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Thursday, Nov 10 2016

Full Issue

Perspectives On Obamacare's Bleak Future And What Might Happen Next

Opinion and editorial writers examine what big changes in health policy might be ahead.

Republicans in Congress have been calling for the repeal of Obamacare since it passed in 2010. With control of both houses of Congress and the presidency, they may finally get their chance to undo huge, consequential parts of the health law next year. If they succeed, about 22 million fewer Americans would have health insurance, according to an estimate from the nonpartisan Congressional Budget Office. (Margot Sanger-Katz, 11/9)

Can Republicans pass a bill repealing Obamacare lock, stock and barrel? Technically, yes. They have control of the House and the Senate. Democrats in the Senate could filibuster, but I doubt the filibuster survives Trump鈥檚 term in any event, so I don鈥檛 see this as a permanent obstacle. There鈥檚 still a wee bit of a problem, however, which is that they have to get Republicans to vote for a repeal. I have no doubt that Republicans would like to vote for something they can call 鈥渞epealing Obamacare.鈥 The problem is that repealing Obamacare will involve getting rid of two provisions that are really, really popular: 鈥済uaranteed issue鈥 (insurers can鈥檛 refuse to sell insurance to someone because of their health status) and 鈥渃ommunity rating鈥 (insurers can鈥檛 agree to sell a policy to some undesirable customer for a million dollars a year; the company has to sell to everyone in a given age group at the same price). (Megan McArdle, 11/9)

Donald Trump was president-elect for less than a day before Republicans in Congress began gearing up to move policy in a way the country has not seen in six years. 鈥淭he opportunity is to go big, to go bold, to get things done,鈥 House Speaker Paul D. Ryan (Wis.) declared. The last time one party controlled Congress and the White House, President Obama signed the Affordable Care Act (ACA) into law. This time, Obamacare is on the chopping block. Full repeal seems unlikely for a variety of practical and political reasons. But even before the new administration and Congress set about scaling back the ACA, they must have a real replacement plan on deck. (11/9)

The election on Tuesday of Donald Trump as the next president is one of the most consequential events in the nation鈥檚 political history for many reasons, not the least of which is that it is likely to alter the basic direction of health care policy. Trump ran hard against the Affordable Care Act (ACA), saying repeatedly it was a 鈥渄isaster鈥 that needed to be repealed and replaced, and he won. There will be a very high expectation among Trump supporters that a Republican Congress can and should move quickly to fulfill this commitment. (James C. Capretta, 11/9)

One of their biggest problems will be how to fund the tax deductions or credits they have proposed to help people afford health insurance in their new system. That's because repealing the ACA means erasing the hundreds of billions of dollars in taxes that pay for the law's premium tax credits and Medicaid expansion. Last January, congressional Republicans passed a repeal bill that wiped out the subsidies, the Medicaid expansion, and most of the major taxes, including taxes on hospitals, health insurers, medical device makers, and high-income taxpayers. President Barack Obama vetoed it. (Harris Meyer, 11/9)

We are a group of doctors who saw in your presidential campaign a threat to the health and well-being of the country. We wrote an open letter sharing our concerns, which more than 600 doctors signed. (Aaron Stupple, Andrew Goldstein and Steven Martin, 11/10)

The election of Donald Trump as president means that there will be a conservative Supreme Court for years and maybe decades to come, but how much the court will move to the right depends on the health and stamina of Justices Ruth Bader Ginsburg, Anthony Kennedy and Stephen Breyer. (Erwin Chemerinsky, 11/9)

The Democrats and President Obama are partly responsible for the defeat of the party and the success of Donald Trump. First of all, the Affordable Care Act was a catastrophic disaster for the Democrats. The chaotic and embarrassing rollout of the plan with a crashing and confusing web site presaged trouble, and now we have increases in premiums and cancelations. This gave the Republicans a piece of meat in which to plant their political hook. (Steffen Schmidt, 11/9)

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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