The GOP’s push to repeal the Affordable Care Act is running out of steam—and time. Unless Republicans can agree by Sept. 30, they won’t be able to pass a bill without 60 Senate votes. So here’s a wild idea: Instead of repealing ObamaCare, make it unconstitutional.

Recall how the Supreme Court split when it upheld ObamaCare in 2012. Four justices thought the law’s individual mandate—the requirement that Americans buy health insurance or pay a penalty—was unconstitutional. Another four thought it was hunky dory. What broke the tie was a novel opinion by Chief Justice John Roberts, who upheld the penalty by declaring it a tax.

With good lawyering, the GOP can take advantage of that premise.

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Kaiser’s tracking poll in July found 53 percent in favor of having all Americans get their health insurance from the government; 43 percent were against that. Opposition climbed to 60 percent when people were asked to consider that such a plan would call for higher taxes for many.

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A true single-payer health care system would mean the discontinuation of employer-sponsored health insurance. Vermont Senator Bernie Sanders’ new single-payer proposal proceeds along these lines, making it unlawful for employers to duplicate the offerings of the new single-payer system once that system is fully phased in. However, a truly single-payer framework is not the only approach policymakers could take.

Dr. Tevi Troy, author of the paper and CEO of the American Health Policy Institute, says, “The federal government would be taking on the responsibility of providing health care to all Americans, a change so drastic with consequences ultimately so uncertain that it seems unlikely to win a majority of votes in Congress, especially considering how politically unfeasible it has proven on a much smaller scale even in very liberal states like Vermont.”

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Anthem announced Friday that it would fill Virginia’s 63 counties that were slated to have no ObamaCare insurers on the exchange next year.

Anthem initially announced it wouldn’t sell plans in Virginia in 2018, but backtracked Friday to cover the so-called bare counties.

“Since learning that 63 counties and cities in Virginia would not have access to Individual health plans, Anthem has been engaged in further evaluation and discussion with regulators to ensure that no bare counties or cities exist in the state,” Anthem said in a statement Friday.

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New Mexico Health Connections, a not-for-profit insurance co-op funded through the Affordable Care Act, is a month overdue in filing its second-quarter financial paperwork. And the co-op’s most recent documents, as well as federal ACA documents, show potentially large financial problems that could force New Mexico to shut the company down.

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Like the Better Care Reconciliation Act, Graham-Cassidy would repeal Obamacare’s individual and employer mandates. Both bills increase annual contributions to health savings accounts. Both bills phase down state-based Medicaid provider taxes that states use to game the federal government into giving them more money than they’re supposed to get. Both bills allow states the ability to frequently cull their Medicaid rolls of ineligible recipients—something they can’t do today.

The bill would institute a per-capita allotment for the legacy Medicaid program that is quite similar to the one in the BCRA. This per-capita approach is essential to ensuring that Medicaid is fiscally sustainable in the future. Both bills allow states to institute work requirements for Medicaid.

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While some progressives campaigned this week for “Medicare for all,” a group of moderate House Democrats aligned themselves with a more modest push to stabilize the ACA, arguing that it could spur broader health care reforms in the future. Thirty-five of the 61 members of the New Democrat Coalition sent a letter Friday urging the leaders of the Senate Health, Education, Labor and Pensions Committee to agree on a bipartisan bill to keep premiums from rising further for Obamacare enrollees next year.

Graham-Cassidy is less ambitious than the Senate’s ObamaCare replacement that failed over the summer, and we could go on at length about its limitations. But the proposal at least takes most decision-making out of Washington and puts a spending cap on Medicaid and ObamaCare. The question for Members is: What is the alternative? The budget procedure that allows the Senate to address the law with a 51-vote majority expires on Sept. 30. ObamaCare’s exchanges will continue to deteriorate, and Democrats will blame Republicans for every premium increase from here to November 2018. The law will require who knows how many patches and bailouts in coming years, and consumers will continue to face higher prices and fewer choices.
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While a slim majority favors the idea of a national health plan at the outset, a prolonged national debate over making such a dramatic change to the U.S. health care system would likely result in the public being exposed to multiple messages for and against such a plan. The poll finds the public’s attitudes on single-payer are quite malleable, and some people could be convinced to change their position after hearing typical pro and con arguments that might come up in a national debate. For example, when those who initially say they favor a single-payer or Medicare-for-all plan are asked how they would feel if they heard that such a plan would give the government too much control over health care, about four in ten (21 percent of the public overall) say they would change their mind and would now oppose the plan, pushing total opposition up to 62 percent. Similarly, when this group is told such a plan would require many Americans to pay more in taxes or that it would eliminate or replace the Affordable Care Act, total opposition increases to 60 percent and 53 percent, respectively.

On Wednesday, Sen. Bernie Sanders introduced a single-payer health care bill that would create a national health insurance program, charting a stem-to-stern reshaping of the country’s health care system. The bill would make it so that Americans would get health coverage simply by showing a new government-issued card and would no longer owe out-of-pocket expenses like deductibles. But Sanders’ description of his measure omitted specifics about how much it would cost and final decisions about how he would pay for it.

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