In crafting an Obamacare replacement, Donald Trump and Republican congressional leaders will have to unite on complicated changes affecting the financial and physical well-being of millions of people. Republicans have “a really narrow path,” says Grace-Marie Turner. “They’ve got to deal with the politics of this, they’ve got to make sure they come up with good policy, and they also have to process challenges.” House Ways and Means Chairman Kevin Brady (R-TX) says of the challenge, “Unlike Obamacare, which ripped up the individual market, this will be done deliberately, in an appropriate timetable.”

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When President-elect Donald Trump chose Representative Tom Price of Georgia to be his health and human services secretary, the American Medical Association swiftly endorsed the selection of one of its own, an orthopedic surgeon who has championed the role of physicians throughout his legislative career.

Then the larger world of doctors and nurses weighed in on the beliefs and record of Mr. Price, a suburban Atlanta Republican — and the split among caregivers, especially doctors, quickly grew sharp.

“The A.M.A. does not speak for us,” says a petition signed by more than 5,000 doctors.

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House Speaker Paul Ryan, incoming Health and Human Services Secretary Tom Price and other top GOP leaders have kept up their barrage against the Affordable Care Act’s premium increases and reduced competition, even after their massively successful election last month.

“This law is hurting families in America,” Ryan said before Congress left Washington for the holidays.

“This law is canceling insurance plans people wanted, this law is giving people repeated double-digit premium increases, this law is raising deductibles so high it doesn’t even feel like you have insurance,” he said. “So you have to bring Obamacare relief as fast as we possibly can in 2017, and that is our plan.”

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Beginning in January, the Republican-controlled Congress, working with the incoming Trump administration, will have the opportunity to roll back the Affordable Care Act and replace it with a plan that is less driven by federal control and regulation. The starting point for this effort ought to be that everyone in the United States should have health insurance, protecting them against major medical expenses. To do so, the GOP should:

  • Grandfather Coverage Provided by the ACA
  • Accept and Clarify Medicaid’s Role as the Safety Net Health Insurance Program
  • Impose Cost-Discipline and Generate Revenue with an Upper Limit on the Tax Preference for Employer-Paid Premiums
  • Build an Effective Auto-Enrollment Program to Achieve Higher Levels of Coverage