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Monday, Jan 30 2017

Full Issue

Cautions, Concepts On How To Replace Obamacare Without Doing Harm

Opinion pages nationwide offer thoughts on the possible pitfalls as well as how some of the ideas taking shape offer promise.

The Trump administration doesn鈥檛 have a plan to replace the Affordable Care Act, but it鈥檚 already trying to sabotage the law. It has canceled advertisements meant to encourage people to pick insurance policies on HealthCare.gov ahead of the Jan. 31 sign-up deadline. (Vikas Bajaj, 1/27)

The Post鈥檚 Mike DeBonis has obtained leaked audio of Republicans at a closed-door session airing serious anxieties about the GOP鈥檚 strategy to repeal and replace Obamacare. What鈥檚 remarkable is how decisively their specific comments in private undercut the party鈥檚 public, carefully-crafted talking points about the battle to come. Now, to be clear, these private comments reveal Republicans actually wrestling with the policy challenges that repeal (and replace) will create, which is a good thing as far as it goes. However, in so doing, they basically admit in various ways that Republicans will be responsible for the mess that repealing the law 鈥 which would probably be done on a delay while Republicans come up with a replacement 鈥 is expected to make. (Greg Sargent, 1/27)

Molina Healthcare, a Long Beach-based health insurer known traditionally as a Medicaid provider, is also one of the more important insurers in the Affordable Care Act marketplace, covering roughly 600,000 ACA enrollees in nine states. So when its chief executive warns that Republican dithering over repealing and replacing Obamacare has the potential to damage the marketplace, it鈥檚 time to sit up and listen. 鈥淲e don鈥檛 know what Congress will do, and certainly President Trump is anything but predictable,鈥 J. Mario Molina, the chairman and CEO of the company founded by his father in 1980, told me Friday. He said his staff is already working on health plan offerings for 2018 鈥 rate applications generally are due around April 1 鈥 but the company hasn鈥檛 yet committed to participating in the ACA for next year. (Michael Hiltzik, 1/27)

Both Rep. Tom Price鈥檚 (R-Ga.) and House Speaker Paul Ryan鈥檚 (R-Wis.) health plans have age-based premium tax credits, high-risk pools, and a guaranteed renewability provision. Guaranteed renewability gives consumers a strong incentive to stay in a risk pool since if they do not keep coverage within a reasonable grace period, they risk being re-rated for a higher premium. Republican replace plans represent a new three-legged stool with simultaneous implementation. Initial estimates from the Center for Health and Economy show the Republican leadership plans could achieve similar coverage to ACA with lower costs and no individual mandate. This meets Senate Minority Leader Chuck Schumer鈥檚 criteria for supporting replacement legislation, so it will be interesting to see if he finds new criteria. (Stephen Parente, 1/30)

Can the Affordable Care Act鈥檚 goal of widespread coverage be met while making the health care system more affordable? Specifically, can a workable policy be crafted to (a) offer universal health care coverage for serious illnesses for everyone in the country; (b) initiate universal wellness screenings for lower-income households that receive such coverage; and (c) inject market-based pricing that will cut federal and private health care costs 鈥 all without resorting to mandates or a single payer system? (Mark Mackie and Steven Kuzmich, 1/30)

The first executive order that President Donald Trump signed after taking office Jan. 20 gave federal agencies broad powers to change, delay or waive provisions of the Affordable Care Act that regulators deem too costly or burdensome. The vague order was short on specifics. At first, it seemed like a gimmick aimed only at fulfilling Trump鈥檚 campaign pledge to start repealing Obamacare on his first day in office. But in its vagueness lies a major problem. (1/29)

The strategy that Congress and the Trump administration will pursue to repeal and replace the Affordable Care Act continues to evolve. In early January, the favored strategy seemed to be to repeal as much as possible of the ACA through legislation, but to delay the repeal of key provisions, such as the premium tax credits and marketplaces, for two or more years and then begin work on a replacement. In mid-January, this seemed to be giving way to an approach, apparently favored by the Trump administration, under which replacement legislation would be adopted more or less simultaneously with repeal, although it was not clear how this could take place without cooperation from Democrats, which seemed unlikely. (Timothy Jost, 1/28)

With deductibles in the lowest-priced Obamacare plans averaging $6,000, many Americans can鈥檛 afford to use their insurance at all. Providers are exiting the marketplaces, leaving only one insurer to choose from in more than 1,000 counties across the country. Soon, many people could be left with no options at all. More than 25 million Americans have no health insurance coverage even though the law mandates it. With Obamacare imploding before our very eyes, keeping a plan built on a faulty premise and faulty promises is simply not an option. And the longer we wait to replace it, the worse it will get. (Lynn Jenkins, Roger Marshall and Kevin Yoder, 1/27)

Two decades ago, a Democratic president and a Republican Congress debated and eventually agreed on a way to, as Bill Clinton had urged, "end welfare as we know it." One key to reform: cede more power to states to design innovative programs to help the poor find work. (1/29)

Cancer patients have cause for great concern when considering the implications of Congress鈥 plan to repeal the Affordable Care Act. As oncologists in Iowa, I have had an up-close and personal view of how the Affordable Care Act works to help people suffering from cancer in our state. Aspects of this law are as vital for people living with cancer as any new drug or scientific discovery. (Joseph J. Merchant and Shobha Chitneni, 1/29)

This is part of the Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.
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