Our American Experiment — After a speech to state legislative leaders in Austin, TX, on August 1, chairman David Avella and Grace-Marie Turner, President of the Galen Institute, talked about the important role for the states in health reform going forward. You’ll enjoy the eight-minute podcast, that concludes with a little-known story about Turner’s early years as a journalist.

Managed Care magazine writes that, “Whether an ACA fix or GOP plans—or neither—prevail, these players are poised to determine what comes next.”  Those listed include ObamaCareWatch guest contributors Tom Miller of the American Enterprise Institute, HHS assistant-secretary designate Steve Parente, and Grace-Marie Turner of Galen as well as Andrew Bremberg, White House Domestic Policy Council chief.

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President Trump likes to govern by Twitter threat, which often backfires, to put it mildly. But he’s onto something with his recent suggestion that Members of Congress should have to live under the health-care law they imposed on Americans.

Over the weekend Mr. Trump tweeted that “If a new HealthCare Bill is not approved quickly, BAILOUTS for Insurance Companies and BAILOUTS for Members of Congress will end very soon!” He later added: “If ObamaCare is hurting people, & it is, why shouldn’t it hurt the insurance companies & why should Congress not be paying what public pays?”

Mr. Trump is alluding to a dispensation from ObamaCare for Members of Congress and their staff, and the back story is a tutorial in Washington self-dealing. A 2009 amendment from Chuck Grassley (R., Iowa) forced congressional employees to obtain coverage from the Affordable Care Act exchanges. The Senate Finance Committee adopted it unanimously.

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Major health insurers in some states are seeking increases as high as 30% or more for premiums on 2018 Affordable Care Act plans, according to new federal data that provide the broadest view so far of the turmoil across exchanges as companies try to anticipate Trump administration policies.

Big insurers in Idaho, West Virginia, South Carolina, Iowa and Wyoming are seeking to raise premiums by averages close to 30% or more, according to preliminary rate requests published Tuesday by the U.S. Department of Health and Human Services. Major marketplace players in New Mexico, Tennessee, North Dakota and Hawaii indicated they were looking for average increases of 20% or more.

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Congressional Republicans moved on Tuesday to defuse President Trump’s threat to cut off critical payments to health insurancecompanies, maneuvering around the president toward bipartisan legislation to shore up insurance markets under the Affordable Care Act.

Senator Lamar Alexander of Tennessee, the influential chairman of the Senate Health, Education, Labor and Pensions Committee, announced that his panel would begin work in early September on legislation to “stabilize and strengthen the individual health insurance market” for 2018. He publicly urged Mr. Trump to continue making payments to health insurance companies to reimburse them for reducing the out-of-pocket medical expenses of low-income people.

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A U.S. appeals court on Tuesday allowed Democratic state attorneys general to defend subsidy payments to insurance companies under the Obamacare healthcare law, a critical part of funding for the statute that President Donald Trump has threatened to cut off.

The U.S. Court of Appeals for the District of Columbia Circuit granted a motion filed by the 16 attorneys general, led by California’s Xavier Becerra and New York’s Eric Schneiderman.

President Donald Trump, frustrated that he and fellow Republicans in Congress have been unable to keep campaign promises to repeal and replace Obamacare, has threatened to stop making the so-called cost-sharing subsidy, or CSR, payments.

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Health insurer Aetna announced Thursday that it would completely withdraw from the Obamacare exchanges in 2018, after seeing its profits soar from reducing its participation this year.

The company said during an earnings call that it was withdrawing from the exchange in Nevada, the last state it had considered staying in. Aetna was leaving the possibility open because it was applying for a Medicaid managed care contract, and the state gives extra consideration to insurers that participate in both programs.

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Even if Republicans had succeeded in their recent effort to repeal the ACA, “skinny repeal” would have come nowhere close to solving the problems that plague our health-care system, especially rising costs and declining choices. Of course, the ACA also failed to solve those problems and in many ways exacerbated them. Republicans should not give up on reform that would lower costs, improve quality and ensure more widespread adoption of exciting health-care innovations. On the legislative front, there are several rifle-shot provisions that could be attached to must-pass pieces of legislation. Beyond legislation, the Trump administration can improve the ACA through the regulatory process. The Trump administration can also work with states that are interested in taking advantage of the innovation waivers in Section 1332 of the ACA, which allow states to fashion health reforms that suit their citizens best.

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The Senate GOP’s health failure is a political debacle that will compound for years, and the first predictable fallout is already here: Republicans in Congress are under pressure to bail out the Obama Care exchanges, even as Donald Trump threatens to let them collapse. The GOP needs to get at least some reform in return if it’s going to save Democrats and insurers from their own failed policies.

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