Last Wednesday, Vice President-elect Mike Pence told House Republicans that President-elect Donald Trump is ready to sign executive orders when he takes office that would enable an orderly transition away from ObamaCare, even as Congress begins to debate alternatives and replacements.

Both Affordable Care Act (ACA) opponents and supporters tended to exaggerate how much immediate harm Trump would do to the outgoing Obama administration’s legacy healthcare program.

The new president certainly “could” swing a wrecking ball against what remains of the troubled effort to expand insurance coverage under tighter federal government control and substantial taxpayer subsidies. His toolkit of potential executive branch actions is large and varied, but it is not unlimited. The more important questions involve how Trump wants to utilize those powers, and for what objectives.

With patience and care, Trump could initiate new formal rulemaking to partially revise or reverse older, existing regulations, and to create new ones.

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Brandishing a new slogan, “Make America Sick Again” adapted from President-elect Donald Trump’s campaign, Democrats are holding rallies in Ohio, Pennsylvania, and West Virginia, featuring the stories of thousands of the red-state Americans who have benefited from Obamacare. Those rallies will culminate in several nationwide events beginning Jan. 15 where they will warn of the chaos to ensue if the health law is repealed without a replacement plan. They’re also urging followers to bombard lawmakers’ district offices and phone lines with calls against repeal.

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Grace-Marie Turner joined Ashley Webster on Fox Business to talk about replacing the failed Affordable Care Act. Turner pushed back that Republicans have no replacement plans of their own, emphasizing that HHS designate Tom Price has been introducing replace legislation since the ObamaCare debate began, many other legislators have comprehensive bills, and Speaker Ryan led a major effort last year to develop a “Better Way” plan. The leadership’s mission is to provide a transition—a life boat—for people currently receiving ObamaCare coverage while building a bridge to better coverage.

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Conservatives make a mistake if they assume Americans went to the voting booth with a specific desire to see the 2015 partial ObamaCare repeal bill passed. In fact, Trump and GOP majorities were elected to solve a problem — making quality, affordable healthcare more than an empty slogan — and now the GOP needs to deliver.  They recommend, among other proposals, legislation to give states more power and resources to create insurance market with real choices and lower premiums, including allowing insurers to sell more flexible plans than ObamaCare allows, continuing protections for those with pre-existing conditions, and making coverage affordable for those who truly need help.

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Don’t be fooled—the debate over whether to scrap the health care law is not yet over, and what appears to be merely a question of timing is about much more than that. Republicans will have to tread a careful path that balances a desire to abandon Obamacare as soon as possible with the need to respect the reality that the complexities of changing the system will persist well beyond any near-term bill signing ceremonies. It’s true that widespread, sudden disruption of existing health insurance arrangements could short-circuit a workable transition to more market-oriented and less Washington-centric health policy reforms. While the risk of ending up on the merry-go-round of ACA replacement proposals lacking sufficient support, depth, or effectiveness is real, there are risks posed by the opposite reaction: the desire for quick and simple repeal.

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Republicans won the first skirmish in the Obamacare fight Wednesday, voting to begin debating fast-track budget procedures that, if successful, would allow the GOP to kill the 2010 health care law without having to face a Democratic filibuster in the Senate. The 51-48 vote, on the second day of the 115th Congress, underscores how serious Republicans are in making good on their repeal pledge. But it also signaled that Democrats are just as committed to defending the Affordable Care Act.

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While the average estimate shows nearly 21 million people have benefitted from Obamacare, it’s important to note that some people currently enrolled in Medicaid could have enrolled in Exchange coverage with nearly full subsidization had their state not expanded Medicaid, and would likely be eligible for whatever new subsidy structure might replace the current system. Regarding those in the Individual Market, not all of these individuals are receiving subsidies and would therefore not be financially impacted by the repeal. Making reasonable assumptions and accounting for those who lost insurance because of the ACA, and setting aside any assistance that would be provided by ACA replacement policies, the number of people who, on net, are potentially at risk of being negatively impacted is likely closer to 13-14 million.

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House Republicans say they aim to send an Obamacare repeal bill to the White House by Feb. 20, following a meeting with Vice President-elect Mike Pence.

“We want to have the budget on the president’s desk by the 20th,” Rep. Marsha Blackburn (Tenn.) said Wednesday after a House GOP conference meeting that Pence attended. “We’re going to be working to hit those benchmarks, and the pace of work is going to change significantly around here.”

House Speaker Paul Ryan’s staff pushed back on that timeline after the meeting, saying it was incorrect.

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On January 3, 2017, Judge Margaret Sweeney of the United States Court of Claims certified Health Republic Insurance Company v. United States as a class action. This is one of more than a dozen cases that have been brought by insurers in the Court of Claims challenging the failure of the government to pay marketplace insurers amounts that they claim were due to them under the ACA’s risk corridor program. The class includes:

All persons or entities offering Qualified Health Plans under the Patient Protection and Affordable Care Act in the 2014 and 2015 benefit years, and whose allowable costs in either the 2014 or 2015 benefit years, as calculated by the Centers for Medicare and Medicaid Services, were more than 103 percent of their target.

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