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The latest news on Obamacare from Business Insider

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    mark cuban barack obama

    Mark Cuban thinks the Affordable Care Act, the healthcare law better known as Obamacare, has its issues but nothing insurmountable.

    In an interview with CNBC on Tuesday, the billionaire investor and media personality said the healthcare law had flaws but was ultimately a positive development.

    "To me, Obamacare is one of the biggest startups of all time," Cuban said during an interview with CNBC's "Squawk Alley."

    "They made certain projections that didn't work out. That's not unusual for a startup. It doesn't help the people in the states — obviously it's very painful for them."

    The current Obamacare premiums are roughly in line with the nonpartisan Congressional Budget Office's expected premium levels for 2017 from when the ACA first passed.

    Cuban said many startups go through growing pains and need to be retooled to be successful. Thus, given the size of the ACA, he said, it was unsurprising that there had been growing pains.

    Cuban also said many people did not understand what was actually happening with the law, with politicians and pundits resorting to what he called "headline porn" that does not convey the whole truth.

    While acknowledging the premium increases in some states, Cuban said there were solutions that could help to mitigate the costs.

    Cuban also criticized Republican presidential nominee Donald Trump, who has been attacking Obamacare over the past week on the campaign trail. Cuban said Trump "doesn't understand Obamacare."

    "Like I said to him directly, he should understand the basics of Obamacare, and obviously he does not," Cuban said.

    The back-and-forth comes at an interesting time, as Obamacare's public exchanges launch their fourth open enrollment period on Tuesday. The Department of Health and Human Services projected that 13.8 million people would sign up for health insurance through the exchanges. Premiums on the exchanges are projected to increase by 25% on average, according to the HHS, drawing the ire of Republicans including Trump.

    SEE ALSO: It's do or die for Obamacare

    Join the conversation about this story »

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    barack obama sad frown

    Anthem, one of the five largest public health-insurance companies in the US, may pull out of the Affordable Care Act's public exchanges if the market does not improve in 2017.

    After the release of Anthem's third-quarter results on Wednesday, CEO Joseph Swedish said the insurer would evaluate its participation in the exchanges, established under the law better known as Obamacare, for 2018 when it gets the results of the 2017 plan year.

     

    Clearly, 2017 is a critical year as we continue to assess the long-term viability of our exchange footprint," said Swedish on the call.

    "We will continue to closely monitor this business, and if we do not see clear evidence of an improving environment and a path towards sustainability in the marketplace, we will likely modify our strategy in 2018.  We believe both the pricing and regulatory environment need to be improved to drive toward a sustainable and affordable marketplace over the long-term."

    The firm has 889,000 people enrolled on exchange-based plans, according to the call.

    A scale back by Anthem would make it the fourth of the five largest US health-insurance companies to pull out substantially from the markets after Aetna, UnitedHealthcare, and Humana. All of these companies have said the people signing up for coverage on the public exchanges are sicker and costlier than expected, leading to substantial losses for the companies.

    Swedish reiterated those concerns on Wednesday, calling the Obamacare performance "disappointing." The Anthem CEO did say, however, that increased premiums and cost controls should make ACA plans profitable in 2017. Here's his comments from the call:

    "We continue to experience higher than initially expected costs from members with chronic conditions, as we've discussed with you previously. Overall, the financial performance in individual ACA compliant products has been disappointing, as membership has been short of our original expectations since its inception and operating margins have been lower than expected beginning in 2015. We believe we've taken the appropriate actions across our served markets to return to slight profitability in 2017."

    These exits have led to fear over the long-term sustainability of the exchanges, given fewer choices for consumers and increasing premiums for those still receiving care from the marketplaces.

    While the exchanges have drawn most of the attention, they also account for only 5% of the total health insurance markets. The Department of Health and Human Services estimates that 13.8 million people will sign up for insurance through the exchanges for 2017. On the other hand, the Kaiser Family Foundation estimates 155.9 million Americans get their insurance from their employer. 

    Anthem's announcement came just 24 hours after open enrollment began for Obamacare, marking a critical time for the administration.

    Anthem missed earnings estimates for its third-quarter earnings, posting $2.45 a share against analyst estimates of $2.47 a share. Revenue, however, beat expectations at $21.1 billion against estimates of $20.7 billion.

    The insurer also said its benefit expense ratio, the ratio of medical payouts against payments coming in, increased to 85.5%, up from 83.6% from the same quarter a year ago. The firm said it was due to its Medicare business but also the "individual" line that includes Obamacare plans.

    "Further, the benefit expense ratio reflects the impact of higher medical cost experience in the Individual business, partially offset by the timing of lower medical cost experience in the Local Group business, as expected,"a release from the company said.

    The company also said it planned to fight the Department of Justice's lawsuit blocking its merger with its rival Cigna.

    The stock was higher by 3.75% after the news, to $121.82 a share as of 10:04 a.m. ET.

    SEE ALSO: It's do or die for Obamacare

    Join the conversation about this story »

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    bill clinton

    Former President Bill Clinton shot back at a heckler at a Tuesday about his position on the Affordable Care Act, better known as Obamacare.

    Clinton seemed to misstep in October calling the ACA the "craziest thing in the world." Republicans seized on the comments and nominee Donald Trump has been using the line at his rallies over the past few weeks.

    In his response Wednesday, Clinton said his comments had been taken out of context and he supported the healthcare law.

    "That is not at all what I said," replied Clinton to the heckler. "No. Oh really, go read it. Go read it. Don't read it over the internet, get the whole thing."

    Clinton said his support of healthcare reform in general and Obamacare specifically went back many years.

    "I campaigned hard for that law," Clinton said. "I risked the Congress to pass universal healthcare. Thirdly, I defended President Obama in 2010 and 2012. He went up 5 points in the polls after I defended what he did on healthcare."

    Clinton also clarified his comments, saying that Obamacare needs some fixes as both the Democratic nominee Hillary Clinton and Obama have said.

    "We shouldn't be in denial, the president said the same thing," Clinton said. "I didn't say a thing that the president hadn't already said, or that the health care people in his administration hadn't already said in his administration."

    In his original comments that spurred controversy, Clinton drew attention to the fact that a chunk of people receiving health insurance through the ACA's public exchanges that do not receive government subsidies to help pay for their plans. This is a small number of the total exchange population, however, with 77% of people on the exchanges able to get a plan for less than $100 a month after subsidies.

    Even so, these are weakness that even Obama pointed out in a speech in Miami last month. Both Clinton and Obama have called on reforms to the law to fill this gap.

    Obamacare has become a key issue in the waning days of the election, with premiums for exchange plans increasing dramatically in many swing states such as Pennsylvania, North Carolina, and Arizona.

    SEE ALSO: Another huge insurer could dump Obamacare

    SEE ALSO: It's do or die for Obamacare

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    Obama doctors Obamacare

    The Affordable Care Act may be one of the keys to swinging the election.

    Republican presidential nominee Donald Trump has been hammering the ACA, better known as Obamacare, on the trail, calling the law a "mess" and "one more way the system is rigged."

    This may in fact be a shrewd move for Trump, since as we've noted before, Obamacare is deeply unpopular among Trump's base and is seen as more unfavorable than favorable among those that consider themselves independent.

    The reason Trump is hitting the issue of Obamacare so hard may be because those states considered "swing states" have generally seen greater premium increases than the national average. According to the Department for Health and Human Services, the premium for benchmark silver-level plan will increase by 22%, for swing states the increases are:

    • Arizona: +116%
    • Pennsylvania: +53%
    • North Carolina: +40%
    • Iowa: +25%
    • Maine: +15%
    • Florida: +14%
    • Nevada: +6%
    • Ohio and New Hampshire: +2%

    This doesn't necessarily help directly for places such as Ohio and Nevada. However, Trump can still use other states as an example of concerns about the law. In fact, he repeatedly cited the massive Arizona jump at a rally in Florida on Wednesday.

    Additionally, the premium increases do not account for subsidies that can reduce the cost for 77% of those in the exchanges to under $100 a month. 

    SEE ALSO: Donald Trump is going scorched earth on Obamacare in a last-ditch campaign effort

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    obama obamacare doctors

    Amid the administration’s latest drive to sign up millions of Americans for Obamacare coverage, a new government study warns that the uninsured rate may have plateaued after years of dramatic decline.

    There were roughly 28 million uninsured Americans during the first six months of this year, a significant change from the 48 million consumers who lacked coverage at the time of the enactment of the Affordable Care Act in 2010.

    Government-subsidized health insurance policies for low and middle-income people, along with an expansion of the Medicaid program in more than half of the states, have helped more than 20 million uninsured people obtain coverage.

    But as the politically embattled program begins its fourth year of operation in January, Obamacare has been rocked by skyrocketing premiums, high deductibles and an alarming number of major insurers including Aetna and UnitedHealthcare deciding to pull out of the market after incurring tens of millions of dollars in losses.

    Department of Health and Human Services officials have projected that an average of 11.1 million people will be covered by an Obamacare plan during any given month next year, and they expect that more than 13.8 million people will sign up for coverage during the open enrollment period that began this week.

    If their forecast pans out, then one million more people will have signed up for coverage than in 2016.

    However, a study released Wednesday by the National Center for Health Statistics offers a slightly gloomier assessment of the government subsidized insurance program, showing that it has begun to stall and could even lose altitude without key fixes and reforms.

    The uninsured rate crept up a little to 8.9 percent in the past three months – a rate essentially unchanged from the first half of 2015, according the study. Moreover, while there was a 200,000-person drop in the number of uninsured people between 2015 and the first six months of 2016, it constituted a “nonsignificant difference,” according to the report.

    obamacare

    The findings were derived from a national health survey, which so far has interviewed more than 48,000 people this year.

    Among other findings:

    • Some 12.4 percent of adults ages 18 through 64 were still uninsured during the first half of 2016, an uninsured rate well above the overall average. Another 20 percent had obtained public coverage through Obamacare and Medicaid, while about 69 percent had private health coverage, typically obtained through employers.

    • The uninsured rate was much lower for children through age 17, with only five percent of that cohort going without coverage. About 42 percent had government-sponsored coverage and nearly 54 percent had private coverage.

    • The percentage of people under the age of 65 enrolled in private insurance plans with high-deductibles steadily increased from 25.3 percent in 2010 to 36.7 percent in 2015 to 38.8 percent in the first six months of this year.

    That final figure, which indicates that nearly four in ten consumers are enrolled in high-deductible policies, is especially important because of compelling findings that many Americans are avoiding medical treatment if at all possible and putting off elective surgery and other procedures because they can’t afford the sizeable up-front costs under their policies.

    A Commonwealth Fund survey last year found that roughly 40 percent of working-age adults put off some kind of medical care because of the cost. The number of workers with annual deductibles rose from 55 percent nearly nine years ago to more than 80 percent today, according to a recent study by the Kaiser Family Foundation.

    Meanwhile the size of the average deductible – the amount of money that patients must contribute up front before their policies kick in – more than doubled in eight years, from $584 to $1,217 for individual coverage, according to USA Today.

    Arminda Murillo, 54, reads a leaflet on Obamacare at a health insurance enrollment event in Cudahy, California, U.S. March 27, 2014.     REUTERS/Lucy Nicholson/File Photo

    Government researchers define high-deductible coverage as any plan that requires patients to pay at least the first $1,300 of annual medical expenses for an individual plan, or $2,600 for a family.

    Emily Zammitti, the lead author of the National Center for Health Statistics survey, told the Associated Press that the study was more of a “snapshot” than a reliable trend line of progress on reducing the rate of the uninsured, and that the CDC couldn’t determine if there was a true trend.

    However, Joseph Antos, a health care expert with the American Enterprise Institute, believes the study points to the challenges of expanding the base of Obamacare enrollees beyond both the low income consumers who signed up in recent years to take advantage of federal subsidies and the higher income Americans who considered the coverage reasonably priced before the latest round of premium increases.

    “The study tends to confirm what happens when prices go up,” Antos said in an interview Thursday. “Demand for the product tends to level off or drop.”

    “I think the Obamacare exchange market is stabilizing, but it’s not stabilizing the way I think the biggest supporters of the ACA were hoping for,” Antos added. “They were hoping that it would be general coverage  that would be attractive to everybody between 100 percent of poverty and 400 percent of poverty, and what it has turned out to be once again is coverage that is attractive primarily to people who are getting very large subsidies – and they have basically picked up all of those people already.”

    “So there isn’t much more room to expand coverage in the insurance exchanges unless something changes – and literally nothing has changed,” he said.

    The study comes as soaring Obamacare premiums have become a major issue in the closing days of the presidential and congressional campaign. Republican presidential nominee Donald Trump has called Obamacare a financial “disaster” and vowed to “repeal and replace” it shortly after he takes power if he wins.  Democratic nominee Hillary Clinton, meanwhile, argues that it is essential to preserve and build on the existing program, and has proposed a list of measures to expand coverage while making it more affordable.

    Join the conversation about this story »

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    obamacare protest

    This week, the government finally confirmed much of the bad news about Obamacare that the health-policy world had been expecting for months.

    After losing a good deal of money on customers who have turned out to be older and sicker than anticipated, insurance companies are pulling back from the individual market next year and significantly raising their prices: About one-fifth of the country will have just a single carrier to choose from on the Affordable Care Act's exchanges, and average premiums before government subsidies are increasing 22 percent in the states where data is available.

    But those problems aren't equally severe everywhere. In places like Massachusetts and Ohio, numerous insurers are still competing for business, and premiums have stayed relatively low—in both the Bay and Buckeye states there will be at least 10 carriers offering coverage, and a 27-year-old will be able to buy a benchmark silver plan for less than $230 a month on average. On the opposite end of the spectrum there are cases like Alabama, where only one insurer is set to sell coverage, and a benchmark plan will cost $384.

    The fact that Obamacare seems to be working much better in some corners of the country than others has raised an obvious question: Is the health reform law having problems because it's badly designed? Or is troubled because some states are too busy fighting the law to properly implement it?

    Unfortunately, it's hard to say for sure. Under the Affordable Care Act, the U.S. is still cursed with 50 different, complicated insurance markets, and nobody that I know of really has a complete read on what's going on in every single one of them. But there is evidence that, yes, some states have sabotaged their own insurance markets by refusing to cooperate with Obamacare's goals.

    Take the law's Medicaid expansion, which 19 states still have not implemented. In the refusing states, low-income families that would otherwise be eligible for government insurance have been pushed onto the exchanges, where they've been some of the most enthusiastic customers, since they qualify for generous subsidies. As the Department of Health and Human Services pointed out in a September report, households that earn between 100 and 138 percent of the poverty line make up about 40 percent of the exchange market in non-expansion states, on average. In states that did expand Medicaid, they make up just 6 percent.

    Obamacare protest

    Herding poorer families into the exchanges has almost certainly left insurers with a sicker customer base, since low-income Americans tend to be less healthy.

    That, in turn, drives up costs for everybody. Controlling for other variables, the Department of Health and Human Services researchers estimated that in 2015, premiums were 7 percent lower in states that decided to expand Medicaid than those that didn't.

    It seems entirely possible that difference has grown with time as carriers have had to further adjust their prices to reflect the health of their customer bases.

    State governments may have undermined their insurance markets in other, less overtly political ways. The majority have allowed their residents to hold onto so-called grandmothered or transitional plans that they purchased after the Affordable Care Act was passed but before healthcare.gov opened for business. That means people who were healthy enough to obtain affordable insurance back when carriers could discriminate against people with pre-existing conditions have been allowed to stay off the exchanges, leaving insurers with a sicker customer base.

    How big a difference did that make? The Kaiser Family Foundation recently looked at this issue by comparing risk scores, which measure how unhealthy the enrollees in health plans are, across different states. They found risk scores were 8 percent lower in states that had expanded Medicaid and banned transitional insurance plans compared with states that had done neither. In states that expanded Medicaid but didn't ban transitional plans, scores were just 3 percent lower.

    Now, letting people keep their old insurance isn't an act of political protest the same way turning down the Medicaid expansion is, since the feds have allowed it. Nonetheless, states that fully implemented Obamacare as it was imagined seem to have more balanced individual insurance markets. (One silver lining here: All Americans will have to relinquish their grandmothered plans after next year, so we can expect some additional healthy customers on the exchanges.)

    Slate chart 8

    To be clear, these are not the only reasons why some states are seeing higher prices and less stable markets than others. Some parts of the country, especially the Deep South and Appalachia, are simply older and sicker than others, and would likely face higher insurance costs no matter what in a system like the Affordable Care Act. Unfortunately, those same states have often fought hardest against properly implementing the law, making a troubled situation worse.

    In other states, the problems are murkier. Arizona's Republican-controlled government went ahead with the Medicaid expansion and, as of 2015, had a much lower risk score than, say, Ohio. Yet none of its counties are being serviced by more than one insurer in 2017, and its benchmark premiums are rising by an astonishing 116 percent, to $422 per month for a 27-year-old before subsidies. I'm not sure anybody has a solid theory as to exactly why that has happened.

    But the point isn't that Obamacare would have been a perfect law had every state cooperated, or that every market would have been in shipshape. It's that health reform almost certainly would have been in a better place had states gone along with plan. Unfortunately, many haven't—and won't.

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    doctor patient concern worry

    Health services providers that have benefitted from the Affordable Care Act (ACA) are getting rocked in pre-market trading after the presumed election of Donald Trump as the next president of the the US.

    The ACA has benefitted health care services and hospital companies as more than 20 million American have gained health insurance.

    The thinking is that higher use of health care facilities and fewer losses from uninsured patients would be beneficial to these firms.

    Now, with Trump elected and a Republican Congress, recent calls for the repeal of the ACA, better known as Obamacare, are more likely and could lead to the loss of these financial benefits.

    Here's a quick rundown of the hardest hit stocks:

    • Hospital Corporation of America, which manages 168 hospitals and 116 surgery centers, is down -15%.
    • Universal Health Services, manages hospitals and clinics, is down -11.5%.
    • Lifepoint Health, a rural-focused healthcare services provider, is down -13%.
    • Tenet Healthcare, owner of 470 outpatient facilites and other healthcare service proviers, is down -27.5%
    • Community Health Systems, owner of 160 hospitals, is down -22.75%.

    Large health insurers such as Aetna, UnitedHealthcare, and Humana that have recently rolled back a significant amount of their Obamacare business are relatively unchanged in pre-market trading.

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    barack  obama sad american flag

    There is an overwhelming chance that the Affordable Care Act, better known as Obamacare, is facing its last few months of existence as we know it.

    For the past few years, congressional Republicans have taken symbolic vote after symbolic vote to repeal Obamacare. And now, with control of the executive branch, these votes will probably become more than just a statement.

    In a press conference Wednesday, House Speaker Paul Ryan said the ACA was an "unpopular law" and that Congress has already proven it could "repeal and replace" it.

    Additionally, Senate Majority Leader Mitch McConnell said that repealing the ACA was a priority for Republicans.

    "It's pretty high on our agenda, as you know. I would be shocked if we didn't move forward and keep our commitment to the American people," McConnell said at a press conference on Wednesday.

    Trump spent a significant part of the final weeks of the campaign railing against the health law, calling it a "bad deal" and highlighting recent premium increases for the ACA's exchange-based plans.

    While the law can't be fully repealed, according to Timothy Jost, a professor at Washington and Lee University and advocate of the law, Republicans could use measures to defund much of the financial support for the law. The results of the election, he said, has put it "on life support."

    Jost said congressional Republicans and Trump could remove funding for tax subsidies that 84% of the people getting their healthcare through the exchanges use to afford care. Trump and the Republican-controlled Congress could also roll back Medicaid expansion and stop outreach efforts to get people to sign up for plans through the exchanges.

    Cynthia Cox, a health policy expert at the nonpartisan Kaiser Family Foundation, said that because Republicans don't control a filibuster-proof majority in Congress, they would only be able to use budget reconciliation measures to change the ACA.

    This means that only parts of the law related to funding could be affected by the new government.

    All in all, more than 20 million people may lose or be priced out of their health coverage after these moves, according to Jost. He said that would have a huge effect.

    "Some of them will die," Jost said. "That's what happens when you lose health coverage. People who maintain their coverage will be under serious financial stress. It will be bad for hospitals because they have to accept more people without care."

    Cox said that those people are "at risk" of losing their coverage, but it is unclear what it will look like.

    "The details of Trump's plan aren't there yet that would help us understand complex way these things will play out," Cox said. "We aren't sure if there is a part of his plan to help people keep their coverage or what they would look like."

    For one thing, Cox said, the plan Trump has proposed doesn't match with congressional Republicans' previous replacement attempts.

    Republicans, including Ryan, have floated plans that would bear some similarities to Obamacare, including tax credits to ensure continued expansion of coverage and methods of providing care for patients.

    Trump's health plan has been less clear, but he has mentioned "doing away with the lines" between states. This appears to mean that state regulation of health insurance — all 50 states have their own insurance commissioners and regulation agencies — would be done away with in favor of unified regulations. The exact coverage proposals are unclear, according to Cox.

    These moves, however, cannot affect some of the other measures, such as the inability of insurers to deny people based on a preexisting condition.

    "Some of the coverage aspects of the law would stay in place," Cox said. "Gender rating where women can't be charged more than men, older people can only be charged three times more than young people, younger people can stay on their parents' insurance until they're 26 — those can't be changed though reconciliation."

    This doesn't mean the Trump administration couldn't influence major pieces of the ACA, according to Jost.

    "Much of the act is administrative, so a new administration could simply not give it support," Jost said. "They can not put resources into outreach, discourage people from signing up for insurance through the law instead of encourage. They can dive insurers out of the market. They can cause a lot of trouble."

    Even in the short term, the Trump election could be a negative for the ACA. According to Cox, since Obamacare exchanges are going through their open-enrollment period right now, Americans could be discouraged from getting health insurance through the exchanges if they think they will soon be gone.

    SEE ALSO: Obamacare stocks are getting slammed as the future of the law is in question

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    barack obama joe biden laughing smiling

    People surged into the Affordable Care Act marketplaces the day after Donald Trump was elected president.

    According to a tweet from Sylvia Burwell, the secretary of health and human services, more than 100,000 people signed up for plans through the exchanges set up by the Affordable Care Act, the healthcare law better known as Obamacare, on Wednesday.

    The exchanges are now in their open-enrollment period during which Americans who do not receive health insurance from their employer or a government program such as Medicare can access private plans.

    Trump has been a vocal opponent of the healthcare law, and the Republican leaders of Congress said repealing it was high on their list of priorities next year.

    More than 13.8 million are expected to sign up for plans through the exchanges this open-enrollment period. Trump has not laid out a full plan on how to cover these people if Obamacare is repealed.

    SEE ALSO: Obamacare is close to death after Trump's election

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    Donald Trump and Barack Obama

    Candidate Trump repeatedly called for repealing and replacing the Affordable Care Act during the campaign, but it is unclear what President Trump will actually do about the ACA. It is not clear even with President Trump, and Republican majorities in the House and Senate, whether full repeal is possible and what replacement might look like.

    There are several reasons for this. First, Trump would face political and financial fall-out from repeal. Second, even with Republican majorities now in the House and Senate, it would be hard to repeal the entire bill. It includes not only the establishment of the exchanges, in which people buy insurance, but also cost-saving and quality-improvement measures. Many health care professionals, systems and tax payers welcomed these.

    Full repeal of the Affordable Care Act would result in at least 18 million Americans losing health care coverage, and that would come at a political and economic cost. According to the Commonwealth Fund, it would actually cost the federal government about US$41 billion.

    Many of those 18 million, such as those with pre-existing conditions, would lose coverage because health insurance would not longer be offered to them at any price. Others would lose coverage because they would no longer be able to afford health insurance, assuming that subsidies go away.

    Repeal would mean fewer resources for health care, especially in rural areas, resulting in decreased access to care.

    Unpopular option, but there aren’t many others that work

    Donald Trump Obama

    Trump, even with the House and Senate behind him, would still face a practical hurdle. Full repeal may require 60 votes in a narrowly divided Senate.

    In addition, repealing and replacing the Affordable Care Act with something entirely different without severely reducing access to care may be impossible. That’s because it’s the only system devised so far that uses the private market to increase coverage and that stops short of single payer government-run programs.

    For decades, policy makers and politicians have tried to devise a way to use private markets to expand coverage to those not covered by employer-sponsored insurance.

    The health reform framework that became the Affordable Care Act has a long history and many champions from all political philosophies. While the ACA will long be associated with Pres. Obama and is most often called Obamacare, many other politicians and policy makers had been working on similar plans for years.

    The basic structure of a regulated individual insurance market with limits on pre-existing exclusions and health insurance marketplaces arose from a desire to provide access to affordable health insurance for individuals without coverage through their employer.

    The challenge in designing a private insurance market for individuals was to match employer plans’ ability to pool risk. In employment-based coverage, employees are given coverage as part of their compensation. So healthier individuals are part of the insurance pool.

    In purchasing insurance as individuals, consumers weigh their own risks of needing care against the cost of insurance. Some healthier individuals will rationally choose not by coverage given their lower probablity of needing health care. As a result, insurers in the individual market found that consumers waited until they needed care before they purchased coverage.

    That meant that insurers could never charge a premium high enough to cover costs. As a result, they excluded claims for pre-existing coverage, denied or canceled coverage for some and charged higher premiums in the individual market for less coverage then was available through employer-based plans.

    Without these exclusions, the individual market’s insurance pool is more costly, which increases premiums driving more of the healthier individuals out of the market and eventually resulting in no market at all. When people became sick with a catastrophic illness, financial disaster was common. Or, people with chronic illnesses, including diabetes and depression, faced such high premiums that they could not afford them. They went without insurance, and they, too, were vulnerable to financial ruin.

    George H.W. Bush, Bill Clinton had similar plans

    George H. W. Bush

    The recession of the early 1990s resulted in two million Americans losing their employment-based coverage. In the 1992 presidential election campaign, both incumbent George H. W. Bush and candidate Bill Clinton had health care reform plans. Both plans were structured similarly to the Affordable Care Act.

    They both created insurance purchasing pools (similar to the ACA marketplaces), eliminated pre-existing exclusion clauses and had individual mandates and subsidies for low-income families. After the election, when it became apparent that the Clinton administration plan would be different from those plans, a group of Republican senators led by Sen. John Chafee (R-R.I.) developed a proposal that had all of these attributes.

    Then along came RomneyCare

    In the early years of the 21st century, then-Governor Mitt Romney of Massachusetts asked his staff to find ways to reduce the burden of the uninsured on the Commonwealth of Massachusetts. Searching for a market-based approach, they found their options narrow to a plan similar to Sen. Chafee’s. At the time the individual mandate penalty was described not as a tax but as a measure of personal responsibility for paying for one’s own health care.

    The Massachusetts plan became the model for the Affordable Care Act.

    The reason all of these proposals resemble each other and the Affordable Care Act is that there are limited options for creating a sustainable private insurance market that allows individuals access to affordable health insurance.

    Trump may be able to repeal the law and return to health care coverage as we knew it in 2010. Consequences, however, will be a sudden drop in access to care not just for those who lose coverage, but for many others who will lose access to care because their local hospital closes, or nearest doctor moves out of areas with high percentages of uninsured.

    Replaced requires something that looks like the ACA: Trumpcare, perhaps?

    Bill Custer, Director of Center for Health Services Reseach, Associate Professor, Georgia State University

    This article was originally published on The Conversation. Read the original article.

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    Republican U.S. president-elect Donald Trump speaks at his election night rally in Manhattan, New York, U.S., November 9, 2016. REUTERS/Carlo Allegri

    The Affordable Care Act, better known as Obamacare, has experienced hiccups of late.

    An older, sicker, and more expensive pool of patients have led to losses for health insurers and pull backs from the ACA's public exchanges. Increased costs — mostly in states that have not expanded Medicaid — and higher deductibles have put pressure on Americans' wallets.

    On the flip side, one of its successes has come from the fact that 20 million Americans who would did not have coverage before Obamacare now have it. Through the exchanges, Medicaid expansion or policies such as young people getting to stay on their parents' insurance until they're 26 years old, have driven down the uninsured rate in the US to an all-time low.

    With the election of Donald Trump on Tuesday, however, the ACA appears to be in jeopardy. Trump has repeatedly promised to repeal and replace the ACA, and both Republican leaders in Congress — House Speaker Paul Ryan and Senate Majority Leader Mitch McConnell — said Wednesday that repealing the law was a top priority.

    Trump released his heath plan on his transition website, greatagain.gov, on Thursday. While it was vague in its details, it appears to have one glaring flaw: It does not yet outline a solution for what to do with the over 20 million Americans with insurance from the law.

    Based on the plan on Trump's transitional website, there are some stabs at maintaining the coverage for these people.

    "A Trump Administration will work with Congress to repeal the ACA and replace it with a solution that includes Health Savings Accounts (HSAs), and returns the historic role in regulating health insurance to the States," read the Trump transition website.

    HSAs are tax-advantaged accounts that can be used for medical expenses. These are typically used in conjunction with high-deductible insurance plans to help ease the burden of out-of-pocket costs. But HSAs alone are not a direct substitute for coverage, but typically used in conjunction. Additionally, most Obamacare plans are high-deductible plans already and a significant portion have HSAs.

    Donald Trump and Barack Obama

    Trump's plan also seemingly contradicts itself in regards to regulation of health insurance and the ability to sell insurance over state lines.

    "To maximize choice and create a dynamic market for health insurance, the Administration will work with Congress to enable people to purchase insurance across state lines," read the Trump plan.

    Currently, insurance is regulated on a state-by-state basis by insurance commissioners, who set their own rules. Trump's plan to "do away with state lines" doesn't necessarily increase coverage, experts say, and it would simply allow business to be domiciled in whatever state has the most favorable regulation or give more power to the federal government in regulating insurance.

    Additionally, as noted by health-policy experts, state regulators are not the largest impediment to introducing plans in new areas. That would be setting up new hospital networks, instead.

    Trump also proposed to reinstitute high-risk pools, which were plans that allowed people with preexisting conditions to get plans that were partially subsidized by the state government.

    "The Administration also will work with both Congress and the States to re-establish high-risk pools – a proven approach to ensuring access to health insurance coverage for individuals who have significant medical expenses and who have not maintained continuous coverage," said the Trump plan.

    These plans, however, typically had premiums twice as high as normal individual health plans, which made them a serious deterrent for many of the people with ACA plans and preexisiting conditions. Additionally, only 226,000 people took part in these pools at their peak in 2011.

    This also does not account for those that have received care from expanded Medicaid provisions. Trump has previously said that he would provide funding in a block for states to do as they please with Medicaid. The transition site reads that the administration plans to "enable states to experiment with innovative methods."

    Whether the 15.7 million people who have gained access to Medicaid through the ACA expansion will keep it is not clear from Trump's plan.

    Theoretically, by defunding the various parts of the law, these people could simply be out of luck. As Timothy Jost, a professor for health law at Washington and Lee University and an advocate of the ACA, told Business insider on Wednesday: "Some of them will die. That's what happens when you lose health coverage."

    Interestingly enough, in the day after Trump's election was the strongest day of enrollment for ACA exchange plans so far. Politico's Dan Diamond speculated this could be because people want to access coverage before changes to the healthcare system.

    That's due to potentially good reason: The current Trump plan is vague, and there is a good chance contributions will come from congressional leaders such as Ryan. There does not appear to be a definite plan to cover the 20 million people who have plans due to Obamacare's provisions.

    SEE ALSO: Obamacare is close to death after Trump's election

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    Donald Trump Obama

    President-elect Donald Trump on Friday signaled he was willing to keep some parts of the Affordable Care Act, better known as Obamacare, when he takes office, according to The Wall Street Journal.

    Trump told Gerard Baker and Monica Langley that he and President Barack Obama spoke about the law during their meeting on Thursday. Trump said he would consider keeping parts of it.

    Trump said he is willing to keep the provisions of the law that prevent insurers from denying coverage because of a preexisting condition and that allow children to stay on their parents' health plan until they turn 26, according to The Journal.

    "I told him I will look at his suggestions, and out of respect, I will do that,"Trump told The Journal.

    Health policy experts have told Business Insider over the last few days that Republicans do not have the filibuster-proof majority needed to repeal these parts of the law anyway.

    Through the budget reconciliation process — which would avoid a drawn-out fight and filibuster by Democrats — Republicans can adjust only parts of the law that have to do with the federal government's finances.

    These parts include the funding for Medicaid expansion given to states, subsidies for people who receive their health insurance through the ACA marketplaces, and money for outreach to get Americans to sign up through the exchanges.

    They do not include statutory measures such as the two provisions Trump said he would consider, or others like the inability of insurers to place lifetime limits on plans.

    Trump has said he favors keeping the preexisting-conditions measure.

    Trump's plans, even with these provisions kept, could leave roughly 20 million people without health insurance.

    SEE ALSO: Obamacare is in serious trouble

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    obama trump obamacare thumb

    Every four years, politicians and pundits like to play a well-known game: Find the Mandate.

    After the ballots get counted, the debate shifts to whether a new or returning president has received a “mandate” for his agenda, or whether the circumstances of an election suggest a humbler approach of compromise with the opposition. 

    This election makes that game more difficult to play than ever, as very little of its dynamics had much to do with policy questions.

    Both candidates offered ambiguities on their plans and spent almost all of the rest of their time excoriating their opponents’ personal and professional shortcomings. 

    However, one mandate does manage to emerge through the fog of political battle. Americans dislike the Affordable Care Act, have become outraged over its skyrocketing costs, and want it repealed. 

    That message doesn’t just come through the presidential race, but it has been one of the most consistent policy messages from Donald Trump over the course of the campaign. After a couple of initial stumbles on the nuance of government-run marketplaces in the primaries, Trump offered a simple message on Obamacare – repeal and replace it. 

    That became almost the only policy issue Trump discussed down the stretch as news of massive premium hikes began emerging as the general election kicked off. By the last week of the campaign – when consumers saw the havoc wreaked on their insurance after open enrollment began – Trump kept hammering Obamacare as the central policy argument for rejecting the political establishment in Washington DC. 

    Don’t just take Trump’s word for it, though. Democrats were poised to take back control of the Senate, having a historic opportunity with Republicans defending 14 more seats. Combined with the normal turnout dynamics of presidential election cycles, predictions about the post-election landscape focused on how Democrats could leverage their Senate majority with a Hillary Clinton presidency.

    obama affordable care act obamacare

    Instead, Democrats lost almost every pickup opportunity they had – even in two states where they brought back popular former Senators to run for their old seats. In states where the premium hikes have hammered voters hardest, Republican Senate candidates outperformed Trump – states like Florida, Pennsylvania, Wisconsin, and Ohio, among others.   

    Two months ago, I predicted that the GOP might stun Democrats over Obamacare, and prices were only one reason. “Voters in almost all key battleground states have at least one insurer pulling out of the exchanges,” I noted. Polls showed that losers far outstripped winners (43 percent to 8 percent) in the Affordable Care Act. 

    Republican strategist Ron Bonjean also predicted a backlash in the Senate races as far back as August. “It feels like there’s a sleeping giant that’s about to awaken on the campaign trail,” he told The Hill’s Sarah Ferris. “It really does seem like an easy target, an easy layup for Republicans to score points.” The Republican triumph in holding Senate control against long odds shows that the sleeping giant did awaken and establishes a mandate for action.

    Besides, Republican voters have already revolted over a lack of progress in dismantling Obamacare. Trump’s ascendancy in the primaries came as a direct result of overpromising on that task in the 2014 midterms. If Republicans dally any farther with single-party governance, then the 2018 election cycle will make this look like, well … a tea party of a more genteel type. Even James Carville acknowledged the politically obvious, noting on MSNBC that “Obamacare is dead.” 

    Obama doctors Obamacare

    What would repeal and replace look like? President Obama scoffed at the promise just a few days ago, claiming that neither Trump nor Republicans have an alternative to the collapsing structure Obama and Democrats shoved through Congress more than six years ago. Until recently, that accusation had a core of truth to it; despite unanimous opposition to Obamacare (no Republican ever cast a vote for it), the GOP had not produced a comprehensive approach to replace it.

    This summer, Republicans finally came together on a free-market approach to dismantling Obamacare and restructuring the market to solve long-standing concerns. Titled “A Better Way,” the proposal would end government control of health insurance markets and the individual mandate for comprehensive policies that many Americans neither need nor can afford. 

    It would also eliminate the employer mandate that has discouraged full-time employment, and end the need to bail out insurers from losses that the individual mandate and “community rating” requirements have produced. It devolves oversight of insurers back to the states and expands choice by allowing interstate sales of health insurance policies. 

    Will this proposal find a consensus in Congress? Perhaps not enough for Republicans to attempt a forced vote in a similar manner as to how Obamacare passed in March 2010, but it certainly will form the basis for negotiations – after repealing the existing system. Voters gave Trump and Republicans perhaps only this one clear mandate – and they had better get it accomplished before taking on anything else.

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    U.S. President Barack Obama signs the Affordable Care Act, dubbed Obamacare, the comprehensive healthcare reform legislation during a ceremony in the East Room of the White House in Washington, U.S., March 23, 2010. REUTERS/Jason Reed/File Photo

    WASHINGTON (Reuters) - Congressional Republicans are looking for the quickest ways to tear down Obamacare following Donald Trump's election as U.S. president, including rapidly confirming a new health secretary who could recast regulations while waiting for lawmakers to pass sweeping repeal legislation.

    Trump's victory on Tuesday means Republicans will control the White House, Senate and House of Representatives. But congressional Democrats are expected to put up a huge fight against Republican efforts to repeal the 2010 law considered President Barack Obama's signature domestic policy achievement.

    The Affordable Care Act, dubbed Obamacare, has provided 25 million previously uninsured Americans with health coverage. Republicans have launched repeated legal and legislative efforts to dismantle the law, which they call a government overreach.

    Wyoming Senator John Barrasso, a member of Senate Republican leadership, said one way for the incoming president and Congress to attack Obamacare immediately after Trump takes office on Jan. 20 would be to quickly confirm a new secretary of Health and Human Services, the official who writes the rules and regulations that enforce the law.

    "We could confirm someone on Jan. 20 who could come in immediately and could be working right now on rewriting rules and regulations to give more freedom and choice to the states, to insurance companies and to businesses that are trying to provide affordable care to their workers," Barrasso said in a telephone interview.

    Barrasso noted that the Senate needs only a simple majority vote in the 100-seat chamber to confirm Cabinet members, as opposed to 60 votes to overcome procedural hurdles the Democrats could present to repeal legislation.

    Passing repeal legislation "is not a 'Day One' activity. But a new secretary of HHS going after the regulations can be a 'Day One' activity," Barrasso added.

    Trump during the campaign called Obamacare "a disaster" and joined fellow Republicans in vowing to repeal and replace it with proposals like tax-free health savings accounts. His transition website says Trump wants a solution that "returns the historic role in regulating health insurance to the states."

    Obamacare protest

    In repealing Obamacare, congressional Republican may have to resort to a special procedure known as reconciliation to get around Democrats in the Senate, where rules protect the rights of the minority party.

    Republicans in Congress used reconciliation to try to undo large chunks of Obamacare in January, but Obama vetoed the legislation. The bill would have wiped out tax subsidies provided to help people afford insurance coverage, as well as tax penalties on people who do not obtain insurance as required by the law, and would have eliminated expansion of the Medicaid insurance health insurance program.

    Republican Representative Chris Collins of New York, one of Trump's earliest supporters on Capitol Hill, said he hopes Congress can pass a similar bill gutting Obamacare within Trump's first 100 days in office, a promise Trump made during the presidential campaign. But some changes will doubtless be phased in over time, Collins said.

    "There's nothing that we will be able to do or would want to do that would impact anyone's health insurance plan for 2017," Collins said in an interview.

    "From a replacement standpoint, our position has always been as Republicans to move forward in a step-by-step fashion," Barrasso said.

    In an interview with the Wall Street Journal published on Friday, Trump said he was considering retaining parts of Obamacare including provisions letting parents keep adult children up to age 26 on their insurance policies and barring insurers from denying coverage to people with pre-existing medical conditions.

    obamacare protest

    More flexibility

    While waiting for Congress to act on legislation, the new HHS secretary could be reworking Obamacare regulations, Barrasso said. For example, regulations could give U.S. states more flexibility under a provision that lets states seek waivers from key provisions of the law, such as exemptions from the so-called individual mandate requiring Americans to obtain insurance and the employer mandate to provide it.

    Kim Monk, an analyst at Capital Alpha Partners, which provides policy research to financial institutions, said Trump's HHS might be able to tighten up the rules governing special enrollment periods for Obamacare. Insurers complain that these periods have allowed some people who initially skipped buying insurance to sign up after becoming ill.

    HHS might also be able to alter the language on "essential benefits" that the law requires insurance plans to cover, which include trips to the emergency room, maternity and newborn care, and mental health services, Monk said.

    "The law requires they have to cover 10 essential health benefit categories, but how that gets defined, a lot of that is interpretative," Monk said. "And of course, everything the Obama administration interpreted was more, more, more, more expensive coverage, and all these things lead to premium increases."

    Collins, a member of the Trump transition team's executive committee, said the job of HHS secretary or surgeon general "would be great for Ben Carson," referring to the neurosurgeon who ran unsuccessfully for the Republican presidential nomination and later endorsed Trump.

     

     

    (Reporting by Susan Cornwell; Editing by Will Dunham)

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    It is an ironic twist of history that Hillary Clinton, a woman who first came to national prominence when her husband won the White House following James Carville’s now-famed mantra—“It’s the economy, stupid”—lost her own presidential run, in part, because she did not take that message seriously enough.

    That is not to say that the Donald Trump voters who were experiencing “economic anxiety,” as the pundit class put it throughout the election, were justified in feeling so, or that there concerns weren’t intimately tied up with racial tribalism. But Clinton didn’t help herself here either: In an election in which there was clear rage against the meritocratic machine, Clinton spent August hobnobbing with Wall Street bankers in the Hamptons just weeks before (accurately if impoliticly) calling half of her opponents’ supporters “a basket of deplorables” at a fundraiser that some donors paid $50,000 to attend. When the John Podesta email hack revealed she had told a roomful of bankers that politicians needed “a private and a public position,” her campaign didn’t address the issue at hand, instead criticizing the leak itself.

    And it’s easy to make much of Clinton’s progressive drift now, but let’s not forget that she was prodded into it by the Bernie Sanders campaign’s left-wing insurgency. Early on, Donald Trump proclaimed on a debate stage that he would not cut Social Security, but for months Clinton’s statements on the issue were so carefully calibrated that retirement-security advocates were aghast. When Sanders first advocated for free tuition at public colleges, she initially pushed back. It was only this past summer that Clinton released her own plan to offer students from families with household incomes less than $125,000 a no-tuition higher education. It was a worthy plan. It was also technocratic. It fiddled at the margins instead of questioning the system itself.

    The Trump campaign was powered in significant part by white resentment, by a cohort that saw America changing and didn’t see itself as part of it. And many members of that group translated those fears into economic terms.

    In exit polls, just under 60 percent of voters said the economy was either the same as in 2012 or worse. A majority of those voters broke for Trump. True, many Trump voters are college-educated and have above-average incomes. But these voters see their economic fortunes in relative, not absolute, terms, with other groups as their measuring stick. People want to make progress, not feel like they’re treading in financial waters while others get life preservers.

    Moreover, many Trump voters, even if they themselves are better off than average, aren’t living in particularly prosperous regions of the country. They often inhabit areas scarred by de-industrialization, drug addiction, and foreclosure, or rural areas where the jobs are barely existent. Housing prices may be soaring in Silicon Valley, but the reality in the Rust Belt is something else entirely. Less than 24 hours after the polls closed, General Motors announced it would lay off 2,000 workers at factories in Ohio and Michigan.

    gm

    Others are way behind where they thought they’d be at this point in their lives. True, incomes for men who never graduated from college improved significantly in 2015, but to say that increase made up for the ground this cohort has lost since the start of the Great Recession—never mind the 1970s—is to engage in vast understatement. No surprise, white men and women who didn’t graduate from college also voted for Trump by significant margins. When asked, they told exit pollsters their personal finances hadn’t improved an iota since 2012. One-third said they were worse.

    I saw all this when I spoke earlier this year to small business owners supporting Trump, a cohort that was among his earliest and strongest backers. Many were doing better than they were in 2008—but not as well as they were in 2000. “My sales have gone down steadily over the past 10 years, not by a huge amount, but again, what sales I have are getting eaten up by what I have to pay for workers’ comp, disability, and health insurance. I can’t pass the cost on to my customers,” says Robert Jones, the owner of Elcon Estimating Service, an electrical cost-estimating firm based in Dobbs Ferry, New York.

    Moreover, we shouldn’t underestimate the ongoing failure to control the price of health care. It seems obvious in retrospect that a decent percentage of Americans are using the term “Obamacare” as a proxy for their own insurance and medical bills, even if they’re not insured on the exchanges that the health reform law set up. Tuesday night’s exit polling revealed that 4 out of 5 of the 45 percent of voters who agreed the signature legislation went too far broke for Trump. Not only didn’t Americans save $2,500 a year on out-of-pocket medical spending, as Obama promised; people with employer-provided health insurance have seen their costs surge by more than 50 percent since 2010.

    And it’s not just that the Affordable Care Act may have become a convenient catchall for any and all health care grievances: Americans are notoriously resentful when they see others getting government assistance while they go without. It’s why Social Security—which is there for everyone— remains so popular but the Affordable Care Act, with its Medicaid expansion and subsidies for some but not all, may now be on the chopping block.

    obamacare protest supreme court

    In truth, many of us don’t admit to the government help we do get. Almost all of us have taken advantage of unemployment insurance, student loans, Social Security, or the mortgage interest-rate tax deduction—the last of which isn’t viewed as a government subsidy but certainly is. When Suzanne Mettler, a professor of government at Cornell University, surveyed Americans a few years ago, she discovered a reason why signs begging the government to stay away from Medicare were popping up at Tea Party gatherings. About 2 out of every 5 recipients of any government aid did not realize where the money came from. But when groups see other groups getting aid, they can react. And they did.

    In his surprise best-seller Hillbilly Elegy, J.D. Vance resentfully recalls that when he worked as a supermarket checkout clerk, he would see customers “buy two dozen packs of soda with food stamps and then sell them at a discount for cash.” Arlie Hochschild’s Strangers in Their Own Landis filled with similar sentiments from whites, who are angered by others—usually darker and poorer than them—who they feel are getting more of a helping hand from the government. It’s hard to sort the economic resentment from the racism. They are not mutually exclusive. The same way a paranoid has enemies, you can harbor racist thoughts and rightly perceive your economic prospects have dropped or at least flatlined. As Jeff Spross of the Week put it on Twitter on Tuesday night, “Trump took the entire frickin’ Rust Belt, most of which Barack Obama won *twice.* Time to revise the narrative.” In other words, instead of damning voters for their nasty thoughts, liberals need to identify what triggers some of them to act on those beliefs and put a stop to it.

    And it’s not like all progressive economics failed last night. Initiatives that will increase the minimum wage not only passed in Colorado, Washington, and Maine, where a majority of voters supported Clinton, but also in Arizona, where Trump triumphed in the polls. People want their personal finances to improve, and they will do what they believe they can to make it happen.

    Make no mistake, the damage of the past several decades to American life is severe. Income and wealth inequality is at record levels. That the stock market has more than doubled since Obama took the oath of office in 2009 means little to most Americans. Only about half of us are even invested in equities and, even then, the amounts a majority own are not significant. A majority of working-age people of barely have a mere few thousand dollars saved for retirement. The fabled 1 percent, on the other hand, has more than $1 million banked for that day.

    It’s easy to think the latter is the normal amount when you live in a place like the Silicon Valley or Brooklyn, New York, where the Clinton campaign was headquartered. The cost of living is so high in these places, and the wealth is so extreme, that people earning several hundred thousand dollars a year are convinced they are struggling middle-class strivers. But that’s not the truth, and the deplorables let us know it. Left behind by the modern economy, resentful toward coastal elites and disdainful of the minorities they felt were the only ones getting a governmental boost, they took what action they could and pulled a lever for Trump.

    None of this is to say Trump was a reasonable answer for them. Instead, this lifelong serial con artist pulled the ultimate con. He convinced millions upon millions of hard-working Americans of the sort he stiffed on contracting jobs, ripped off at Trump University, or otherwise defrauded in some way, that he was their champion. And they’re about to find out what it’s like to be his mark.

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    CNN anchor Jake Tapper grilled House Speaker Paul Ryan on Sunday over whether his Obamacare replacement plan would still provide free birth control to insured women.

    In an interview on "State of the Union," Tapper asked the speaker and self-styled policy wonk whether his future Obamacare replacement plan would still allow insured women to receive birth control with no additional cost.

    "Look I'm not going to get into all the nitty-gritty detail of these things," Ryan replied.

    Tapper continued to drill down on the question.

    "With all due respect, I don’t know that the average woman of childbearing years out there who relies upon contraception provided by health insurance mandated by the Affordable Care Act I don’t know that she would think that that’s just a nitty-gritty detail," Tapper said.

    Ryan argued that Tapper was asking him "details about legislation that hasn’t been written yet."

    "Right but is it important to you. Would that be a principle of whatever replaces it?" Tapper replied.

    Ryan interjected: "I’m not going to get into hypotheticals about legislation that hasn’t even been drafted yet."

    President-elect Donald Trump's upset victory in Tuesday's election has inspired a flurry of questions over the future of the Affordable Care Act, President Barack Obama's signature legislative achievement.

    While Trump promised last week that he would consider keeping popular parts of the law, Ryan's 37-page healthcare overhaul outline essentially dismantles the law by eliminating federal rules for who qualifies for Medicaid, delegating the decision to states, and creating vouchers for Americans who don't have health insurance and don't qualify for Medicare or Medicaid.

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    My family may be Democrats, but I have always been a Republican, and I officially registered for the party shortly after my 18th birthday. The first Donald Trump rally I went to was in Las Vegas last year. The crowd was joyful and happy, people were singing and cheering, and when Trump got up on stage all eyes were on him.

    That rally energised me, and ensured I did everything possible to get Trump elected. My father and his family are from Nicaragua, and my mum is half Puerto Rican, so I joined “Latinos for Trump”. My whole senior year of high school, I volunteered countless hours for the Trump campaign: making phone calls, speaking to voters, knocking on doors. I researched issues America faces such as our debt, and policies I feel are failing us, including ObamaCare. Trump has promised to tackle these issues head on.

    He wants to repeal ObamaCare, to achieve a cheaper service. A more free market in healthcare will increase competition for consumers among insurance companies, and ensure that our prices will get lower. He has also said he will renegotiate the North American Free Trade Agreement and make sure TTIP is not put in place. He has be talking about our terrible trade deals since the 1980s, whereas Hillary Clinton has voted in favour of every one of these disastrous deals that have cost Americans jobs.

    The media has tried to suggest Latinos are all against Trump, but a not-insignificant chunk of us cast votes for him – 29%, according to CNN exit polls. Many of the comments Trump has made about Mexicans, such as calling them “rapists”, have been taken completely out of context. He has only said a certain portion of illegal immigrants coming across the southern border are committing crimes, which is surely true.

    In his book Crippled America, Trump talks about his certainty that many illegal immigrants in America are good, hard-working people, but with the US in its current state we have to put Americans first. There are more than 3 billion people in the world who live in poverty. The US can’t help every single one of them. We have to focus on feeding the 13 million starving American children, the single mothers who under Barack Obama have gone into poverty, and our veterans who have lost their benefits.

    donald trump

    Trump cares about our wellbeing and our future. He wants to lower taxes to make it easier for working families to make money and start businesses, and he wants to help stimulate the economy and create more jobs which will tackle all these issues. That’s how he won over the middle and working classes. When he first announced he was running, he said he would be “the greatest jobs president god ever created”. I was walking in a local mall and spoke with another Latino my age who said she wasn’t necessarily against Trump but just unclear of his policies, and didn’t trust the negativity about him in the media.

    I talked about his policies on trade and bringing jobs back, and she agreed with him that we need to get big money out of politics. She had supported Bernie Sanders, but said she would look more into Trump. Those are the policies that have appealed to people like me.

    His desire to deport illegal immigrants doesn’t alarm me. It needs to be done. He wants to deport criminals, stop employers from hiring illegal immigrants by implementing an E-Verify system [an internet-based system that allows businesses to determine the eligibility of their employees to work in America], and only then push those left towards a path of legalisation. Throughout his campaign Trump has said many times that he loves Latinos and that Latino-Americans are a major backbone of this country.

    Trump represents Latino-American tenacity, the ability to be straightforward about life and to be passionate in everything we do. He will be great for my community by bringing jobs back, investing over $20bn in inner cities where a lot of minorities live by lowering taxes, and through improvements to education which is a major issue in our community. He wants to end Common Core– the educational standards initiative which dictates what students must be taught – and give the power back to parents and teachers to decide how children are educated.

    hillary clinton

    In contrast, Clinton has offended many Americans because she supported policies that have taken jobs away from the US, and risked national security with a vulnerable personal email server that could have been hacked. For 30 years Clinton has been part of the Washington establishment, putting money before citizens. No wonder so many Americans didn’t vote for her.

    As an 18 year old from a middle-class family, living in a small town close to Las Vegas, Donald Trump gave me the chance to intern for his campaign. It has transformed me as a person. On the occasions I’ve met him he has treated me like an equal and listened to every word I have said. I want to become the first American Latino president of the United States, and the way Trump has stuck to his message no matter what has inspired me beyond words. All Americans can agree we want a leader who has our best interests at heart. Trump was elected on the basis he would put Americans first. I’m sure that people will unite behind his presidency when they see that he’s followed through on his promise.

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    President Barack Obama on Monday laid out why the repeal of the Affordable Care Act, better known as Obamacare, will be difficult for the incoming Republican leadership and the administration of President-elect Donald Trump.

    "The holy grail for Republicans over the last six or seven years was to kill Obamacare," Obama said during a press conference at the White House.

    Trump, House Speaker Paul Ryan, and Senate Majority Leader Mitch McConnell all have called for the repeal of the law since Trump's stunning electoral victory last week.

    Obama said, however, that it will be a rough road for Republicans if they simply try to repeal the law, given some of its more popular benefits — the end of lifetime limits, prescription drug discounts for seniors, free mammograms, and the fact that more than 20 million now have coverage through some of the law's provisions, among others.

    "Now it's one thing to characterize this thing as not working when it's an abstraction," said Obama. "Now, suddenly, you're in charge and you're going to repeal it — OK, well, what happens to those 20 million people who have health insurance? Are you just going to kick them off and suddenly, they don't have health insurance?"

    Obama said he would be open to fixes to the law or a new plan that ensures many of the benefits — such as children having the ability to stay on their parents' insurance until age 26 and insurers not being able to deny coverage due to a preexisting condition — do not disappear.

    "My view on these issues is that if they can come up with something better that actually works and in a year or two after they've replaced the Affordable Care Act with their own plan, and 25 million people have health insurance, and it's cheaper and better and running smoothly, I'll be the first one to say that's great. Congratulations," Obama said.

    Obama did say that if their plan leads to million of people losing coverage and other issues, he and the American people will not be happy.

    "We're going to have a problem," Obama said. "I don't think that's unique to me, I think the American people will feel that way."

    Obamacare has come under fire from Republicans mostly due to its public exchanges, which have seen increasing premiums and high-profile insurer exits.

    Currently, Trump's healthcare plan on his transition website does not have provisions to ensure that those 20 million people are still covered. Trump did say on Friday he may keep two of the law's most popular provisions after speaking with Obama.

    These parts of the law, however, can not be easily repealed, given Republicans do not have a filibuster-proof majority in the Senate and can only repeal parts of the law that have to do with the federal budget through a budget-reconciliation process. Health policy experts told Business Insider last week that these do not include the preexisting condition and children-under-26 provisions.

    Said Obama: "On a lot of issues, now comes the hard part, now comes the governance."

    Watch the full press conference below:

    SEE ALSO: Trump says he's willing to keep 2 key parts of Obamacare that he couldn't repeal anyway

    Join the conversation about this story »

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    Obamacare

    Like many politically divisive issues today, when it comes to the Affordable Care Act and Obamacare, it can be hard to separate fact from fiction.

    The cornerstone of the ACA (aka Obamacare) is Healthcare.gov, home of the new health care marketplace. Nov. 1 marks the beginning of open enrollment for 2017.

    Americans have until Jan. 31 to choose a plan. We developed an in-depth guide to shopping on the marketplace, which you can find here.

    We also figured there could be no better time to revisit some of the misconceptions about the health care law that created it.

    Below, we list 10 common myths associated with Obamacare.

    1. I have to sign up for health insurance in the federal marketplace

    The marketplace exists for people who do not receive health benefits through their employer, or a public program like Medicare, Medicaid, or the Children's Health Insurance Program.

    The ACA does require all Americans to have a qualified health plan, but that hasn't stopped millions of Americans from going without. Just know that if you do not enroll in a health plan, you may face a tax penalty. There are exemptions for some groups of people. Some consumers choose to forego insurance for financial reasons — sometimes it costs more to pay for a health plan than to incur the tax penalty for not having insurance.

    Before you give up on finding an affordable plan, check to see if you are eligible for a tax subsidy, which can drastically reduce the cost of your Obamacare premium.

    2. Obamacare hasn't changed the health care landscape all that much

    The percentage of uninsured Americans fell to 10.5% from 16.6% since the implementation of the Affordable Care Act back in 2013. The U.S. is currently experiencing its highest rate of insured people ever in history, according to a report released by the Centers for Disease Control and Prevention in September. As of February 2016, 12.7 million Americans received health coverage through the marketplace.

    There are five other big advantages of Obamacare:

    • Obamacare made it mandatory for insurers to cover certain preventive services such as cancer screenings and immunizations. Those services cannot count toward a patient's deductible or require a co-pay.
    • The law also allows young adults to stay on a parent's health insurance plan until they turn 26 years old— even if they get married, go to college, move away from home, or aren't claimed on their parent's taxes as a dependent anymore.
    • No lifetime caps on how much the insurance company will pay if you get sick.
    • Insurers can't cancel your coverage midterm if you made a mistake on the paperwork.
    • The company can't deny anyone because of pre-existing conditions like asthma or diabetes.

    3. If I lose my insurance, I will have to pay a fee

    It is true that some people will face tax penalties if they do not sign up for a qualifying health plan in a given year. But there are exceptions to this rule.

    If you lose your job, you can purchase a plan in the marketplace outside of the open enrollment period. This applies even if you quit or get fired. If you can't afford insurance and will be uninsured for a bit, you may qualify for a short-gap exemption and avoid the tax penalty. To qualify, you can be uninsured for no longer than two consecutive months. If you don't qualify for any exemptions, you are then subject to a tax penalty for each month that you are uninsured.

    4. I'll have to wait longer to see my doctor if I have Obamacare

    When the health care exchange opened, people worried that Obamacare patients would encounter the same service delays common among Medicaid and Medicare recipients. But evidence points to the contrary. The Commonwealth Fund, a private foundation that supports independent research on health care issues, found in its 2016 ACA Tracking Survey that wait times for those with Medicaid or marketplace coverage were similar to wait times for other insured adults.

    The survey found that 58% of adults with Medicaid or marketplace coverage who looked for a new primary care physician found it easy or somewhat easy to find one, and more than half of those surveyed waited less than two weeks to see a primary care physician. About 41% of those surveyed needed to see a specialist. Out of those, 60% got an appointment within two weeks.

    5. If I sign up for Obamacare, I have to agree to a home inspection

    This myth arose after a widely circulated August 2013 blog post claimed that the health care law would allow forced home inspections. There are no forced home inspections, or home inspections at all.

    That blogger misinterpreted the Maternal, Infant, and Early Childhood Home Visiting Program (MIECHV), which was created with the ACA.

    The program allows "at-risk" pregnant women or families to enroll in an optional home health care program that sends nurses to their homes. It gives moms who wouldn't normally have access to prenatal advice access to advice and care in the comfort of their homes.

    6. My boss might decrease my hours to avoid paying for Obamacare coverage

    The ACA provision that requires employers with 50 or more full-time equivalent employees to offer health benefits went into full effect in 2016. There was worry that employers would decrease employee hours to reduce the number of full-time employees and avoid having to pay full health benefits (under the provision, employees are considered full time if they work 30 hours per week or more).

    According to a report from the Kaiser Family Foundation earlier this year, only 2% of employers said they were going to change job classifications from full-time to part-time so that employees would not be eligible for health benefits, while 7% said they had changed or planned to switch part-timers to full-time so that they could qualify. The report also said 12% of employers were extending or planned to extend eligibility for health benefits to workers who were not currently eligible.

    obamacare

    7. Only very poor people qualify for tax credits

    Under the ACA, the majority of those who get health care through the marketplace are eligible for tax credits that can make the plans more affordable.

    About 8 in 10 people are eligible for $290 average monthly subsidies that can bring monthly payments down to less than $100. Some small businesses that offer health benefits to employees could be eligible for a credit as well to help with affordability.

    It is true, however, that eligibility for the tax credit is determined by a host of factors, primarily household size and income. The IRS has a flow chart you can use to quickly see if you'd be eligible for the tax credit.

    Premiums overall are getting more expensive, however, even for those with employer-sponsored health coverage. The rise is fueled by the rising cost of services, medicine, and other medical treatments. However, as premiums rise, subsidies rise, too, which can help offset the increase in cost.

    8. I won't be able to choose my own doctor anymore

    Simply enrolling in a health plan through the exchange won't mess with your choice of doctors. Your provider determines which doctors are accessible through your insurance plan. When policy conditions change — as they are apt to do when employers switch plans, people change or lose jobs, or when insurers alter plans — you're not guaranteed that your doctor will still be in-network.

    Even when that happens, you may still be covered, but may have to pay more to go to a doctor outside of your network. If you're concerned about this, ask your doctor which insurers they accept, and see if you can sign up for one of those plans through your employer or the marketplace.

    9. If I like my plan, I can keep it no matter what

    You can keep your plan as long as it complies with the ACA or was grandfathered in. However, nothing in the ACA promises that you can keep your plan no matter what. Your employer could switch plans, or you could lose or switch your job and lose your current plan, as it's always been.

    When the ACA went into effect, some insurance plans didn't meet the minimum requirements of a Qualified Health Plan. Those plans were eventually phased out and replaced with ACA-compliant plans.

    10. Most people were better off without Obamacare

    The Affordable Care Act added important consumer protections that cannot be ignored. Before the act, insurers were able to deny coverage to people because they had a pre-existing condition. Now they can't. Certain preventative care such as obesity, depression, domestic violence screening, and birth control, among many others now must be covered by insurance without a co-pay. Overall, more people are insured, and more services are being provided.

    In its 2016 report, the Commonwealth Fund asked 4,802 working-age adults with Medicaid or marketplace coverage about the ACA. Of those, 881 were new to marketplace or Medicaid coverage. Only 11% of those new to the marketplace and 4% of those new to Medicaid said their ability to get care had worsened.

    It is true that Obamacare patients are seeing higher premiums year after year, but they are not alone. Premiums are also becoming more expensive for people who receive employee benefits. According to a report released this year by the Kaiser Family Foundation, the average health care premium for an employer-provided family plan has jumped 58% over the past 10 years, while employee contribution toward the total premium has also risen 78%.

    Some states will be especially hard hit by price hikes in 2017. The largest decrease in available plans was in Arizona, which lost six insurers. The state's enrollees will see an average 116% price increase in 2017.

    SEE ALSO: Here's how much Obamacare premiums are going up in every state

    Join the conversation about this story »

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    Obama doctors Obamacare

    Dale Wettlaufer, founder and portfolio manager at Buffalo, NY-based Charlotte Lane Capital, published a 12-page thesis recommending shares of hospital giant HCA Holdings on SumZero, a collaborative research platform for hedge funds, mutual funds, and PE funds.

    The heavily-researched thesis on HCA goes into a detailed interpretation of the future of the Affordable Care Act (ACA), aka Obamacare, and the broad, downstream impacts on relevant sectors. We sat down with Wettlaufer for a Q&A to learn more.

    Dale Wettlaufer is the CIO / CEO of Charlotte Lane Capital, which emerged from a large asset manager in 2016 after incubating the strategy for seven quarters. He has has 16 years of professional money management experience, including 11 years with Legg Mason Capital Management, where he was an analyst, PM, and Consumer Real Estate sector head.

    SumZero: What is the future of the Affordable Care Act (ACA), aka Obamacare, under a Trump presidency?

    Dale Wettlaufer, Charlotte Lane Capital: I believe Medicaid expansion will survive while State Health Insurance Exchanges have some bad adverse selection problems right now.

    Those can be ameliorated with a national underwriting pool and clearer risk sharing support for the Exchanges. Penalties for non-enrollment should go to the underwriters, not the US Treasury; otherwise the adverse selection problem remains.

    A number of State exchanges are running on fumes and this is hurting middle income people the most. It’s no surprise that group was Trump’s biggest supporters. The two lowest income quintiles represent the biggest swing towards the GOP vs. 2012 and benefit most from Medicaid expansion.

    I don’t think Mr. Trump and the GOP will throw overboard these cohorts. I believe the overall thrust of ACA will remain with a re-ordering of some key financial elements.



    SumZero: What is the opportunity with HCA Holdings stock right now?

    Dale Wettlaufer, Charlotte Lane Capital: HCA has grown its business under a cloud of regulatory worry since the inception of the Affordable Care Act six years ago.

    Will the ACA be repealed? Will ACA harm the sector? The Act has faced a number of tests, including at the Supreme Court level.

    While HCA’s revenue grew 60% and earning per share grew 250% from 2008 through 2015, the multiple on the stock compressed and stands at 11x 2016E consensus EPS because of the overhang.

    I argue ACA or broad healthcare access won’t be repealed, based on what President-Elect Trump and members of Congress have said, based on my read of how a social democracy works, and based on my read on the political consequences of a such a repeal for the newly- unified government under the GOP.

    I also argue it’s inconsequential for excess return potential in HCA from this point. Remove ACA and it gets re-rerated. Modify ACA and it gets re-rated.



    SumZero: Why now?

    Dale Wettlaufer, Charlotte Lane Capital: HCA was down 16% the day after the 2016 national election. It has recovered somewhat, but was already cheap because of the overhang. It has traded off on adverse headlines and the stock has been over the last 18 months jumpier than a long-tailed cat in a room full of rocking chairs.

    I believe the long-term growth outlook of the company and its competitive position are highly attractive with or without ACA and this point of heightened fear in the stock has improved the expected excess return in the stock.



    See the rest of the story at Business Insider

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