The Affordable Care Act’s insurance exchanges have become too risky for major health insurers, and that’s creating further doubt about coverage options consumers might have next year.

Anthem CEO Joseph Swedish said Wednesday his company is waiting to see whether the government makes some short-term fixes to the shaky exchanges before it decides how much it will participate next year. The Blue Cross-Blue Shield carrier is the nation’s second largest insurer and sells coverage on exchanges in 14 states.

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President Trump’s statement that his preferred replacement for the ACA would provide health “insurance for everybody” surprised those who have followed the contentious debate over the health care law since its passage in 2010. In recent years, though, Republicans have emphasized that gains in insurance coverage should not be the sole barometer by which health care reform is measured. Rather, the affordability of that coverage is the key to a better health care system with fewer uninsured Americans. For too long, Republicans have shied away from calling for “universal coverage” because they’ve equated it with the Democratic push for a government-run, single-payer health-care system. But that simply isn’t the case. Market-based reforms can both lower costs and lead to health insurance coverage for more Americans. Any market-based replacement to the ACA should: (1) Expand access to consumer-directed coverage arrangements such as health savings accounts coupled with high-deductible insurance plans; (2) Tailor government assistance to individual situations; (3) Give those with preexisting conditions access to mechanisms, such as properly funded high-risk pools, to help them both acquire and afford coverage; and (4) Allow for alternative pathways to private, tax-preferred coverage, by allowing health plans to be sold across state lines, as well as by giving unions, churches or other civic organizations the opportunity to offer coverage to members.

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Uninsured rates in low-income families have fallen under the Affordable Care Act, yet more than a third of Americans continued to face difficulties paying their medical bills in 2016, a survey found.

Adults in poor families were among the greatest beneficiaries of the ACA, with uninsured rates falling as much as 17 percentage points since it became law in 2010, according to a study from the Commonwealth Fund.

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A key House panel on Thursday debated the first draft legislation to replace Obamacare since Donald Trump became president, pledging to repeal his predecessor’s signature health care law.

The Energy and Commerce Health Subcommittee discussed drafts of four bills which each address piecemeal issues within the larger Affordable Care Act, including how to deal with people who have pre-existing health conditions, how much more to charge seniors compared to young people, and how to spur people to keep continuous coverage throughout their lives.

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House Republicans on Wednesday highlighted changes to Medicaid in a series of bills that target eligibility, but got stiff pushback from Democrats who argue the GOP actually wants to cut federal aid to low-income Americans.

A subcommittee of the House Energy and Commerce Committee examined three draft bills that would prevent lottery winners and illegal immigrants from getting Medicaid coverage. Another bill would close a loophole that allows couples to get Medicaid although their income and assets are beyond the threshold for eligibility.

Republicans argued the bills, introduced in earlier Congresses, are needed to reform an entitlement program that has used more and more federal funding.

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Everywhere you turn, health markets are nearing collapse. It’s an unfortunate and catastrophic reality of too much federal intervention in our health care. From soaring deductibles and skyrocketing premiums to fleeing insurers, it’s no wonder patients are paying more out of pocket each year under the so-called “Affordable Care Act.”

Today, the Energy and Commerce Committee’s Health Subcommittee will examine four legislative solutions to help deliver relief. Together, the bills will play an important role in being among the first bricks placed in the rebuilding of our health care system. Collectively, they will give patients relief from the law’s soaring costs, tighten enrollment gaps, and protect taxpayers.

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