Donald Trump hadn’t been president-elect for a week when he appeared to abandon his oft-repeated pledge to repeal Obamacare in its entirety. In interviews with the Wall Street Journal and 60 Minutes, Trump appeared to want to keep, or at least to be willing to accept, the Affordable Care Act’s centerpiece: it’s supposed prohibition on discrimination against health-insurance applicants with pre-existing conditions. Ramesh Ponnuru, my friend and a senior editor of these pages, says the downside of Trump’s triangulation is that retaining those provisions “makes it much, much harder to get rid of the individual mandate” — as if the mandate were the bigger problem. On the contrary, the pre-existing-conditions provisions are the centerpiece of Obamacare.
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Colorado voters rejected a ballot measure that would have created a first-in-the-nation single-payer health insurance system, a significant setback for progressive proponents of universal health care.
Tuesday’s defeat of Amendment 69 was decisive, as predicted. Polling ahead of Election Day showed that two-thirds of residents opposed the measure, which would have established a program called ColoradoCare to cover most people in the state.
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Democrats are already panicked that Donald Trump will repeal ObamaCare and throw millions of people off the subsidy rolls, while some conservatives seem panicked that the President-elect will renege on his campaign promises and millions of people won’t be thrown off the entitlement. Like most inflamed political questions after Mr. Trump’s victory, the health-care debate would benefit from some perspective.
“Either ObamaCare will be amended, or repealed and replaced,” Mr. Trump told the Journal last week, and on “60 Minutes” on Sunday he added that “we’re not going to have a two-year period where there’s nothing. It will be repealed and replaced.” Mr. Trump is being more subtle than his critics.
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Not all of Obamacare would be “shut right down” once the unified Republican government takes power next year, House Majority Leader Kevin McCarthy said Monday.
“You wouldn’t have everything shut right down. … You wouldn’t take everything away,” the California Republican told reporters on Capitol Hill.
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In an ongoing backdoor attempt to pay off insurers burned by President Barack Obama’s signature legislation, the Affordable Care Act, the Obama administration is creating the framework needed to implement a “public option,” the precursor to a single-payer health-care system. Distracted by the presidential election and the news that ACA insurance premiums will increase by an average of 25 percent in 2017, many have failed to notice the administration’s plan to use a special U.S. Department of Justice fund, called the Judgment Fund, to funnel billions of dollars to insurers without congressional approval. If it successfully executes this plan, the Centers for Medicare and Medicaid Services will have circumvented Congress to secure a taxpayer bailout for insurers — directly contradicting Congress’s intentions as expressed by multiple spending bills, and possibly violating federal law.
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Republicans could pass a budget reconciliation bill that gradually sunsets the law, preserving its subsidies and Medicaid expansion for a time while they agree on a replacement. They’ve already got a script for that approach, after passing a reconciliation bill last January which President Obama vetoed.
Or Congress could pass a replacement plan right away by coupling it with a repeal bill, although it’s questionable Republicans could find consensus in such a short timeframe.
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Over the past few years, pundits have dismissed the Republican Party’s chances of repealing and replacing Obamacare. But with President-elect Donald Trump’s victory Tuesday and the GOP’s successful effort to keep control of Congress, conservatives now have a real chance to eliminate the health care law. The question is how to do it.
Three years into its implementation, the Affordable Care Act has clearly failed. The law has wrecked the individual market for health insurance—premiums have soared, coverage has been canceled en masse, and choices have been drastically curtailed. The cost of the law’s major coverage provisions—Medicaid expansion and subsidies for plans purchased through the exchanges—have soared. In fact, the per enrollee cost of the Medicaid expansion is nearly 50 percent above estimates.
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In a move virtually ignored outside Washington and largely unnoticed even within it, last December the House and Senate passed legislation repealing much of Obamacare. President Obama promptly vetoed the measure — an obstacle that will disappear come January 20. As reporters and policymakers attempt to catch up and learn the details of a process they had not closely followed, three important lessons stand out from last year’s “dry run” at repealing Obamacare.
Republicans’ path on Obamacare could prove more complicated than the new conventional wisdom in Washington suggests. If past is prologue, last year’s reconciliation bill provides one possible roadmap for how the congressional debate may play out.
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A total repeal of ObamaCare will prove difficult — but there’s plenty Donald Trump and his fellow Republicans can do to effectively dismantle President Obama’s signature domestic program.
Trump could exempt more people from the individual mandate to buy insurance, and his administration could stop assisting consumers with enrollment.
If the government stops fighting a lawsuit that’s trying to put an end to subsidies for low-income people’s bills, insurers’ costs would go up, and they could choose to drop out of the markets.
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The Wall Street Journal, The Washington Post, CBS News and other news outlets have led with headlines over the weekend touting the big news that Donald Trump is willing to keep parts of the Affordable Care Act––notably the pre-existing condition protections and the ability for children up to the age of 26 to stay on their parents policies.
In May, Trump’s policy advisor told Healthline that a Trump administration would consider keeping the children to age 26 provision.
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