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The latest news on Obamacare from Business Insider

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    jeff jeans obamacare paul ryan

    Jeff Jeans, a cancer survivor who owns a small business in Arizona, confronted House Speaker Paul Ryan during a CNN town-hall event on Thursday night over the future of the Affordable Care Act, the healthcare law better known as Obamacare.

    Jeans said he was a lifelong Republican who worked on the campaigns of Ronald Reagan and George H.W. Bush and that he disliked the ACA when it was passed.

    "Just like you, I was opposed to the Affordable Care Act," Jeans told Ryan. "When it was passed, I told my wife we would close our business before I complied with this law."

    But then he said the law saved his life. Soon after it passed, he said, he learned he had cancer and was given six weeks to live. He said he was able to get insurance, which allowed him to receive treatment, through the Affordable Care Act.

    "Thanks to the Affordable Care Act, I'm standing here today alive," Jeans said. "Being both a small-business person and someone with preexisting conditions, I rely on the Affordable Care Act to be able to purchase my own insurance. Why would you repeal the Affordable Care Act without a replacement?"

    As Ryan began his answer, saying the GOP planned to replace the law when repealing it, Jeans interrupted to add a message onto his question.

    "Can I say one thing?" Jeans said. "I want to thank President Obama from the bottom of my heart because I would be dead if it weren't for him."

    Ryan said Republicans planned to replace Obamacare with high-risk pools, which had been used by states before the ACA was passed, so that Jeans and others could continue to get coverage. Health-policy experts have been wary of this plan because of the low enrollment and prohibitively high costs in previous state-level pools.

    While Republicans have been pushing for the law to be repealed and replaced, Democrats and the Obama administration have been highlighting the positive effects of the law — using stories much like Jeans' to try to get the GOP to preserve some of the more popular provisions of the law.

    The first legislation that would advance a repeal of the ACA was passed by the Senate early Thursday morning and was scheduled to be voted on by the House on Friday.

    Watch the exchange below:

    SEE ALSO: The first blow to Obamacare

    Join the conversation about this story »

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    During a town hall on CNN, Speaker Paul Ryan defended his push to repeal the Affordable Care Act when confronted by a man who said that Obamacare saved his life when he was diagnosed with cancer. 

    Follow BI Video: On Twitter

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    Goats

    The debate over Obamacare's future is getting a little wild.

    During the debate over a budget resolution that would move forward the repeal of the Affordable Care Act (ACA), better known as Obamacare, Rep. Drew Ferguson of Georgia used a colorful metaphor for what the law has done to the country.

    He said the "need for this process" could be explained by a goat getting into his house.

    "A little over six years ago i lived in a pretty decent house,"Ferguson said."And one day I heard a knock on the door and before I knew it my colleagues form the other side of the aisle had let a goat loose in my house."

    This appeared to refer to the passage of the ACA, which took roughly two years from the time Obama took office. The bill was passed in 2010.

    "Now for six years, that goat has been messing and destroying my house," Ferguson continued.

    Republicans have been citing the increasing premiums and deductibles as a reason the ACA is not working, which could be interpreted as the goat messing up the house. On the other hand, Democrats have cited the more than 20 million people who have gained access to healthcare and the fact that total spending on healthcare in the US has been increasing at the slowest rate in 50 years.

    "I want to renovate my house, but before I can I have to get the goat out of the house before it does any more damage," Ferguson said. "It makes no sense to start fixing up my house until we get the goat out."

    Certain members of the GOP and Democrats are concerned that repealing the ACA before having a replacement would be disruptive to those that have insurance through the law or could increase the federal deficit. Ferguson is arguing that the ACA (the goat) has to be repealed (kicked out of the house) before the repairs (a replacement for the ACA) can begin.

    "Voting for the fiscal year '17 budget resolution gets this goat out of the house," Ferguson concluded. "Mr. Speaker, make no mistake we must renovate out house, we must undo the Affordable Care Act..."

    So there you have it: the House will vote to kick the goat out (or at least the first past of that process) later in the day.

    Check out the goat speech here:

     (h/t Dan Diamond)

    SEE ALSO: Man who says he 'would be dead' without Obamacare confronts Paul Ryan on the law's repeal

    Join the conversation about this story »

    NOW WATCH: These are Stratfor's chilling predictions for 2017


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    paul ryan smile

    The US House of Representatives on Friday struck the second blow against the Affordable Care Act, better known as Obamacare.

    The House passed a resolution Friday that directs committees in the Senate to draft legislation that would repeal the ACA.

    The resolution's passage followed a morning of spirited debate, including a colorful goat analogy from one Republican lawmaker. But both parties largely stuck to their talking points: Republicans highlighted increasing premiums and costs, while Democrats focused on expanded coverage to more than 20 million Americans.

    In the end, the resolution passed 227 to 198, with nine Republicans and no Democrats crossing party lines.

    "By taking this first step toward repealing Obamacare, we are closer to giving Americans relief from the problems this law has caused," House Speaker Paul Ryan said in a statement. "Too many families have seen costs soar, quality drop, and choices reduced to one — which just isn't a choice at all. This resolution gives us the tools we need for a step-by-step approach to fix these problems and put Americans back in control of their health care."

    There was a sliver of doubt about the resolution's passage when Sen. Rand Paul tried to bring together Republicans to reject the bill over concerns that repealing the law without a replacement would increase the federal deficit. Paul was the only Republican to vote against the resolution in the Senate.

    Despite Paul's attempted wrangling, the march toward the repeal of Obamacare continues.

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

    Obamacare Repeal Checklist_v02

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

    Budget reconciliation allows lawmakers to pass legislation that affects the federal budget with a simple majority. In this case, outlays for things in the ACA such as Medicaid expansion and funding for the 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 has 52 Republicans.)

    So where does the resolution passed by the House on Friday go next?

    Relevant committees will convene over the next few weeks to begin the process of drafting a repeal bill. The resolution has a provision that directs these committees to come up with a draft of the repeal bill by January 27.

    From there, the draft will act like any other bill — it'll go to a vote on it in the House, where it would need a simple majority to pass, and then to a vote the Senate, where it can be amended. If it is amended, then it goes to a 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 President-elect Donald Trump's desk for a signature or veto.

    Though the repeal is at 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. Ryan has said the law's replacement and repeal would happen "concurrently," and Trump has said it will happen "simultaneously."

    SEE ALSO: Man who says he 'would be dead' without Obamacare confronts Paul Ryan on the law's repeal

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    BI Graphics_The road to Trumpcare

    What's happening now

    Friday 5 p.m.: Congress has taken the first steps toward partial repeal of the Affordable Care Act (ACA), better known as Obamacare.

    Republicans in both the House of Representatives and the Senate passed a resolution that begins the process of repealing President Obama's signature healthcare law.

    The resolution directs members of relevant committees to draft a repeal bill through the budget-reconciliation process.

    With dissent among Republicans over whether or not to complete the repeal process before a replacement plan is finalized and strident Democratic resistance to any repeal of the ACA, it appears that there is a significant fight ahead over the future of American healthcare, which could lead the process down the long, winding road to Trumpcare.

    Road to Trumpcare

    BI Graphics_The road to Trumpcare_Martha car piece

    President-elect Donald Trump, along with Republican leaders in Congress, says he's committed to repealing and replacing Obamacare with something "terrific." Republicans have put forth a variety of different replacement plans, but it's unclear what the final version will look like. And the path to get to the implementation of a replacement could take many forms.

    Imagine it's like a board game where there are a number of ways to get to a replacement. One is fast and efficient, another winding and full of obstacles. We call it "The Road to Trumpcare," and we'll be updating the game as Congress and the new administration make their moves.

    The player in our game is a hypothetical Obamacare participant. We'll call her Martha. She's a 29-year-old from Tennessee and self-employed. Martha used the federal Healthcare.gov platform to sign up for her insurance two years ago and has been reenrolling every year; she receives some tax credits for her premiums since she makes roughly $45,000 a year.

    While an overwhelming majority of Americans get their health insurance from employers or a government-based program like Medicare or Medicaid, Martha is one of more than 11.5 million people who signed up for an exchange-based plan for 2017. Over 80% of these people, according to the Department of Health and Human Services, also receive subsidies for their coverage.

    Martha is a bit frustrated that there are fewer choices on the platform this year, and her premiums are increasing, but she is glad to have coverage because she has Crohn's disease, which could have excluded her from coverage before ACA.

    To get a better understanding of what a repeal-and-replace could mean to someone such as Martha, here are the four major scenarios for how lawmakers can address or not address the future of Obamacare.

    The Replacement Superhighway

    BI Graphics_The road to Trumpcare_Replacement superhighwayThe fastest and least disruptive path for Republicans to follow would be to repeal Obamacare and advance a replacement bill at the same time.

    The GOP could use a procedure called budget reconciliation in the Senate to strip away most of the provisions of Obamacare, specifically those that cost the government money, without the need for a single Democrat vote. Then, simultaneously, Republicans would need to go through typical lawmaking to pass a replacement bill and create some sort of new exchanges.

    House Speaker Ryan and Trump both seemed to favor this option. In fact, Ryan told CNN that some of the repeal and replace measures could be "in the same bill."

    According to Cynthia Cox, associate director for the Program for the Study of Health Reform and Private Insurance at the nonpartisan health think tank Kaiser Family Foundation, this would be the ideal option for patients in the event of a repeal.

    "This would provide both insurers and patients a clear picture of what's going to happen fairly quickly, which would prevent disruptions to the market," said Cox. "Though, a lot of this depends on the replacement bill that the Republicans come up with."

    What does this mean for Martha?

    This would likely be the least disruptive for Martha's coverage since it would ensure that there would be no period in which the exchanges that she uses are not funded or have no federal support. For one thing, as long as Martha reenrolls in her plan during the current Obamacare-enrollment period, she will have insurance through 2017.

    A quick replacement could be in place for the 2018 plan year, and depending on what the replacement is, Martha may not notice any effect on her coverage at all.

    What could go wrong?

    A lot of this hinges on the details of the Republicans' plan. Since Martha receives subsidies to help cover the costs of her plan, a number of the replacement proposals floated by the GOP could affect how much she receives. Additionally, a number of plans would institute high-risk pools, which are separate markets reserved just for people with preexisting conditions. These existed before the ACA and generally had astronomically high costs and limited utilization.

    The other issue is that any change to the law may be rejected by Democrats. If Republicans want to make any larger changes outside the budget process they would need Democrats on board. If the GOP advances a bill that changes coverage in some way or rolls back parts of the ACA that do not deal with the federal budget, Democrats may block a replacement using the filibuster. Additionally, if even a few Republicans in the Senate don't like the replacement, that could sidetrack the process. If the GOP moves ahead with the repeal while Democrats object to changes to the law, it could make the road that Martha is on even more winding.

    The long and winding road

    BI Graphics_The road to Trumpcare_Winding roadsOne of the first scenarios floated by Republicans was a partial repeal of the law under what is called budget reconciliation — delaying until a later date so that Republicans can craft a full replacement bill. This would pass a law that says the ACA will be repealed in the future, somewhere between two and four years, effectively delaying the end of the ACA.

    In theory, this allows GOP lawmakers to advance the political goal of repeal while giving enough time to develop a comprehensive plan for replacement. The exchanges set up by Obamacare could be intact, meaning that the more than 20 million people with ACA-based plans would still be covered, while Republicans devise a plan that would replace the ACA and keep these people covered, as numerous GOP lawmakers have promised.

    Since the delay aspect could stretch the replacement process out up to four years, this would allow the GOP time to build a consensus on a replacement. It would also be politically beneficial since it would push the repeal out past the 2018 midterms or 2020 presidential election.

    Republicans could avoid political fallout if the replacement plan falls short of expectations, and they could build a larger majority in the Senate to pass the bill without worrying about a filibuster.

    According to Cox, while the plan sounds good, there are a few problems that could arise with this strategy.

    "Depending on the parts of the law that are repealed through the reconciliation process, you could see destabilization in the individual insurance market," Cox told Business Insider.

    According to Cox, without an individual mandate for people to sign up for insurance, there would be significant numbers of younger people leaving the individual market, which would lead to a pool of even older and sicker people in the exchanges.

    In a worst-case scenario, this would lead to a breakdown of the individual insurance market. Businesses hate uncertainty, so it is likely that with the exchanges' futures in doubt, insurance companies would simply pull out completely. Healthy policyholders could see the writing on the wall and not renew their policies, leaving only the sickest patients in the marketplace causing, as Cox called it, "a real death spiral," repeating the turn of phrase used by Republicans to describe Obamacare's growing issues.

    Also, by leaving just the sickest Americans in these exchanges, premiums for those who remain behind would be much higher than the current increases.

    "If the individual mandate were to be repealed without countermeasures, it would cause very large increases in the cost of premiums," Cox said. "These increases would make what we've seen in the market so far look small."

    There are, of course, ways to mitigate this. For one, Republicans could extend and enhance certain measures, called reinsurance and risk corridors, which help to provide money for insurers that take on a higher percentage of sick patients. This would help decrease the large losses some insurers are reporting and possibly inspire more companies to offer plans on the exchanges.

    Many GOP lawmakers, however, have referred to these provisions as "bailouts," so that may be politically untenable.

    What does this mean for Martha?

    This plan takes her down our game's long and winding road, full of stops and starts and pitfalls along with way. As debates over the repeal continue, Martha could be stuck in a car she has no control over, stalled out and awaiting updates about her coverage. The process could take years.

    Republicans, through reconciliation, would have options to pull funding for the law in a few different ways while crafting a replacement. They could simply roll back the taxes associated with the law, they could also repeal the individual mandate that all people have to buy insurance, or they could pull all funding including subsidies people like Martha get or eliminate Medicaid expansion. All these would create a different level of disruption to the market.

    In the best-case scenario for Martha, the individual mandate is maintained to ensure stability of the individual market until some other plan is proposed. While Martha doesn't see her premiums or deductibles shrink, nothing goes too awry. Also, lawmakers provide enough assurances to insurers that they stay in the market, preventing a monopoly-like situation in Martha's market and higher costs.

    In the worst-case scenario, these four factors go the opposite way. Insurers, facing the uncertainty of the next two to four years, decide to exit the markets leaving Martha with just one or even no choices for coverage. With only a small penalty, people healthier than Martha leave the exchanges, which leads to an even sicker group of people being covered by the exchanges and higher prices for Martha. The "death spiral" predicted by GOP lawmakers for Obamacare truly does set in and prices shoot to astronomical levels, well above projections made before the passing of the law. Concerned that allowing a lapse in her coverage could cause her to be denied coverage in a replacement because of her preexisting condition, Martha sticks with the ever more expensive coverage

    The leave-as-is loop

    BI Graphics_The road to Trumpcare_Leave as is loopA third option for ACA changes would be to simply pass a few bills that make minor but needed adjustments to the law without a full-on repeal.

    Democrats may be more amenable to this option. They have long pushed for reforms to the ACA, recognizing the increasing premium costs. Some ideas floated by Democrats have been to expand premium subsidies, strengthen the penalty for not enrolling, and provide more assistance to insurers that take on a larger number of sick patients.

    This would leave a majority of the framework of the law — Medicaid expansion, the exchanges, and the statutory aspect — while providing tweaks to encourage younger, healthier people to sign up and balance the market.

    Politically this may be tough for Republicans since they've made ACA repeal a talking point in elections for the better part of a decade, but if there were enough face-saving concession it could placate this worry.

    What does this mean for Martha?

    Essentially, Martha would see few changes in her healthcare. The exchanges would still be intact and all the provisions protecting her care would also be in place. There may be some positive changes, new provisions could bring down various costs, or another insurer may be available in her area, but not much else.

    The repeal-without-replacement cliff

    BI Graphics_The road to Trumpcare_Repeal without replacement cliffA final, though perhaps least likely option, would be for Republicans to simply repeal the bill and not worry about replacement.

    After running against the bill for so long, the GOP could just repeal it and label it a disaster, making small changes along the way but not introducing a full-scale replacement.

    This seems the least likely of the options, however, since Republicans have repeatedly said that they want to ensure continuing coverage and uphold the popular parts of Obamacare. Also, the political blowback from those losing coverage would be significant.

    What does this mean for Martha?

    Martha would likely lose any type of coverage come 2018 and be back to the pre-ACA world. She could try to access health insurance through the individual health insurance market, but with a preexisting condition there is no guarantee she could get access to coverage.

    She could hope that her state implements a high-risk pool, where higher risk patients can get catastrophic insurance that covers the worst-case scenarios, but these plans are incredibly expensive and few people chose to access the pools when they did exist pre-ACA.

    This, in many ways, would be the worst-case scenario for Martha.

    Democratic response

    In terms of direct action, there are few choices for Democrats to block moves on the law made by Republicans.

    Obviously, unless there is a change to the rules, Senate Democrats could filibuster any statutory changes to the ACA. Outside of that, it appears that they simply have to influence the Republican agenda.

    Perhaps most potent for Democrats would be to use Republicans' repeal against them. Some of the highest rates of utilization for ACA plans come from heavily Republican areas, and waging a public-relations campaign to get the conservative base to push back on any changes to the bill, the Democrats may have a way to get at least some of what they want.

    Politico reported that many Democrats, while vehemently opposing a repeal of the ACA, would be willing to work with Republicans to find some way to keep various part of the law in a replacement bill.

    "If it makes sense, I think there'll be a lot of Democrats who would be for it," Democratic Sen. Claire McCaskill told Politico.

    Whether Democrats go along with a replacement may come down to the amount of influence they can exert over the law.

    An uncertain future

    For now Martha, in our game, is hurtling down the road in her car. She doesn't like the increasing costs but wants to keep her coverage.

    What turns The Road to Trumpcare takes are, for now, unknown, but more than 20 million real Americans are waiting anxiously to find out.

    SEE ALSO: The House just took another major step toward repealing Obamacare

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    tom price hhs secretary

    Rep. Tom Price, President-elect Donald Trump's nominee for secretary of the Department of Health and Human Services, is facing ethics questions over investments he made in medical companies while serving in Congress.

    Citing House records, CNN revealed on Monday that Price last year bought $1,001 to $15,000 in Zimmer Biomet, a leading provider of knee and hip implants.

    A week after the purchase, Price introduced a bill called the HIP Act, which would have delayed a new regulation expected to be damaging to Zimmer Biomet's business.

    Additionally, Zimmer Biomet's political action committee made donations of $1,000 to Price's reelection campaign both before and after the introduction of the bill, according to CNN's report.

    A representative for Price told CNN after the report came out that the investment, campaign contributions, and bill's introduction had nothing to do with one another. Trump transition team spokesman Phil Blando later said the shares were bought through a broker without Price's knowledge.

    "Any effort to connect the introduction of bipartisan legislation by Dr. Price to any campaign contribution is demonstrably false," Blando said Monday in a statement.

    Democratic Senate Minority Leader Chuck Schumer has called for an ethics investigation into Price for a possible violation of the Stock Act, which limits the investments and trading activities of members of Congress.

    "This isn't just a couple of questionable trades, but rather a pattern of Rep Price trading stock & using his office to benefit" those companies, Schumer tweeted on Monday night along with the CNN report, adding that the Office of Congressional Ethics "needs to conduct an immediate, thorough investigation into Rep. Price's potential violations of the STOCK Act before nom moves forward."

    Price goes before the Senate for his confirmation hearing for the health and human services post on Wednesday. Price's office has said his investments followed ethical guidelines and he will divest himself of all his stock holdings within 90 days of a confirmation by the Senate.

    Other trades

    The news came a few days after a report from Kaiser Health News and The Daily Beast reported that Price received a "sweetheart" stock deal from an Australian biotech firm, Innate Immunotherapeutics. Innate was clear in its business plan that it was seeking to influence key US officials to get approval for a new multiple sclerosis drug, according to the report.

    Price, along with Rep. Chris Collins of New York and other US investors, received a 12% discount on the shares. These sorts of discounts, however, are typical in private-placement investment such as the one in which Price took part.

    Price's office also said the Innate investment complied with all ethics guidelines for congressional members.

    The Wall Street Journal also looked at Price's history of ownership in healthcare stocks in December. According to the Journal report, Price traded about $300,000 worth of healthcare-related stocks over the past four years while introducing or cosponsoring a large number of healthcare-related bills.

    Price is also the head of the House Budget Committee and sits on the Ways and Means Committee, which is influential in crafting healthcare-related legislation.

    Price, an orthopedic surgeon, has been picked by Trump to help shepherd the repeal and replacement of the Affordable Care Act, the healthcare law better known as Obamacare. The president-elect said last week at his press conference that the replacement bill would be developed as soon as the Senate confirmed Price.

    Price has long been critical of the ACA, while in Congress he introduced a bill— the Empowering Patients First Act — that would have repealed and replaced the law.

    SEE ALSO: Here's what could happen if Obamacare is repealed

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    paul ryan

    The Congressional Budget Office, the nonpartisan office within the legislature that provides research on the impact of possible policies, said in a report released Tuesday that a partial repeal of the Affordable Care Act, better known as Obamacare, would have huge effects on the US healthcare system.

    According to the report, the partial repeal proposed by Republicans would lead to a huge increase in the number of uninsured Americans and skyrocketing premiums for those in the individual insurance market.

    The report expands on an analysis done last year by the CBO that analyzed the effects of a GOP-led repeal of various provisions of the ACA. Republicans have proposed rolling back the individual mandate, Medicaid expansion, and subsidies for people purchasing insurance in the individual marketplace.

    The CBO analysis also accounts for a repeal that would, as Republicans have promised, leave intact provisions such as children's ability to stay on their parents' insurance until age 26 and insurers' inability to deny coverage based on a preexisting condition.

    The CBO projections are based on the 2015 ACA repeal bill that was vetoed by President Barack Obama. A new repeal bill is currently being drafted and could have some differences, though the GOP's message on its goals has been roughly the same. Additionally, congressional Republicans and President-elect Donald Trump have promised to quickly create a replacement for the healthcare law, and these projections do not take into account the possible effects of such a bill.

    In terms of coverage, the CBO projects that the increase in the number of uninsured people would be dramatic after a partial repeal.

    "The number of people who are uninsured would increase by 18 million in the first new plan year following enactment of the bill," the report said. "Later, after the elimination of the ACA's expansion of Medicaid eligibility and of subsidies for insurance purchased through the ACA marketplaces, that number would increase to 27 million, and then to 32 million in 2026."

    Republicans have said they don't want to end up with fewer people with health insurance, and Republican lawmakers have said they don't want to be "pulling the rug out" from the more than 20 million people who have gained access to insurance through the ACA.

    In addition to the effects on insurance coverage from a repeal, the CBO report estimates that premiums would be 20-25% more than they would be if the ACA were kept in place over the next year; if the ACA were fully repealed, premiums would increase by 50%. One of the main complaints from Republicans about Obamacare is the increase in premiums for 2017.

    From the report (emphasis ours):

    "The majority of that increase would stem from repealing the penalties associated with the individual mandate. Doing so would both reduce the number of people purchasing health insurance and change the mix of people with insurance — tending to cause smaller reductions in coverage among older and less healthy people with high health care costs and larger reductions among younger and healthier people with low health care costs. Thus, average healthcare costs among the people retaining coverage would be higher, and insurers would have to raise premiums in the non-group market to cover those higher costs."

    The CBO also projects that a partial repeal that keeps the popular provisions of the ACA would lead insurers to rapidly ditch the individual marketplace.

    "After weighing the evidence from prior state-level reforms and input from experts and market participants, CBO and [the Joint Committee on Taxation] estimate that about half of the nation's population lives in areas that would have no insurer participating in the non-group market in the first year after the repeal of the marketplace subsidies took effect, and that share would continue to increase, extending to about three-quarters of the population by 2026,"the report said.

    Essentially, this would create what Republicans have called the "death spiral." With no incentive from the individual mandate for younger and healthier Americans to stay in the insurance marketplace, the pool of people covered would become dominated by sicker people who need the coverage.

    The increasing cost of covering these people would cause more and more insurers to ditch the individual marketplace, leaving fewer choices and even higher prices.

    So far, enrollment in the individual marketplaces has increased every year since the law took effect, and the number of sign-ups recently set a record. So while the individual marketplace has faced problems, health officials have pushed back on the idea of a "death spiral" in terms of coverage.

    While the concerns raised by the CBO may be addressed by a replacement plan through block subsidies and other proposals, the possibility of a repeal without a plan to replace would be a disaster for the individual marketplace, based on the CBO report.

    Politicians on both sides of the aisle were quick to jump on the report. Democratic lawmakers used it to show that a repeal is dangerous, while Republicans dismissed the findings.

    AshLee Strong, a spokesperson for House Speaker Paul Ryan, responded to the report in a statement: "This projection is meaningless, as it takes into account no measures to replace the law nor actions that the incoming administration will take to revitalize the individual market that has been decimated by Obamacare."

    House Majority Whip Rep. Steve Scalise tweeted that the CBO report "assumes no Obamacare replacement" and that the replacement would "provide people with coverage that they want and can actually use."

    On the other hand, Senate Minority Leader Chuck Schumer tweeted that the report showed the dangers of repealing the law.

    "CBO report says premiums will skyrocket under GOP's plan,"Schumer said. "Why are they raising costs and taking us from #CaretoChaos? #MakeAmericaSickAgain."

    House Minority Leader Nancy Pelosi also said in a statement that the CBO report showed that the ACA repeal "will be nothing less than a nightmare for the American people."

    "Republicans need to wake up to the brutal impact that repealing the ACA will have on the lives of their constituents,"Pelosi said. "Behind each of these statistics are stories of millions of Americans whose lives hang in the balance."

    Democratic Sen. Ron Wyden of Oregon tweeted that the report showed that the GOP's repeal "means higher healthcare costs and less coverage."

    Read the full CBO report »

    SEE ALSO: This is what could happen if Obamacare is repealed

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    barack obama smile

    The Affordable Care Act, the healthcare law better known as Obamacare, has never been more popular, according to a new poll.

    According to the NBC News/Wall Street Journal poll, for the first time more Americans think the ACA was a good idea than a bad one. Forty-five percent of Americans surveyed said that the law was a good idea, while 41% said it was a bad one.

    This is the highest percentage of respondents saying it was a good idea since NBC News and The Wall Street Journal started asking the question in 2009.

    Additionally, 50% of people in the survey said the ACA was working well or needed only minor improvements. Forty-nine percent said it needed major changes or should be done away with altogether, according to the report.

    With the possible repeal of the law nearing, Americans also do not have much faith in Republicans' promise to replace the law with something better.

    Just 26% of people surveyed had a "great deal" or "quite a bit of confidence" that the GOP's replacement would be better than the current law.

    The survey comes as congressional Republicans have begun repealing the ACA by passing a budget resolution that directs the legislature to draft a repeal bill.

    Additionally, a report from the nonpartisan Congressional Budget Office on Tuesday projected that a repeal with no replacement could lead to 18 million more people becoming uninsured in the first year after repeal and an increase in premiums of 20% to 25% over current projections.

    The survey was conducted with 1,000 Americans from Thursday to Sunday, according to NBC News.

    SEE ALSO: The GOP's Obamacare repeal could leave 27 million people without health insurance and cause premiums to skyrocket

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    tom price

    Rep. Tom Price of Georgia is headed to Capitol Hill to face the Senate Health, Education, Labor and Pensions Committee on Wednesday in the first day of his confirmation hearing.

    A former orthopedic surgeon, Price has an impressive record in the healthcare field.

    He is also a vocal critic of the Affordable Care Act, the healthcare law better known as Obamacare, and his appointment perhaps signals Trump's seriousness in intending to dismantle the law.

    "The Trump administration's mantra has been that the ACA is a disaster and the only way to fix it is to repeal and replace it, and this appointment seems to confirm that idea,"Timothy Jost, a law professor and health-policy expert at Washington and Lee University who supports the ACA, told Business Insider.

    Price has been at the forefront of congressional fights to repeal and replace President Barack Obama's signature legislation.

    While Trump's own details on how to replace the law have been spotty, Price has written legislation called the Empowering Patients First Act, which would repeal most of the sections of Obamacare and shift toward what Republicans call a "market-based" approach.

    How it would work

    Price's plan would significantly restructure the benefits given to Americans without health insurance through their employer or the government. Price's plan structures tax credits based on age brackets — $1,200 for people ages 18 to 35 and up to $3,000 for those 50 and older. This is different from the ACA, which bases its tax credits on the income of the patient.

    Another key aspect of Obamacare — one Trump has said he would consider keeping — that prevents insurers from denying coverage based on a preexisting condition, would change. Under Price's proposal, people would be able to continue coverage if they shifted from the employer market to the individual market, but only if they have no interruptions in coverage. Thus, a break in care would allow insurers to deny coverage to people with an illness.

    For those who do not maintain that care, Price's plan would institute state-level high-risk pools to help cover them. The Price plan would provide $1 billion in federal funding to help control costs for these pools. The Commonwealth Fund, however, a nonpartisan health-policy think thank, estimates that these pools would require well over $170 billion a year in federal funding to cover those who today have ACA-based plans.

    Additionally, such high-risk pools typically have premium costs double those of normal individual-market plans.

    The expansion of Medicaid under Obamacare would also be rolled back under Price's plan, shifting roughly 15 million people from the government-sponsored insurance to the individual marketplace. The expansion provided coverage for those making roughly $16,490 and below annually. Questions loom over, even with a subsidy, how affordable it will be for those people to obtain plans on the individual market.

    In total, Price's proposal bears much of the same hallmarks of plans from Republican other congressional leaders, such as House Speaker Paul Ryan, who called Price the "absolute perfect choice" for the position in Trump's Cabinet.

    "We could not ask for a better partner to work with Congress to fix our nation's healthcare challenges," Ryan said in a statement.

    barack obama sad frown

    'Asking the fox to guard the hen house'

    The appointment of Price has drawn criticism from Democrats and advocates of the Affordable Care Act. Sen. Chuck Schumer of New York, the Senate minority leader, said Price's healthcare proposals were "far out of the mainstream of what Americans want."

    "Nominating Congressman Price to be the HHS secretary is akin to asking the fox to guard the hen house," Schumer's statement said.

    Jost said Price's proposals would, incidentally, end up hurting many of the people who elected Trump to the White House.

    Price's plan "shows where we're heading," Jost told Business Insider. "It will help wealthier people and does nothing to help the working-class people who actually voted for Trump."

    Critics point to potential rollbacks of provisions in the ACA that compel insurance companies to provide certain types of care, meaning insurance companies could exclude comprehensive coverage needed by sick people. For older individuals, Price's plan would take away the provision linking what insurers can charge young people compared with seniors, providing the potential for insurers to increase rates for older people with chronic-care needs.

    Even the majority of Americans who get their insurance through their employer, Jost said, might see their costs increase under a Price-type plan. Those with insurance through their workplace currently do not pay federal taxes on premiums and other health-related payments — such as health savings accounts and health reimbursement arrangements — paid to these plans.

    Price's plan would cap the amount of healthcare spending that is non-taxable at $20,000 for a family and $8,000 for an individual. While such a provision could hurt affordability for those with employer-based insurance, according to the Tax Policy Center, the exemption cost the federal government $250 billion in lost taxes in 2015.

    Jost also suggested many of the provisions in Price's plan — such as state-level tribunals for malpractice cases and limitations on what patients may use in cases as evidence against a doctor — are designed to guard physicians from patients.

    "The bill should probably be called 'Empowering Doctors First,'" Jost told Business Insider. "He's a doctor, and it's clear he is trying to shield doctors."

    SEE ALSO: CBO: The GOP's Obamacare repeal could leave 27 million people without health insurance and cause premiums to skyrocket

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    The "Thanks, Obama" joke has been a part of pop culture for a few years now. Here's its origin story.

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    donald trump repeal obamacare late night with seth meyers nbc

    One of the first major campaign promises President-elect Donald Trump says he'd like to fulfill is the repeal of the Affordable Care Act, a.k.a. Obamacare, so Seth Meyers dedicated Tuesday's "A Closer Look" segment to the topic.

    Meyers started the segment by replaying clips from Trump's campaign in which he repeatedly said that he intends to "win on health care," which the "Late Night" host found vague.

    "What does 'win on health care' even mean?" Meyers said. "The only time I ever consider myself winning on health care is when the nurse calls me in before anyone else in the waiting room."

    Trump hasn't been very open about what his Obamacare replacement would be. Meyers pointed to a recent interview in which Trump would only say that his plan was in the "final strokes" and would be for "everyone."

    "Trump talks about policy like he’s trying to get off the phone with someone," Meyers joked. "'Yeah, no, health care, it’s going to be great. For who? Um, everybody. Look, I’m going to let you go. Goodbye.'"

    Despite the ambiguity of the health care plan and the reported 23 million people who will be affected by the Obamacare repeal, Republicans are moving forward on it. And although Obamacare opponents say the plan is flawed, Meyers played a clip from a recent town hall by Speaker of the House Paul Ryan. During it, a man who claimed to be a lifelong Republican and worked for the Reagan and Bush campaigns said that he owed his life to the coverage Obamacare gave him.

    "Republicans want to forget that the whole reason we have Obamacare in the first place is because health care sucked before," Meyers said. "Sure, Obamacare isn't perfect, but it's better. Obamacare is like a fireman who carried you from a burning building. But on the way out, he banged your head on the door frame. Sure, you have a headache now, but at least you're not on f---ing fire."

    Watch the video below:

     

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    paul ryan

    With the political climate thoroughly poisoned by the election, and Trump, Ryan and Senate Majority Leader Mitch McConnell (R-KY) holding the whip hand in dictating the direction Congress will go, the prospects of any meaningful compromise on health care seems far-fetched.

    Yet even if the Republicans succeed in ramming through a budget resolution later this month or in early February to repeal Obamacare at some future date, Republicans will need eight or more Senate Democrats to adopt a replacement plan under Senate rules.

    One idea that is gaining some attention is the Solomon-like proposal of freshman Sen. Bill Cassidy (R-LA) to create an unusual hybrid approach. Cassidy’s approach would essentially shift major decision-making authority away from the federal government and allow the states to decide whether to stick with some version of Obamacare or opt for whatever Trump and the Republicans come up with.

    bill cassidy

    Cassidy, one of a half-dozen moderate Senate Republicans who has voiced concern about their party’s increasingly perilous course on health care, first introduced “The World’s Greatest Healthcare Plan” bill a year ago in concert with Rep. Pete Sessions (R-TX). It began as a bid to give patients “market-based solutions” by lowering costs, eviscerating Obamacare mandates on individuals and businesses, and returning power over insurance to the states.

    But over time, the Cassidy-Sessions approach has evolved into a potential starting point for the two parties to negotiate a compromise that would somehow preserve many of the features strongly favored by Democrats and blue states while allowing the Republican majority and its allies among red states to chart a new course in national health care.

    “I believe that Republicans and Democrats can find common ground,” Cassidy said in a floor speech earlier this month. “My replacement plan would give states the option.”

    “I am willing to concede that some folks—the Minority Leader—believe that Obamacare is working just fine,” he said. “In my plan, we repeal Obamacare on a federal level, but if states like California or New York think that Obamacare works for them, then god bless them.”

    Donald Trump

    Under Cassidy’s approach, state legislatures in Sacramento, Albany and the rest of the country could decide to take federal funding to maintain an Obamacare-style system in their own states or opt for the GOP alternative.

    The legislation would repeal the federal mandates that require individuals to purchase health insurance and that require employers to provide coverage under the threat of penalties. Every American would receive a refundable tax credit that could be spent on health insurance premiums or deposited into a Health Savings Account and used to pay directly for health care services. They would also qualify for catastrophic major medical coverage and prescription drugs.

    “Under my replacement plan, we would also cover more Americans than Obamacare by giving states the option of enrolling the uninsured in a basic health plan unless they choose to opt out,” Cassidy explained. “This will likely lead to 95 percent enrollment or more.”

    Barack Obama

    The plan calls for a two-year transition period that would give states through 2018 to decide what approach to take. By 2019, the GOP repeal and replace plan would take effect, although states that chose to stick with Obamacare could subsequently opt out.

    Joseph Antos, a health care expert with the conservative-leaning American Enterprise Institute, said on Tuesday that the Cassidy-Sessions approach might offer the seeds of a compromise.

    “It’s a hybrid approach, and like all hybrid approaches it could be the basis for conversation,” he said. “I think that there would be substantial changes to it, but it does point in a useful direction for Republicans.

    “You have to recognize that many aspects of the ACA have changed the individual insurance market in a fundamental way, and some of those things you’re just not going to be rolling back.”

    Jumaane Cook (bottom R), age 5, of Cleveland, Ohio stands with his father James Cook (obscured, holding sign at R) as they join Obamacare supporters demonstrating at the Supreme Court building in Washington March 4, 2015. REUTERS/Jonathan Ernst

    Ezra Klein, writing today in Vox, recalled that in 2006, Price and Tammy Baldwin, then a liberal Democratic House member and now a senator from Wisconsin, co-sponsored a bill to allow states to make more creative use of federal funds in providing health care to their residents.

    The bill asked that states submit health reform plans that would likely lead to “increased health coverage and access.” If a special bipartisan commission approved of a state’s proposed new approach to health care coverage, it would be submitted to Congress for final approval.

    The Price-Baldwin bill, which drew a strong endorsement from the conservative Heritage Foundation, would provide states with a combination of repurposed existing federal money and new federal grants.

    “Here, then, is what the Trump Administration could do to replace Obamacare with something better without falling flat on their face,” Klein wrote in praising an approach similar in some ways to Cassidy’s bill. “Tell the states to do it, instead.”

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    barack obama

    President Obama wrote a final note on Thursday to the American public expressing his gratitude for "the honor" of serving as the nation's 44th president. 

    "It’s a long-standing tradition for the sitting president of the United States to leave a parting letter in the Oval Office for the American elected to take his or her place," the letter said. "But before I leave my note for our 45th president, I wanted to say one final thank you for the honor of serving as your 44th."

    Obama continued to thank the American public for its "goodness, resilience, and hope," and said that "[a]ll that I’ve learned in my time in office, I’ve learned from you. You made me a better President, and you made me a better man."

    He went on to talk about his experiences dealing with tragedy and difficult economic times.

    "I’ve seen neighbors and communities take care of each other during the worst economic crisis of our lifetimes. I have mourned with grieving families searching for answers – and found grace in a Charleston church," Obama wrote.

    He also took time to thank the military and scientific communities for their dedicated service to the country and their fellow citizens. He additionally pointed out a few key aspects of his legacy, writing, "I’ve seen Americans whose lives have been saved because they finally have access to medical care, and families whose lives have been changed because their marriages are recognized as equal to our own."

    He continued: "I’ve seen the youngest of children remind us through their actions and through their generosity of our obligations to care for refugees, or work for peace, and, above all, to look out for each other."

    Obama ended the letter on a note he's frequently struck in the final days of his presidency: urging the American public to participate in civic life. "All of us, regardless of party, should throw ourselves into that work – the joyous work of citizenship," he wrote, and added that he will "be right there with you every step of the way."

    "America is not the project of any one person. The single most powerful word in our democracy is the word ‘We.’ ‘We the People.’ ‘We shall overcome,'" the letter said.

    It ended with the slogan that kicked off Obama's 2008 presidential campaign: "Yes, we can."

    Read the full text of the letter below

     

    SEE ALSO: Trump's approval rating is the lowest of any incoming president in nearly 25 years

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    barack obama joe biden chuck schumer nancy pelosi obamacare pin

    House Democrats attending the inauguration of Donald Trump are wearing blue pins emblazoned with the American flag and the phrase "Protect Our Care" to protest the repeal of the Affordable Care Act (ACA), better known as Obamacare.

    House Democratic Leader Nancy Pelosi wore the pin while walking onto the inauguration podium and other members are wearing them as well.

    Last week, Republicans advanced a resolution that would repeal substantial parts of the ACA. A bill to formally repeal the law via budget reconciliation is expected from Republicans on January 27.

    Republicans have long promised to repeal the law, saying that it has increased costs for Americans and not delivered on its promises. Democrats on the other hand have pointed to the fact that more than 20 million Americans have gained health coverage through the ACA's provisions such as the ban on insurers denying people insurance due to a pre-existing condition.

    Republicans have promised to keep some of the more popular parts of the ACA — such as the aforementioned pre-existing conditions provision — with a replacement plan. So far there have been a number of ideas advanced by Republicans but no single, concrete plan has been advanced.

    Here are the pins via Yahoo's Olivier Knox:

     

    SEE ALSO: This is what could happen if Obamacare is repealed

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    Donald Trump Paul Ryan Mike Pence

    WASHINGTON (Reuters) - President Donald Trump signed his first executive order on Friday, heading into the Oval Office shortly after his inaugural parade to direct agencies to ease regulations associated with Obamacare, the signature healthcare law of his predecessor that Trump has vowed to replace.

    The White House also directed an immediate regulatory freeze for all government agencies in a memo from Trump's chief of staff, Reince Priebus, White House spokesman Sean Spicer said.

    The White House did not immediately provide details about what the executive order or memo entailed.

    Repealing and replacing the Affordable Care Act was a central pledge for Trump during the presidential election campaign, although Republicans in the U.S. Congress have not yet laid out a plan to replace the insurance program.

    In a hastily arranged signing ceremony, with some of his top aides around him, Trump sat behind the presidential Resolute Desk, signing the order. He also signed commissions for his newly confirmed Defense Secretary James Mattis and his Homeland Security Secretary John Kelly.

    Trump spoke briefly about his day with reporters. "It was busy, but good. It was a beautiful day," Trump said.

    Vice President Mike Pence then swore in Mattis and Kelly in a separate ceremony.

    There were other signs of change in the Oval Office, which former President Barack Obama vacated on Friday morning. Golden drapes hung where crimson ones had earlier in the day, and new furniture dotted the room.

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    Donald Trump

    Anybody who watched more than a handful of Donald Trump’s appearances on the campaign trail got used to hearing the man who today will become the 45th president promise to do any number of things on “day one” of his term in the Oval Office.

    Now it’s time for him to deliver.

    But first, the weekend.

    Asked about his plans for the first day of his term, Trump said in an interview with The Times of London and Germany’s Bildnewspaper earlier this week that he’ll be taking a couple of days off before getting down to the serious work of running the country.

    “Day one -- which I will consider to be Monday as opposed to Friday or Saturday, right? I mean, my day one is going to be Monday because I don't want to be signing and get it mixed up with lots of celebration,” he said.

    But regardless of when he actually gets going, Trump is facing quite the to-do list, and at a luncheon for supporters Thursday, the incoming president seemed to acknowledge that he would have to take some sort of significant action today, if only as a nod to his repeated promises to hit the ground running.

    “We will be signing some papers that will be very meaningful tomorrow right after the speech to get the show going,” Trump told the crowd of donors and senior Republican lawmakers.

    Trump was not specific about what he would do today, and his incoming press secretary, Sean Spicer, was equally vague, telling reporters that the president-elect was still “working through” his options.

    While it’s anybody’s guess what Trump will actually do after he’s sworn in at noon today, here are some of the things he repeatedly promised to do on his Day One that might get immediate attention from the new president.

    build the wall trump supporter

    Build the Wall. Perhaps Trump’s single most frequent campaign promise was that he would build a “big, beautiful wall” between the United States and Mexico (and to force the Mexican government to pay for it.) A symbolic step toward starting construction of the wall is one of the more likely things to come out of a Trump White House today.

    Start Mass Deportations. Second only to the wall, at least early in his campaign, was Trump’s vow that he would immediately deport the more than 11 million undocumented immigrants living in the U.S. While senior Republicans, like House Speaker Paul Ryan, have thrown cold water on the idea that Trump will be able to form a “deportation force” to start moving people across the border, it’s not out of the question that the new president could take some early steps to speed up the removal of criminal aliens.

    Overturn Executive Orders. Trump repeatedly vowed to void executive orders signed by President Obama, sometimes suggesting he’d invalidate all of them, sometimes promising to undo just the ones he views as “unconstitutional.” It seems safe to expect that there will be at least a gesture toward rolling back his predecessor’s legacy of aggressive executive actions. A possible target, of a piece with promises to deport the undocumented and build a wall, is Obama’s Deferred Action for Childhood Arrivals program, which lifted the threat of deportation from certain immigrants brought here illegally as children. Obama's order was nullified by an appeals court and left in place by the Supreme Court in a 4-4 decision last June.  

    paul ryan obamacare

    Repeal Obamacare. The law Trump called a “disaster” is not going away at the stroke of a pen, regardless of how much its opponents might like to see that happen. The Affordable Care Act is far too woven into the fabric of the nation’s healthcare system to be eliminated in an instant. However, given that doing away with it has been a key promise from not just Trump, but the entire Republican Party, some precursor step from Trump today directing federal agencies to prepare for a post-Obamacare world would not be a surprise.

    Institute a Lobbying Ban. Trump’s repeated promises to “drain the swamp” of Washington -- personified, more often than not, by lobbyists -- was another standard on the trail. Trump said that he would take steps to shut down the revolving door between the federal government and the K Street offices of major lobbying firms. He could formalize his promise to require all his White House employees to agree to a five-year ban on lobbying after leaving they leave, and a lifetime ban on lobbying for foreign governments. He could also request that Congress follow suit, however unlikely such a move would be.

    Withdraw from the Trans-Pacific Partnership. The massive trade deal, years in the making, was a constant target for Trump, who has criticized that treaty and others like it for costing America jobs. At this point, anything other than total withdrawal from the arrangement will look like a failure, so an official announcement that the US will not seek to ratify the deal could be something that comes out of the White House this afternoon.

    Donald Trump

    Go After China’s Currency. Usually mentioned by Trump in the same breath as the TPP was China, the great bogeyman of his story of American industrial decline. On the trail, he constantly hammered on the idea that Beijing is using unfair trade practices to make US products uncompetitive on the world market. A common Trump vow was that he would label China a “currency manipulator,” claiming the Chinese government takes illegitimate steps to keep the yuan’s value artificially low. Though experts say China hasn’t actually engaged in currency manipulation for several years, Trump has continued to insist that they do.

    Get ‘Tough’ on ISIS. Getting “tough” on the terror group ISIS was also one of Trump’s go-to promises during the campaign. From saying he would reinstate torture, target terrorists’ families, or just plain “bomb the shit out of them” stepping up the campaign against ISIS is something his supporters will expect Trump to do very early in his term. So, some sort of initial steps toward broadening the campaign against ISIS could also be on the table for this afternoon.

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    kellyanne conway

    The Trump administration may no longer enforce a rule requiring individual Americans to carry health insurance or pay a penalty if they do not, a senior White House official said on Sunday.

    Speaking on ABC's "This Week" program, Kellyanne Conway, counselor to the president, said President Donald Trump "may stop enforcing the individual mandate."

    Separately, on CBS' "Face the Nation" show, she reiterated Republican promises that no one would lose their health insurance under Obamacare while a replacement is being developed.

    "For the 20 million who rely upon the Affordable Care Act in some form, they will not be without coverage during this transition time," she said.

    On Friday Trump signed an executive order concerning the 2010 healthcare law, urging U.S. agencies to "waive, defer, grant exemptions from, or delay the implementation" of provisions deemed to impose fiscal burdens on states, companies or individuals.

    Healthcare experts had speculated that Trump could expand exemptions from the individual mandate.

    Senate Majority Leader Mitch McConnell, speaking on "Fox News Sunday," reiterated Republican promises to replace Obamacare and allow patients to buy health insurance across state lines using health savings accounts.

    "We’re going to move carefully in conjunction with the administration to repeal and replace it with things like health savings accounts and interstate health insurance sales and high-risk pools at the state level to take care of people who have pre-existing conditions." he said.

    obamacare enrollment florida

    Last week Republican Representative Tom Price, Trump's nominee to lead the Department of Health and Human Services, told the Senate Committee on Health, Education, Labor and Pensions, that an overhaul of Obamacare will initially focus on individual health plans sold on online exchanges and the Medicaid health insurance program for low-income Americans.

    He added that the revamp would not immediately tackle changes to Medicare, the federal health insurance program for those 65 and older and people with disabilities.

    Trump has said he wants to keep some elements of Obamacare, such as allowing young adults to be covered under their parents' insurance. He is in favor of plans that use health savings accounts and the sale of insurance across state lines.

    SEE ALSO: Trump is officially making an economic promise that will be nearly impossible to keep

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    mirena IUD cost if obamacare is repealed

    If Republicans succeed in their plan to repeal the Affordable Care Act, our current era of affordable birth control will likely end. The ACA requires insurers to fully cover the cost of contraception and preventive health care such as cancer screenings, making them free to all insured patients.

    Senate Republicans have indicated that they hold no part of the ACA sacred, even the popular provisions that guarantee maternity care coverage and no-cost contraception. Last week, they shot down an amendment that would have protected both. That means a lot of people who currently get birth control for free may soon have to pay out of pocket for some or all of the costs. Preventive services such as routine mammograms also stand to get a lot more expensive.

    The exact amount charged to the patient will vary based on her insurance plan, but doctor-database site Amino has mapped out the median network rate estimates (that is, the rate an insurance company negotiates with providers on behalf of patients) for intrauterine devices and mammograms in all 50 states and D.C.

    The report notes that since 51 percent of workers with private insurance have an annual deductible of at least $1,000, patients could conceivably be on the hook for most or all or most of the cost of these services if the ACA goes away.

    mammogram cost if obamacare is repealed

    Nationwide, the median cost of a screening mammogram is $267, and the median cost of a Mirena IUD—including insertion by a medical practitioner—is $1,111. Amino used the Mirena as its IUD example because more women choose it than the other two types of IUD (the copper Paragard and the smaller, hormonal Skyla) combined. 

    Alaska showed up as the most expensive state to get both a screening mammogram and an IUD. There, the median insurance rate for a mammogram is $496, and a Mirena IUD costs $1,586. Utah has the lowest median mammogram cost ($157), and Washington, D.C. has the lowest median IUD cost ($936).

    The ACA also currently mandates that insurers cover tubal ligation as permanent birth control for women. The national median cost for that procedure is $4,002, with Arkansas ($3,059) and Wyoming ($6,900) coming in at the ends of the cost spectrum.

    Some states have already passed laws codifying the contraception mandate for insurance companies, pre-emptively protecting their residents from the rising costs that will come with the ACA’s possible repeal. Without that protection and the ACA’s current requirements for preventive care coverage, women will pay for costly services they’ve gotten used to getting for free.

    SEE ALSO: Here's the 10-step process that the Republicans will use to repeal Obamacare

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    best birth control 2x1

    The INSIDER Summary:

    • Congress struck down an amendment that kept healthcare coverage for birth control. 
    • Congress plans to replace and repeal the Affordable Care Act. 
    • Without insurance, an IUD can cost up to $1,500. 


    The Republican-majority Congress took the first of many steps to dismantle the Affordable Care Act (ACA) last week. Congress rejected several amendments proposed by Democrats that would have preserved key components of ACA, including one that would have ensured continued access to insurance for people with pre-existing conditions. Another of the most noteworthy votes struck down a proposed amendment that would have preserved healthcare coverage for contraception. This means, as millions of American women have already figured out, that your birth control may get a whole lot more expensive.

    Don't expect a huge increase over the next month, though. The process for repealing ACA will be long and complicated, and changes to your insurance plan won't occur right away. If you are currently insured through Obamacare, your plan will likely remain unchanged through the end of 2017, regardless of how Congress votes.

    The process is further complicated by the promises some Republicans have made to replace Obamacare simultaneously while repealing it, which theoretically might preserve consistent coverage for the millions of Americans insured through ACA. However, Republicans do not currently have a plan to replace Obamacare. If they wait to repeal it until they do have a plan, the resulting process could be much longer than a simple repeal.

    The U.S. Capitol is pictured on the opening day of the 112th United States Congress in Washington, January 5, 2011. REUTERS/Jim Bourg

    Until Obamacare is officially repealed, birth control will still be available without a copay, assuming you are currently enrolled in a plan that provides it. According to the National Women's Law Center, 55 million American women currently have no-copay birth control coverage, which saved those women an estimated $1.4 billion in 2013 alone. All of these women could lose this benefit if Obamacare is repealed.

    Some states are taking action to ensure that their residents are able to continue access to free contraception, including New York, California, Illinois, and Massachusetts. Citizens of other states may be in trouble, though. An IUD can cost upwards of $1,500, according to Amino, and birth control pills will cost out-of-pocket patients between $100 and $600 annually.

    MIRENA IUD

    While Trump's pick to lead the Health and Human Services Department, Tom Price, believes that "not one" woman has struggled to afford birth control, most Americans realize that an annual cost of $1,500 or $600 could certainly be prohibitive for someone trying to make ends meet. My Bustle colleague Morgan Brinlee recently described her own experiences abroad trying to pay for a $1,000 IUD insertion. The threat of having to pay that much for contraception in the United States should rightly concern all American women.

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    Bill Cassidy

    Republican Sens. Bill Cassidy and Susan Collins introduced the first Affordable Care Act replacement bill from the GOP on Monday, called the Patient Freedom Act.

    Based on the fact sheet for the bill, it's a curious opening salvo from the party. It appears that the replacement would give states the option to keep nearly all of the law intact if they wish.

    The bill has three options for how states can cover people:

    1. "Reimplementation of the ACA." This option would allow states to put most of the provisions of the ACA, which is also known as Obamacare, back into place, including the individual mandate and Medicaid expansion. Funding from the federal government would remain the same for Medicaid expansion, cost-sharing subsidies, and premium subsidies up to 95% of current outlays.
    2. "Choose a new state alternative." This would allow states to create a "new market-based system" with federal funding "equal to 95% of federal premium tax credits and cost-sharing subsidies" and having "per beneficiary grants or advanceable, refundable tax credits" deposited directly in health savings accounts.
    3. "Design an alternative solution without federal assistance." This would allow states to create their own individual market solution with no funding from the federal government.

    The bill, according to the fact sheet, would keep in place a number of provisions of the ACA, including not allowing insurers to deny coverage because of a preexisting condition, allowing children to stay on their parents' insurance until age 26, and prohibiting lifetime limits.

    It does, however, repeal mandates on certain baselines for coverage (the fact sheet did not specify what types of coverage), the provision that premiums for elderly people can be only three times that of young people, and other clauses.

    Larry Levitt, senior vice president at the Kaiser Family Foundation, a nonpartisan healthcare think tank, said the bill appears to keep a majority of the ACA intact — to the point that it's almost indistinguishable from the original law.

    "Based on this summary, the ... plan basically block grants the ACA with a cut in federal funding of 5%," Levitt tweeted.

    Levitt added that the final legislative language will be important to determining the effect of the law. Only the fact sheet has been released so far.

    Senate Minority Leader Chuck Schumer pushed back on the plan, saying it would be possible some people currently insured would lose coverage and that there were concerns about keeping parts of the ACA while repealing others.

    "Ultimately, this proposal is an empty facade that would create chaos — not care — for millions of Americans," Schumer said in a statement. "Republicans should drop their disruptive repeal plans and work with Democrats to improve, not gut, the Affordable Care Act and healthcare system for all Americans."

    SEE ALSO: CBO: The GOP's Obamacare repeal could leave 27 million people without health insurance and cause premiums to skyrocket

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