President Trump issued an ultimatum on Thursday to recalcitrant Republicans to support the American Health Care Act or see their opportunity to repeal the ACA vanish, demanding a Friday vote on a bill that appeared to lack a majority to pass. The demand, issued by his budget director, Mick Mulvaney, in an evening meeting with House Republicans, came after a marathon day of negotiating at the White House and in the Capitol in which President Trump sought to sell members of his own party on the health plan. House Speaker Paul D. Ryan emerged from the session and announced that President Trump would get his wish for a vote on Friday.

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President Trump has mostly stayed on the sidelines of the messy policy debates regarding health care reform. But amid the war on Capitol Hill among Republican factions, he could seize the opportunity to provide leadership consistent with his campaign message to disrupt existing health policy.

Instead of trying to satisfy the free-market wing of his party, Mr. Trump could push for a solution that delivers on his populist promises by proposing universal catastrophic coverage, ending the specter of medical bankruptcy for many Americans. By providing catastrophic care for all, President Trump could ensure that everyone has an ultimate backstop against medical bankruptcy, while freeing the states to experiment with options for reform. It would also enable the private sector to offer new insurance products to supplement the basic catastrophic care coverage.

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A day after a harsh judgment by the Congressional Budget Office on the House plan to repeal the Affordable Care Act, nervous Senate Republicans on Tuesday suggested changes to the bill. They told Trump administration officials – including the health secretary, Tom Price – that they wanted to see lower insurance costs for poorer, older Americans and an increase in funding for states with high populations of hard-to-insure people.

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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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The Trump administration proposed new rules on Wednesday to stabilize health insurance markets roiled by efforts to repeal the ACA, by big increases in premiums and by the exodus of major insurers. The move came a day after Humana announced that, starting next year, it would completely withdraw from the public marketplaces created under the ACA. The proposed rules, backed by insurance companies, would tighten certain enrollment procedures and cut the health law’s open enrollment period in half, in hopes that a smaller but healthier consumer base will put the marketplaces on sounder financial footing and attract more insurance companies in states with limited choices.

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The U.S. Senate approved the nomination of Representative Tom Price (R-GA) to be Secretary of Health and Human Services early this morning by a vote of 52 to 47. As secretary, Price will be responsible for a department with an annual budget of more than $1 trillion and will put him in charge of President Trump’s efforts to repeal and replace Obamacare.

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About 27 percent of people under 65 are thought to have some sort of pre-existing condition that will most likely leave them without individual insurance if the law is repealed, according to a recent study. The guarantee of coverage has already become a rallying cry for people who want to keep the law.

The issue “is the third rail” for the Republicans, said Michael Turpin, a longtime health industry executive.

Before the law, a fairly typical life event — like a divorce or the loss of a job — and a relatively minor medical condition could upend a person’s health coverage options. Stories of sick people unable to get coverage when they needed it most were legion.

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The American health care system is not like a normal market. When you make most health care decisions, you don’t get much information on comparative cost and quality; the personal bill you get is only vaguely related to the services; the expense is often determined by how many procedures are done, not whether the problem is fixed. Republicans are going to try to introduce more normal market incentives into the process. They will likely rely on refundable tax credits and health savings accounts to ensure that everybody can afford to shop for their own insurance and care.

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Industries that were integral to the creation of the ACA are keeping their voices down as Republicans quickly dismantle it. The speed of Republican efforts to repeal the ACA has stunned health industry lobbyists, leaving representatives of insurance companies, hospitals, doctors and pharmaceutical makers struggling for a response to a legislative quick strike that would upend much of the American health care system. Given that repeal is forthcoming, the health care industry is staying relatively silent on the binary question of repeal, but is expected to get more heavily involved on the nature and details of replace.

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President-elect Donald J. Trump demanded on Tuesday that Congress immediately repeal the Affordable Care Act and pass another health law quickly. His remarks put Republicans in the nearly impossible position of having only weeks to replace a health law that took nearly two years to pass.

“We have to get to business,” Mr. Trump told The New York Times in a telephone interview. “Obamacare has been a catastrophic event.”

Mr. Trump appeared to be unclear both about the timing of already scheduled votes in Congress and about the difficulty of his demand — a repeal vote “probably some time next week” and a replacement “very quickly or simultaneously, very shortly thereafter.”

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