Hospitals and health insurers are gaining confidence that their nightmare scenario – millions of Americans instantly losing health insurance once President-elect Donald Trump delivers on a promise to “repeal and replace” Obamacare – is looking more like a bad dream than becoming reality.

The early view from the healthcare sector still includes an end eventually to President Obama’s signature health program.

But Trump’s picks to head the U.S. health department and its top regulator on Tuesday, along with his recent softening on some aspects of the existing law, is a sign to some sector insiders that instead of chaos, an orderly transition of up to three years to replace it with a plan that healthcare companies actually want could be in store.

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Congress may vote to repeal President Barack Obama’s health care law before coming up with a replacement, GOP leaders said Tuesday.

The approach could allow congressional Republicans to take swift action on one of President-elect Donald Trump’s campaign promises, while putting off the hard part. And while repealing the law could be done with GOP votes alone, any replacement plan would likely require the cooperation of minority Democrats in the Senate, something that will not be easy to come by.

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House Republicans are taking pole position in repealing and replacing ­ObamaCare with Donald Trump’s pick of Tom Price as secretary of Health and Human Services.

The Republican lawmaker from Georgia, a confidant of Speaker Paul Ryan(R-Wis.) and Vice President-elect Mike Pence, is a former physician with a deep understanding of both the thorny politics and wonky details of healthcare.

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Substantially more health plans on the federal insurance marketplaces require consumers next year to pay a hefty portion of the cost of the most expensive drugs, changes that analysts say are intended to deter persistently ill patients from choosing their policies. The class of medicines known as specialty drugs treat chronic illnesses such as multiple sclerosis, rheumatoid arthritis, HIV, hemophilia, some cancers, and hepatitis C. Some medicines can cost $10,000 a month. Even a small cost-sharing requirement means patients could have to come up with thousands of dollars to get the medicines.

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The most likely scenario to achieve reform and assure coverage similar to what currently exists is to pass a reconciliation bill similar or identical to the bill passed approximately a year ago. This bill eliminated funding for the Medicaid expansion and the subsidies in the exchange and also includes a two-year implementation delay. Since the majority of newly insured individuals have come from Medicaid rather than the exchanges, this portion of the repeal, unless accompanied by other changes such as a refundable tax credit, would have the largest effect on the newly insured.

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Any Republican attempt to replace the Affordable Care Act must address Medicaid, which has literally become the 800-pound gorilla in the health-care policy room. Simply rolling back the ACA’s Medicaid expansion would spike the number of uninsured Americans and expose Congress and the Trump administration to withering criticism. On the other hand, leaving Medicaid unchanged exposes the federal budget to the program’s unsustainable cost trajectory: Federal Medicaid spending has doubled over the past decade.

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On Tuesday, President-Elect Donald Trump announced that he will nominate Rep. Tom Price (R., Ga.) for Secretary of the U.S. Department of Health and Human Services. It’s a strong pick, and one that increases the likelihood that Republicans will succeed in repealing and replacing Obamacare. Here’s why.

Price, who chairs the House Budget Committee and represents the northern suburbs of Atlanta, has long been one of the House of Representative’s foremost policy wonks. He previously chaired the Republican Study Committee and the Republican Policy Committee, two of the most significant Congressional engines of conservative policy thinking.

And he has long been passionate about, and constructive on, health care reform.

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