Emboldened by election wins, Democrats are starting to see a political edge in health care, particularly widening Medicaid access for more low-income people.

In Virginia, Democrat Ralph Northam promised a vigorous push as governor to expand Medicaid. Voters who said health care was important went decisively for Northam, according to political analysts. In Maine, voters defied Republican Gov. Paul LePage’s determined opposition by passing a referendum to expand Medicaid to cover an estimated 70,000 more residents.

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Californians better get comfortable. The wait time to see a doctor in the Golden State may be about to skyrocket.

Last week, California Assembly Speaker Anthony Rendon and a select committee of representatives held two days of hearings in Sacramento on Senate Bill 562 — the Healthy California Act — which promises to enroll all Californians in a government-run, single-payer healthcare system.

The controversial bill passed the state Senate on June 1. But Speaker Rendon “parked” it because he said it did not give enough details on cost and coverage. The California Nurses Association is pushing hard for the Assembly to pass the bill early next year. It is unclear whether Governor Brown would sign it.

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It is generally assumed that the biggest obstacle to a national health plan like Medicare for All will be the large tax increase needed to pay for it. But new polling shows another challenge: Almost half of the American people don’t know that they would have to change their current health insurance arrangements if there was a single-payer plan.

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The Affordable Care Act is failing. Focused on shrinking the uninsured population, the law expanded government insurance programs and imposed considerable federal authority over U.S. health care via new mandates, regulations, and taxes. The harmful impacts of this ill-conceived approach should now be clear: Insurance premiums have skyrocketed even as deductibles rose; consumer choice on the state insurance marketplace has rapidly vanished; and for those with ACA coverage, doctor and hospital choices have narrowed dramatically. Meanwhile, consolidation across the health care sector has accelerated at a record pace, portending further harm to consumers, including higher costs in medical care.

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Suggestions to improve the bipartisan health care bill from Sens. Lamar Alexander (R-TN) and Patty Murray (D-WA) include: 1) Increase the threshold for requiring employers to offer health benefits to 200 full-time employees from the current 50; 2) Broaden the use of tax-advantaged accounts; 3) Add a provision creating a federal reinsurance fund to help finance care for America’s most expensive patients; 4) Loosen the existing rules to encourage growth of interstate sales of health-care policies; 5) Repeal the Independent Payment Advisory Board, a panel of appointed officials that is supposed to constrain the growth of Medicare costs.

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The Alexander-Murray compromise is a good first attempt at bipartisanship, but it is flawed. Democrats want to fund the cost-sharing reduction subsidies through 2019. If this plan is agreed to, Democrats will have no incentive to continue negotiating until after the 2018 midterms and the GOP would lose its opportunity to make more progress on health care.
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In the Wall Street Journal, Sens. Lamar Alexander (R-TN) and Mike Rounds (R-SD) write that their bipartisan bill is the short-term solution to reduce health-insurance premiums and avoid chaos in the individual market so 18 million Americans won’t be hurt. After eight years of ObamaCare speeches and votes but zero legislative victories, they argue that their bill actually could make conservative ideas law. It would permanently roll back some restrictions on states and allow anyone to buy a lower-cost catastrophic plan. To achieve these conservative victories, cost-sharing reduction payments should be expanded for two more years.
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Republicans should focus on revisions and improvements to the state-innovation-waiver provision in the A.C.A. As part of that provision, Section 1332 allows states to receive federal financial support in a lump sum and to waive or revise many of Obamacare’s most noteworthy provisions, including its mandates, the structure and administration of subsidies provided by it, and covered benefits. In return for this flexibility, states must certify that the changes will still result in coverage that is as comprehensive, affordable and widespread as that provided for under the law.

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Finally, a Republican has gotten a boost from the CBO. A bipartisan Senate plan to try to stabilize Affordable Care Act marketplaces would lower the federal deficit by nearly $3.8 billion during the next decade and would not affect the number of people with health insurance, Congress’s official budget scorekeepers said Wednesday. This bill does what the CBO predicted Congress would eventually need to do so the costs were built in to existing budget estimates.
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A bipartisan Senate proposal to stabilize health insurance markets and continue paying subsidies to insurance companies would produce a modest reduction in federal budget deficits but would not substantially change the number of people with coverage, the Congressional Budget Office said on Wednesday.
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