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Congress has begun the work of replacing the Affordable Care Act, and that means lawmakers will soon face the thorny dilemma that confronts every effort to overhaul health insurance: Sick people are expensive to cover, and someone has to pay. ... If policyholders don’t pick up the tab, who will? Letting insurers refuse to sell to individuals with what the industry calls a “pre-existing condition”—in essence, forcing some of the sick to pay for themselves—is something both parties appear to have ruled out. Insurers could charge those patients more or taxpayers could pick up the extra costs, two ideas that are politically fraught. (Wilde Mathews and Radnofsky, 1/12)

President-elect Donald Trump and GOP leaders on Capitol Hill pledged this week to move swiftly to not only repeal but also replace the Affordable Care Act. It will be a difficult promise to keep. Republicans’ legislative maneuvering to repeal and replace the health law involves two party leaders, four congressional committees, dozens of GOP proposals groomed over six years, one unpredictable president-elect and a vice president-elect emerging as a clear center of power on policy for the incoming administration. (Peterson and Radnofsky, 1/12)

Republicans are heading toward a bitter fight over two competing cornerstones of modern conservative ethos: the read-the-bill, take-our-time, Schoolhouse Rock mantra that fueled this decade’s tea party revolution, and their utter hatred for the Affordable Care Act. Back in 2009, as Democrats slogged through the final stages of passing the massive health-care law, Republicans took then-Speaker Nancy Pelosi’s statement that Congress would “have to pass the bill so that you can find out what is in it” as an admission that discussion and scrutiny had intentionally been thwarted. They vowed never again to allow laws of such enormous import to pass under such circumstances. (Kane, 1/12)

Under mounting pressure from Donald Trump and rank-and-file Republicans, congressional leaders are talking increasingly about chiseling an early bill that dismantles President Barack Obama's health care law and begins to supplant it with their own vision of how the nation's $3 trillion-a-year medical system should work. Yet even as Republicans said they will pursue their paramount 2017 goal aggressively, leaders left plenty of wiggle room Thursday about exactly what they will do. (Fram, 1/12)

House Republicans on Thursday emphasized that their efforts to repeal and replace the health care law will rely heavily on revised interpretations of the law that they can make administratively, a sign of the challenges in writing replacement legislation that can overcome the Senate's 60-vote threshold. "Let's not forget, we now have an HHS, an administration, that is ready to work with us to fix this problem," House Speaker Paul D. Ryan, R-Wis., said at his weekly press conference. (Mershon, 1/12)

An outside group affiliated with House GOP leadership is ramping up its advertising campaign for a Republican alternative to the 2010 health care law, running $400,000 in digital ads across 28 congressional districts. American Action Network, a conservative nonprofit advocacy organization, is launching its first digital campaign of the year Friday, when the House is expected to vote on the budget resolution that would begin the process of repealing President Barack Obama’s signature health care law. AAN debuted TV ads Thursday night during House Speaker Paul D. Ryan’s CNN town hall that promoted the party’s health care law replacement efforts. More than $1 million in TV ads are running in 15 districts, including those of some vulnerable GOP incumbents and committee chairmen. (Pathé, 1/13)

Ben Carson on Thursday said it would be unfair to “pull the rug out” from under people who rely on ObamaCare without having a suitable replacement. “Yeah, I’ve said that many times,” Carson said during his Senate confirmation hearing. “I don’t think it’s reasonable to pull the rug out from anybody. We always have to make sure that we are taking care of our citizens, regardless of our political persuasions.” Carson, a retired neurosurgeon, is President-elect Donald Trump’s pick to lead the Department of Housing and Urban Development (HUD). Trump has vowed to repeal large swaths of ObamaCare early on in his administration. (Devaney, 1/12)

House Minority Leader Nancy Pelosi (D-Calif.) is going after the GOP's "repeal-and-replace" ObamaCare strategy by offering a cheeky moniker of her own. "I call it the 'cut-and-run' approach," she said Thursday.  "Cut the benefits and run away from it; cut the access to Medicaid and run away from it; cut the advantages to Medicare, and run away from it." (Lillis, 1/12)

Congress just took the first step toward repealing President Barack Obama’s signature domestic achievement in a budget vote that sets the unwieldy repeal train in motion. But Republicans are still divided about precisely how and when to replace Obamacare, given that the law, despite its flaws, is covering about 20 million people and has broadly influenced the American health care system. But Trump voters know what they want, and their intensity and immediacy was reflected in Trump’s announcement at his press conference this week that he wants to move rapidly on both repeal and replace — arguably more rapidly than is realistic given the nature of Congress and the complexity of the task. A full 85 percent of Trump voters said repealing Obamacare was extremely or very important — even more than those who cited stopping undocumented immigration (78 percent) or ending or modifying NAFTA (55 percent). (Kenen, 1/13)

As Congress takes up a new health-insurance overhaul, a major focus will be on the individual-insurance market, where consumers and families buy their own plans. Here are some key individual-insurance terms. (Wilde Mathews and Radnofsky, 1/12)