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With President-elect Donald Trump’s decision to appoint Representative Tom Price as his secretary of health and human services, plans to repeal and replace the Affordable Care Act are no longer a matter of if, but when. There is no question that Obamacare could use some fixing, but are the Republican plans that Price and his colleague Speaker Paul Ryan have in mind the best approach to health care? (Tom Miller and Timothy Jost, 12/12)

Republican leaders in Congress have announced their intention to repeal key parts of Obamacare in early 2017, but delay the implementation of that repeal until 2019 or 2020. Some conservatives are complaining about this delay, arguing that the GOP should replace Obamacare immediately. But GOP leadership is right—and here’s why. Republicans don’t have a shovel-ready replace plan. The fundamental problem is that in order to fully replace Obamacare, Republicans need to come up with a bipartisan plan that can attract the 60 votes necessary to overcome a Democratic filibuster. Given that Republicans don’t even agree among themselves as to how to replace Obamacare, it’s going to take them some time—at least a year or two—to figure out how to do that. (Avik Roy, 12/11)

The GOP’s emerging plan is to vote immediately to repeal much of the Affordable Care Act but not have the repeal take effect for a few years, giving Congress time to deal with the complexities of crafting and passing a replacement. This “repeal and delay” strategy may appear to be a reasonable way to minimize the negative effects of transitioning off Obamacare. It is not. The plan would represent a reckless act of congressional malpractice , threatening the well-being of millions of Americans. (12/10)

Ever since the Affordable Care Act became law, critics have warned that it would cause a “death spiral” in the individual health insurance market. Those fears were unfounded, but if Republicans in Congress repeal the ACA without immediately replacing it, they might just cause one. ... But there are ways to avoid this potential chaos. One approach would be to hold off on voting to repeal the ACA until the Republicans settle on a replacement. That could put Republicans in a difficult position because they have promised to repeal the ACA quickly and have not yet reached consensus on an alternative. Another approach would be to leave the individual mandate in place and extend temporary mechanisms included in the ACA to stabilize the insurance market, providing subsidies to insurance companies that enroll high-cost patients and those that experience financial losses. (Larry Leavitt, 12/12)

Our national health care “system” is a shambles. The problem isn’t just money — our annual per capita expenses already exceed every other Western country. According to 2014 data, we spent about $9,024 per person, while the next nine countries spent between $3,207 (Italy) and $6,787 (Switzerland). The money is there — it just isn’t in the right places at the right time. And still we have our uninsured millions going to hospital emergency rooms with a cold or the flu. ... We need to put the law of large numbers to work by not asking insurance companies to underwrite a smaller group with a disproportionate number of older and sick people in the pool. If the underwriting companies can’t make any money, they’ll exit the business — which is exactly what’s happening to the Affordable Care Act right now. (Michael Pandzik, 12/9)

With the transition to a new administration well underway, the fate of the Affordable Care Act is weighing on everyone's mind. We've all heard the rhetoric of repeal and replace, but what will a new system look like? One thing remains clear: The challenges haven't changed. Healthcare costs continue to soak up budgets in families, states and the federal government. (Susan DeVore, 12/10)

Across the U.S., people who have cancer, heart disease, diabetes, or other serious conditions will want to know whether they or their sick family members will be able to get and afford coverage in the future. Their partisan views about Obamacare are likely to quickly be supplanted by these more practical concerns. And a substantial number of people could be affected. A Kaiser Family Foundation analysis to be released next week found that almost 30% of U.S. adults younger than 65 have health conditions that would have left them uninsurable in a pre-ACA world. (Drew Altman, 12/9)

Asking patients to have “more skin in the game” can work, but not through high-deductible plans. Nearly 30% of the 150 million people in employer-based health insurance plans are now responsible for the first $1,000 or more of their healthcare costs. Most individual plans sold on the Obamacare exchanges have high deductibles. ... The economists' logic for making patients price-sensitive is that they will introduce market discipline to the delivery of healthcare services. Over time, as demand inevitably falls, it will force down the price of care. Unfortunately, the logic doesn't apply to healthcare that is not discretionary, i.e., most of healthcare. (Merrill Goozner, 12/10)

To be sure, national exit polls showed that the most important issues in this campaign were the economy (52%), terrorism (18%), immigration (13%) and foreign policy (13%). However, according to David Wasserman's definitive vote tallies at Cook Political Report, a swing of only 38,595 votes in 3 states (MI, PA, WI) would have given the election to Hillary Clinton. ... Voters in these states certainly had a reason to be upset. The 2017 premium increase for the second lowest-cost Silver plan facing 27-year-olds on the Obamacare exchanges was 7% in MI, 53% in PA and 16% in WI, averaging 22% nationally. ... the bottom line is that in the aggregate, Clinton's margin among those who accepted Obamacare as is or wanted it to go farther (923,270) was smaller than Trump's margin among those who thought Obamacare went too far (976,903). (Chris Conover, 12/10)

A few days after Donald J. Trump was elected president, I started getting anxious phone calls from some of my patients. They were not just worried about the direction President-elect Trump might take the nation, but about how they were going to fare, given their longstanding and serious mental illnesses. “Will I still have insurance and have my medications covered?” one depressed patient asked me. (Richard A. Friedman, 12/12)

Over the past few weeks, there has been talk both of funding infrastructure projects and defunding Medicaid, at least in part. I recently saw a patient who reminded me that Medicaid itself provides an essential kind of infrastructure. His black beard pointed stiffly down his chest. At the middle of his sternum, it flowered out into plastic beads, strung on the dozens of rosaries he wore about his neck. Red, yellow and green beads flashed as he yelled, “Go, go, go on, and get me out of here.” (Abraham M. Nussbaum, 12/9)

Here's an ethical dilemma. If you could save your family more than $8,000 next year simply by signing a statement affirming belief in principles you find repugnant, would you? It sounds absurd. But in fact that’s the position I’m in this week, thanks to a loophole in the Patient Protection and Affordable Care Act, otherwise known as Obamacare. My health insurance poses a financial hardship to my family. All I have to do to lower my yearly bills by thousands of dollars is use my John Hancock to denounce gay marriage and a woman’s right to control her reproductive destiny. (Hillary Rosner, 12/10)

Now, new data shows that a U.S. life expectancy dropped in 2015 – a year after the major provisions of the ACA went into effect – and for the first time since 1993, when the drop was attributed to the AIDS epidemic, a flu outbreak, and an spike in homicide rates. While the relationship between health insurance and mortality might still be debated – and it is certainly too early to say that the ACA is as bad as the AIDS epidemic – one thing is clear: There is no evidence that the ACA is, on net, saving lives. (Robert Book, 12/11)