The new Republican Congress may not be able to repeal and replace Obamacare entirely, but it could make substantial progress by targeting the health law’s key structural components.

This November’s electoral wave reopened and widened the strategic playing field for critics of the Affordable Care Act (ACA). Republican control of both houses of Congress, plus larger majorities of state governors and state legislatures present both opportunities and challenges to move beyond rhetorical opposition and advance changes in national health policy. Initial speculation tends to focus more on tactical considerations on Capitol Hill: which items are easiest to pass in the Senate, how to use budget reconciliation, and which votes will “look good” politically even if vetoed by President Obama.

By Megan McArdle: While I was away last week, Vermont decided to scuttle its single-payer health-care plans. I predicted as much six months ago, for one simple reason: A single-payer system would cost too much. When faced with the choice of imposing double-digit payroll taxes or dropping his cherished single-payer plan, the governor of Vermont blinked.

“But Megan!” I hear you cry. “Single-payer systems are cheaper, not more expensive! Look at Europe!”

The one state that not only embraced Obamacare but insisted on going beyond it to a full single-payer system was Vermont, the haven of hippies and expatriate New Yorkers, which has become one of the most liberal states in the nation. In 2011, it adopted a form of neighboring Canada’s government-financed health care and promised to implement it by 2017. (And Jonathan Gruber was a key architect of this plan as well as of Obamacare.) This week, however, Governor Peter Shumlin, a Democrat, admitted the state couldn’t afford the plan’s $2 billion price tag and consequent sky-high taxes, and pulled the plug. The lessons for Obamacare are obvious and profound.

Avik Roy: Last week, Vermont Governor Peter Shumlin (D.) announced that he was pulling the plug on his four-year quest to impose single-payer, government-run health care on the residents of his state. “In my judgment,” said Shumlin at a press conference, “the potential economic disruption and risks would be too great to small businesses, working families, and the state’s economy.” The key reasons for Shumlin’s reversal are important to understand. They explain why the dream of single-payer health care in the U.S. is dead for the foreseeable future—but also why Obamacare will be difficult to repeal.

Leading left-wing economists worked on Vermont plan

Sarah Dutton, Jennifer De Pinto, Anthony Salvanto and Fred Backus: Fifty-two percent of Americans say they find basic medical care affordable, but that’s down from 61 percent last December. Today, for 46 percent of Americans, paying for medical care is a hardship, up 10 points.

Similarly, just over half of Americans are at least somewhat satisfied with their health care costs, while 43 percent are dissatisfied.

WASHINGTON – Trying to head off a new round of consumer headaches with President Obama’s health care law, the insurance industry says it will give customers more time to pay their premiums for January.

America’s Health Insurance Plans, the main industry trade group, says the voluntary steps include a commitment to promptly refund any overpayments by consumers who switched plans and may have gotten double-billed by mistake.

Over the past year, the ranks of people working part-time jobs by choice — as opposed to business-driven factors — has grown by more than one million, the fastest pace in at least two decades.

The timing with ObamaCare’s first year of subsidies to buy health insurance is likely more than coincidental. While analysts on the left and right have sparred over whether businesses have shifted to part-time jobs to limit liability under ObamaCare, no one disputes that the law will lead more people to choose to work part-time. Any disagreement is over whether the law should get credit for making less work possible or blame for making work less financially rewarding.

By Bruce Parker | Vermont Watchdog

Jonathan Gruber’s health care forecasting is failing in Colorado as Vermont’s Gov. Peter Shumlin prepares to use the economist’s math for single-payer health care.

As Vermonters anxiously await a Gruber-modeled financing plan for Green Mountain Care, modeling done for Colorado’s health exchange by Jonathan Gruber Associates has proven wildly erroneous.

By Stephanie Armour:
Some free health clinics serving the uninsured are shutting their doors because of funding shortfalls and low demand they attribute to the Affordable Care Act’s insurance expansion.

Nearly a dozen clinics that have closed in the past two years cited the federal health law as a major reason.

The closings have occurred largely in 28 states and Washington, D.C., which all expanded Medicaid, the federal-state insurance program for low-income people, and are being heralded by some clinic officials as a sign the health law is reducing the number of uninsured.

Continued at… http://www.wsj.com/articles/health-law-hurts-some-free-clinics-1418429551

By Sam Baker and Sophie Novack:
Republicans want the Supreme Court to blow a major hole in Obamacare next year, but they are still debating whether they would help repair it—and what they should ask for in return.

There’s a very real chance the high court will invalidate Obamacare’s insurance subsidies in most of the country, which would be devastating for the health care law. It would become almost entirely unworkable in most states, and the cost of coverage would skyrocket.