If Donald Trump and the Republican Congress have a mandate to do anything, it is to repeal Obamacare. The law is already cratering. Sick enrollees, former president Bill Clinton laments, are seeing “their premiums doubled and their coverage cut in half.” Even supportive economists admit the program is in a death spiral.

Repeal won’t be easy. But if Trump sets for Congress the same agenda he laid out during the campaign, he could become America’s greatest health-care reformer, all while cutting taxes more than Ronald Reagan and George W. Bush combined.

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The health care crowd in the Beltway is abuzz this morning with press reports that president-elect Donald Trump has named Georgia Congressman Tom Price, M.D. as Secretary of the Department of Health and Human Services. In a related move, he will name longtime Mike Pence aide Seema Verma to the critical role of administrator of the Center for Medicare and Medicaid services. As a result, there’s a raft of interest in how Obamacare “repeal and replace” will now proceed.

It’s important to not get ahead of ourselves here and reflect on what a huge pro-taxpayer accomplishment Obamacare repeal will be. By all accounts, Obamacare will be off the books early in 2017, perhaps before the Patriots win their fifth Super Bowl in NRG Stadium in Houston on the first Sunday in February. Understandably, most of the attention has been focused on the health care aspects of this. But this action will be an enormous tax cut for the American people, with implications for tax reform later in the year.

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The Obama administration hasn’t done enough to ensure that the right people get Obamacare subsidies, according to a new report from congressional Republicans.

The report details earlier investigations into Obamacare’s verification process for income eligibility, which screens whether a person is eligible for tax credits. It also criticizes the administration for relaxing standards for income eligibility.

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The Obama administration is trying to calm the panic over soaring ObamaCare premiums by pointing to subsidies many will receive to offset the cost — but analysts and GOP lawmakers counter that those subsidies nevertheless will stick taxpayers with a rising bill.

With enrollment set to begin Nov. 1, the administration announced Monday that premiums are set rise an average of 25 percent across the 39 states served by the federally run online market. Some states, such as Arizona, will see premiums jump by as much as 116 percent.

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States are beginning to turn to hospitals to cover the cost of Medicaid expansion once the federal match begins to drop next year. The Affordable Care Act provides 100% federal financing for those made newly eligible for Medicaid under the law. The federal match rate falls to 95% in 2017, 94% in 2018, 93% in 2019, and then 90% in 2020 and beyond. Starting next year, eight of the 32 states that have expanded Medicaid planned to use provider taxes or fees to fund all or part of the states’ share of costs, the report said. These states have chosen to implement a new or modify an existing provider assessment specifically for the purpose of covering the costs of expansion.

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The Obama administration is maneuvering to pay health insurers billions of dollars the government owes under the Affordable Care Act through a move that could circumvent Congress. Justice Department officials have privately told several health plans suing over the unpaid money that they are eager to negotiate a broad settlement, which could end up offering payments to about 175 health plans selling coverage on ACA marketplaces. The payments likely would draw from an obscure Treasury Department fund intended to cover federal legal claims, controverting congressional will and intent.

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Medicaid expansion is a poor use of taxpayer dollars. Blase rebuts Dr. Aaron Carroll, a long-time supporter of the Affordable Care Act’s (ACA) Medicaid expansion, writing in The New York Times to encourage further expansion.  Carroll doesn’t not address new data showing government spending on Medicaid expansion enrollees is nearly 50% higher than the government projected, nor that Medicaid enrollees obtain only 20 to 40 cents of value for each dollar the government spends on their behalf.

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Vermont did not properly allocate millions of dollars in federal grants when establishing its marketplace created under the Affordable Care Act, a report released Tuesday by the Department of Health and Human Services Office of Inspector General said.

Vermont’s Agency of Human Services did not always follow federal requirements for allocating costs to establishment grants to establish its marketplace or for drawing down establishment grant funds, the report says.

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Complications arising from the Affordable Care Act (ACA) premium tax credits (PTCs) are causing millions of people to effectively break the law. People who benefit from advance premium tax credits (APTCs) must file tax returns and include a form to reconcile the advanced amount to the actual end-of-year entitled amount. The failure of so many people to fulfill this new legal requirement has led the government to spend more than it should have as APTCs tend to be higher than legally entitled amounts.

The big news is that tax filers, as of April 28, 2016, reported $15.8 billion in total APTC payments. According to data released by HHS, I estimate the amount of APTCs paid in 2015 equaled $26.7 billion—nearly $11 billion more than the amount reported by tax filers. It appears that about 3 million households that received an APTC in 2015 had not filed the required paperwork with the Internal Revenue Service (IRS) by the end of April 2016.

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They say you’re damned if you do and you’re damned if you don’t. So House Speaker Paul Ryan did, and got damned on both the left and right—and all but ignored by his own party’s presidential candidate—when he unveiled his caucus’s outline for a replacement of the Affordable Care Act.

Which raises the question: How serious can this ACA alternative be? Maybe not very. The centerpiece of Ryan’s proposal—tax credits for everyone who needs to purchase individual policies regardless of income—may not go far enough to prevent people from losing coverage while creating new spending that would benefit high-income earners who can already buy their own health insurance.

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