Official Washington still is struggling to understand and adapt to the populist wave that carried Donald Trump to the White House. Anger and denial linger still, emotions rooted in the social and economic chasm between Trump voters and the political class.

What does this mean for health? The first fight is already shaping up, of course, over Obamacare. The way forward falls on President-Elect Trump, his presumptive HHS Secretary Tom Price (R-GA) and the GOP-controlled Congress to make good on his campaign promise of replacing Obamacare with “something terrific.” This won’t be easy, and the latest reports are that the can might be kicked down the road a few years.

Responding to populist frustrations will require policymakers to recognize that long-held policy assumptions may no longer apply in a rapidly changing economy. These include:

  • The link between jobs and coverage. How workers – and seniors — get coverage will evolve.
  • The broken link between “health” and health insurance. Regulators will at some point give insurers room to innovate, permitting new forms of coverage that promote health and offer new ways to finance care for chronic conditions.
  • The broken link between premium and risk. A health promotion approach will require restoring this link, allowing insurers to encourage and reward healthy behaviors.
  • New technology. Technology will one day penetrate the health care regulatory encrustation and dispel the lingering paternalism that regards consumers as incapable of making informed choices about their medical care.

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Last Wednesday, Vice President-elect Mike Pence told House Republicans that President-elect Donald Trump is ready to sign executive orders when he takes office that would enable an orderly transition away from ObamaCare, even as Congress begins to debate alternatives and replacements.

Both Affordable Care Act (ACA) opponents and supporters tended to exaggerate how much immediate harm Trump would do to the outgoing Obama administration’s legacy healthcare program.

The new president certainly “could” swing a wrecking ball against what remains of the troubled effort to expand insurance coverage under tighter federal government control and substantial taxpayer subsidies. His toolkit of potential executive branch actions is large and varied, but it is not unlimited. The more important questions involve how Trump wants to utilize those powers, and for what objectives.

With patience and care, Trump could initiate new formal rulemaking to partially revise or reverse older, existing regulations, and to create new ones.

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Brandishing a new slogan, “Make America Sick Again” adapted from President-elect Donald Trump’s campaign, Democrats are holding rallies in Ohio, Pennsylvania, and West Virginia, featuring the stories of thousands of the red-state Americans who have benefited from Obamacare. Those rallies will culminate in several nationwide events beginning Jan. 15 where they will warn of the chaos to ensue if the health law is repealed without a replacement plan. They’re also urging followers to bombard lawmakers’ district offices and phone lines with calls against repeal.

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Grace-Marie Turner joined Ashley Webster on Fox Business to talk about replacing the failed Affordable Care Act. Turner pushed back that Republicans have no replacement plans of their own, emphasizing that HHS designate Tom Price has been introducing replace legislation since the ObamaCare debate began, many other legislators have comprehensive bills, and Speaker Ryan led a major effort last year to develop a “Better Way” plan. The leadership’s mission is to provide a transition—a life boat—for people currently receiving ObamaCare coverage while building a bridge to better coverage.

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Conservatives make a mistake if they assume Americans went to the voting booth with a specific desire to see the 2015 partial ObamaCare repeal bill passed. In fact, Trump and GOP majorities were elected to solve a problem — making quality, affordable healthcare more than an empty slogan — and now the GOP needs to deliver.  They recommend, among other proposals, legislation to give states more power and resources to create insurance market with real choices and lower premiums, including allowing insurers to sell more flexible plans than ObamaCare allows, continuing protections for those with pre-existing conditions, and making coverage affordable for those who truly need help.

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Don’t be fooled—the debate over whether to scrap the health care law is not yet over, and what appears to be merely a question of timing is about much more than that. Republicans will have to tread a careful path that balances a desire to abandon Obamacare as soon as possible with the need to respect the reality that the complexities of changing the system will persist well beyond any near-term bill signing ceremonies. It’s true that widespread, sudden disruption of existing health insurance arrangements could short-circuit a workable transition to more market-oriented and less Washington-centric health policy reforms. While the risk of ending up on the merry-go-round of ACA replacement proposals lacking sufficient support, depth, or effectiveness is real, there are risks posed by the opposite reaction: the desire for quick and simple repeal.

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President-elect Donald Trump lashed out at Democrats on Thursday over their efforts to preserve Obamacare, denouncing the measure as a “lie” as he called for a less expensive and more effective health care system. “The Democrats, lead by head clown Chuck Schumer, know how bad Obamacare is and what a mess they are in,” Mr. Trump wrote in the first of three posts on Twitter. “Instead of working to fix it, they do the typical political thing and BLAME,” Trump continued on Twitter. “The fact is Obamacare was a lie from the beginning. ‘Keep you doctor, keep your plan!’” He said it was time for Republicans and Democrats to work together on a “plan that really works — much less expensive & FAR BETTER!”

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Republicans won the first skirmish in the Obamacare fight Wednesday, voting to begin debating fast-track budget procedures that, if successful, would allow the GOP to kill the 2010 health care law without having to face a Democratic filibuster in the Senate. The 51-48 vote, on the second day of the 115th Congress, underscores how serious Republicans are in making good on their repeal pledge. But it also signaled that Democrats are just as committed to defending the Affordable Care Act.

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House Republicans say they aim to send an Obamacare repeal bill to the White House by Feb. 20, following a meeting with Vice President-elect Mike Pence.

“We want to have the budget on the president’s desk by the 20th,” Rep. Marsha Blackburn (Tenn.) said Wednesday after a House GOP conference meeting that Pence attended. “We’re going to be working to hit those benchmarks, and the pace of work is going to change significantly around here.”

House Speaker Paul Ryan’s staff pushed back on that timeline after the meeting, saying it was incorrect.

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President Obama and Vice President-elect Mike Pence both paid a visit to Capitol Hill Wednesday, in the first formal engagement over the future of the Affordable Care Act. Republicans finally have the power to repeal, but the question is whether they have the grit to replace ObamaCare.

Mr. Pence told Republicans that repeal and replace is the Trump Administration’s “first order of business,” while Mr. Obama ordered Democrats not to “rescue” the GOP by helping to pass a “TrumpCare replacement.” Going by his business background Donald Trump won’t mind putting his name on a health-care plan, or anything else, but Republicans need to appreciate the reality that they will soon own ObamaCare. Until they pass a coherent and market-oriented substitute, as a political matter ObamaCare is TrumpCare, like it or not.

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