President Donald Trump’s core principles for health care include ensuring that Americans with pre-existing conditions have access to coverage, and that Americans should be able to purchase the health insurance plan they want, not one forced on them by the government. Each of these goals is laudable and achievable, taken separately. But President Trump and others are about to confront what others have learned the hard way: Achieving both goals simultaneously is extremely challenging.

. . .

Given the focus on the disastrous launch of the Obamacare insurance Exchanges in 2013, many people don’t know that most of Obamacare’s coverage gains have come not through those Exchanges, but through a new expansion of Medicaid to able-bodied, working-age adults.

Medicaid was originally intended to provide important safety net coverage to vulnerable populations such as individuals with disabilities, low-income children and the elderly, among others.  But Obamacare’s massive expansion of this entitlement to able-bodied adults has placed added strain on an already stressed program in many states.

Even prior to Obamacare, Medicaid stood in desperate need of reform. In many states, low physician reimbursement rates resulted in poor access for beneficiaries. One supporter of the program called a Medicaid card a “hunting license”—the chance for beneficiaries to try to find a doctor who will treat them.

. . .

We will have, over the next few weeks, a once-in-a-generation opportunity to get our health sector back on track, moving control over health care and coverage decisions to doctors, patients, and families.

Congress has an extremely difficult task, with innumerable hurdles in repealing and replacing ObamaCare, but the train is nearly ready for boarding and the month-long journey is about to begin.

This is the chance for Congress to show the American people members hear them and that they can govern.

. . .

House Republicans have rolled out their highly anticipated bill to repeal and replace Obamacare this week, but a more obscure measure introduced by Rand Paul (R-KY) is gaining attention and should not escape notice.

Paul, who has positioned himself as a leading conservative critic of the forthcoming GOP proposal, has sponsored a measure that would leave untouched both Obamacare’s $1 trillion in taxes and its Medicaid expansion.

Stranger still, though Paul has characterized Republican plans for an age-related refundable tax credit as “Obamacare Lite,” his bill does the unthinkable: It retains the Obamacare income-related refundable tax credits.

. . .

House Republicans on Monday unveiled their long-awaited legislation to repeal and replace ObamaCare.

The two measures dismantle the core aspects of ObamaCare, including its subsidies to help people buy coverage, its expansion of Medicaid, its taxes and its mandates for people to have insurance. (READ THE BILLS HERE AND HERE.)

In its place, Republicans would put in place a new system centered on a tax credit to help people buy insurance.

. . .

How should the GOP move forward on Obamacare? First, they must honor their promise to repeal the law. Second, Republicans can’t make it worse; instead, they need to fix the problem. They can do this by: 1.) Beginning with the 2015 reconciliation bill repeal language, 2.) Also repealing the insurance regulations, and 3.) Focusing on areas of consensus among Republicans. Don’t try to replace one 2,000-page monstrosity with another. Instead, adopt common-sense specific reforms that will increase competition, drive down costs, expand choices and put patients back in charge of their health care.

. . .

President Donald Trump, heading into a critical stretch of Republicans’ push to rewrite the Affordable Care Act, acknowledged Monday the effort would be complex and politically risky, but said he is determined to forge ahead because the ACA is a “disaster.”

“Nobody knew that health care could be so complicated,” Mr. Trump told a group of Republican governors after meeting with them and insurers—two groups whose cooperation could make or break the attempt to overturn the law some call Obamacare.

. . .

Spending on prescription drugs for health plans created under the Affordable Care Act increased last year at a rate more than three times that of other commercial plans and most government-run plans managed by Express Scripts Holding Co.

Express Scripts, the largest manager of prescription drug plans for U.S. employers, on Tuesday said year-over-year spending per person for individual insurance plans sold on the Obamacare exchanges where it manages the pharmacy benefit rose 14% in 2016, driven by higher drug prices and utilization.

Express Scripts said per-capita spending for other commercial plans it manages, mostly for employers, rose just 3.8% last year, despite an 11% increase in list prices for brand-name drugs.

. . .

With the passage of the ACA, Congress promised Americans that they would be able to keep the plans and doctors they like while paying less for health insurance and healthcare overall. Seven years later, many Americans have fewer choices when it comes to health decisions and are paying more for care and insurance. The State Policy Network has compiled stories from around the country that highlight state and local challenges and represent the need for a state-based approach that unleashes innovation in health care based upon the needs of citizens.

. . .