Despite days of intense negotiations and last-minute concessions to win over wavering GOP conservatives and moderates, House Republican leaders Friday failed to secure enough support to pass their plan to repeal and replace the Affordable Care Act.

House Speaker Paul Ryan pulled the bill from consideration after he rushed to the White House to tell President Donald Trump that there weren’t the 216 votes necessary for passage.

“We came really close today, but we came up short,” he told reporters at a hastily called news conference.

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Section 202 of the AHCA contains a transitional schedule of tax credits that would apply only in 2018 and 2019. These tax credits vary by both age and income, and they are set up so that they cap Americans’ exposure to high premiums. Take a childless 40-year-old making $25,000. Under Section 202, he would be expected to pay 6.3% of his income—roughly $1,500—for out-of-pocket premiums. The tax credit covers the rest. So if he buys a policy that costs $5,000 a year, the tax credit would be $3,500. If congressional leaders continue Section 202’s tax credits past 2019, they can kill three birds with one stone: repealing more of ObamaCare, lowering premiums for everyone, and making coverage especially affordable for the working poor.

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The American Health Care Act is all about is the boldest and most conservative health-care legislation to come before Congress in decades. Bold because it dismantles the progressive health-care experiment and replaces it with a dynamic, patient-centered system. Conservative because it applies America’s founding principles—freedom, free enterprise and federalism—to the problems of the day. Repeal of ObamaCare must happen, and urgently—not because of any ideology but because American families are already paying the price of the law’s collapse. The legislation gives control of Medicaid back to the states, equips state insurance markets to take care of people with pre-existing conditions without driving up costs for everyone else, and expands health savings accounts.

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President Trump issued an ultimatum on Thursday to recalcitrant Republicans to support the American Health Care Act or see their opportunity to repeal the ACA vanish, demanding a Friday vote on a bill that appeared to lack a majority to pass. The demand, issued by his budget director, Mick Mulvaney, in an evening meeting with House Republicans, came after a marathon day of negotiating at the White House and in the Capitol in which President Trump sought to sell members of his own party on the health plan. House Speaker Paul D. Ryan emerged from the session and announced that President Trump would get his wish for a vote on Friday.

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The House GOP yanked its health-care bill on Thursday ahead of a planned vote, and perhaps they’ll reconvene on today or later. The House bill to repeal Obamacare is a realistic compromise that can improve health-care markets, and no one has offered a better policy alternative to the American Health Care Act that could pass the House and Senate. The obstacle to progress has been the 29 or so Members of the House Freedom Caucus, who have the power to deny House Speaker Paul Ryan a majority of 216 with a mere 22-vote margin of error. The Freedom Caucus blocked incremental reform progress after the GOP took Congress under President Obama, and the question is whether they will indulge the same rule-or-ruin tactics now against Mr. Trump.

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Across the board, for all ages and family sizes, for HMO, PPO, and POS plans, premium increases averaged about 60 percent from 2013, the last year before ACA reforms took effect, to 2017. In same length of time preceding that, all groups experienced premium increases of less than 10 percent, and most age groups actually experienced premium decreases, on average.

These findings come from new data from eHealth, which not only sells ACA Marketplace health plans, but sold a wide variety of health plans through its own website for many years before the ACA was passed, as well as both on and off the Exchanges after the ACA took effect.

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The House health-care bill is gaining momentum, and on Monday night the GOP posted amendments meant to add fence-sitters to the coalition. Don’t discount the stakes: The vote scheduled for Thursday is a linchpin moment for this Congress, and a test of whether the GOP can deliver on its commitment to voters.

For seven years and across four elections, Republicans have promised to repeal and replace ObamaCare if entrusted with the Presidency and House and Senate majorities. Now they have the opportunity to dispose of the failing law and begin to stand up a more market-oriented, patient-centered system. The reform isn’t perfect, and no bill ever is, but the reality is that a no vote is a vote for the ObamaCare status quo.

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Another insurer sued the U.S. government to recoup unpaid payments under the ACA’s risk-corridor program, but it’s looking less and less likely that the feds will ever pay up.

Sanford Health Plan, the insurance arm of Sioux Falls, S.D.-based Sanford Health, sued the federal government, demanding it pay nearly $9 million in overdue risk-corridor payments for 2014 and 2015. The CMS so far has paid Sanford Health Plan just 15.1% of the amount it owes, according to the complaint filed last week in the U.S. Court of Federal Claims.

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The Congressional Budget Office’s (CBO) estimate of the American Health Care Act (AHCA) finds it will reduce deficits by $337 billion through 2026 (read our analysis here). But what would it mean for the long term?

While CBO hasn’t yet provided second decade estimates (other than to say the bill would not be deficit-increasing), we estimate – very roughly – that the bill would save $2 trillion over two decades, including $1.6 trillion between 2027 and 2036. Including interest, we estimate 20-year savings of $2.4 trillion. However, the bill also includes several “cliffs” that if addressed could significantly reduce that estimate.

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Republicans are talking about repeal-and-replace as “three pronged”—pass the current House bill, deregulation through Mr. Price’s executive action, and then measures that can later be attached to must-pass bills. Mr. Price’s letter is the beginning of prong two.

Republicans have an obligation to try to revitalize insurance markets, and not only because Americans depend on coverage. Repealing and replacing ObamaCare is also an opportunity to show that conservative ideas can work in health care. The reason the opposition is so furious is that liberals fear they might succeed.

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