As congressional Republicans’ efforts to repeal and replace the Affordable Care Act remain in limbo, the Trump administration and some states are taking steps to help insurers cover the cost of their sickest patients, a move that industry analysts say is critical to keeping premiums affordable for plans sold on the law’s online marketplaces in 2018.

This fix is a well-known insurance industry practice called reinsurance. Claims above a certain amount would be paid by the government, reducing insurers’ financial exposure and allowing them to set lower premiums.

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House GOP leaders during a members-only conference call Saturday vowed to avoid a government shutdown and said they’re closer to a deal to repeal and replace Obamacare, according to members who participated on the call.

But Speaker Paul Ryan also downplayed the possibility of a vote next week, the same sources said. The Wisconsin Republican said the chamber will vote on a conference-wide deal when GOP whips are confident they have the votes for passage — but not until then.

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Although insurers have generally remained profitable overall since implementation of the Affordable Care Act, many companies participating in the individual market – where most of the major market reforms took place in 2014 – experienced substantial losses in this market in the early years of reform. The individual market is where just 7% of the U.S. population gets their insurance (and thus also represents a small share of most health insurers’ business), but the stability of the market and willingness of insurers to continue to participate is essential to the ACA’s success. Going into 2017, there were a number of high-profile exits and premium increases, raising concerns over the stability of the individual market. Although some local markets are likely fragile, the Congressional Budget Office expects the ACA individual market to remain stable across most part of the country.

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Republicans have put themselves in a deep hole on ObamaCare, both politically and on the health-market merits, but maybe they’ll grab the rescue line now dangling in front of them. A potential compromise among the House’s contentious GOP factions could begin the climb out.

The chance to revive the failed repeal-and-replace bill developed this week when the House Freedom Caucus’s Mark Meadows and the centrist Tuesday Group’s Tom MacArthur struck a tentative deal. Their compromise would allow states to seek waivers to opt out of most of ObamaCare’s insurance mandates.

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As House Republicans regain momentum in their quest to replace Obamacare, GOP moderates have done something unexpected: they’ve focused not broadly on covering the uninsured, but specifically on protecting those with pre-existing conditions. There’s a reason for that, and it has to do with wildly exaggerated claims that Democrats made when they were passing the law in 2009 and 2010.

The vast majority of Americans who are uninsured aren’t without coverage because of a health problem. They’re uninsured because of an economic problem: the problem that American health care costs too much, especially for lower-middle-income Americans who earn too much to qualify for government assistance.

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Fresh hopes for resuscitating the American Health Care Act are pegged to an amendment being offered by Rep. Tom MacArthur (R-N.J.) that aims to attract enough conservatives and moderates so the measure can pass in the House. The tentative deal would allow states to apply for limited waivers from some of ObamaCare’s regulatory requirements if they establish a high risk pool to protect sicker enrollees. While some senior White House administration officials suggested that a vote will occur next week, Speaker Ryan won’t bring it up unless he knows there are enough votes for passage.

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Insurance executives, as well as the head of the trade group America’s Health Insurance Plans, met with Seema Verma, administrator of the Centers for Medicare and Medicaid Services, on Tuesday. Insurers have been pressuring administration officials and lawmakers to fund the ACA’s cost-sharing reduction payments. Insurers have struggled to adjust to the individual marketplaces since the ACA created the exchanges, and the ACA’s uncertain political future has only added to the questions they face as they approach the June 21 deadline for filing their 2018 premium rate requests. That will be the first indication of how the individual exchanges fare next year.

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As Members of Congress debate repealing and replacing Obamacare, they should learn from the failures of that law in crafting a better set of health care policies. One important step in that crafting is the establishment of a fairer and more reasonable set of rules for limiting health plans’ application of pre-existing condition exclusions. Policymakers should link the ban on exclusions for pre-existing conditions to a requirement of continuous coverage. Setting the right rules around the prohibition on plans applying pre-existing condition exclusions will not only stabilize insurance markets, but also provide a firmer foundation for future reforms of other aspects of health care policy.
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Many people are going without insurance under ObamaCare because they cannot afford the law’s expensive plans or aren’t aware of their options. Congress can help these Americans and many others get insurance by enrolling them in no-premium, no-obligation plans from which they could withdraw if they wanted to. Opponents will argue that automatic enrollment infringes on personal liberty. But people placed into such coverage would be free to opt out or to select an option that better suits their needs. Few people opt out of employer pensions when they are placed into them automatically, and no-premium insurance would impose no cost on the enrollees.

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With time running out to set insurance prices and uncertainty surrounding whether the Trump administration will continue funding cost-sharing subsidies on the ACA exchanges, several states are giving health insurers a little more wiggle room to file 2018 rates. State insurance regulators hope an extra few weeks to price plans will be enough to ease the insurance industry’s jitters created by efforts to repeal and replace the ACA and keep insurers from bailing on the exchanges. Colorado, New Hampshire, Oregon and Kentucky have extended deadlines for insurers to submit rates for 2018 ACA health plans.

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