A nascent effort to resurrect Obamacare repeal this year in the Senate is running into the same roadblock that stymied efforts last year: not enough GOP support.

Sen. Lindsey Graham, R-S.C., said he is working on a new repeal bill that could come out in “hopefully the coming weeks, not months.” Republicans could be blamed for premium increases on Obamacare’s exchanges in 2019 if they don’t act to repeal the law, he said.

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As unlikely as it seems that congressional GOP leaders will try once again to repeal and replace the Affordable Care Act, both Republican and Democratic political observers say there’s a small chance they refuse to rule it out.

Why? Conservatives remain furious that last year’s Obamacare repeal effort failed. And with midterm elections looming, the GOP needs to fire up right-wing voters to help maintain control of Congress.

Sen. Lindsey Graham (R-S.C.) said he hopes to revive a new version of the repeal bill he co-sponsored with Sen. Bill Cassidy (R-La.) that narrowly failed in the Senate last fall. It’s being developed by the Heritage Foundation and the Galen Institute, working with former Pennsylvania Sen. Rick Santorum.

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Almost no one saw it coming.

In 2012, Chief Justice John Roberts famously ruled the Affordable Care Act’s provision mandating most people purchase health insurance or else pay a fine constitutional on the basis that Congress has the authority to tax individuals, and the so-called Obamacare “fine” is effectively a tax.

As the now-deceased Justice Antonin Scalia pointed out in his dissenting opinion, in classifying the Obamacare penalty as a “tax,” Roberts ignored history, the language of the healthcare law, statements made by the Obama administration and Democrats in Congress, and common sense. (The obvious difference between a fine and a tax is that the purpose of a tax is to raise revenue, not to force people to behave in a particular way.)

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Yes. They could do it. But only if they accept two principles:

  1. All the Obamacare money must be used for health care – it can’t be used to cut taxes for the rich or for special interests.
  2. There must be a clear and sustainable path to lower premiums and better access to care.

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Sen. Lindsey Graham (R-S.C.) said Wednesday he is working on a new version of his ObamaCare repeal-and-replace bill and has not given up on efforts to do away with the law despite Republicans’ failure last year. “I haven’t given up,” Graham said. “Will there be another effort to replace ObamaCare with a state-centric plan? I hope so.”

The effort appears to have little, if any, chance of passing this year. Republican leadership has made clear that it has moved on from the ObamaCare repeal effort, and the GOP has an even slimmer margin in the Senate than they did last year when they failed to win enough votes for a bill.

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Medicaid has made major headlines over the last year and for good reason. The welfare program originally intended to provide medical assistance to poor children, seniors and individuals with disabilities has expanded to include more and more able-bodied adults.

A program initially intended for the truly needy now covers 28 million able-bodied adults and costs taxpayers more than $500 billion a year.

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Republican Sen. John Kennedy (La.) on Thursday said Medicaid work requirements should be mandatory for states, and the Department of Health and Human Services (HHS) should take the lead to make it happen.

During a hearing on the HHS budget, Kennedy said many Medicaid beneficiaries who aren’t working “would like to know the dignity of work” noting he would like to see HHS work with Congress to put together a program that would institute a mandatory requirement that Medicaid beneficiaries work 20 hours a week.

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By better focusing the Affordable Care Act’s subsidies on the subset of individuals who are uninsurable in an actuarially priced market, STLDI deregulation would increase overall insurance enrollment. Reductions in premiums for individuals able to enroll in STLDI plans are likely to greatly exceed the slight increase in costs for higher-income unsubsidized individuals remaining on the exchange. STLDI deregulation might even save taxpayers a little money too.

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Sen. Lamar Alexander (R-Tenn.) wrote in a recent letter that bipartisan efforts to fix ObamaCare have failed and he is now turning to focus on additional actions the Trump administration can take on its own regarding the health-care law.

Alexander worked for months with Sen. Patty Murray (D-Wash.) on a bipartisan effort to provide funding to bring down ObamaCare premiums, but the effort fell apart in March.

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Some Republican lawmakers continue to try to work around the federal health law’s requirements. That strategy can crop up in surprising places. Like the farm bill.

Tucked deep in the House version of the massive bill — amid crop subsidies and food assistance programs — is a provision that supporters say could help provide farmers with cheaper, but likely less comprehensive, health insurance than plans offered through the Affordable Care Act.

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