�鶹Ů��

President Trump has discovered that trying to work with Republicans, like trying to work on health care policy, is complicated. So with all his big campaign pledges in limbo following last week’s Obamacare fiasco, he reportedly is contemplating overtures to a party that actually wants to govern: the Democrats. This new tack comes, mind you, after Mr. Trump blamed Democrats for refusing to help him and House Speaker Paul Ryan eviscerate Obamacare. With zero support from Democrats, the pair had no margin for error as Republicans started to defect and were forced to pull their bill. (Will Marshall, 3/30)

President Trump is now claiming he really, really wants to make a big deal with Democrats, striking a rhetorically conciliatory pose after previously suggesting that Democrats would come to him on their knees begging him to bail them out once Obamacare collapsed all around them. ABC News reports that Trump told senators at a White House reception Tuesday night that a deal is “going to happen,” because “we’ve all been promising — Democrat, Republican — we’ve all been promising that to the American people.” (Greg Sargent, 3/29)

House Speaker Paul D. Ryan (R-Wis.) told GOP donors Monday that he had not abandoned his effort to pass a major health-care reform bill. But he sounded a more realistic note last Friday: “We’re going to be living with Obamacare for the foreseeable future,” he admitted after House Republicans failed to unite around a repeal-and-replace bill. The real question facing Republicans is one Mr. Ryan fielded Friday: “Do we try to prop it up?” His answer: “It is so fundamentally flawed, I don’t know if that is possible.” (3/29)

There’s no better time for Congress to prove that it can still do the tough stuff. Members should lay down their swords and figure this out. Watching the slow-motion death of the Affordable Care Act may be the choice of politicians seeking an electoral advantage in 2018. But it’s no way to govern the world’s leading democracy when so many other countries have health care systems that work. (3/29)

If the GOP is going to be a governing party, and not just the raucous opposition, it has an opportunity and a duty to repair the flaws in the Affordable Care Act, aka Obamacare. Contrary to the hot talk from Trump, it is not exploding. But it needs work. Premiums on the individual market are rising faster than they should in some parts of the nation — although less so in Washington — and insurers are skittish about the future. (3/28)

House Republicans are suing to pare back Obamacare subsidies, and President Trump implied he will revisit the insurance issue, because Obamacare is “exploding right now.” Here’s what you need to know going forward. While Republicans marketed their dumber-than-dirt plan as a conservative replacement for the Affordable Care Act, they were wrong. We already have a conservative health plan. (Rich Barlow, 3/30)

The Trump administration, working with governors and state legislatures, could make dramatic state by state changes to Medicaid and the ACA marketplaces using waivers that are allowed by federal law. Because waivers are enacted at the state level, they generally don’t garner the attention from the national press as federal health care bills in Congress. With less press and public scrutiny, reforms unpopular in Congress can still become policy. The Trump administration has already signaled its intention to push state health reform forward using waivers by sending letters to governors. (Rachel Gershon, 3/29)

As House Republicans discuss how to reboot their effort to repeal and replace Obamacare, President Trump’s favorite idea has been curiously absent: buying insurance across state lines. But a new approach to replacing Obamacare could make it easier for Republicans to enact this idea under Senate rules. It has long been a favorite concept among Republicans. ... Sometimes, interstate insurance sales are brought up as an idea that can singlehandedly eliminate the health cost problem in America. That’s not true, but what is true is that interstate insurance—especially in metropolitan areas that cross state lines, like New York City or St. Louis, a regional multi-state plan could do a better job of playing cross-state hospitals against each other. (Avik Roy, 3/29)

Fee for service, the dominant payment model in health care today, relies on an elaborate fee schedule for every identifiable procedure. Unfortunately, it has created incentives for doing more tests and surgeries than may be necessary. The concept of population health stands in contrast to the fee-for-service model. It focuses on managing the health of a population by providing the right interventions for patients at the least costly point in the care continuum — from preventive care programs to post-acute services. Population health management means paying providers or health systems on a per-patient, per-month basis rather than sticking with the fee-for-service system of paying for each service rendered. With quality reporting and guarantees built in, this change provides incentives to keep people healthy — not just treat them when they are injured or sick. (Rita E. Numerof and David B. Nash, 3/29)

Health policy in this country is, in fact, really challenging, not simply because of all the systems involved, but also because of our conflicting principles and feelings. We are very worried about who is sick now and not always clear about how to keep others from getting sick. As we consider health care policy, we would do well to think about how and why we allocate our resources the way we do. (Ryan Holmes, 3/29)