Republican legislators and policy experts are kicking around a novel way to increase health coverage: automatically enrolling millions of uninsured Americans into low-cost insurance plans.
The idea has shown up on the opinion pages of the Wall Street Journal and been discussed in private meetings of the Senate working group on health care.
“It’s a viable idea,” says Andy Slavitt, who ran Medicare under President Obama and is an ardent Affordable Care Act advocate. “What’s appealing about it to Republicans and to Democrats is you want people to have free choice but not be free riders.”
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The Trump administration and House of Representatives Monday asked a federal court for another 90-day delay in a lawsuit over Obamacare insurance subsidies. “The parties continue to discuss measures that would obviate the need for judicial determination of this appeal, including potential legislative action,” the House and White House wrote to the court. If the request is approved, the parties would have to file another update in 90 days. “We continue to work with the Trump administration on a solution,” said AshLee Strong, spokeswoman for House Speaker Paul Ryan.
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The Senate GOP will need to produce a bill that can claim to have significantly changed Obamacare, achieve at least the same amount of cost savings as the House bill did through the budgetary reconciliation process, and that will be able to garner support in both the Senate and the House. The Senate will also need to fix the simple fact that the age-adjusted, fixed-dollar tax credits to subsidize insurance coverage in the AHCA are too simple and insensitive to the income-related health needs of lower income Americans.
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GOP senators say they’re discussing a possible short-term bill if their health care talks drag on. It might include money to help stabilize shaky insurance markets with subsidies to reduce out-of-pocket costs for low-earning people and letting states offer less expensive policies. It’s unclear Democrats would offer their needed cooperation, but Republicans are talking about it. “We’ve discussed quite a bit the possibility of a two-step process,” said Sen. Lamar Alexander (R-TN), chairman of the Senate Health, Education, Labor and Pensions Committee. “In 2018 and ’19, we’d basically be a rescue team to make sure people can buy insurance.”
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House Republicans may face the possibility of having to vote again on the American Health Care Act (AHCA), which passed the House earlier this month. House Speaker Paul Ryan hasn’t yet sent the bill to the Senate because there’s a chance that parts of it may need to be redone, depending on how the Congressional Budget Office (CBO) estimates its effects. House leaders want to make sure the bill conforms with Senate rules for reconciliation, a mechanism that allows Senate Republicans to pass the bill with a simple majority. The CBO is expected to release an updated estimate next week.
The American Health Care Act (AHCA), which passed the House earlier this month, is a health care revolution. It isn’t about returning to the way things were. It’s about asking the country to imagine a system that has never existed before. Instead of offering a plan centered on Washington, D.C., the AHCA is centered on you. It empowers you and respects your relationship with your family and your doctor. It delivers to you increased access, benefits, choices and health savings. The opposition has been so intense precisely because the plan is so ambitious. One bogus argument government elites are using is the claim that thousands of Americans with pre-existing conditions will die if the AHCA becomes law. Actually, the bill includes “continuous coverage” protections for people with pre-existing conditions. For anyone with continuous coverage, pre-existing conditions do not apply.
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More than a dozen states and the District of Columbia filed a motion on Thursday to intervene in the appeal of a lawsuit targeting the ACA’s cost-sharing reduction (CSR) subsidies. The lawsuit was originally brought by the U.S. House of Representatives against the Obama administration, which the Trump administration must now deal with. The Kaiser Family Foundation has estimated that the average premiums for silver plans sold on the ACA exchanges would increase by about 19% to compensate for insurers’ lack of funding without the CSR payments. The Trump administration and the House are set to update the court on Monday on how they plan to proceed with the case.
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Those advocating for universal health coverage know very well that resources are limited, and that costs must be contained. They also understand that the burgeoning bureaucracy must be well paid. So the answer is to cut services. Some plans “incentivize” doctors to make more money by skimping on care. Others call for a “global budget”—the deliberate creation of scarcity. When the money is gone, treatment is canceled. There will be fewer beds, fewer CT scanners, fewer drugs, and fewer doctors. But all will be fair. No rationing by price, just by waiting lines, political pull—and death. There will be no medical bills to pay after a service, if you get any service. Only taxes in advance, service or no service.
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The Trump administration took another step Wednesday toward deregulating federal insurance exchanges created under the Affordable Care Act.
For coverage in 2018, consumers can buy an ACA-approved plan directly from a broker or an insurer’s website instead of having to go through HealthCare.gov, the CMS announced. The news comes just two days after small businesses were given permission to skip the federal marketplace to sign their employees up for SHOP coverage.
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Now that the House of Representatives passed a revised version of the American Health Care Act (AHCA) to replace the Affordable Care Act (ACA) the ball is in the Senate’s court. Despite calls to start from scratch, the Senate would be well advised to work off the structure of the AHCA. AHCA provides a solid foundation that could be improved with some tweaks. It repeals the ACA’s unpopular individual and employer mandates and penalties but preserves its well-liked protections for people with pre-existing conditions, the ban on lifetime coverage caps, coverage for children up to age 26 on their parents’ insurance and coverage of essential health benefits.
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