Although it’s said that victory has hundreds of fathers and defeat is an orphan, the temporarily triumphant Trump White House might need to engage more effective “adoption” counselors. If and when a Senate bill to repeal and replace the ACA passes, it’s highly likely to differ from the House measure and require working out a shaky compromise in conference committee. If Republicans finally succeed in snatching legislative victory from the still-ominous jaws of defeat, then their next challenge of implementing new law and policy for health care could remind them of the “Winner’s Curse” in such endeavors.
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With the House’s passage of the American Health Care Act, House Republican leaders have handed their Senate counterparts the biggest legislative weapon they have held in their entire careers. At this point, Senate Republicans should learn from a bit of wisdom often attributed to one of the wittiest and most clear-eyed Founders, Ben Franklin: “We must, indeed, all hang together,” he supposedly told the Continental Congress in 1776, “or most assuredly we shall all hang separately.” If the 52 GOP senators agree to stay together and maneuver through the next month together, they could bring about a huge breakthrough for the country and a rejection of the gridlock that has consumed the Senate for years.
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In the United States, the difference between being in poverty and out of poverty is a job. The nation’s public assistance programs successfully alleviate suffering among low-income households, but they fail to raise self-sufficiency because they do not connect able-bodied people to work. Going forward, policymakers must incorporate work requirements throughout the safety net, which are proven to enhance programs like TANF and the EITC. Medicaid is an ideal candidate for work requirements, as it would encourage over 1 million people to find work without greatly disrupting the program itself.
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Years of promising to repeal and replace the Affordable Care Act took a major step last week with the House passing the American Health Care Act. The years of rancorous debate leading to this vote have highlighted the profound divisions in our political system. But, it has also obscured the encouraging reality that most Democrats and Republicans actually share a common goal – the creation of a high quality, high-performance, high-value health care system. We cannot continue to spend more than $3 trillion a year on health care, yet lag behind much of the developed world in overall health outcomes.
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The following are some of the most important changes the Senate GOP should make to the House bill:
Strike a Medicaid Compromise.
Provide More Generous Subsidization of Lower-Income Households.
Fix the AHCA’s Premium Surcharge.
Limit the Tax Preference for Employer-Paid Premiums.
Provide More Flexible Use of HSAs.
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Almost every promise made eight years ago about ObamaCare turned out to be a falsehood. You couldn’t keep your insurance plan, doctor or provider in many cases. It didn’t save $2,500 per family (more like $2,500 more). It didn’t lead to expanded patient choice. And the tax increases badly hurt the economy and jobs market, and the insurance markets really have entered a death spiral that if left unfixed will blow-up the entire insurance market.
The fundamental lie of ObamaCare is revealed in the law’s very title: The Affordable Care Act.
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Our ongoing troubles with health care stem from an unwillingness to deal with certain facts. One of those facts is scarcity. “Scarcity” is a term from economics, and it refers to the fact that there is never enough of anything to satisfy every possible desire — the universe holds only so much, and human desire has a way of outgrowing whatever we have. So we have to come up with a way of dividing up that which is scarce. We have tried many different ways of doing that — war, caste systems, central planning — though mostly we’ve relied on the fact that everybody wants lots of different things, which makes it possible to trade. But buying and selling stuff is not, to be sure, the only way to divide up that which is scarce.
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We pride ourselves on being a compassionate society, and insurance companies use this to manipulate us into sharing the costs of other people’s excessive health care. Meanwhile, 5 percent of Americans generate more than 50 percent of health care expenses. Why shouldn’t a patient who continues to see me unnecessarily pay more?
The government’s job is to maintain public health and safety. It should ensure that insurance plans include mandatory benefits like emergency, epidemic, vaccine and addiction coverage. The Republican bill would let states apply for waivers to define these benefits differently; it would be a big mistake to drop such coverage entirely.
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When you’re facing years of doctor’s appointments, you want to know that having a preexisting condition, such as an extra 21st chromosome or a heart defect, won’t prevent you or your loved ones from accessing the care you need. And despite what people are saying, House Republicans aren’t seeking to strip these protections—or anyone’s protections—away. Our effort to create a better health-care future for all Americans isn’t finished. Whether it’s allowing insurance to be purchased across state lines or implementing other insurance reforms, we will continue our work until every American has access to good-quality, affordable health care and our most vulnerable communities have peace of mind.
AHCA contains many important reforms, but it risks throwing millions of low-income Americans off of their health insurance plans. Senate Republicans can fix this—but only if they prioritize sound health care policy over short-term messaging. Improvements to the health care system need to do four things: (1) establish a functioning individual health insurance market by replacing Obamacare’s exchanges; (2) gradually raise Medicare’s eligibility age for future retirees so that more people in their sixties would buy individual coverage that is subsidized where needed; (3) gradually migrate certain populations out of Medicaid and into the individual market; (4) address the grab-bag of other health-reform problems like medical malpractice, hospital consolidation, drug pricing, and veterans’ health care.
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