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house Bill H.R. 1730

Should Oral Cancer Drugs be Covered at the Same Cost as Other Cancer Treatments?

Argument in favor

It doesn’t make sense for oral cancer treatments to be covered by a different part of patients’ health insurances from other cancer treatments, especially when this difference in coverage leads to big differences in cost for patients, as well. Treatment efficacy, not price, should be the deciding factor when patients are choosing between life-saving treatments.

Ellen's Opinion
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11/06/2019
Cancer is cancer. Medicine to treat cancer is medicine to treat cancer. I cannot understand why they would be covered differently.
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Francisco's Opinion
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11/06/2019
We should eliminate the Insurance industry from health! MEdicare 4 All!! Then have drug companies compete for best drugs at lowest cost universally!! Government needs to begin to represent us instead of billionaires!!
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11/06/2019
No reason to cover medicine differently based on disease. Medicine is medicine
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Argument opposed

“Oral parity” laws’ effectiveness seems to be mixed, based on available evidence. Additionally, policies like this don’t address the root cause of high healthcare costs in the U.S.: high drug prices. Rather than quibbling about how insurance covers extremely expensive drugs, it’d be a better use of Congress’s time to figure out how to make drugs more affordable, period.

jimK's Opinion
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11/06/2019
This case is an excellent argument for universal healthcare. If a drug is overpriced it will be excluded from consideration, thus eliminating the profiteering by drug companies who are pricing critical medicines, such as commonly needed insulin at higher prices simply because they can. If the market is effectively removed by a universal healthcare program, there would be an incentive to price these meds at lower, more realistic prices and with a reasonable manufacturer profit margin. Prices for meds will go up for all of the other countries with universal healthcare since they would have to bear some of the burden of needed R&D costs- which are currently paid for by US consumers since the manufacturers are free to price our meds at higher prices. I seem to recall a company that only bought out the manufacturers of unique, patent-protected life-saving drugs and then raised the prices incrementally up to 1000%-3000% of their original prices, simply because they were greedy and they could. This crap has nothing to do with R&D costs, manufacturing costs or any reasonable basis except that they were required life-saving drugs for a captive market and the new owners could charge whatever they liked. This is the kind of stuff that needs to be legislatively prevented.
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RjGoodman's Opinion
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11/06/2019
This is NOT THE ISSUE! Congress needs to work on how all healthcare is priced. As hospitals move from non-profit institutions run by local interests to for profit faculties run by venture capitalists, prices have increased dramatically, not just oral cancer drugs. You should try having dementia.
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Lesia's Opinion
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11/06/2019
So now we o my care about cancer drugs? This is bullshit. Tens of thousands of Americans die every year due to the unbridled greed of drug dealers and their insurance companies. Drug companies do very little research. We the tax payers pay for the research done at NIH while the blood suckers drain us literally to death. Single payer NOW.
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bill Progress


  • Not enacted
    The President has not signed this bill
  • The senate has not voted
  • The house has not voted
      house Committees
      Committee on Energy and Commerce
    IntroducedMarch 13th, 2019

What is House Bill H.R. 1730?

This bill — the Cancer Drug Parity Act of 2019 — would require any health plan that provides coverage for cancer chemotherapy treatment to provide coverage for self administered anticancer medication at a cost no less favorable than the cost of IV, port administered, or injected anticancer medications.

Impact

Cancer patients; oral cancer treatments; cancer treatment; health insurance plans; pharmaceutical benefits; and medical benefits.

Cost of House Bill H.R. 1730

A CBO cost estimate is unavailable.

More Information

In-DepthRep. Brian Higgins (D-NY), Chair of the House Cancer Caucus, introduced this bill to require health insurance plans that cover intravenous and injectable cancer medications to also cover orally administered cancer medications at the equivalent rate:

“Innovative research has led to more effective and accessible treatment options for Cancer patients, but insurance coverage hasn’t kept pace. The Cancer Drug Parity Act, levels the costs, allowing patients and doctors, not insurance companies, to decide the best course of treatment, removing the cost discrepancy as a factor in cancer care.”

In a letter to his Congressional colleagues seeking cosponsors for this bill, Rep. Higgins expounded upon the need for this bill:

“[D]espite the fact that oral chemotherapy is popular with oncologists and patients, this legislation is needed because health insurance coverage for different types of cancer treatments often is not uniform. While intravenous treatments are usually covered under a plan’s medical benefit component, orally-administered anti-cancer medications are covered under a plan’s prescription drug component which often places a higher percentage of cost-sharing on the patient. This considerable disparity in coverage can leave cancer patients to make difficult decisions on what type of care they will receive based on the outdated guidelines of their health insurance policy, rather than the advice of their doctor. Studies have consistently shown that, when faced with high co-pays for orally administered anti-cancer drugs, some patients choose to simply not fill a prescription. Ensuring parity in coverage would both increase access to life-saving treatments and improve the quality of life for cancer patients. While America continues to set an example for the world in biomedical research, Americans will struggle to gain access to these new discoveries if insurance coverage does not keep up with the science. This legislation prepares us for the next generation of cancer treatments.”

Original cosponsor Rep. Brett Guthrie (R-KY) adds:

“Due to great innovation, many cancer treatments can now be taken orally by a patient themselves, and I believe we must ensure these patients have full access to these important drugs. Americans suffering from cancer should not have to choose between one treatment option or another based on how their insurance classifies each treatment. The Cancer Drug Parity Act will fix the discrepancy between cancer treatment drugs that are orally administered and those that are intravenously or injected and will allow patients and doctors to choose the treatment that is right and most effective for them.”

The Leukemia & Lymphoma Society is one of a number of organizations that supports this bill. Louis J. DeGennaro, Ph.D., the organization’s president and CEO, says:

“Pioneering research in precision medicine is transforming the way cancer is treated. Even with these breakthroughs, far too many cancer patients face burdensome out-of-pocket costs and cannot access their treatments because insurance rules have not kept pace with innovation. The Cancer Drug Parity Act will ensure that patients across the country experience the same cost-sharing for all cancer treatments, allowing cancer patients to have equal access to the treatments recommended by their physicians. The Leukemia & Lymphoma Society applauds Representative Higgins, Representative Guthrie, Representative Matsui and Representative Bilirakis for their leadership on behalf of cancer patients and looks forward to working with Congress to move this important bill forward.”

Oral parity’s critics argue that it doesn’t address cancer drugs’ high costs, leaving health insurers to deal with those costs by increasing premiums. However, The Leukemia and Lymphoma Society argues that this simply isn’t true, as “in the 43 states with an oral parity law, cancer patients have seen their costs go down without any evidence that parity has increased premiums for other plan holders.”

Some data on oral parity laws’ effectiveness suggests that legislative effects are, at best, only a partial solution. A November 2017 study by Dr. Stacie B. Dusetzina, Ph.D., of Vandervilt University School of Medicine, and colleagues found only “modest” improvement in financial protection for patients in states with parity laws. Dr. Dusetzina said, “We found really mixed results for the effectiveness of parity legislation. For most people it decreased [out of pocket] spending, but strangely it increased spending for those with the higher cost-sharing levels.”

The late Princeton health economist Uwe Reinhardt, Ph.D. and authors memorably suggested that the high cost of healthcare — including oral cancer drugs — in the U..S. is because, “It’s the prices, stupid.” In this vein, some researchers and clinicians suggest that the real answer to oral parity lies in lower oncology drug prices overall. They contend that any other efforts are just serving to shift the burden of costs to insurers, who’ll ultimately pass along increased costs along to policyholders in the form of increased premiums. America’s Health Insurance Plans (AHIP) subscribes to this view. Its director of communications, Cathryn Donaldson, says:

“We need to find ways to bring the ever-increasing prices of prescriptions under control. Health plans are committed to ensuring that patients have access to medications that are safe, effective, and affordable. However, oral-parity legislation would place an arbitrary limit on cost-sharing between medical and pharmacy benefits, forcing premiums to increase for all consumers as a result – not just those who would use oral chemotherapy.”

This bill has 33 bipartisan House cosponsors, including 17 Democrats and 16 Republicans, in the 116th Congress. A Senate version, sponsored by Sen. Tina Smith (D-MN), has nine bipartisan Senate cosponsors, including five Republicans and four Democrats.

In the 115th Congress, the House version of this bill, sponsored by Rep. Lance Leonard (R-NJ), had 175 bipartisan cosponsors, including 90 Democrats and 85 Republicans, and didn’t receive a committee vote. A Senate version, sponsored by Sen. Tina Smith (D-MN), had five bipartisan cosponsors, including three Democrats and two Republicans, and didn’t receive a committee vote.

This bill has the support of the Lymphoma Research Foundation (LRF), American Cancer Society Cancer Action Network, American Society of Hematology, American Society of Clinical Oncology, National Brain Tumor Society, Susan G. Komen, and numerous other organizations.


Of NoteNew, targeted drug therapies for cancer — many of which come in pill rather than intravenous form — have transformed a cancer diagnosis from a death sentence to a manageable chronic disease for many Americans with leukemia, lymphoma, or myeloma. For patients with certain cancers, these oral drugs are the only treatments available for their specific cancers.

Rep. Higgins’ office notes, “Oral chemotherapy is increasingly becoming a standard treatment option for cancer doctors and patients, representing approximately 35% of the oncology development pipeline. However, insurance coverage for cancer treatment has not kept up with science.” Under current law, traditional IV/injectable treatments are routinely covered under health insurance plans’ medical benefit components, whereas orally-administered anti-cancer medications are generally covered under the prescription drug component, often creating a considerable disparity in cost. As an example, in 2012, Dr. Brian Durie of the IMF wrote in the Journal of the American Society of Clinical Oncology that even though the purchase price of two myeloma medications was similar,“total cost per day was $48 higher for treatment with (injectable) vs. (oral) due to higher Medical management costs for (the injectable). The annual excess total cost of (the injectable) was $17,647.”

The Lymphoma Research Foundation (LRF) argues that this means “many patients are exposed to unmanageable cost sharing requirements in order to access oral cancer therapies.” In a The Hill op-ed, Terry Wilcox, cofounder and executive director of Patients Rising, a patient advocacy organization, adds that this also impacts cancer treatment overall:

“Due to a quirk in how Medicare and private insurance plans cover cancer drugs, chemotherapy in the preferred pill form costs patients thousands of dollars a month whereas intravenous drugs administered in a hospital or oncologist’s office may only require a small copay.”

In some cases, it’s reported that patients are even electing to forgo to delay treatment due to high out-of-pocket prices for oral treatments.

Over the past decade, 43 states have adopted their own oral parity by passing laws requiring more equitable cost-sharing for oral cancer drugs. These “oral parity laws” have a long track record of helping cancer patients without increasing premiums. However, state laws only apply to certain types of health plans, and don’t cover the approximately 60 percent of Americans on private insurance whose benefits are regulated by federal law.


Media:

Summary by Lorelei Yang

(Photo Credit: iStockphoto.com / FatCamera)

AKA

Cancer Drug Parity Act of 2019

Official Title

To amend the Public Health Service Act to require group and individual health insurance coverage and group health plans to provide for cost sharing for oral anticancer drugs on terms no less favorable than the cost sharing provided for anticancer medications administered by a health care provider.

    Cancer is cancer. Medicine to treat cancer is medicine to treat cancer. I cannot understand why they would be covered differently.
    Like (47)
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    This case is an excellent argument for universal healthcare. If a drug is overpriced it will be excluded from consideration, thus eliminating the profiteering by drug companies who are pricing critical medicines, such as commonly needed insulin at higher prices simply because they can. If the market is effectively removed by a universal healthcare program, there would be an incentive to price these meds at lower, more realistic prices and with a reasonable manufacturer profit margin. Prices for meds will go up for all of the other countries with universal healthcare since they would have to bear some of the burden of needed R&D costs- which are currently paid for by US consumers since the manufacturers are free to price our meds at higher prices. I seem to recall a company that only bought out the manufacturers of unique, patent-protected life-saving drugs and then raised the prices incrementally up to 1000%-3000% of their original prices, simply because they were greedy and they could. This crap has nothing to do with R&D costs, manufacturing costs or any reasonable basis except that they were required life-saving drugs for a captive market and the new owners could charge whatever they liked. This is the kind of stuff that needs to be legislatively prevented.
    Like (72)
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    How about a universal single payer healthcare system? BTW, ALL drug prices are made of lies. My sisters breast cancer drug is still in trials. The company that makes it in Sweden gives it to the patients in the USA for free. The middle men of the insurance company’s up charge that free drug to 13 THOUSAND DOLLARS A MONTH. Not the manufacturer. THE BLOODSUCKER INSURANCE COMPANY. So yeah. I have no chill with the goddamn “health” insurance lies. Fuck those leeches. Profiting of the sick is immoral. All of them should be out of business.
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    This is NOT THE ISSUE! Congress needs to work on how all healthcare is priced. As hospitals move from non-profit institutions run by local interests to for profit faculties run by venture capitalists, prices have increased dramatically, not just oral cancer drugs. You should try having dementia.
    Like (29)
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    We should eliminate the Insurance industry from health! MEdicare 4 All!! Then have drug companies compete for best drugs at lowest cost universally!! Government needs to begin to represent us instead of billionaires!!
    Like (22)
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    No reason to cover medicine differently based on disease. Medicine is medicine
    Like (17)
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    Insurance companies are the death panels.
    Like (16)
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    Oral cancer medications are covered and should be covered in the same manner as other oncology medications.
    Like (11)
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    Is this a trick question? First of all, the cost for all cancer treatments should be affordable and accessible to all that need it-doesn’t matter if it’s orally taken or taken in through IV as long as it’s helping the patient get better. Hows about we work on bringing the cost down across the board of all cancer meds??
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    Nice idea, but another piecemeal step to a much broader and more basic problem that Congress refuses to debate the fundamentals of: is healthcare in the United States a privilege or a right? Until that question is decided nothing will work.
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    Not just this oral cancer treatment. ALL TREATMENTS FOR ALL DISEASES SHOULD ALL COST THE SAME NO MATTEE WHERD OR WHEN IT IS ADMINISTERED. When are we going to get leaders of this country who make laws to protect the people INSTEAD OF BIG PHARMA & MEDICAL CORPORATE.
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    Better yet, let’s get a universal healthcare system like the rest of the modern world! I support Medicare For All, giving the government the opportunity to negotiate the lowest drug prices! Medicine for people, not profit!
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    Give working Americans Medicare for all you bastards-all people deserve any and all treatment that helps them live! Break up big pharma and kill the predatory health care insurance mafia!
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    So now we o my care about cancer drugs? This is bullshit. Tens of thousands of Americans die every year due to the unbridled greed of drug dealers and their insurance companies. Drug companies do very little research. We the tax payers pay for the research done at NIH while the blood suckers drain us literally to death. Single payer NOW.
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    A lot of drug research is done at universities where grant money is used for R&D. A pharmaceutical company can by the drug, for a lot of money, and then bring the drug over the finish line in terms of trials. So, you are paying for the drug twice. Once with grant money, usually from NHS, and then when it is prescribed. It’s not like the universities put the money they received back into research or new grants. It’s placed back into the endowments. The market can’t correct for greed when it’s a matter of living or dying.
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    All medicine—but especially meds for life threatening illnesses—should be based on humane standards of ability to pay. The less you make, the more of a reduction or free voucher should be given to patients. Stop making a profit from diseases! Medicare for All is a human right in the first world nations with sane leaders. The USA should try being moral and compassionate to its citizenry and immigrants and having moral leaders! We might regain first world status again.
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    With a caveat though, we need some way to cut the cost of the drug overall.
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    Why would this be different then the rest. Will this bill after the votes are tallied sit on Moscow Mitch's desk like the hundreds of other bills waiting for him to sign? Pete as we watch our government being torn to shreds by your president. I ask myself what does the GOP get from this what does Pete King get from this? Would love to know From a very disappointed registered voter in your district. Ps with a very loud and proud mouth
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    Cancer drugs in all forms should be covered!
    Like (4)
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    Because I have to live with this knowledge every day: White House official who heard trumps call with Ukraine president was told to keep quite. White House lawyer moved transcript of trump call to classified server after Ukraine adviser raised alarms. He has politicized our national security and has chosen Putin and other dictators over our own congress and security agencies. “I stated to Amb. Sondland that his statements were inappropriate, that the request to investigate Biden and his son had nothing to do with national security, and that such investigations were not something the NSC was going to get involved in or push,” Vindman adds. Lt. Col. Alexander S. Vindman, a top Ukraine expert on the National Security Council is testifying that trump demanded that a foreign government investigate an American citizen in exchange for Congresses approved aide. Just reached a $984 billion deficit while he lines his pockets with our tax dollars and foreign money at his resorts. $400 million in aide money was withheld from Ukraine back in August and Ukrainian leaders were told it was not red tape, that they needed to talk to Chief of Staff Mulvaney to resolve it and make a CNN statement about Biden in order to receive said aide. Rudolph W. Giuliani, the president’s personal lawyer, is running a shadow foreign policy in Ukraine that circumvents U.S. officials and career diplomats in order to personally benefit President trump. Igor Fruman and Lev Parnas. Look them up. North Korea just tested a submarine launched missile. Deserted our Kurdish allies who have been fighting ISIS with us and now are being slaughtered. All because he has a tower in Istanbul. “The Americans betrayed us. We do not trust them anymore,” she added. These used to be our Kurdish allies that stood against ISIS. He is refusing to comply with the law. He is using the power of the presidency to withhold aide to one of the worst humanitarian crisis on the planet in exchange for political favors in order to sway the 20/20 election. He is acting like a criminal and threatening the life of the whistleblower. Mr. America first is sending troops to Saudi Arabia in support of a murdering dictator who spends millions at his hotels and resorts. Corey Lewandowski testified to congress that trump ordered him to obstruct justice. He is blocking information that pertains to the safety of our country from reaching congress. He has been threatening NOAA, a federal agency, with punishment if they do not disavow the truth and side with his lies. He invited the Taliban to Camp David the week of 9/11. He is a #PussyAssBitch He’s doctoring weather maps to try and prove he’s not an idiot. He has stayed at trump properties 293 days in 3 years, that’s our tax dollars going directly into his pocket. He took money from military daycares to pay for a wall that won’t work and no one wants. The Vice President and the Attorney General are both spending tax payer dollars on trump hotels, lining his pockets and currying his favor. He has privately instructed aides to skirt laws and regulations to get the wall built faster — and told them he will pardon them if necessary. He is pressuring a government agency to give a contract for his wall to a company whose chief executive is a donor to one of his top GOP allies in Congress. He took hundreds of millions from 127 different projects (FEMA being one of those) for his wall. He thinks nuking a hurricane is an idea. He is host the next G-7 at one of his own resorts. Again our tax dollars paying him directly. He taunted Iran by tweeting a classified image of an Iranian rocket that had exploded, thereby potentially compromising U.S. intelligence capabilities. His own company would save millions from the low interest rates he is demanding. He was going to give you tax cuts through your paychecks but decided not to. This year the richest of us payed less in taxes than the rest of us. He is destroying the economy with HIS trade war. We will soon average a 1.2 trillion deficit. He is repeating NRA talking points on background checks so expect no action taken regardless of the fact there has been 27 arrested over threats to commit mass attacks since El Paso( NOT TOLEDO). He made fun of republicans being afraid of the NRA and then caved after a 30 minute phone conversation with them. He bragged about indefinite child detention because it brings families together. He is refusing flue shots, that protect us all(google influenza pandemic), to immigrant children. He is attacking fellow congresswomen in really disgusting ways and making anti-Semitic remarks about Jews calling them disloyal. He thinks he’s the chosen one based on a conspiracy theory web sight. He has: Obstructed Justice. Is profiting from the Presidency. Colluded - They had a meeting & lied about it. Advocated political & police violence. Abuse of power. Engaging in reckless behavior. Persecuting political opponents. Attacking the free press. Violating immigrants Right to Due Process. Violating campaign finance laws. Racist: Speaks directly to and often tweeting straight from white supremacists. Calls them very fine people. Told fellow congresswomen to go back where they came from. Called them shit hole countries. Called them murderers and rapists. Calls her Pocahontas. Took out full page adds calling for the death of five innocent black kids in New York, 1989. Literally has said in an interview he has Hitlers speeches, My New Order in his nightstand. Our Money: Spent campaign finance money on hush payments to silence a porn star he had an affair with in order to hide it from the voters. Has spent over $100 million of our tax dollars playing golf at his own golf courses. Has never divested from companies and advertises and profits off the White House. Was going to cut Medicaid and Medicare funding to pay for the tax cuts he gave to the rich. Is actively destroying farmers lives with his trade wars that we all know only hurts our pockets not Chinas. Has made the lives of every truck driver across America as well as our own, more dangerous by removing safety regulations that only benefits the pockets of the CEOs of those companies. Has removed any and all protections we had in place from work safety, environment, women’s rights, LGBTQ rights and gives that power back to the CEOs, oil companies, men and old white men. Saudi funded lobbyist rented 500 rooms at a trump hotel he never divested from right after he became president. Wonder why? Sexual Predator: Accused by more than 20 women of molestation and rape. Bragged about said molestation on tape. Has cheated on all three wives (see above). Has made sexual remarks on camera about his daughter. Belittles and bully’s women. Not even sure he’s aware he has two daughters. Idiot: Has allowed North Korea to grow there nuclear weapons program. Took the side of Putin over America’s own security agencies on the national stage. Lacks the intelligence and facts needed to communicate on a global level much less national one. Makes policy decisions based on FOX media. Lies when speaks. Doesn’t believe in science and quite often displays his ignorance of it. Russia: Lied about meetings with Russians. Lied about a trump tower Moscow. Personal attorney Michael Cohen (same guy who broke campaign finance laws under trumps direction) had contacts with russian officials. National Security aide Flynn resigned over Russian contacts. Jeff Sessions recused himself because of Russian contacts. Manafort resigned because of Russian contacts. Campaign foreign policy adviser Papadopoulos met with Russians then bragged about it to Australians who then turned that info over to our FBI. Sixteen campaign officials had contacts with Russia and at least nine others new about it. Russian mobster lived in trump tower. trump casino was flagged 106 times for lax money laundering standards and same Russian frequently stayed at trump casino. Has been selling real estate to Russians for years. It really is surprising how many connections to Russians this man has. Rick Scott, Marco Rubio, Bill Posey You are my representatives. OLC policy: The indictment or criminal prosecution of a crime sitting President would unconstitutionally undermine the capacity of the executive branch to perform its constitutionally assigned functions. It’s time to do your job. You swore an oath to this country, it’s people and me to uphold the constitution. The president has never upheld that oath. How do you want to be remembered?
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