The do-or-die moment for the Trump Administration and the GOP Congress arrived on Monday, as House Republicans rolled out their ObamaCare repeal-and-replace bill. The question now is whether they can deliver on their reform promises and govern to improve the lives of American voters.
The American Health Care Act would be the most consequential GOP social-policy reform since the welfare overhaul of 1996. Not only does the bill repair the failures of the Affordable Care Act, it starts to correct many of the government-created dysfunctions that have bedeviled U.S. health care for decades.
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House Republicans released on Monday legislation to repeal and replace the Affordable Care Act, also known as Obamacare.
It fundamentally changes how health care is financed for people who do not have insurance through work, and it eliminates the mandate requiring most Americans to have health insurance, a centerpiece of the Affordable Care Act.
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Progressives are lining up to assail the GOP’s health-care bill, though many on the political right seem to be even more unhappy. A little internal division is inevitable in any reform campaign worth fighting for, but the alternative strategies these conservative critics are suggesting are less than persuasive.
To repeal and replace ObamaCare, Republicans must manage a mix of policy, political and procedural variables that are more complicated than usual. Compromises are necessary to earn 218 votes in the House and then a simple majority among the 52-member Senate GOP conference under the budget reconciliation process, which can bypass the filibuster but limits the scope of what the bill can contain. Call it the art of the deal.
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The Affordable Care Act (ACA) has substantially increased the number of Americans with public and private health insurance coverage. The Assistant Secretary for Planning and Evaluation (ASPE) at the US Department of Health and Human Services estimates that the ACA has resulted in 20 million additional nonelderly adults gaining coverage between the law’s enactment and February 2016. This estimate is likely overstated. Government surveys’ estimates of the number of people who gained coverage between December 2013 and December 2015 vary by 20 percent. Moreover, while the ASPE estimates that the ACA increased the number of young adult dependents with insurance coverage between 2010 and 2013 by 2.3 million, data from government surveys indicate that 1.2 million fewer dependent children had private coverage in 2013 than in 2010, offsetting half the gain in coverage among older dependents. Coverage gains have nonetheless been significant, with most of the increase coming from enrollment surges in Medicaid and the Children’s Health Insurance programs. But a substantial proportion of those who have enrolled in these public programs since 2014 met eligibility standards that predated the ACA. This increase in public coverage may have crowded out private coverage, although further study is needed to determine the existence and magnitude of this effect.
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‘ObamaCare is collapsing,” President Trump said during his address to Congress last week, “and we must act decisively to protect all Americans.” House Republicans have heard the president’s message loud and clear. On Monday night the congressional committees we lead released the American Health Care Act, which will rescue those hurt by ObamaCare’s failures and lay the groundwork for a patient-centered health-care system.
Our fiscally responsible plan will lower costs for patients and begin returning control from Washington back to the states, so that they can tailor their health-care systems to their unique communities. The bill will improve access to care and restore the free market, increasing innovation, competition and choice.
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No single bill will fix all the challenges Medicaid faces, but Congress and the president have a historic opportunity to adopt permanent reforms. Working together with governors and state Medicaid reformers, we can empower states with new statutory flexibilities. We can modernize the waiver process so states can focus on managing their programs based on the needs of their patients, not managing paperwork for the Centers for Medicare and Medicaid Services. We can create better tools and incentives for states to reduce costs, boost quality and improve health outcomes.
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Although letting U.S. patients buy drugs from other countries sounds free-market, doing so would actually import price controls dictated by foreign governments.
President Donald Trump pledged on the campaign trail to allow drugs from foreign countries to be sold in the United States. Although this may sound laissez-faire, the fact is other countries undermine free and fair trade by imposing price controls that would be imported to the U.S. This would further undermine the profit, and thus increase the cost, of developing safe drugs in the U.S., for which manufacturers currently pay $2.6 billion on average per new drug, argues Grace-Marie Turner, president and founder of the Galen Institute, in this Health Care News Podcast Episode, hosted by HCN Managing Michael Hamilton.
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As Congress and the Trump administration move forward with plans to repeal and replace the Affordable Care Act (ACA), they are looking for proven state-led reforms that maintain access for those with pre-existing conditions in the current exchange market while also lowering premiums for everyone buying insurance in the individual market.
Maine faced similar challenges in 2011 as it sought to unwind failed experiments that pushed its market into a long-term death spiral. But by creating an invisible high-risk pool and relaxing its premium rating bands, Maine policymakers were able to cut premiums in half while still guaranteeing those with pre-existing conditions access to plans.
As a result of these changes, individuals in their early 20s were able to see premium savings of nearly $5,000 per year, while individuals in their 60s saw savings of more than $7,000.
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President Donald Trump’s core principles for health care include ensuring that Americans with pre-existing conditions have access to coverage, and that Americans should be able to purchase the health insurance plan they want, not one forced on them by the government. Each of these goals is laudable and achievable, taken separately. But President Trump and others are about to confront what others have learned the hard way: Achieving both goals simultaneously is extremely challenging.
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Given the focus on the disastrous launch of the Obamacare insurance Exchanges in 2013, many people don’t know that most of Obamacare’s coverage gains have come not through those Exchanges, but through a new expansion of Medicaid to able-bodied, working-age adults.
Medicaid was originally intended to provide important safety net coverage to vulnerable populations such as individuals with disabilities, low-income children and the elderly, among others. But Obamacare’s massive expansion of this entitlement to able-bodied adults has placed added strain on an already stressed program in many states.
Even prior to Obamacare, Medicaid stood in desperate need of reform. In many states, low physician reimbursement rates resulted in poor access for beneficiaries. One supporter of the program called a Medicaid card a “hunting license”—the chance for beneficiaries to try to find a doctor who will treat them.
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