President Donald Trump signed a broad executive order urging a revamp of federal government aid programs Tuesday, invigorating a contentious debate from which Republicans hope to gain momentum before the November elections.

The executive order lays out broad principles for overhauling government aid programs to require that more participants prove they are working or trying to find jobs, senior administration officials said. It also instructs federal agencies to propose changes to the programs they oversee and craft new regulations if necessary. The order is primarily aimed at programs such as food stamps, which covers about 43 million Americans, Medicaid, which covers 74 million people, and housing programs, an official said.

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Maryland lawmakers on Wednesday finalized a bipartisan measure to collect $380 million in taxes from health insurers next year to help curtail surging premiums for 150,000 Marylanders and prevent the state’s Obamacare marketplace from a potential collapse.

The legislation was a quiet, one-year compromise between the Democratic-controlled General Assembly and Republican Gov. Larry Hogan, who is expected to sign the measures.

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Key Takeaways

  1. It appears that Congress, backed by powerful special interests in the health care industry, is getting ready to bail out, once again, Obamacare’s a failing program.
  2. The bottom line: Taxpayers still end up paying more over the next several years for a failing health insurance scheme.
  3. We are witnessing the evolution of a classic government failure, and Congress is getting ready to reward that failure with another round of corporate bailouts.

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The most significant federal entitlement reform in our lifetime was a little noticed provision that Democrats included in the Affordable Care Act (Obamacare). The provision garnered almost no attention from the mainstream media or even from most conservative commentators. Yet according to the Medicare Trustees report that followed, this one provision eliminated $52 trillion of unfunded federal government liability – an amount that was more than three times the size of the US economy.

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Here’s what the Department of Health and Human Services could do:

  • Relax rules so companies of all sizes can take advantage of HRAs. Medium-sized and large employers want the same option of setting up HRAs for workers to buy ACA coverage, said Chris Condeluci, who worked on the ACA as a Senate GOP staff attorney.
  • Now that the individual mandate has been repealed, the administration could open the door for companies “to provide funds to buy noncompliant coverage,” said Gary Claxton, a vice president at the Kaiser Family Foundation.

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Oregon voters recently upheld a myriad of new taxes that were passed as part of a major health-care law last summer. The state government is planning to use the estimated $320 million in revenue to cover hundreds of thousands of residents who have enrolled through the Affordable Care Act. The outcome of this vote has serious implications anyone enrolled in a health-care plan in Oregon.

The referendum was on sections of House Bill 2391, which imposes a 0.7 percent tax on small hospitals as well as a 1.5 percent on individual and family health-care premiums. These revenue raisers are intended to generate more tax dollars for the state. But they also allow Oregon to receive $630 million to $960 million in federal Medicaid matching funds.

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Using 2017 dataOut of 9,201,805 healthcare.gov enrollees, here’s how many would win and lose if the insurer subsidies were now funded:

  • Winners: 682,712 unsubsidized exchange enrollees enrolled in middle-of the-road “silver” plans
  • Losers: 1,621,325 enrollees who receive premium subsidies and don’t have silver plans
  • Likely losers: 1,706,780 enrollees with silver plans and incomes between 200%-400% of the federal poverty level.

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GOP leaders from both chambers of Congress want reinsurance. But they want it in different ways.

And with two different Republican measures on the table, each handling the mechanics differently, the big question is: Which one will win out if congressional Republicans go through with their plan to address stabilization in an upcoming spending bill.

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The less-explored question involves why Obamacare’s overall combination of taxpayer subsidies, expanded insurance programs, health benefits requirements, AND coverage mandates had so much less of an effect than the law’s architects envisioned.

It turns out that many of the nominally uninsured still have other alternatives to health care than just through heavily-subsidized Medicaid and exchange-based insurance. You might call such uncompensated care either an option for “implicit insurance” or a hidden tax on acquiring more formal coverage.

Health policy researchers Amy Finkelstein, Neale Mahonem and Matthew Nolowidigdo unravel the puzzle in a recent National Bureau of Economic Research paper. They explain why there is less “demand” than expected for the increased “supply” of subsidized coverage for lower income individuals and more limited take up of subsidized coverage than once predicted.

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Congress is apparently not done cutting taxes, even after passing a $1.5 trillion tax overhaul last year.

The deal struck by Democrats and Republicans on Monday to end a brief government shutdown contains $31 billion in tax cuts, including a temporary delay in implementing three health-care-related taxes.

Those delays, which enjoy varying degrees of bipartisan support, are not offset by any spending cuts or tax increases, and thus will add to a federal budget deficit that is already projected to increase rapidly as last year’s mammoth new tax law takes effect.

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