Health Care Reform Articles - January 2, 2017

Job No. 1 for a New Congress? Undoing Obama’s Health Law

by Robert Pear - NYT

WASHINGTON — Congress often waits for a new president to take office before it gets down to business. This year, Republicans will drop that custom in their dash to scrap the Affordable Care Act.

Within hours of the new Congress convening on Tuesday, the House plans to adopt a package of rules to clear the way for repealing the health care law and replacing it with as-yet-unspecified measures meant to help people obtain insurance coverage.

Then, in the week of Jan. 9, according to a likely timetable sketched out by Representative Greg Walden, Republican of Oregon, the House will vote on a budget blueprint, which is expected to call for the repeal of the Affordable Care Act.

Later, in the week starting Jan. 30, said Mr. Walden, incoming chairman of the House Energy and Commerce Committee, the panel will act on legislation to carry out what is in the blueprint. That bill would be the vehicle for repealing major provisions of the health care law, including the expansion of Medicaid.

Republicans in both houses of Congress have said that repealing the health law is a top priority for the first months of 2017. “The Obamacare repeal resolution will be the first item up,” said the Senate majority leader, Mitch McConnell, Republican of Kentucky.

President-elect Donald J. Trump has called the law an “absolute disaster,” and has said he is eager to sign a repeal bill like one vetoed by President Obama in early 2016.

Representative Nancy Pelosi of California, the House Democratic leader, said the rules devised by House Republicans were “their opening salvo” against a law that she said had been “successful in meeting its goals of reducing cost, increasing access and improving quality of care.”

In a last-ditch bid to save his signature legislative achievement, which has provided coverage to some 20 million Americans, Mr. Obama plans to visit a meeting of House and Senate Democrats on Wednesday to rally support for the law.

The Affordable Care Act, approved in 2010 without any Republican votes, provides tax credits to help people buy private insurance. It also allowed states to expand Medicaid eligibility, with the federal government paying most of the cost for new beneficiaries.

The law also saves hundreds of billions of dollars by reducing the growth of Medicarepayments to hospitals, nursing homes, health maintenance organizations and other health care providers. Repealing the law would eliminate those savings and thus increase federal spending, the Congressional Budget Office says.

The proposed rules written by House Republicans allow lawmakers to raise a point of order against legislation that causes an increase in certain types of federal spending. But the rules give special protection to bills repealing or “reforming” the Affordable Care Act, even if such bills cause a temporary increase in spending.

Republicans worry that the Congressional Budget Office could count their plan for replacing the law as new spending, making it subject to challenge on the House floor. The exception being written into House rules would help them avoid that possibility.

Ms. Pelosi pointed to this provision as evidence that the health care law, as written, saves money. In their version of the rules, she said, “Republicans are admitting that repealing the Affordable Care Act will increase costs.”

The Congressional Budget Office said in 2015 that “repealing the A.C.A. would raise federal deficits by $137 billion over the 2016-2025 period” — not only because the government would spend more on Medicare, for older Americans, but also because it would collect less in taxes from high-income households.

The 2010 law, the budget office noted, increased the payroll tax rate for many high-income taxpayers and imposed a surtax on their net investment income. The law also imposed annual fees on health insurers and manufacturers of brand-name drugs and medical devices.

Republicans may want to hold on to some of the tax revenue and Medicare savings, to help offset the cost of their plan to replace the Affordable Care Act. They have been trying to devise that replacement, but do not have a consensus and may hold hearings to examine the options.

If Congress votes to repeal the health care law early in 2017, Republican leaders say, they may delay the effective date for several years, to avoid disrupting coverage for people who have recently gained it.

The Republican rules package would also allow the House to continue its legal challenge to spending on insurance subsidies that reduce out-of-pocket costs for more than six million Americans.

In addition, the rules would require House committee chairmen to propose ways of imposing more fiscal discipline on federal entitlement programs. In the jargon of the federal budget, the goal is to switch some programs from “mandatory funding” to “discretionary appropriations,” over which Congress has greater control.

This rule mirrors ideas advanced by Representative Tom Price, Republican of Georgia and chairman of the House Budget Committee, whom Mr. Trump has selected to be his secretary of health and human services.

“Two-thirds of current expenditures are dedicated to a relatively small number of automatic spending programs like Medicare, Medicaid and Social Security, which are not subject to annual appropriations and therefore operate largely outside the control of Congress,” Mr. Price said in a recent speech.

http://www.nytimes.com/2016/12/31/us/politics/obamacare-congress.html?hpw&rref=us&action=click&pgtype=Homepage&module=well-region&region=bottom-well&WT.nav=bottom-well

House Republicans Fret About Winning Their Health Care Suit

by Carl Hulse - NYT

WASHINGTON — Congressional Republicans have a new fear when it comes to their two-year-old health care lawsuit against the Obama administration: They might win.

The incoming Trump administration could choose to no longer defend the executive branch against the suit, which challenges the administration’s authority to spend billions of dollars on health insurance subsidies for low- and moderate-income Americans, handing House Republicans a big victory on separation-of-power issues.

But a sudden loss of the disputed subsidies could conceivably cause the health care program to implode, leaving millions of people without access to health insurance before Republicans have prepared a replacement. That could lead to chaos in the insurance market and spur a political backlash just as Republicans gain full control of the government.

To stave off that outcome, Republicans could find themselves in the awkward position of appropriating huge sums to temporarily prop up the Obama health care law, angering conservative voters who have been demanding an end to the law for years.

In another twist, Donald J. Trump’s administration, worried about preserving executive branch prerogatives, could choose to fight its Republican allies in the House on some central questions in the dispute.

Eager to avoid an ugly political pileup, Republicans on Capitol Hill and the Trump transition team are gaming out how to handle the lawsuit, which, after the election, has been put in limbo until at least late February by the United States Court of Appeals for the District of Columbia Circuit. They are not yet ready to divulge their strategy.

“Given that this pending litigation involves the Obama administration and Congress, it would be inappropriate to comment,” said Phillip J. Blando, a spokesman for the Trump transition effort. “Upon taking office, the Trump administration will evaluate this case and all related aspects of the Affordable Care Act.”

In a potentially far-reaching decision in 2015, Judge Rosemary M. Collyer ruled that House Republicans had the standing to sue the executive branch over a spending dispute and that the Obama administration had been distributing the health insurance subsidies, in violation of the Constitution, without approval from Congress. The Justice Department, confident that Judge Collyer’s decision would be reversed, quickly appealed, and the subsidies have remained in place during the appeal.

In successfully seeking a temporary halt in the proceedings after Mr. Trump won, House Republicans last month told the court that they “and the president-elect’s transition team currently are discussing potential options for resolution of this matter, to take effect after the president-elect’s inauguration on Jan. 20, 2017.” The suspension of the case, House lawyers said, will “provide the president-elect and his future administration time to consider whether to continue prosecuting or to otherwise resolve this appeal.”

Republican leadership officials in the House acknowledge the possibility of “cascading effects” if the cost-sharing payments, which have totaled an estimated $13 billion, are suddenly stopped. Insurers that receive the subsidies in exchange for paying out-of-pocket costs such as deductibles and co-pays for eligible consumers could race to drop coverage since they would be losing money. Over all, the loss of the subsidies could destabilize the entire program and cause a lack of confidence that leads other insurers to seek a quick exit as well.

Anticipating that the Trump administration might not be inclined to mount a vigorous fight against the House Republicans given the president-elect’s dim view of the health care law, a team of lawyers this month sought to intervene in the case on behalf of two participants in the health care program. In their request, the lawyers predicted that a deal between House Republicans and the new administration to dismiss or settle the case “will produce devastating consequences for the individuals who receive these reductions, as well as for the nation’s health insurance and health care systems generally.”

No matter what happens, House Republicans say, they want to prevail on two overarching concepts: the congressional power of the purse, and the right of Congress to sue the executive branch if it violates the Constitution regarding that spending power.

House Republicans contend that Congress never appropriated the money for the subsidies, as required by the Constitution. In the suit, which was initially championed by John A. Boehner, the House speaker at the time, and later in House committee reports, Republicans asserted that the administration, desperate for the funding, had required the Treasury Department to provide it despite widespread internal skepticism that the spending was proper. The White House said that the spending was a permanent part of the law passed in 2010, and that no annual appropriation was required — even though the administration initially sought one.

Just as important to House Republicans, Judge Collyer found that Congress had the standing to sue the White House on this issue — a ruling that many legal experts said was flawed — and they want that precedent to be set to restore congressional leverage over the executive branch.

But on spending power and standing, the Trump administration may come under pressure from advocates of presidential authority to fight the House no matter their shared views on health care, since those precedents could have broad repercussions.

It is a complicated set of dynamics illustrating how a quick legal victory for the House in the Trump era might come with costs that Republicans never anticipated when they took on the Obama White House.

http://www.nytimes.com/2016/12/31/us/politics/house-republicans-health-care-suit.html?&moduleDetail=section-news-2&action=click&contentCollection=Politics&region=Footer&module=MoreInSection&version=WhatsNext&contentID=WhatsNext&pgtype=article

With New Congress Poised to Convene, Obama’s Policies Are in Peril

by Jennifer Steinhauer - NYT

WASHINGTON — The most powerful and ambitious Republican-led Congress in 20 years will convene Tuesday, with plans to leave its mark on virtually every facet of American life — refashioning the country’s social safety net, wiping out scores of labor and environmental regulations and unraveling some of the most significant policy prescriptions put forward by the Obama administration.

Even before President-elect Donald J. Trump is sworn in on Jan. 20, giving the G.O.P. full control of the government, Republicans plan quick action on several of their top priorities — most notably a measure to clear a path for the Affordable Care Act’s repeal. Perhaps the first thing that will happen in the new Congress is the push for deregulation. Also up early: filling a long-vacant Supreme Court seat — which is sure to set off a pitched showdown — and starting confirmation hearings for Mr. Trump’s cabinet nominees.

“It’s a big job to actually have responsibility and produce results,” said Senator Mitch McConnell of Kentucky, the majority leader. “And we intend to do it.”

But as Republicans plan to reserve the first 100 days of Congress for their more partisan goals, Democrats are preparing roadblocks. The party’s brutal election-year wounds have been salted by evidence of Russian election interference, Mr. Trump’s hard-line cabinet picks and his taunting Twitter posts. (On Saturday, he offered New Year’s wishes “to all,” including “those who have fought me and lost so badly they just don’t know what to do.”)

Obstacles will also come from Republicans, who are divided on how to proceed with the health care law and a pledge to rewrite the tax code. Some are also skittish about certain policy proposals, like vast changes to Medicare, that could prove unpopular among the broad electorate. And any burst of legislative action will come only if Congress can break free of its longstanding tendency toward gridlock.

For Republicans, the path to this moment has been long and transparently paved — the House in particular has signaled the Republican policy vision through bills it has been passing for years. But many of those measures have gathered dust in the Senate or been doused in veto ink.

The cleave between the two chambers recalls the situation faced by the insurgent House Republican majority in the mid-1990s. Speaker Newt Gingrich took control with a determined agenda, only to be stymied by the Senate majority leader, Bob Dole, who stacked conservative House bills like so many fire logs in the back of the Senate chamber.

“They’ve been given a golden opportunity here,” said Trent Lott, the former Republican Senate majority leader. “But I have watched over the years when one party has had control of the White House and the Senate and the House, and the danger is overplaying your hand. If you go too far like what happened with Obamacare, and you get no support at all from the other side, you have a problem. You have to find a way to work with people across the aisle who will work with you.”

The tax overhaul and an infrastructure bill may be two opportunities for bipartisan cooperation — the Senate Finance Committee is already moving in that direction. Still, both of those issues are expected to remain on the back burner, despite promises to the contrary from Mr. Trump’s chief of staff, Reince Priebus.

The Senate may be narrowly divided, but among the 48 Democratic senators are 10 who will stand for re-election in two years in states that voted for Mr. Trump. Republicans are counting on their support, at least some of the time.

But on many issues, Senate Democrats — including their new leader, Chuck Schumer of New York — are expected to pivot from postelection carping to active thwarting, using complex Senate procedures and political messaging to slow or perhaps block elements of Mr. Trump’s agenda.

“After campaigning on a promise to help the middle class, President-elect Trump’s postelection actions suggest he intends to do the exact opposite after he’s sworn in,” said Senator Patty Murray, Democrat of Washington. “Democrats will do everything we can to fight back if he continues to pursue an agenda prioritizing billionaires and big corporations while devastating middle-class families and the economy.”

Republicans have chafed for years at a host of rules, many business-related, that Mr. Obama has issued through the regulatory process, and they have been advising the Trump team on which ones should be undone.

“I hear probably more about the strangulation of regulations on business and their growth and their development than probably anything else,” the House speaker, Paul D. Ryan of Wisconsin, said at a recent forum. “I think if we can provide regulatory relief right away, that can breathe a sigh of relief into the economy.”

In late December, the Obama administration rolled out a major new environmental regulation intended to rein in the practice of mountaintop-removal mining. That regulation, one of dozens that Mr. Trump is expected to reverse, is meant to go into effect one day before his inauguration.

But Congress is likely to block it, using the obscure Congressional Review Act, which permits lawmakers to undo new regulations with only 51 Senate votes within the first 60 legislative days of the rules’ completion.

Given time constraints on the Senate floor, members will have to pick some priorities. They are expected to train their sights on a rule that requires oil and gas producers to reduce methane gases, another that requires mining and fossil fuel companies to disclose payments they have made to foreign governments to extract natural resources, and still others that restrict pesticide use.

Republicans will also move quickly to repeal the Affordable Care Act. They plan to pass a truncated budget resolution for the remainder of the current fiscal year — already a quarter over — that includes special instructions ensuring that the final repeal legislation could circumvent any Democratic filibuster. But Republican leaders have not settled on a health care plan to replace Mr. Obama’s, and they may delay the repeal measure’s effective date for years.

The Senate must also confirm Mr. Trump’s cabinet picks, and Senate Democrats are already trying to slow the process. However, they cannot do much more than that, because, when they were in charge, they changed the rules so that presidential nominees other than Supreme Court picks need only 51 votes to be confirmed. Previously, such nominations could be filibustered, which required 60 votes to overcome.

Democratic leaders have encouraged members to avoid meeting with Mr. Trump’s nominees until they have turned over their tax returns and made other disclosures. Republicans have been particularly upset that Senator Jeff Sessions of Alabama, whom Mr. Trump picked quickly to be attorney general, has either not gotten meetings with Democrats on the Senate Judiciary Committee or had meetings canceled.

Senator Dianne Feinstein of California postponed her meeting with Mr. Sessions until January because, she said, her schedule got too busy. “The senator doesn’t want to rush,” said her spokesman, Tom Mentzer. One reason that Democrats are in no hurry is their bitterness over Mr. McConnell’s refusal last year to hold a hearing on the Supreme Court nomination of Judge Merrick B. Garland.

Lingering in the background is the specter of Russia. Democrats — and some Republicans, who are at odds with Mr. Trump on the issue and may at times be a brake on him — want a vigorous investigation of its efforts to disrupt the election. The Obama administration, which took sweeping steps last week to punish the Russians over election hacking, will release a report this month that is likely to serve as a turning point in those discussions.

While Republicans may have a rare chance to open the flow of legislation, the party’s leaders are acutely aware of the punishment Americans have historically delivered in midterm elections when things have not gone well. “This is no time for hubris,” Mr. McConnell said. “You have to perform.”

http://www.nytimes.com/2017/01/01/us/politics/with-new-congress-poised-to-convene-obamas-policies-are-in-peril.html?hp&action=click&pgtype=Homepage&clickSource=story-heading&module=first-column-region&region=top-news&WT.nav=top-news

Lessons From the Media’s Failures in Its Year With Trump

by Nicholas Kristof - NYT

The last year has not been the news media’s finest.

Despite some outstanding coverage, over all we misled many people into thinking that Donald Trump would never win the Republican nomination, let alone the White House. Too often we followed what glittered, yapped uselessly at everything in sight and didn’t dig hard enough or hold politicians accountable for lies.

In 2008, the three broadcast networks, in their nightly news programs, devoted over the entire year a total of three hours and 40 minutes to issues reporting (defined as independent coverage of election issues, not arising from candidate statements or debates). In 2016, that plummeted to a grand total of just 36 minutes.

ABC and NBC had just nine minutes of issues coverage each; CBS had 18 minutes. So ABC and NBC each had less than one minute of issues coverage per month in 2016.

Those figures come from Andrew Tyndall, whose Tyndall Report monitors the news programs. By Tyndall’s measures, there was zero independent coverage in 2016 on those nightly programs about poverty, climate change or drug addiction.

“Journalists were confronted with the spectacle of an issues-free campaign,” Tyndall told me. “They had to decide how to react: with complicity, since such tactics were easy to shoehorn into the ratings-pleasing entertainment structure of a reality TV show, or with defiance, by delving into what was at stake.”

They chose the former, he says, and “treated their viewers not as citizens, but as so many pairs of eyeballs.”

Granted, there were exceptions, including first-rate digging by newspapers and magazines into Trump’s foundation, taxes and past. One challenge was commercial pressure as news organizations in all platforms — print, digital and TV — scrambled for a business model. Everyone knew that Trump was ratings gold, while a segment on poverty was ratings mud.

As Leslie Moonves, the CBS president, said in February about Trump’s run: “It may not be good for America, but it’s damn good for CBS.”

The entire media world needs new revenue sources — including philanthropy — to finance coverage that is important but unprofitable.

Still, many of us chose journalism because we believed it to be a public good. I’ve seen journalists abroad risk their lives to get a story because they believed it important. If they can do that, maybe executive producers can occasionally risk ratings?

As early as March, Trump had received $1.9 billion in free media coverage, 190 times as much as he paid for. Back then, I called around to journalists and scholars, and there was already a widespread view that television had screwed up by handing Trump the microphone and failing to fact-check him adequately.

In addition, Trump was masterly at diverting us from substance. As Tom Rosenstiel, a veteran press critic, noted: “We need journalists to cover what is important, not bark at every car.”

It didn’t help that the national media isn’t very diverse — not just in racial or ethnic terms, but also socioeconomically and geographically. We don’t have many national journalists with working-class or evangelical roots, so our coverage of Trump voters was often shallow or condescending, and we largely missed the fury and despair that Trump rode to victory.

We’ll have to figure out new ways of doing things while focusing on journalism and not stenography. Jay Rosen of New York University suggests perhaps sending interns to cover White House briefings, and the veterans to dig up real stories.

We’ll have to be persistent, continuing to press for the release of taxes and for policy details. We’ll have to avoid the perils of false equivalence, quoting a person on each side as if there’s a genuine debate when we know there isn’t. And this may sound odd for a columnist to say, but we need more reporting, less pontificating.

We should also try harder to debunk fake stories. A false story on Facebook about President Obama banning the Pledge of Allegiance in schools had more than two million shares or other interactions, and a make-believe story about Pope Francis endorsing Trump had nearly one million such interactions.

When so many Americans believe false claims, we should weigh in aggressively on the side of truth.

Would it matter if the mainstream media did a better job? Or do we live in a post-truth age in which we are so distrusted that our investigations will be dismissed, if they are seen at all? I’m not sure, but we must at least try.

We will soon have as commander in chief the most evasive, ignorant and puerile national politician I’ve ever met, and while there are many factors behind his election, I think we in the media contributed by skimping on due diligence.

The lesson learned? As 2017 dawns, let’s focus on what matters. Not celebrity, but substance: Will millions of Americans lose health insurance? What will happen to the 21 percent of American children living in poverty? Will Syrians be endlessly slaughtered, and will South Sudan collapse into genocide? Will there be a trade war? A real war?

For too much of 2016, we in the news media — with many stellar exceptions — sometimes were mindless mutts that barked at everything. Partly because of that lapse, the country today needs a robust fourth estate more than ever. We should be infused with a renewed sense of mission. So, for a New Year’s resolution, let’s try harder to be watchdogs, not lap dogs.

http://www.nytimes.com/2016/12/31/opinion/sunday/lessons-from-the-medias-failures-in-its-year-with-trump.html?action=click&pgtype=Homepage&clickSource=story-heading&module=opinion-c-col-left-region&region=opinion-c-col-left-region&WT.nav=opinion-c-col-left-region

Snatching Health Care Away From Millions

by Paul Krugman

If James Comey, the F.B.I. director, hadn’t tipped the scales in the campaign’s final days with that grotesquely misleading letter, right now an incoming Clinton administration would be celebrating some very good news. Because health reform, President Obama’s signature achievement, is stabilizing after a bumpy year.

This means that the huge gains achieved so far — tens of millions of newly insured Americans and dramatic reductions in the number of people skipping treatment or facing financial hardship because of cost — look as if they’re here to stay.

Or they would be here to stay if the man who squeaked into power thanks to Mr. Comey and Vladimir Putin wasn’t determined to betray his supporters, and snatch away the health care they need.

To appreciate the good news about Obamacare you need to understand where the earlier bad news came from. Premiums on the exchanges, the insurance marketplaces created by the Affordable Care Act, did indeed rise sharply this year, because insurers were losing money. But this wasn’t because of a surge in overall medical costs, which have risen much more slowly since the act was passed than they did before. It reflected, instead, the mix of people signing up — fewer healthy, low-cost people than expected, more people with chronic health issues.

The question was whether this was a one-time adjustment or the start of a “death spiral,” in which higher premiums would drive healthy Americans out of the market, further worsening the mix, leading to even higher premiums, and so on.

And the answer is that it looks like a one-shot affair. Despite higher premiums, enrollments in the exchanges are running ahead of their levels a year ago; no death spiral here. Meanwhile, analysts are reporting substantial financial improvement for insurers: The premium hikes are doing the job, ending their losses.

In other words, Obamacare hit a bump in the road, but appears to be back on track.

But will it be killed anyway?

In a way, Democrats should hope that Republicans follow through on their promises to repeal health reform. After all, they don’t have a replacement, and never will. They’ve spent seven years promising something very different from yet better than Obamacare, but keep failing to deliver, because they can’t; the logic of broad coverage, especially for those with pre-existing conditions, requires either an Obamacare-like system or single-payer, which Republicans like even less. That won’t change.

As a result, repeal would have devastating effects, with people who voted Trump among the biggest losers. Independent estimates suggest that Republican plans would cause 30 million Americans to lose coverage, with about half the losers coming from the Trump-supporting white working class. At least some of those Trump supporters would probably conclude that they were the victims of a political scam — which they were.

Republican congressional leaders like Paul Ryan nonetheless seem eager to push ahead with repeal. In fact, they seem to be in a great rush, probably because they’re afraid that if they don’t unravel health reform in the very first weeks of the Trump era, rank-and-file members of Congress will start hearing from constituents who really, really don’t want to lose their insurance.

Why do the Republicans hate health reform? Some of the answer is that Obamacare was paid for in part with taxes on the wealthy, who will reap a huge windfall if it’s repealed, even as many middle-income families face tax hikes.

More broadly, Obamacare must die precisely because it’s working, showing that government action really can improve people’s lives — a truth they don’t want anyone to know.

How will Republicans try to contain the political fallout if they go ahead with repeal, and tens of millions lose access to health care? No doubt they’ll try to distract the public — and the all-too-compliant news media — with shiny objects of various kinds.

But surely a central aspect of their damage control will be an attempt to push a false narrative about Obamacare’s past. Health reform, they’ll claim, was always a failure, and it was already collapsing on the eve of the G.O.P. takeover. When the number of uninsured Americans skyrockets on their watch, they’ll claim that it’s not their fault — like everything, it’s the fault of liberal elites.

So let’s refute that narrative in advance. Obamacare has, in fact, been a big success — imperfect, yes, but it has greatly improved (and saved) many lives. And all indications are that this success is sustainable, that the teething problems of health reform weren’t fatal and were well on their way to being solved at the end of 2016.

If, as seems all too likely, a health care debacle is imminent, blame must be placed where it belongs: on Donald Trump and the people who put him over the top.

http://www.nytimes.com/2016/12/30/opinion/snatching-health-care-away-from-millions.html?action=click&pgtype=Homepage&clickSource=story-heading&module=opinion-c-col-left-region&region=opinion-c-col-left-region&WT.nav=opinion-c-col-left-region&_r=0

Obama seeks to salvage health care law

by Josh Lederman - Associated Press

The president will meet with Democrats to forge a common strategy to protect the Affordable Care Act, and he also plans a deliver a major valedictory address before his presidency ends.

HONOLULU — Eager to stop Republicans from destroying his signature health care law, President Obama and Democratic lawmakers will meet next week to try to forge a common strategy. Obama also plans a major valedictory speech in Chicago, his hometown, shortly before his presidency ends.

Obama will travel to the Capitol on Wednesday morning for the meeting with House and Senate Democrats, according to an invitation sent to lawmakers. The White House is casting it as an effort to unite Democrats behind a plan to protect the law, known as the Affordable Care Act, before Republicans have a chance to settle on their own plan for repealing it.

Democrats are on edge over the future of the ACA, given the GOP’s disdain for “Obamacare” and President-elect Donald Trump’s vows to gut it. Though Republicans are united behind the notion of repealing the law, they’re split over how best to replace it. Some want to strip out unpopular provisions while leaving others intact, but other Republicans prefer a start-from-scratch approach.

It’s that lack of unanimity among Republicans that Obama and Democrats hope can be exploited, if they can lay the groundwork even before Trump takes office. To that end, Obama also planned to answer questions about the future of the health care law next Friday during a livestreamed event at Blair House, just across Pennsylvania Avenue from the White House.

Initially stunned by the defeat of Hillary Clinton, Democrats are now trying to organize a counterattack to preserve the ACA, among the most significant expansions of the social safety net since Medicare and Medicaid were created 50 years ago. House Democratic leader Nancy Pelosi has urged her lawmakers to make health care their focus at the start of the year.

Defenders of the law have also launched a political coalition called “Protect Our Care,” bringing together more than 20 groups, including the NAACP and the Service Employees International Union.

One of their objectives is to try to prevent Republicans from repealing the ACA without also enacting a replacement. (Currently Republicans plan to quickly vote on repealing the law, and delay the effective date to give them time to craft a replacement.) Another goal for Democrats is to pre-empt bigger health care changes to Medicare and Medicaid long sought by Republicans.

Since the ACA passed, about 20 million people have gained coverage and the uninsured rate has dropped to a historic low of around 9 percent. Some of the coverage gains are due to employers offering jobs with health care in a stronger economy, but most experts mainly credit Obama’s law.

A recent poll suggests that defenders of the law may get a receptive hearing from the public. Only about 1 in 4 Americans want Trump and the GOP-led Congress to completely repeal the ACA, according to a post-election survey by the nonpartisan Kaiser Family Foundation.

“Republicans don’t fully appreciate the implications of even a partial repeal of the ACA,” said Rob Restuccia, executive director of Community Catalyst, one of the advocacy groups in the coalition trying to preserve the law. “People use the analogy of the dog that caught the car.”

Obama’s speech in Chicago on Jan. 10 is expected to serve as his closing words to the nation as president. His appearance will be open to the public and followed by a “family reunion” for alumni of Obama’s former campaigns, according to a save-the-date notice sent to Obama alumni and obtained by The Associated Press.

The White House has not confirmed Obama’s speech or trip to Chicago.

http://www.pressherald.com/2016/12/30/obama-seeks-to-salvage-health-care-law/

Maine tried allowing the sale of health insurance from other states. It didn’t work.

by Jackie Farwell - Bangor Daily News

As part of his plan to reform American health care, President-elect Donald Trump has proposed what sounds like a simple enough idea: Allow health insurance to be sold across state lines.

Health insurance companies can already operate in multiple states, but they tailor their plans to each area where they do business. Trump’s proposal, a perennial favorite of Republicans, would instead allow, say, Anthem to sell the same plan in Maine, Kentucky, and any other state it chooses.

Insurers would be freed from complying will all the different insurance laws in each state, encouraging states to reduce cumbersome regulations, the thinking goes. Increased competition would in turn give consumers more options and therefore reduce prices.

Trump put it this way during his campaign:

“As long as the plan purchased complies with state requirements, any vendor ought to be able to offer insurance in any state. By allowing full competition in this market, insurance costs will go down and consumer satisfaction will go up.”

Maine has already tried this. Not a single insurer took us up on the offer.

A law passed in 2011, called PL 90, allowed insurers from other states to sell their plans in Maine. The state’s Bureau of Insurance even reached out to major insurance companies that weren’t offering plans in Maine to tell them about the law and encourage them to do business here.

It received no responses, according to a bureau spokesman.

Maine wasn’t alone. Two other states — Georgia and Wyoming — also allowed the interstate sale of health insurance. No takers there, either.

Granted, Trump’s proposal is different, aimed at allowing sales of health plans across all 50 states instead of just a few. And he has released no specifics about how it would work. But Maine’s experience reveals some of the problems with this general approach.

First, let’s be clear that this proposal would likely affect a minority of Maine residents. Large employers that use their own funds to cover employees’ health expenses, rather than contracting with an insurer, are exempt from these state regulations. So that leaves out workers at big companies such as Bath Iron Works, Hannaford and Wal-Mart. It also wouldn’t affect people with health insurance through the government (Medicaid and Medicare), which is roughly half of the insured population here.

Now, back to the pitfalls of selling insurance across state lines:

Insurers still have to set up networks. Those networks — made up of doctors, physical therapists, hospitals, pharmacies, etc. — are formed in each state to provide care for beneficiaries. That’s how insurers keep costs down, by negotiating lower prices with providers in their networks, which should lead to more affordable monthly premiums for consumers. Networks also allow insurers to select doctors and hospitals that meet certain safety and quality standards.

But networks are expensive to set up. Insurers have to pay lawyers to draw up contracts, spend time negotiating rates and so on. That’s part of why even in states with lax insurance regulations, you don’t see 20 insurers competing for business. Allowing the sale of insurance across state lines wouldn’t make forming networks any easier.

Health care costs vary from state to state. Health insurers set prices largely based on how much they expect to fork over to doctors and hospitals on behalf of their customers. But the cost of health care is inconsistent from state to state because of the relative age and health of residents and other factors. That’s reflected in different monthly premiums in each state.

Under Trump’s proposal, a wide swath of America’s population would presumably become the customer pool for health insurers. States with cheaper health care would likely end up subsidizing customers in other states such as Maine, where health expenditures are among the fastest-growing in the past two decades.

That could theoretically lead to lower premiums on average. But health insurers would have to grow even bigger to serve such a big customer base. Is that in consumers’ best interests? Just look at the separate bids by insurance giants Anthem and Aetna to merge with their competitors, which sparked antitrust suits by the U.S. Department of Justice.

Consumers could lose benefits and still pay more. Under the current system, insurers selling plans in Maine must be licensed here.

Insurance regulators fear they’d have no authority to help customers in their own states who bought health plans from companies based outside their borders. And insurers might rush to set up headquarters in states with the least burdensome regulations. That would allow them to sell cheap, bare bones policies in Maine, undermining the insurers who already sell policies here.

“Interstate policies would for the first time allow insurers unlicensed in the purchaser’s state to sell health insurance, which would otherwise be a criminal offense,” the National Association of Insurance Commissioners points out.

The association also warns of a “race to the bottom,” in which insurers cherry pick the healthiest customers in each state, who are the cheapest to insure. That would leave everyone else — the older, sicker and more expensive — to face steep premium hikes, if those people can even find a plan to cover them. State regulators, stripped of authority, could do nothing to stop insurers from hiking prices or from cutting benefits, the association notes.

Proponents point out that the proposals pushed by Trump’s pick for HHS secretary, Tom Price, and House Speaker Paul Ryan, R-Wisconsin, would require insurers to provide a minimum level of benefits in order for consumers who buy them to qualify for tax credits.

And Trump has said that health plans would have to comply with regulations in each state. But if that’s the case, it’s difficult to envision how the benefits of his proposal would be realized. They’re built, at least theoretically, on doing away with a lot of those regulations.

Uncertainty ahead

Even a champion of PL 90, the law that allowed interstate insurance sales in Maine, acknowledges that the practice could do more harm than good.

“It sounds kind of nice, and it’s easy to put on a bumper sticker,” said Joel Allumbaugh, who runs an Augusta employee benefit insurance agency and serves as a senior fellow at the conservative Foundation for Government Accountability. “It’s also fraught with complicated challenges.”

He points out that the timing of PL 90 also may have deterred more insurers from setting up shop here. The law coincided with passage of the Affordable Care Act, so insurers were grappling with a daunting new regulatory landscape, Allumbaugh said. Selling a few policies in Maine wasn’t at the top of their priority lists, in other words.

Compared to other states, the pool of people needing to buy their own insurance in Maine is small, older and not so healthy. That’s part of why cross-border shopping could prove disastrous here, said Andy Coburn, a rural health expert at the Muskie School of Public Service at the University of Southern Maine.

That’s been a problem in our market for years — well before the ACA, which boosted regulations, and PL 90, which eased them. Maine’s population isn’t exactly the most attractive to insure.

“If we have health plans coming in and picking off our young, healthy people with low premiums, bad policies, etc., it’s just going to exacerbate our problem in Maine,” Coburn said. “It’s a really terrible idea.”

Allumbaugh thinks shopping for plans across state lines could work, but many fundamental questions must be answered first, he said. Could insurers deny people with pre-existing health problems? Would the mandate to buy insurance still apply? Those are just some of the uncertainties remaining about Trump’s plan to overhaul the country’s health care.

“The potential is there, but there are a lot of intricacies that you don’t often hear them talk about in conjunction with talking about interstate shopping,” he said. “I’d like to see those two conversations come together.”

http://bangordailynews.com/2016/12/28/the-point/maine-tried-allowing-the-sale-of-health-insurance-from-other-states-it-didnt-work/

Media legitimizing GOP’s ‘universal’ health plan that doesn’t exist

By Michael Corcoran

Fairness and Accuracy in Reporting, FAIR.org, Dec. 19, 2016

Members of the GOP leadership were likely jubilant when they read the New York Times (12/15/16) and saw the following headline: “GOP Plans to Repeal Health Law with ‘Universal Access.’”

The Times’ decision to include the words “universal,” “health” and “plan” in the headline was extremely misleading and irresponsible. It gave readers the distinct—and deceptive—impression that Republicans have something resembling a “universal” health plan, and will use it to replace the Affordable Care Act (ACA).

It appears that the same corporate media who misled us into the Affordable Care Act (ACA) (Extra!, 4/10) are now misleading us out of it—and the Times’ reporting  on the GOP’s health care agenda is a particularly egregious example of this.

Republicans haven’t determined what, if any, plan will be enacted to “replace” the ACA after it is repealed. Donald Trump’s brief 7-point campaign proposal (3/16) does not even contain the word “universal.” There are several other conservative proposals from prominent organizations and politicians, including House Speaker Paul Ryan (6/22/16), the Cato Institute (7/4/12), the Heritage Foundation (10/13, 11/22/16) and various legislative efforts vetoed by President Obama (Health Affairs, 1/9/16). There is nothing in any of these plans approaching universality—not as a goal, a result or a guiding principal.

The phrase “universal access” sounds nice, but is a meaningless slogan clearly aimed to confuse the status quo, in which healthcare is a commodity, with everyone actually being able to get the medical treatment they need. “Our goal here is to make sure that everybody can buy coverage or find coverage if they choose to,” one anonymous GOP aide told the Times (12/15/16). Of course, the right to “buy coverage” has never been in question—the more than 30 million Americans who currently lack insurance can “choose” to buy coverage today. And when that number swells by another 20 million or so, which the Congressional Budget Office (12/3/15) predicts will happen if the ACA is repealed, they will all be allowed to buy coverage then too. Using this flawed logic, the Times could just as well amplify nonexistent GOP plans to provide “universal access” to housing, childcare and transportation, too.

But not a single critic was quoted in the Times article. The only quotes were from the anonymous Republican aide, Paul Ryan and a federal judge who ruled against some ACA subsidies. Not even a token response from the Democratic leadership was included, let alone an independent policy expert or advocate for true universal care. This omission occurs despite the article being 853 words and 20 paragraphs long—25 column inches, to use old print vernacular, and not a solitary clause devoted to a critical response.

But misleading coverage from the dominant newspaper is hardly surprising on this topic. In addition to spreading nonsensical and unchallenged arguments made by Republicans, major media outlets also routinely rely on current or former industry executives as sources or op-ed contributors.

Politico, for instance, has relied on Heritage Foundation health analyst and former Pfizer executive Ed Haismaier as their go-to expert. Haismaier, who co-authored the Heritage repeal plan, has been cited or mentioned in 22 Politico articles since the passage of the ACA, including six times in November 2016. This included more than 20 minutes in a Politico podcast (11/28/16). This, it would turn out, was just 10 days before he was announced (Politico, 12/7/16) to be part of Trump’s Department of Health and Human Services (DHS). Yet more evidence of how, according to the Wall Street Journal (11/25/16), “Heritage has become a hybrid of an administration-in-waiting for Mr. Trump” and “a policy factory for the new Republican-led Congress.”

The Washington Post (12/7/16) recently published an op-ed from Marilyn Tavenner that advanced the agenda of private insurers whom she represents as CEO of America’s Health Insurance Plans (AHIP). “There is no single ‘silver bullet’ to ensure that people get and stay covered,” Tavenner wrote, advancing the notion that universal health care is virtually impossible. Of course, despite using the word “single,” she ignores a policy that is used in almost every industrialized nation to “ensure that people get and stay” covered: a single-payer system (or a similarly structured public plan).

This is hardly a surprise. The corporate media have long allowed partisan power brokers in Washington, funded heavily by the health industry, to frame the debate in the narrowest of terms, treating the commodification of healthcare as a default setting that can never be changed (Extra! Update, 6/94; FAIR.org, 5/11/11, 1/20/11).

While the industry and Heritage/Trump staffers all get to have their say about what should replace Obamacare, finding an advocate for single-payer in these outlets is far more difficult. For instance, the only mention of Physicians for a National Health Program (PNHP) in Politico is a reference to a failed health reform effort in Vermont (12/20/14). In fact, PNHP compiles a list of major articles that advocate for single-payer, and with the exception of two articles from the Hill (11/16/16, 11/30/16), and one letter to the editor in the Times (11/16/16), since Trump’s stunning victory, the only articles advocating a national health system are from small local papers or independent news sites.

This problem existed during the Obama presidency as well, when the media portrayed the ACA, which was a “market solution” once promoted by Heritage (7/20/90; Forbes, 10/20/11), as the furthest acceptable “left” solution to the healthcare crisis. Single-payer, and even the far less transformative public option, were largely dismissed (FAIR.org, 5/11/11, 1/20/11).

Further, the media published a great deal of hyperbole from partisan liberals about the ACA, falsely portraying the law as a groundbreaking path to universal coverage as a human right (Washington Post, 11/23/13; Politico, 1/1/16). This portrayal further enforced the doctrinal notion that only market solutions were worthy of consideration, thereby undermining legitimate critiques of the ACA and its shortcomings (Truthout, 6/9/16).

The Times story uncritically advancing GOP talking points, just as the party prepares to take a hacksaw to what little safety net already exists in the United States, is a worrisome sign that the media’s flawed coverage of health policy will not be improving anytime soon.  In terms of the coming repeal of the ACA, it seems the public will have “universal access” to the narrow viewpoints of a small group of power brokers in Washington, and little in the way of critical dialogue.

Michael Corcoran is a journalist based in Boston. He has written for the Boston Globe, The Nation, the Christian Science Monitor, Extra!, NACLA Report on the Americas and other publications. Follow him on Twitter: @mcorcoran3.

http://fair.org...

http://www.pnhp.org/news/2016/december/media-legitimizing-gop’s-‘universal’-health-plan-that-doesn’t-exist

Costly Drug for Fatal Muscular Disease Wins F.D.A. Approval

by Katie Thomas - NYT

The Food and Drug Administration has approved the first drug to treat patients with spinal muscular atrophy, a savage disease that, in its most severe form, kills infants before they turn 2.

“This is a miracle — seriously,” Dr. Mary K. Schroth, a lung specialist in Madison, Wis., who treats children who have the disease, said of the approval, which was made last week. “This is a life-changing event, and this will change the course of this disease.” Dr. Schroth has previously worked as a paid consultant to Biogen, which is selling the drug.

The drug, called Spinraza, will not come cheap — and, by some estimates, will be among the most expensive drugs in the world.

Biogen, which is licensing Spinraza from Ionis Pharmaceuticals, said this week that one dose will have a list price of $125,000. That means the drug will cost $625,000 to $750,000 to cover the five or six doses needed in the first year, and about $375,000 annually after that, to cover the necessary three doses a year. Patients will presumably take Spinraza for the rest of their lives.

The pricing could put the drug in the cross hairs of lawmakers and other critics of high drug prices, and perhaps discourage insurers from covering it. High drug prices have attracted intense scrutiny in the last year, and President-elect Donald J. Trump has singled them out as an important issue.

“We believe the Spinraza pricing decision is likely to invite a storm of criticism, up to and including presidential tweets,” Geoffrey C. Porges, an analyst for Leerink Partners, said in a note to investors on Thursday.

Mr. Porges said the price could lead some insurers to balk or to limit the drug to patients who are the most severely affected, such as infants, even though the F.D.A. has approved Spinraza for all patients with the condition.

“What you will have is a standoff with payers,” he said in an interview on Thursday. “How is this all going to play out?”

The price of the drug would be comparable to some other drugs that treat rare diseases. A spokeswoman for Biogen said the company set the price after considering several factors, including the cost to the health care system and the clinical value it brought to patients. She said that the company has also consulted insurers about covering the drug, and that while the talks are in their early stages, insurers have responded positively to the drug’s effectiveness.

“We are working to help ensure no patient will forgo treatment because of financial limitations or insurance status,” said the spokeswoman, Ligia Del Bianco.

She said Biogen, like many companies that sell expensive drugs, had set up a program to help families navigate insurance approvals and other logistics, and will provide financial assistance.

Kenneth Hobby, the president of Cure SMA, a patient advocacy group that invested $500,000 in early academic research that led to the development of Spinraza, said more important than the list price of the drug is whether patients who need it will get it.

“Are our families going to get access to the drug in the end?” he said.

About 1 in 10,000 babies are born with spinal muscular atrophy — or about 400 a year in the United States — and it is among the leading genetic causes of death in infants. People with the disease have a genetic flaw that makes them produce too little of a protein that supports motor neurons, leading muscles to atrophy. Spinraza addresses the underlying genetic cause of the disease and enables a backup gene to produce more of the necessary protein.

Blake Farrell, 6, has the disease. As an infant, Blake reached developmental milestones, learning to roll over, sit up and crawl at all the right times. “She was doing everything on target,” Kacey Farrell, Blake’s mother, said recently from the family’s home in Cincinnati.

But as she approached her first birthday, Blake started regressing. She struggled to sit on her own and stopped crawling. At 14 months, tests revealed that Blake had a moderate form of spinal muscular atrophy. As she got older, the muscle loss caused her bones to weaken, and she suffered fractures. She could no longer sit up in the bathtub, and had trouble swallowing food.

In May of 2015, when she was 4, Blake was accepted into a clinical trial for Spinraza, also known as nusinersen. A third of the patients in the study were given a placebo, so the Farrells were not sure if she was getting the real thing. But after receiving her first few doses, which were injected into her spinal fluid, Blake started to improve. She joined her two sisters in the bathtub, sitting up on her own. One day, she even scooted across the floor.

“I was just in shock,” Ms. Farrell said. “These were all things we hadn’t seen her do since she was 8 months old.”

In an analysis of 82 infants in the clinical trial that led to the approval, 40 percent of babies on the drug reached milestones such as sitting, crawling and walking. None of the babies that received a placebo did. The F.D.A. approved the drug months ahead of time and, because the drug treats a rare pediatric disease, granted Biogen a special voucher that it can use to gain priority review of a future drug that would not otherwise qualify for the program.

The F.D.A. said the most common side effects were respiratory infections and constipation, and there is a warning about possible low blood platelet counts and toxicity to the kidneys.

Even though trial investigators did not know which patient was receiving Spinraza, “anecdotally, it just seemed quickly obvious to us that some patients were following a very different trajectory than what we were used to seeing,” said Dr. John Brandsema of the Children’s Hospital of Philadelphia, one of the investigators.

He said that while the patients who improved were the most remarkable, the drug also appears to stop the progression of the disease in other patients.

“It’s hard not to use very exaggerated terms when you are talking about this, because it really is a pretty major step forward,” Dr. Brandsema said.

For now, Blake receives Spinraza free because she is enrolled in an extension study of the drug. But her father, Nick Farrell, a lawyer, said cost is a concern.

“That is a whole lot of money,” he said, adding that among parents of children with the disease, access is already a major topic. “The conversation has already started about, O.K., what’s the next step here?”

http://www.nytimes.com/2016/12/30/business/spinraza-price.html?hpw&rref=business&action=click&pgtype=Homepage&module=well-region&region=bottom-well&WT.nav=bottom-well

Number of Mainers on Insurance Marketplace on Rise 

By PATTY WIGHT • DEC 21, 2016

More than 56,000 Mainers have enrolled in the Affordable Care Act’s marketplace insurance plans for next year, according to figures released Wednesday by the U.S. Department of Health and Human Services. That’s about 5,000 more enrollments in Maine compared to the same time last year.

Still, Emily Brostek of Consumers for Affordable Health Care says she’s concerned some people aren’t enrolling due to rising premiums.

“Because people have gotten letters from their insurance company that can sometimes be misleading,” she says. “It makes it look like you’re going to be paying more than you will, because it doesn’t account for the tax credit going up as well.”

Brostek says there’s also concern about the future of the ACA. Though President-elect Donald Trump has vowed to repeal and replace the Affordable Care Act, HHS Secretary Sylvia Burwell says currently, the federal health law is intact.

“Insurers have emphasized that the coverage people buy today is a contract for 2017 — a contract that they will continue to honor,” she says.

Across the U.S., enrollment for ACA marketplace insurance is on track to outpace last year’s numbers, with 6.4 million people currently signed up.

http://mainepublic.org/post/number-mainers-insurance-marketplace-rise

Q&A: Republicans’ path to repeal and replace Obamacare

Leaders will begin the process this week even as they delay critical decisions on what will come next

Alan Fram - Associated Press

WASHINGTON — The stakes confronting Republicans determined to dismantle President Obama’s health care law were evident in one recent encounter between an Ohio congressman and a constituent.

“He said, ‘Now you guys own it. Now fix it. It’s on your watch now,’ ” recalled GOP Rep. Pat Tiberi, chairman of a pivotal health subcommittee. “And this is a supporter.”

Republicans have unanimously opposed Obama’s law since Democrats muscled it through Congress in 2010. They’ve tried derailing it scores of times but have failed, stymied by internal divisions and Obama’s veto power.

With the Republicans controlling Congress and Donald Trump entering the White House on Jan. 20, their mantra of repeal and replace is now a top-tier goal that the party’s voters fully expect them to achieve – starting this week.

But by unwinding the statute, the GOP would kill or recast programs that provide coverage to 20 million Americans who will be wary of anyone threatening their health insurance. That and continuing Republican rifts over how to reshape the law, pay for the replacement and avoid destabilizing health insurance markets mean party leaders have a bumpy path ahead.

Q: What’s first?

A: When the new Congress convenes Tuesday, Senate Majority Leader Mitch McConnell, R-Ky., has said his chamber will begin debating a bare bones budget for next year. Most significantly, that would trigger a special procedure letting Republicans repeal much of Obama’s law by a simple Senate majority.

That’s big because GOP senators will only have a 52-48 edge. The debate will also be a way for Republicans to signal quickly to voters that they’re starting to erase the law, even as they save actually doing it for later.

Q: And then?

A: Lawmakers will work on legislation actually repealing much of Obama’s law.

The legislation is likely to erase the mandate that people buy insurance or face hefty IRS fines, which Republicans despise. Also facing elimination or reductions: taxes Obama imposed on upper-income people to finance the law, subsidies that help millions afford health care and the expansion of Medicaid health coverage to more lower-earning people. Federal aid to Planned Parenthood would be halted, reflecting GOP opposition to the right to abortion, one of the women’s health services provided by the organization.

They hope to pass the bill by late spring, but its provisions probably won’t take effect for up to four years to give lawmakers time to craft a replacement.

This won’t be easy. Many congressional Republicans are from states like Arizona, Nevada and Pennsylvania that have added about 10 million people to Medicaid and will oppose abandoning so many voters. Others will be nervous about voting to repeal the overall law without having replacement legislation to show constituents.

Republicans also worry that during the transition to a new system, health insurers – already struggling in some states – might protect themselves by leaving some markets and boosting premiums. To ease that, GOP aides say they’re considering including some kind of stabilization fund in the repeal bill to protect insurers against losses. That remains a work in progress.

Q: Will the 20 million people now covered lose their benefits?

A: Some probably will, a byproduct of reducing Medicaid coverage and dropping the requirement that individuals buy insurance.

That could be partly offset by some who’d purchase less expensive policies because the bill will probably let insurers drop coverage for some of the 10 services they now must provide, such as outpatient care and pregnancies.

At a briefing for reporters, top House GOP aides said the goal is “universal access” to health benefits, as opposed to aiming for coverage of all Americans. They said Obama’s law ended up with many policies that are too expensive and offer limited access to doctors, but the shift in focus to “access” suggests Republicans don’t want to be measured by the number of people actually covered.

The Senate’s new minority leader, Chuck Schumer, D-N.Y., said recently that repealing Obama’s law without a replacement would mean “huge calamity from one end of America to the other.”

House Ways and Means Chairman Kevin Brady, R-Texas, called claims that 20 million people will lose coverage a “big lie.” He said Republicans will provide “an adequate transition period to give people piece of mind.”

Q: What about the replacement legislation?

A: Its ingredients remain unclear.

Trump, who’s been vague, has proposed tax breaks to help people afford insurance, letting insurers sell policies across state lines and freeing states to decide how to spend Medicaid dollars.

House Speaker Paul Ryan, R-Wis., has offered similar ideas plus transforming Medicare into a system that offers subsidies for buying policies. He’d tax – for the first time – the most expensive employer-provided health benefits.

The GOP effort might involve several bills, with Republicans pushing measures through Congress as they’re ready. And it will probably take years, which would put political pressure on the GOP.

“The American people will want to see change overnight,” said Rep. Kristi Noem, R-S.D.

http://www.pressherald.com/2017/01/02/q-and-a-republicans-path-to-repeal-and-replace-obamacare/