Years of promising to repeal and replace the Affordable Care Act took a major step last week with the House passing the American Health Care Act. The years of rancorous debate leading to this vote have highlighted the profound divisions in our political system. But, it has also obscured the encouraging reality that most Democrats and Republicans actually share a common goal – the creation of a high quality, high-performance, high-value health care system. We cannot continue to spend more than $3 trillion a year on health care, yet lag behind much of the developed world in overall health outcomes.

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The following are some of the most important changes the Senate GOP should make to the House bill:

Strike a Medicaid Compromise.

Provide More Generous Subsidization of Lower-Income Households.

Fix the AHCA’s Premium Surcharge.

Embrace Auto-Enrollment.

Limit the Tax Preference for Employer-Paid Premiums.

Provide More Flexible Use of HSAs.

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Almost every promise made eight years ago about ObamaCare turned out to be a falsehood. You couldn’t keep your insurance plan, doctor or provider in many cases. It didn’t save $2,500 per family (more like $2,500 more). It didn’t lead to expanded patient choice. And the tax increases badly hurt the economy and jobs market, and the insurance markets really have entered a death spiral that if left unfixed will blow-up the entire insurance market.

The fundamental lie of ObamaCare is revealed in the law’s very title: The Affordable Care Act.

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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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Our ongoing troubles with health care stem from an unwillingness to deal with certain facts. One of those facts is scarcity. “Scarcity” is a term from economics, and it refers to the fact that there is never enough of anything to satisfy every possible desire — the universe holds only so much, and human desire has a way of outgrowing whatever we have. So we have to come up with a way of dividing up that which is scarce. We have tried many different ways of doing that — war, caste systems, central planning — though mostly we’ve relied on the fact that everybody wants lots of different things, which makes it possible to trade. But buying and selling stuff is not, to be sure, the only way to divide up that which is scarce.

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We pride ourselves on being a compassionate society, and insurance companies use this to manipulate us into sharing the costs of other people’s excessive health care. Meanwhile, 5 percent of Americans generate more than 50 percent of health care expenses. Why shouldn’t a patient who continues to see me unnecessarily pay more?

The government’s job is to maintain public health and safety. It should ensure that insurance plans include mandatory benefits like emergency, epidemic, vaccine and addiction coverage. The Republican bill would let states apply for waivers to define these benefits differently; it would be a big mistake to drop such coverage entirely.

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Two years ago, I was a 7-month-pregnant widow with one toddler who got a letter two weeks after my husband died informing me I’d lost my third or fourth health insurance plan since the ACA passed. If you’ll remember, the promise was that I could keep my plan if I liked it. I could not. While the ACA has helped millions of people, there are many of us—many with far fewer resources than I—who now have much more expensive, less effective, junkier, nearly unusable plans than we had back when our allegedly “junk” plans were outlawed. Again, we are not the only ACA story. But we are part of the story, we were sold a bill of goods, and we’re often overlooked.

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Aetna Inc. is quitting Virginia’s Obamacare market for 2018, the second state that Chief Executive Officer Mark Bertolini is exiting as he seeks to limit his insurer’s risks from the beleaguered health law.

“We will not offer on- or off-exchange individual plans in Virginia,” Aetna said in an emailed statement, citing $200 million or more in losses the company anticipates this year on individual products. The insurer also cited “growing uncertainty in the marketplace” for the plans.

UnitedHealth Group Inc., which has largely stopped selling ACA health plans, said last month it was pulling out of Virginia. Also in April, Aetna said it wouldn’t sell Obamacare plans on Iowa’s market next year.

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When you’re facing years of doctor’s appointments, you want to know that having a preexisting condition, such as an extra 21st chromosome or a heart defect, won’t prevent you or your loved ones from accessing the care you need. And despite what people are saying, House Republicans aren’t seeking to strip these protections—or anyone’s protections—away. Our effort to create a better health-care future for all Americans isn’t finished. Whether it’s allowing insurance to be purchased across state lines or implementing other insurance reforms, we will continue our work until every American has access to good-quality, affordable health care and our most vulnerable communities have peace of mind.

AHCA contains many important reforms, but it risks throwing millions of low-income Americans off of their health insurance plans. Senate Republicans can fix this—but only if they prioritize sound health care policy over short-term messaging. Improvements to the health care system need to do four things: (1) establish a functioning individual health insurance market by replacing Obamacare’s exchanges; (2) gradually raise Medicare’s eligibility age for future retirees so that more people in their sixties would buy individual coverage that is subsidized where needed; (3) gradually migrate certain populations out of Medicaid and into the individual market; (4) address the grab-bag of other health-reform problems like medical malpractice, hospital consolidation, drug pricing, and veterans’ health care.

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