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The Obamacare repeal train is leaving the station. Leading Republicans have agreed to a strategy of repealing the Affordable Care Act’s funding streams soon after Donald Trump’s inauguration, but waiting two to three years to replace the health law with better reforms. While the GOP strategy could pay off, it’s highly risky. If Republicans don’t get the initial repeal bill right, they’ll make it extremely difficult—if not impossible—to replace the ACA later on. (Avik Roy, 12/24)

With Republicans controlling both ends of Pennsylvania Avenue next year, they have a great, and rare, opportunity for reform. Ronald Reagan revived the economy, but some of his ambitions were checked by Democratic Congresses. The Gingrich Congress reformed welfare but crashed against other entitlements, and the George W. Bush-Tom DeLay GOP wasted a unified government after 2004. The question now is whether Donald Trump and a new congressional generation can enact center-right reform solutions, and the first proving ground will be ObamaCare. (12/27)

Until the GOP can pass something that garners bipartisan support and solves the Obamacare problems it has identified, it should do nothing. That’s the ultimate “grandfathering” — leave the system in place. That is the only real solution politically or policy-wise that doesn’t create a raft of victims. The sooner the GOP figures this out, the better. (Jennifer Rubin, 12/29)

Republican critics of the Affordable Care Act have long described it as a house of cards on the verge of collapse. And they continue to be wrong. A record number of people have signed up for health insurance for 2017 on the federal exchanges created by the 2010 law. Nearly 6.4 million people had signed up for coverage as of Monday, which is about 400,000 more than at a similar point last year. Among them were two million people who did not participate in 2016, some of whom might have previously been covered through an employer. (12/23)

Premiums on the exchanges, the insurance marketplaces created by the Affordable Care Act, did indeed rise sharply this year, because insurers were losing money. But this wasn’t because of a surge in overall medical costs, which have risen much more slowly since the act was passed than they did before. It reflected, instead, the mix of people signing up — fewer healthy, low-cost people than expected, more people with chronic health issues. The question was whether this was a one-time adjustment or the start of a “death spiral,” in which higher premiums would drive healthy Americans out of the market, further worsening the mix, leading to even higher premiums, and so on. And the answer is that it looks like a one-shot affair. (Paul Krugman, 12/30)

Republicans believe they have a mandate for wholesale, dramatic change. Which is why it’s important to keep in mind that despite what everyone seems to think, 2016 was not really a “change” election, and that’s not just because the outgoing president is extremely popular and his chosen successor got almost 3 million more votes than the person who’ll be in the Oval Office. (Paul Waldman, 1/2)

Poor Americans are facing the gravest threat to the federal safety net in decades as President-elect Donald Trump takes office accompanied by a Republican-controlled Congress. The risks to essential benefits for tens of millions of low- and moderate-income Americans include losing coverage extended to them by the Affordable Care Act, threats to the fundamental structure of the Medicaid health-insurance program for the poor and further reduction of already squeezed funding for scores of other important programs serving the most vulnerable Americans. (Robert Greenstein, 12/26)

With Republican leaders promising to quickly repeal the Affordable Care Act and only promising to enact a replacement, it's worth revisiting the question of whether healthcare is a right. If the answer is no, then any replacement bill can be deemed acceptable as long as its architects maintain political power. But if the answer is yes, then any replacement bill must be evaluated in terms of what's included in that right. (Merrill Goozner, 12/31)

Critics of the Affordable Care Act love to bathe the pre-Obamacare period in a golden glow, as if everyone just adored their old insurance plans before the ACA mucked everything up. That adoration doesn’t make much sense to people who tried to find coverage for their pre-existing medical conditions. They were routinely denied coverage, offered bare-bones plans at stratospheric prices or dropped from their plans when they fell ill. ... The consequences of returning to that world would be dire for millions of Americans with such conditions, as a recent paper from the Kaiser Family Foundation reminds us. (Michael Hiltzik, 12/28)

The effort by the GOP to peel away parts of the Affordable Care Act could also lead to a showdown over how the Senate runs, due to Republicans’ use of a special Senate rule that allows certain legislation to move through with a simple majority, rather than the 60-vote supermajority typically required. ... Most significantly, Majority Leader Mitch McConnell and his caucus may be forced to choose between their antipathy toward the ACA, also known as Obamacare, and their allegiance to longstanding institutional norms. In the end, the scope of ACA repeal will likely depend on whether Senate Republicans decide to score political victories in the short term or to maintain the Senate’s unique culture for the long haul. (Daniel J. Hemel and David J. Herzig, 12/30)

Republicans in Congress will soon be able to repeal Obamacare, as they have long wished to do. The Upshot’s health care columnists, Aaron E. Carroll and Austin Frakt, discuss the possibilities — the practical and the political. (12/26)

As soon as the new Congress is sworn in Tuesday, some Republicans will set about following through on their promise to repeal the Affordable Care Act. If they succeed, it will be a blunder, one that will strike especially hard in California. ... Instead of attacking a program that has worked to provide coverage to 20 million previously uninsured Americans, Congress should turn its attention to what drives up the cost of health care. One place to start is with the high cost of drugs. (1/2)

Kevin Drum of Mother Jones thinks that making Obamacare work could have been a simple task for Democrats. All they needed was two things: About twice as much funding, and a higher tax penalty for not buying insurance. ... I agree that higher subsidies and a stronger mandate would have made Obamacare less of a policy train wreck; we probably wouldn’t be so worried about a death spiral if they had passed. On the other hand, it would have made the program much more of a fiscal train wreck. (Megan McArdle, 12/28)

Last night, CNN aired a terrific segment on people from coal country who voted for Donald Trump — but are now worried that his vow to repeal Obamacare will deprive them of crucial protections that enable them to stay afloat financially. This dovetails with other reporting that suggests a lot of Trump voters may be harmed by repeal of the law. Which raises a question: Did voters such as these know they were voting for this? After all, Trump promised countless times throughout the campaign to repeal the Affordable Care Act, didn’t he? If they are complaining about this now, don’t they have only themselves to blame? (Greg Sargent, 12/27)