Enough insurers are planning to sell coverage on the Affordable Care Act’s insurance exchanges next year to keep them working — if only barely — in most parts of the country.

Competition in many markets has dwindled to one insurer — or none in some cases — and another round of steep price hikes is expected to squeeze consumers who don’t receive big income-based tax credits to help pay their bill.

“What we’re seeing is a deterioration in these markets, but the markets haven’t imploded, they haven’t gone into a rapid downward decline,” said Dan Mendelson, president of the consulting firm Avalere.

. . .

Republicans are facing a critical test of Senate unity in the Trump era as leaders prepare to unveil a healthcare bill that they have grappled over in secrecy to reconcile the conflicting demands of party factions.

President Donald Trump’s policy ambitions depend on Republicans’ ability to bridge deep internal divisions, and after false starts on healthcare in the House of Representatives earlier this year the drama now moves to the Senate.

Mitch McConnell, the Senate majority leader, has promised to release a draft healthcare bill on Thursday, incorporating substantial revisions to a measure that passed the House in May. But whether it will secure enough votes to pass the Senate remains in doubt.

Healthcare reform has become a quagmire for Mr Trump, who campaigned on a pledge to repeal his predecessor’s Obamacare reforms. But he has seen efforts falter as his party disagrees on who should get health insurance and how it will be paid.

. . .

Much of the public discussion about health care and health insurance reform abounds with misinformation. Medicaid, in particular, has become a political tool, with daily posts and articles about reforms to the program that distort the record for political gain. But there is little mention of the need to empower governors to take ownership of the program.

. . .

The government’s price tag for a single-payer health care system would be astonishing. When Sen. Bernie Sanders (I-VT) proposed a “Medicare for all” health plan in his presidential campaign, the nonpartisan Urban Institute figured that it would raise government spending by $32 trillion over 10 years, requiring a tax increase so huge that even the democratic socialist Mr. Sanders did not propose anything close to it.

. . .

As the Republican Congress struggles to “repeal and replace” Obamacare, the political landscape is steadily shifting.

Since the Democratic Congress enacted Obamacare in 2010 (without a single Republican vote), Democrats have increasingly been on the defensive about their creation. The individual mandate that Obamacare relied upon to corral healthy young people into insurance pools has failed to do the job – partly because the tax penalty was not severe enough, and partly because the Obama administration felt compelled to create 14 different types of “hardship exemptions” that exempted millions of young people from the penalty.

. . .

Recall that under Democratic Governor Peter Shumlin Vermont committed to a single-payer for the state but had to abandon the effort in 2015. Why? The cost was staggering — $4.3 billion when Vermont’s entire fiscal 2015 budget, including both state and federal funds, was about $4.9 billion. That’s right: essentially doubling the size of the government.
. . .

While Senate Republicans are drafting their healthcare plan behind closed doors, they’ve given reporters a general idea of what might be in it.

  1. It will slow down the phase-out of the Medicaid expansion
  2. Tax credits will be beefed up
  3. It will keep some ObamaCare taxes
  4. It will include more funding to combat the opioid crisis
  5. It will try to stabilize the ObamaCare exchanges
  6. It will include more funding to handle preexisting conditions

 

Rep. Greg Walden of Oregon, who helped shepherd the party’s health-care overhaul bill through the House last month, sat down with Louise Radnofsky, The Wall Street Journal’s White House reporter, to offer his take on where the repeal and replace effort stands.

“The House has passed the American Health Care Act to try to do reforms, to get cost control on the Medicaid system, give states more flexibility to design plans that will work for them and move people into an insurance product they can afford. We know there’s more work to be done. We believe we gave the Senate some nice headroom and some dollars set aside in there to make other changes. So they’ve got some flexibility. We’ll see where this leads. But I think we’ll get a bill to the president’s desk before August.”

The chief obstacle to repealing and replacing Obamacare may no longer be congressional Democrats. It could be the GOP itself.

Senate Majority Leader Mitch McConnell has promised to hold a vote on the party’s repeal-and-replace plan by the end of June. But as he’s tacked his plan to the center as part of a bid to hold onto moderate Republicans, he’s raised the ire of conservatives who are pressing for a plan that more fully repeals Obamacare.

Senate Republicans must iron out their differences — and not let fear of the unknown derail their seven-year-long plan to repeal Obamacare. The law is collapsing. The GOP may not have made this mess, but the American people are counting on them to clean it up.

. . .

Senate Democrats are escalating their attack on Republicans’ plans to repeal Obamacare this week, though their party remains divided on how far to take activists’ demands that they shut down the Senate in protest of the GOP’s dismantling of the Affordable Care Act.

Democratic senators are planning to hold the Senate floor until at least midnight on Monday to thrash Senate Republicans for refusing to hold committee hearings on their healthcare overhaul, according to several people familiar with the plan. The round of speeches is being organized by Sens. Patty Murray of Washington state and Brian Schatz of Hawaii.

. . .