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Modern conservatism, at least in its pre-Donald Trump incarnation, evolved to believe in a marriage of Edmund Burke and Milton Friedman, in which the wisdom of tradition and the wisdom of free markets were complementary ideas. Both, in their different ways, delivered a kind of bottom-up democratic wisdom — the first through the cumulative experiments of the human past, the second through the contemporary experiments enabled by choice and competition. In health care policy, however, conservatives tend to simply favor Friedman over Burke. That is, the right’s best health care minds believe that markets and competition can deliver lower costs and better care, and they believe it even though there is no clear example of a modern health care system built along the lines that they desire. (Ross Douthat, 1/25)

If you’re following the health insurance debate—and since the coverage of more than 20 million Americans is under threat from the Trump White House and the Republican congressional majority, you should be—you’re going to be hearing a lot in the coming weeks about Cassidy-Collins. That’s an Obamacare replacement plan just introduced by Sens. Bill Cassidy (R-La.) and Susan Collins (R-Maine). Dubbed the Patient Freedom Act, It’s the first such proposal that indicates that the GOP is becoming increasingly panicked about the political price of repealing the Affordable Care Act outright, and increasingly desperate to reassure voters that the provisions of Obamacare they actually value can be retained without a break. (Michael Hiltzik, 1/24)

I’m just not professionally or temperamentally wired for policy discussions. I am, however, temperamentally and professionally wired for doctoring, and here's what I see: Undoing the Affordable Care Act with such rapid and angry vehemence will be bad for our health. (Steve Schlozman, 1/24)

The Department of Health and Human Services has discretion under the ACA to offer states waivers, formally “state innovation waivers,” from many of the law's most expensive and onerous regulations. The Trump administration can immediately signal its commitment to promoting market competition and empowering patients and consumers by offering such waivers. Along with new reforms to promote transparency on pricing and quality, the administration and Congress can facilitate a health care revolution from the ground up. ... Trump’s pick for HHS secretary, Tom Price, can put even more punch behind this approach by allowing states to merge ACA and Medicaid funding, via so-called “1115 waivers,” and granting greater flexibility to state Medicaid programs. (Tom Coburn and Paul Howard, 1/24)

The repeal of Obamacare is nigh, agree Republican leaders in Congress, but there’s plenty of dissent in the ranks over a repeal-and-replace strategy. Those same GOP leaders are in the dark about President Trump’s vow to substitute a plan that offers “insurance for everybody” — which pretty much describes how Obamacare was supposed to work all along. Not to be overlooked in the unpredictable debate over health care coverage and costs is the need to preserve quality of care. (Tom Still, 1/24)

On January 23, 2017, Senator Bill Cassidy (R-LA), joined by Senator Susan Collins (R-ME), Johnny Isakson (R-GA) and Shelly Moore Capito (R-WV), introduced the Patient Freedom Act of 2017 (PFA), their proposal for partially repealing and replacing the Affordable Care Act (ACA) (here are the press release, one-page description, and section-by-section summary). The legislation combines features of the Healthcare Accessibility, Empowerment, and Liberty Act, which Senator Cassidy introduced into Congress with Congressman Pete Sessions (R-TX) in 2016, and earlier Patient Freedom Acts which Senator Cassidy introduced as potential responses had the Supreme Court held in King v. Burwell that the federal marketplace could not issue premium tax credits. (Timothy Jost, 1/24)

President Donald Trump isn’t delaying his promise to repeal and replace Obamacare. On his first business day in office, he signed an executive order offering some relief from the law’s oppressive regulations. Congress is equally eager to take action, but any major shakeup will create challenges for the states — especially the ones that expanded Medicaid under the Affordable Care Act. Michigan must be ready for a plan B, depending on how Congress acts. ... Repeal of the Affordable Care Act will likely roll back federal assistance for Medicaid expansion, if not scrap it completely. Michigan will have two choices: pay the higher bill or drop coverage for some, or all, of the 640,000 people enrolled in the Medicaid expansion. That’s more than 30 percent higher than originally projected. The state government needs to begin saving for increased Healthy Michigan costs — something it was supposed to do from the beginning — while preparing to close the plan in the long run. It’s too costly and hasn’t delivered on its promises. (1/24)

Republican leaders in Congress in recent years have championed the idea of transforming Medicaid from a fully shared federal-state program with matching federal payments to one where Washington provides block grants to the states, leaving each state to manage its own Medicaid program. If Congress now proceeds in this direction, it should do so with utmost care. Under most scenarios, block granting will likely have disastrous implications for current Medicaid patients, providers, as well as state finances. (Kenneth L. Davis, 1/25)

A serious threat to seniors and those with disabilities is being ignored in the debate over repealing the Affordable Care Act. We must not forget that the Medicaid program dates back to 1965, not the ACA expansion for the working poor. This half-century-old safety net is responsible for more than three-fifths of all nursing home patients, and it, too, is imperiled. (Brendan Williams, 1/25)

Colorado needs to have an honest and immediate conversation about Medicaid, a simple talk that before now was avoided in favor of political vitriol and defensiveness over the Affordable Care Act. Medicaid makes up 26 percent of the state’s general fund and is estimated to cost $2.65 billion of the state’s fungible budget in the 2017-18 fiscal year. ... As lawmakers face a budget crunch, those numbers have created an easy target for some Republicans to claim there is money in the budget for transportation and education, if Democrats were only willing to cut Medicaid. But Republicans have to be honest about what that money is and isn’t paying for, and what the state can and can’t do. (Megan Schrader, 1/24)

Ever since the Brownback administration privatized Medicaid, there has been a disconnect between its rose-colored assessments of KanCare’s success and the complaints of many service providers and those receiving (or not receiving) care. So it wasn’t a huge surprise when federal officials denied Kansas’ request to extend KanCare contracts beyond this year, saying the state was “substantively out of compliance with federal statutes and regulations, as well as its Medicaid state plan.” Nor was it particularly surprising that the Brownback administration lashed out in response, saying the denial was “politically motivated.” (1/24)