House Republican leaders, racing toward a planned Thursday vote on their proposed health-care overhaul, unveiled changes to the legislation late Monday that they think will win over enough members to secure its passage.

The tweaks addressed numerous GOP concerns about the legislation, ranging from the flexibility it would give states to administer their Medicaid programs to the amount of aid it would offer older Americans to buy insurance. They are the product of two weeks of negotiations that stretched from the Capitol to the White House to President Trump’s Florida resort.

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Almost 30 years after leaving office, Ronald Reagan is widely considered one of America’s greatest leaders and the icon of the conservative movement. As a Republican member of Congress, I often speak at Lincoln-Reagan Day dinners and other events honoring his legacy.

Yet as I watch the debate over our House Republican plan to repeal and replace ObamaCare, I’m struck by a question. Would President Reagan be acceptable to some of today’s conservatives? Does anyone remember that Reagan was a master of advancing his principles by looking for common ground and finding consensus?

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Millions may lose coverage next year if Congress does not repeal Obamacare. That’s not what this week’s Congressional Budget Office (CBO) analysis says, but it is reality. CBO’s estimating models seem impervious to reality.

In the real world, the Obamacare exchanges are in crisis, millions of uninsured people willingly pay or avoid IRS penalties, and consumers struggle with rising premiums and cost-sharing requirements.

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Lawmakers will undoubtedly concern themselves with many policy objectives as they consider modifications to the AHCA. They would be prudent, however, to ensure that anything signed into law repairs some of the fiscal damage done by the ACA. This will require them to be cognizant of real-world fiscal effects that may not be fully captured in Congress’s current scorekeeping methods.  Three factors contribute to confusion about the ACA’s damaging fiscal effects: 1.) Many of the provisions designed to finance its expansion of insurance coverage haven’t borne fruit, 2.) Scorekeeping rules Congress imposes on the Congressional Budget Office require the CBO to compare the effects of legislation to a baseline that differs from actual law in various critical respects, and 3.) Misinterpretation of intermittent CBO reports over the past several years on the evolving cost estimates for the ACA’s coverage expansion.

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The AHCA will suffer its share of criticism and praise as it moves through the legislative process. Secretary Tom Price has stated this is merely round one in the effort of reform. The next two phases will involve broader regulatory patches and targeted legislation. Initially, from a regulatory perspective, the first draft has the potential to eliminate $3.4 billion in costs and create more than 72 million hours of paperwork savings. This could generate tangible benefits to insurers, businesses, and ultimately, patients. Consider a law that imposed $53 billion in costs and 176 million paperwork burden hours. Even a 20 percent to 30 percent cut could create tremendous regulatory cost reductions.

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While the emphasis on moving quickly is not surprising, there is also a significant risk that unnecessary haste could lead to major mistakes in the legislation that would generate strong political backlash. The ACA has extended insurance coverage to millions of people with expensive health problems, and to many lower-income households. Acknowledging this is not the same thing as saying the ACA should not be changed; however, Republicans would be well advised to take the time necessary to ensure that their plan will provide adequate insurance for these populations while remaining consistent with an overall framework of less federal control and regulation and more reliance on market incentives. Moving in this direction would help with public acceptance of the AHCA and improve the chances that what is ultimately passed remains on the books longer than the law it is intended to displace.

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On the one hand, the CBO score provides an opportunity for the bill’s sponsors to bolster support amongst conservatives, some of whom have been critical of the congressional leadership’s approach — but whose backing will likely be needed if the bill is to pass the GOP-controlled House. This conservative support may come, however, at the expense of moderates, who will be vocal when debate over the bill reaches the Senate. They might only support the legislation with changes that will improve upon CBO estimates of how many people it will leave uninsured.
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A day after a harsh judgment by the Congressional Budget Office on the House plan to repeal the Affordable Care Act, nervous Senate Republicans on Tuesday suggested changes to the bill. They told Trump administration officials – including the health secretary, Tom Price – that they wanted to see lower insurance costs for poorer, older Americans and an increase in funding for states with high populations of hard-to-insure people.

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The American Health Care Act is taking fire from all sides, not the least from the circular firing squad conservatives have formed, threatening passage of the only piece of repeal and replace legislation that House leaders say will be presented to members for a vote this year.

Conservatives may not like to hear it, but leaders and staffers have crafted what they believe is the best bill possible given the limits of the reconciliation process, the pressures of the legislative calendar, and the need to provide a safety net for those currently receiving ACA coverage.

Democrats want nothing more than to get Obamacare off their political backs. Any replace strategy is risky. But voting against “repeal” could be the death knell for Republicans in 2018.

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The furor over the Congressional Budget Office’s report on the House GOP health bill is concentrated on predictions about insurance coverage, which suits Democrats fine. Lost amid the panic is that CBO shows the bill is a far-reaching advance for the market principles and limited government that conservatives usually favor.

The CBO is not omniscient, but if its projections are even close to accurate then ObamaCare repeal and replacement is the most significant government reform in perhaps three decades. Under conventional (static-revenue) scoring, the bill cuts spending on net by $1.22 trillion and eliminates a raft of new taxes worth $883 billion through 2026.

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