The Republican platform seems to have taken its cue from Speaker Paul Ryan’s A Better Way, at least when it comes to health policy. Not surprisingly, health care did not get top billing in the 66 page document. The economy, jobs, and taxes led off, with the Affordable Care Act, Medicare, and Medicaid relegated to later chapters.  Although there is not much text, those words are important.\

Significantly, the platform takes up Medicare and Medicaid in the chapter on government reform. The document points out that Medicare’s long-term debt is in the trillions, and does not shrink from recommending actions that could set the program on a fiscally sound path.  That requires change that will not be welcomed by everyone, so the platform pushes off that change for a decade in the hope of not alienating the senior vote.  Nonetheless, the Republican Party has now officially endorsed Ryan’s premium support plan that can promote competition and more efficient health care.

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A provision of the Affordable Care Act that allows insurers to charge smokers higher premiums may have discouraged smokers from signing up for insurance, undercutting a major goal of the law, according to a study published this month.

The surcharges, of up to 50 percent over nonsmokers’ premiums, also showed no sign of encouraging people to quit.

The Affordable Care Act eliminated insurers’ ability to charge higher premiums based on whether a person was sick. But it does allow them to vary premiums with age, geography, family size and smoking status.

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The Republican party’s 2016 platform, unveiled Monday, echoes many of the proposals included in the health care plan House Republicans laid out last month.

The platform calls for the full repeal of the Affordable Care Act and for state control of insurance markets. It backs selling insurance across state lines and states that insurance should be more portable so that consumers can move from job to job with the same policy.

“We must recover the traditional patient-physician relationship based on mutual trust, informed consent, and confidentiality,” the platform reads.

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State and federal officials have negotiated a deal to delay a federal policy that threatened to destabilize health insurance rates at small businesses across Massachusetts.

Governor Charlie Baker’s administration said Tuesday that the agreement will postpone for one year a piece of the Affordable Care Act that requires a change in the way small businesses’ insurance rates are calculated. Massachusetts will have to phase out its current rules and switch to the federal formula by 2019.

The rules apply to businesses with 50 or fewer employees.

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