On Wednesday, Sen. Bernie Sanders introduced a single-payer health care bill that would create a national health insurance program, charting a stem-to-stern reshaping of the country’s health care system. The bill would make it so that Americans would get health coverage simply by showing a new government-issued card and would no longer owe out-of-pocket expenses like deductibles. But Sanders’ description of his measure omitted specifics about how much it would cost and final decisions about how he would pay for it.

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Single-payer is back on the docket in California. Late last month, Assembly Speaker Anthony Rendon announcedthat he’d formed a special committee “to develop plans for achieving universal health care in California.”

Rendon has been under pressure from progressive activists all summer, ever since he shelved SB 562, a bill passed by the state Senate on June 1 that would put all the state’s residents into a new, state-run single-payer healthcare system. At the time, he deemed it “woefully incomplete.” SB 562 did not specify how, exactly, the state would pay for single-payer.

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The Trump administration and Republican leaders in Congress are pledging to turn their attention toward tax reform after their failure to pass a repeal and replacement of the Affordable Care Act. But Republicans can still improve health care and lower costs if they change the treatment of employer-sponsored health insurance plans in tax reform.

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HHS plans to save taxpayer dollars by curtailing waste and requiring better performance in the ACA Navigator program which pays organizations to enroll people in ObamaCare coverage. The HHS analysis showed that in 2016 “One [Navigator] grantee received $200,000 and enrolled ONE person in Obamacare.” The top 10 most costly Navigators spent a total of $2.77 million to enroll 314 people in Obamacare—costing an average of $8,800 to enroll each person (on top of tax credits and other subsidies). In the upcoming enrollment period, CMS plans to spend $10 million on promotional activities—consistent with similar spending on Medicare Advantage and Medicare Part D.

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Although the GOP’s plan to repeal the Affordable Care Act industry taxes died with the party’s health care bill, it’s conventional wisdom that some of the taxes will still be delayed. But there’s no plan to do so yet.
Lobbying campaigns to repeal or delay the health insurance tax and the medical device tax are ramping up, yet there’s no clear vehicle for Congress to take action. Well-wired lobbyists and Hill aides say the appetite for doing anything major on health care isn’t really there.

“It is a have-to-get-done that’s really hard to get done,” said one lobbyist.

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Congressional Republicans plan to use the next four weeks away from Washington making a public case for a sweeping rewrite of the tax code, an ambitious legislative undertaking they hope will heal divisions that opened when the party’s signature health-care bill collapsed. But at home in their districts, they face pressures that could make it hard to focus on taxes.

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Obamacare gave the federal government a heretofore unprecedented power: the power to force us to buy health insurance irrespective of our desire to do so. Republicans, for both moral and economic reasons, oppose this mandate. The framers of the Constitution never envisioned granting Congress the power to force people to buy a privately delivered financial service. There are also important economic reasons to oppose Obamacare’s mandate. Gross premiums for individually purchased coverage have doubled over the past four years under Obamacare. But the authors of Obamacare don’t need to care about whether they’ve made coverage costlier, because they’re forcing you to buy it anyway. Without a mandate, insurers would have to do what businesses have to do in every other sector of the economy: design products that you voluntarily want to buy because they represent a good value for you. Under Obamacare, they don’t have to.

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The new Senate health bill abolishes the following Obamacare taxes: 1) Individual Mandate Tax; 2) Employer Mandate; 3) Medicine Cabinet Tax; 4) Flexible Spending Account Tax; 5) Chronic Care Tax; 6) Health Insurance Tax; 7) Medical Device Tax; 8) Tax on prescription medicine; 9) Tax on Medicare Part D retiree prescription drug coverage; 10) Health Savings Account (HSA) Withdrawal Tax; and 11) 10% excise tax on small businesses with indoor tanning services. The Senate bill also delays the “Cadillac” tax on employer-provided insurance until 2026 and doubles the maximum HSA contribution from $3,400 to $6,550 for individuals and from $6,750 to $13,100 for families. The Senate bill also allows Americans to use HSA funds to pay for health insurance premiums.

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The new Senate bill  1) Reduces the number of people eligible for subsidies, reduces the values of the premium subsidies, and lowers the cap on total subsidy expenditure;  2) Eliminates the individual and employer mandates;  3) Restricts coverage for abortion;  3) Ends the cost-sharing reductions — but not before paying insurers back for the money they’ve already laid out;  4) Gives states a great deal more flexibility in the waiver program;  5) Gets rid of a lot of Obamacare taxes;  6) Provides market stabilization funds;  7) Winds down the Medicaid expansion funding, but not as fast as the House bill; and  8) Converts Medicaid to a per-capita allotment rather than an open-ended entitlement.

The government’s price tag for a single-payer health care system would be astonishing. When Sen. Bernie Sanders (I-VT) proposed a “Medicare for all” health plan in his presidential campaign, the nonpartisan Urban Institute figured that it would raise government spending by $32 trillion over 10 years, requiring a tax increase so huge that even the democratic socialist Mr. Sanders did not propose anything close to it.

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