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.

. . .

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.

. . .

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.

. . .

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.

. . .

House GOP leaders determined Thursday night that they didn’t have the votes to pass a rewrite of the Affordable Care Act and would not seek to put their proposal on the floor on Friday.

A late push to act on health care had threatened the bipartisan deal to keep the government open for one week while lawmakers crafted a longer-term spending deal. Now, members are likely to approve the short-term spending bill when it comes to the floor and keep the government open past midnight on Friday.

. . .

Congressional Republicans have called for restructuring Medicaid, reviving a debate that has largely remained dormant for two decades. During the mid-1990s, Congress and President Clinton advanced competing Medicaid reform proposals. Republicans urged that the federal government issue Medicaid block grants to states. The White House and congressional Democrats proposed instead to place per capita limits on federal Medicaid payments to states. The most salient difference between these approaches is that per capita allotments retain the individual entitlement to Medicaid while block grants generally do not. Today, Republicans who once resisted Medicaid per capita allotments support them, and Democrats who backed such allotments oppose them. Given this legislative history, policymakers seeking common ground might look to Medicaid per capita allotments as a point of departure.

. . .

Even as Anthem, one of the nation’s largest insurers, reported an improved financial picture for the last year, the company warned on Wednesday that it would consider leaving some federal health care marketplaces or raising its rates sharply if the government does not continue subsidies to help low-income people.

Joseph R. Swedish, the company’s chief executive, set a deadline of early June for a decision on the subsidies, saying Anthem would weigh increasing rates by at least 20 percent next year.

. . .

The conventional approach to health insurance keeps consumers in the dark about how their health care dollars are spent. Patients pay premiums every month and rely on insurers to cover their medical expenses, no matter how small or routine. Consequently, patients have little incentive to be cost-conscious. The more care they consume, the more value they capture for their premium dollar. Health Savings Accounts inject much-needed competitive forces into the health care marketplace. Expanding access to HSAs should be a centerpiece of any congressional effort to expand access to quality, affordable health care.

. . .

The “MacArthur Amendment” to the American Health Care Act is responsive to what House Republicans have learned about the priorities different factions within their coalition. The Freedom Caucus prioritizes deregulation of the individual insurance market to lower costs and constrain the federal role. The moderates prioritize coverage levels and protection for people with pre-existing conditions. Rather than try to arrive at a single overall balance, the approach Republicans are now pursuing allows state governments to have relief from the rules that drive up costs and make their insurance markets unsustainable if they propose alternative rules that would still protect people with pre-existing conditions and make coverage accessible.

. . .

Health information technology regulations have become overly burdensome, according to Health and Human Services Secretary Tom Price, who vowed that the Trump administration would work to spur innovation in the field. This week, he laid out several principles he said would guide the Trump administration on health IT and electronic medical records, saying the administration was committed to promoting the exchange of medical information between providers. “We simply have to do a better job of reducing the burden of health IT on physicians and other providers,” said Price.

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