A majority (61 percent) of the public say that because President Trump and Republicans in Congress are in control of the government, they are now responsible for any problems with the ACA moving forward. About three in ten Americans (31 percent) say that because President Obama and Democrats in Congress passed the law, they are responsible for any problems with it.

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President Donald Trump has reiterated on several recent occasions that the effort to repeal and replace the ACA is far from over. Whether Republicans will hold another vote before the August recess, or even before the end of the year, remains uncertain.

For this second attempt at reform to succeed, the GOP needs to get back to the market- and patient-centered basics it’s spent years trumpeting to the public—and thereby lay the foundation for a competitive health insurance marketplace that offers affordable, quality care to all Americans.

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By ending federal matching funds and shifting managerial responsibility to the states, Republicans propose to modernize Medicaid’s funding and give local authorities greater flexibility to design program innovations that are more specific to each state’s needs. The reason Medicaid costs less than private insurance is because it provides less. Medicaid provides “comprehensive coverage,” but coverage isn’t care. It is easy to write down a long list of services that are covered. Think of it as having a coupon for free health care—a coupon that is difficult, sometimes impossible, to redeem. Per capita allotments or block grants may result in reduced federal spending, but their primary purpose is to bring about reform of Medicaid.

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The most popular parts of the Affordable Care Act (ACA) are the most expensive. Universal coverage is a top priority not only for Democrats but also for President Trump. Both Republicans and Democrats want to preserve many costly coverage features of the ACA, including those that prevent insurers from precluding people with preexisting conditions and those that eliminate lifetime or annual coverage limits. The challenge is how to preserve these features and make insurance affordable.

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One of the more interesting television commercials I see is an ad sponsored by Cancer Treatment Centers of America. The message: if you have cancer, we want you.

Welcome to a small glimpse of how the market for health care might be different.

If we had a genuinely free market for health care, ads like this would not be rare and unusual. There would be centers of excellence for heart disease and diabetes and dozens of other afflictions. Through television, radio, the Internet and other means, these centers would be seeking out people with problems and offering to solve them – just like in other markets.

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In an interview aired Wednesday, President Trump said that his overriding legislative priority is to pass health care reform, but he won’t wait indefinitely to turn his attention to overhauling the nation’s tax code. Trump told the Fox Business Network, “We’re going to have a phenomenal tax reform, but I have to do health care first. . . . I don’t want to put deadlines. Health care is going to happen at some point. Now, if it doesn’t happen fast enough, I’ll start the taxes.” The White House had hoped to pass a tax bill before the congressional recess in August, though officials have conceded the deadline is slipping. Trump suggested that it is important to pass the health care bill first, because it would provide “hundreds of millions of dollars” in savings that could be used to offset a net tax cut.

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Rep. Mark Meadows intends to deliver an Obamacare repeal and replacement plan to House Speaker Paul Ryan, R-Wis., on Tuesday that would leave in place the existing law’s mandates for insurers to cover people with pre-existing conditions.

“What I’m getting to him is based on conversations that I’ve had with (Tuesday Group co-chairman) Tom MacArthur and leadership, but I wouldn’t say that it’s approved at this point,” Meadows, chairman of the Freedom Caucus, told USA TODAY. “What we’re trying to do is work through issues that are important to all of us but make sure that pre-existing conditions are taken care of.”

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On April 6, the House Rules Committee discussed an amendment to the American Health Care Act (AHCA) that would allocate $15 billion over 10 years to be used to develop an invisible high-risk pool (IHRP)—a risk-sharing mechanism meant to alleviate issues caused by the uneven distribution of health care costs. In a marketplace with some form of guaranteed issue, efficient risk-spreading mechanisms are a must. The creation of a IHRP program is a logical next step. However, if the program is improperly funded and fails to account for geographical differences between states and regions, it will only result in a marketplace marked by the same problems plaguing the current marketplace: rising premiums and lack of insurer competition.

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Here is something you can take to the bank. If Republicans can’t produce an alternative to Obamacare that solves the real problems of ordinary people, they will never be able to pass a health reform bill. But if they do solve problems, they will have no trouble getting support — even from Democrats.

That means getting the focus right. Over the past three years there have been a series of Republican proposals that have been excessively focused on Obamacare rather than on a conservative approach to health reform. These proposals have been hell bent on repealing Obamacare taxes and Obamacare mandates instead of solving the problems that Obamacare has created or exacerbated.

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Republicans left Washington on Friday without a health-care deal, despite renewed negotiations after last month’s fiasco and a burst of White House diplomacy. Perhaps the two-week recess will be a cooling-off period and we hope the House’s factions can agree on a deal. If they can’t, then at least we’ll learn who’s responsible for defeat.

President Trump and Republicans campaigned on repeal and replace, and the President at least wants to keep his word. The ObamaCare exchanges are also fragile and precarious, and consumers harmed by rising premiums and declining choices are likely to blame the party in power.

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