Tag Archives: Government

House Republicans seek $1 billion in Medicaid funds for Puerto Rico

A local resident sits on the roof of his home that was damaged by Hurricane Maria in Guaynabo, Puerto Rico, October 2, 2017. REUTERS/Alvin Baez

WASHINGTON (Reuters) – Puerto Rico, struggling to recover from hurricane damage, could receive $1 billion in additional funding for the Medicaid health insurance program for the poor under a proposal from a U.S. House of Representatives panel, a congressional aide said on Tuesday.

Republicans who lead the House Energy and Commerce Committee included the request for more Medicaid funding for Puerto Rico as part of a separate bill to reauthorize the Children’s Health Insurance Program. It is scheduled to be considered and voted on in committee on Wednesday.

The U.S. territorial island, hard-hit by Hurricane Maria, already had faced a drop-off of Medicaid funding at the end of the year, according to the Washington Post, which first reported Republicans’ plan.

Now Puerto Rico also faces massive damage from Maria that wiped out much of its infrastructure, left hospitals struggling and residents without clean water, electricity and cellphone service.

Committee spokeswoman Jennifer Sherman said the panel would take up the bill on Wednesday as part of its effort to renew funding for the larger U.S. children’s insurance program, which saw its funding expire during the weekend.

Under the proposal, Puerto Rico would receive $880 million through 2019. It also would get another $120 million if its financial oversight board certified that the joint federal-state program there had taken steps to prevent fraud and abuse and improve efficiency, among other oversight steps.

Lawmakers sought to pay for the additional Medicaid funding by charging higher premiums on wealthier people in the Medicare health insurance program for seniors, and redirecting some prevention health funding from community-based health centers, among other changes, according to a copy of the plan.

Republican U.S. President Donald Trump visits the island on Tuesday amid criticism over his administration’s response to the storm. [nL2N1ME09T]

About 3.4 million people live in Puerto Rico, which in recent years had faced recession and, in May, bankruptcy.

(Reporting by Susan Cornwell; Writing Susan Heavey; Editing by Bill Trott)

As Trump set to visit Puerto Rico, 95 percent lack power

As Trump set to visit Puerto Rico, 95 percent lack power

By Robin Respaut and Gabriel Stargardter

SAN JUAN, Puerto Rico (Reuters) – President Donald Trump is set to make his first visit to Puerto Rico on Tuesday, two weeks after Hurricane Maria devastated the U.S. territory, and is likely to face more criticism of his handling of the disaster as the vast majority of inhabitants lack power and phone service and are scrambling for food, clean water and fuel.

San Juan Mayor Carmen Yulin Cruz led the attack on the administration’s response on Friday, criticizing an official’s description of relief efforts as a “good news story” and urging Trump to act more decisively. Trump fired back at Cruz on Twitter, accusing her of “poor leadership.”

It is not clear if the two will meet during Trump’s visit.

“She (Cruz) has been invited to participate in the events tomorrow, and we hope those conversations will happen and that we can all work together to move forward,” White House spokeswoman Sarah Sanders told reporters on Monday.

Trump will spend “significant time” on the island. He is due in Las Vegas on Wednesday to meet with people affected by Sunday’s mass shooting.

For 72-year-old Angel Negroni of Juana Matos, the situation has begun to improve as flood waters receded from his neighborhood, located 20 minutes from San Juan.

Locals could occasionally get spotty cellular service, an improvement from the communication vacuum of days earlier. And he can trade his neighborhood’s restored municipal water for ice made by a friend’s generator-powered freezer.

“It’s better now,” said Negroni, while standing on his covered porch on Monday, cooking fish on a propane-powered camping stove. “We’re OK.”

At least 5.4 percent of customers in Puerto Rico had their power restored by mid-morning on Monday, according to the U.S. Energy Department, with San Juan’s airport and marine terminal and several hospitals back on the power grid. It said the head of Puerto Rico’s power utility expects 15 percent of electricity customers to have power restored within the next two weeks.

Mobile phone service is still elusive. The U.S. Federal Communications Commission said on Monday 88.3 percent of cellphone sites – which transmit signals to create a cellular network – were out of service, virtually unchanged from 88.8 percent on Sunday.

FEMA Administrator Brock Long on a trip to the island on Monday said things were improving with traffic moving and businesses reopening.

“I didn’t see anybody in a life-threatening situation at all,” he told reporters. “We have a long way to go in recovery,” adding that rebuilding Puerto Rico is “going to be a Herculean effort.”

GAS FLOWING

Nearly two weeks after the fiercest hurricane to hit the island in 90 years, everyday life was still severely curtailed by the destruction. The ramping up of fuel supplies should allow more Puerto Ricans to operate generators and travel more freely.

“We’ve been increasing the number of gas stations that are open,” Governor Ricardo Rossello said at a news briefing, with more than 720 of the island’s 1,100 gas stations now up and running.

Puerto Rico relies on fuel supplies shipped from the mainland United States and distribution has been disrupted by the bad state of roads.

Within the next couple of days, Rossello expects 500,000 barrels of diesel and close to 1 million barrels of gasoline to arrive on the island. All of Puerto Rico’s primary ports have reopened but many still have restrictions, according to the U.S. Department of Energy.

At least four tankers carrying fuel are waiting to unload with two more on the way, according to Thomson Reuters shipping data.

“The flow is coming, gasoline is getting here,” Rossello said. “We have been able to reduce the time that it takes to get gasoline and diesel at different stations.”

Federal and local authorities were working together to keep 50 hospitals operational and Rossello said the U.S. Navy hospital ship Comfort would arrive in Puerto Rico between Tuesday and Wednesday.

RUNNING OUT OF CASH

As it tries to get back on its feet, Puerto Rico is in danger of running out of cash in a matter of weeks because the economy has come to a halt in the hurricane’s aftermath, Rossello told the local El Nuevo Dia newspaper in an interview published on Monday.

After filing for the largest U.S. local government bankruptcy on record in May, Puerto Rico owes about $72 billion to creditors and another $45 billion or so in pension benefits to retired workers.

What little cash it has is now being diverted to emergency response while it works to secure aid from the federal government. The grinding halt to the economy will delay a fiscal recovery plan and negotiations with creditors.

“There is no cash on hand. We have made a huge effort to get $2 billion in cash,” Rossello said in the interview. “But let me tell you what $2 billion means when you have zero collection: it’s basically a month government’s payroll, a little bit more.”

Trump’s administration is preparing to ask Congress for $13 billion in aid for Puerto Rico and other areas hit by natural disasters, congressional sources said. The island’s recovery will likely cost more than $30 billion.

(Reporting by Robin Respaut, Gabriel Stargardter; additional reporting by Nicholas Brown and Carlos Barria in SAN JUAN, Puerto Rico; Doina Chiacu, Roberta Rampton, Tim Ahmann and Makini Brice in WASHINGTON; Marianna Parraga in HOUSTON; Rodrigo Campos and Herb Lash in NEW YORK and Esha Vaish in BENGALURU; Writing by Bill Rigby and Lisa Shumaker; Editing by Bill Trott and Mary Milliken)

Under pressure from Trump, Price resigns as health secretary over private plane uproar

HHS Secretary Tom Price speaks at a news conference on annual influenza prevention at the Press Club in Washington, U.S., September 28, 2017. REUTERS/Kevin Lamarque

By Steve Holland

WASHINGTON (Reuters) – U.S. Health and Human Services Secretary Tom Price resigned under pressure from President Donald Trump on Friday in an uproar over Price’s use of costly private charter planes for government business.

His abrupt departure was announced an hour after Trump told reporters he was disappointed in Price’s use of private aircraft and did not like the way it reflected on his administration.

“Secretary of Health and Human Services Thomas Price offered his resignation earlier today and the president accepted,” the White House said in a statement.

Trump named Don Wright to serve as acting secretary. Wright is currently the deputy assistant secretary for health and director of the office of disease prevention and health promotion.

“I’m not happy. OK? I’m not happy,” Trump told reporters on the White House South Lawn.

Candidates to succeed Price included Seema Verma, who is administrator of the Centers for Medicare and Medicaid Services and who is close to Vice President Mike Pence, and Scott Gottlieb, a physician who serves as commissioner of the Food and Drug Administration, according to industry analysts.

Several sources saw Gottlieb as a clear front runner. They said he got along well with the White House and is viewed favorably there.

Price’s resignation leaves Trump with a second Cabinet position to fill. He has yet to pick a secretary for homeland security after hiring former Secretary John Kelly as his White House chief of staff.

It was the latest blow to the Trump White House, which has struggled to get major legislative achievements passed by Congress and has been embroiled in one controversy after another since Trump took office in January.

Price, a former congressman, was instrumental in the Trump administration’s policies aimed at undercutting Obamacare, as well as working with governors across the country to slowly begin unraveling parts of the law.

In a resignation letter, Price offered little in the way of contrition. He said he had been working to reform the U.S. healthcare system and reduce regulatory burdens, among other goals.

“I have spent forty years both as a doctor and public servant putting people first. I regret that the recent events have created a distraction from these important objectives,” he said.

Trump, currently trying to sell his tax cut plan and oversee the federal response to devastation wreaked by three hurricanes, saw the Price drama as an unnecessary distraction and behind the scenes was telling aides “what was he thinking?,” a source close to the president said.

Price promised on Thursday to repay the nearly $52,000 cost of his seats on private charter flights. “The taxpayers won’t pay a dime for my seat on those planes,” Price said.

But that was not enough to satisfy Trump.

Trump told reporters that the “optics” of Price’s travel were not good, since, as president he was trying to renegotiate U.S. contracts to get a better deal for taxpayers.

“Look, I think he’s a very fine person. I certainly don’t like the optics,” Trump said.

Price had also been seen in the White House as having been ineffective in getting Congress to pass healthcare reform legislation, an effort that has fizzled on Capitol Hill.

Price was one of a handful of senior officials in Trump’s administration put on the defensive over reports about their use of charter flights and government aircraft, sometimes for personal travel, when they could have flown commercial for less money.

The White House issued an order late on Friday saying use of private planes required approval from White House Chief of Staff John Kelly and that the commercial air system was appropriate even for very senior officials with few exceptions.

The Washington Post on Friday reported that Veterans Affairs Secretary David Shulkin attended a Wimbledon tennis match, toured Westminster Abbey and took a cruise on the Thames this summer during a 10-day trip to discuss veterans’ health issues in Britain and Denmark.

Shulkin, who traveled on a commercial airline, was accompanied on the trip by his wife, whose airfare was paid for by the government and who received a per diem for meals, the Post said, noting that the Department of Veterans Affairs said she was traveling on “approved invitational orders.”

His six-person traveling party included an acting undersecretary of health and her husband as well as two aides. They were accompanied by a security detail of as many as six people, the Post said.

Washington news media outlet Politico has reported that Price had taken at least two dozen private charter flights since May at a cost to U.S. taxpayers of more than $400,000. Politico also reported he took approved military flights to Africa and Europe costing $500,000.

Senior U.S. government officials travel frequently, but are generally expected to keep costs down by taking commercial flights or the train when possible.

Environmental Protection Agency Administrator Scott Pruitt and Treasury Secretary Steve Mnuchin have also been in the spotlight for their travel habits.

(Additional reporting by David Alexander, James Oliphant, Yasmeen Abutaleb and Toni Clarke; Editing by Jonathan Oatis and Andrew Hay)

Senators close to bipartisan deal on health exchanges: Schumer

FILE PHOTO - Senate Minority Leader Chuck Schumer speaks with reporters following the party luncheons on Capitol Hill in Washington, U.S., September 26, 2017. REUTERS/Aaron P. Bernstein

WASHINGTON (Reuters) – Two U.S. senators from both parties are close to finalizing a bipartisan deal to shore up the health insurance exchanges created under Obamacare, the chamber’s top Democrat said on Thursday.

The move, which Senate Democratic Leader Chuck Schumer said was “on the verge” of completion, would stabilize the market for individuals who buy their own insurance plans on the federal or state-based exchanges.

The potential agreement comes after Republicans have repeatedly failed to carry out their years-long pledge to repeal and replace the 2010 Affordable Act, former Democratic President Barack Obama’s signature healthcare overhaul.

Schumer said Senate Health, Education, Labor and Pension Committee Chairman Lamar Alexander, a Republican, and ranking Democrat Patty Murray had resurrected a bipartisan approach, which had been cast aside amid the latest near-vote on a repeal bill.

Alexander and Murray had been working to protect the government payments made to insurers to help reduce medical expenses for low-income Americans enrolled in Obamacare. Alexander also wanted states to have more flexibility to design insurance plans under the program.

“They both inform me that they’re on the verge of an agreement, a bipartisan healthcare agreement to stabilize markets and lower premiums,” Schumer said on the Senate floor on Thursday.

The pact could buoy health insurance companies, which came out forcefully against the Republican repeal effort and have faced uncertainty since the November election of Republican President Donald Trump, who vowed to sink the law.

While the majority of insured Americans receive coverage through their employers or government programs such as Medicare and Medicaid, more than 10 million people have individual plans through the online exchanges, and about 11 million are expected to sign up next year.

Most of these consumers receive income-based tax credits and subsidies to reduce costs. Insurers have filed their premium rates for 2018, many of which are expected to rise at least 20 percent because of uncertainty that the government will continue paying some of those subsidies.

Despite those worries, insurers on Wednesday signed contracts with the government that will result in every U.S. county having at least one company selling Obamacare plans.

Trump has signaled that his administration would take other action to unwind the law, and on Wednesday said he would sign an order next week allowing people to buy insurance coverage across U.S. state lines.

Republican Senator Rand Paul, who has been pushing for the move, says Trump can do this by legalizing nationwide health associations that individuals could then join.

(Reporting by Susan Heavey; Editing by Lisa Von Ahn)

California moves presidential primary for bigger say in candidate choice

FILE PHOTO - A poll worker places a mail-in ballot into a voting box as voters drop off their ballot in the U.S. presidential primary election in San Diego, California, United States, June 7, 2016. REUTERS/Mike Blake/File Photo

By Sharon Bernstein

SACRAMENTO, Calif. (Reuters) – California will move its presidential primary from June to March under a bill signed on Wednesday by Democratic Governor Jerry Brown, a change aimed at giving the liberal-leaning state more influence in choosing candidates from either national party.

The most populous U.S. state, which voted heavily for Democrat Hillary Clinton in November’s presidential election, has traditionally held its primary so late that Democratic and Republican voters in other states had essentially already chosen their parties’ candidates.

“The Golden State will no longer be relegated to last place in the presidential nominating process,” said Secretary of State Alex Padilla, a Democrat who backed the change, in a statement. “Candidates will not be able to ignore the largest, most diverse state in the nation as they seek our country’s highest office.”

The bill was passed mostly along party lines in the majority-Democrat legislature.

The new date will leave the Iowa caucuses and the New Hampshire primary in place as the first and second contests of the presidential election cycle, during which voters in each state choose the candidate they would like their party to nominate for president.

Because California’s primary has been in June while others were held earlier, candidates have largely ignored the state, spending less on outreach than elsewhere, making fewer visits, and failing to prioritize California voters’ concerns in their campaigns, supporters said.

In 2016, California Democrats chose Clinton and Republicans opted for Donald Trump, the populist businessman who ultimately won the presidency.

Backers in the legislature said the early primary would lead to less divisive choices by members of both major parties in the 2020 election cycle, and establish California as a leading voice in the choice of candidates.

Progressive Democrats also believe that moving the primary up could result in their party’s selection of more liberal candidates.

“California is the beating heart of the national resistance to Trump, and California Democrats are defining the progressive agenda for America,” state Democratic Party Chairman Eric Bauman said in a press release. “When it comes to deciding the Democratic nominee, our voices need to be heard early in the process.”

(Reporting by Sharon Bernstein; Editing by Richard Chang)

Trump proposes U.S. tax overhaul, stirs concerns on deficit

U.S. President Donald Trump delivers remarks on proposed changes to the U.S. tax code at the state fairgrounds in Indianapolis, Indiana, U.S. September 27, 2017. REUTERS/Jonathan Ernst

By David Morgan and Richard Cowan

WASHINGTON (Reuters) – President Donald Trump proposed on Wednesday the biggest U.S. tax overhaul in three decades, calling for tax cuts for most Americans, but prompting criticism that the plan favors business and the rich and could add trillions of dollars to the deficit.

The proposal drew a swift, skeptical response from Senator Bob Corker, a leading Republican “fiscal hawk,” who vowed not to vote for any federal tax package financed with borrowed money.

“What I can tell you is that I’m not about to vote for any bill that increases our deficit, period,” Corker, who said on Tuesday he would not seek re-election in 2018, told reporters.

Trump said his tax plan was aimed at helping working people, creating jobs and making the tax code simpler and fairer. But it faces an uphill battle in the U.S. Congress with Trump’s own Republican Party divided over it and Democrats hostile.

The plan would lower corporate and small-business income tax rates, reduce the top income tax rate for high-earning American individuals and scrap some popular tax breaks, including one that benefits people in high-tax states dominated by Democrats.

Forged during months of talks among Trump’s aides and top congressional Republicans, the plan contained few details on how to pay for the tax cuts without expanding the budget deficit and adding to the nation’s $20 trillion national debt.

The plan still must be turned into legislation, which was not expected until after Congress makes progress on the fiscal 2018 budget, perhaps in October. It must then be debated by the Republican-led congressional tax-writing committees.

Analysts were skeptical that Congress could approve a tax bill this year, but that is what Republicans hope to achieve so they can enter next year’s congressional election campaigns with at least one legislative achievement to show for 2017.

Financial markets rallied on the plan’s unveiling, an event long anticipated by traders betting that stocks would benefit from both faster economic growth and inflation.

TRUMP IN INDIANA

At an event in Indianapolis, Trump called the plan the largest tax cut in U.S. history. “We want tax reform that is pro-growth, pro-jobs, pro-worker, pro-family and, yes, tax reform that is pro-American,” he said.

The real estate mogul-turned-politician, who promised big tax cuts as a candidate, told reporters he personally would not gain financially from the proposal.

“I think there’s very little benefit for people of wealth,” said Trump, who unlike many of his White House predecessors, has refused to make public his own tax returns.

Republicans have produced no major legislative successes since Trump took office in January, even though they control the White House and both chambers of Congress. Their top legislative priority, overhauling the U.S. healthcare system, collapsed again in the Senate on Tuesday.

A comprehensive rewrite of the U.S. tax code has eluded previous presidents and Congress for decades. The last one was passed in 1986 under Republican President Ronald Reagan.

Trump’s plan falls short of the sweeping, bipartisan package crafted by Reagan and congressional Democrats, analysts said.

The White House said that, under the proposal, typical middle-class families would have less income subject to federal tax. Trump said the first $12,000 earned by an individual and the first $24,000 by a married couple would be tax-free.

The plan would lower the top individual tax rate, paid by the nation’s top earners, to 35 percent from 39.6 percent.

It would lower the top corporate income tax rate to 20 percent from the current 35 percent. The existing rate is high globally, but many U.S.-based multinationals pay much less than the headline rate because of abundant loopholes and tax breaks.

DEMOCRATS SKEPTICAL

Trump has appealed to Democrats to back the plan, although they were not consulted in drafting it.

Republicans hold a thin 52-48 Senate majority and may need some Democratic support to win passage. But Democrats said the plan would expand the federal deficit in order to deliver tax cuts to wealthy Americans rather than the middle-class families that Trump and Republicans say they are trying to help.

“If this framework is all about the middle class, then Trump Tower is middle-class housing,” said Senator Ron Wyden, the top Democrat on the tax law-writing Senate Finance Committee.

Republican Kevin Brady, chairman of the tax-writing House of Representatives Ways and Means Committee, said he expected tax legislation to be passed by the end of this year.

The Committee for a Responsible Federal Budget, a Washington-based policy group, estimated on Wednesday the plan contained about $5.8 trillion of total tax cuts over a decade and would have a net cost of $2.2 trillion through 2027.

Analysts have warned huge tax cuts would balloon the deficit if economic growth projected by Republicans to offset the costs fails to materialize amid rising interest rates.

‘PASS-THROUGH’ RATE

The plan would set a new 25 percent tax rate for “pass-through” businesses, which are usually small, private enterprises, such as partnerships and sole proprietorships. They represent about 95 percent of all U.S. businesses.

Under current law, the profits of those companies “pass through” directly to their owners and are taxed as personal income, often at the top 39.6 percent individual income rate.

Cutting that to 25 percent could mean big tax savings for small-business owners, but also be vulnerable to abuse by other individuals and companies, analysts said.

Republicans proposed eliminating some tax deductions. They did not target the popular ones for mortgage interest and charitable giving, but called for scrapping the one for state and local tax payments. That could especially hurt people in high-tax states like California and New York.

In a step to simplify tax returns, the plan would shrink the current seven tax brackets to three: 12 percent, 25 percent and 35 percent. That would raise the bottom tax rate on low-earning Americans to 12 percent from 10 percent, but analysts said other parts of the plan would still mean a net tax cut.

(Reporting by David Morgan and Richard Cowan; Additional reporting by Susan Heavey, Doina Chiacu and Amanda Becker; Writing by Will Dunham and Kevin Drawbaugh; Editing by Alistair Bell and Peter Cooney)

Iraqi Kurdish leader says ‘yes’ vote won independence referendum

Kurds celebrate to show their support for the independence referendum in Erbil, Iraq September 25, 2017. REUTERS/Ahmed Jadallah

By Maher Chmaytelli and Ahmed Rasheed

BAGHDAD/ERBIL, Iraq (Reuters) – Iraqi Kurdish leader Masoud Barzani said on Tuesday that Kurds had voted “yes” to independence in a referendum held in defiance of the government in Baghdad and which had angered their neighbors and their U.S. allies.

The Kurds, who have ruled over an autonomous region within Iraq since the 2003 U.S.-led invasion that toppled Saddam Hussein, consider Monday’s referendum to be an historic step in a generations-old quest for a state of their own.

Iraq considers the vote unconstitutional, especially as it was held not only within the Kurdish region itself but also on disputed territory held by Kurds elsewhere in northern Iraq.

The United States, major European countries and neighbors Turkey and Iran strongly opposed the decision to hold the referendum, which they described as destabilizing at a time when all sides are still fighting against Islamic State militants.

In a televised address, Barzani said the “yes” vote had won and he called on Iraq’s central government in Baghdad to engage in “serious dialogue” instead of threatening the Kurdish Regional Government with sanctions.

The Iraqi government earlier ruled out talks on Kurdish independence and Turkey threatened to impose a blockade.

“We may face hardship but we will overcome,” Barzani said, calling on world powers “to respect the will of millions of people” who voted in the referendum.

Earlier, the Kurdish Rudaw TV channel said an overwhelming majority, possibly over 90 percent, had voted “yes”. Final results are expected by Wednesday.

Celebrations continued until the early hours of Tuesday in Erbil, capital of the Kurdish region, which was lit by fireworks and adorned with Kurdish red-white-green flags. People danced in the squares as convoys of cars drove around honking their horns.

In ethnically mixed Kirkuk, where Arabs and Turkmen opposed the vote, authorities lifted an overnight curfew imposed to maintain control. Kirkuk, located atop huge oil resources, is outside the Kurdish region but controlled by Kurdish forces that occupied it in 2014 after driving out Islamic State fighters.

In neighboring Iran, which also has a large Kurdish minority, thousands of Kurds marched in support of the referendum, defying a show of strength by Tehran which flew fighter jets over their areas.

The referendum has fueled fears of a new regional conflict. Turkey, which has fought a Kurdish insurgency within its borders for decades, reiterated threats of economic and military retaliation.

Barzani, who is president of the Kurdish Regional Government, has said the vote is not binding, but meant to provide a mandate for negotiations with Baghdad and neighboring countries over the peaceful secession of the region from Iraq.

IRAQI OPPOSITION

Baghdad said there would be no such talks.

“We are not ready to discuss or have a dialogue about the results of the referendum because it is unconstitutional,” Iraqi Prime Minister Haider al-Abadi said on Monday night.

Abadi ordered the Kurds to hand over control of their airports to the central government within three days or face an international embargo on flights.

Abadi, a moderate from Iraq’s Shi’ite Arab majority, is coming under pressure at home to take punitive measures against the Kurds. Hardline Iranian-backed Shi’ite groups have threatened to march on Kirkuk.

“We as Popular Mobilisation would be fully prepared to carry out orders from Abadi if he asks to liberate Kirkuk and the oilfields from the separatist militias,” said Hashim al-Mouasawi, a spokesman for the al-Nujabaa paramilitary group.

The Kurds, who speak their own language related to Persian, were left without a state of their own when the Ottoman empire crumbled a century ago. Around 30 million are scattered in northern Iraq, southastern Turkey and parts of Syria and Iran.

The autonomous region they control in Iraq is the closest the Kurds have come in modern times to a state. It has flourished, largely remaining at peace while the rest of Iraq has been in a continuous state of civil war for 14 years.

Since the fall of Saddam, they have had to carefully balance their ambitions for full independence with the threat of a backlash from their neighbors and the reluctance of Washington to redraw borders.

In the past four years they achieved a measure of economic independence by opening a route to sell oil through pipelines to a port in Turkey. But that still leaves them at the mercy of Ankara, which draws a firm line at formal independence.

Turkish President Tayyip Erdogan warned that Iraqi Kurds would go hungry if Turkey imposed sanctions, and said military and economic measures could be used against them.

“This referendum decision, which has been taken without any consultation, is treachery,” he said, repeating threats to cut off the pipeline.

The Kurds say the referendum acknowledges their contribution in confronting Islamic State after it overwhelmed the Iraqi army in 2014 and seized control of a third of Iraq.

Voters were asked to say ‘yes’ or ‘no’ to the question: “Do you want the Kurdistan Region and Kurdistani areas outside the (Kurdistan) Region to become an independent country?”

Iraqi soldiers joined Turkish troops for military exercises in southeast Turkey on Tuesday near the border with the Kurdistan region. Turkey also took the Rudaw TV channel off its satellite service TurkSat.

STATE DEPARTMENT

Iraq’s Kurds have been close allies of the United States since Washington offered them protection from Saddam in 1991. But the United States has long encouraged the Kurds to avoid unilateral steps so as not to jeopardize the stability of Iraq or antagonize Turkey.

The U.S. State Department said it was “deeply disappointed” by the decision to conduct the referendum but Washington’s relationship with region’s people would not change.

Asked about the referendum, White House spokeswoman Sarah Sanders said on Monday: “We hope for a unified Iraq to annihilate ISIS (Islamic State) and certainly a unified Iraq to push back on Iran.”

The European Union regretted that the Kurds had failed to heed its call not to hold the referendum and said Iraqi unity remained essential in facing the threat from Islamic State.

The Kremlin said Moscow backed the territorial integrity of countries in the region. Unlike other powers, Russia had not directly called on the Kurds to cancel the referendum. Moscow has quietly pledged billions of dollars in investment in the past year, becoming the biggest funders of the Kurds.

Iran banned flights to and from Kurdistan on Sunday, while Baghdad asked foreign countries to stop oil trading with the Kurdish region and demanded that the KRG hand over control of its international airports and border posts with Iran, Turkey and Syria.

Iranian Major General Yahya Rahim Safavi, a top adviser to the Supreme Leader, called on “the four neighboring countries to block land borders” with the Iraqi Kurdish region, according to state news agency IRNA. Tehran supports Shi’ite Muslim groups that are powerful in Baghdad.

Syria, embroiled in a civil war and whose Kurds are pressing ahead with their own self-determination, also rejected the referendum.

KRG Prime Minister Nechirvan Barzani said he hoped to maintain good relations with Turkey.

“The referendum does not mean independence will happen tomorrow, nor are we redrawing borders,” he said in Erbil on Monday. “If the ‘yes’ vote wins, we will resolve our issues with Baghdad peacefully.”

(Additional reporting by Ece Toksabay in ANKARA and Umit Bektas in HABUR, Turkey; Editing by Philippa Fletcher, Peter Graff and Giles Elgood)

Obamacare repeal on the ropes as pivotal Republican rebuffs Trump

U.S. Senator John McCain (R-AZ) (C) departs after the weekly Republican caucus policy luncheon at the U.S. Capitol in Washington, U.S. September 19, 2017. REUTERS/Jonathan Ernst

By Susan Cornwell and Yasmeen Abutaleb

WASHINGTON (Reuters) – U.S. Senator Susan Collins rebuffed intense lobbying from fellow Republicans and the promise of money for her state in deciding on Monday to oppose – and likely doom – her party’s last-ditch effort to repeal Obamacare.

The most moderate of Republican senators joined John McCain and Rand Paul in rejecting the bill to end Obamacare. It was a major blow for President Donald Trump who has made undoing Democratic former President Barack Obama’s signature healthcare law a top priority since the 2016 campaign and who pressured Collins in a call on Monday.

The bill’s sweeping cut in funding to Medicaid, a program for low income citizens and disabled children, was her top reason for opposing the bill, said Collins, from the state of Maine where 20 percent of the population depend on the program.

“To take a program that has been law for more than 50 years, and make those kinds of fundamental structural changes … and to do so without having in depth hearings to evaluate the impact on our most vulnerable citizens was unacceptable,” Collins said outside the Senate chambers.

She also opposed the bill for weakening protections for people with pre-existing conditions, such as asthma, cancer and diabetes.

Collins’ decision came even after the sponsors of the bill, Senators Lindsey Graham and Bill Cassidy, offered a boost in federal health care funds of 43 percent for Maine and benefits for states with other undecided senators.

Republicans have vowed to get rid of the Affordable Care Act, or Obamacare, since it was passed in 2010. While it extended health insurance to some 20 million Americans, they believe it is an unwarranted and costly government intrusion into healthcare, while also opposing taxes it imposed on the wealthy.

Republicans hold a slim 52-48 majority in the Senate and are up against a tight September 30 deadline to pass a bill with a simple majority, instead of the 60-vote threshold needed for most measures. Senate Majority Leader Mitch McConnell wanted to hold a vote this week, but it is not clear he will do so now that three senators have said they will cast “no” votes.

Graham dismissed notions that the bill was the last chance for Republicans to get rid of Obamacare and pledged to keep working on the legislation.

$1 TRILLION CUT TO MEDICAID

Democrats kept up their pressure for killing the bill. In an evening speech on the Senate floor, Senate Democratic leader Chuck Schumer said, “The Trumpcare bill would gut Medicaid, would cause millions to lose coverage, cause chaos in the marketplace.”

Schumer said once repeal of Obamacare is off the table, Democrats want to work with Republicans “to find a compromise that stabilizes markets, that lowers premiums.”

Collins and McCain, who voted against the last major repeal effort in July, have both advocated for a bipartisan solution to fixing the parts of Obamacare that do not function well.

U.S. hospital stocks were down across the board as the bill struggled. Shares of HCA Healthcare Inc and Tenet Healthcare Corp were hit particularly hard, falling 2.5 percent and 5.7 percent, respectively, on Monday.

“The Graham-Cassidy bill is looking to reduce funding for Medicaid in the longer term,” said Jefferies analyst Brian Tanquilut. “That is a benefit that we have seen improve the earnings outlooks for these hospitals.”

Collins announced her opposition shortly after the non-partisan Congressional Budget Office said that the number of people with health insurance covering high-cost medical events would be slashed by millions if it were to become law.

CBO also found that federal spending on Medicaid would be cut by about $1 trillion from 2017 to 2026 under the Graham-Cassidy proposal, and that millions of people would lose their coverage in the program, mainly from a repeal of federal funding for Obamacare’s Medicaid expansion.

The Trump administration, including Health Secretary Tom Price had lobbied her hard in recent days, Collins said.

“The president called me today, the vice president called me in Maine over the weekend, Secretary Price has called me, it would probably be a shorter list of who hasn’t called me about this bill,” she said.

Trump had not called Collins before the vote in July.

PROTESTERS IN WHEELCHAIRS

The Senate held its first hearing all year on the proposed Obamacare repeal on Monday, but it was immediately disrupted by protesters who forced Senate Finance Committee Chairman Orrin Hatch to postpone its start by about 15 minutes.

Police arrested 181 demonstrators, including 15 in the hearing room. The protesters, mainly from a disability rights group and many of whom were in wheelchairs, were forcibly removed one-by-one from the hearing room as they yelled, “No cuts to Medicaid, save our liberty.” The hearing eventually proceeded for about five hours, but protests could be heard outside for more than an hour.

Television talk show host Jimmy Kimmel, who had become part of the debate on U.S. healthcare legislation in May after discussing his newborn son’s heart surgery, had taken aim at the bill in recent days. On Monday he tweeted: “Thank you @SenatorCollins for putting people ahead of party. We are all in your debt.”

A new CBS poll released on Monday said that a majority of Americans, or 52 percent, disapprove of the Graham-Cassidy bill, while 20 percent approve. The poll was taken between Sept. 21 and 24.

(Reporting by Susan Cornwell and Richard Cowan; Additional reporting by Timothy Gardner, Philip Stewart, Makini Brice, Amanda Becker and Alistair Bell in Washington and Caroline Humer in New York; writing by Timothy Gardner; Editing by Bill Trott and Mary Milliken)