The struggles faced by Presidents Obama and Trump since the passage of the Affordable Care Act have created the impression that it’s impossible to successfully reform American health care. On the non-group market, premiums have soared, networks have narrowed, individuals have refused to enroll, and insurers have fled the marketplace. But despite the dysfunction of the market that was the primary focus of the ACA’s reforms, employer-provided coverage and the Medicare program have never been in better shape. Under those arrangements, which cover the majority of Americans, spending growth has abated, quality of care is improving, and premiums are rising at the slowest rate in recent memory. President Obama tried to claim credit for these trends, but they actually date to 2003, when President Bush pushed his own signature legislative achievement, the Medicare Modernization Act, through Congress.

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The Trump administration has made critical ObamaCare payments to insurers for the month of June but won’t provide any certainty about whether they’ll continue in the future.

The payments, known as cost sharing reduction subsidies, reimburse insurers for providing discounts to low-income patients.

Insurers have been threatening to raise premiums — or leave the ObamaCare markets — if they don’t receive certainty about the payments from Congress or the White House.

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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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Much of the public discussion about health care and health insurance reform abounds with misinformation. Medicaid, in particular, has become a political tool, with daily posts and articles about reforms to the program that distort the record for political gain. But there is little mention of the need to empower governors to take ownership of the program.

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The government’s price tag for a single-payer health care system would be astonishing. When Sen. Bernie Sanders (I-VT) proposed a “Medicare for all” health plan in his presidential campaign, the nonpartisan Urban Institute figured that it would raise government spending by $32 trillion over 10 years, requiring a tax increase so huge that even the democratic socialist Mr. Sanders did not propose anything close to it.

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As the Republican Congress struggles to “repeal and replace” Obamacare, the political landscape is steadily shifting.

Since the Democratic Congress enacted Obamacare in 2010 (without a single Republican vote), Democrats have increasingly been on the defensive about their creation. The individual mandate that Obamacare relied upon to corral healthy young people into insurance pools has failed to do the job – partly because the tax penalty was not severe enough, and partly because the Obama administration felt compelled to create 14 different types of “hardship exemptions” that exempted millions of young people from the penalty.

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Recall that under Democratic Governor Peter Shumlin Vermont committed to a single-payer for the state but had to abandon the effort in 2015. Why? The cost was staggering — $4.3 billion when Vermont’s entire fiscal 2015 budget, including both state and federal funds, was about $4.9 billion. That’s right: essentially doubling the size of the government.
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While Senate Republicans are drafting their healthcare plan behind closed doors, they’ve given reporters a general idea of what might be in it.

  1. It will slow down the phase-out of the Medicaid expansion
  2. Tax credits will be beefed up
  3. It will keep some ObamaCare taxes
  4. It will include more funding to combat the opioid crisis
  5. It will try to stabilize the ObamaCare exchanges
  6. It will include more funding to handle preexisting conditions

 

Rep. Greg Walden of Oregon, who helped shepherd the party’s health-care overhaul bill through the House last month, sat down with Louise Radnofsky, The Wall Street Journal’s White House reporter, to offer his take on where the repeal and replace effort stands.

“The House has passed the American Health Care Act to try to do reforms, to get cost control on the Medicaid system, give states more flexibility to design plans that will work for them and move people into an insurance product they can afford. We know there’s more work to be done. We believe we gave the Senate some nice headroom and some dollars set aside in there to make other changes. So they’ve got some flexibility. We’ll see where this leads. But I think we’ll get a bill to the president’s desk before August.”

The chief obstacle to repealing and replacing Obamacare may no longer be congressional Democrats. It could be the GOP itself.

Senate Majority Leader Mitch McConnell has promised to hold a vote on the party’s repeal-and-replace plan by the end of June. But as he’s tacked his plan to the center as part of a bid to hold onto moderate Republicans, he’s raised the ire of conservatives who are pressing for a plan that more fully repeals Obamacare.

Senate Republicans must iron out their differences — and not let fear of the unknown derail their seven-year-long plan to repeal Obamacare. The law is collapsing. The GOP may not have made this mess, but the American people are counting on them to clean it up.

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