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The Trump administration, working with governors and state legislatures, could make dramatic state by state changes to Medicaid and the ACA marketplaces using two types of state innovation waivers. Section 1332 of the ACA, which went into effect on Jan. 1, 2017, lets states waive several key provisions of the ACA, including the individual mandate, the employer mandate, the premium tax credit, cost-sharing subsidies, and essential health benefits for ACA marketplace plans. In short, Section 1332 (ACA) waivers let states operate their health care systems as if major parts of the ACA do not exist. Additionally, Section 1115 (Medicaid) waivers give states the opportunity to waive federal Medicaid law. The changes made possible by Section 1115 waivers aren’t as dramatic as those contained in the AHCA—for example, states can’t use these waivers to fully restructure Medicaid under block grants or per capita caps, nor can the federal government use them to take away federal reimbursements for Medicaid expansion—but they are still significant.
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House Speaker Paul D. Ryan told Republican donors Monday that he intends to continue pushing for an overhaul of the nation’s health-care system by working “on two tracks” as he also pursues other elements of President Trump’s agenda. “We are going to keep getting at this thing,” Ryan said three days after intraparty opposition forced him to pull the American Health Care Act after it became clear it did not have enough Republican votes to pass.
President Donald Trump blamed Democrats for the defeat of his bid to overturn the 2010 Affordable Care Act and enact Republican policy in its place. In some ways he may have been right.
Supporters of the health law popularly known as Obamacare launched an all-out campaign for its survival, keeping Democrats unified in opposition to its repeal, and identifying and exploiting Republican divisions that ultimately forced GOP leaders to pull the bill at the eleventh hour Friday.
In every corner were top officials from former President Barack Obama’s administration, reeling from an election that put their party out of government and left them with plenty of free time on their hands.
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With the collapse of Republicans’ health plan in the House on Friday, the Trump administration is set to ramp up its efforts to alter the Affordable Care Act in one of the few ways it has left—by making changes to the law through waivers and rule changes.
The initiative now rests with Health and Human Services Secretary Tom Price, who has vowed to review every page of regulation and guidance related to the ACA. The steps he and the administration take next could have sweeping repercussions, accomplishing some of the same types of changes Republicans were unable to push through Congress.
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Last night Phil Klein had a report that is much more significant than I think a lot of people have realized:
Sen. Mike Lee, R-Utah, said on Wednesday that the Senate parliamentarian has told him that it may be possible for Republicans to push harder on repealing Obamacare’s regulations than the current House bill, which contradicts the assertion by House leadership that the legislation goes after Obamacare as aggressively as possible under Senate rules. . . . Lee also said that the parliamentarian told him it wasn’t until very recently, after the unveiling of the House bill, that any Republican even asked her about the possibility of repealing regulations with a simple majority.
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Business groups were hoping a quick repeal of the Affordable Care Act would give employers more flexibility on health care and create momentum for priorities like a tax overhaul.
Friday’s decision by House GOP leaders and President Donald Trump to abandon a vote on the Republican health plan left them less certain on both fronts.
“This is a dismal failure,” said Juanita Duggan, chief executive of the National Federation of Independent Business, a group representing small businesses. “NFIB is officially unamused, and we’re not going to let them off the hook.”
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Speaker Paul Ryan and House leaders had been toiling behind closed doors for weeks assembling their Obamacare repeal bill as suspicion on the far-right simmered to a boil.
So on March 7, just hours after Ryan unveiled a plan that confirmed its worst fears, the House Freedom Caucus rushed to devise a counterstrategy.
In a conference room in the Rayburn House Office Building, the group met that evening and made a secret pact. No member would commit his vote before consulting with the entire group — not even if Trump himself called to ask for an on-the-spot commitment.
Twenty-eight of the group’s roughly three dozen members took the plunge.
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What politicians, those hardy folk, don’t understand about health care is how anxious it makes their constituents. Not suspicious, not obstinate, but anxious. Because unlike such policy questions as tax reform, health care can be an immediate life-or-death issue for you. It has to do with whether, when, and where you can get the chemo if you’re sick, and how long they’ll let you stay in the hospital when you have nobody, or nobody reliable and nearby, to care for you. To make it worse, the issue is all hopelessly complicated and complex and pits you as an individual against huge institutions—the insurance company that doesn’t answer the phone, the hospital that says “I’m afraid that’s not covered”—and you have to make the right decisions.
House Republicans pulled their health-care bill shortly before a vote on Friday, and for once the media dirge is right about a GOP defeat. This is a major blow to the Trump Presidency, the GOP majority in Congress, and especially to the cause of reforming and limiting government.
The damage is all the more acute because it was self-inflicted. President Trump was right to say on Friday that Democrats provided no help, but Democrats were never going to vote to repeal President Obama’s most important legislation. And that’s no excuse. Republicans have campaigned for more than seven years on repealing and replacing ObamaCare, and they finally have a President ready to sign it. In the clutch they choked.
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Despite days of intense negotiations and last-minute concessions to win over wavering GOP conservatives and moderates, House Republican leaders Friday failed to secure enough support to pass their plan to repeal and replace the Affordable Care Act.
House Speaker Paul Ryan pulled the bill from consideration after he rushed to the White House to tell President Donald Trump that there weren’t the 216 votes necessary for passage.
“We came really close today, but we came up short,” he told reporters at a hastily called news conference.
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