Affordable Care Act aka Obamacare 2017

See also Affordable Care Act aka Obamacare 2012-16
The problem isn’t Obamacare; it’s the insurance companies

28 October
(Brookings) No evidence of a health care market “death spiral.” After years of losses, U.S. health insurance providers were back on track financially in 2017, until the Trump administration took actions that destabilized the market. In a new analysis, Matthew Fiedler estimates that premiums are likely to increase substantially more than they would have in a more stable policy environment.

17 October
GOP senator announces deal on health insurer payments
The [bipartisan] deal would extend key Obamacare payments to insurers for two years and give states more flexibility to change Obamacare rules.

13 October
15 states sue over Trump-halted ObamaCare payments
(The Hill) The complaint will seek a temporary restraining order, preliminary injunction and permanent injunction requiring the cost-sharing reduction payments be made.

12 October
Trump healthcare order could face strong legal objections
(Reuters) – U.S. President Donald Trump’s expected plan to let Americans buy insurance across state lines could violate federal law governing employee benefit plans and will almost certainly be challenged in court, several legal experts said.

10 October
Trump could make waves with health-care order
Trump’s order, expected as soon as this week, would allow small businesses or other groups of people to band together to buy health insurance. Some fear that these Association Health Plans (AHPs) would not be subject to the same rules as ObamaCare plans, including those that protect people with pre-existing conditions.
That would make these plans cheaper for healthy people, potentially luring them away from the ObamaCare market. The result could be that only sicker, costlier people remain in ObamaCare plans, leading to a spike in premiums.

7 October
Trump sabotage seen on ObamaCare
(The Hill) The administration has cut funding for advertising and outreach by 90 percent, raising the odds that fewer people will join the health-care exchanges in the fall enrollment period. It has also chopped the enrollment period in half and plans to take down the Healthcare.gov site for maintenance at a critical time for sign-ups.

22 September
Atul Gawande: If the U.S. Adopts the G.O.P.’s Health-Care Bill, It Would Be an Act of Mass Suicide
(The New Yorker) The fundamental thing to understand about Senate Republicans’ latest attempt to repeal Obamacare is that the bill under consideration would not just undo the Affordable Care Act—it would also end Medicaid as we know it and our federal government’s half-century commitment to closing the country’s yawning gaps in health coverage. And it would do so without putting in place any credible resources or policies to replace the system it is overturning.
When he was governor of Massachusetts, it was Mitt Romney, a conservative, who brought Republicans and Democrats together to make a viable state system of near-universal coverage. That system then served as a model for the A.C.A. The results have been clear: increases in coverage have markedly improved people’s access to care and their health. For the last four years, health-care costs in Massachusetts have risen more slowly than the national average—while the national numbers themselves have been at historic lows. I have not seen a single uninsured patient—zero—in a decade. And now comes an utterly reckless piece of legislation that would destroy these gains.

15 August
(NYT evening brief) If President Trump makes good on his promise to “let Obamacare implode,” premiums would rise by as much as 20 percent, the Congressional Budget Office said.
Mr. Trump’s threat to cut subsidies, which are paid to insurance companies for the benefit of low-income people, would also increase the deficit by $194 billion in the coming decade.
“About 5 percent of people live in areas that would have no insurers” in the individual insurance market in 2018, according to the budget office.

28 July
(Quartz) The “skinny” repeal of Obamacare failed in a late-night US senate vote. It was senator John McCain who cast the decisive “no” vote, ending the months-long Republican effort to repeal some elements of the 2010 Affordable Care Act. This effectively leaves the GOP without any clear next steps and no significant legislation pushed through in Donald Trump’s first seven months in office.
(NYT Opinion) Phew.
The effort to take health insurance from millions of people — an effort opposed by doctors, nurses, scientists, public-health workers and a strong majority of the American people — failed last night.
It failed by the slimmest of margins: a single vote. It failed because every single Democratic senator voted against it, as did three Republicans, including an ailing John McCain of Arizona.
Above all, it failed because Congressional Republicans and President Trump never developed a real health care plan. They developed a make-believe plan, made up of lies about Obamacare and talking points about their own plan that were unconnected to reality.

26 July
(The Atlantic) Health-Care Hardships: Republican senators’ successful motion to proceed in debate marks a legislative victory for the president: Just as it did with the House health-care bill, his refusal to let lawmakers move on revived legislation that was widely considered too unpopular to pass. The Senate still isn’t making much headway, however. After several Republicans rejected a broad repeal of Obamacare, the party’s leaders are scrambling to put together a plan they can agree on. If the tangle of plans and procedures has you confused, here’s a primer on the process the senators will need to follow.
Dave Leonhardt of the NYT writes in the Morning Brief:
Senate leadership wants to pass a bill this week, Marianna Sotomayor of NBC reported. One worrisome possibility, as Senator Chris Murphy noted, is the Senate passing a bare-bones bill, under the guise of fixing it during so-called conference negotiations with the House. That would almost certainly lead to massive losses in insurance coverage.

17-18 July

UNITED STATES – JUNE 04: Mitch McConnell R-Ky. holds a press conference on campaign finance reform. (Photo by Douglas Graham/Congressional Quarterly/Getty Images)

Mitch McConnell’s Obamacare repeal plan stalled
(CNN) Another day — another excruciating setback for the Republican Party.
Three Republican senators [all women: Lisa Murkowski of Alaska, Shelley Moore Capito of West Virginia and Susan Collins of Maine]  said Tuesday that they would oppose a procedural vote to advance the Senate’s efforts to overhaul Obamacare, once again plunging into chaos Senate Majority Leader Mitch McConnell’s latest efforts to make good on the GOP’s seven-year campaign promise to gut the Affordable Care Act.
Those revelations came just hours after McConnell was forced to concede that his original attempt to repeal and replace the health care law at the same time was no longer a viable strategy.

Health Care Overhaul Collapses as Two Republican Senators Defect

Good summary of the battle over ObamaCare
(NYT) With four solid votes against the bill, Republican leaders now have two options.
They can try to rewrite it in a way that can secure 50 Republican votes, a seeming impossibility at this point, given the complaints by the defecting senators. Or they can work with Democrats on a narrower measure to fix the flaws in the Affordable Care Act that both parties acknowledge.
Senator Mitch McConnell, the Republican leader, conceded Monday night that “the effort to repeal and immediately replace the failure of Obamacare will not be successful.” He outlined plans to vote now on a measure to repeal the Affordable Care Act, with it taking effect later. That has almost no chance to pass, however, since it could leave millions without insurance and leave insurance markets in turmoil.
The Senate Democratic leader, Chuck Schumer of New York, responded to the announcement on Monday by urging his Republican colleagues to begin anew and, this time, undertake a bipartisan effort.
“This second failure of Trumpcare is proof positive that the core of this bill is unworkable,” Mr. Schumer said. “Rather than repeating the same failed, partisan process yet again, Republicans should start from scratch and work with Democrats on a bill that lowers premiums, provides long-term stability to the markets and improves our health care system.”
Mr. McConnell has now failed twice in recent weeks to roll out a repeal bill and keep his conference together for it. He first wanted to hold a vote in late June, only to reverse course after running into opposition.
“Make no mistake, Paul Ryan can’t turn back time and undo the damaging vote he imposed on his conference,” said Meredith Kelly, a spokeswoman for the Democratic Congressional Campaign Committee. “House Republicans all own a bill that would strip health care from 23 million Americans and raise costs for millions more, and it will haunt them in 2018.”

Old Truth Trips Up G.O.P. on Health Law: A Benefit Is Hard to Retract

(Reuters) Hospitals in rural communities across America are scaling back services to save on insurance and staffing costs, and maternity departments are often among the first to get shuttered. More than 200 maternity wards closed between 2004 and 2014 because of higher costs, fewer births and staffing shortages, leaving 54 percent of rural counties across the United States without hospital-based obstetrics, data from the University of Minnesota’s Rural Health Research Center show.

14 July
(The Atlantic) A new study finds the U.S. spends more and performs worse on health care than 11 similar countries do, and suggests the path to improvement is to increase access to primary care. That’s unlikely to come from the revised health-care bill newly released in the Senate, which among other changes would make significant cuts to Medicaid. The bill includes a proposed amendment from Senator Ted Cruz that’s intended to free insurance companies from regulation—but risks creating a dangerously unstable market.

9 July
Single-payer healthcare gains traction with Dems
(The Hill)  What was once considered only a progressive talking point has gained traction as more Democratic candidates have been willing to embrace government-funded healthcare on the campaign trail and more House members have been signing onto the idea.
A Kaiser Family Foundation poll shows a modest increase in Americans’ support for the concept, with 53 percent of the public supporting all Americans getting their coverage through a single government plan.

5 July
Cruz plan could be key to unlocking healthcare votes
The Texas Republican is pushing for a provision that would allow insurers to sell plans that do not comply with ObamaCare insurance regulations, so long as they also sell plans that comply with those rules. Cruz says giving insurers a path around the regulations should allow them to offer some plans at a lower cost.

27 June
Trump admits that Senate Republicans may not pass Obamacare repeal bill, ‘and that’s okay’
“This will be great if we get it done,” Trump said. “And if we don’t get it done, it’s just going to be something that we’re not going to like. And that’s okay, and I understand that very well.”
THE FLOODGATES OPEN: GOP senators come out in furious force against healthcare bill after vote delayed
After the delay, Republican senators went on record opposing the current iteration of the bill, the Better Care Reconciliation Act (BCRA). Combined with those that defected before the delay, at least nine GOP senators have said they opposed the first iteration of the bill.
Senate Republicans delay Obamacare repeal vote until after recess
(Politico) The bill lacked sufficient support to even begin debate amid resistance from moderate and conservative Republicans.

Stay tuned!
Governors Attack G.O.P. Health Plan: ‘This Bill Is Unacceptable’
(NYT) A quiet effort by governors to block the full repeal of the Affordable Care Act reached its climax in Washington on Tuesday, as state executives in both parties who have conspired privately for months mounted an all-out attack on the Senate’s embattled health care legislation.

Stephen Colbert and Patrick Stewart Wait for Godot (and an Obamacare Replacement)
The actor and the late-night host gave healthcare the theater-of-the-absurd treatment.
Beckett, in fact, might be the perfect arbiter of these times, between his ineffably pessimistic view of life and his determination to laugh at it. Hence the sequence Stephen Colbert presented  Samuel Beckett’s never-before-seen masterpiece, Waiting for Godot’s Obamacare Replacement (video) the skit starred Patrick Stewart as Vladimir and Stephen Colbert as Estragon, two of theater’s most notorious fatalists.

26 June
(NYT evening brief) The Congressional Budget Office found the Senate’s version of the health care bill would increase the number of uninsured by 22 million by 2026, slightly less than the 23 million it found for the House version. Majority leader, Senator Mitch McConnell wants to call a vote before the end of the week, when the July 4 recess begins.
But a handful of Republicans remain reluctant. Our survey of local news outlets around the country turned up little support for the bill.

24 June
Poll: Most Americans Unaware GOP Plans Would Make Deep Funding Cuts To Medicaid
(Kaiser Health News) … most Americans say the program — which Republicans call a “broken system” — is working well on the national level and within their states. That’s according to a monthly tracking poll released Friday by the Kaiser Family Foundation. (Kaiser Health News is an editorially independent project of the foundation.) That support, the poll suggests, holds true across the political spectrum, though support was strongest among Democrats. The sample of 1200 tracks by political affiliation – no details regarding age or location of respondents

23 June
(NYT Evening Brief) “I cannot support a piece of legislation that takes insurance away from tens of millions of Americans.”
With those words, Senator Dean Heller of Nevada became the fifth Republican to say he could not support the Senate health care overhaul in its current form, dealing a blow to his party’s attempt to repeal the Affordable Care Act.
Our analysis of the draft bill found that the largest benefits would go to the wealthiest Americans, and its biggest losses would fall to poorer Americans who rely on government support. Here’s how the Senate plan would dismantle Obamacare.
The fate of the bill, which would cut more than 40 percent of Planned Parenthood’s funding, could rest on the issue of abortion.

(LA Times Politics newsletter) Read the text of the healthcare bill that McConnell unveiled Thursday, and you find an audacious bait and switch.
For years, Republican leaders have talked about repealing Obamacare — it’s been the centerpiece of their campaigns since 2010.
But conservatives like Sens. Rand Paul of Kentucky and Mike Lee of Utah are correct when they say McConnell’s plan doesn’t truly repeal Obama’s signature healthcare law. Instead, it makes it cheaper and able to cover fewer people — how many fewer, the Congressional Budget Office will estimate next week.
Like the measure that passed the House last month, the Senate plan really takes aim at a bigger, older and more established part of the healthcare safety net — Medicaid. If it passes, the new law will mark the biggest cutback of that program since Lyndon B. Johnson pushed it through Congress a half century ago.
[Here’s our side-by-side comparison of the Senate plan, the bill that passed the House last month and current law].

22 June
Four Senate conservatives say they oppose ObamaCare repeal bill
(The Hill) Sen. Rand Paul (R-Ky.) on Thursday said he and three colleagues oppose the healthcare legislation unveiled earlier in the day by GOP leaders.
Paul and conservative Sens. Mike Lee (Utah), Ted Cruz (Texas) and Ron Johnson (Wis.) all said they are not ready to vote for the bill in a joint statement
While the statement was not scathing, it said the current bill would not lower healthcare costs enough to win their support..
Conservatives want to pressure Senate Majority Leader Mitch McConnell (R-Ky.) to revise the legislation and move it further to the right.
McConnell is also under pressure from GOP centrists, creating a difficult balancing act for the leader. Each move he makes to one of the two sides risks losing support from the other.
Arm twisting and political ‘persuasion’ aka bribery now commence. It’s time for the constituents, e.g. the PEOPLE affected, to flood the senators’ offices with messages.
Hospitals to Senate: ‘Go back to the drawing board’ on health plan
(The Hill) “From the onset of this debate, America’s hospitals and health systems have been guided by a set of key principles that would protect coverage for Americans,” AHA President Rick Pollack said in a statement.
“Unfortunately, the draft bill under discussion in the Senate moves in the opposite direction, particularly for our most vulnerable patients,” he said
“The Senate proposal would likely trigger deep cuts to the Medicaid program that covers millions of Americans with chronic conditions such as cancer, along with the elderly and individuals with disabilities who need long-term services and support,” the AHA said.
“Medicaid cuts of this magnitude are unsustainable and will increase costs to individuals with private insurance.”
Health groups, whose support was key to passing ObamaCare in 2010, largely opposed the House GOP health bill passed earlier this year and have been mostly shut out of the process. (emphasis added)

19 June
NYT Opinion: The G.O.P. can’t explain its health bill
David Leonhardt, Op-Ed Columnist
Reporters for Vox went to eight Republican senators in recent days and asked a simple question: How will your health care bill improve the lives of Americans?
The answers were remarkable. They consisted mostly of platitudes that no independent expert believes to be true.
If you want details of the bill, you can read the analysis by the Congressional Budget Office, articles by conservative and liberal experts or statements from virtually every major health care group, including those representing doctors, nurses, hospitals, retirees, cancer patients, heart-disease patients and many others.When the senators weren’t offering bromides, they were either talking in circles or admitting that they didn’t know what was in their bill.
Paul Krugman, in a blog post, summarized the answers to Vox as, “Er. Ah. Um.”
The Republican caucus has only 52 members, which means that, as Krugman writes, “three senators who cared even a bit about substance, legislative process, and just plain honesty with the public, could stop this.” The full Opinion report includes Christy Ford Chapin on how the doctors’ lobby helped create the country’s health care mess.

15 June
Secrecy Surrounding Senate Health Bill Raises Alarms in Both Parties
(NYT) Senate Republican leaders say the bill is still a work in progress, and they have not said exactly how it will differ from the one approved last month in the House. President Trump raised the stakes when he told senators this week that the House version was “mean.”
The Senate bill is likely to phase out the Affordable Care Act’s Medicaid expansion more slowly than the House version. It is also expected to include larger tax credits to help older Americans buy health insurance.

4 June
States scramble to prevent ObamaCare exodus
Insurance commissioners are pulling out all the stops to keep insurers from leaving their states amid uncertainty over ObamaCare’s future.
They are offering insurers new, previously unheard of flexibilities to try to keep them in the market.
But the effort faces an uphill climb … Insurers are skittish and pleading for certainty from Washington. They want assurances that they will continue to receive cost-sharing reduction payments from the federal government, which total about $7 billion this year.

Senators want governors involved in health talks
Republican senators from states that expanded Medicaid enrollment under ObamaCare are pressing for their home-state governors to be involved in the Senate talks over a new healthcare bill.
Republican senators want governors from their home states, who would have to deal directly with a cap on federal spending, to give their conference an analysis of the potential impact.

24 May
CBO: ObamaCare repeal bill would leave 23M fewer people with insurance
(The Hill) The GOP’s ObamaCare replacement bill that passed the House would result in 23 million fewer people with health insurance over 10 years, the nonpartisan Congressional Budget Office said in an analysis released Wednesday.
The CBO also found that an amendment allowing states to waive certain regulations would mean premiums would be somewhat lower than in the previous version of the bill, and slightly more people would get coverage, because they are buying plans that cover fewer healthcare services.
Premiums for healthy people would be lower, but with a wide variation, the CBO found.
Overall, premiums would increase for two years before they decreased — by 20 percent in 2018 and 5 percent in 2019. After 2020, premium costs would depend on which states get waivers and how much funding they get from the proposal’s Patient and State Stability Fund.
Many GOP lawmakers had already expressed concern about price spikes for older people under the bill. In the updated version price spikes would also be dramatic in states that got waivers from the ObamaCare rules.

19 May
(The Atlantic) Health Issues: As the Senate considers the GOP replacement for the Affordable Care Act, several Democratic doctors are planning to run for Congress. They’re motivated by concern for how the new bill may affect their patients. Children, for example, would be particularly affected by cuts to Medicaid—they constitute about half of the people who benefit from the program. Also in health news: The administration is moving ahead with Trump’s executive order to withhold funding from organizations that perform or promote abortion, which could hurt global efforts at HIV/AIDS relief.
As we have been predicting
Trumpcare Is Already Hurting Trump Country
(NYT editorial) What’s bizarre about the Republican strategy is that it is likely to cause the most damage where many of Mr. Trump’s supporters live. Rural and suburban areas are more likely to lose insurers and see big premium increases if Obamacare goes down, because companies have less incentive to stay in markets where there are fewer potential customers and where it is harder to put together networks of hospitals and doctors.

12 May
David Lauter, Washington bureau chief of the LA Times writes:
The House-passed healthcare bill is, in large part, a huge tax cut for upper-income Americans offset by deep cuts in Medicaid. Several senators want to go easier on Medicaid, but that would require reducing the size of the tax cuts.

11 May
(The Atlantic) Representative Tom MacArthur—the man behind the resurrection of the GOP health-care bill—held a town hall last night that quickly got heated as constituents berated MacArthur over the bill. Even so, as Russell Berman reports, the angry shouts shaped up to a detailed policy discussion. One frequently cited reason for repealing Obamacare is the fact that several insurers have pulled out of its exchanges. Here’s why they left.

5 May
Winners and losers from the GOP’s health-care bill
By Aaron Blake
(WaPost) Among the winners: The bill passed Thursday was a veritable smorgasbord of easy ads for Democrats to run against the dozens of vulnerable House Republicans who voted for it. And the Democratic ad-makers who get paid to use these lines should probably do so at a healthy discount. A few that I foresaw in my piece about how this bill impacts the GOP in 2018: “Congressman XYZ voted to take 24 million people off health insurance,” “Congressman XYZ voted to cut coverage for preexisting conditions,” “Congressman XYZ voted to raise premiums by 750 percent for low-income senior citizens.” Republicans will dispute all of these claims, but they are all substantiated in what the GOP passed Thursday and how the Congressional Budget Office scored a previous version of the bill.
Among the losers: You almost get the sense that Senate Republicans hoped this day would never come — the day the House actually passed something and put the onus on them to pass something, too.

(The Atlantic)  AHCA Fallout: As President Trump celebrates the passage of his party’s health-care bill in the House, his victory remarks haven’t included much detail on what its policies actually mean. So, how will AHCA affect people? Low-income households are likely to lose benefits, while the wealthy will gain a tax cut. Such effects are hard to square with Trump’s populist message, but one explanation might be found in the gospel of prosperity.  As for House Republicans, David Frum argues this choice could cost some of them their jobs.

4 May
Say what? Trump praises Australia’s universal health care
Hours after Obamacare repeal approved, Trump touts diametrically opposite system
(Market Watch) “It’s going to be fantastic health care,” Trump said of the American Health Care Act during a press conference in New York on Thursday night with Australian Prime Minister Malcolm Turnbull. “I shouldn’t say this to our great gentleman and my friend from Australia because you have better health care than we do.”
Australia has universal health care, where the government pays for all citizens to have access to doctors and public hospitals for free.

(Quartz) The GOP health-care bill treats being female as a pre-existing condition. Women who have experienced C-sections, sexual assault, and domestic violence stand to suffer the most

(The Atlantic Daily) The House of Representatives narrowly passed the GOP’s replacement health-care bill today. Now, it goes to the Senate, where it faces stiff opposition from Democrats—and where conservative and moderate Republicans alike hope their Senate allies will demand changes. For now, the bill has the same basic provisions as the version that failed last month, apart from a couple amendments aimed at convincing Republican holdouts to vote for it. One of these creates a subsidized risk pool for people with preexisting conditions—but that change may not be enough to protect their coverage.
David Leonhardt, NYT Opinion: The bill, at its core, is still what it has always been: It’s a large cut in health benefits for the sick, the old, the middle class and the poor, as an academic study published today — which I cover in a new column — shows. The savings from these cuts is then funneled into tax cuts for the rich.
That’s why the bill continues to be opposed by conservative, moderate and liberal health care experts, as well as groups representing doctors, nurses, hospitals, the elderly, the disabled and people with cancer, diabetes and multiple sclerosis. Oh, and that’s a partial list. … “There have been no hearings, no studies, no Congressional Budget Office analysis; not even the text of a bill circulated the day before Thursday’s vote,” Jonathan Chait’s latest piece for New York magazine points out.
John Cassidy: The House G.O.P.’s Shameful Health-Care Victory
(The New Yorker) In the most immediate of terms—congressional whip counts—that was a victory for Ryan and his ally in the White House, Donald Trump. On their third attempt at passing an Obamacare-repeal measure, and after much drama and humiliation, the House Republicans had assembled a majority. But at what cost? The vote represented a moral travesty, a betrayal of millions of vulnerable Americans, and a political gift to the Democrats.
Analysis: 5 issues that could derail the GOP health care bill in the Senate
BY Julie Rovner, Kaiser Health News
(PBS Newshour) After weeks of will-they-or-won’t-they tensions, the House managed to pass its GOP replacement for the Affordable Care Act on Thursday by a razor-thin margin. The vote was 217-213.
Democrats who lost the battle are still convinced they may win the political war.Democrats … claim Republicans could lose their seats for supporting a bill that could cause so much disruption in voters’ health care.
Democrats have made clear they will unanimously oppose the bill. “Trumpcare” is just a breathtakingly irresponsible piece of legislation that would endanger the health of tens of millions of Americans and break the bank for millions more,” said Senate Minority Leader Chuck Schumer (D-N.Y.).
What’s in the House GOP health care bill?

1 May
Republican Blurts Out That Sick People Don’t Deserve Affordable Care
(New York Magazine) The Republican plan expresses one of the core beliefs shared by movement conservatives, and utterly alien to people across the globe, right and left: that people who can’t afford the cost of their own medical care have nobody to blame but themselves.
22 April
Probably not because of anti-vaping. More likely sacrificed to the interests of the anti-vaccers and the NRA.
Anti-Vaping Surgeon General Has Been Abruptly Replaced
(Gizmodo) With no nominee for the surgeon general position, the decision to replace Dr. Murthy certainly raises questions about why he needed to resign so suddenly, late on a Friday when news is often dropped to avoid raising attention.Dr. Murthy first generated conservative pushback during his confirmation proceedings when the NRA pushed lawmakers to oppose his nomination because of his willingness to label gun violence as a public health issue.
Another notable issue that Murthy might have butted heads with the Trump administration on is vaccination. Trump has wavered between saying he was unsure about the safety vaccinations and outright alluding to a link between early vaccinations and autism. Being a man of science, Dr. Murthy has slapped down that notion which is generally understood to be complete nonsense.

20 April
Health Complications: The GOP plan to repeal and replace Obamacare is back: Paul Ryan says a new bill is nearly done, President Trump is pushing Congress to pass it, and some reports say conservatives and moderates have reached a tentative agreement. But congressional staffers are skeptical, and the proposal comes with a long list of pitfalls. Health care, as Trump infamously declared last month, is complicated—and so are the host of other issues whose complexity he’s marveled at in his first few months as president. His learning curve is unnerving to critics, but if it helps his supporters understand how hard it is to govern, it might be an unexpected public service.

17 April
Harold J. Goldfarb: Examining the reality of America’s health care
Neither Obamacare nor Trumpcare can truly meet unrealistic expectations of Americans
(The Morning Call) The public has four major expectations, which are inherently mutually incompatible.
The public wants: (1) freedom to choose doctor and hospital; (2) the latest modern, state-of-the-art technology in diagnostic equipment and medical and surgical treatments; (3) no delay in appointments and treatments; and (4) minimal (or at least, reasonable) cost. People can have two, perhaps three, but in no way can they have all four. That is the reality.
Unfortunately, but realistically, there is an inherent structural impediment to cost control, when party A (the patient) can go to party B (the doctor) and party C (the insurance company) pays, which is the medical system we now have.
The best cost control is when there is a direct relationship between buyer and seller. Perhaps, for outpatient services, we should do what some European countries do — the patient pays the doctor directly, then he turns the receipt into his or her health insurance plan for reimbursement.

28 March
Get ready for Trumpcare 2.0: White House reverses course, looks to renew health care battle
House GOP leaders and the White House are already negotiating with conservatives, despite Trump’s vows to move on
(Salon) “I would say that we will probably start going very, very strongly for the big tax cuts and tax reform. That will be next,” Trump told reporters in the White House after the GOP failed to rally enough support to pass the American Health Care Act last Friday.

26 March
SINCE OBAMACARE CAN’T BE REPEALED, WHY CAN’T WE REPAIR IT?
By James Heffernan, Contributor
(HuffPost) Now that the GOP leadership has lost a purely political battle over health insurance, why can’t moderate Republicans join Democrats in a truly bipartisan effort to build on the ACA?
Doing so will take months of study, hearings, and negotiation. But since we now have seven years of data on the results of the Affordable Care Act, we ought to know exactly what its strengths and weaknesses are.
During the whole of the battle over Obamacare this year, for instance, did anyone ever propose to repeal and replace fee-for-service medicine with team medicine? Yet as Atul Gawande showed eight years ago The Cost Conundrum in the New Yorker , the difference between the two largely explains why the Mayo Clinic in Rochester, Minnesota, could treat its Medicare patients for half the cost required to treat Medicare patients in McAllen, Texas—with results that were just as good or better.

24 March
REPUBLICANS YANK OBAMACARE REPEAL BILL
It’s a staggering setback for President Donald Trump and Speaker Paul Ryan.
(Politico) Facing a growing rebellion within his own ranks, House Speaker Paul Ryan pulled the Republican Obamacare replacement plan from the House floor on Friday just before a scheduled vote.
The decision is a staggering defeat for Ryan and President Donald Trump in their first attempt to partner on major legislation and fulfill a seven-year Republican promise to repeal Obamacare. It comes a day after Trump issued an ultimatum to House Republicans to vote for the bill or live with Obamacare.
The bill met sharp resistance from both ends of the Republican caucus, as hard-line conservatives in the House Freedom Caucus contended it failed to do away with Obamacare’s core components and moderates argued that its curbs on Medicaid could harm vulnerable constituents. Ultimately, those competing pressures proved irreconcilable.

23 March
House Vote to Repeal Affordable Care Act Is Postponed, Despite Trump’s Effort
(NYT) The emerging power of the Freedom Caucus, a group that has been historically marginalized in policy-making but a thorn in the side of leadership, is one of the surprises of the rushed health care debate. The Freedom Caucus has been empowered by the addition of one of their own, former Representative Mick Mulvaney, to the senior White House staff as budget director, and Mr. Trump’s disengagement from policy details coupled with his intense desire to score a win after a rocky start to his presidency.

21 March
Trump, GOP struggle to find healthcare votes
(The Hill) With only a day before a scheduled vote on the House floor, the White House and Speaker Paul Ryan (R-Wis.) are facing an uphill fight to get the majority — 216 votes — needed to clear the lower chamber.
In a closed-door meeting with House Republicans, Trump warned that failure to pass the legislation might trigger a backlash for the GOP in the 2018 midterm elections. Republicans, the president said, could lose their seats next year, give Democrats the majority and derail Trump’s ambitious 2017 agenda if they fail to fulfill their campaign promise of repealing ­ObamaCare, said sources in the room.

19 March
Contrast with the Finnish model
Anu Partanen: The Fake Freedom of American Health Care
(NYT) As House Speaker Paul Ryan put it in a tweet: “Freedom is the ability to buy what you want to fit what you need.” Vice President Mike Pence picked up that baton: “Obamacare will be replaced with something that actually works — bringing freedom and individual responsibility back to American health care.”
In practice, though, this Republican notion is an awfully peculiar kind of freedom. It requires most Americans to spend not just money, but also time and energy agonizing over the bewildering logistics of coverage and treatment — confusing plans, exorbitant premiums and deductibles, exclusive networks, mysterious tests, outrageous drug prices. And more often than not, individual choices are severely restricted by decisions made by employers, insurers, doctors, pharmaceutical companies and other private players. Those interest groups, not the consumer, decide which plans are available, what those plans cover, which doctors patients can see and how much it will cost.
And I haven’t even mentioned the millions of Americans who don’t earn enough to pay for insurance or a lifesaving treatment. If you can’t afford it, not buying it is hardly a choice.
Ross Douthat: Make America Singapore
(NYT) Republican politicians may offer pandering promises of lower deductibles and co-pays, but the coherent conservative position is that cheaper plans with higher deductibles are a very good thing, because they’re much closer to what insurance ought to be — and the more they proliferate, the cheaper health care will ultimately be for everyone.
Is there an existing health insurance system that vindicates this boast? Yes, in a sense: There is Singapore, whose health care system is the marvel of the wealthy world.
Under their Medisave program, they spend money saved in mandatory health-savings accounts, to which employers contribute as well. Second, their catastrophic insurance doesn’t come from a bevy of competing health insurance companies, but from a government-run single-payer system, MediShield. And then the government maintains a further safety net, Medifund, for patients who can’t cover their bills, while topping off Medisave accounts for poorer, older Singaporeans, and maintaining other supplemental programs as well.
So the Singaporean structure does not necessarily minimize state involvement or redistribution. It minimizes direct public spending and third-party payments, while maximizing people’s exposure to what treatments actually cost. And the results are, again, extremely impressive:

13 March
The Republicans’ Health Bill Would Add 24 Million Uninsured but Save $337 Billion,the nonpartisan Congressional Budget Office Report says.
Meanwhile, the Senate has confirmed Seema Verma, a health policy expert from Indiana, as Medicare and Medicaid Administrator to lead efforts by the Trump administration to transform Medicaid, expand Medicare and upend the Affordable Care Act. Ms. Verma was an architect of Indiana’s Medicaid program, widely seen as a model by conservatives, and worked closely with Vice President Mike Pence when he was the state’s governor. Indiana expanded Medicaid eligibility, but emphasized “personal responsibility.” That means that beneficiaries pay premiums, contribute to health savings accounts and receive incentives for healthy behavior.
The CBO Deals Paul Ryan’s Health-Care Plan a Major Blow
The hotly anticipated Congressional Budget Office report on the Republican replacement for Obamacare found it would increase the number of uninsured Americans by 86 percent.
(The Atlantic) The Congressional Budget Office on Monday projected that the House leadership’s American Health Care Act would result in 24 million Americans losing their health insurance while raising premiums for those covered on the individual market. Their bill would lower federal deficits by $337 billion over 10 years, largely as a result of cuts to Medicaid that would reduce its enrollment by 14 million, according to the estimate. Average premiums would rise by as much as 20 percent in 2018 and 2019 before falling in later years.
Of particular concern for GOP backers of the American Health Care Act is the CBO’s projection for its immediate impact. If enacted soon, an estimated 14 million people would drop their insurance next year because the proposal repeals the tax penalties associated with the individual mandate, the CBO forecasts. If people are not required to buy insurance, in other words, many will stop doing so. Millions more would join the ranks of the uninsured after 2020, when the bill would roll back the expansion of Medicaid under the Affordable Care Act. Conservatives have called for repealing the expansion sooner, which would likely result in more people dropping coverage in the first years after enactment.
White House attacks on CBO signal how Trump will fight for his agenda
(Chicago Tribune) The Congressional Budget Office’s explosive report Monday that projected a GOP health-care bill would lower the number of Americans with health insurance by 24 million over a decade triggered a blistering backlash from the Trump administration, with senior White House officials working to undermine the independent budget office’s credibility.
CBO officials are often political punching bags, but vitriolic attacks from top White House officials in recent days have the potential to erode the agency’s standing at a time when its assessments of health-care policy, changes to the tax code and deficit projections will factor into whether Congress enacts key parts of the Trump administration’s agenda.
(Vox) Trump promised not to cut Medicaid. His health bill will cut $880 billion from it.
12 March
We should be hearing more on this
Trump supporters in the heartland fear being left behind by GOP health plan
Republican proposal would upend a healthcare system in Indiana that covers many low-income people – in a program that Mike Pence put in place

10 March
Six reasons to fight the ACA replacement plan
By Dr. Leana Wen, Commissioner of health in Baltimore City.
(Baltimore Sun) This ACA replacement plan will roll back gains for millions of Americans and be detrimental to health and well-being of our nation. It is fiscally irresponsible and a national security risk. We must do everything we can to safeguard life for Baltimore’s residents, and for our generations to come.
Breitbart May Have Just Killed Trumpcare
(New York Magazine) So, Breitbart’s latest headline on the Trump-Ryan health-care plan is probably causing some consternation at 1600 Pennsylvania Avenue.
Perhaps the most shocking thing about Breitbart’s headline is its accuracy. Trumpcare is a much less generous program than Obamacare — and its cuts will be felt, disproportionately, by the people who wanted Trump to Make America Great Again.

9 March
White House Casts Pre-emptive Doubt on Congressional Budget Office
(NYT) The C.B.O.’s official judgment on the American Health Care Act, as the Republican legislation is known, is expected to be released on Monday and it is more than an intellectual exercise. It could make or break the bill.
Budget rules that Republicans are using to bypass a possible Democratic filibuster in the Senate stipulate that the health care legislation must not add to deficits over the span of a decade. If the C.B.O. predicts that it would, Senate Democrats could block the bill. More broadly, a judgment by the C.B.O. that the Republican plan would strip health care from millions of people could have politically disastrous effects.
Analysts at the Brookings Institution said last Friday that the plan could increase the ranks of the uninsured by more than 15 million — and said the C.B.O. estimate might put that figure considerably higher.
Health Bill Clears House Panel in Pre-Dawn Hours
The critical House Ways and Means Committee gave a pre-dawn approval on Thursday to a major part of the Republican plan to repeal and replace the Affordable Care Act, moving Republicans a step closer toward a full vote on the measure over the growing opposition of senators, health care providers and some conservatives.
Republicans on the panel held together and rejected a variety of Democratic amendments while doing little on their own to change the health bill.
Many of the amendments were drafted to make Republicans look heartless or rash, forcing Republicans to cast votes that could be cited in campaign advertisements in next year’s midterm elections.
David Leonhardt NYT Opinion:
Many Americans over the age of 60 would have to pay more for health insurance under the Republican health care plan. Many low-income families would lose their insurance. Many disabled people, hepatitis patients and opioid addicts, among others, would no longer receive treatments that they do now.
Care to guess where the billions of dollars in savings from these cuts would go instead?
They would go largely to the richest 1 percent of households, those earning at least $700,000 a year, according to the Tax Policy Center. A disproportionate amount of the savings would go to the richest of the rich — those earning in the millions.
Jonathan Chait: Paul Ryan Won’t Admit His Plan Is Obamacare, Only Less of It
(New York Magazine) The most naked and revealing moment of Ryan’s press conference came when he was asked about why his plan provides a huge tax cut for the rich. You can watch his response, ten minutes in. Ryan scoffs and makes a dismissive hand gesture, like he’s been presented with an utterly frivolous objection. Then Ryan says, “Read the bill! Go to readthebill.gop!” and moves on to next question … .
It is of course incontrovertibly true that Ryan’s bill provides a big tax cut for the rich. It’s a $600 billion tax cut, almost all of which would accrue to the very rich. His tax cut is a major reason why his plan provides fewer resources to cover the poor and sick. He believes that feature is so unpopular and objectionable he literally cannot even acknowledge its existence. It is emblematic of his entire approach. Ryan’s strategy is to pass his plan into law without ever admitting its central objective.

7 March
Republicans’ Only Selling Point for Their Obamacare Replacement Bill Is How Short It Is
The return of the dumbest talking point ever.
(Mother Jones) This curious line of argument reemerged on Tuesday at a White House press briefing, when the two pieces of legislation—Obamacare and the GOP replacement plan—were prominently displayed alongside each other for the purpose of emphasizing the difference in length.

6 March
House Republicans Unveil Plan to Replace Health Law
(NYT) The bill sets the stage for a bitter debate over the possible dismantling of the most significant health care law in a half-century. In its place would be a health law that would be far more oriented to the free market and would make far-reaching changes to a vast part of the American economy.
The House Republican bill would roll back the expansion of Medicaid that has provided coverage to more than 10 million people in 31 states, reducing federal payments for many new beneficiaries. It also would effectively scrap the unpopular requirement that people have insurance and eliminate tax penalties for those who go without. The requirement for larger employers to offer coverage to their full-time employees would also be eliminated.
People who let their insurance coverage lapse, however, would face a significant penalty. Insurers could increase their premiums by 30 percent, and in that sense, Republicans would replace a penalty for not having insurance with a new penalty for allowing insurance to lapse
(The Atlantic) GOP Health Plan: Paul Ryan has set a three-week deadline for passing the Republican health-care bill in the House, and the pressure is on: GOP leaders are rushing to gather support in Congress, while Democrats are poised to pull it apart. Once the plan gets to the Senate, though, it will need the support of every Republican—and that could prove a challenge. For those GOP senators whose states have benefited from the Affordable Care Act, keeping the bill in place—even while denouncing it—might be safer than trying something new.

Atul Gawande: Trumpcare vs. Obamacare
Americans don’t want to lose the benefits they have gained, and Republicans are hearing about it.
(The New Yorker, 6 March edition) … Obamacare, it turns out, has done a lot of good. It guarantees that people with preëxisting health conditions cannot be rejected by insurers or charged more than others. It has reduced the number of uninsured people by twenty million. It has increased access to primary care, specialty care, surgery, medicines, and treatment for chronic conditions. Patients are less likely to skip needed care because of the cost. As a result, according to studies conducted at Harvard, the A.C.A. is saving tens of thousands of lives each year.
Now Republicans in Congress are facing the wrath of constituents who don’t want to lose those gains.
Conservatives have had to back off from their plan to repeal Obamacare now and worry about replacement later. Instead, they must grapple with what they have tried to ignore: the complexities of our health-care system, especially in the four vital areas of employer-sponsored coverage, Medicaid, the individual insurance market, and taxes.

There are some headlines that are so outlandish that, no matter what the source, we have to double-check with Snopes before publishing. This is one.
Republican Congressman: Repeal Obamacare Because Poor People Don’t Want to Be Healthy
(New York Magazine) Representative Roger Marshall is a Kansas Republican, a former obstetrician, and a first-year member of Congress, and opponent of the Affordable Care Act. In an interview with Stat, Marshall draws upon his medical experience to explain why the law’s expansion of Medicaid is a bad thing. It is quite an interesting explanation:
“Just like Jesus said, ‘The poor will always be with us,’” he said. “There is a group of people that just don’t want health care and aren’t going to take care of themselves … Just, like, homeless people … I think just morally, spiritually, socially, [some people] just don’t want health care,” he said.

3 March
‘Secret’ Obamacare bill gets leaked, and it looks like the wealthy would get less financial aid under new GOP plan
(CNBC) A “new” Republican congressional plan to replace Obamacare, which was being kept secret from the public and even GOP senators, reportedly is considering barring wealthier people from receiving tax credits to help pay for their health insurance plans.
But the new GOP outline still contains many of the same details of a previous replacement proposal, including a provision that has drawn the ire of very conservative members of the Republican House caucus, Politico reported Friday.
That provision would offer tax credits to people based on their age, as opposed to their income, as the Affordable Care Act currently offers people who purchase plans on government-run Obamacare marketplaces. Conservatives have complained that the tax credits would make a replacement merely “Obamacare Lite,” and decry the credits as a new entitlement.However, the new version would not allow higher-income people to get those credits, Politico reported.

1 March
Republicans in Washington Are in Control, but Not in Agreement
In particular, the party push to undo the health care law while avoiding major disruptions in coverage — a priority reinforced on Tuesday by President Trump in his prime-time address — is encountering major resistance from the right. The determined opposition has thrown the party’s repeal effort into confusion and created uncertainty over what to eliminate and how to pay for any alternative.
… just as conservatives are adamant that Republicans repeal the law before replacing it, other more centrist Republicans are threatening to withhold their votes if there is no suitable alternative in place. That division is creating a real headache for Republican leaders such as Speaker Paul D. Ryan of Wisconsin and Senator Mitch McConnell, the majority leader from Kentucky, who have to find something a majority will support.
Health Care Is Front and Center in Democrats’ Response to Trump Address

27 February
President Trump: ‘Nobody Knew Health Care Could Be So Complicated’
By Jonathan Chait
(New York Magazine) If there’s one thing almost everybody across the political spectrum knows about health-care reform, it’s that it’s really hard. People who study the issue closely know it. People who don’t follow the issue know. (That’s why lots of smart people don’t follow the issue closely — it’s really hard!) But there is apparently a category of people who did not realize until very recently that the issue is hard, and that category consists of Donald J. Trump, who told reporters today, “It’s an unbelievably complex subject. Nobody knew health care could be so complicated.”
… Trump held together the contradiction by simply pretending the solution would reveal itself over time and would be extremely easy. Quite likely Trump believed this himself — as a committed nonreader, and a narcissistic devotee of his own negotiating prowess, he surely believed that he could broker a deal that would satisfy both the moral objective of universal coverage and the specific ideological hang-ups that had prevented his party from ever supporting a plan that would accomplish it in the past. The only thing that held Trump’s position together was a refusal to engage with the substance of the issue, and a magical belief that it could all be waved away. At best, he will keep either his promise to the Republican elite or his promise to the electorate. At worst he will keep neither. His offhand comment that the issue is hard is a window into the mind of a man who realizes the jig is almost up.
GOP Leaders Bet Wavering Republicans Don’t Have the Guts to Stop Obamacare Repeal

24 February
AP fact check: Trump claims Affordable Care Act covered ‘very few’ people
(PBS) THE FACTS: More than 20 million people are covered by the two major components of former President Barack Obama’s health care law: expanded Medicaid and subsidized private health insurance.
The Medicaid expansion, adopted by 31 states and Washington, D.C., covers about 11 million low-income people, according to the Congressional Budget Office. The fate of the expansion is a major sticking point as Republicans try to complete their repeal plan. Sixteen states with GOP governors have expanded their Medicaid programs.
The other more visible component is HealthCare.gov. The federal website and state-run online insurance markets have signed up 12.2 million people for this year, according to an Associated Press count earlier this month, based on federal and state reports.
This is lower than the 12.7 million who initially enrolled for 2016. But it is not dramatically lower when considering the problems the markets have had with rising premiums and dwindling insurer participation, not to mention Trump’s vow to repeal the program.

21 February
Reality Begins to Set in on Obamacare—For Both Sides
(Mother Jones) For seven years, few issues have animated conservative voters as much as the repeal of the Affordable Care Act. But with President Barack Obama out of office, the debate over “Obamacare” is becoming less about “Obama” and more about “care” — greatly complicating the issue for Republican lawmakers.
….As liberals overwhelm congressional town hall-style meetings and deluge the Capitol phone system with pleas to protect the health law, there is no similar clamor for dismantling it, Mr. Obama’s signature legislative accomplishment. From deeply conservative districts in the South and the West to the more moderate parts of the Northeast, Republicans in Congress say there is significantly less intensity among opponents of the law than when Mr. Obama was in office.
But the intensity of opinion has changed. With Obama out of office, the Republican base doesn’t care as much. Hating Obamacare was mostly just a way of hating Obama. Likewise, the Democratic base cares more. They spent the past seven years griping about how weak Obamacare was—no public option, too friendly to insurance companies, subsidies too low, blah blah blah—under the apparent assumption that it didn’t matter that practically no one was passionately defending the law. With Trump in office, Democrats have finally figured out that it matters, and congressional phones are now ringing off the hook.

‘Don’t repeal Obamacare, improve it’: Republicans face wrath at town-hall events
(Business Insider) Republicans members of Congress, away from Washington for the Presidents Day week, are getting an earful as constituents have come out in force to voice displeasure for some of the party’s policy positions, particularly the plan to repeal and replace the Affordable Care Act.

(PBS Newshour) In coal country, putting faith in Trump’s economic promises
“Our new administration is talking about repealing Obamacare and doing away with Obamacare and starting a new one. And one of our greatest fears now is, if you take the provisions out for the coal miners — I spent four-and-a-half years in litigation to get my black lung benefits started.”

19 February
Conservatives See Obamacare Repeal Slipping Away
(Forbes) Conservatives who were optimistic less than a month ago that the Affordable Care Act would be fully repealed now see missed deadlines and delays from the Republican-led Congress and Donald Trump’s White House.
U.S. House Speaker Paul Ryan’s repeal-and-replace mantra of less than two months ago has turned into more of a Congressional repair job for the 20 million Americans who have gained coverage under the ACA. And Trump has said people will maintain coverage after the law is repealed and replaced “simultaneously” but has yet to offer a plan to achieve that. Meanwhile, bills in the Senate and House aren’t gaining a consensus among the Republican majorities in either chamber of Congress.

10 February
(LA Times) In his campaign, Trump said he would move to repeal Obamacare on “Day 1” of his administration. Instead, he signed an executive order that was long on rhetoric but short on specifics. Then, in his first week, he said the repeal would come “very quickly,” insisting Congress should act within weeks.
But Republicans are increasingly divided on how to proceed .
As Noam Levey reported, Republicans succeeded in confirming Trump’s nominee for Secretary of Health and Human Services, Tom Price, on a party-line vote early Friday morning, but they have yet to come up with a plan for repeal.
Many GOP lawmakers now talk about “fixing” Obamacare, not repealing it. That prospect threatens mutiny from the GOP’s most ardent conservatives.

24 January
Health Plans: Not too long after his inauguration on Friday, President Trump signed an executive order empowering his administration’s agencies to do all they can—within the bounds of the Affordable Care Act—to undercut that law. And that’s not just symbolic; the powers of the incoming Health and Human Services secretary are broad enough to cripple the ACA so it has to be replaced. The replacement option most often advocated by the GOP has centered on health savings accounts, which are meant to help families save money to cover medical expenses—but they usually come attached to high-deductible plans. There’s a new alternative: Some Congressional Republicans proposed a bill yesterday giving states the option to keep Obamacare in place.

21 January
Trump, in Oval Office, signs first order on Obamacare
(Reuters) Heading into the Oval Office shortly after the conclusion of his inaugural parade, Trump signed an order on the Affordable Care Act that urged government departments to “waive, defer, grant exemptions from, or delay the implementation” of provisions that imposed fiscal burdens on states, companies or individuals.
It also called for efforts to give states greater flexibility in implementing healthcare programs while developing “a free and open market in interstate commerce for the offering of healthcare services and health insurance.”

18 January
Vaccine Nation: One early act of Trump’s that has public-health advocates worried is his expected appointment of Robert F. Kennedy, a vaccine skeptic, to head a commission “on vaccine safety and scientific integrity.” Though there’s no scientific evidence to back up claims that vaccines are dangerous, there’s already a network of doctors that help patients avoid or delay receiving them, and Kennedy could bring their views more into the mainstream—with possibly serious consequences for public health. Some optimistic vaccine news: CEPI, a global vaccine-development fund, launched today with $460 million devoted to creating vaccines to stop outbreaks of the world’s deadliest diseases.

17 January
(The Atlantic) Health Care: For now, it looks like the Trump administration’s most immediate policy challenge will be replacing Obamacare, after GOP legislators cleared the way to repeal the law on Friday. Paradoxically, the voters given most credit for supporting Trump—the older white working class—may be among the Americans most at risk from the law’s repeal, which places their Republican representatives in a tricky position. Meanwhile, scrapping the law will likely have big economic consequences—particularly for women, thousands of whom are more financially secure as a result of Obamacare coverage. But Obama isn’t the only president whose public-health legacy may be in doubt; Trump’s team has considered scrapping PEPFAR, George W. Bush’s highly successful program for AIDS relief in Africa—a move that could have tragic and devastating consequences.

13 January
House Clears Path for Repeal of Health Law
(NYT) The House cleared the way on Friday for speedy action to repeal the Affordable Care Act, putting Congress on track to undo the most significant health care law in a half-century.
With a near party-line vote of 227 to 198, the House overcame the opposition of Democrats and the anxieties of some Republicans to approve a budget blueprint that allows Republicans to end major provisions of President Obama’s health care law without the threat of a Democratic filibuster in the Senate.
President-elect Donald J. Trump, Speaker Paul D. Ryan and other Republican leaders now face a much bigger challenge: devising their own plan to ensure broad access to health care and coverage while controlling costs. While their party is far from a consensus on how to replace the health care law — under which more than 20 million Americans have gained health insurance — they will need votes from Democrats in the Senate to enact a robust replacement plan

Dismayed Trump Voters Tweet About What Losing ACA Means To Them

6 January
Reality check.
Republican Skepticism Grows Over Strategy on Health-Law Repeal
Growing number doubt move to dispatch with Affordable Care Act if they don’t know what will replace it
(WSJ) Republicans in both the House and Senate are expressing growing skepticism of their party’s approach to repealing the Affordable Care Act, signaling potential peril ahead for a strategy that relies on nearly complete GOP unity.
In the House, some conservatives are balking at a budget document meant to serve as the vehicle to repeal the 2010 health law. Meanwhile, in the Senate, a growing number of Republicans are questioning the wisdom of repealing the law without knowing how they will replace it.
Divisions within the GOP over strategy highlight the challenges Republicans face as they balance their desire to immediately enact a conservative agenda with the time needed to draft complicated and contentious legislation.

4 January
Fully repealing Obamacare will cost $350 billion
(CNN Money) President-elect Donald Trump and Congressional Republicans love to say how unaffordable Obamacare is. But completely repealing the health reform law would be pretty costly to the federal budget.
A full repeal of Obamacare would cost $350 billion over the next decade, according to a new analysis from the bipartisan Committee for a Responsible Federal Budget. This makes its wholesale dismantling much more complicated.
Obamacare was carefully crafted in 2010 so that it didn’t add to the federal deficit — in fact, it boosted revenues slightly. The law affects the federal budget in three ways: coverage provisions, taxes and fees, and Medicare components.

Republicans Are Courting Disaster on Health Care
(NYT Editorial) President Obama and congressional Democrats met on Wednesday to discuss how best to protect the A.C.A. They might start by making the case that Mr. Obama has never quite managed to make for the benefits of the law and the dangers of repeal. In particular, they might highlight the stories of the millions of people who voted for Donald Trump and congressional Republicans and now stand to lose their health insurance. A recent Urban Institute study estimated that 956,000 people in Pennsylvania and one million each in Georgia and North Carolina could lose coverage under a repeal done through a reconciliation bill. Most of them are among the very population Mr. Trump said he was running to give a voice to — nationally, 56 percent of those who would lose coverage are white, and 80 percent of adults who would lose insurance have less than a college degree.
The best hope for protecting the major provisions of the A.C.A. rests with the handful of Republicans in the Senate who hold more common-sense views than right-wing ideologues like Mr. Ryan and Mr. Pence. They include: Susan Collins of Maine, who voted against a similar reconciliation bill the Senate passed in 2015 because it would also have defunded Planned Parenthood; Bob Corker and Lamar Alexander, both of Tennessee, who have said they would prefer to repeal once they can replace it with something else; John McCain of Arizona, who told reporters on Tuesday that “we’ve got to concentrate our efforts to making sure that we do it right so that nobody’s left out”; and Rand Paul of Kentucky, who is concerned that repeal will greatly increase the federal debt.

3 January
Obama’s mission: Save the Affordable Care Act
Mr. Obama, who returned on Monday from a two-week vacation in Hawaii, plans to make a rare visit to Capitol Hill on Wednesday morning to huddle privately with House and Senate Democrats and discuss how to thwart the coming Republican assault on his legacy.
Democrats are strategizing about the best way to block the repeal of the health care law, as well as attempts to cut Medicare or Medicaid, and Mr. Obama has made it clear that he will use his remaining days in the White House to secure as many of his priorities as possible.

Trump and Republicans take measures to gut the Affordable Care Act
Before the new members could even be sworn in, Senate Republicans revealed the parliamentary language that congressional Republicans will use to dismantle Mr. Obama’s signature domestic achievement, the Affordable Care Act, without fear of a filibuster by Democrats in the coming months.
The instructions are simple and vague: The Senate Finance and the Health Committees, along with the House Ways and Means and Energy and Commerce Committees, have until Jan. 27 to “report changes in laws” within their jurisdiction “to reduce the deficit by not less than $1,000,000,000 for the period of fiscal years 2017 through 2026.”
Translation: The Senate and House have barely more than three weeks to complete legislation that reduces the deficit slightly over the next decade and, in the process, guts the Affordable Care Act beyond repair.
Left unsaid: What will happen to more than 20 million Americans now insured under the Affordable Care Act, or to the 27 percent of Americans with pre-existing medical conditions who, under the health care act, cannot be denied coverage by insurance companies?

Congress Returns. Republicans Are in Charge. 6 Things to Watch.
How quickly will Republicans vote to repeal the health care law?
The majority leader, Senator Mitch McConnell of Kentucky, promised that repeal would be the first order of business. But this does not mean the end of the Affordable Care Act, at least not any time soon.
Republicans will most likely wind their way through a complex process known as budget reconciliation, setting instructions that congressional committees would then have to follow to draft final repeal legislation. And because Republicans have yet to agree on how to replace the law, leaders may postpone for years the effective date for any repeal measure.

2 January
After Obama, Some Health Reforms May Prove Lasting
A transformation of the delivery of health care may be an enduring legacy for the president, even as Republicans plan to repeal the Affordable Care Act.
The transformation of American health care that has occurred over the last eight years — touching every aspect of the system, down to a knee replacement in the nation’s heartland — has a momentum that could prove impossible to stop.
Expanding insurance coverage to more than 20 million Americans is among Mr. Obama’s proudest accomplishments, but the changes he has pushed go deeper. They have had an impact on every level of care — from what happens during checkups and surgery to how doctors and hospitals are paid, how their results are measured and how they work together. … The emphasis now is on preventive care, on taking responsibility for the health of patients not only in the hospital, but also in the community.
Social work has become a larger part of the medical mission. Collaboration between doctors is becoming a necessity.
Coal country afraid Trump will repeal black lung benefits with Obamacare (video)
Former coal miners and their families in Kentucky, who voted for Donald Trump, are worried that the President-elect will repeal Obamacare, and the benefits for black lung that come with it.