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In his final Senate press conference of 2016, Majority Leader Mitch McConnell (R-Ky.) renewed his pledge to start repealing the Affordable Care Act on Jan. 3 even with no replacement in sight, declaring that “surely” the GOP revision will wind up covering Americans better than Obamacare. He declined to say when or how Republicans will pass their superior “replacement” plan. ... Exactly how Republicans intend to do better remains to be seen. ... That uncertainty doesn’t seem to be giving McConnell and his allies pause, however. (Michael McAuliff and Jonathan Cohn, 12/12)

There has been a lot of uncertainty about how Republicans are going to follow through on their long-held goal of repealing the Affordable Care Act, and in a press conference today, Senate Majority Leader Mitch McConnell offered a little more clarity — with some frightening implications for Americans’ health care. ... Repealing and replacing are going to be separate, and repeal will happen immediately in January. In other words, the Republican Congress is going to toss millions of Americans off a cliff, then shout down to them, “Don’t worry, we’ll get you some kind of parachute before you hit the ground! Probably!” (Paul Waldman, 12/12)

[T]here is reason to believe that the Trump administration, despite Trump’s campaign promises, could deliver on the longstanding conservative goals of not only repealing Obamacare (which Trump pledged to do) but also transforming Medicaid into block grants, turning Medicare into a “premium support” system (ending the program’s traditional open-ended commitment to pay for medical services) and sharply cutting funding for Great Society programs, including food stamps. “I’ve been working on these issues since 1972,” Robert Greenstein, the president of the Center on Budget and Policy Priorities, said in a recent interview. “This is by far the gravest threat to the safety net, and to low-income people, that I’ve seen in my close to half a century of working on these issues.” But if Republicans pursue a retrenchment agenda, they will quickly learn that shredding the safety net is much harder than it seems. (Julian Zelizer and Eric Patashnik, 12/12)

In the six years since President Obama signed the Affordable Care Act (ACA) into law, 20 million more people have health insurance, and, for the first time in our history, more than nine out of every 10 Americans are insured. Growth in both premiums for employer coverage and overall Medicare spending has also slowed. The Centers for Medicare and Medicaid Services’ Actuaries now project that we are on track to spend $2.6 trillion less over the ACA’s first decade than was projected without the ACA back in 2010. ... This work has gone on steadily for years — through political turmoil and challenges in the courts. Yet through each challenge, these reforms have endured. They must continue to endure. (Sylvia Mathews Burwell, 12/12)

California probably gained more than any other state from the Affordable Care Act, the federal health reform better known as Obamacare. Now, with the program facing an almost certain demise, the state and its low-income residents have the most to lose. (Daniel Weintraub, 12/12)

Privatizing Medicare, or turning it into a voucher system, would take seniors back to a time where they have to make difficult financial tradeoffs if they get sick and need good health coverage. It would mean higher out-of-pocket costs for seniors and higher insurance premiums for younger Americans. (Sen. Joe Donnelly, D-Ind., 12/12)

Ryan is a committed Catholic, and thus inspired by Christ’s command to see his face in the least among us. He is rightly concerned that health-care reform protect vulnerable prenatal children. But this commitment applies just as earnestly to the vulnerable populations hurt by his proposed policies above. ... Ryan’s commitment to the Catholic Church means that he ought to rethink his health-care reform proposals and make sure that — instead of privileging the young, wealthy and healthy — they instead lift up the sick, poor and old. (Charles Camosy, 12/13)