Longtime ObamaCare lobbyists are soundly rejecting one of Hillary Clinton’s most prominent healthcare pitches: the public option.

Leaders of the nation’s largest hospital, pharmaceutical and insurer trade groups said on Tuesday they wouldn’t support a Clinton administration’s push for a public option without first ensuring the Obamacare marketplaces work.

“We think we need to make these [marketplaces] viable before we give any consideration of going to a public option,” Rick Pollack, president of the American Hospital Association, told a crowd at the U.S. Chamber of Commerce.

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Some health insurers say they’re paying too much to rival Blue Cross Blue Shield plans under a key pillar of the federal health law designed to compensate insurers that take on sicker and more expensive patients.

The critics’ chief complaint is that the Affordable Care Act’s risk-adjustment program unfairly rewards health plans — including Blue Shield of California — that have excess administrative costs and higher premiums. That comes at the expense of more efficient, lower-priced plans in the individual market, they say.

The Obama administration is considering changes to how these dollars are allocated in the state and federal exchanges, but critics say the proposed modifications don’t go far enough.

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The debate over what’s wrong with Obamacare matters beyond this political cycle; what happens to the health care system in the next administration will be driven by what Americans think needs fixing. And while the headlines and stump speeches have focused on the struggles of the exchanges, the Affordable Care Act is quietly reshaping the entire system. It’s reining in the spiraling growth of health care costs, cutting by half the ranks of the uninsured, and providing a host of new protections and perks to the insured.

The political debate has been primarily detached from that transformation.

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Health care experts on both sides of the aisle projected the next Congress may tie reforms to Obamacare to other legislative efforts, speaking Tuesday at a National Coalition on Health Care forum. Conservatives on the panel suggested any negotiations would be tied to how willing both parties are to compromise. Douglas Holtz-Eakin, president of the American Action Forum, suggested GOP priorities such as tax reform or adjusting how the federal government addresses poverty could address health care in some way if the next administration and Senate are willing to acknowledge them and make trades. Joseph Antos, a health analyst at the American Enterprise Institute, agreed, saying adjustments would be possible based on how much the incoming administration is willing to negotiate with Congress.

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Clinton says she wants to save the best of Obamacare while reducing costs. Trump says it is an expensive “disaster” that is on track to implode in 2017. He wants to replace it with something cheaper.

Trump has proposed getting rid of the exchanges and setting up tax-free health savings accounts for people with high-deductible insurance plans. He has also said he would set up state-based high-risk pools for people with medical conditions that make it hard to get coverage on their own. He also wants to allow companies to sell insurance across state lines to boost competition and drive down prices.

Whoever wins the presidency on Nov. 8 will likely face pressure to move quickly to reshape a healthcare initiative that affects millions of Americans.

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The Affordable Care Act (ACA) extends health insurance coverage to people who lack access to an affordable coverage option. Under the ACA, as of 2014, Medicaid coverage is extended to poor and near poor adults in states that have opted to expand eligibility, and tax credits are available for low and middle-income people who purchase coverage through a health insurance Marketplace. Millions of people have enrolled in these new coverage options, and the uninsured rate has dropped to the lowest level ever recorded. However, millions of others are still uninsured. Some remain ineligible for coverage, and others may be unaware of the availability of new coverage options or still find coverage unaffordable even with financial assistance.

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When the Affordable Care Act’s health insurance marketplace opens in two weeks, many consumers will have a new option for the law’s fourth open-enrollment period: standardized health plans that cover basic services without a deductible.

With many health plans on the marketplace coming with deductibles in the thousands of dollars, consumers have complained that they were getting little benefit beyond coverage for catastrophic problems. The new standardized options are meant to address that concern — to ensure that “enrollees receive some upfront value for their premium dollars,” as the Obama administration said.

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Some health insurers say they’re paying too much to rival Blue Cross Blue Shield plans under a key pillar of the federal health law designed to compensate insurers that take on sicker and more expensive patients. The critics’ chief complaint is that the Affordable Care Act’s risk-adjustment program unfairly rewards health plans—including Blue Shield of California—that have excess administrative costs and higher premiums. That comes at the expense of more efficient, lower-priced plans in the individual market, they say.

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Obamacare is collapsing. Its utter failures become more obvious by the day. We all remember the promises of Obamacare, chief among them that the “Affordable Care Act” would lower health care costs. The opposite has occurred. Despite the offer of subsidies through the exchanges, enrollment in Obamacare has been dismal. Younger, healthier individuals have little interest in paying exorbitant premiums for insurance plans that come with $5,000 deductibles. The result has been an unbalanced insurance pool where insurers must charge ever-increasing premiums to continue offering coverage.

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Marilyn Tavenner, the face of private insurers, does not think Affordable Care Act exchanges are about to implode. But she does think Congress will have to make some tough decisions relatively soon about how much to buffer insurers from risk.

“I do not think the exchanges are in a death spiral. I do think they’re unstable, and we have a responsibility to stabilize them,” said Tavenner, president and CEO of America’s Health Insurance Plans, in an interview with Morning Consult. “That’s on all of us.”

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