Health care has been central to U.S. political debate for nearly a decade as Democrats created a new entitlement with little public support.

Compared to that effort, the Senate this time has been a model of deliberative democracy. On Dec. 19, 2009, a Saturday, then Majority Leader Harry Reid tossed the 2,100-page bill the Senate had spent that fall debating and offered a new bill drafted in an invitation-only back room. Democrats didn’t even pretend to care what was in it while passing it in the dead of night on Dec. 24, amid a snowstorm, in the first Christmas Eve vote since 1895.

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Obamacare provides states with a greater incentive to expand Medicaid to able-bodied adults than to cover services for individuals with disabilities. States receive a 95 percent match this year (declining to 90 percent in 2020 and all future years) to cover the able-bodied, but a match ranging from 50-75 percentto cover individuals with disabilities, while more than half a million are on waiting lists to receive home or attendant care.

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Section 1332 of the ACA permits states to submit simultaneous and combined “superwaivers” for Medicaid and for provisions of the ACA itself. These superwaivers could make it easier for states proposing plausible ways to allow states that serve Medicaid beneficiaries more efficiently to reprogram federal and state savings into health programs for non-Medicaid eligible households. For households with working, nondisabled adults, it should also be made easier for states to pool their federal and state funds for Medicaid, the Children’s Health Insurance Program (CHIP), the ACA, and other programs to deliver coverage through private plans in the ACA exchanges. It is also time to allow states more flexibility in using Medicaid and other health care funds to invest in the social determinants of health—items such as adequate housing, school-based social services, improved lifestyles, and safer household environments, which can contribute to improved health and reduced medical costs.

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To estimate the impact of the AHCA, the CBO had to compare it to predictions of coverage under the current law, the ACA. If the prediction for the current law is incorrect the prediction of lost coverage will be too.Yet the CBO has consistently overestimated future ACA coverage gains. In 2012 it predicted an additional 28 million would gain health insurance by 2017. The actual figure is 20 million. It forecast 25 million would gain coverage on the ACA exchanges and 10 million would gain Medicaid coverage. Less than half as many actually enrolled on the exchanges and not all of them gained coverage – many were replacing non-exchange policies they lost after ACA passage. Conversely, about 14 million – 40 percent higher than predicted – newly enrolled in Medicaid. The CBO prediction that 5 million would lose employer coverage was also wrong – employer provided coverage was stable.

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The House-passed Obamacare repeal bill would leave 12.6 million more Americans uninsured over the next decade and reduce federal spending by $328 billion, according to an analysis released today by CMS’ Office of the Actuary.

The coverage estimate is well below the 23 million more uninsured that the CBO has projected under the American Health Care Act. The congressional scorekeeper additionally estimated that the American Health Care Act would reduce spending by only $119 billion over a decade.

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Senate Republicans raced Tuesday to bridge divisions over rickety insurance markets and billions of dollars in insurance subsidies in their pursuit of a health-care deal.

While President Donald Trump predicted a deal would emerge, hard work remained behind the scenes.

Much of this week’s negotiations have focused on specific measures to help shore up the individual insurance market, including billions of dollars in funding to smooth the transition to a new plan if they succeed in knocking down much of the 2010 Affordable Care Act, according to Republican aides.

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Reforming Medicaid does not have to be an all-or-nothing approach, where millions of people are thrown off of the program to reduce the budget. The states, which administer Medicaid, are closest to the problem and also are in the best position to develop solutions for Medicaid. With leeway to innovate and the pressure to achieve savings, the circumstances are ideal for change.

Since the program’s inception, the federal government has had regulations in place that mandate certain services be provided and that also set rules around eligibility. Those states seeking to innovate have had to secure a waiver from those rules.

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The House passed legislation Tuesday to ensure that immigrants in the country illegally can’t access tax credits for health insurance premiums.

Rep. Lou Barletta’s (R-Pa.) bill, approved in a largely party-line vote of 238-184, would require the Treasury Department to confirm that people applying for the tax credits are verified as U.S. citizens or legal residents by the Commissioner of Social Security or the Secretary of Homeland Security.

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Senate Republicans said Tuesday that President Donald Trump was open to their suggestions about how to stabilize the Obamacare exchanges, but did not give any clear policy updates, leaving insurers hanging.

Health and Human Services Secretary Tom Price also highlighted the individual and small group markets as one of the “toughest challenges” for his employees, without providing specific steps that HHS would take. The focus on stabilizing the Affordable Care Act’s individual marketplace comes even as Senate Republicans are struggling to reach consensus on a bill that would overhaul major parts of the ACA.

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From the earliest days of Obamacare, a great many Democrats and others on the left have wanted a “public option.” At least one plan offered in the Obamacare exchanges should be a government plan, they proclaimed. The state of Nevada may make that wish a reality, if the governor signs a bill just passed by the legislature – allowing everyone who resides there to buy into the state’s Medicaid program.

Why does the left like this idea? Because they are ideologically committed to the propositions that when it comes to health care (1) non-profit is always better than for-profit and (2) public is always better than private.

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