Mr. Trump and congressional Republicans are hoping the Labor Department will identify a way to allow associations and small employers to create self-insured plans—or something similar. That change could allow them to adjust benefits and offer more affordable coverage to more people. Since the passage of ObamaCare, however, states are no longer the driving force behind most insurance mandates and regulations. Washington is. A more straightforward solution would be for Congress to change the law.
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Conservatives are supposed to get two wins in the Alexander-Murray bill. The first is the creation of “copper” plans within the Obamacare exchanges. Moderate Democrats have championed this idea as a way for consumers to buy plans with lower premiums and higher deductibles than others available on the exchange. But because the plans would still be subject to Obamacare’s regulations, they would still be a far cry from the low-cost catastrophic plans that conservatives would like to see. The deal also gives states a little more flexibility — but constrains that flexibility in a way that makes it valueless. States would have to show that any policy changes they make would lead to a comparable number of people having the same kind of comprehensive coverage that Obamacare seeks to foster. But that’s not the kind of coverage conservatives want to make the focus of public policy.
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President Donald Trump will support a bipartisan bill on health care only if it includes a series of conservative measures that Republicans sought in their failed effort to repeal the Affordable Care Act, a White House spokesman said Thursday, as two senators officially unveiled the legislation without many of those demands. In order for Mr. Trump to support such legislation, it must provide relief from the ACA’s requirement that most people have health coverage or pay a penalty, the spokesman said Thursday. It should also roll back or end the requirement that certain employers provide health coverage, the White House official said.
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Despite President Trump’s mixed messages, key senators unveiled their bipartisan plan Thursday to stabilize health insurance markets, drawing widespread support.
Sen. Lamar Alexander (R-Tenn.), chairman of the Senate Health committee, and the top Democrat on the panel, and Sen. Patty Murray of Washington jointly announced 22 bipartisan co-sponsors to their effort, more than typical for a bill.
Alexander noted that Trump, too, continued to encourage him to push forward. The president called the senator twice Wednesday, even after speaking critically of the plan.
“I want to thank him for his encouragement,” Alexander said.
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At the core of Medicaid’s troubles is its provider reimbursement system, which is based on price controls. In general, it pays rates substantially less than those of private insurance and can even be less than the cost to deliver that care. According to a Kaiser Family Foundation analysis, in 2016, Medicaid reimbursed physicians across the country 72 percent of Medicare rates for all services and 66 percent of Medicare rates for primary care. In general, Medicare rates are already less than those of private insurance. With noncompetitive reimbursement and the administrative hassle of the program, many providers are reluctant to accept Medicaid patients.
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