Under extreme pressure from conservative activists, House Republican leaders and the White House have restarted negotiations on legislation to repeal the ACA. But efforts to revive the legislation in the House could take weeks, lawmakers conceded, as Congress moves forward with a full plate of other time-consuming issues. And the renewed push did not meet with much enthusiasm from Senate Republicans, who said they had other priorities at the moment. Nonetheless, Speaker Paul Ryan vowed to renew efforts to repeal the law, despite last’s week crushing setback when House Republicans tossed aside a repeal bill because they lacked the votes to pass it.

. . .

Nearly two-thirds of Republicans still want Congress to pursue health care reform, a new Morning Consult/POLITICO poll shows.

Among Republicans, 62 percent of registered voters want reform efforts to continue, versus just 30 percent who think lawmakers should stop. Among all voters, 51 percent said the GOP should move on to other efforts, while 37 percent said they want Congress to continue with health care reform.

James C. Capretta argues that going forward, the goal shouldn’t be to find a bill that is acceptable to 100% of the Republican caucus. Even if that were possible, it would entail too much risk of another political debacle. On health care, he says that Republicans will be better off trying to reach a deal with some willing Democrats. That can be done, but only if Republicans first demonstrate they are serious about producing a workable approach that moves decisively away from key ACA provisions without leaving millions without insurance. If they do that, and the CBO produces an estimate showing it would work, they will find they have the leverage necessary to bring some willing Democrats to the table and get a good deal.

. . .

As House Republicans struggle to find a way to repeal ObamaCare, the two GOP senators from Tennessee are looking to temporarily fix an issue that may strike the health insurance exchanges next year.

A bill introduced by Sens. Lamar Alexander and Bob Corker would allow people to use their ObamaCare subsidies to purchase any state-approved plan on the private market if there are no insurers selling policies on the federal exchange in their county.

. . .

On June 21, 2017, health insurers have to decide whether they will sell coverage on the Obamacare marketplaces. “It will give us the first indication of what the ballpark rate increases are, what counties have insurers and which ones don’t,” says Robert Laszewski, an industry consultant who works with insurers that sell on the marketplace. “Insurers will have to make a statement.” The number of insurers selling on the marketplace fell significantly this year. There are 960 counties on Healthcare.gov that had just one health insurer selling coverage in 2017. That was a big increase from the 180 counties in the same situation in 2016.

Secretary of Health and Human Services Tom Price came into office last month ready to lead the charge on repealing ObamaCare. Now, that effort has run into a brick wall, leaving him to oversee a law he fiercely opposes.

President Trump last week predicted that ObamaCare “soon will explode,” stirring speculation that the administration could seek to undermine the law.

. . .

President Donald Trump and GOP lawmakers, seeking to regroup following the collapse of the effort to repeal the Affordable Care Act, have an option for gutting the health law relatively quickly: They could halt billions in payments insurers get under the law.

House Republicans were already challenging those payments in court as invalid. Their lawsuit to stop the payments, which they call illegal, was suspended as Republicans pushed to replace the ACA, but it could now resume—or the Trump administration could decline to contest it and simply drop the payments. Mr. Trump could unilaterally end the payments regardless of the lawsuit.

. . .

“What went wrong?” poses an erroneous query about the American Health Care Act. The question is not why it failed, but why anyone thought it might succeed. Irrespective of what one thinks of the bill’s policy particulars—whether the bill represents a positive, coherent governing document and vision for the health care system—this thinking demonstrates that Republicans have to re-learn not just how to govern, but also how to legislate. As a policy matter, Obamacare imposed a more sweeping scope on the nation’s health care system. But the tactics used to “sell” AHCA—“We’re doing this now, and in this way. Get on board, or get out of the way”—were far more brutal, and resulted in a brutal outcome, an outcome easily predicted, but the one its authors did not intend.

. . .

It is premature to assume health care legislation won’t be brought up again this year; there is too much instability in the individual insurance market under the ACA to expect the problem to resolve itself without a significant policy intervention. Republican leaders should look again at the AHCA and correct the flaws that made it difficult to pass in the first place. As a replacement for the individual mandate, the AHCA as written would have imposed a new, one-year 30 percent surcharge on premiums for customers who have experienced more than a two-month break in their insurance enrollment over the previous year. A major flaw is that the surcharge is not adjusted to correspond to the length of the spell without insurance.

. . .

The Trump administration, working with governors and state legislatures, could make dramatic state by state changes to Medicaid and the ACA marketplaces using two types of state innovation waivers. Section 1332 of the ACA, which went into effect on Jan. 1, 2017, lets states waive several key provisions of the ACA, including the individual mandate, the employer mandate, the premium tax credit, cost-sharing subsidies, and essential health benefits for ACA marketplace plans. In short, Section 1332 (ACA) waivers let states operate their health care systems as if major parts of the ACA do not exist. Additionally, Section 1115 (Medicaid) waivers give states the opportunity to waive federal Medicaid law. The changes made possible by Section 1115 waivers aren’t as dramatic as those contained in the AHCA—for example, states can’t use these waivers to fully restructure Medicaid under block grants or per capita caps, nor can the federal government use them to take away federal reimbursements for Medicaid expansion—but they are still significant.

. . .