Full-scale repeal of Obamacare has failed, at least for now. But there are still components of the law that can, and should, be rolled back immediately. The Independent Payment Advisory Board is a prime example.

Obamacare created the board of 15 unelected, presidentially-appointed bureaucrats to keep Medicare’s costs under control. If entitlement spending growth surpasses a specific target (currently, aggregate GDP growth plus 1 percent) the board must recommend Medicare cuts.

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Not even 24 hours after the latest “repeal and replace” proposal ran out of steam, Sen. Rand Paul (R-Ky.) ignited a new round of health policy speculation by predicting, during a cable news interview, impending Trump administration action on a longtime Republican go-to idea: association health plans.

“If [consumers] can join large groups, get protection and less expensive insurance … it will solve a lot of problems in the individual market,” Paul said last week on the MSNBC show “Morning Joe.”

Later, President Donald Trump told reporters that he would “probably be signing a very major executive order” that could affect “millions of people.”

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It’s sort of poetic, in a sad way, that the resignation of Health and Human Services Secretary Tom Price on September 29 coincided so closely with the expiration of the 2017 budget resolution on September 30.  Those two events signaled the end, at least for now, of Congressional Republicans’ efforts to repeal and replace Obamacare through reconciliation–that being the arcane process by which the GOP could have avoided a crippling Democratic filibuster in the Senate.

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Republicans have now failed twice to repeal and replace ObamaCare. But their whole focus has been wrong. The debate centered, like ObamaCare, on the number of people with health insurance. A more direct path to broadening access would be to reduce the cost of care. This means creating market conditions long proven to bring down prices while improving quality—empowering consumers to seek value, increasing the supply of care, and stimulating competition.

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During his short stint leading health policy for the Trump administration, Dr. Tom Price spearheaded a number of efforts to ease the regulatory burden on the industry, especially for his peers in the physician community.

While few expect the administration to dial back on that commitment, Price’s resignation Friday as HHS secretary could, at least momentarily, force agency heads to tap the brakes on any bold new policies.

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Republicans have a new promise on health care: It’s not over. As the GOP trumpeted the framework of a new tax overhaul plan at the Capitol on Wednesday, lawmakers wrestled with their message to voters after promises to roll back the Affordable Care Act officially came up short Tuesday. The GOP health-care push “is not going to stop. It’s just that we’re not going to focus solely on that,” said Senate Majority Whip John Cornyn. President Trump said he now expects a bill to pass early next year. He also said he would issue an executive order, likely next week, targeting rules that make it hard for insurers to sell policies across state lines.
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The main sponsors of the last ObamaCare repeal bill committed on Thursday to hold hearings in the coming months in an effort to eventually pass their legislation.

“Over the coming weeks and months, we are committed to holding congressional hearings and working with our nations’ governors who believe returning power to states is a vast improvement over Obamacare,” Sens. Lindsey Graham (R-S.C.) and Bill Cassidy (R-La.) said in a joint statement.
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Lots of observers, including some very well placed ones in Congress, argue that health care will just be put aside now for a time and will wait for a later opportunity. They say it’s time to turn to tax reform. The “put it aside” argument assumes that the Trump administration will just continue to administer Obamacare as it has been, which is unlikely. This fall we may well see a much expanded “hardship exemption” for the individual mandate that could render the mandate essentially void, and the administration may also stop providing funds for cost-sharing reduction payments if Congress does not appropriate money for them.

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Senate Republicans on Tuesday abandoned their latest effort to replace ObamaCare, or, more precisely, a handful of Senators defeated the Graham-Cassidy proposal despite their campaign rhetoric. Mark them down as ObamaCare’s saviors.

Top billing goes to Kentucky’s Rand Paul, who rode into Congress in 2010 on repealing the Affordable Care Act but in office has become the definition of a feckless libertarian. He helped to kill the Senate’s first replacement bill over the summer because it did not repeal every last footnote in the law. Then he supported “skinny repeal” that merely repealed the individual and employer mandates and medical-device tax, justifying that vote as realistic.
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Senate Majority Whip John Cornyn (R-Texas) on Tuesday said Congress should move onto tax reform and not try to pair it with a new plan to repeal ObamaCare.

Cornyn signaled the widespread GOP fear that adding a health-care debate to the tax bill will only bog down a reform package that is President Trump’s new top priority.

Cornyn, the No. 2 Republican in the Senate, said he does not support combining tax reform and ObamaCare repeal in a single budget reconciliation measure that would allow the GOP to protect their bill from a Democratic filibuster.
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