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Last month, President Trump demonstrated how not to bring a health care bill before Congress. Fifty-two years ago, President Lyndon B. Johnson — a parliamentary wizard with more than three decades of Capitol Hill experience — established a model for how to do it with his landmark program for Medicare. ... This year, while House Speaker Paul D. Ryan helped to shape the Trump proposal, the president did not show deep knowledge of the bill and relied largely on congressional Republicans to manage its progress. By contrast, Mr. Johnson mastered the details of his own legislation, and through inspiration, arm twisting and other maneuvering, pushed it through the House and Senate despite powerful opponents like the American Medical Association. (Michael Beschloss, 3/31)

The failure of the Republican Party to parlay its control of the White House and Congress into a repeal of Obamacare launched a predictable blame game in Washington. The Tea Party-inspired House Freedom Caucus, which opposed its party’s “repeal and replace” substitute, faulted House Speaker Paul Ryan. Turns out these three dozen conservatives were always more about “repeal” than “replace.” (Carl M. Cannon, 4/2)

But if anything has become clearer as the dust settles, it's that neither side in the health care debate can afford a continuing standoff that preserves the status quo. Sooner or later, our elected leaders in Washington are going to have to make a choice: Either they construct a new health care system that strips coverage from tens of millions who obtained it under the Affordable Care Act, or take proactive steps to support and strengthen the superstructure that supports the current health care scheme. (Brian Dickerson, 4/1)

By now it has become clear that the Trump administration, much like its predecessor, imagined that its health care mission was to devise another universal insurance plan to optimally distribute limited health care resources (like Obamacare only better). But had the Administration’s proposal actually passed, it would have likely guaranteed the GOP ownership of both old and new failures because the current occupants of both the Whitehouse and the Congress still fail to understand the difference between a health care crisis and a crisis in health care financing — a distinction that demands better medicine before better law. (Anthony J. Nania, 4/2)

The conventional wisdom—repeated by President Trump—is that the right-wing House Freedom Caucus is singlehandedly blocking Republican attempts to repeal and replace Obamacare. In fact, Freedom Caucus members have been reaching out to the larger bloc of “no” votes—GOP moderates—to find a path forward. Moderates are rebuffing them. Here’s why. (Avik Roy, 4/2)

After the collapse of the Republican health-care bill, President Trump said he wanted to work with Democrats on a bipartisan deal to improve the Affordable Care Act. A historic deal is possible, one that would lower premiums and expand coverage — simply by extracting and passing just two parts of the GOP’s measure. (Topher Spiro and Emily Gee, 4/3)

On a beautiful spring day five years ago, a blood vessel burst in the back of my brain. I was airlifted to the hospital for emergency brain surgery. Neurosurgeons repaired the aneurysm — a balloon-like bulge in an artery that had exploded. During the operation, doctors discovered two other aneurysms, both waiting to blow. (Melanie Ormand, 4/3)

What will Paul Ryan and the Trump administration do now that they have failed to repeal Obamacare? They’ll try to sabotage it. After their legislative debacle, they said they would let Obamacare explode on its own, after which, they hope, the Democrats will come crawling to them, pleading for a new plan. “I’m open to that,” President Trump announced. (Donald M. Berwick, 4/1)

Parts of the country are in jeopardy of not having an insurer offering Obamacare plans next year. Many counties already have just one insurer offering health plans in the Obamacare marketplaces, and some of those solo insurers are showing signs that they are eyeing the exits. (Margot Sanger-Katz, 3/31)

When the Affordable Care Act passed in 2010, few provisions were more controversial on both sides of the aisle than the Independent Payment Advisory Board. This board was created to cap Medicare spending growth, proposing cuts that automatically take effect unless Congress passes similar reductions. Congress can adjust the types of cuts, but it cannot change the dollar amount. Since ACA’s adoption, the advisory board has not received much attention because Medicare spending has not increased enough to spur it to action. But that is about to change. (Sara Radcliffe, 4/2)

There seems to be little that people agree on these days regarding the Affordable Care Act. Perhaps, though, there could be a consensus that insurers need to behave honestly, all the more so when we punish people for not having insurance. Previously unexamined data released last month from data.healthcare.gov exposes a problem with Obamacare insurers: they are varying hugely in their willingness to pay claims and their willingness to admit claims processing mistakes. Although there may be innocent explanations for the variation, the alternative possibility -- some insurers are systematically chiseling on claims -- can not be dismissed. The federal government and the states, who retain primary regulatory authority over health insurers, need to examine with greater care ACA insurer claims adjusting practices. (Seth Chandler, 3/31)