House leaders set to repeal and replace Obamacare on Thursday

Republican leaders plan a vote Thursday to repeal and replace much of Obamacare, optimistic that President Donald Trump can help them close the deal, multiple House Republican sources tell CNN.

Leaders continue to work toward the 216 votes needed to back the health care bill led by House Speaker Paul Ryan, and believe with some of the changes they are making they are securing additional support.
Friday morning, members of the Republican Study Committee — who have expressed serious doubts about the House’s health care bill — emerged from a meeting at the White House supportive.
“You’re looking at some of the top conservatives in the House,” he said. We stand united today to move this forward for the American people,” the chairman of the Republican Study Committee Mark Walker, R-North Carolina, told reporters Friday morning.
The timeline is still fluid and subject to change, but Republican members are being told that the current House bill is on track and being reworked to include the option for states to impose work requirements for able-bodied adults who are on Medicaid, something the RSC has been lobbying for. The RSC also was told, according to a GOP aide, that states were given the option to receive block grant funding rather than per capita funding.
Changes may also include making tax credits for older Americans more generous, an item that could win over some moderates.
In tinkering around the edges, leadership is optimistic that they can cobble together enough votes from both corners of their party to pass their legislation next week and move it onto the Senate where it faces another set of challenges and even more narrow math.
Trump said Friday he is “100% in favor” of the health care measure.
“I just want to let the world know I am 100% in favor and these folks — and they are tough and they love their constituents and they love their country — these folks were nos, mostly nos yesterday and now every single one is a yes,” the President said.
Thursday is the seventh anniversary of President Barack Obama signing the Affordable Care Act into law.

House Republicans unveil bill to dismantle Obamacare

Long-awaited legislation to dismantle Obamacare was unwrapped on Monday by U.S. Republicans, who called for ending health insurance mandates and rolling back extra healthcare funding for the poor in a package that drew immediate fire from Democrats.

In a battle waged since the 2010 passage of the Affordable Care Act, Democratic President Barack Obama’s signature domestic policy achievement, Republicans including President Donald Trump have long vowed to repeal and replace the law. But they failed for years to coalesce around an alternative.

With a proposal now on the table, the fate of the plan is uncertain even with Republican majorities in both chambers. Also unclear is where Trump stands on many of the details.

“Today marks an important step toward restoring healthcare choices and affordability back to the American people,” the White House said in a statement, adding Trump looked forward to working with Congress on replacing Obamacare.

Republicans condemn Obamacare as government overreach, and Trump has called it a “disaster.”

Critics complained about the penalty the law charged those who refused to buy insurance. The Republican proposal would repeal that penalty immediately.

Congressional Democrats denounced the Republican plan, saying it would hurt Americans by requiring them to pay more for healthcare, to the benefit of insurers.

Obamacare is popular in many states, even some controlled by Republicans. It has brought health insurance coverage to about 20 million previously uninsured Americans, although premium increases have angered some.

About half those people gained coverage through an expansion of the Medicaid program for the poor. The Republican proposal would end the Medicaid expansion on Jan. 1, 2020, and cap Medicaid funding after that date.

Just before the plan was unveiled, four moderate Senate Republicans jointly expressed concern that an earlier draft would not adequately protect those who got coverage under Medicaid, raising doubts about the legislation’s future in the Senate.

Several Senate and House conservatives have already expressed doubt about another aspect of the plan, the offering of tax credits for the purchase of health insurance. The proposal seeks to encourage people to buy insurance with the age-based credits, which would be capped at upper-income levels.

The legislation would abolish the current income-based subsidies for purchasing insurance under Obamacare.

The proposal would protect two of the most popular provisions of Obamacare. It would prohibit insurers from denying coverage or charging more to those with pre-existing conditions, and it would allow adults up to age 26 to remain on their parents’ health plans. Trump has long supported by both ideas.

The measure would also provide states with $100 billion to create programs for patient populations, possibly including high-risk pools to provide insurance to the sickest patients.


The overall cost of the Republican plan, a key issue in a time of high federal deficits, was not yet known, Republican aides said. Two House committees will next review the plan.

Craig Garthwaite of Northwestern University said the proposed tax credits, which would range from $2,000 to $4,000, were “frankly not enough for a low-income person to afford insurance.”

Republicans said the legislation would give Americans the flexibility to make their own healthcare choices, free of Obamacare’s mandate that people buy health insurance and the law’s taxes, including a surtax on investment income earned by upper-income Americans.

“Our legislation transfers power from Washington back to the American people,” House Ways and Means Chairman Kevin Brady said in a statement.

Senate Democratic Leader Chuck Schumer said in a statement, however, that “Trumpcare doesn’t replace the Affordable Care Act, it forces millions of Americans to pay more for less care.”

“Paying for all this is going to be a big issue,” said Joe Antos of the American Enterprise Institute think tank.

“It’s possible that CBO (the Congressional Budget Office) is going to say the Medicaid reductions aren’t enough to offset the revenue losses from repealing all the taxes.”

A hospital group voiced disappointment that lawmakers were willing to consider the measure without knowing how much it cost or how it might affect healthcare coverage.

The proposal “could place a heavy burden on the safety net by reducing federal support for Medicaid expansion over time and imposing per-capita caps on the program,” said America’s Essential Hospitals, which represents hospitals that provide care to low-income and uninsured individuals.


Source: Reuters

Repealing Obamacare could leave 32 million uninsured, says Congressional Budget Office

Republicans still don’t have an official plan to replace Obamacare. You know that already. What you may not realize, though, is that they don’t have a plan to fully repeal Obamacare, either. Because the GOP only controls 52 seats in the Senate, party leaders are planning to partially scrap the law using the budget reconciliation process, which prevents filibusters on tax and spending legislation, but can’t be used to change regulations. As a result, Republicans have a clear path to ending Obamacare’s Medicaid expansion, insurance subsidies, and even the individual mandate (it’s a tax, after all). But without a filibuster-proof 60 votes, they can’t do much about the law’s rules that bar insurers from discriminating against patients with pre-existing conditions and require health plans to cover certain essential benefits.

What would happen if they did that and then failed to replace the law? The Congressional Budget Office and the Joint Committee on Taxation have released a new analysis exploring that question, based on the reconciliation bill that Republicans passed about a year ago as a dry run for Obamacare repeal (and that President Obama vetoed). While the report says its estimates are a bit “uncertain”—modeling massive changes to the health care market is hard to do—they also aren’t pretty. The number of uninsured Americans would rise by about 18 million in the first year after passage. Once the Medicaid expansion and subsidies were gone, the number would hit 27 million, before eventually hitting 32 million in 2026.

One reason the uninsured rate would rise so quickly, according to the report, is that the repeal bill Republicans voted for would immediately end the individual mandate’s tax penalties, which are designed to force Americans to buy coverage. As a result, many healthy Americans would choose to go uninsured. That would leave behind a smaller pool of customers full of sicker patients, forcing insurers to raise their prices—the CBO and JCT predict premiums would rise 20 to 25 percent. Meanwhile, many carriers would probably gaze upon this impending wreck and pull out of the individual market altogether. “As a consequence, roughly 10 percent of the population would be living in an area that had no insurer participating,” the CBO and JCT conclude.

According to the report, the uninsured rate really begins to swell two years after passage, when Obamacare’s Medicaid expansion and insurance subsidies finally sunset. Here’s the report’s final tally of the carnage:

The estimated increase of 32 million people without coverage in 2026 is the net result of roughly 23 million fewer with coverage in the nongroup market and 19 million fewer with coverage under Medicaid, partially offset by an increase of about 11 million people covered by employment-based insurance. By CBO and JCT’s estimates, 59 million people under age 65 would be uninsured in 2026 (compared with 28 million under current law), representing 21 percent of people under age 65. By 2026, fewer than 2 million people would be enrolled in the nongroup market, CBO and JCT estimate.

It is unclear how closely the repeal bill Congress is now concocting will follow the timeline it settled on in last year’s legislation. But one takeaway from all of this is that Republicans in Congress would be absolutely insane to repeal the individual mandate before dealing with other pieces of the law, since that could trigger the sort of immediate market collapse that the “repeal and delay” strategy is meant to prevent in the first place. More broadly, it shows the extent of the disaster that could ensue if the GOP passes partial repeal without a clear path to replacement. They’ll be setting a time bomb without a kill switch. Who wants to bet that will end well?

Trump’s pledge to kill Obamacare, faces reality check.

With his shock victory in the race for the White House, President-elect Donald Trump at last, is in position to deliver on one of his most strident campaign promises: to repeal Obamacare.

With fellow Republicans in control of the US Congress, Trump has the means and ostensibly a mandate from his party to gut the law. But he may find the reality is more challenging.

Exit polls suggest Trump rode to victory in no small part on the support of those battleground state voters who strongly disliked President Barrack Obama’s sweeping health care reforms, especially given rising costs.

However, after Trump met President Barack Obama last week he seemed to backpedal on his intentions.

Candidate Trump vowed to “completely repeal” the Affordable Care Act and describing it as a “total disaster.”

But after his win, President-elect Trump said he hoped to preserve two of the most popular features: allowing children to stay on their parents’ plans until age 26, and forbidding insurance companies from denying coverage to people with pre-existing conditions.

– ‘Death spiral’ –

The latter element is popular even with Republican lawmakers who have attempted on scores of occasions to repeal Obama’s landmark health reform. Trump told the television newsmagazine “60 Minutes” it was “very much something we’re going to try and keep.”

Yet analysts say keeping those features will be difficult if not impossible if Trump’s reform abolishes another key part of Obamacare, the so-called “individual mandate.” That is the requirement that Americans carry health coverage regardless of whether they are sick or healthy.

To cover the cost of providing coverage for sicker patients, health insurers depend on the revenue they get from the healthy enrollees that Obamacare required to buy in.

If that requirement is eliminated, “that’s basically going to cause a death spiral,” Sandy Ahn, a research professor at Georgetown’s Health Policy Institute, told AFP.

As insurers lose income from departing healthy consumers, they will raise premiums, putting coverage out of reach for many.
“The health care markets will look like they did before the Affordable Care Act,” said Ahn.

In fact, problems getting enough healthy young people to sign up for insurance has already contributed to rising premiums. The administration late last month announced that costs will jump by an average of 25 percent next year.

Individual US states already have experience with this dilemma. When Kentucky attempted in the 1990s to guarantee coverage without instituting an individual mandate, it saw 43 of 45 insurance companies flee its market over seven years. Similar outcomes occurred in New York and New Jersey.

Already there are signs that a “Trump effect” is roiling the health care market. In just the day after Trump’s victory, enrollments in the Obamacare individual marketplace surged to 100,000, the government said.

By early next year, providers will have to settle on premium rates but they currently do not know whether the public subsidies that help low-income consumers will exist by then.

Two days after Trump’s victory, America’s Health Insurance Plans, an industry lobby, warned against “sudden disruptions” that could jeopardise “continuous coverage.”

Some in the resurgent GOP may fear a backlash.

“Clearly, we don’t want to do any harm to people already in the system,” Mississippi Republican Senator Roger Wicker told Bloomberg last week.

Since Obamacare took effect, 20 million people gained health coverage, pushing the level of the uninsured below 10 percent, an historic low. And one survey found more than 80 percent of whose who gained coverage are happy with their plans.

Disappointing the base

The Congressional Budget Office estimated about 22 million people would have lost their coverage, with a large share being children and the poor, had congressional Republicans succeeded in repealing Obamacare early this year.

Trump’s softening stance also may cause him problems among supporters.

Michael Cannon, director of health policy studies at the libertarian Cato Institute and a critic of Obamacare, warned Trump risks alienating his most ardent supporters if he fails go through with a full repeal, including eliminating the ban on denying insurance to those with pre-existing conditions.

“That’s going to be a big problem not only for President Trump but also for a lot of congressional Republicans,” he told AFP.

“President Trump could be starting his administration by signalling that he’s no different from anyone else.”

Representatives for Trump and for Paul Ryan, the Republican leader in the House of Representatives, did not respond to requests for comment.

Trump Weighs Cabinet Picks & ‘Amended’ Obamacare

Donald Trump is to huddle Saturday with his White House transition team for a second day over cabinet picks as the president-elect says he is open to keeping parts of President Barack Obama’s signature healthcare law.

The billionaire real estate mogul said in interviews that he would consider an “amended” version of the 2010 law, a shift in position after vowing on the campaign trail to repeal the measure.

The announcement was one of several surprises, as Trump shook up his transition team by putting running mate Mike Pence in charge and named a cohort of Washington insiders — and three of his children — to help with the process of choosing a new cabinet.

The reshuffle came as anti-Trump protesters spilled onto the streets for a third straight night, with the Republican facing mounting calls to reassure Americans who fear a xenophobic crackdown under his authority.

Throngs of people — among them families and children — rallied late Friday in New York’s Washington Square carrying banners reading “Peace and Love” and “Your wall can’t stand in our way.” Local media estimated a turnout of some 4,000 protesters.

More than 1,000 people gathered in Miami, with weekend protests planned in at least half a dozen cities.

A focal point for New York protests is Trump Tower, where the real estate tycoon-turned-world-leader has been ensconced in his luxury apartment, mapping out his next steps.

The 70-year-old incoming president has a mammoth task of fleshing out his cabinet, as well as steering the complex transition of power, and announced on Friday he was elevating Vice President-elect Pence to lead the process.

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After Trump Repeals Obamacare, What Next?

Republican President-elect Donald Trump vowed on the campaign trail to repeal Obamacare, but making good on that promise may be easier said than done.

President Barack Obama’s 2010 national healthcare reform law extended medical insurance to 25 million more people by expanding the Medicaid plan for the poor and creating subsidized coverage for individuals.

Republican lawmakers, who have voted more than 50 times to repeal all or part of the law, have begun pressing Trump to deliver. Senate Majority Leader Mitch McConnell said on Wednesday repealing Obamacare is a “pretty high item on our agenda” for the new Congress.

But a complete repeal of Obama’s Affordable Care Act may not be immediately in the cards, as Republican lawmakers now hold 51 seats in the Senate at latest count, well short of the 60 seats required to overturn it.

Instead, health policy experts said, Trump could try to dismantle key elements through a process called budget reconciliation. That would allow him to eliminate funding for the income-based subsidies that make the new insurance plans affordable, or cut the money providing expanded Medicaid benefits in 31 states.

“Some of the policy experts on the Republican side would say tearing it up and starting over would be very disruptive,” said Paul Howard, director of health policy at the conservative Manhattan Institute.

Parts of the law have been weakened through legal challenges. Several of the largest U.S. health insurers have pulled out of the exchanges for individual coverage after losing money on a sicker-than-expected group of patients. Consumers not eligible for government subsidies have seen premiums rise sharply, including a projected average increase of 25 percent for 2017.

Scrapping the law altogether without a clear plan for providing replacement coverage for so many people would be politically risky, experts said.

Trump also would face a tight deadline were he to try to dismantle the insurance exchanges by 2018; many state-based health insurance regulators require insurers to submit plans for the upcoming year by April or May – only a few months into a new administration.

Trump also could seek changes to other provisions of the law, such as a tax on medical device makers, or the so-called “Cadillac tax” that is due to hit rich employer-based healthcare plans in 2020.

However, some elements could not be eliminated by depriving the law of funds. For instance, the law prevents insurers from denying coverage to people based on their health or pricing insurance based on gender. Mandatory coverage of preventive benefits also would be unaffected – short of a complete repeal.

It also is not clear if Trump would try to reverse the individual mandate, which requires people to purchase health insurance or pay a penalty. The goal of the requirement was to broaden the pool of policyholders to include more healthy Americans.

Read More: reuters