President Trump’s statement that his preferred replacement for the ACA would provide health “insurance for everybody” surprised those who have followed the contentious debate over the health care law since its passage in 2010. In recent years, though, Republicans have emphasized that gains in insurance coverage should not be the sole barometer by which health care reform is measured. Rather, the affordability of that coverage is the key to a better health care system with fewer uninsured Americans. For too long, Republicans have shied away from calling for “universal coverage” because they’ve equated it with the Democratic push for a government-run, single-payer health-care system. But that simply isn’t the case. Market-based reforms can both lower costs and lead to health insurance coverage for more Americans. Any market-based replacement to the ACA should: (1) Expand access to consumer-directed coverage arrangements such as health savings accounts coupled with high-deductible insurance plans; (2) Tailor government assistance to individual situations; (3) Give those with preexisting conditions access to mechanisms, such as properly funded high-risk pools, to help them both acquire and afford coverage; and (4) Allow for alternative pathways to private, tax-preferred coverage, by allowing health plans to be sold across state lines, as well as by giving unions, churches or other civic organizations the opportunity to offer coverage to members.

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A key House panel on Thursday debated the first draft legislation to replace Obamacare since Donald Trump became president, pledging to repeal his predecessor’s signature health care law.

The Energy and Commerce Health Subcommittee discussed drafts of four bills which each address piecemeal issues within the larger Affordable Care Act, including how to deal with people who have pre-existing health conditions, how much more to charge seniors compared to young people, and how to spur people to keep continuous coverage throughout their lives.

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House Republicans on Wednesday highlighted changes to Medicaid in a series of bills that target eligibility, but got stiff pushback from Democrats who argue the GOP actually wants to cut federal aid to low-income Americans.

A subcommittee of the House Energy and Commerce Committee examined three draft bills that would prevent lottery winners and illegal immigrants from getting Medicaid coverage. Another bill would close a loophole that allows couples to get Medicaid although their income and assets are beyond the threshold for eligibility.

Republicans argued the bills, introduced in earlier Congresses, are needed to reform an entitlement program that has used more and more federal funding.

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Everywhere you turn, health markets are nearing collapse. It’s an unfortunate and catastrophic reality of too much federal intervention in our health care. From soaring deductibles and skyrocketing premiums to fleeing insurers, it’s no wonder patients are paying more out of pocket each year under the so-called “Affordable Care Act.”

Today, the Energy and Commerce Committee’s Health Subcommittee will examine four legislative solutions to help deliver relief. Together, the bills will play an important role in being among the first bricks placed in the rebuilding of our health care system. Collectively, they will give patients relief from the law’s soaring costs, tighten enrollment gaps, and protect taxpayers.

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Part of why Obamacare is so unpopular is that it is neglects the typical American.

Obamacare is bad for the typical—or median—American for a variety of reasons, including: its unprecedented individual mandate; its inept manner of dealing with preexisting conditions, which has sent premiums soaring (by 40% over the past two years); its roughly $2 trillion price-tag (over a decade); and its consolidation and centralization of power and money at the expense of Americans’ liberty and their wallets. Rather than offering overdue tax breaks to everyone who buys his or her own health insurance, Obamacare instead gives direct subsidies to insurance companies (falsely labeled as “tax credits”) on behalf of the select few.

As Republicans deliberate over an alternative to Obamacare, this provides a huge opening. A more consumer-friendly system will go a long way towards reducing costs for all and bringing down overall health care spending.

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Insurers are generally confident they could manage the transition away from Obamacare and into a new replacement plan, according to a survey from the Urban Institute.

The group interviewed executives at 13 insurance companies participating in the individual market in 28 states to ask them how they would respond in various repeal scenarios proposed by the new administration. While all insurers said that uncertainty regarding the future of Obamacare is bad for business and for the stability of the individual market, they were confident they could manage policy changes. They also expressed optimism about a replacement plan that offered continuous coverage, which many Republican plans include.

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President Donald Trump’s administration has promised to repeal and replace the Affordable Care Act and Congressman Darrell Issa is proposing a new health care plan to Congress.

In an interview Saturday, he told NBC 7 he calls his plan “The Access to Insurance for All Americans Act.”

The plan would give people access to the federal employee health benefit plan that government employees use. It calls for no mandates on businesses and individuals.

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Since its passage in 1965, Medicaid has expanded and contracted with the political tides. With concurrent Republican executive and legislative control in 2017, conservative policy makers have already declared their desire to repeal the Affordable Care Act (ACA) and its Medicaid expansion, which has been responsible for approximately 12 million of the 20 million individuals who became newly insured as a result of the ACA. But proposals for fundamental reform of Medicaid are even more far-reaching in terms of their consequences for the other 60 million low-income children, parents, the elderly, and individuals with disabilities who rely on the program. Understanding the rationale for and likely effects of these proposals is critical for physicians and patients alike.

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The strategy that Congress and the Trump administration will pursue to repeal and replace the Affordable Care Act continues to evolve. In early January, the favored strategy seemed to be to repeal as much as possible of the ACA through legislation, but to delay the repeal of key provisions, such as the premium tax credits and marketplaces, for two or more years and then begin work on a replacement. In mid-January, this seemed to be giving way to an approach, apparently favored by the Trump administration, under which replacement legislation would be adopted more or less simultaneously with repeal, although it was not clear how this could take place without cooperation from Democrats, which seemed unlikely.

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During the election campaign, Donald Trump promised to abolish Obamacare and replace it with better health reform that would not leave anyone behind. In order to understand what is implied by that promise, consider Figure I, which highlights three groups of people:

    • About 11 million people are getting insurance in the exchanges and many of them are unhappy. In the words of former president Bill Clinton, many are “paying twice as much for half the coverage” they were previously enjoying.
    • Another 11 million or so people are getting individual insurance outside the exchanges. These people have all the same problems as people in the exchanges. But, they receive no federal tax break for the purchase of insurance, even though a federal mandate requires them to buy it.
    • In addition, about 29 million people are uninsured and that number is unlikely to change very much going forward. Polls show that the most important reason why so many people are uninsured is cost.

One way to think about Donald Trump’s campaign promise is to see that he wants to make health insurance less expensive and better for the first two groups without leaving the third group permanently uninsured. And he wants to do it with money that is already in the system. In other words, without raising taxes.

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