Five Republican-led states and several provider groups are suing to block a new Obamacare rule that’s meant to prevent health care providers and insurers from discriminating against transgender patients.

The five states — Texas, Wisconsin, Kentucky, Nebraska and Kansas — and the provider groups argue that the nondiscrimination rule requires doctors to perform gender transition procedures even when they are against the doctor’s medical judgment.

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An Arizona county is poised to become an Obamacare ghost town because no insurer wants to sell exchange plans there.

Aetna’s recent announcement that it would exit most of the states where it offers Obamacare plans leaves residents of Pinal County, Arizona, without any options to get subsidized health coverage next year, unless regulators scramble to find a carrier to fill the void between now and early October.

About 9,700 people in Pinal signed up for Obamacare plans this year, according to administration data.

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At the start of 2015, Marilyn Tavenner held one of the most important jobs in health care: Implementing Obamacare, as the head of CMS. Six months later, she’d swapped it for a completely different major role: Lobbying to change Obamacare, as the head of America’s Health Insurance Plans.

It’s an unusual career shift, and it’s given Tavenner — a long-time government official turned top lobbyist — a rare perspective on the changes unfolding in the industry.

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Anthem fought back against an Obama administration antitrust lawsuit on Wednesday by conditioning its expansion in the struggling Obamacare market to approval of its acquisition of Cigna. The company plans to add nine states to its Obamacare participation if the deal goes through, company officials said on a call with investors. Last week, the Department of Justice sued to block Anthem’s proposed $54 billion acquisition of Cigna and also filed suit against Aetna’s planned $37 billion takeover of Humana.

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More than six years of efforts by Republican and other right-of-center opponents to repeal, replace, or substantially reshape Obamacare have fallen short.

The strategic options ahead for Obamacare critics on the right are:

  • Rinse and repeat: more of the same
  • Gamble on a more ambitious long-shot strategy
  • Adapt tactically in the near term, to minimize future damage

House Republicans released their latest plan – “A Better Way” – to repeal and replace the Affordable Care Act last month. It blends all three of the strategies above, but its lite brew for reform remarkably manages to be both too cautious and too unrealistic all at once.
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President Barack Obama and Hillary Clinton over the past week have both called for a new government-run insurance option. But the “public option”— which some Democrats have been trying to enact since health law negotiations in 2009 — isn’t a panacea for the problems plaguing Obamacare, Harvard expert Katherine Baicker tells POLITICO’s “Pulse Check” podcast.

“More competition in insurance markets is a great idea,” Baicker said. “It’s not clear to me that the public option is going to be an effective way to introduce that competition.”

Baicker, a respected economist who served on President George W. Bush’s Council of Economic Advisers, has standing to weigh in: In the JAMA article where Obama laid out his public option earlier this week, no expert was cited more than her.

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The word is right there in the name of the law: “Affordable.” The ACA promised to bring health insurance down to earth, letting uninsured people buy policies that didn’t break the bank, and bringing the astonishing cost of medical care into reach for all Americans.

What’s becoming clear, three years in, is that “affordable” depends where you look. Twenty million more people are covered and tens of millions of others have broader benefits because of Obamacare. But many insurers, faced with new coverage requirements and competition on premiums, have shifted costs onto consumers.

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If you’re looking to find a smashing Obamacare success story—a place where the nation’s biggest and most controversial new law in a generation has truly lived up to its promise—you might stick a pin directly in North Carolina.
The central pledge of the Affordable Care Act was to make insurance available to people who didn’t have it, creating a new safety net for millions nationwide. And in North Carolina that’s exactly what happened. People flocked to the program: More than 600,000 people there signed up for Obamacare policies in 2016, and roughly 90 percent of those got financial help to pay their insurance bills, also through Obamacare. Thanks directly to the ACA, the number of people without health insurance in North Carolina has plummeted by 30 percent in the past three years. Far more people are covered, and far more of them can afford their health insurance.

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Sen. Lamar Alexander says he’s more than happy to strike deals with Democrats — even on Obamacare.

“Whoever the president is in January, we’re going to have to take a good, hard look at Obamacare,” the powerful chairman of the Senate HELP committee told POLITICO’s “Pulse Check” podcast. “It can’t continue the way it is.”

Alexander laid out several changes that he’d like to see in health care: Less government “management,” more support of private sector innovation and more flexibility for states on Medicaid. He also credited House Speaker Paul Ryan’s recent white paper that summarized Republican health care proposals as a “helpful” starting point, though he didn’t explicitly endorse the House GOP’s insistence on replacing the whole law.

John McCain is running for reelection like it’s 2010.

The Arizona Republican has made his opposition to Obamacare — which dominated Senate races across the country six years ago — a central point of his campaign, by all accounts, the toughest reelection fight of his career.

He’s betting that shrinking coverage options and premium increases that could go as high as 65 percent if insurers get their way will resonate with Arizona voters, even as most of his Republican colleagues running this year have moved on to other issues.

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