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.

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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.

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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.
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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.

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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.

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Conservatives inside and outside the Senate GOP are sounding alarms over the emerging shape of the chamber’s bill to dismantle the Affordable Care Act, a sign that the faction’s support may be increasingly difficult to secure.

Pressure from outside groups has intensified in recent days, and conservative lawmakers have signaled their concern that the Senate bill doesn’t do enough to curb spending on the Medicaid federal-state program for the poor or to reduce health-care premiums—two of their top goals.

“We’re not there yet,” Sen. Ted Cruz (R., Texas), a leading Senate conservative, said Thursday.

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Section 1332 of the ACA permits states to submit simultaneous and combined “superwaivers” for Medicaid and for provisions of the ACA itself. These superwaivers could make it easier for states proposing plausible ways to allow states that serve Medicaid beneficiaries more efficiently to reprogram federal and state savings into health programs for non-Medicaid eligible households. For households with working, nondisabled adults, it should also be made easier for states to pool their federal and state funds for Medicaid, the Children’s Health Insurance Program (CHIP), the ACA, and other programs to deliver coverage through private plans in the ACA exchanges. It is also time to allow states more flexibility in using Medicaid and other health care funds to invest in the social determinants of health—items such as adequate housing, school-based social services, improved lifestyles, and safer household environments, which can contribute to improved health and reduced medical costs.

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To estimate the impact of the AHCA, the CBO had to compare it to predictions of coverage under the current law, the ACA. If the prediction for the current law is incorrect the prediction of lost coverage will be too.Yet the CBO has consistently overestimated future ACA coverage gains. In 2012 it predicted an additional 28 million would gain health insurance by 2017. The actual figure is 20 million. It forecast 25 million would gain coverage on the ACA exchanges and 10 million would gain Medicaid coverage. Less than half as many actually enrolled on the exchanges and not all of them gained coverage – many were replacing non-exchange policies they lost after ACA passage. Conversely, about 14 million – 40 percent higher than predicted – newly enrolled in Medicaid. The CBO prediction that 5 million would lose employer coverage was also wrong – employer provided coverage was stable.

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