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“What went wrong?” poses an erroneous query about the American Health Care Act. The question is not why it failed, but why anyone thought it might succeed. Irrespective of what one thinks of the bill’s policy particulars—whether the bill represents a positive, coherent governing document and vision for the health care system—this thinking demonstrates that Republicans have to re-learn not just how to govern, but also how to legislate. As a policy matter, Obamacare imposed a more sweeping scope on the nation’s health care system. But the tactics used to “sell” AHCA—“We’re doing this now, and in this way. Get on board, or get out of the way”—were far more brutal, and resulted in a brutal outcome, an outcome easily predicted, but the one its authors did not intend.
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It is premature to assume health care legislation won’t be brought up again this year; there is too much instability in the individual insurance market under the ACA to expect the problem to resolve itself without a significant policy intervention. Republican leaders should look again at the AHCA and correct the flaws that made it difficult to pass in the first place. As a replacement for the individual mandate, the AHCA as written would have imposed a new, one-year 30 percent surcharge on premiums for customers who have experienced more than a two-month break in their insurance enrollment over the previous year. A major flaw is that the surcharge is not adjusted to correspond to the length of the spell without insurance.
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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.