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The latest news on Obamacare from Business Insider

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    Obama doctors Obamacare

    President-elect Donald Trump has once again weighed in via Twitter on the Affordable Care Act, the healthcare law better known as Obamacare, in what is shaping up to be the fist major legislative battle of the new congressional session.

    "The Democrats, lead by head clown Chuck Schumer, know how bad ObamaCare is and what a mess they are in,"Trump said, beginning a series of tweets on Thursday. "Instead of working to fix it, they do the typical political thing and BLAME. The fact is ObamaCare was a lie from the beginning."

    The tweets came one day after Republicans and Democrats laid out their respective strategies for dismantling and defending the ACA.

    Republicans argue that the law — primarily citing the state-level health-insurance marketplaces — is collapsing on its own and that there needs to be a "stable" transition to replace it.

    The GOP advocates a "market-based" approach that would give money to consumers up front to find their own insurance.

    Democrats are arguing that the law is working in broad strokes — more people have insurance than ever before and some provisions are popular, including the inability for insurers to deny coverage based on preexisting conditions — and that only small tweaks are needed to provide stability to the exchanges.

    Schumer, the Senate minority leader, and other Democrats argue that any change to the law made by Republicans may lead to the loss of coverage for the more than 22 million people who have gained insurance through the ACA, and the party has said any lapses will be the fault of Republican tinkering.

    Vice President-elect Mike Pence was on hand to meet with Republicans about an ACA repeal, while President Barack Obama met at the same time with Democrats.

    Obama, according to CNN's sources at the Democratic meeting, told lawmakers to call the new plan "Trumpcare" and not to "rescue" Republicans by agreeing to an inadequate replacement plan.

    Trump continued his tweetstorm by citing the claim made by Obama and Democrats during the passing of the Affordable Care Act that "if you like your doctor, you can keep them." While this refers mainly to the individual insurance market such as the ACA's marketplaces — which are used by 7% of the American public— a declining number of insurers participating and narrower coverage networks have led to more limited health-provider options.

    The president-elect concluded by calling for bipartisan support for a replacement.

    "It is time for Republicans & Democrats to get together and come up with a healthcare plan that really works — much less expensive & FAR BETTER!" Trump tweeted.

    The Department of Health and Human Services also released its most recent update for Obamacare's 2017 open enrollment on Thursday, showing that 8.8 million had signed up for or renewed a plan through the ACA as of the end of December. That is 200,000 more than the total from the same time in the previous year.

    Check out all of Trump's tweets:

    SEE ALSO: The battle lines are being drawn in the fight over Obamacare

    Join the conversation about this story »

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    Paul Ryan

    Paul Krugman, the Nobel Prize-winning economist and New York Times columnist, thinks Republicans have boxed themselves into a corner with their attempt to repeal the Affordable Care Act (ACA), better known as Obamacare.

    In a series of tweets Thursday, Krugman laid out the political and policy pickles in which the GOP finds itself as it tries to deliver on its years-old promise of repeal, while also maintaining coverage for more than 20 million people who have gained access health insurance through the ACA.

    "Watching Republicans trying to grapple with the reality of ACA repeal is both entertaining and deeply dispiriting," Krugman said. "The entertainment comes from watching them get caught by a trap of their own devising. Their base will punish them if they don't repeal. But white working-class voters convinced themselves that that nice man Trump wouldn't possibly take away their coverage."

    Krugman also argued that Republicans have cornered themselves on any substantive policy changes to the health law by accepting the more popular parts of Obamacare.

    Trump and other members of the GOP have said they plan to keep some of those provisions, like one that prevents insurance companies from denying coverage based on a preexisting condition.

    The only problem, according to Krugman, is that to keep the "good parts," the other aspects — such as the individual mandate — have to stay too.

    "To cover preexisting conditions, you need community rating," the economist said. (Community rating forces insurers to charge people in the same location the same premium regardless of health status, gender, and more.)

    "To avoid a death spiral from community rating, you need an individual mandate — require people to sign up when healthy. To ensure that everyone can afford to buy insurance under the mandate, you need subsidies. So it has to be regulation+mandate+subsidy. In other words, it basically has to be Obamacare."

    The problem, according to Krugman, is that Republicans have been so vehemently against the law for so long that they simply can't back down now that they control Congress and the White House. 

    "Now, after all that denial, they can repeal at will — and are realizing that 30 million people, half of them [white working class], will lose coverage, and they're terrified of the political fallout," Krugman concluded. "Horrible that they got away with this for so long. Now they should pay the full price."

    While more than half of those that have gained access to health insurance from the ACA are white and an overwhelming amount make less than $100,000 as a household, it is unclear how many are Republicans or Trump supporters.

    Additionally, much of the fallout comes down to how the Democrats and Republicans sell their plans. Republicans have said Obamacare is simply going to fail on its own anyway, so their changes are more palatable than the "death spiral" in which the law currently finds itself.

    Democrats, on the other hand, cite the record number of people signing up for ACA coverage and say the law only needs minor tweaks to make it sustainable without depriving people of coverage.

    View Krugman's full tweetstorm below:

    SEE ALSO: TRUMP: 'Obamacare was a lie from the beginning'

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    Barack Obama

    WASHINGTON (AP) — President Barack Obama is deriding as "reckless" a Republican plan to repeal his health care law now and replace it later.

    Obama is urging lawmakers to come up with an alternative to the Affordable Care Act before voting to gut it. He writes in the New England Journal of Medicine that it would be "irresponsible" to do otherwise and could devastate the health care system.

    Obama says the resulting uncertainty could lead insurance companies to bail on the health care marketplaces during the phase-out years, leaving millions without insurance. He says it would set up a "cliff" with harmful consequences if lawmakers fail to approve a replacement in time.

    The president says there's no guarantee Republicans will manage to get a "second vote" to approve an "Obamacare" replacement.

    SEE ALSO: TRUMP: 'Obamacare was a lie from the beginning'

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    Supporters of Sen. Bernie Sanders

    President Barack Obama said on Friday that criticism from the left wing of his own Democratic Party helped feed into the unpopularity of Obamacare, his signature healthcare reform law.

    Obama has been spending part of his last two weeks in office urging supporters to speak out against plans by Republicans - who will soon control both the White House and Congress - to dismantle the 2010 Affordable Care Act.

    At a town hall event with Vox Media, Obama acknowledged the politics have been stacked against his reforms, mainly blaming Republicans who he said refused to help make legislative fixes to Obamacare, which provides subsidies for private insurance to lower-income Americans who do not have healthcare plans at work.

    But Obama also said Liberals like former Democratic presidential candidate Senator Bernie Sanders had contributed to the program's unpopularity.

    During Sanders' campaign for the presidential nomination, he proposed replacing Obamacare with a government-run single-payer health insurance system based on Medicare, the government plan for elderly and disabled Americans.

    "In the 'dissatisfied' column are a whole bunch of Bernie Sanders supporters who wanted a single-payer plan," Obama said in the interview.

    "The problem is not that they think Obamacare is a failure. The problem is that they don't think it went far enough and that it left too many people still uncovered," Obama said.

    Obamacare

    Michael Briggs, a spokesman for Sanders, agreed that many people would rather the government "take on the private insurance industry and the pharmaceutical companies" and play a bigger role in providing healthcare.

    "There are many millions of Americans, including many of Bernie's supporters, who don’t understand why we are the only major country on earth that does not provide healthcare as a right and they don’t understand why we pay more but get less for what we spend on healthcare," Briggs said.

    Polling by the Kaiser Family Foundation last month showed 46 percent of Americans have an unfavorable opinion of Obamacare, while 43 percent have a favorable view. Americans are also split on whether the law should be repealed.

    Trump and congressional Republicans have vowed to quickly repeal the law, but Obama and Democrats have argued they should reveal a replacement plan before dismantling the program.

    More than 20 million previously uninsured Americans gained health coverage through Obamacare, according to the White House. Coverage was extended by expanding the Medicaid program for the poor and through online exchanges where consumers can receive income-based subsidies.

    (Reporting by Roberta Rampton; Editing by Tom Brown)

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    rand paul

    Congressional Democrats are planning a blizzard of publicity events and delaying tactics to try to block the Republicans’ drive to repeal the Affordable Care Act in the coming weeks, although few give them much chance of success. 

    Arguably the Democrats’ longest of long-shots in slowing or sidetracking the Obamacare repeal legislation is the effort of Sen. Rand Paul, the libertarian, free-spirted Republican from Kentucky who unsuccessfully challenged Donald Trump for the GOP presidential nomination. 

    Paul, 53, is one of at least three Republican senators who have said it might be a colossal mistake for the Republicans to forge ahead with repealing Obamacare without a replacement plan ready in the wings to avert upheaval in the health insurance industry and prevent millions of Americans from losing their coverage.

    “We should repeal Obamacare, but partial repeal will only accelerate the current chaos and may eventually lead to calls for a taxpayer bailout of insurance companies,” he wrote recently. 

    Two other more moderate Republican senators, Susan Collins of Maine and Bill Cassidy of Louisiana, also voiced concern that reckless action now by the GOP could leave millions of Americans in the lurch and trigger political retribution against their party. But Paul was the only Senate Republican to vote on Wednesday against beginning the complex “reconciliation”  budget process that will culminate in a final vote to repeal Obamacare. 

    Donald Trump

    Then on Thursday, he attempted to up the ante with a morning meeting with nearly two dozen arch conservatives in the House — members of the Freedom Caucus — to discuss possible opposition strategies. Freedom Caucus members are universally opposed to Obamacare and have long called for its repeal. However, many of those members are also ideological purists on the subject of budgets and spending and are opposed to almost anything that raises the spending caps and drives up the now $19.9 trillion national debt. 

    Paul argued that the fiscal 2017 budget resolution that the leadership just placed on a fast track to passage by a simple majority vote not only would dismantle key sections of Obamacare, but theoretically would permit major tax cuts and spending that could increase the debt by $9.7 trillion over the coming decade. 

    “I want to make sure that conservatives in the House knew that together we can have some power and impact on what the budget will be, that the budget is a Republican document, there will be no Democrats on board,” Paul told reporters after the meeting. “It should be a conservative document that should not add $9.7 trillion to the debt over 10 years.” 

    Ross Baker, a political scientist and congressional expert at Rutgers University, said yesterday that it’s hard to imagine that Trump’s proposed combination of tax cuts and $1 trillion dollars in infrastructure spending would please House conservatives. “So I think Paul sees an opportunity to make some converts,” Baker said. “At this point they may just take a wait-and-see attitude and then decide later their feelings about Trump’s spending and taxing plans. 

    Barack Obama

    Although the GOP holds a solid 247-to-188 majority in the House, a defection by 24 members of the Freedom Caucus could derail House Speaker Paul Ryan’s crusade to repeal Obamacare, just as a defection by Paul and two other Senate Republicans could give Senate Majority Leader Mitch McConnell (R-KY) fits in steering repeal through the Senate. 

    But as The Washington Post reported yesterday after Paul’s meeting with the Freedom Caucus, “Few of the House’s staunch conservatives were ready to pull the trigger.” 

    Rep. David Schweikert (R-AZ) told reporters that “I just came to understand all the different ideas about where we go next,” but added that he would probably vote for the budget resolution. 

    Rep. Mark Meadows (R-NC) said his group hasn’t made a decision whether to support the budget resolution or not. However, he argued that it would be far preferable to simultaneously repeal and replace Obamacare instead of putting off a decision on a new program for months or even years, as many GOP leaders have suggested. 

    paul ryan Obamacare repeal

    However, after what the Post described as a “collective shrug” from House conservatives this time, Paul may find himself on a lonely quest. During a news conference yesterday, Ryan told reporters he was “really not concerned” about Paul’s intervention in internal House GOP policy-making. He said his members know that a second, fiscal 2018 budget resolution will be introduced next fall that would address concerns about a rising debt. 

    “This is a repeal resolution,” he said of the pending budget legislation. “Our members fully understand that. We’ve been planning for this for quite some time. The full budget resolution — the traditional budget resolution — will occur this fall, like it always does. And our members understand this process.” 

    Ryan indicated that the GOP would have a replacement plan in hand before the end of this year. However, he declined to commit when asked if the Republican plan would allow everyone covered through Obamacare to remain insured.

    An aide to the Senate Budget Committee agreed with Ryan that the fiscal 2018 budget will be a comprehensive plan “that will put our fiscal house in order.” He added that, the current budget resolution would at least provide $2 billion in savings for deficit reduction. “And we know repeal will generate a lot more savings, according to the Congressional Budget Office,” he added.

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    Donald Trump

    Senate Republicans are walking into a trap, and Donald Trump might be the only person who can save them from themselves.

    Republicans want to repeal Obamacare. That much we know, and we’ve known it ever since Obamacare was first signed into law. Had Mitt Romney been elected president in 2012, undoing the Affordable Care Act would have been relatively straightforward, as the Medicaid expansion and the health insurance exchanges didn’t kick in until 2014. Repealing Obamacare now would have huge real-world effects. It would mean taking insurance coverage away from millions of people—unless, that is, Republicans can coalesce around a replacement that will cover all those people or at least get in the same ballpark.

    Republicans, though, are far less unified around what a replacement ought to look like than they are in their opposition to Obamacare. There are a couple of ways of going forward.

    Option No. 1: GOP legislators suck it up and do the hard work of passing piecemeal health reform legislation, with the help of centrist Senate Democrats. The smartest approach would be to give up on starting from scratch, at least for now, and instead give people who can’t or won’t buy Obamacare-compliant insurance plans the option of buying cheaper, less-comprehensive insurance without premium subsidies. Subsidized Obamacare-compliant plans would still be available on the exchanges, which would serve as a safety net for those too sick or too poor to afford bare-bones plans with high out-of-pocket costs. Instead of pulling the rug out from under states that expanded Medicaid under Obamacare, Congress could pick up a higher share of the tab for the poorest and sickest Medicaid beneficiaries while asking states to take on more responsibility for helping the healthiest of them, a swap that would greatly relieve the pressure on state budgets. In short, rather than taking a wrecking ball to Obamacare, Republican lawmakers could act as sculptors, chipping away at the provisions they like least.

    Option No. 2: Repeal Obamacare without a plan for replacing it and hang a “Mission Accomplished” banner while America’s health insurance market erupts in flame.

    Obamacare protest

    Naturally, Senate Majority Leader Mitch McConnell appears hellbent on Option No. 2. This is “repeal and delay,” a strategy for unraveling Obamacare in the messiest, most chaotic way possible.

    Because Senate Republicans have a narrow 52-seat majority, they can’t overcome a Democratic filibuster, so they can’t really repeal Obamacare root and branch. The only way to get to a filibuster-proof majority is to embrace Option No. 1. What the Republicans can do without Democratic votes is use the budget reconciliation process—which requires a simple majority vote—to roll back Obamacare’s premium subsidies, its payments to states that expanded their Medicaid rolls, and its tax penalties targeting those who choose to go without insurance coverage. Republicans in Congress passed a bill in early 2016 that did just that, which President Obama promptly vetoed. Once President Trump takes the reins, the thinking goes, Republicans can get a big win under their belts, establish their conservative bona fides, and then press ahead with slashing taxes and regulations.

    Repeal and delay wouldn’t cut off the flow of Obamacare funds immediately. It would give Republicans in Congress until 2019 or 2020 to come up with a viable replacement. So what could possibly go wrong? Pretty much everything.

    The Obamacare exchanges are already in shambles, because they’ve attracted an older, sicker set of enrollees than the Obama administration had anticipated, which has driven up costs. Obamacare was designed to nudge younger, healthier people into enrolling on the exchanges by threatening them with steep penalties if they failed to do so, but the penalties have either been delayed or haven’t had much bite. President Obama wanted to give insurers open-ended subsidies to compensate them for these higher-than-expected costs, but Republican lawmakers intervened, insisting this would amount to a bailout for the insurance industry.

    Obamacare Protest

    The end result has been a highly unstable insurance market, from which major insurers are constantly threatening to jump ship. Instead of easing these pressures, repeal and delay would further destabilize the market. Eliminating the tax penalties would give the young and healthy even less reason to buy insurance. Once the subsidies are placed in jeopardy, even more insurers will lose interest in offering plans. Low- and middle-income enrollees who currently receive premium subsidies won’t be able to afford their insurance. Repeal and delay, then, is a recipe for tens of thousands of individual health care horror stories, heart-wrenching tales Republicans would have to answer for.

    There’s also the nightmare that would befall state governments, including Republican-led state governments, that embraced the Obamacare Medicaid expansion. By zeroing out the federal payments that made the Medicaid expansion possible, repeal and delay would bring on crippling budget crises. Just imagine the tongue-lashings Republican governors would give their home-state senators or the rowdy town halls where Republicans members of Congress would find themselves burned in effigy. It’s not a pretty picture. Honestly, the only way repeal and delay makes sense is if you’re a small-government true believer who’d rather see the GOP destroy itself than sell out.

    But wait: Wouldn’t Republicans have years to craft a functioning Obamacare replacement? Well, sure. But they’d still have to unify the GOP and attract a handful of Democrats. How exactly would they do that if repeal and delay set off a massive national backlash? And what if Democrats smelled blood in the water and sensed they had a decent shot at taking back the House? Repeal and delay assumes Republicans will have more leverage in two or three years than they do today. That’s not obviously true.

    The good news is that a handful of Senate Republicans get that repeal and delay would be an epic disaster for the GOP, so they’re pushing back against McConnell. Maine Sen. Susan Collins has come out against it, which is not shocking considering she represents a Democratic-leaning state. More surprising is the opposition of Kentucky Sen. Rand Paul, who has said he’s opposed to repeal and delay because it adds too much to the federal budget deficit. Louisiana Sen. Bill Cassidy, who has a reputation as an obsessive health care wonk, has also expressed skepticism about repealing Obamacare without having a replacement ready to go. And as of Thursday night, Arkansas Sen. Tom Cotton, a leading light among younger conservatives, has joined the rebels.

    You’d think that objections from at least four senators, who almost certainly speak for several others, would be enough to get McConnell to shelve his repeal-and-delay plans. But most senators, like most humans, are wimps. If McConnell forces GOP senators to choose sides on a repeal-and-delay bill, he knows armies of conservative activists will pillory any “nay” voters for having kept Obamacare alive. That prospect might not frighten Susan Collins, who has every incentive to present herself as a level-headed centrist. But it might be enough to bring the other dissenters in line.

    Unless, that is, Trump gets in the way. Trump’s tweeting earlier this week managed to spook House Republicans out of weakening the Office of Congressional Ethics. Now, he’s taken to Twitter to suggest he wants Republicans and Democrats to work together to replace Obamacare with a better and cheaper approach to providing Americans with insurance coverage. Could this be a signal that Trump doesn’t want Congress consumed with a slow-motion Obamacare meltdown? Might he be more favorably disposed to Option No. 1 (play nice) than Option No. 2 (let slip the dogs of war)? More to the point, could Trump give cover to Senate Republicans who don’t want to go along with McConnell’s kamikaze strategy? There’s no way of knowing. Trump could tweet the exact opposite sentiment five minutes after I publish this story.

    But how weird would it be if Trump—a man who seems blithely indifferent to the nitty-gritty details of policy, and who’s had no compunction about belittling his fellow Republicans when it has suited his purposes—managed to prevent Republicans in Congress from making a colossal policy blunder?

    SEE ALSO: TRUMP: 'Obamacare was a lie from the beginning'

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    Senate Majority Leader Mitch McConnell (R-KY) speaks about the election of Donald Trump in the U.S. presidential election in Washington, U.S., November 9, 2016. REUTERS/Joshua Roberts

    WASHINGTON (Reuters) — The U.S. Senate will take its first steps toward repealing President Barack Obama's signature healthcare reform act by the end of the week, Republican Senate Majority Leader Mitch McConnell said on Sunday.

    Speaking on CBS's "Face the Nation," McConnell said: "There ought not to be a great gap" between repealing the act and replacing it and that Republicans would be "replacing it rapidly after repealing it."

    McConnell did not define what he meant by "rapidly." Another top Republican, House Majority Whip Steve Scalise, told Fox News that it could take two years to fully replace the Affordable Care Act, popularly known as Obamacare.

    "I think everybody recognizes that there will be a transition period," Scalise said. "President-elect Trump and our leaders have said nobody is going to get the rug pulled out from underneath them."

    Scalise cited a previously proposed Republican bill to repeal the healthcare law that laid out a two-year transition period for putting in place an alternative. "That's a benchmark for what we're looking at again," he added.

    Since his election on Nov. 8, Trump, who will be sworn in as Obama's successor on Jan. 20, has made clear he wants to move swiftly on his campaign pledge to repeal and replace the 2010 law.

    Republicans have a chance to make good on the Republican president-elect's promise since they control both chambers of Congress. House Republicans took a step last week to clear the decks for Obamacare repeal by approving a procedural rule that would make it harder for Democrats to impede progress on such legislation.

    Repealing the act without an immediate replacement raises the question as to what happens to those who have insurance under Obamacare.

    On ABC's "This Week," Obama said that while the law could theoretically be repealed, "suddenly 20 million people or more don't have health insurance."

    "I think Republicans now are recognizing that may not be what the American people, including even Trump voters, are looking for," he said.

    'May take time'

    Reince PriebusThe healthcare law extended insurance coverage to millions of Americans through an expansion of the Medicaid program for the poor and the creation of online exchanges where consumers can shop for private health insurance coverage. The law also provides for subsidies to help individuals and families afford coverage purchased on the exchanges.

    Reince Priebus, Trump's incoming White House chief of staff, told "Face the Nation" that while repealing and replacing Obamacare all at once would be ideal, it "may take time" to get all elements of the new plan ready.

    Obamacare came under renewed criticism recently after the government disclosed that benchmark 2017 Healthcare.gov premiums would rise 25 percent compared with 2016. Several large health insurers have withdrawn from the market, saying they are losing money.

    Obama said he expected the law to survive, albeit in a modified form.

    "If in fact the Republicans make some modifications," he said, "and re-label it as Trumpcare, I'm fine with that."

     

    (Reporting by Toni Clarke in Washington; Editing by Caren Bohan and Peter Cooney)

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    barack obama smile

    While the public has long agreed with President-elect Donald Trump and congressional Republicans that the Affordable Care Act is badly flawed and requires major surgery, far more Americans believe the program should be kept but improved than repealed and replaced.

    Shortly after Trump’s stunning November 8 victory over Democrat Hillary Clinton – an ardent champion of Obamacare -- a Gallup poll found that while slightly more than half of Americans continued to express dissatisfaction with the program, 57 percent said they either wanted to keep the law as is or wanted to keep it and change the law significantly. Just 37 percent wanted to repeal and replace it as the Republicans have vowed to do.

    Not surprisingly, views differ sharply between Republican and Democratic voters, reflecting the larger political divide throughout the country and in Washington. Seventy-one percent of Republicans told Gallup they disapprove of the law and want it repealed, while 59 percent of Democrats want to keep it with significant changes.

    Obamacare Affordable Care Act

    Taken together, the findings suggest a national unease among Americans over GOP leaders’ determination to pass a budget resolution in the coming weeks that would repeal President Obama’s signature national health insurance program that – for all its flaws – has provided coverage to more than 20 million Americans in recent years.

    House Speaker Paul Ryan (R-WI) and Senate Majority Leader Mitch McConnell (R-KY) have joined Trump in denouncing Obamacare as irredeemable. They have vowed rapid legislative action in the coming weeks and months to repeal the law, even while the party is far from a consensus on replacement legislation.

    “Obamacare is a disaster,” Ryan said. “Insurance markets are collapsing. Premiums are soaring. Patients’ choices are dwindling. The law has failed to deliver on its core promises, hurting far more than it is helping.”

    GOP leaders, for now, intend to repeal the program by the spring while setting the effective date a year or two down the road while Republican lawmakers hammer out a comprehensive alternative program that depends on more on market forces than government intervention and subsidies.

    Obamacare protest

    Yet that strategy is being met with opposition from insurers, hospitals and doctors, drug companies, consumer advocates and even many Republican governors who fear chaos and a collapse of Obamacare while the Republicans struggle to map out a new approach.

    Just this week, the American Medical Association (AMA), the premier physician organization, wrote a letter to Republican leaders warning against jeopardizing the health care coverage of millions of Americans by abruptly repealing Obamacare without a suitable replacement. And Republican Gov. Rick Snyder of Michigan hailed the success of his state’s expansion of Medicaid that was made possible by the Affordable Care Act.

    A dozen moderate Democratic senators, including Tim Kaine of Virginia, Clinton’s vice presidential running mate, wrote to the GOP leadership yesterday urging them to slow down and work with them to draft changes to the existing law to address concerns such as soaring premium and onerous taxes and mandates.

    “There is so much we can immediately improve, but by pushing an immediate repeal through a partisan budget process, we won’t have the opportunity to work together to build on that common ground,” Kaine said, according to The New York Times.

    Donald Trump

    G. William Hoagland, a vice president of the Bipartisan Policy Center and a former Senate Republican budget expert, said that the Republicans are still caught up in their campaign slogans and enthusiasm and aren’t being pragmatic. However, reality will begin to set in when House and Senate committees begin stitching together the specific budget instructions to dismantle Obamacare, and many divisive issues rise to the surface, he said.

    “Campaign rhetoric is one thing and legislating is another thing,” Hoagland said in an interview Friday. “And I think the word ‘repeal’ is maybe being overused here by the Republicans – even before President-elect Trump is sworn in. What people are really talking about is amending the Affordable Care Act.”

    Hoagland, a health care policy expert, suggested that there is plenty of room for bipartisan compromise on changes to Obamacare, including adding Trump’s proposals for lowering barriers to interstate sales of health insurance and the establishment of health care savings accounts. The biggest sticking point between Republicans and Democrats will be over how to subsidize health care costs for low-income Americans through the federal tax code and whether to make coverage mandatory or voluntary.

    The Affordable Care Act mandates uninsured Americans to acquire coverage or pay the penalty. Ryan and others say their goal is to replace Obamacare with a law that guarantees “universal access” to health care coverage, but not necessarily to force everyone to be covered. Ryan yesterday declined to speculate on whether the 20 million or more Americans currently receiving coverage under the Affordable Care Act would continue to receive coverage under the GOP approach.

    barack obama

    There is another obstacle for the Republicans in completely reinventing a national health insurance program: the cost. Blowing up Obamacare and starting from scratch would be a very costly enterprise. A complete repeal would include getting rid of a dozen major tax provisions that help underwrite the program’s operating costs.

    Before the election, the Congressional Budget Office projected that Obamacare operating costs would total $1.24 trillion between 2019 and 2026. There is compelling evidence that if the Republicans scrap all of the Obamacare taxes, they could raise at most $850 billion of the total required cost through a number of budgetary and tax policy maneuvers, according to a recent Brookings Institution analysis.

    For these and other reasons, Hoagland says he could imagine a bipartisan deal next summer or fall that would retain the basic framework of Obamacare while layering in GOP provisions and innovations. He said that it would give Trump the opportunity to show off his legendary bargaining skills.

    “The more I look at it . . . the more I sense that we’re really talking about what you might call Trumpcare One or Trumpcare Two – Trumpcare modification of Obamacare,” Hoagland said. “It just seems to me we’re dealing with rhetoric right now and we’re still in the campaign mode.”

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    domacrats obamacare schumer pelosi

    WASHINGTON (AP) — President-elect Donald Trump says that President Barack Obama's health care law "will fall of its own weight."

    House Speaker Paul Ryan says the law is "in what the actuaries call a death spiral."

    And Senate Majority Leader Mitch McConnell says that "by nearly any measure, Obamacare has failed."

    The problem with all these claims: They are exaggerated, if not downright false.

    As congressional Republicans prepare to repeal the health law, they are working to portray it as a mess of Democrats' making, and themselves as the ones who will clean up that mess.

    In the process they are exaggerating the law's very real problems, according to health care experts, who largely believe that the Affordable Care Act's troubles with high prices and lack of competition could be addressed with bipartisan solutions.

    Republicans, who've gained political advantage from campaigning against the law since its passage in 2010, aren't interested in playing along. Instead they've denounced the law and made the case to repeal it, although there are signs some are getting cold feet now that the reality is upon them.

    Democrats, too, are guilty of rhetorical excesses around the health care law, often claiming that it's working as intended while downplaying its flaws.

    But with Republicans in the majority and driving the agenda, here's a look at some of the GOP claims about the law, and how they compare with the facts:

    TRUMP, RYAN AND MCCONNELL: The law will "fall of its own weight," is in a "death spiral" and "has failed."

    THE FACTS: Experts agree that the law is not currently in a "death spiral," an actuarial term that refers to a vicious cycle when rising insurance costs force healthy customers out of the marketplace, resulting in still higher prices, which cause even more customers to bail, etc., until the system collapses.

    But some say that if the current situation continues, that is a likely or possible scenario. Health care premiums are jumping by double digits this year, and the health care marketplaces created by the law are short on the healthy consumers who make insurance companies profitable.

    "It's not a failure in that 20 million people or more have insurance that didn't used to have insurance. Everything else, it's too early to judge," said economist Gail Wilensky, who ran Medicare under former President George H.W. Bush.

    "To say that the exchange markets remain unstable and in turmoil is an appropriate statement," she said. "To say that they're in a death spiral really depends on what happens."

    The American Academy of Actuaries itself disputed the "death spiral" claim Monday. The group provided a statement from its senior health fellow asserting that high premium increases in many states this year "do not necessarily indicate that a premium spiral is occurring" and could be a one-time adjustment.

    paul ryan obamacare___

    RYAN:"You cannot fix a fundamentally broken law; you've got to replace it."

    THE FACTS: Experts agree that Congress could fix the law's problems, should it choose. Indeed many argue that some of the law's problems can be traced to the decision by Obama and Democrats to push it through on a partisan basis — alienating Republicans who have refused ever since to participate in any attempt to tweak the law to improve it, as would be necessary with any program of such size and complexity.

    Some predict that when Republicans get through with their repeal-and-replace effort, what it will really amount to will be an improved Obamacare — even if they don't admit it.

    The health care exchanges, for example, could be improved with changes aimed at getting more young and healthy people to sign up, such as giving insurers more flexibility to charge older people higher prices.

    "You could, I think, relatively simply address the issues that the exchanges have," said Dan Mendelson, president of Avalere Health, a health consulting firm, noting that other major programs including Medicare have been tweaked repeatedly since their creation. "If you freeze a program in a point of time, it is likely to have problems, and that's exactly what's happening."

    Bob Laszewski, a health care consultant, predicted: "Before this all ends they're going to fix it ... The Republicans are going to say they repealed and replaced, and the Democrats are going to say they fixed it."

    ___

    Obamacare

    MCCONNELL: Obamacare "didn't lower costs, it didn't increase choice."

    THE FACTS: McConnell's comments are true in part.

    The first five years of Obama's presidency saw historically slow growth in U.S. health care spending, though experts differ on whether the law had anything to do with that. Some credit the global recession. Individual consumers in the law's marketplaces, meanwhile, face higher premiums this year, though subsidies protected most customers from the increases.

    And while the Affordable Care Act did increase choice initially in the individual market, that is not the case now with brand-name insurers bailing out of the online state markets, although the many Americans with employer-based health coverage have been insulated from such changes.

    In about one-third of U.S. counties, consumers in the individual markets don't have a choice of plans.

    "It depends for whom you're talking about," said Larry Levitt, senior vice president at the Kaiser Family Foundation. "For people with pre-existing conditions, choices are infinitely more abundant because they couldn't get coverage at all. For someone who's young and healthy there are likely fewer choices available now than before."

    ___

    Associated Press writer Ricardo Alonso-Zaldivar contributed to this report.

    EDITOR'S NOTE _ A look at the veracity of claims by political figures

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    paul ryan

    Facing the realities of the complicated health insurance market, Republican members of Congress have wavered over the past week on a Senate bill to repeal President Barack Obama's healthcare law, pushing instead a strategy of crafting a replacement before going ahead with repeal.

    Last Tuesday, Republican Senate leaders introduced a bill that would use the budget reconciliation process to undo significant parts of the Affordable Care Act (ACA), better known as Obamacare.

    On Monday night, however, five GOP Senators — Bob Corker of Tennessee, Rob Portman of Ohio, Susan Collins of Maine, Bill Cassidy of Louisiana, and Lisa Murkowski of Alaska — submitted an amendment to the bill in the Senate that would extend the deadline for the committees to craft a repeal bill from its current January 27 deadline to March 3.

    "By extending the deadline for budget reconciliation instructions until March, Congress and the incoming administration will each have additional time to get the policy right," Corker said in a statement on Monday night.

    "Repealing President Obama’s health care law and replacing it with a responsible alternative is a top priority, and by exercising due diligence we can create a stable transition to an open healthcare marketplace that provides far greater choice and more affordable plans for the American people," he added.

    Corker also emphasized that President-elect Donald Trump has said "repeal and replace should take place simultaneously."

    Other GOP senators have expressed a desire to make sure there is a replacement plan in place before repeal is triggered. Sen. Tom Cotton of Arkansas told MSNBC last week that he also had reservations on repealing the law without a replacement ready to go.

    "It would not be the right path for us to repeal Obamacare without laying out a path forward," Cotton said.

    Sen. Lamar Alexander also has said the GOP has to"consider what it would take to create a new and better alternative and then begin to create that alternative" before repealing the ACA.

    Given the slight majority of Republicans in the Senate and the unwillingness of Democrats to help tearing down Obama's signature legislative achievement, even a few defections from the Republican Party would cause a repeal bill to fail on a vote.

    It also appears that the Trump administration is working with congressional leaders to lay out a plan to replace the bill before any repeal happens.

    The Associated Press' Erica Werner reported that top Trump advisers Steve Bannon and Jared Kushner, along with incoming chief of staff Reince Priebus and Treasury Secretary-designate Steven Mnuchin all met with House Speaker Paul Ryan for two hours on Monday night. At the conclusion of the meeting, Bannon told reporters the group was "still thinking that through" in regard to the Obamacare repeal and replacement.

    Bob Corker

    Simultaneously, Sen. Rand Paul has been gathering support over the past week to delay any repeal of Obamacare until the GOP has a full replacement bill ready to go. Paul has cited concerns over a possible increase in the deficit due to a repeal and has tweeted that Trump supports his call for a replacement on the same day as repeal.

    Concerns have been raised over the past week by Republican leaders that any repeal without a replacement may lead to a disruption for those people in the individual marketplaces — that is, those not getting their insurance through their employer or a government program like Medicaid or Medicare.

    Given that more than 23 million people gained healthcare coverage through various provisions of the ACA, GOP leaders appear to want to ensure that there is no gap in their care, given the political and practical complications.

    Additionally, health policy experts have expressed concerns that the possibility of repeal with no clear replacement could lead to insurers pulling out of the individual marketplace at a faster pace, leaving fewer choices and potentially causing price increases that would make current premium hikes look small by comparison.

    The move would also be politically unpopular. A poll by the Kaiser Family Foundation, a nonpartisan healthcare-focused think tank, found that just 20% of Americans want Obamacare repealed even if there is no replacement. Another 28% want a repeal if there is a replacement plan ready, while 47% do not want a repeal at all.

    Former Republican House Speaker and Trump confidant Newt Gingrich told Fox News on Monday night that Republicans are worried about a possible loss of coverage for some Americans.

    "I don’t think Republicans want to have 23 million people out there worried that they’re going to lose their insurance," Gingrich said.

    GOP senators such as John McCain of Arizona have also expressed reservations about possible coverage lapses. Collins, a sponsor of the amendment to delay the repeal, said in a statement Monday night that avoiding coverage lapses is a key part of the reason Republicans should delay.

    "Repeal and replacement is a complicated task, and my number one concern is that we not create a gap in coverage for individuals who are currently insured and who rely on that coverage,"Collins said in the statement announcing the amendment.

    And Democrats appear to be unwilling to help kill Obamacare. Senate Minority Leader Chuck Schumer previously told the Washington Post that Democrats "will not then step up to the plate and come up with a half-baked solution that we will partially own."

    In a meeting with Democrats on Capitol Hill last week, Obama told members not to "rescue" Republicans with a replacement bill and to call any changes to the ACA "Trumpcare."

    As for the current administrators of the law, it appears the administration will go full steam ahead with the current open enrollment period until Trump takes office.

    As of the end of 2016, 8.8 million people had signed up for plans through Obamacare according to the Department of Health and Human Services. Additionally, Obama, HHS Secretary Sylvia Burwell, and Centers of Medicare and Medicaid Services chief Andy Slavitt have been on a public-relations blitz to defend the growth of the law and its positive impact on patients and Americans before Trump is inaugurated next week.

    SEE ALSO: The battle lines are being drawn in the fight over Obamacare

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    11.54 million have signed up for plans through the Affordable Care Act's (ACA), better known as Obamacare, marketplaces so far this open enrollment season, according to the Centers of Medicare and Medicaid Services.

    According to CMS, this is 286,000 more plan selections than were made through the same time period last year, making it the most sign ups in the four years of the marketplaces.

    "Nationwide demand for health coverage is higher than ever, as Americans prove again that Marketplace coverage is vital to them and their families," said Health and Human Services Secretary Sylvia Burwell in a release from CMS.

    Add in state-level exchanges in New York and Minnesota, and 12.2 million Americans have signed up for some sort of ACA plan.

    The sign ups come as the looming threat of the ACA's repeal by the new Republican-led Congress looms over the law. The GOP appears to be slowing on its plans to repeal and replace Obamacare, but House Speaker Paul Ryan said in a press conference on Tuesday that the law is failing and must be replaced.

    CMS pointed to the enrollment numbers as proof that the law is in fact thriving, counter to the GOP's suggestions.

    "Growing demand for Marketplace coverage refutes predictions that 2017 premiums changes would lead to sharp declines in enrollment and a so-called 'death spiral,' a notion also debunked in a report released today by the Council of Economic Advisors," said the release from CMS. "Instead, today's data show that a broad cross-section of Americans continue to rely on the Marketplace to access affordable, quality coverage."

    obamacare enrollment 1 10 17 COTD

    One issue that does appear to be nagging the sign ups once again is the lack of young people in the exchanges. According to the CMS, the share of people aged 18 to 34 signing up for ACA plans is the same as the year before, 26%.

    The low number of young people in the exchanges has led to an older, sicker risk pool for insurers, which in turn has led to losses and insurers leaving the markets. That trend does not appear to be turning around this year, but it includes only the 8.7 million people who have signed up through Healthcare.gov  and not the state-level exchanges.

    Other interesting demographic notes from the Healthcare.gov enrollees:

    • 3.9 million enrollees are white, 584,000 African-American, 882,000 Latino, and 573,000 Asian.
    • 4.8 million enrollees are women, while 4.0 million are men
    • 1.6 million enrollees are classified by CMS as "rural Americans"

    Open enrollment will continue through January 31 and the CMS said it intends to push for sign ups up until that point.

    SEE ALSO: The GOP is pumping the brakes on repealing Obamacare

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    donald trump

    President-elect Donald Trump is pushing Republicans to shorten their timetable for repealing the Affordable Care Act, the healthcare law better known as Obamacare.

    According to a report from The New York Times, Trump told The Times on Tuesday that he wanted the ACA immediately repealed and replaced, calling the law a "catastrophic event."

    Trump appeared to be pushing back at Republicans who have in recent days suggested delaying a repeal until a full replacement plan is developed.

    It also flies in the face of a plan by GOP lawmakers to pass a bill that would nominally repeal the bill while delaying actual implementation of the repeal by two to four years to build a replacement.

    According to the Times report, Trump said he wanted Obamacare to be repealed "probably sometime next week" and a replacement to be introduced "very quickly or simultaneously."

    This is a massive undertaking given the complexity of the ACA.

    Trump told The New York Times that a long time for getting repeal done "would be weeks" and that he did not favor a repeal-and-delay strategy that would take years to roll back the ACA.

    A bill currently in front of Senate committee would repeal most of Obamacare using a process known as budget reconciliation and has a deadline for January 27 to bring a full repeal bill to the Senate.

    There has been some cooling on the fast-tracked repeal of the ACA among Republicans, however. Five GOP senators proposed an amendment to the bill on Monday night to extend this deadline to March 3 to give lawmakers more time to come to an agreement on a replacement bill.

    The leader of the amendment, Sen. Bob Corker, of Tennessee, said the delay was to ensure a replacement could be found that would keep the more than 23 million people who have gained access to health insurance through the ACA from seeing a disruption in their coverage.

    "By extending the deadline for budget-reconciliation instructions until March, Congress and the incoming administration will each have additional time to get the policy right,"Corker said in a statement on Monday night.

    House Speaker Paul Ryan said in a press conference on Tuesday that Republican leaders wanted to repeal and replace the ACA "concurrently." Ryan said Republicans had a plan to replace the law — most likely referring to his "Better Way" healthcare proposal — but GOP leadership has not advanced a specific bill.

    Additionally, numerous GOP senators including Rand Paul, John McCain, Lamar Alexander, and Tom Cotton have all expressed a desire to wait until a full replacement plan is ready to go before repealing the law.

    In addition to lighting a fire under Republicans, Trump told The Times that he was taking on Democrats as well. Democrats have said they will not assist Republicans on any replacement or repeal of Obamacare, saying any such plan would "make America sick again."

    Trump noted to The Times that Democrats had numerous senators up for reelection in 2018 in states carried by the president-elect in November. Trump said he would "be out there campaigning" in those states and those Democrats should therefore assist with the new healthcare bill.

    SEE ALSO: The GOP is pumping the brakes on repealing Obamacare

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    Obama doctors Obamacare

    President-elect Donald Trump on Wednesday laid out a timeline for the repeal and replace of the Affordable Care Act (ACA), better known as Obamacare, in his first press conference since he was elected, arguing that Republicans are helping Democrats by replacing it immediately.

    Trump said that the law is collapsing on its own, citing increases in premiums in particular states for ACA exchange-based plans.

    Trump said that instead of letting the law fail and having Americans beg Trump to repeal the law, which he said would make Democrats look bad, he plans to repeal and replace Obamacare soon after he takes office and Secretary of Health and Human Services nominee is confirmed.

    "They own it right now. So the easiest thing would be to let it implode in 2017 and, believe me, we'd get pretty much whatever he wanted. But it would take a long time," Trump said.

    "We're going to be submitting, as soon as he is approved, we'll almost simultaneously — shortly thereafter — have a plan. It will be repeal and replace. It will be simultaneously," he added.

    Trump told the New York Times on Tuesday that he wants the ACA repealed "within days," but the comments from the press conference appear to set a slightly longer timetable. Price's confirmation hearing will be held January 18.

    Additionally, a bill currently in the Senate to repeal significant parts of the ACA through the budget reconciliation process has set a January 27 deadline for committees to produce a repeal bill. GOP leaders have also discussed delaying the law even further until a full replacement bill can be created.

    Trump also insisted that the burden of Obamacare would remain on Democrats, echoing remarks by GOP leaders that the law is failing. Democrats have said that the law has its problems but needs small changes in order to protect the positive from the ACA — such as the expanded coverage for more than 20 million Americans.

    "Obamacare is the Democrats problem," Trump said. "We are going to take the problem off the shelves for them. We're doing them a tremendous service by doing it. We could sit back and let them hang with it. We are doing the Democrats a great service."

    The Department of Health and Human Services reported on Tuesday that more than 11.5 million have signed up for ACA-based plans so far in this open-enrollment period, higher than any other enrollment period in the ACA's history.

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    Donald Trump.

    President-elect Donald Trump said Wednesday that repeal and replacement of the Affordable Care Act should occur "essentially simultaneously," perhaps even within "hours" of each other.

    Like a lot of Republicans, Trump seems to have realized the political hazards that would result from "repeal and delay," the proposed strategy of passing a quick repeal of the Affordable Care Act but delaying the effectiveness of that repeal for years to give lawmakers time to come up with "something terrific" to replace it with.

    The problem for Trump and congressional Republicans is that similar political hazards will arise with nearly any approach they take to healthcare policy — unless they can get Democrats to take part of the responsibility for the new changes and deliver on Trump's very elusive promise to make healthcare "far less expensive and far better."

    This is a very tall order.

    But on Wednesday, Trump took one step in this direction: reiterating his support for using the federal government's negotiating power to push down the prices of prescription drugs, a cost-control policy usually supported by Democrats and opposed by Republicans.

    Making health policy is like sticking your finger in an electrical socket

    American healthcare is very expensive. This holds back the economy as a whole. Of more political importance, the high cost of healthcare imposes painful burdens on individual consumers.

    The Affordable Care Act, the healthcare law also known as Obamacare, has affected individuals' costs at the margin, sometimes downward and sometimes upward. But mostly, excessive cost is a problem that predated the ACA, and that is hard to do much about within the constraints that exist on American policymaking.

    As Democrats have painfully learned, voters tend to place an inordinate share of the blame for problems with healthcare on whoever enacted the latest big change to healthcare policy.

    Unfortunately for Republicans, they were just elected on a promise to make big changes to healthcare policy.

    High premiums and high deductibles — the things, aside from the individual mandate, that people seem to hate most about the ACA — are natural consequences of high costs. They can be expected to persist after any Republican-driven changes. The main change will be that Republicans take the blame for them.

    Republicans can't keep all their promises in a big overhaul

    Republicans have been able to have it both ways on Obamacare for years. They have attacked the law for being too expensive to taxpayers and requiring insurance that is too comprehensive — and also for the fact that plans sold under the law have high deductibles and limited provider networks.

    These complaints are in tension: If you want low deductibles and the most popular doctors, you need higher premiums to cover the cost of all the healthcare the plans will end up paying for. If you want lower premiums, you need plans that are stingier about what they will cover.

    The only ways to address all the major complaints about Obamacare — to deliver better insurance at a lower cost to the insured — would be to throw a lot more government subsidies at the program (increasing costs to taxpayers) or to find some way to greatly reduce the actual cost of healthcare.

    Cost control has mostly eluded policymakers for decades — and a successful effort to control costs would greatly upset the lobbies for hospitals and doctors, since the main way you make a unit of healthcare cheaper is by paying them less.

    Once Republicans have to take ownership of healthcare policies and make choices among their stated goals, they're bound to upset someone.

    Republicans have been intermittently pledging that their plans won't throw millions of people off of health insurance — but the math will not work on this pledge without spending an amount similar to what is spent under the ACA, unless the quality of the insurance offered is significantly reduced, for example by excluding coverage for important services like maternity care.

    And if Republicans make good on their rhetoric about the nature of health insurance — if they shift more people toward "catastrophic" plans that cover only very large medical bills and expect individuals to pay for their own healthcare through money they deposit in Health Savings Accounts — their replacement plan is likely to be even less popular than the ACA.

    Informative focus groups by the Kaiser Foundation, surveying Trump voters who are enrolled in Obamacare exchange plans, found many participants were jealous of the Medicaid coverage available to people with lower incomes.

    Medicaid plans — which have limited provider networks but impose very limited out-of-pocket costs on the insured — are roughly the opposite of the preferred Republican approach to insurance.

    obamacare enrollment florida

    Making small changes and declaring victory won't work

    Given how mad people tend to get when you change their healthcare, one option that might tempt Republicans is to make a few, mostly symbolic changes to the ACA, declare that they have "repealed and replaced" it, and call it a day.

    Certainly, this is the option a lot of liberals are hoping Republicans choose.

    But I don't think it would be likely to insulate Republicans politically, either.

    That's because, even if Republicans stopped demagoguing the ACA, the very real problems of high premiums, high deductibles, and limited networks would remain — and since the ACA would be gone, "repealed and replaced" by a nearly identical Republican alternative, Republicans would shoulder all the blame.

    Indeed, you could expect Democrats to start making many of the same complaints about the "new" Republican health law that Republicans have been making for the past eight years.

    Republicans are right to be wary about repeal-and-delay

    All these political problems are a major reason Republicans never coalesced around a substitute for Obamacare, and they are a major reason they have flirted with repeal-and-delay, an approach that would be designed to buy Republicans several more years without committing to a plan that creates specific winners and losers.

    The problem is, repeal-and-delay would be likely to wreak havoc in health-insurance markets.

    Many insurers have already been exiting Obamacare insurance exchanges in various markets because they are losing money. If they expect the program to soon be repealed — and starved of financial support in the meantime — they will be even more likely to quit selling insurance at all.

    Repeal-and-delay would especially cause problems if it included an immediate repeal of the individual mandate or if the Trump administration indicated it would not strictly enforce the unpopular mandate.

    Insurers already suffer because many healthy people are reluctant to buy insurance plans under Obamacare that they view as expensive and low-quality. Healthy people would be even less inclined to buy if they knew they wouldn't be penalized. And if they didn't buy insurance, insurers would lose even more money — and would have to raise premiums even higher.

    Plus, Republican governors of states that have expanded Medicaid are nervous about what uncertain changes to federal health policy could mean for their budgets, because hospitals depend heavily on Medicaid payments.

    paul ryan obamacare

    The only way to survive healthcare reform 2.0 is to get Democrats to share the credit and blame

    If I were Trump, I would try very hard to get Democrats in Congress to walk the plank with me on healthcare reforms that aim to reduce costs to both taxpayers and consumers.

    By withholding any Republican support for the ACA, Republicans ensured that Democrats took all the blame on healthcare for eight years. Democrats are surely eager to turn the tables — but they won't be able to if they're party to the next set of changes.

    Getting them on board would mean offering up a lot of policy concessions to the left, but Trump was never an ideologically committed conservative anyway.

    Trump's position on prescription drug prices is an obvious place to start. When Trump stressed his intention to negotiate drug prices down on Wednesday, saying pharmaceutical companies were "getting away with murder," pharma stocks tanked.

    But the largest chunk of healthcare expenditure does not go to pharmaceutical companies or insurers. It goes to providers of care like doctors, hospitals, and nursing homes, which charge much higher prices than they do in other countries.

    Trump could take his theatrical approach toward large companies into the health sector, waving around hospital bills and demanding to know where a hospital and an insurer get off charging the patient for an out-of-network anesthesiologist, when the hospital itself is in the insurance network.

    One possibility would be to move more exchange participants into Medicaid — using Medicaid's negotiating leverage to hold down payments to doctors and hospitals and allowing more Americans to enjoy low deductibles, even if that means having a limited choice of providers.

    We would see how much this would do about the actual problem of high costs, just as we will see how much stunts like the deal with Carrier do to change norms and get companies to create jobs in the US.

    Certainly, healthcare provision is a sector that is deserving of some Trump-y public shaming over cost. It's one where Democrats might be prepared to help him, even if it means sharing some of the credit and blame for what he does to healthcare.

    SEE ALSO: This AP story shows the problem with fact-checking

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    Obamacare Protest

    WASHINGTON (Reuters) - The largest U.S. business lobby group on Wednesday said it could be a mistake to quickly repeal Obamacare without developing a replacement healthcare insurance plan and urged the incoming Trump administration not to erect trade barriers.

    The U.S. Chamber of Commerce faces challenges with the next U.S. president and his team, including overcoming deep divisions on key issues like trade while trying to work together on common goals like repealing President Barack Obama's signature 2010 healthcare law.

    The group opposed that restructuring, which extended medical coverage to millions of Americans, as an unnecessary burden on business. The Republican-controlled Congress earlier this month began working to repeal it.

    "As a new healthcare plan takes shape, it's important to remember things were far from perfect before we started, before Obamacare," Chamber President Tom Donohue said in his annual address outlining the group's priorities.

    "Repeal alone is not going to fix our health care, there should be a smooth transition."

    At a news conference later in the day in New York, U.S. President-elect Donald Trump said he was going to submit a plan to Congress that would outline a replacement plan.

    "It'll be repeal and replace, it'll be essentially simultaneously," Trump said.

    The Chamber has historically been tightly aligned with Republicans, especially during the Obama administration when it fought against the healthcare law and criticized what it saw as heavy-handed regulation of the financial sector.

    But the lobby group, which says it represents more than 3 million businesses and professional organizations, has clashed with Trump over his positions on trade and immigration.

    Donald Trump

    Trump has threatened large taxes against companies that produce goods in other countries and import them into the United States - a move that would be counter to the U.S. Chamber's desire to allow for free trade across international boarders.

    Many in corporate America worry that if the Republican businessman-turned-politician begins to levy taxes against imported goods, nations like China will in turn impose large taxes and fees against U.S. goods that are exported there.

    "It's important that the new administration does not add to the burdens facing our exporters or the thousands whose jobs depend on exports by erecting barriers to trade," Donohue said.

    The Chamber will continue to press Trump on supporting the framework of the Trans-Pacific Partnership, the trade agreement that the incoming president frequently vowed to tear up once taking office, Donohue said.

    Donohue argued that the agreement, even if recreated under a different name, would bring "significant geopolitical and security benefits."

    "(Trump) knows the value of trade in terms of economic growth," he said.

    Work with administration

    Donohue also predicted that U.S. interest rates would rise this year, impacting the dollar and making it more difficult for American companies to compete in foreign markets.

    In trying to work with the administration on trade, Donohue said Trump's selection of people to work in his administration, including Wilbur Ross to lead the Commerce Department, is encouraging.

    "The two things I've been most impressed by with this new administration is the quality and the capability of people they’ve appointed," he said.

    On issues where the Chamber agrees with Trump, Donohue renewed calls to roll back regulations imposed by the 2010 Dodd-Frank Wall Street reform law and said he agreed with calls to change the Consumer Financial Protection Bureau, which has been opposed by Republicans who say it restricts lending.

    "If this organization is going to be kept - it ought to be kept - it ought to have three, five or various commissioners," Donohue said.

    (Reporting by Ginger Gibson; Editing by Paul Simao)

    SEE ALSO: The GOP is pumping the brakes on repealing Obamacare

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    Mitch McConnell

    The US Senate is about to undertake a long evening session of votes in the first step towards a repeal of the Affordable Care Act (ACA), better known as Obamacare.

    The Senate will vote on well over 100 amendments to a budgetary resolution in what is called a "vote-a-rama."

    The budget resolution and subsequent amendments being considered tonight, in essence, will direct the Senate and House to come up with a piece of legislation that would allow Senate Republicans to repeal any aspect of the ACA that relates to the federal budget.

    Republicans have chosen to use this route since a typical bill is subject to a filibuster, that can only be broken by a 60 person vote to end it. Republicans only hold 52 Senate seats. On the other hand, the budget process starting Wednesday needs only a simple majority of 51 senators to pass amendments that directly involve taxes and spending.

    So, the aspects of the health law that can be addressed by these votes include funding for subsidies that allow people in the law's exchanges to pay for their insurance, Medicaid expansion funding, and more.

    The "vote-a-rama" part comes in since any number of amendments can be attached to a budget resolution like the one being considered. Wednesday's amendments do not have any power of law, but they force a series of symbolic votes that will go well into the night.

    Thus, with some political posturing and parliamentary procedure, the wheels of Obamacare repeal will be set in motion.

    The ACA repeal has become one of the top priorities for the Republican-led government since the election of President-elect Donald Trump.

    Vice President-elect Mike Pence and President Barack Obama met with Congressional members of their respective parties last week to strategize.

    In recent days, it appears that the GOP has begun to fracture on their approach to repeal, with particular disagreements about the replacement of the ACA.

    Many GOP lawmakers have said that they do not want to cause a lapse in coverage for the over 20 million Americans that have gained insurance through Obamacare. In order to do this, GOP members have proposed waiting on a repeal until a full replacement health care law has been created.

    House Speaker Paul Ryan told reporters on Tuesday that he wants a repeal and replace to happen "concurrently," while other GOP members have also pushed for repeal and replace at the same time. However, if the original process of writing and passing the ACA is any indication, crafting a replacement law could take a while.

    Even Trump said in his press conference on Wednesday that he wants to go ahead with a repeal and replace as soon as his nominee for the Department of Health and Human Services Tom Price is confirmed.

    "We're going to be submitting, as soon as he is approved, we'll almost simultaneously — shortly thereafter — have a plan," said Trump. "It will be repeal and replace. It will be simultaneously."

    Price's confirmation hearing is scheduled for January 18.

    Democrats have pledged to fight the repeal, citing the positive aspects of the law including the expanded coverage and the inability for insurers to deny coverage based on pre-existing conditions (both of which are incredibly popular). In terms of the votes tonight, Democrats have little power to stop the budget votes but have been waging a press relations fight against the repeal.

    SEE ALSO: TRUMP: We are 'doing the Democrats a great service' by repealing and replacing Obamacare

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    Donald Trump and Barack Obama

    WASHINGTON — The US Senate on Thursday took a first concrete step toward dismantling Obamacare, voting to instruct key committees to draft legislation repealing President Barack Obama's signature health-insurance program.

    The vote was 51-48. The resolution now goes to the House of Representatives, which is expected to vote on it this week. Scrapping Obamacare is a top priority for the Republican majorities in both chambers and Republican President-elect Donald Trump.

    Republicans have said repealing Obamacare could take months, and developing a replacement plan could take longer. But they are under pressure from Trump to act fast; he said on Wednesday that the repeal and replacement should happen "essentially simultaneously."

    Some 20 million previously uninsured Americans gained health coverage through the Affordable Care Act, as Obamacare is officially called. Coverage was extended by expanding Medicaid and through online exchanges where consumers can receive income-based subsidies.

    Republicans have launched repeated legal and legislative efforts to unravel the law, criticizing it as government overreach. They say they want to replace it by giving states, not the federal government, more control.

    But in recent days some Republicans have expressed concern about the party's strategy of voting for a repeal without having a consensus replacement plan ready.

    House Speaker Paul Ryan said this week he wanted to pack as many replacement provisions as possible into the legislation repealing Obamacare. But fellow Republican Orrin Hatch, the Republican Senate Finance Committee chairman, said this could be difficult under Senate rules.

    The resolution approved Thursday instructs committees of the House and the Senate to draft repeal legislation by a target date of January 27. Both chambers will then need to approve the resulting legislation before any repeal goes into effect.

    Senate Republicans are using special budget procedures that allow them to repeal Obamacare by a simple majority; this way they don't need Democratic votes. Republicans have a majority of 52 votes in the 100-seat Senate; one Republican, Sen. Rand Paul, voted no on Thursday.

    Democrats mocked the Republican effort, saying Republicans had never united around an alternative to Obamacare. "They want to kill ACA, but they have no idea how they are going to bring forth a substitute proposal," Sen. Bernie Sanders of Vermont said.

    Trump said Wednesday he would submit a replacement plan as soon as his nominee to lead the Health and Human Services department, Rep. Tom Price, was approved by the Senate. But Trump gave no details.

    Democrats passed the Affordable Care Act in 2010 over united Republican opposition. Democrats say the act is insuring more Americans and helping to slow the growth in healthcare spending.

    But Republicans say the system is not working. The average Obamacare premium is set to rise 25% in 2017.

    (Reporting by Susan Cornwell; Editing by Nick Macfie)

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    FILE PHOTO - Supporters of contraception rally before Zubik v. Burwell, an appeal brought by Christian groups demanding full exemption from the requirement to provide insurance covering contraception under the Affordable Care Act, is heard by the U.S. Supreme Court in Washington, DC, U.S. on March 23, 2016. REUTERS/Joshua Roberts/File Photo

    (Reuters) - Growing numbers of U.S. states are seeking to ensure that women have continued access to free birth control in case the insurance benefit is dropped as part of President-elect Donald Trump's vow to repeal and replace the Affordable Care Act.

    The 2010 law, popularly called Obamacare, requires most health insurance plans to provide coverage for birth control without a patient co-payment, which can be as much as $50 per month for birth control pills or $1,000 for long-acting contraceptives such as intrauterine devices.

    California, Maryland, Vermont and Illinois since 2014 have enacted statutes codifying the Affordable Care Act's contraception mandate in state law and expanding on the federal law's requirements. Democratic lawmakers in New York, Minnesota, Colorado and Massachusetts said they are pursuing similar measures this year, with Obamacare under mortal threat in Washington.

    New York's Democratic attorney general, Eric Schneiderman, on Wednesday introduced such a measure in his state's legislature that would expand on the Obamacare contraception mandate.

    "Women across New York are very concerned that Republican efforts to repeal the ACA will mean the loss of the contraception on which they rely," Schneiderman said.

    "I won't hesitate to act to protect New Yorkers' rights - including the right to choose, and the right to birth control - no matter what a Trump administration does," Schneiderman added, referring to abortion rights.

    Trump, who succeeds Democratic President Barack Obama on Jan. 20, and his fellow Republicans in Congress have made dismantling Obamacare their "first order of business," as Vice President-elect Mike Pence put it on Jan. 4.

    Republicans in Congress have not presented a detailed proposal for repealing and replacing the law but many Republicans and religious conservatives have opposed the Obamacare contraception mandate.

    Twenty-eight of the 50 states currently have laws requiring private insurers to provide coverage for birth control. But not all the laws affect all insurance plans, and only a few mandate cost-free birth control.

    Out-of-pocket expenses 

    birth control

    The Obamacare contraception mandate has applied since 2012 to most new insurance plans including employer-provided coverage.

    In 2013, for example, the mandate saved U.S. women more than $1.4 billion in out-of-pocket expenses for birth control pills, according to a report by University of Pennsylvania researchers. Almost 6.9 million privately insured U.S. women used the pill that year.

    The legislative move by some states, most of them Democratic governed, is designed to clear up uncertainty for some of the 55 million women who now have access to free contraceptives and related treatments under the Affordable Care Act.

    Conservatives also have chipped away at the Obamacare mandate in court. The U.S. Supreme Court ruled in 2014 that forcing family-owned businesses to pay for employee insurance coverage for birth control ran afoul of another federal law safeguarding religious freedom.

    The Supreme Court last May sent another legal challenge by nonprofit Christian employers back to lower courts to reconsider the matter after tossing out their rulings favoring the Obama administration.

    "I think it is even more important now," said Colorado state Representative Susan Lontine, who last year co-sponsored a contraception coverage bill in her state's legislature that did not get passed but she expects to be resurrected in 2017. "We don't know what will happen on the federal level."

    California in 2014 became the first state to pass a contraception mandate that went further than the Obamacare language. Maryland, Vermont and Illinois last year passed laws that also eliminated co-pays for vasectomies and allowed women to fill a birth control prescription for at least six months rather than one to three.

    The New York legislation would allow women to fill multiple months of a birth control prescription, prohibit private insurers from "medical management" reviews that could limit or delay contraception coverage, and provide coverage for vasectomies without a co-pay.

    Within a matter of months, the Trump administration even without congressional action could drop contraception from Obamacare's list of preventive services that health insurance plans must cover without out-of-pocket costs, said Laurie Sobel, senior policy analyst at the nonprofit Kaiser Family Foundation.

    If repealed, some employers might choose to maintain the coverage without a co-pay because it is a relatively inexpensive benefit popular with employees.

    The proportion of privately insured women who paid nothing out of pocket for birth control pills increased from 15% in the fall of 2012 to 67% in the spring of 2014 during the time when the coverage went into wide effect, according to the Guttmacher Institute research organization.

    The no-cost contraceptives coverage also spurred women to switch to long-acting methods such as the IUD, which is offered in the United States by Bayer, Teva, Allergan and Medicines360, studies have found.

    More than 77% of women and 64% of men support the no-cost contraceptives coverage, according to a 2015 Washington Post/Kaiser Family Foundation survey.

     

    (Reporting by Jilian Mincer; Editing by Caroline Humer, Edward Tobin and Will Dunham)

    SEE ALSO: The Obamacare repeal has begun

    SEE ALSO: Planned Parenthood is gearing up for a fight

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    obama dark night frown

    Early Thursday morning, Senate Republicans kicked off what is expected to be a long, winding process of repealing the Affordable Care Act, the healthcare law better known as Obamacare.

    The Senate passed a budget resolution by a vote of 51 to 48 after 1 a.m. ET that is designed to direct the legislature to draft a bill that will repeal the ACA.

    Sens. Elizabeth Warren and Bernie Sanders were among those who spoke out against the repeal bill to no avail during the vote. Sen. Rand Paul, who has grumbled about the effect a repeal could have on the federal deficit without a replacement plan in place, was the only Republican to cross party lines.

    "Congrats to the Senate for taking the first step to #RepealObamacare - now it's onto the House!"President-elect Donald Trump tweeted on Thursday.

    Democrats added more than 100 amendments — with mostly symbolic intentions, as they do not have control of the chamber— to protect provisions such as insurers not being able to deny coverage based on preexisting conditions and the ability of children to stay on their parents' insurance until age 26. All of the amendments were voted down.

    The vote comes as Republicans and Democrats have made the ACA and its possible repeal one of the central parts of their agendas.

    With Trump in line to take the Oval Office in just more than a week, Republicans have been moving forward with a long-planned repeal while a debate has arisen among GOP lawmakers over the timing of the bill's replacement.

    Democrats have vowed to fight the repeal of the law at every step and so far have said they will be uncooperative on a replacement.

    The resolution next moves to the House of Representatives for a similar vote that is expected as soon as Friday.

    The process is a bit complicated, so let's break it down

    Obamacare Repeal Checklist_v01

    Republicans are using what is called budget reconciliation to repeal a large part of Obamacare.

    Budget reconciliation allows lawmakers to pass legislation that has an effect on the federal budget with only a simple majority. In this case, outlays for things in the ACA, such as Medicaid expansion and funding for exchanges on which people can sign up for insurance, fit the bill.

    Trying to pass a bill outside budget reconciliation would allow Democrats to filibuster any legislation. A filibuster can be quashed only with a cloture vote, which needs to be approved by 60 senators to pass. (The Senate includes only 52 Republicans.)

    So where does the resolution passed by the Senate on Thursday morning go next?

    House Republicans will convene over the next few days to take up the Senate's budget resolution. If it passes the Republican-controlled House, which is likely, the resolution will instruct committees in the House to begin drafting legislation for repeal.

    From there, the drafting will go much like any other bill: to a vote on it in the House (subject to simple majority) and then on to the Senate, where it can be amended. If it is amended, then it goes to conference committee.

    If the Senate adds amendments, the conference committee made up of both House and Senate members responsible for drafting the bill would come together and create a compromise bill. That bill would then go through votes in both bodies and, if passed, go to Trump's desk for approval or veto.

    Though the repeal is on the top of the legislative agenda, Trump is unlikely to put his pen into action on it anytime soon.

    GOP leaders' comments that they want to replace the bill at the same time they repeal it suggest that a seamless transition may take time. House Speaker Paul Ryan said replacement and repeal would happen "concurrently," and Trump has pledged it will be "simultaneously."

    SEE ALSO: The GOP is pumping the brakes on repealing Obamacare

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    Paul Ryan

    Should President-elect Donald Trump and congressional Republicans make good on their pledge to dismantle the Affordable Care Act, the repeal of a handful of tax increases on individuals and businesses and the elimination of a federal tax credit that subsidizes health insurance premiums likely would result in a massive windfall for wealthy households and a financial setback for low and moderate-income people, according to a new study.

    Indeed, the 400 highest income taxpayers in the country could receive millions of dollars in tax relief next year while middle and lower income Americans would come up empty or in the hole, according to the report by the liberal-leaning Center on Budget and Policy Priorities.

    Obamacare is financed by a combination of tax increases on individuals and businesses, Medicare tax increases and cost savings measures, among others. Those taxes – which have long been criticized by Republican lawmakers and special interest groups – potentially could be wiped away if the Republican-controlled Congress moves ahead with plans to repeal Obamacare in the coming month or two, without a clear replacement plan. 

    Barack Obama sad shutdown

    The study released on Thursday focused on two Obamacare taxes that target the wealthiest households in the country but have virtually no effect on middle and lower-income Americans. One is a 0.9 percent federal Hospital Insurance tax increase on individuals with incomes above $200,000 and couples with incomes above $250,000. The other is a 3.8 percent Medicare tax on “unearned income” that wealthy Americans derive from capital gains, dividends and royalties.

    The top 400 highest-income taxpayers -- with average annual incomes of more than $300 million each -- would receive an estimated average annual tax cut of $7 million as part of the repeal, according to the study of Internal Revenue Service data.That would result in a $2.8 billion a year loss in tax revenue to the Treasury.

    Roughly 160 million households with incomes below $200,000 would get nothing from the repeal of these two taxes, according to the report.

    Meanwhile, the repeal of Obamacare would effectively raise taxes on about seven million low-and-moderate income families that currently qualify for health insurance premium tax credits under the federal tax code. Those credits, which can be used to purchase private health insurance policies through government-run marketplaces, will be worth on average $4,800 this year.

    affordable care act supporters

    “The $2.8 billion a year total tax cut for the top 400 . . . is roughly the value of premium tax credits that 813,000 people in the 20 smallest states and Washington, D.C. would lose combined if the ACA is repealed without a replacement,” the study notes.

    Before the advent of the 2010 health reform law, Medicare taxes applied only to wage and salary and self-employment income, and not to unearned income from wealth, according to the study. That meant that low and moderate income families with little if any unearned income felt the brunt of the tax on practically all of their income, while the wealthiest taxpayers owed no Medicare taxes on their hefty dividends and capital gains -- which frequently accounted for a significant share of their total income.

    “Repealing the two ACA Medicare taxes, particularly the 3.8 percent tax on investment and other unearned income, delivers tax cuts that are extremely tilted to the top,” the report states. “In fact, the 0.4 percent of households with income of over $1million a year would reap 80 percent of the benefits of repealing these two provisions in 2017.

    Similarly, the Urban Institute last December published an analysis of the effects of Obamacare repeal suggesting that doing away with the law would be a de facto tax cut in and of itself, with the benefits disproportionately going to the wealthy and very wealthy.

    “Repealing the Affordable Care Act would cut taxes significantly for the highest income one percent of US households,” wrote Howard Gleckman of the Urban-Brookings Tax Policy Center in Washington. “At the same time, it would raise taxes on average for low- and moderate-income households.”

    Obamacare Protest

    The reports are speculative in part because there is no way of knowing at this point the fate of these tax increases which have been vital in operating the Obamacare program and providing subsidies to many of the 20 million people who take part in the program.

    As The Fiscal Times has reported, it is now dawning on GOP leaders that repealing the dozen or so major Obamacare tax increases along with the premium subsidies for low and middle-income Americans would seriously crimp their effort to devise and finance a substitute health insurance program down the road.

    Should President-elect Donald Trump and congressional Republicans make good on their pledge to dismantle the Affordable Care Act, the repeal of a handful of tax increases on individuals and businesses and the elimination of a federal tax credit that subsidizes health insurance premiums likely would result in a massive windfall for wealthy households and a financial setback for low and moderate-income people, according to a new study.

    Indeed, the 400 highest income taxpayers in the country could receive millions of dollars in tax relief next year while middle and lower income Americans would come up empty or in the hole, according to the report by the liberal-leaning Center on Budget and Policy Priorities.

    Obamacare is financed by a combination of tax increases on individuals and businesses, Medicare tax increases and cost savings measures, among others. Those taxes – which have long been criticized by Republican lawmakers and special interest groups – potentially could be wiped away if the Republican-controlled Congress moves ahead with plans to repeal Obamacare in the coming month or two, without a clear replacement plan. 

    A security camera hangs near a corner of the U.S. Internal Revenue Service (IRS) building in Washington May 27, 2015. REUTERS/Jonathan Ernst

    The study released on Thursday focused on two Obamacare taxes that target the wealthiest households in the country but have virtually no effect on middle and lower-income Americans. One is a 0.9 percent federal Hospital Insurance tax increase on individuals with incomes above $200,000 and couples with incomes above $250,000. The other is a 3.8 percent Medicare tax on “unearned income” that wealthy Americans derive from capital gains, dividends and royalties.

    The top 400 highest-income taxpayers -- with average annual incomes of more than $300 million each -- would receive an estimated average annual tax cut of $7 million as part of the repeal, according to the study of Internal Revenue Service data.That would result in a $2.8 billion a year loss in tax revenue to the Treasury.

    Roughly 160 million households with incomes below $200,000 would get nothing from the repeal of these two taxes, according to the report.

    Meanwhile, the repeal of Obamacare would effectively raise taxes on about seven million low-and-moderate income families that currently qualify for health insurance premium tax credits under the federal tax code. Those credits, which can be used to purchase private health insurance policies through government-run marketplaces, will be worth on average $4,800 this year.

    “The $2.8 billion a year total tax cut for the top 400 . . . is roughly the value of premium tax credits that 813,000 people in the 20 smallest states and Washington, D.C. would lose combined if the ACA is repealed without a replacement,” the study notes.

    paul ryan Obamacare repeal

    Before the advent of the 2010 health reform law, Medicare taxes applied only to wage and salary and self-employment income, and not to unearned income from wealth, according to the study. That meant that low and moderate income families with little if any unearned income felt the brunt of the tax on practically all of their income, while the wealthiest taxpayers owed no Medicare taxes on their hefty dividends and capital gains -- which frequently accounted for a significant share of their total income.

    “Repealing the two ACA Medicare taxes, particularly the 3.8 percent tax on investment and other unearned income, delivers tax cuts that are extremely tilted to the top,” the report states. “In fact, the 0.4 percent of households with income of over $1million a year would reap 80 percent of the benefits of repealing these two provisions in 2017.

    Similarly, the Urban Institute last December published an analysis of the effects of Obamacare repeal suggesting that doing away with the law would be a de facto tax cut in and of itself, with the benefits disproportionately going to the wealthy and very wealthy.

    “Repealing the Affordable Care Act would cut taxes significantly for the highest income one percent of US households,” wrote Howard Gleckman of the Urban-Brookings Tax Policy Center in Washington. “At the same time, it would raise taxes on average for low- and moderate-income households.”

    The reports are speculative in part because there is no way of knowing at this point the fate of these tax increases which have been vital in operating the Obamacare program and providing subsidies to many of the 20 million people who take part in the program.

    As The Fiscal Times has reported, it is now dawning on GOP leaders that repealing the dozen or so major Obamacare tax increases along with the premium subsidies for low and middle-income Americans would seriously crimp their effort to devise and finance a substitute health insurance program down the road.

    Join the conversation about this story »

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