Like the Better Care Reconciliation Act, Graham-Cassidy would repeal Obamacare’s individual and employer mandates. Both bills increase annual contributions to health savings accounts. Both bills phase down state-based Medicaid provider taxes that states use to game the federal government into giving them more money than they’re supposed to get. Both bills allow states the ability to frequently cull their Medicaid rolls of ineligible recipients—something they can’t do today.

The bill would institute a per-capita allotment for the legacy Medicaid program that is quite similar to the one in the BCRA. This per-capita approach is essential to ensuring that Medicaid is fiscally sustainable in the future. Both bills allow states to institute work requirements for Medicaid.

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While some progressives campaigned this week for “Medicare for all,” a group of moderate House Democrats aligned themselves with a more modest push to stabilize the ACA, arguing that it could spur broader health care reforms in the future. Thirty-five of the 61 members of the New Democrat Coalition sent a letter Friday urging the leaders of the Senate Health, Education, Labor and Pensions Committee to agree on a bipartisan bill to keep premiums from rising further for Obamacare enrollees next year.

Graham-Cassidy is less ambitious than the Senate’s ObamaCare replacement that failed over the summer, and we could go on at length about its limitations. But the proposal at least takes most decision-making out of Washington and puts a spending cap on Medicaid and ObamaCare. The question for Members is: What is the alternative? The budget procedure that allows the Senate to address the law with a 51-vote majority expires on Sept. 30. ObamaCare’s exchanges will continue to deteriorate, and Democrats will blame Republicans for every premium increase from here to November 2018. The law will require who knows how many patches and bailouts in coming years, and consumers will continue to face higher prices and fewer choices.
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While a slim majority favors the idea of a national health plan at the outset, a prolonged national debate over making such a dramatic change to the U.S. health care system would likely result in the public being exposed to multiple messages for and against such a plan. The poll finds the public’s attitudes on single-payer are quite malleable, and some people could be convinced to change their position after hearing typical pro and con arguments that might come up in a national debate. For example, when those who initially say they favor a single-payer or Medicare-for-all plan are asked how they would feel if they heard that such a plan would give the government too much control over health care, about four in ten (21 percent of the public overall) say they would change their mind and would now oppose the plan, pushing total opposition up to 62 percent. Similarly, when this group is told such a plan would require many Americans to pay more in taxes or that it would eliminate or replace the Affordable Care Act, total opposition increases to 60 percent and 53 percent, respectively.

On Wednesday, Sen. Bernie Sanders introduced a single-payer health care bill that would create a national health insurance program, charting a stem-to-stern reshaping of the country’s health care system. The bill would make it so that Americans would get health coverage simply by showing a new government-issued card and would no longer owe out-of-pocket expenses like deductibles. But Sanders’ description of his measure omitted specifics about how much it would cost and final decisions about how he would pay for it.

. . .

The Democratic Party now is, for all intents and purposes, the party of single-payer health insurance.

Big mistake.

Democrats are committing themselves to years more of treacherous health care debate, at a time when there are more pressing issues to confront. They are emulating Donald Trump’s penchant for quick-fix, bumper-sticker solutions that prove to be, in his own words, more “complicated” once in power. And instead of maintaining a candid relationship with its ideological base in order to temper expectations, the party establishment is indulging it, risking bitter disappointment in the future.

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If Bernie Sanders wants to follow Medicare as his model, then the Sanders plan could easily earn another moniker: Benefits for Billionaires. An analysis released by the Congressional Budget Office in August demonstrates how Medicare currently provides significant financial benefits to seniors at all income levels, including the wealthy. The CBO found that at every income level, seniors received more in Medicare benefits than they paid in Medicare taxes. Men in the highest income quintile—the top 20% of income—received a net lifetime benefit from Medicare of nearly $50,000, even after taking into account the Medicare taxes and premiums they paid.

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As ObamaCare continues to collapse, options for quality, affordable health care move further out of reach for many Americans. This week, Senator Bernie Sanders, D-Vt., and other Senate Democrats plan to offer their solution: a complete Washington takeover of America’s health care system.

A majority of Democrats in the U.S. House of Representatives have signed on as co-sponsors of their own “single-payer” legislation. This idea is good for whipping up the far-left base – and bad for everyone else. It will deliver worse care, inevitably leading to rationing. It also will be outrageously expensive for everyone.

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“Single-payer” is a broadly popular slogan that papers over intraparty disagreements and wrenching policy choices. A recent survey by Kaiser found that initial support for single-payer dropped by about a third when supporters were told of criticisms that it might increase their taxes, give the government “too much control” over health care or eliminate the ACA. Each of those critiques would probably be made prominently by Republican opponents of the policy.

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This brief describes alternative forms of subsidized reinsurance and the mechanisms by which they spread risk and reduce premiums. For a given amount of funding, a particular program’s efficacy will depend on how it affects insurers’ risk and the risk margins built into premiums, incentives for selecting or avoiding risks, incentives for coordinating and managing care, and the costs and complexity of administration. These effects warrant careful consideration by policymakers as they consider measures to achieve stability in the individual market in the long term.

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