Democrats loudly complain that people will lose health insurance if the Affordable Care Act is repealed. They never mention those who lose jobs because the ACA remains.

The ACA includes a penalty on employers that fail to provide “adequate” insurance for full-time workers. Thanks to the ACA, hiring the 50th full-time employee effectively costs another $70,000 a year on top of the normal salary and benefits.

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The new Senate bill  1) Reduces the number of people eligible for subsidies, reduces the values of the premium subsidies, and lowers the cap on total subsidy expenditure;  2) Eliminates the individual and employer mandates;  3) Restricts coverage for abortion;  3) Ends the cost-sharing reductions — but not before paying insurers back for the money they’ve already laid out;  4) Gives states a great deal more flexibility in the waiver program;  5) Gets rid of a lot of Obamacare taxes;  6) Provides market stabilization funds;  7) Winds down the Medicaid expansion funding, but not as fast as the House bill; and  8) Converts Medicaid to a per-capita allotment rather than an open-ended entitlement.

The health care industry killed Hillarycare in the 1990s and cut deals to shape Obamacare more to its liking in 2009. But now, as Republicans push a sweeping and widely reviled health bill through Congress, the industry has often appeared declawed in the biggest health care fight of the decade.

It’s a deliberate strategy, interviews with nearly 20 lobbyists and other experts suggest. Health industry groups generally don’t love Obamacare enough to jeopardize their ability to shape the rest of the Republican agenda — including big corporate tax cuts. They also fear incurring White House retaliation.

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According to Robert Wood Johnson Foundation data that looks at state markets where all insurers must sell plans that meet Obamacare standards, regardless of how they’re purchased, more than half of the 22 million people who buy their own insurance use Obamacare marketplaces, where most of them get a federal tax credit to help pay for coverage. The rest buy directly from an insurer or broker, and they do not get a tax credit. Supporters of the Affordable Care Act hoped the law would spur more competition among insurers across the country. But so far, the law has not delivered on that promise, especially in states that never had much competition. Even before Obamacare, there have always been two distinct markets: states that still have plenty of competition and states that rely heavily on one or two insurers. In 15 states, eight or more insurers offer Obamacare plans. They are mostly the same ones where no single insurer had a dominant share of the market in 2013, before the law was enacted. But the 19 states that currently have fewer than five carriers statewide are all ones where a single insurer had more than half of the overall market before Obamacare.

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A new Lancet study adds to the growing mountain of evidence that market-oriented health care systems outperform the single-payer systems that have captivated the imagination of progressives for more than a century. Yet despite their claims of believing in evidence-based policy, far too many progressives persist in disparage efforts by Republicans to move the U.S. health system in a more market-oriented direction even while working feverishly on a misguided quest to put California on the path to single-payer health care.

The Lancet study focuses on the extent to which countries are able to avert “amenable mortality.” “Amenable mortality” refers to “unnecessary, untimely deaths,” i.e., deaths that hypothetically would not occur with timely and effective medical care. The idea is that it makes no sense to fault a country’s health system for deaths that never could have been averted even if the system was organized to be as efficient and effective as possible. Market-driven systems have shown to be superior at averting avoidable deaths.

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Senate Republicans reworking Obamacare are considering taxing employer-sponsored health insurance plans, a move that would meet stiff resistance but which would help make the tax preferences for health insurance more equal. The move could raise billions in revenue that could be used to help stabilize the fragile individual insurance market. But it could be politically risky, since it could expand the impact of GOP health proposals from Medicaid recipients and those who buy insurance on their own to the roughly 177 million people who get coverage through their employers.

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Congress can and should still move forward with important health care reforms to ease the burden on millions of American businesses and workers. The National Restaurant Association and the one million foodservice locations they represent have urged elected officials to make a few basic changes to relieve the burdens on businesses that are stifling growth and impacting their ability to hire new employees. Regardless of the Republican bill’s passage, legislative and regulatory constraints imposed by the ACA continue to negatively impact restaurants.
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The Trump administration plans to let small businesses bypass the Affordable Care Act’s online marketplace to get health insurance for their employees.

Obamacare was meant to offer better insurance options for small businesses through the Small Business Health Options Program while rewarding companies with tax credits for offering insurance to their employees. But enrollment in SHOP plans fell drastically below expectations. Just 230,000 Americans were insured in the plans as of January, less than one-tenth of the Congressional Budget Office’s estimate of 4 million covered by this year.

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Health care has become an ongoing source of pain for many small-business owners. It was the top issue owners wanted Trump to address in a survey of 700 owners and prospective buyers in late February by BizBuy Sell, a marketplace for small businesses.

Among respondents, 60 percent favored an ACA repeal. The major reason: spiraling health insurance premiums — often a result of insurance companies fleeing the marketplace.

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One of the more interesting television commercials I see is an ad sponsored by Cancer Treatment Centers of America. The message: if you have cancer, we want you.

Welcome to a small glimpse of how the market for health care might be different.

If we had a genuinely free market for health care, ads like this would not be rare and unusual. There would be centers of excellence for heart disease and diabetes and dozens of other afflictions. Through television, radio, the Internet and other means, these centers would be seeking out people with problems and offering to solve them – just like in other markets.

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