As the debate continues in Virginia over whether to expand Medicaid, it is crucial to look at what the outcome has been for other states that have already expanded their programs. Thirty-one states have taken this step under the provisions laid out in the Affordable Care Act. The ACA expanded Medicaid eligibility to able-bodied adults below 138 percent of the federal poverty level, and covered 100 percent of the cost of the expansion enrollees for the initial period. That percentage declines, and by the year 2020 the federal government will only cover 90 percent of the cost of expansion enrollees. With funding after that unclear, residents of Virginia will face an unknown future of Medicaid. Given the facts staring back at us, why would any Virginian support expanded coverage?

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For the better half of a decade, lawmakers in Washington have been experimenting with the nation’s healthcare policy in an attempt to bring coverage to all Americans, while controlling costs and sustaining quality. The Affordable Care Act was the climax of such attempts.

While the ACA did bring some positive ideas to the table—such as giving more Americans the ability to enjoy health insurance and protecting people with pre-existing conditions from predatory premiums—it fell short in many other aspects.

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Should Republicans be worried that they will lose control of the House in 2018 because they adopted legislation that repeals Obamacare? Don’t bet on it. Under the current House bill, states could let insurers take a person’s health status into account when deciding how much to charge in premiums. According to the media narrative, this would take away coverage from those with pre-existing conditions. The public furor over this allegation is predictable, but that does not make pre-existing conditions an existential threat to Republican political chances in the next election. The GOP plan protects everyone who remains continually covered by health insurance and they cannot be charged more if they have a pre-existing condition.

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The American Health Care Act eliminates Obamacare’s taxes and mandates that are crushing small businesses in my home state of Tennessee and around the country. It is a once-in-a-generation entitlement reform, saving and strengthening Medicaid so that it can continue to serve the most vulnerable Americans but doesn’t incentivize a culture of dependency. And it brings free-market competition into the health care marketplace to bring down costs and improve the quality of care while continuing to protect those with pre-existing conditions.

Creating good policy in Congress is not always easy, and we never get everything we want. That’s why this bill is far from perfect. But it is a good first step and this is a particularly proud moment for me.

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In presidential politics, party professionals on both sides of the aisle live in fear of the dreaded “October surprise” that can compromise their candidates’ chances.

In 2016, the joker in the deck may come the first week of November — and it won’t be a surprise, just a shock: Fueled by the requirements of the Affordable Care Act, Americans’ health insurance premiums are likely to spike.

The policy debates that preoccupy Beltway insiders are often far removed from the concerns of most American voters. The Export-Import Bank, the intricacies of the Dodd-Frank financial regulatory requirements, quantitative easing, and rules promulgated in obscure administrative agencies — this is not the stuff of middle-class anxiety. While such policy and regulatory decisions do affect citizens nationwide, it’s not always immediately obvious how. Not so jobs, wages, schools, and health care — these issues hit home.

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The Senate voted to repeal the Affordable Care Act and defund Planned Parenthood Thursday evening, clearing a nearly six-year hurdle that kept previous attempts to undo the health care law from reaching President Obama’s desk. Though the president has vowed to veto the bill, it passed 52-47. The legislation would repeal major parts of the president’s signature policy achievement, including the individual and employer mandates and Medicaid expansion, which would be aborted after a two-year delay.