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So powerful is the political appeal of entitlement programs that modern democracies routinely choose bankruptcy over curtailing them. That’s even true of ObamaCare. Despite surging premiums, lagging enrollment, the growing burden on the economy, and the enduring opposition of most voters, the debate is about replacing rather than simply repealing it. (Phil Gramm, 2/2)

Supporters of healthcare reform may feel disheartened as President Trump and Republican lawmakers prepare to repeal the Affordable Care Act and replace it with … well, something. They can’t even agree among themselves on what the U.S. healthcare system should look like. But there’s reason for hope, albeit a long shot. OK, a very long shot. (David Lazarus, 2/3)

Donald Trump’s statement that his preferred replacement for the Affordable Care Act (ACA) would provide health “insurance for everybody” surprised those who have followed the contentious debate over the health-care law since its passage in 2010. Rep. Tom Price (R-Ga.), Trump’s nominee for health and human services secretary, signaled agreement with the president when he said during his confirmation hearing that a Republican replacement for the ACA should cover more people. In recent years, though, Republicans have emphasized that gains in insurance coverage should not be the sole barometer by which health-care reform is measured. (Lanhee J. Chen and Tevi D. Troy, 2/2)

The Washington Post obtained a leaked audio recording of congressional Republicans at a closed-door retreat in late January. The topic of discussion: the GOP strategy to repeal and replace the Affordable Care Act. The 93-minute peek behind the political curtain instills no confidence in a listener that lawmakers have any idea what to do next. (2/2)

The results of the 2016 election portend a vigorous 2017 debate about the future of the Affordable Care Act (ACA). Both President Donald Trump and large fractions of the Republican majority party in the House and Senate campaigned on an explicit pledge to repeal and replace the ACA. At least part of the impetus for these promises is a general belief that the ACA’s state-based insurance marketplaces are unworkable and are resulting in higher prices and fewer choices. (Craig Garthwaite and John A. Graves, 2/1)

In the summer of 2016, Representative Paul Ryan (R-WI) released “A Better Way,” a wide-ranging proposal that included a plan for reforming Medicaid. Its fate depended heavily on the presidential election, and now that Republicans hold majorities in both the Senate and the House of Representatives and Donald Trump is President, Ryan’s plan seems much more likely to become reality. The proposal would eliminate many aspects of the Affordable Care Act and make fundamental changes to the entire Medicaid program by setting a limit — a per capita cap — on federal Medicaid spending. (Andrew J. Goodman-Bacon and Sayeh S. Nikpay, 2/1)

One of the great lessons learned from the implementation of Obamacare is the importance of building bipartisan support and broad support with patients and their physicians. Because of that lack of support, every hiccup created a mini-crisis. Perhaps that was unavoidable given the complexity of the problem. It’s been unsettling for our health care system and business, and health-threatening for some. Now, as President Trump’s administration and congressional leaders consider replacing Obamacare, there is little evidence they have learned this lesson. What a shame. (Hank Werronen, 2/2)