America spends too much on Medicaid relative to other programs and services that might have a bigger impact on measured health outcomes for the poor. Giving states more flexibility in reaching these broad population health goals and better tools for measuring their progress would help states and the federal government scale up what works, while phasing out what doesn’t. Seema Verma, Trump’s pick to lead the Centers for Medicare & Medicaid Services, called for CMS “as the nation’s largest purchaser of health care…[to] do more, achieve more than the mere distribution of insurance cards,” saying it should use its programs to “truly make a difference in people’s lives to prevent and cure disease, manage chronic illnesses, and promote healthy lifestyles and independence from government assistance.”

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Current federal tax policy treats workers and their families who do not or cannot get health insurance through employment-based coverage unfairly and contributes to disruption in coverage when employees change jobs. Obamacare imposes a hefty excise tax on expensive employer coverage, a punitive measure that adds to the complexity of the current health care system.

Congress should repeal Obamacare’s Cadillac tax and set a simple cap on the employer exclusion. In addition, Congress should create a new type of individual tax relief that would be available to everyone, regardless of where they purchase coverage. Together, these policies would help to ensure that the federal government is not favoring one type of coverage or consumer over another and would go a long way toward restoring a functioning market in health care that is responsive to consumers.

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As high health costs persist, insurance affordability remains a challenge for many employers and individuals. However, allowing insurers to sell coverage across state lines could result in unintended consequences such as market segmentation that could threaten the viability of insurers licensed in states with strict benefit coverage, issue, or rating rules. The ability for high-risk individuals to obtain coverage could be compromised as a result. If rules governing insurance are consistent across the states, as they are under the ACA, market segmentation could be minimized. However, potential premium savings would also be minimal, as premiums would continue to reflect local health care costs, regardless of location of the insurer.

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A leaked “discussion draft” of House Republicans’ Obamacare repeal-and-replace bill surfaced on Friday. The draft reveals important details about the plan being designed by House GOP leadership. The 106-page discussion draft, dated February 10, was obtained by Politico. It corresponds reasonably closely to the 19-page outline that House GOP leadership leaked on February 16.

The centerpiece of the plan is its attempt to replace Obamacare’s health insurance exchanges with a new program that would provide subsidies for Americans to buy any health insurance plan that is legally available in their state. It would enact two key regulatory reforms of the individual market for health insurance: it would revert back to states the ability to define the “essential health benefits” that insurers must cover, and it would allow insurers to charge their policyholders a much wider range of prices based on age. The plan would also significantly expand the ability of Americans to save money, tax-free, in health savings accounts, and it would make two major changes to the Medicaid program:

  1. It phases down Obamacare’s Medicaid expansion. States would retain the option to maintain a larger Medicaid program, but the federal government would only fund around 60% of the cost, compared to 90% under the ACA. That’s a fair way of balancing the interests of states that expanded Medicaid, and want to maintain that expansion, and states that did not, and don’t want to be punished for their fiscal restraint.
  2. It overhauls the pre-Obamacare Medicaid program, by converting it into a system of per-capita subsidies, in which states would receive a fixed dollar amount for each Medicaid enrollee resident within their borders, which they could then use to fund a safety-net health insurance program that they would design and administer.

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The U.S. House of Representatives is considering a bill that would repeal and replace the Affordable Care Act (ACA) as early as March of 2017, preceding by more than a year one of the  deadlines President Donald Trump has stated for repealing and replacing Obamacare.

House Speaker Paul Ryan (R-WI) has said the House should pass legislation repealing Obamacare before April, and the House Energy and Commerce Committee is one of several aiming to mark up the legislation by March 1, The Hill reported on February 8.

The Trump administration may not be willing to repeal, replace, or repair ACA until the summer of 2018, Trump told Fox News host Bill O’Reilly on The O’Reilly Factor on February 5.

. . .

Vice President Pence forcefully defended on Thursday night the Trump administration’s plans to repeal and replace the Affordable Care Act, saying the law known as Obamacare is a “nightmare” and that the administration is committed to “an orderly transition” to a new health care system. Pence said he and President Trump are committed to giving every American “access to quality, affordable health insurance. . . . We’ll have an orderly transition to a better health-care system that finally puts the American people first,” Pence said.

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As policymakers debate repealing and replacing the ACA, they grapple with how to address the ACA’s “Cadillac Tax.” Rather than repealing the 40% tax on high-cost insurance plans outright, many advocates of “repeal and replace” have proposed replacing it with a limit on the tax exclusion for employer-sponsored health insurance. Doing so would be a wise choice, and limiting the ESI exclusion would both generate significant revenue to pay for an ACA replacement and help to limit the overall growth of health care spending. Other options include capping the income tax exclusion, capping the payroll tax exclusion, and replacing the income tax exclusion with a fixed-dollar credit/deduction.

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As Republicans in Congress look to repeal and replace the ACA, they’re considering a return to high-risk pools like one in Wisconsin, which some considered a national model. The “Health Insurance Risk-Sharing Plan” — which ran from 1979 to 2014, when the federal health law’s exchanges started — was funded through premiums, insurance company assessments and reduced payments to providers. “Pooling the high-risk individuals together and managing their needs separately was a huge factor in the state’s success in offering a competitive insurance market,” J.P. Wieske, the state’s deputy insurance commissioner, told the House Energy and Commerce Committee this month.

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Let the states derive their own health care solutions, particularly when it comes to cost containment. That’s why we may need to look to six states that are aggressively working to contain costs. The Florida, Georgia, Alabama and Tennessee legislatures are considering a proposal to eliminate defensive medicine by abolishing each state’s medical malpractice system and replace it with a no-blame model similar to workers’ compensation. Two other states are also examining the concept. When doctors are no longer the target of litigation, they would be less likely to order unnecessary tests, medications and procedures.

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Arizona Gov. Doug Ducey heads to Washington this week to attend the Conservative Political Action Conference. The Washington Examiner asked him to preview his main priorities regarding Obamacare replacement and what they should know about Arizona’s healthcare challenges.

He said, “The damage from Obamacare is clear: Insurance markets have been wrecked; premiums have soared; and promises, such as “you can keep your doctor,” have been broken. That’s what happens when one party imposes a one-size-fits-all solution on one-sixth of the country’s economy without even bothering to read the bill. Congress should do the opposite of what occurred in 2010: It should seek to expand choices for consumers, not limit them; it should encourage innovation in the states, not stifle it; and it should read the bill and understand the implications of what it’s passing instead of simply hoping for the best despite ample evidence to the contrary.”

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