House GOP leaders determined Thursday night that they didn’t have the votes to pass a rewrite of the Affordable Care Act and would not seek to put their proposal on the floor on Friday.

A late push to act on health care had threatened the bipartisan deal to keep the government open for one week while lawmakers crafted a longer-term spending deal. Now, members are likely to approve the short-term spending bill when it comes to the floor and keep the government open past midnight on Friday.

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Congressional Republicans have called for restructuring Medicaid, reviving a debate that has largely remained dormant for two decades. During the mid-1990s, Congress and President Clinton advanced competing Medicaid reform proposals. Republicans urged that the federal government issue Medicaid block grants to states. The White House and congressional Democrats proposed instead to place per capita limits on federal Medicaid payments to states. The most salient difference between these approaches is that per capita allotments retain the individual entitlement to Medicaid while block grants generally do not. Today, Republicans who once resisted Medicaid per capita allotments support them, and Democrats who backed such allotments oppose them. Given this legislative history, policymakers seeking common ground might look to Medicaid per capita allotments as a point of departure.

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The conventional approach to health insurance keeps consumers in the dark about how their health care dollars are spent. Patients pay premiums every month and rely on insurers to cover their medical expenses, no matter how small or routine. Consequently, patients have little incentive to be cost-conscious. The more care they consume, the more value they capture for their premium dollar. Health Savings Accounts inject much-needed competitive forces into the health care marketplace. Expanding access to HSAs should be a centerpiece of any congressional effort to expand access to quality, affordable health care.

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The “MacArthur Amendment” to the American Health Care Act is responsive to what House Republicans have learned about the priorities different factions within their coalition. The Freedom Caucus prioritizes deregulation of the individual insurance market to lower costs and constrain the federal role. The moderates prioritize coverage levels and protection for people with pre-existing conditions. Rather than try to arrive at a single overall balance, the approach Republicans are now pursuing allows state governments to have relief from the rules that drive up costs and make their insurance markets unsustainable if they propose alternative rules that would still protect people with pre-existing conditions and make coverage accessible.

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The Invisible Risk-Sharing Program (IRSP) will stabilize the individual insurance market and lower premiums while concurrently providing guaranteed access to coverage and protecting those with pre-existing conditions. Different than a traditional high-risk pool, no one is declined coverage, enrollees with pre-existing health conditions get the same plans at the same lower price as a healthy individual, and those with pre-existing conditions are not segregated to higher cost and limited benefit high-risk pool plans. Several questions have been raised about IRSP and the amendment. We address a number below.

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Health information technology regulations have become overly burdensome, according to Health and Human Services Secretary Tom Price, who vowed that the Trump administration would work to spur innovation in the field. This week, he laid out several principles he said would guide the Trump administration on health IT and electronic medical records, saying the administration was committed to promoting the exchange of medical information between providers. “We simply have to do a better job of reducing the burden of health IT on physicians and other providers,” said Price.

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Forty-nine percent of registered voters say congressional Republicans should continue with their efforts to replace Obamacare, up from 37 percent in March immediately after the GOP canceled a House floor vote on its legislation, a Morning Consult/POLITICO survey shows.

The White House, top House conservatives and a key moderate Republican have finalized a new Obamacare repeal and replace plan they hope will break a month-long logjam on a key priority for President Donald Trump.

But it is far from clear that the fragile agreement will provide Speaker Paul Ryan the 216 votes needed for the House to pass the stalled legislation. Optimism is growing among Republican officials on the Hill and in the White House.

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In what will be a busy week in Washington, the Republican House hopes to take another whack at ObamaCare reform, a large chunk of which is Medicaid. As if this were not enough to handle, Donald Trump promises a “big announcement” Wednesday about his tax plan, which will likely include cuts in the corporate tax rate.

Let us stipulate that Medicaid reform and corporate tax cuts are both excellent initiatives. Done properly, each would offer Americans, including those at the lower end of the income scale, a better deal than they have now. Unfortunately, pitching health-care reform as the way to help “pay for” corporate tax cuts undermines the best arguments for both.

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House GOP leaders during a members-only conference call Saturday vowed to avoid a government shutdown and said they’re closer to a deal to repeal and replace Obamacare, according to members who participated on the call.

But Speaker Paul Ryan also downplayed the possibility of a vote next week, the same sources said. The Wisconsin Republican said the chamber will vote on a conference-wide deal when GOP whips are confident they have the votes for passage — but not until then.

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