Thanks to all of the issues with our vast and complicated healthcare system, any attempts at reform will require massive amounts of effort, political capital, cooperation from various public and private entities and, likely, luck. So while Donald Trump ran on a platform of “repealing and replacing Obamacare”, it might be wise to start with some small changes to the Affordable Care Act (ACA) that could still have large benefits.

. . .

Donald Trump and Republicans in Congress are vowing to repeal and replace the Affordable Care Act, the signature health care overhaul of President Obama.

Trump has offered a few ideas of where he’d like to see a health care overhaul go, such as a greater reliance on health savings accounts, but he hasn’t provided a detailed proposal.

The absence of specifics on health care from the president-elect makes the 37-page plan that Speaker of the House Paul Ryan has released the fullest outline of what Republicans would like to replace Obamacare.

. . .

The GOP Congress and incoming Trump administration will need to make some decisions in the coming weeks on how to proceed with a legislative agenda in 2017. The course they choose to take is likely to define the rest of the Trump presidency, just as decisions President-elect Obama made in late 2008 and early 2009 — to do a large stimulus bill first, followed by a sweeping health care law, and then Dodd-Frank — came to define his presidency.

Based on press reports, it seems the GOP is about to choose a path that will haunt them for years to come.

. . .

Repeal of the 2010 health care law is a top priority as soon as Donald Trump takes office in January, Vice President-elect Mike Pence said in a Sunday television interview.

“Decisions have been made, that, by the president-elect, that he wants to focus out of the gate on repealing Obamacare and beginning the process of replacing Obamacare with the kind of free-market solutions that he campaigned on,” Pence said on “Fox News Sunday.”

. . .

Congressional Republicans are itching to dismantle Obamacare, but a group of conservatives say the current plan to take down key parts of the law is not quick enough, and is already pushing for alternatives that completely and immediately repeal it entirely.

Republicans in the House and Senate have pointed to a repeal bill that was approved last year through a procedural move called reconciliation as a means to quickly gut the law after Trump assumes office in January. Reconciliation bills require only a simple 51-vote majority as opposed to 60 votes to break a filibuster, which means they’re a way to quickly pass a proposal in the Senate.

. . .

The House Speaker wants Obamacare dead. The House Budget Chairman — a leading candidate for HHS secretary — wants Medicare reform. But all the focus on Republicans’ health strategies is ignoring the biggest elephant in the room: Donald Trump, a president-elect who’s spent more than a year bucking congressional Republicans — and may not share their priorities, two leading conservative thinkers tell POLITICO’s “Pulse Check” podcast.

“For all the times that the president-elect has expressed his desire to repeal and replace Obamacare … [he] campaigned on universal coverage,” said Avik Roy of the Foundation for Research on Equal Opportunity. “That’s a very different set of principles … than you might expect from a generic Republican president-elect.”

. . .

Healthcare is the top issue Americans want Donald Trump to address during his first 100 days in the White House, according to a Reuters/Ipsos poll released on Thursday, an apparent rebuke of outgoing President Barack Obama’s signature reform, Obamacare.

Some 21 percent of Americans want Trump to focus on the healthcare system when he enters the White House on Jan. 20, according to the Nov. 9-14 poll, conducted in the week after the Republican won the U.S. presidential election.

. . .

But it is absolutely possible to craft a health-reform agenda that conforms to Trump’s core policy principles: (1) repealing and replacing Obamacare; (2) near-universal coverage; (3) lower health insurance premiums. As a bonus, these goals can be achieved by a plan that reduces federal spending, cuts taxes, and improves health outcomes for the poor.

Few would have predicted that Donald Trump could be a more successful health reformer than Barack Obama. But if he can get over a few important hurdles, it could very well end up being true.

. . .

House Republicans and Vice President-elect Mike Pence on Thursday agreed on a plan to punt the government funding debate into early next year and begin preparations to repeal Obamacare.

Emerging from their meeting with Pence in the Capitol, House GOP lawmakers unified behind a continuing resolution that would extend government funding, set to expire on Dec. 9, through March.

“I think the main reason was the Trump admin had a desire to have an input on what’s in that spending bill when they take office,” House Appropriations Committee Chairman Hal Rogers (R-Ky.) told reporters after the meeting.

. . .

President-elect Trump has made waves by saying that though he plans to repeal Obamacare, he wants to keep the aspect of it that bans coverage for those with pre-existing conditions. But this is not possible without broader changes to the healthcare system.

The pre-existing condition ban is ultimately one of the primary drivers of the premium hikes we’re seeing within Obamacare. The reason is that with insurers forced to offer coverage to anybody who applies, they incur higher medical costs, and they thus require more signups from younger and healthier people — but those signups aren’t materializing in a large enough volume to offset costs.

. . .