The upside of the failure of the Senate to pass any semblance of repealing and reforming the ACA is that it highlights three structural impediments to achieving not only health care insurance reform, but most of the Trump agenda as well: 1) Congress must realign its interests with voters’ interests; 2) The Senate must eliminate the Senate’s incumbent protection racket, where deliberation on legislation is avoided to spare Senators—of both parties—tough votes; 3) Conservatives must learn how to sell their ideas.

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President Donald Trump called Wednesday for repealing the Obamacare individual mandate in a tax overhaul, a day before House GOP leaders planned to unveil a bill without that provision.

In a pair of tweets, Trump said: “Wouldn’t it be great to Repeal the very unfair and unpopular Individual Mandate in ObamaCare and use those savings for further Tax Cuts for the Middle Class. The House and Senate should consider ASAP as the process of final approval moves along.”
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The Oct. 26 editorial “Health-care reform that pays off” unfairly maligned a bill introduced by two committee chairmen as “dismantling major pieces of Obamacare.” It does nothing of the sort.

Like the bill proposed by Sens. Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.) that the editorial praised, a bill from Sen. Orrin Hatch (R-Utah) and Rep. Kevin Brady (R-Tex.) would appropriate money for cost-sharing-reduction subsidies. That’s not nearly enough to provide relief to consumers, who are leaving health-insurance markets in droves. Gallup reported that the uninsurance rate in the third quarter of 2017 reached its highest level since 2014, as the Affordable Care Act makes insurance unaffordable.

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When the GOP released their “Framework” for tax reform last month, official Washington got excited that they could finally chew on all sorts of wonky tax details. They will get even more excited when the full package is out this week. That’s why it was very disappointing to read that Senate Finance Committee Republicans were considering keeping the death tax in place.

That would be a grievous error.
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The Trump executive order calls for broadening the definition of a “bona fide group or association” to allow a greater number of small employers that are members of local chambers of commerce or a national trade association to form fully insured “large group” or self-insured “group” association health plans.Association health plans are by definition required to provide adequate coverage, and additional federal protections apply, including fiduciary responsibilities, a rigorous appeals process, and prohibitions against basing premium rates on an individual participant’s health condition.

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Iowa is abandoning its quest to shed major elements of the Affordable Care Act, after federal health officials failed to approve the plan in time for the insurance-buying season that begins in just over a week. The state’s withdrawal comes two months after President Trump telephoned a top federal health official with instructions to reject Iowa’s proposal.

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Mr. Trump and congressional Republicans are hoping the Labor Department will identify a way to allow associations and small employers to create self-insured plans—or something similar. That change could allow them to adjust benefits and offer more affordable coverage to more people. Since the passage of ObamaCare, however, states are no longer the driving force behind most insurance mandates and regulations. Washington is. A more straightforward solution would be for Congress to change the law.

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At the core of Medicaid’s troubles is its provider reimbursement system, which is based on price controls. In general, it pays rates substantially less than those of private insurance and can even be less than the cost to deliver that care. According to a Kaiser Family Foundation analysis, in 2016, Medicaid reimbursed physicians across the country 72 percent of Medicare rates for all services and 66 percent of Medicare rates for primary care. In general, Medicare rates are already less than those of private insurance. With noncompetitive reimbursement and the administrative hassle of the program, many providers are reluctant to accept Medicaid patients.
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President Trump has defended his decision to end cost-sharing reduction (CSR) subsidies — an element of the Affordable Care Act that helped lower the cost of deductibles and co-pays for people making less than 250 percent of the federal poverty level — by pointing to the gain in stock prices for health-insurance companies.

Insurance companies do not make money through the cost-sharing provision, estimated to be worth about $7 billion in fiscal 2017. They’re being paid back for money they’ve already spent. If they do not get repaid for doing what is required under law, companies say they will raise premiums to make up the difference.

That in turn will raise the cost to taxpayers, because whatever savings result from eliminating the CSRs will be exceeded by additional costs for higher tax credits to defray the new premiums.
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Any agreement to restore funding for cost-sharing payments should be tied to provisions allowing families to opt out of ObamaCare and buy coverage that meets their individual needs. The compromise should also grant insurers the right to sell such plans independent of ObamaCare’s rules and its rigged risk pool.

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