomination for 293 days, and then fully expect Democrats to bend over, start playing by the rules again and approve their nomination?

Two wrongs don’t make a right, you say? You got it wrong. I am not suggesting Democrats refuse to approve a Trump nominee, when a Trump Supreme Court vacancy exists. I am simply saying, Republicans must fill the seat that is rightfully in the hands of President Obama, before that can happen. The only time in our history when an elected presidents’ nominations were denied, were when they were made after the new president was elected. Not relevant this time.

President Obama’s pick still must be defended.

Yes, Democrats have rejected nominees. But when a nominee was rejected, the elected president always had time to make a second appointment, and the elected president always had one of his appointments approved—103 times in a row. If Republicans don’t like Merrick Garland, vote him down.

Want to win back some Trump Democrats? Democratic senators can start by showing some gumption, some resolve, and some principles. History is on your side. Be tough and regain some respect in the heartland.

IMAGE: President Barack Obama (L) announces Judge Merrick Garland (R) as his nominee to the U.S. Supreme Court, in the White House Rose Garden in Washington, March 16, 2016.  REUTERS/Kevin Lamarque