President Donald Trump said Monday the Republican health-care bill being negotiated in Congress ultimately will protect Americans with pre-existing conditions as well as Obamacare does.

“I want it to be good for sick people. It’s not in its final form right now,” he said during an Oval Office interview Monday with Bloomberg News. “It will be every bit as good on pre-existing conditions as Obamacare.”

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There’s no way around a simple truth: treating an expensive health condition costs (someone) lots of money.  There are four basic approaches that can be taken to this problem:  1) Leave sick people to face the costs of their own treatment, whether out of pocket or through high-cost insurance, no matter how ruinous those costs become;  2) Mandate that other, healthier people overpay for the value of their own health insurance, so that sick people can underpay for the value of theirs;  3) Spread the costs of paying expensive health bills throughout society, for example by having taxpayers pick up the tab; and  4) Require a targeted group to shoulder the costs.  [The AHCA opts for 3).]
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Health insurers and small businesses are pushing their long-sought goal of abolishing Obamacare’s health insurance tax as lawmakers work to repeal and replace the healthcare law.

The tax is a priority for insurers even as negotiations have centered on the Obamacare repeal bill and federal insurance payments.

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House Republicans still hope to vote on their health care overhaul next week, though lawmakers said Friday they may need further changes to scrape together enough votes to pass it.

Rep. Tom MacArthur of New Jersey, who authored an amendment that won the support of hardline conservatives earlier in the week, acknowledged Friday that Republicans are discussing changes to his language. He declined to specify what those changes might include. “I’m open to any good idea that gets us across the line,” he said.

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Some lawmakers are also discussing changes to the bill to help bring moderates on board. How to balance the demands of the two groups is a difficult task, and no one has found the right formula yet.

Rep. Charlie Dent (R-Pa.), co-chairman of the moderate Tuesday Group, said “it’d be hard” to design a bill that both he and the Freedom Caucus could support. Dent also offered stark criticisms of the latest bill, which he saw as an “exercise in blame-shifting” to make centrists appear responsible for the failure to Trump instead of conservatives.

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A renewed effort to bring a House Republican plan to the floor faltered by week’s end, a blow to President Donald Trump’s hopes of landing a health-care deal in his first 100 days. Republicans are vowing to push ahead with the bill, saying it has stalled but not died.

But the herculean struggle to craft a politically viable proposal reflects the party’s sharp divisions and rising support for the ACA. Conservative Republicans want to gut most of the existing law, citing rising premiums and limited choice. Moderate Republicans remain reluctant to support a new plan that erases the ACA’s expanded coverage and patient protections.

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The three latest theatrical gambits to fan the smoldering embers of the previously-abandoned AHCA include: 1. The cost-sharing subsidy payment termination bluff, 2. Grasping for the thinly-funded straw of “invisible” risk pools to promise individual insurance market premium reductions and protection of coverage for persons with pre-existing health conditions, and 3. The Freedom Caucus “lions” are preparing to lie down with the Tuesday Club “lambs” in a new compromise that revives an amended version of the AHCA.

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House GOP leaders determined Thursday night that they didn’t have the votes to pass a rewrite of the Affordable Care Act and would not seek to put their proposal on the floor on Friday.

A late push to act on health care had threatened the bipartisan deal to keep the government open for one week while lawmakers crafted a longer-term spending deal. Now, members are likely to approve the short-term spending bill when it comes to the floor and keep the government open past midnight on Friday.

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Congressional Republicans have called for restructuring Medicaid, reviving a debate that has largely remained dormant for two decades. During the mid-1990s, Congress and President Clinton advanced competing Medicaid reform proposals. Republicans urged that the federal government issue Medicaid block grants to states. The White House and congressional Democrats proposed instead to place per capita limits on federal Medicaid payments to states. The most salient difference between these approaches is that per capita allotments retain the individual entitlement to Medicaid while block grants generally do not. Today, Republicans who once resisted Medicaid per capita allotments support them, and Democrats who backed such allotments oppose them. Given this legislative history, policymakers seeking common ground might look to Medicaid per capita allotments as a point of departure.

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The conventional approach to health insurance keeps consumers in the dark about how their health care dollars are spent. Patients pay premiums every month and rely on insurers to cover their medical expenses, no matter how small or routine. Consequently, patients have little incentive to be cost-conscious. The more care they consume, the more value they capture for their premium dollar. Health Savings Accounts inject much-needed competitive forces into the health care marketplace. Expanding access to HSAs should be a centerpiece of any congressional effort to expand access to quality, affordable health care.

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