In the latest Trump administration gamble, senior White House officials have predicted a vote to overhaul Obamacare this week even though party chiefs on Tuesday did not have enough support to pass a bill.

Grace-Marie Turner, who advises Republican lawmakers on healthcare as president of the Galen Institute think-tank, said: “Obamacare handed Republicans a bucketful of hand grenades and they are now trying to work out how to stop them going off.”

Ms Turner said Republicans’ healthcare struggles stemmed partly from the fact they had done a poor job explaining to voters what their proposals would mean. “They’ve not had enough time to spend on core messaging to persuade people that you are going to be OK, that [Obamacare] is going to stay in effect while we move to a better system,” she said.

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House conservatives rebelled over the original version of the American Health Care Act, which only partially deregulated insurance markets. The bill maintained the rule known as guaranteed issue, which requires insurers to cover all applicants regardless of medical history. It also relaxed community rating, which limits how much premiums can vary among beneficiaries.

The media and the left thus claim that conservatives want to allow insurers to charge sick people more, and some conservatives agree, which spooks the moderates. But the latest compromise between conservatives and centrists doesn’t repeal guaranteed issue or community rating. It keeps these regulations as the default baseline, and states could apply for a federal waiver if they want to pursue other regulatory relief.

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President Donald Trump said Monday the Republican health-care bill being negotiated in Congress ultimately will protect Americans with pre-existing conditions as well as Obamacare does.

“I want it to be good for sick people. It’s not in its final form right now,” he said during an Oval Office interview Monday with Bloomberg News. “It will be every bit as good on pre-existing conditions as Obamacare.”

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There’s no way around a simple truth: treating an expensive health condition costs (someone) lots of money.  There are four basic approaches that can be taken to this problem:  1) Leave sick people to face the costs of their own treatment, whether out of pocket or through high-cost insurance, no matter how ruinous those costs become;  2) Mandate that other, healthier people overpay for the value of their own health insurance, so that sick people can underpay for the value of theirs;  3) Spread the costs of paying expensive health bills throughout society, for example by having taxpayers pick up the tab; and  4) Require a targeted group to shoulder the costs.  [The AHCA opts for 3).]
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Health insurers and small businesses are pushing their long-sought goal of abolishing Obamacare’s health insurance tax as lawmakers work to repeal and replace the healthcare law.

The tax is a priority for insurers even as negotiations have centered on the Obamacare repeal bill and federal insurance payments.

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House Republicans still hope to vote on their health care overhaul next week, though lawmakers said Friday they may need further changes to scrape together enough votes to pass it.

Rep. Tom MacArthur of New Jersey, who authored an amendment that won the support of hardline conservatives earlier in the week, acknowledged Friday that Republicans are discussing changes to his language. He declined to specify what those changes might include. “I’m open to any good idea that gets us across the line,” he said.

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Some lawmakers are also discussing changes to the bill to help bring moderates on board. How to balance the demands of the two groups is a difficult task, and no one has found the right formula yet.

Rep. Charlie Dent (R-Pa.), co-chairman of the moderate Tuesday Group, said “it’d be hard” to design a bill that both he and the Freedom Caucus could support. Dent also offered stark criticisms of the latest bill, which he saw as an “exercise in blame-shifting” to make centrists appear responsible for the failure to Trump instead of conservatives.

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The Trump administration appears to have scrapped one of the key tools the Obama administration used to encourage states to expand Medicaid under the Affordable Care Act.

The shift involves funding that the federal government provides to help hospitals defray the cost of caring for low-income people who are uninsured. Under a deal with Florida, the federal government has tentatively agreed to provide additional money for the state’s “low-income pool,” in a reversal of the previous administration’s policy.

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A renewed effort to bring a House Republican plan to the floor faltered by week’s end, a blow to President Donald Trump’s hopes of landing a health-care deal in his first 100 days. Republicans are vowing to push ahead with the bill, saying it has stalled but not died.

But the herculean struggle to craft a politically viable proposal reflects the party’s sharp divisions and rising support for the ACA. Conservative Republicans want to gut most of the existing law, citing rising premiums and limited choice. Moderate Republicans remain reluctant to support a new plan that erases the ACA’s expanded coverage and patient protections.

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The three latest theatrical gambits to fan the smoldering embers of the previously-abandoned AHCA include: 1. The cost-sharing subsidy payment termination bluff, 2. Grasping for the thinly-funded straw of “invisible” risk pools to promise individual insurance market premium reductions and protection of coverage for persons with pre-existing health conditions, and 3. The Freedom Caucus “lions” are preparing to lie down with the Tuesday Club “lambs” in a new compromise that revives an amended version of the AHCA.

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