The House GOP yanked its health-care bill on Thursday ahead of a planned vote, and perhaps they’ll reconvene on today or later. The House bill to repeal Obamacare is a realistic compromise that can improve health-care markets, and no one has offered a better policy alternative to the American Health Care Act that could pass the House and Senate. The obstacle to progress has been the 29 or so Members of the House Freedom Caucus, who have the power to deny House Speaker Paul Ryan a majority of 216 with a mere 22-vote margin of error. The Freedom Caucus blocked incremental reform progress after the GOP took Congress under President Obama, and the question is whether they will indulge the same rule-or-ruin tactics now against Mr. Trump.

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The House health-care bill is gaining momentum, and on Monday night the GOP posted amendments meant to add fence-sitters to the coalition. Don’t discount the stakes: The vote scheduled for Thursday is a linchpin moment for this Congress, and a test of whether the GOP can deliver on its commitment to voters.

For seven years and across four elections, Republicans have promised to repeal and replace ObamaCare if entrusted with the Presidency and House and Senate majorities. Now they have the opportunity to dispose of the failing law and begin to stand up a more market-oriented, patient-centered system. The reform isn’t perfect, and no bill ever is, but the reality is that a no vote is a vote for the ObamaCare status quo.

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The Congressional Budget Office’s (CBO) estimate of the American Health Care Act (AHCA) finds it will reduce deficits by $337 billion through 2026 (read our analysis here). But what would it mean for the long term?

While CBO hasn’t yet provided second decade estimates (other than to say the bill would not be deficit-increasing), we estimate – very roughly – that the bill would save $2 trillion over two decades, including $1.6 trillion between 2027 and 2036. Including interest, we estimate 20-year savings of $2.4 trillion. However, the bill also includes several “cliffs” that if addressed could significantly reduce that estimate.

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President Trump has mostly stayed on the sidelines of the messy policy debates regarding health care reform. But amid the war on Capitol Hill among Republican factions, he could seize the opportunity to provide leadership consistent with his campaign message to disrupt existing health policy.

Instead of trying to satisfy the free-market wing of his party, Mr. Trump could push for a solution that delivers on his populist promises by proposing universal catastrophic coverage, ending the specter of medical bankruptcy for many Americans. By providing catastrophic care for all, President Trump could ensure that everyone has an ultimate backstop against medical bankruptcy, while freeing the states to experiment with options for reform. It would also enable the private sector to offer new insurance products to supplement the basic catastrophic care coverage.

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House Republican leaders, racing toward a planned Thursday vote on their proposed health-care overhaul, unveiled changes to the legislation late Monday that they think will win over enough members to secure its passage.

The tweaks addressed numerous GOP concerns about the legislation, ranging from the flexibility it would give states to administer their Medicaid programs to the amount of aid it would offer older Americans to buy insurance. They are the product of two weeks of negotiations that stretched from the Capitol to the White House to President Trump’s Florida resort.

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Almost 30 years after leaving office, Ronald Reagan is widely considered one of America’s greatest leaders and the icon of the conservative movement. As a Republican member of Congress, I often speak at Lincoln-Reagan Day dinners and other events honoring his legacy.

Yet as I watch the debate over our House Republican plan to repeal and replace ObamaCare, I’m struck by a question. Would President Reagan be acceptable to some of today’s conservatives? Does anyone remember that Reagan was a master of advancing his principles by looking for common ground and finding consensus?

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Millions may lose coverage next year if Congress does not repeal Obamacare. That’s not what this week’s Congressional Budget Office (CBO) analysis says, but it is reality. CBO’s estimating models seem impervious to reality.

In the real world, the Obamacare exchanges are in crisis, millions of uninsured people willingly pay or avoid IRS penalties, and consumers struggle with rising premiums and cost-sharing requirements.

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Lawmakers will undoubtedly concern themselves with many policy objectives as they consider modifications to the AHCA. They would be prudent, however, to ensure that anything signed into law repairs some of the fiscal damage done by the ACA. This will require them to be cognizant of real-world fiscal effects that may not be fully captured in Congress’s current scorekeeping methods.  Three factors contribute to confusion about the ACA’s damaging fiscal effects: 1.) Many of the provisions designed to finance its expansion of insurance coverage haven’t borne fruit, 2.) Scorekeeping rules Congress imposes on the Congressional Budget Office require the CBO to compare the effects of legislation to a baseline that differs from actual law in various critical respects, and 3.) Misinterpretation of intermittent CBO reports over the past several years on the evolving cost estimates for the ACA’s coverage expansion.

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The AHCA will suffer its share of criticism and praise as it moves through the legislative process. Secretary Tom Price has stated this is merely round one in the effort of reform. The next two phases will involve broader regulatory patches and targeted legislation. Initially, from a regulatory perspective, the first draft has the potential to eliminate $3.4 billion in costs and create more than 72 million hours of paperwork savings. This could generate tangible benefits to insurers, businesses, and ultimately, patients. Consider a law that imposed $53 billion in costs and 176 million paperwork burden hours. Even a 20 percent to 30 percent cut could create tremendous regulatory cost reductions.

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While the emphasis on moving quickly is not surprising, there is also a significant risk that unnecessary haste could lead to major mistakes in the legislation that would generate strong political backlash. The ACA has extended insurance coverage to millions of people with expensive health problems, and to many lower-income households. Acknowledging this is not the same thing as saying the ACA should not be changed; however, Republicans would be well advised to take the time necessary to ensure that their plan will provide adequate insurance for these populations while remaining consistent with an overall framework of less federal control and regulation and more reliance on market incentives. Moving in this direction would help with public acceptance of the AHCA and improve the chances that what is ultimately passed remains on the books longer than the law it is intended to displace.

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