It looks like House Republicans have been trying over the past few days to coalesce around a revised version of the AHCA. One key revision has involved a more assertive temporary federal reinsurance scheme to quickly lower premiums and stabilize the transition period to a new system. But maybe the most significant, and least familiar, new proposal has involved allowing states to obtain waivers from some Title I regulations in Obamacare.   The devil will be in the details, and they will matter enormously here, but the general concept of returning regulatory power to the states through waivers that are connected to the bill’s spending measures is an interesting way to deal with the constraints Republicans confront and could have real promise.

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Health and Human Services Secretary Tom Price holds broad authority over administration of the Affordable Care Act, including the power to give additional flexibility to states and insurers under the law. Section 1332 of the ACA allows HHS to offer “state innovation waivers” for that allow states to waive some (but not all) of Obamacare’s insurance regulations in return for a block grant of ACA funding. States that want to keep the ACA status quo could do so, while Republican-led states could go in a different direction.

An approach that started with 1332 waivers and layered on additional legislative reforms would allow both the more conservative and moderate members of the GOP to declare victors, because the states themselves would be put back in charge of their own health insurance markets.

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The demise of the American Health Care Act (AHCA) was ultimately precipitated by factional opposition to different provisions of the bill. Moderate and conservative members of the Republican conference did not agree on much, except they shared an animus towards the ill-fated legislation.

The future of health-care reform is now highly uncertain. Forging a legislative consensus will continue to be a challenge due to the inherent trade-offs between broad-based coverage and personal freedom, to say nothing of competing views about the respective roles of the market and the state (including different levels of government).

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President Trump cannot repeal the ACA by executive order. The ACA is a statute, enacted by Congress, which under the Constitution only Congress can repeal or modify. Furthermore, the order does not itself change existing regulations. Rather, it provides instructions or guidelines as to how Trump wants responsible agencies to exercise their discretion in interpreting and applying statutory requirements. The order appropriately recognizes that the new priorities it outlines can be followed by administration officials only “to the maximum extent permitted by law.”

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Democrats, hoping to seize on momentum from the apparent collapse of the Republicans’ health bill, are grappling with a tough question—whether they can do anything to prevent the Trump administration from weakening the Affordable Care Act through administrative actions by the Department of Health and Human Services.

Democrats are trying to mobilize public support to block potential changes. Five Democrats on the Senate health committee sent a letter to President Donald Trump Monday calling on him not to undermine the health law.

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It is valuable to understand what would happen if AHCA in fact became law, and what could be done to improve it or a new reform proposal. The best place to start is with the cost estimate of the plan produced by the Congressional Budget Office (CBO). Some have criticized CBO for this estimate, arguing that it is a fundamentally inaccurate assessment. While some of CBO’s assumptions are indeed questionable, there is little doubt that the agency’s bottom line assessment is basically correct: The bill, as currently structured, would trigger a rise in premiums in the short-run, a sharp increase in the number of people without insurance over the next two years, and then also a steady increase in the number of uninsured Americans over the following eight years. Instead of trying to discredit this finding, the authors of the legislation would be better off fixing the bill. CBO’s estimate provides a roadmap for what needs to be done to improve the chances the bill will produce the results its authors intend.

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The conventional wisdom—repeated by President Trump—is that the right-wing House Freedom Caucus is singlehandedly blocking Republican attempts to repeal and replace Obamacare. In fact, Freedom Caucus members have been reaching out to the larger bloc of “no” votes—GOP moderates—to find a path forward. Moderates are rebuffing them. The contours of a deal exist that could satisfy the concerns of both the House Freedom Caucus and GOP pragmatists. They involve replacing the AHCA’s flat tax credit with a means-tested one that focuses on offering assistance to the working poor, and pairing that change with rolling back more of Obamacare’s premium-increasing insurance regulations. But members of the Tuesday Group, the countervailing faction of House GOP moderates, are saying no to any phone calls from members of the Freedom Caucus.

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White House officials presented an offer to the conservative House Freedom Caucus on Monday night as they seek to revive the ObamaCare replacement bill. Vice President Mike Pence and other White House officials presented an idea to the Freedom Caucus meeting to allow states to choose to apply for waivers to repeal two ObamaCare regulations that conservatives argue are driving up premiums.

Those two regulations detail ObamaCare’s essential health benefits, which mandate which health services insurers must cover, and “community rating,” which prevents insurers from charging sick people higher premiums.

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Grace-Marie Turner tells One America News, “I am optimistic I see the speaker’s commitment, the president has said he’s going to do this- I think he publicly said he’s going to do this with the Republicans or I’m going to do this with the Democrats. Clearly, if the conservatives want to have more reform of Medicaid, more free market options for individuals, more control over the states to be able to approve the kind of plans that people actually want to buy, they need to move quickly before they wind up with more government controlled options which is very likely to happen if they have to put together a majority with half of them Democrats.”

President Trump expressed confidence Sunday that he and aides can resurrect their attempt to repeal President Barack Obama’s health care law.

Trump tweeted: “Anybody (especially Fake News media) who thinks that Repeal & Replace of ObamaCare is dead does not know the love and strength in R Party!”

He also tweeted: “Talks on Repealing and Replacing ObamaCare are, and have been, going on, and will continue until such time as a deal is hopefully struck.”

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