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The latest news on Obamacare from Business Insider

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    obama smile happy

    Apparently, all it took for Americans to warm up to Obamacare was for President Barack Obama to leave office.

    According to a new Gallup poll, 55% of American surveyed approve of the Affordable Care Act, the law known as Obamacare. This is the first time in Gallup's polling of the ACA that the law has cracked 50% approval since the firm began asking about the law in November 2012.

    The 55% approval and 41% disapproval of the ACA represents a huge shift from just after the 2016 election. In November, Gallup found that Obamacare had only a 42% approval rating, while 53% disapproved.

    The shift also comes after a number of polls have showed increasing popularity for the law, as well as the failure of the Republican Party to pass their repeal and replacement bill — the American Health Care Act — through the House. That legislation was viewed highly unfavorably, with one survey suggesting as few as 17% of Americans viewed it in a positive light.

    Gallup also found that 26% of those surveyed favored keeping the ACA in place as it is. Another 40% wanted Obamacare in place with significant changes, while 30% wanted Obamacare repealed and replaced.

    Take a look at the progression Gallup has found through the years:

    Gallup Obamacare

    SEE ALSO: The new GOP Obamacare replacement could have a fatal flaw

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    donald trump paul ryan

    WASHINGTON (AP) — The Trump administration and Republican lawmakers plan to continue their uphill effort to exhume the House GOP's all-but-buried health care bill, but remain adrift and divided over how to reshape it to attract enough votes to muscle it through the chamber.

    White House officials and leading legislators aimed to resume talks Wednesday. Late Tuesday, they failed in a Capitol basement office meeting to shake hands on a White House proposal to let states seek federal waivers to drop coverage mandates that President Barack Obama's health care law slapped on the insurance industry.

    "All of us want an agreement," Rep. Mark Meadows, R-N.C., told reporters after two dozen lawmakers from both ends of the GOP spectrum huddled with Vice President Mike Pence and other White House officials. Meadows added, "There's a whole lot of things that we have to work out."

    Meadows leads the conservative House Freedom Caucus, whose roughly three dozen members have largely opposed the GOP legislation for not going far enough to abrogate Obama's Affordable Care Act, and their opposition helped to thwart the measure in the House in late March.

    The White House offers got an uneven reception earlier Tuesday from GOP moderates and conservatives, leaving prospects shaky that the party could salvage one of its leading legislative priorities. There was no evidence that the proposals won over any of the GOP opponents who humiliated President Donald Trump and House leaders on March 24, forcing them to cancel a planned vote on a Republican health care bill that was destined to lose.

    "We want to make sure that when we go, we have the votes to pass this bill," House Speaker Paul Ryan, R-Wis., told reporters. He said talks were in "the conceptual stage."

    Later Tuesday, Rep. Steve Scalise, R-La., his party's chief vote counter, said discussions were not "where there is consensus" on health care and indicated a vote this week was unlikely. Congress leaves town in days for a two-week recess, when lawmakers could face antagonistic grilling from voters at town hall meetings and the entire GOP drive might lose momentum.

    Under the White House proposal, states could apply for a federal waiver from a provision in Obama's law that obliges insurers to cover "essential health benefits," including mental health, maternity and substance abuse services. The current version of the GOP legislation would erase that coverage requirement but let states reimpose it themselves, language that is opposed by many of the party's moderates.

    In addition, the White House would let states seek an exemption to the law's provision banning insurers from charging higher premiums for seriously ill people. Conservatives have argued that such restrictions inflate consumer costs.

    mark Meadows

    Conservative Rep. Mo Brooks, R-Ala., said he remained a "no" votes, saying states should be allowed to opt out of Obama's insurance requirements without seeking federal permission "on bended knee."

    Moderate Rep. Frank LoBiondo, R-N.J., also remained an opponent, citing the GOP bill's cuts in care offered low-income people under Medicaid and the higher out-of-pocket costs it would impose on many poorer and older consumers.

    Some members of the Freedom Caucus were showing signs of accepting less than many originally wanted. Meadows said talks were boiling down to curbing several of Obama's coverage requirements — a sharp contrast to the full repeal of the statute that many initially demanded.

    "It perhaps is as much of a repeal as we can get done," Meadows told reporters.

    A poll by the nonpartisan Kaiser Family Foundation flashed a warning for the White House, showing that 3 in 4 Americans want the Trump administration to make Obama's law work.

    About 2 in 3 said they were glad the House GOP bill didn't pass last month. But people split evenly between wanting to keep or repeal Obama's statute.

    The underlying House Republican bill would repeal much of Obama's 2010 law. It would erase its tax fines for consumers who don't buy policies, federal aid to help many afford coverage and Medicaid expansion for additional poor people.

    Instead, opponents of the current measure say they want tax subsidies for health care to less generous than under Obama's program for many lower wage-earners and people in their 50s and 60s. They also would cut the Medicaid program and tax increases on higher earners would be eliminated. Consumers who let coverage lapse would face 30 percent premium hikes.

    ___

    AP reporters Erica Werner, Richard Lardner, Kevin Freking, Ken Thomas and Ricardo Alonso-Zaldivar contributed to this report.

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    mike pence donald trump

    The effort by the White House to revive the Republican bill to overhaul healthcare appears to have hit multiple roadblocks in the past two days, as a deal that would please all sides of the House GOP conference has again proved hard to nail down.

    After a two-hour negotiation session Tuesday night between White House representatives and members of various GOP House caucuses, major sticking points were left unresolved. And the future of the American Health Care Act — the bill to repeal and replace Obamacare — is as murky as ever.

    Accusations of a double-faced deal, a significant policy disagreement, and a tight schedule all threaten to derail the AHCA.

    Two deals

    The White House's effort to revive the bill, which was pulled from the House floor before a vote in March, is being led by Vice President Mike Pence, Chief of Staff Reince Priebus, and Office of Management and Budget Director Mick Mulvaney.

    The group has been attempting to bring the conservative House Freedom Caucus on board to secure enough votes to pass the bill through the House. At the same time, the White House team is attempting to keep the bill palatable for the more moderate members of the Tuesday Group.

    According to Politico's Rachael Bade and Josh Dawsey, during meetings on Tuesday, the White House team offered the two sides different deals — or they at least felt that way.

    The disagreements are over two Obamacare regulations regarding so-called essential health benefits and community ratings. Freedom Caucus members want these regulations repealed to ensure what they consider a freer market for insurance, while moderates believe a repeal would undermine protections for people with preexisting conditions and leave sick Americans without affordable coverage.

    In a meeting with moderates, Pence seemed to hint that a repeal of the provisions would be limited and subject to approval by the federal government.

    But in a later meeting with Freedom Caucus members, however, lawmakers said Pence painted the repeal of these regulations as simpler and said the federal government would rubber-stamp any state that wished to do so.

    According to Politico, members of both sides said there were a variety of options the White House team promised to one side but not the other.

    mark Meadows

    'No agreements'

    Overall, the two sides do not appear any closer to taking any meaningful steps toward a deal.

    House Speaker Paul Ryan told reporters at a press conference on Tuesday that the negotiations were still in "conceptual stages."

    Lawmakers said the two-hour meeting didn't bring the sides together.

    "There were no agreements tonight in principle, and certainly no agreements in terms of a foundation," Rep. Mark Meadows, the chairman of the Freedom Caucus, told reporters after the meeting.

    As was the case during the first negotiations over the AHCA, it appears the Freedom Caucus is forcing the bill further to the right and pushing for the repeal of the regulations. This would make support from moderate Republicans less and less likely.

    According to David Nather at Axios, some GOP leaders believe the changes being proposed to appease the Freedom Caucus are losing the bill votes rather than winning them.

    With a vote on the bill this week, before a two-week break for Congress, looking increasingly unlikely, it appears, again, that "Trumpcare" isn't moving forward anytime soon.

    SEE ALSO: Obamacare's popularity has gone through the roof after Trump’s election

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    donald trump

    As talks break down over the Republican legislative bid to repeal and replace Obamacare, one GOP House lawmaker laid out a frank and brutal assessment of his own party.

    Rep. Steve Chabot of Ohio told reporters on Wednesday that the GOP's inability to pass the American Health Care Act was the party's own fault.

    "I thought this would be the easiest thing to do. I'm surprised we've been this incompetent," Chabot said, according to the Washington Examiner's Kimberly Leonard.

    Chabot added that "cautiously optimistic may be a little strong" on the chances that recent wrangling between Republican moderates and conservative factions — with moderation from the White House — would lead to a deal.

    Soon after Chabot's comments, Politico's Jake Sherman reported that House Majority Leader Kevin McCarthy's office confirmed there would be no vote on legislation this week before the House's two-week Easter recess.

    While the lack of a vote is not surprising, it came after a week during which Republicans started optimistic. And it capped off a wild month for the AHCA, which wasintroduced on March 6 by the House GOP leadership that included House Speaker Paul Ryan, Ways and Means Committee Chair Kevin Brady, and Energy and Commerce Committee Chair Greg Walden.

    Since then, it has gone through three committees and a last-minute overhaul over fierce objections from conservatives. The bill was pulled not once, but twice from planned floor votes because it lacked the Republican support needed to pass. The second time came after an ultimatum from President Donald Trump the night before the vote, in which he told the conference to pass the bill or be stick with Obamacare.

    Even after the bill was yanked and it seemed Republicans were ready to move on, the White House — led by Vice President Mike Pence — attempted to revive the negotiations over the past week and a half. But they found little common ground for ways to change the bill and make it acceptable for both conservatives and moderates. 

    Or as Rep. Chris Collins of New York told the Washington Examiner: "I went from pessimistic two weeks ago to being somewhat hopeful on Monday to now being pessimistic again."

    SEE ALSO: The negotiations over 'Trumpcare' 2.0 are already looking like a disaster

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    NOW WATCH: Watch Trump's budget director explain proposed cuts for after-school programs that feed children


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    Paul Ryan Cathy McMorris Rodgers Lynn Jenkins Kevin McCarthy

    WASHINGTON — The White House and House Republicans appear short of a last-ditch deal on their long-promised repeal of Barack Obama's healthcare law. And in an unexpected twist, "Obamacare"— never very popular — seems to be rising in public opinion polls.

    "There's no suggestion we should be changing our flights," moderate Rep. Chris Collins, a New York Republican, said Wednesday afternoon, a day before lawmakers were slated to leave Washington for their two-week recess. "We're going home ... without a deal."

    From the party's right flank, Freedom Caucus member Rep. Mark Sanford of South Carolina said: "I've heard nothing of substance at this point that would break the logjam."

    The Thursday schedule from House Majority Leader Kevin McCarthy, a California Republican, delivered the hard truth — no health bill vote.

    Two weeks ago, House Speaker Paul Ryan was forced to call off a floor vote on a GOP measure to repeal much of the Obama-era Affordable Care Act, the healthcare law better known as Obamacare. The GOP legislation replacing it would have scaled back the federal role in healthcare, covering 24 million fewer people over time, while also cutting taxes for upper-income earners.

    Then as now, deep differences among hardliners and moderates impeded the Republican march. Each side blames the other. The congressional recess could drain more momentum from the repeal drive, though many Republicans say individually they're not giving up.

    At the same time, weeks of truth-or-consequences debate on Capitol Hill may be shifting public attitudes on the ACA, which has remained divisive since Democrats passed it in 2010 without any Republican support.

    Gallup this week said the law gained majority approval for the first time, with 55% supporting it and 41% disapproving. It was the first majority for Obamacare since Gallup started asking the question in the same format in November 2012. It marked a major shift from five months ago, when 42% approved and 53% disapproved.

    Another nonpartisan survey by the Kaiser Family Foundation found relief that Congress had not managed to repeal the health law. It showed that three in four Americans wanted the Trump administration to make the law work. About two in three said they were glad the House GOP bill didn't pass. But people split evenly between wanting to keep or repeal the statute.

    Unwelcome fallout from translating the GOP vision into practical policy seems to be contributing to the party's difficulty selling its plans.

    Donald Trump

    For example, experts said the latest idea floated this week would raise premiums for people with medical problems.

    Roughed out in negotiations between the White House and leaders of the conservative Freedom Caucus, the idea would allow states to seek waivers of two ACA requirements. One, known as community rating, forbids insurers from charging higher premiums on account of people's medical problems or preexisting conditions. The other is the essential-health-benefits provision that spells out categories of benefits all insurance plans must cover.

    Conservatives who want the federal government out of healthcare argue that those provisions have driven up premiums and decreased choice. The idea is to put states back in charge of insurance rules, reasoning that doing so would increase the availability of plans with lower premiums, attractive to younger, healthier customers.

    But healthcare industry consultant Robert Laszewski said it would also open a "back door" to a system where the sick can get priced out of coverage.

    "It's hard for me to believe that any state would take us back ... when it comes to the protections that consumers have for preexisting conditions," Laszewski said. "There is no doubt that Obamacare as a system is not working very well, but nobody wants to go backward."

    Republicans say their bill includes a fallback option for people with health problems. It would create a $100 billion fund that states can use for a variety of purposes, including high-risk insurance pools where people with medical problems would seek get coverage.

    But Trish Riley, the executive director of the National Academy for State Health Policy, said those didn't work well in the past. Patients tended to be very sick, and premiums were often too expensive.

    "There would be real challenges for people with illnesses to get affordable coverage," Riley said. "You will get guaranteed access to coverage, but you won't be able to afford it." Her nonpartisan organization offers policy advice to states.

    Trump administration officials and leading GOP legislators said they were not giving up trying to find common ground between conservatives and moderates. Ryan and McCarthy met with Pence at the White House on Wednesday night to discuss their next steps on healthcare, an aide to Ryan said. They also talked briefly with President Donald Trump.

    Democrats were dismissive. "It's as if the president and Paul Ryan went to some of the Republicans and the Freedom Caucus and said, 'We can make this worse,'" Rep. Jan Schakowsky of Illinois said.

    ___

    Associated Press writer Kevin Freking contributed to this report.

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    Barack Obama smile

    The first explanation for why House Republicans weren't even trying to repeal most of the insurance-regulation provisions in Obamacare — provisions that Republicans have been complaining for years are needlessly driving up insurance premiums — was that Senate rules would make it impossible to do so without Democratic votes.

    The second explanation was that, while some provisions might be repealable with just Republican votes in the Senate, a partial regulatory repeal would cause unacceptable interactions with other Obamacare provisions that really did have to be left in place because of those Senate rules. (This is the "quirky death spiral" scenario I wrote about several weeks ago.)

    The third explanation, offered once the White House and conservative Republicans in the House Freedom Caucus started talking about going ahead and trying to gut all the offending provisions, was that, well, the core Obamacare insurance rules are good policy and should be maintained, even if it is technically possible to repeal them.

    This is a shocking admission from the party that staked its reputation on opposition to Obamacare, and it came Wednesday.

    Here's what Rep. Patrick McHenry, the chief deputy whip of the Republican conference, said about Obamacare's insurance regulations on Wednesday, by way of explaining why the House Freedom Caucus' vision for a bill to deregulate health insurance couldn't pass:

    "There are a lot of provisions that are part of the law now that I want to preserve. So if you look at a cross-section of the conference, they have similar positions about similar provisions — preexisting conditions, guarantee issue, and medical underwriting are core components of that ... The core provisions here are really important protections."

    What McHenry was saying there sounds technical, but it can be summed up in a three-word sentence:

    Obamacare is good.

    McHenry is not just endorsing an incidental piece of Obamacare that can be kept while junking most of the law — in the way Republicans have for years by saying, for example, that they favor Obamacare's rule requiring insurance plans to cover the insured's children up to age 26.

    The portions of Obamacare that Rep. McHenry said he and the Republican conference wanted to preserve — the ban on preexisting condition exclusions, and provisions called "community rating" and "guaranteed issue," which I'll explain in a moment — cannot be preserved without keeping Obamacare's overall strategy: standardize insurance, require uniform pricing, subsidize premiums for those who cannot afford them, and find a way to get as many people as possible to buy.

    Republicans are now endorsing enough of Obamacare that we can say they are for Obamacare. Period.

    Patrick McHenry

    What McHenry is endorsing is the beating heart of Obamacare

    McHenry said many in the Republican conference wanted to preserve Obamacare rules on three issues: "preexisting conditions, guarantee issue, and medical underwriting."

    Guaranteed issue means health insurers have to sell insurance to whoever wants it. Obamacare prohibits medical underwriting through a policy called community rating. This rule says insurers have to charge all their customers the same price, regardless of medical status, except for limited adjustments based on age and smoking. The law also prohibits insurers from excluding preexisting conditions from coverage.

    Put together, these policies ensure that insurance is available to all people at a predictable price — and when combined with the subsidies created by the law, it is ideally supposed to be an affordable price. These policies are very popular because they appeal to ideas about fairness — people should be able to get health insurance they can afford and shouldn't be punished financially just because they are sick.

    Republicans have a mandate to "repeal and replace Obamacare," but they don't have a mandate to make it possible for insurers to charge cancer patients a fortune (or decline to cover them altogether).

    That said, these popular policies tend to cause some problems in insurance markets. If you're going to keep them, you also have to keep the parts of Obamacare that were built to address those problems.

    And when you add all of those parts up, you basically have the entirety of Obamacare except for the Medicaid expansion.

    You can't do what Republicans want without something like the individual mandate

    Buyers of health insurance know quite a bit about their health status. Some expect to make few claims, while others know they will be expensive to cover. Some are even likely to know they will file claims that well exceed the premium they will be charged.

    In other words, the regulations McHenry likes, because they flatten prices, will tend to make health insurance a lot more appealing to sick people than to healthy people. If that means mostly sick people buy health insurance, then premiums will have to be set very high to cover their expected costs, making insurance even more unappealing to healthy people.

    To make this suite of policies work (community rating, guaranteed issue, preexisting-condition coverage) you need to find a way to get healthy people to buy health insurance, even though it is priced quite a bit higher than it would be if they were able to buy insurance underwritten to their excellent health.

    You can do this by subsidizing health insurance (so the pricing is favorable even if you are healthy), or you can do it by penalizing people who do not buy health insurance. Obamacare does both: It gives subsidies that can be used only to buy insurance, and it assesses a penalty on people who go uninsured.

    So, by committing to a set of core Obamacare policies, McHenry is also committing to a regime of subsidies to help people buy insurance and to some mechanism to discourage going uninsured, even if he's not necessarily committing to Obamacare's precise set of subsidies and mandates.

    Paul Ryan

    You can't do what Republicans want without Obamacare's essential-health-benefits rules

    One incarnation of the AHCA — a version for which McHenry was whipping votes just weeks ago — would have kept the rules he listed as important this week but repealed rules about so-called essential health benefits, which say health insurance must cover certain benefits, such as hospitalization, maternity care, and prescription drugs.

    Under this bill, insurers would have been able to sell plans that didn't cover substance-abuse treatment or even plans that covered only one specific category of care, such as doctor's visits.

    I explained at the time why this approach would create a huge mess:

    "People in good health would tend to buy plans with relatively narrow benefits, and people in poor health would tend to buy plans with a lot more benefits.

    "This fact would force insurers to price the broad plans much higher than the narrow plans. That would discourage healthy people from buying broad coverage, further shrinking the participant pool and pushing premiums even higher.

    "Before Obamacare, insurers could mitigate this behavior by evaluating the health status of people who wanted to buy insurance and refusing to sell to people they thought would be expensive, or by refusing cover people for their preexisting conditions.

    "But because the AHCA would preserve Obamacare's rules about guaranteed issue and its ban on preexisting-condition exclusions, insurers couldn't stop sick people from gravitating toward the most generous plans, and therefore causing the premiums for such plans to skyrocket.

    "As a result, Dylan Scott of Stat News notes, some insurance markets could experience a death spiral that does not kill off all plans but that puts premiums for benefits that some people really care about (like hospitalization, prescriptions, or substance-abuse treatment) out of reach, forcing most people to buy plans that omit key benefits."

    Squeamishness about this mess that would ensue if you repealed the EHB rules while leaving other rules in place was a major reason the American Health Care Act could not pass — and it is a reason the Freedom Caucus has been pushing to gut rules like community rating in conjunction with the EHB rules.

    But if Republicans are committed to maintaining guaranteed issue and community rating, then by extension they also have to be committed to keeping the EHB rules unless they wish to cause the mess.

    When you add this all together, you have Obamacare

    paul ryan donald trumpSo, let's see.

    According to McHenry, Republicans in the House of Representatives now think it's important to require health insurers to sell insurance to everyone. They think insurance shouldn't exclude preexisting conditions. And they think it should be sold at a fixed price, except for adjustments based on age and smoking.

    If you do all that, you're going to have to take some steps to encourage healthy people to buy insurance, since premiums are going to be pretty high in relation to the care they actually use and since they're needed in the pool to cross-subsidize sick people.

    You're going to need to hand out some subsidies, because those premiums will be unaffordable to a lot of people, especially those with a low income.

    And you're going to have to set out rules ensuring that health insurance covers a comprehensive suite of benefits, as otherwise insurance markets will fall apart as only extremely stripped-down plans become viable.

    All of which is to say, you're going to have to keep Obamacare.

    Republicans are for Obamacare.

    Now, can we talk about how to optimize Obamacare, instead of pretending that one party wants to repeal it?

    SEE ALSO: Zombie Trumpcare is undead, and that won't end well for Republicans

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    paul ryan donald trump

    Republicans are making one final effort to move forward with their plan to reform the US healthcare system before Congress goes on a two-week break.

    The House Rules Committee will reportedly consider an amendment to the American Health Care Act to fund high-risk pools in states in an attempt to show progress on the GOP's plan to repeal and replace Obamacare before the House goes on a two week recess starting Friday.

    The full AHCA is not expected to move to the House floor.

    Bloomberg's Jennifer Jacobs and Billy House reported that the move on high-risk pools represents an attempt to show some progress on the healthcare bill after months of setbacks and an inability of House Republicans to come to a consensus on the details of their healthcare overhaul.

    High-risk pools have long been a target for House Republicans, and passing the amendment would show some consensus before the Easter break.

    The pools separate individuals with preexisting conditions into a separate risk pool from healthier people. It brings down costs for people without ailments and could improve losses for insurers. Critics of the plan say many states had high-risk pools before the Affordable Care Act and the costs were so high that few people enrolled in them. In order to solve this issue, they say, the federal government would have to massively subsidize the costs for people in these pools.

    The move comes the day after a meeting at the White House between House GOP leaders and members of the Trump administration over the failed attempts to get the AHCA passed through the lower chamber.

    The Washington Post's Robert Costa reported that the meeting between White House officials including Vice President Mike Pence, White House Chief of Staff Reince Priebus, and Chief Strategist Steve Bannon and House leaders including Speaker Paul Ryan and Majority Leader Kevin McCarthy was tense.

    According to Costa, Pence demanded action on healthcare and the meeting was "at times heated."

    Pence, Priebus and, Office of Management and Budget Director Mick Mulvaney have been working with lawmakers to iron out details in the AHCA that would get enough members onboard to pass the bill. The AHCA was pulled minutes before a House vote last month after disagreements between the conservative House Freedom Caucus and moderate members left the bill short of the needed votes to pass 

    Talks between the conservative and moderate wings of the GOP House conference ave not yielded any common group on regulations. Conservatives still wants a repeal of regulations such as essential health benefits and community ratings, which moderates say would allow people with preexisting conditions to be charged exorbitant insurance premiums.

    SEE ALSO: One quote from a Republican lawmaker shows just how much of a mess the 'Trumpcare' process has been

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    obama minnesota frown

    Health insurance giant Aetna is pulling out of the Affordable Care Act individual insurance exchanges in Iowa, the company announced Thursday.

    The move comes after Wellmark, another large player in Iowa's ACA markets, said Tuesday it would also leave Iowa's exchanges.

    Based on the current offerings, after the exits five Iowa counties will have two insurers left and the other 99 will have only one: Medica.

    Aetna said the decision was due to uncertainty surrounding the future of the ACA, also known as Obamacare, and financial losses the company was taking.

    "Earlier today we informed the appropriate federal and state regulators that Aetna will not participate in the Iowa individual public exchange for 2018 as a result of financial risk and an uncertain outlook for the marketplace," said Aetna spokesman TJ Crawford, who added the insurer was also evaluating all of their individual insurance offerings.

    Iowa Insurance Commissioner Doug Ommen pinned the blame on the ACA itself.

    “We're deeply troubled by the angst and concern the Affordable Care Act is causing in Iowa," Ommen said in a statement. "This is a problem created by the Affordable Care Act and needs to be fixed by Congress."

    The uncertainty comes as President Donald Trump and Republicans have begun attempting to repeal the ACA and the Department of Health and Human Services has said it will do anything it can to offer "relief" from Obamacare. 

    Aetna also announced in August 2016 that it was pulling out of roughly 70% of the markets where it offered Obamacare plans in part due to financial losses. The company also left those exchanges partly because of the failure of its proposed merger with rival Humana.

    SEE ALSO: Republicans are making one last healthcare push as Trump's administration is getting frustrated with the mess

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    doctor patient hospital

    With little movement toward an overall agreement on the American Health Care Act, the House GOP introduced an amendment Thursday for the AHCA to establish "invisible high-risk pools" to help cover people with preexisting conditions.

    The amendment is aimed at foisting a public show of progress toward the repeal and replace of the Affordable Care Act, also known as Obamacare, while adding a popular Republican proposal to their healthcare legislation.

    These "invisible" pools would operate similarly to Obamacare's reinsurance policies, which gave money to insurers to help lower premiums for the sickest people. In theory, this would help stabilize the individual insurance market for those without coverage through an employer or government program like Medicare.

    However, high-risk pools have long been criticized for their hiccups, and the Republican amendment remains unclear on its specifics.

    The amendment lays out funding for the pools but does not specify how states will qualify for the funding, how it will be apportioned, how enrollees will be determined, and more.

    Instead, those details would be left up to the Centers of Medicare and Medicaid Services, a division of the Department of Health and Human Services that oversees many government insurance programs, including the Affordable Care Act's insurance exchanges.

    Additionally, the funding allocated toward the invisible high-risk pools in the amendment could be inadequate. To mitigate costs to insurers from high-risk pools, since sicker people are more expensive and there are no healthy people to balance out the costs, the federal government would allocate funding to the states to distribute to insurers and patients to bring the costs down.

    The GOP amendment would allocate $15 billion over a nine-year period until 2026 for states to establish high-risk pools, or roughly $1.67 billion annually. Based on most studies on high-risk pools, that number would fall well short of the amount needed to keep insurers in the market and keep costs down for enrollees.

    Cynthia Cox, Associate Director at the Kaiser Family Foundation, told Business Insider that this funding would not be nearly enough compared to what would be needed to properly fund a pool of this type.

    "I think an invisible high-risk pool or reinsurance could work so long as it's adequately funded, and this does not seem like a significant amount of money," Cox said.

    "It is likely a drop in the bucket compared to what insurers would likely need to stabilize the market and to help convince them to stick around," she added.

    The old reinsurance program under the ACA provided $20 billion in funding over three years for these funds, which still struggled to keep some costs under control even then.

    Interestingly, when talking about the extension of the Obamacare reinsurance program, many Republican lawmakers called such funding a "bailout," as reported by Chris Jacobs, a conservative policy consultant who previously worked for then-Rep. Mike Pence during the original ACA debate. 

    "Congressional leadership previously called the $20 billion in Obamacare reinsurance funding a 'bailout' and 'corporate welfare,'"Jacobs wrote on Thursday."But the $15 billion in funding under the proposed amendment echoes the Obamacare mechanism—only with more details missing and less oversight. Why do Republicans now support a program suspiciously similar to one that they previously opposed?" 

    By most estimations, the money set aside by the new amendment does not measure up, potentially leading to a massive number of the sickest people with either incredibly high costs in the pool, massive insurer losses, or sick people simply opting to go without insurance.

    SEE ALSO: Republicans are making one last healthcare push as Trump's administration is getting frustrated with the mess

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    Steve Bannon

    It hasn't been a good week for Steve Bannon.

    Trump’s embattled right-hand man has seen a slew of negative coverage over the last few days. That includes reports of widening rifts between Bannon and senior adviser Jared Kushner, news that Trump is increasingly unhappy with Bannon, reports of looming staff shake-ups in the White House, and above all, the chief strategist’s removal from his post on the National Security Council.

    Bannon, famous for his nationalistic politics and confrontational style, is in hot water as Kushner, economic adviser Gary Cohn, and other centrist forces in the West Wing have begun gaining influence in the president’s inner circle.

    Bannon reportedly lashed out at the turn of events and called Kushner a “globalist” and a “cuck” – short for “cuckservative,” a mash-up of the words “cuckold” and “conservative” that’s frequently used as a slur by the alt-right – and had “face-to-face” clashes with the president’s son-in-law, senior administration officials told The Daily Beast.

    Steve Bannon Jared Kushner

    Bannon has also been the subject of the president’s ire in more recent days. The New York Times reported that Trump is apparently unhappy with the way magazines and talk shows refer to his strategist as “President Bannon,” as well as the credit Bannon has received for setting the administration’s agenda.

    He has also borne the brunt of the blame for the White House’s failed attempts at implementing a travel ban, as well as the disastrous rollout of the American Health Care Act, the bill Republicans championed as the replacement for the Affordable Care Act, or Obamacare.

    The bill was pulled from the floor of the House before it could come to a vote, after it became clear the AHCA would not have enough votes to pass. The Freedom Caucus, a hardline conservative faction of the House of Representatives that some say were responsible for sinking the bill, was reportedly put off by Bannon’s dictatorial tone when he told them they had “no choice” but to vote for the AHCA.

    steve bannon donald trump

    On the travel ban, Trump was initially on board with Bannon’s drafting of the executive order, but grew incensed when it became clear the order would not withstand judicial scrutiny, a source familiar with the president’s thinking told The Associated Press.

    Tensions reached their boiling point on Wednesday when Bannon was removed from his post on the National Security Council at the behest of national security adviser H.R. McMaster. According to a White House official, Bannon resisted the shake-up and threatened at one point to quit if it was carried out. "If my talents aren't needed here, I can take them somewhere else," Bannon reportedly said. 

    His allies, however, say that Bannon’s removal from the NSC was a natural next step, because he was placed there to keep an eye on former national security adviser Michael Flynn. With Flynn out of the picture, they said, there was no need for Bannon to remain on the council.

    “Susan Rice operationalized the N.S.C. during the last administration,” Bannon said in a statement released after his removal. “I was put on the N.S.C. with General Flynn to ensure that it was de-operationalized. General McMaster has returned the N.S.C. to its proper function.”

    Michael Flynn

    Following the various blunders that have plagued this administration since its first day, Kushner and Ivanka Trump are pushing hard for a more “open process driven by the interests of the president, not ideology,” according to an Axios report on Saturday.

    And despite earlier reports that Chief of Staff Reince Priebus may be replaced, a senior official told Axios that Priebus is on board with the administration’s centrist push and that “Reince is staying.”

    In yet another sign of Bannon’s waning influence, sources told Axios that the administration may be shifting towards collaboration, as opposed to the combative stance it has adopted thus far.

    Although Bannon's allies are desperate to save his job in the White House – arguing that Bannon’s demotion will cost Trump dearly with his core constituency that has favored his “America First” tone – other officials told Axios: “Either Steve becomes a team player and gets along with people, or he’ll be gone.”  

    SEE ALSO: Trump is reportedly considering a major staff shakeup amid a deepening rivalry between Steve Bannon and Jared Kushner

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    The percentage of Americans that did not have health insurance increased during the first quarter of 2017, according to data from Gallup-Health Ways.

    The Well-Being Index found that the percentage of uninsured Americans ticked up to 11.3% in the quarter, an uptick from 10.9% at the end of 2016, which was a record low for the history of the index.

    According to Gallup and Health Ways, the recent fight over the repeal and replacement of the Affordable Care Act, or Obamacare, may have been a contributing factor for the increase, as the future of healthcare became murkier.

    "The slight rise in the number of uninsured Americans in the first quarter of 2017 could, in part, be attributable to the uncertainty surrounding the long-term future of the Affordable Care Act," the release said. "As such, it will be important to monitor the uninsured trends in the coming months as these events unfold. If coverage options and premiums do change, members of Congress from both parties may show a renewed urgency to address the healthcare issue."

    While the increase in the uninsured rate was just the third increase since the start of Obamacare's individual insurance exchanges launched in 2013, the overall rate is still well below its level when Obamacare was instituted.

    "Despite an uptick in the uninsured rate in the first quarter of 2017, the number of U.S. adults without health insurance is still 6.7 percentage points lower than it was at its peak in the third quarter of 2013," Gallup-Health Ways. "The uninsured rate reached 18.0% that quarter, just before the health insurance exchanges opened in October 2013."

    The survey found that the largest declines since the end of 2013 have come for Americans aged 26 to 34 (a 9.8-percentage point decline), Hispanics (a 10.1-point decline), and households making less than $36,000 annually (a 8.6-point decline).

    The Republican plan to repeal and replace Obamacare, the American Health Care Act, was estimated to decrease the number of Americans with insurance by 24 million over 10 years compared to the current baseline under the ACA, according to the Congressional Budget Office.

    Insurers have also begun to exit some Obamacare exchanges preemptively, as the future of the exchanges remains in limbo.

    SEE ALSO: One of the nation's biggest health insurers is ditching Iowa's Obamacare exchanges

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    Soon after the Republican bill to overhaul the US healthcare system was pulled from the House floor because of insufficient support from the GOP, President Donald Trump told reporters the existing law was "exploding." He has also said the law's insurance exchanges are "collapsing" and "dead."

    Despite the dire predictions, most analysts — including S&P and the Brookings Institution — say the individual marketplace as it now operates will not collapse on its own.

    Trump could quicken its demise, however, through a range of options, from standing pat on key issues or deciding to use regulatory power to weakening some of the central tenets of Obamacare.

    As Trump said, "The best thing we can do is let Obamacare explode."

    Cost-sharing subsidies

    Perhaps the most significant way Trump could aid the explosion of the Affordable Care Act, the law better known as Obamacare, would be to halt the payment of the law's crucial cost-sharing subsidies.

    Such payments go to insurers to offset the costs they incur for offering plans with lower deductibles and out-of-pocket costs to people in the ACA exchanges with income of up to 200% of the federal poverty line. Roughly 58% of the 12.2 million people signed up for healthcare through the exchanges benefit from these subsidies.

    The House has argued that since this money was not assigned in an appropriations bill, it constitutes an illegal use of funds. It sued the executive branch under the Obama administration in a case now named House v. Price (referring to current Health and Human Services Secretary Tom Price). A court ruled in favor of the House in May 2016, but the Obama administration appealed the ruling, and a judge ordered the payments to continue until the appeal was heard.

    The New York Times reported Monday that the Trump administration planned to continue the cost-sharing subsidies. The Department of Health and Human Services pushed back on the report Tuesday, however, calling it "inaccurate." HHS spokeswoman Alleigh Marré said regarding the decision to prosecute the case (emphasis ours):

    "The administration is currently deciding its position on the matter. We have not been contacted by Democrats to save Obamacare, perhaps because they consider Obamacare to be a losing cause. Democrats need to help solve this failed Obamacare plan. The report was in reference to the current status of the lawsuit and is not an indication of what will happen in the future. No decision has been made about how the administration will proceed."

    If Trump and Attorney General Jeff Sessions decide to drop the appeal, the subsidies would end and cause costs to soar, said Cynthia Cox, the associate director at the Kaiser Family Foundation, a nonpartisan health organization.

    "If the administration were to drop the case, the fear for insurers is that costs to cover those lowest-income people would soar," Cox said. "These subsidies help insurers provide that coverage, and without it, fewer of them would be willing to be in the exchanges."

    Even if the companies stayed in the market, insurers would have to increase their premiums substantially to make up for the lost payments. Kaiser estimates that premiums would have to increase 19% on average on top of current estimates to make up for the lost payments.

    Additionally, states would see a wide range of premium increases, varying between an extra 9% in North Dakota to an additional 27% in Mississippi.

    Screen Shot 2017 04 11 at 1.31.59 PM

    Laid-back mandate enforcement

    Another major option the Trump administration has at its disposal would be taking a step back on the ACA's tax penalty for people who don't obtain insurance.

    The Internal Revenue Service already confirmed in February that if people did not fill out their tax form indicating they had insurance, called a "silent" return, the agency would still accept it. While the mandate could still come up in an audit, it is a big change from the outright rejection of forms the IRS had outlined, making it easier to avoid the individual mandate.

    Cox said the Trump administration could also instruct the IRS not to investigate any instances of a "silent" return for the individual mandate or to easily grant waivers for the mandate penalty, allowing people to get out of paying.

    "If the Trump administration were to do either of those things, it would have the same effect as repealing the individual mandate," Cox said.

    While the individual mandate is an incredibly unpopular provision of Obamacare, it is designed to get healthier people into the marketplace to bring down costs for those who are older and sicker. It has also helped improve insurers' financial performance in the markets.

    Time is running out

    There are also smaller ways Trump and his administration could undermine the law, like pulling outreach and advertising for exchange enrollment. The most under-the-radar move for Trump, however, would be to stay incredibly silent.

    During the Obama administration, the Department of Health and Human Services attempted to provide as much clarity as possible to insurers to get them to participate in the insurance market. Changes to the exchanges were announced early, and there was active engagement from HHS.

    If Trump and Price decide to stay mum on any future plans for the ACA, the silence alone could deter insurers from continuing to offer plans.

    obama obamacare doctors

    For instance, on April 4, the insurer Wellmark said it was pulling out of Iowa's individual health-insurance marketplace. Two days later, Aetna announced it was exiting Iowa. The moves leave 99 counties in the state with only one insurer — and five counties with two. A large portion of this is due to the uncertainty surrounding 2018, Cox said.

    "Insurers don't know what the rules are going to be next year, so that is making them uncertain about sticking around in a lot of these markets," she said. "If there isn't more clarity from the Trump administration, it's likely that these exits will continue and possibly accelerate."

    Cox said Iowa was a relatively stable marketplace before the exits. There were multiple providers in every county, and premiums went up by less than the national average for 2017. Despite these positive factors, insurers were worried about sticking around too long.

    "Aetna didn't want to be the last one in these markets," Cox said. "A lot of insurers are evaluating their plans for 2018 and don't want to get stuck in a situation where they are the only insurer. This means there are more of these exits to come.”

    Insurers could be pressured into sticking in markets where there is only one insurer to avoid a gap in coverage, so by leaving early, Aetna made sure it wouldn't get stuck with the bag.

    By June 21, insurers have to submit their plans for the 2018 coverage year to be approved in whichever states they wish to participate. If the Trump administration sows the uncertainty until that point, with silence and a lack of clarity, then the explosion he predicted may come to pass.

    SEE ALSO: Trump's next big economic plan is already hitting speed bumps

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    President Donald Trump on Wednesday said changes to the US healthcare system were still needed to ensure a "great tax reform" bill.

    In an interview with Fox Business' Maria Bartiromo, Trump said that tax reform was going to happen "at some point very soon" but that Republicans needed to first repeal and replace the Affordable Care Act, the healthcare law better known as Obamacare, to have the budgetary freedom to pass the tax plan they want.

    Additionally, Trump said the death of the American Health Care Act— the aborted House GOP bill to overhaul healthcare — was greatly exaggerated.

    "I think we're doing very well on healthcare," Trump said. "It's been very much misreported that we failed with healthcare. We haven't failed — we're negotiating and we continue to negotiate and we will save perhaps $900 billion."

    Trump is referring to the Congressional Budget Office report on the AHCA. The CBO estimated that the bill could cut the federal spending by $880 billion over the next 10 years and that the deficit could shrink by $337 billion. After the most recent additions to the AHCA, however, the CBO updated this estimate to say the deficit could shrink by only $151 billion, with spending decreasing by $1.15 billion and revenue falling by $999 billion.

    While the AHCA had some tax cuts directly baked in, Republicans had hoped the bill's proposed spending cuts, largely through Medicaid reductions, would allow for even more tax cuts.

    "You know if you look at the kind of numbers we're talking about, that's all going back into the taxes and we have to do healthcare first to pick up additional money so that we get great tax reform," Trump said. "So we're going to have a phenomenal tax reform, but I have to do healthcare first."

    Trump did acknowledge that passing healthcare legislation was "very, very difficult," but he said something needed to be done because Obamacare was "failing." While most healthcare policy experts argue that the Obamacare individual health-insurance exchanges are not failing, they say the Trump administration could still undermine the marketplace.

    Trump also on Wednesday would not commit to the deadline for tax reform laid out by Treasury Secretary Mnuchin, who had said Trump would sign a tax bill by the congressional recess in August.

    "I don't want to put deadlines," the president said. "Healthcare is going to happen at some point. Now, if it doesn't happen fast enough, I'll start the taxes. But, the tax reform and the tax cuts are better if I can do healthcare first."

    While there has been little clarity so far on tax reform, the other major part of Trump's economic agenda — a promised $1 trillion in infrastructure investment — remains murky as well. The president said that to get a second bill on healthcare passed, which would require 60 votes to avoid a Democratic filibuster in the Senate, he may include an infrastructure package.

    "I see it, perhaps, as part of the healthcare plan," Trump said. "Because phase two of the healthcare plan in order to get the votes, I need 60% for that, and if I put that in, the Democrats are actually gong to love the infrastructure plan."

    Watch Trump's comments here via Fox Business:

    SEE ALSO: There are a few simple ways Trump could cause Obamacare to 'explode'

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    Americans who get their health insurance through the exchanges set up by the Affordable Care Act may have more difficulty finding a doctor next year, but it won’t necessarily have anything to do with insurers leaving the system.

    It could be because the Trump administration earlier this year quietly announced that it is dropping federal review of something called “network adequacy” in deference to state regulators.

    When implementation of the ACA began in 2014, health care researchers immediately noticed that the insurers offering plans on the exchanges were pursuing what they called a “narrow network” strategy. That meant that they were keeping the web of care and service providers considered “in-network” as small as possible to lower costs.

    The law requires insurers who want to sell their policies through the exchanges to “maintain a network that is sufficient in number and types of providers, including providers that specialize in mental health and substance use disorder services, to assure that all services will be accessible to enrollees without unreasonable delay.”

    The Obama administration, over the next few years, found that insurers were not always complying with those requirements — at least not in a way that the administration believed the law intended — and began placing new requirements on them. Among other things, the Obama Department of Health and Human Services worked up a requirement under which medical professionals in particular fields had to be within specific geographic range of 90 percent of the people covered by a qualifying plan.

    In a Federal Register filing in February, the Department of Health and Human Services announced that determinations of network adequacy would be left to the states going forward. States that don’t have the capacity to set network adequacy on their own would be expected to revert to the standard used in 2014, before the Obama administration added additional requirements.

    doctors performing surgery

    Health care experts have expressed concern that the reduced level of federal scrutiny will create an atmosphere in which insurers can continue to narrow their networks.

    “While the future of the ACA’s marketplaces remains uncertain, insurers are likely to continue to push the envelope towards narrower provider networks in order to deliver more competitive premiums for consumers,” wrote Sabrina Corlette, a research professor at the Center on Health Insurance Reforms at Georgetown University's Health Policy Institute. “And while many consumers have shown willingness to trade a broad choice of providers for a lower price, overly narrow networks could impinge on their ability to access care in a timely way.”

    While some states have the capacity to police insurance companies to assure that coverage is accessible to consumers, Corlette warned, not all of them do.

    “Some states do not conduct network adequacy reviews; in these states, [the federal Center for Consumer Information and Insurance Oversight] has done them. It remains to be seen, in the absence of federal oversight, whether these states will have the capacity or willingness to take on a more expanded role. Accreditation alone will not assure that consumers have access to plans with adequate provider networks.”

    SEE ALSO: Mark Cuban says healthcare 'should be a right'

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    WASHINGTON/SAN FRANCISCO (Reuters) -  To stop President Donald Trump from undermining Obamacare, Democratic Massachusetts Attorney General Maura Healey is considering an approach that has worked against the administration on immigration: using Trump's own words against him.

    Trump said he would let the Affordable Care Act "explode" after Republicans failed last month to pass their own repeal bill in Congress, and told the Wall Street Journal on Wednesday that he may withhold billions of dollars of payments to insurers to force Democrats to negotiate on healthcare.

    Public statements like that led to judges blocking Trump's proposed travel bans earlier this year, and could prove to be one line of attack in legal attempts to protect the healthcare bill, according to a handful of liberal U.S. lawyers and state attorneys general. They said they are waiting to see what action the administration ultimately takes on the healthcare law before they will officially respond.

    Democratic attorneys general took a lead role to successfully block Trump's executive orders restricting travel from some Muslim-majority countries, and are also resisting efforts to roll back environmental regulations.

    Now, the threat of potential litigation over the healthcare law from states, which takes a page from the Republicans' playbook during the Obama administration, is complicating the Trump administration's efforts to formulate its own approach on health policy outside congressional legislation, according to two conservative lobbyists briefed on internal discussions.

    Maura Healey Eric Schneiderman

    The White House maintains that the healthcare law is "already collapsing on its own, and will continue to go in the wrong direction as more Americans face skyrocketing premiums, higher deductibles, and less choice," an administration spokesman told Reuters. "President Trump and his administration are committed to working with Congress to repeal and replace Obamacare."

    Noting that several federal judges cited Trump's comments on Muslims to support the idea that his executive orders unconstitutionally targeted a religious group, Massachusetts AG Healey said Trump is legally bound to enforce the ACA. But his words make it clear he is willing to sabotage it, in her view.

    "He is intent on setting the dynamite and blowing this up," Healey told Reuters.

    She said it is too early to speculate about specific legal action but said Trump's remarks about the law "suggest he is out there not just hoping that it fails but working to see it fail."

    In addition to Healey, Democratic attorneys general for California, Connecticut and the District of Columbia told Reuters they are closely monitoring the administration for any signs it is undermining the ACA.

    The California attorney general's office recently hired a health policy expert, Melanie Fontes Rainer, who worked for Democrats in the U.S. Senate. California Attorney General Xavier Becerra said in a statement his office is "leaning forward when it comes to protecting our people's right to affordable, quality health care."

    Four private lawyers in Washington D.C. said they have discussed possible challenges among themselves and potential clients who have benefited from the law. One such legal challenge being discussed is suing the Trump administration for failing to abide by the "take care clause," which requires that the president faithfully execute laws enacted by Congress, according to Deepak Gupta, a Washington lawyer who often works on public interest cases.   

    "That the president is operating in good faith … is pretty critical to how the law works. That good faith is legitimately in question," he said.

    Texas and other states that challenged Obama's executive action seeking to prevent immigrants from being deported cited the take care clause in their lawsuit, claiming he was failing to enforce immigration law.

     'A Playbook That Republicans Wrote'

    Obamacare, former President Barack Obama's signature legislative achievement, enabled 20 million Americans to gain health insurance.

    The new administration could effectively cripple Obamacare with a pending Republican lawsuit over cost-sharing subsidies that was appealed by the Obama administration and put on hold when Trump took office.

    Trump said he may withhold the payments, which help cover out-of-pocket medical costs for low-income people, that Republicans argue must be appropriated by Congress. Proponents of Obamacare say that not funding the subsidies, which amount to about $7 billion a year, would torpedo the law because it would cause insurers to flee the individual market and could leave millions of people without a place to purchase insurance.

    But the administration must weigh whether to fund the subsidies at the risk of being viewed as helping the law succeed, or be blamed - and possibly sued by attorneys general - for the law's demise, according to the lobbyists, who have been briefed on internal discussions.

    "There's a concern that liberal attorneys general would file suits," one lobbyist said. "This is a playbook that Republicans wrote during the Obama administration."

    Obamacare protest

    In some respects, the Trump administration has already taken steps to erode parts of the law.

    It said it will not enforce the individual mandate, the requirement that everyone have health insurance or pay a penalty, which experts say is needed to keep healthy people in the markets and offset more expensive patients. 

    Dave Jones, the California state insurance commissioner, wrote a letter to Trump earlier last month requesting that the administration "stop taking administrative actions which undermine the Affordable Care Act and destabilize health insurance markets across the country."

    Jones is also running for attorney general in California, a heavily Democratic state where fighting the Trump administration is a key political asset.

    If the administration does not enforce the law, "we will certainly look at all our legal options and remedies that might be available," he said.

     

    (Editing by Edward Tobin)

    SEE ALSO: The uninsured rate just ticked up for the first time in a while during Trump's first quarter in office

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    donald trump martin luther king III

    CNN commentator Jeffrey Lord on Thursday compared President Donald Trump's moves to overhaul healthcare to Dr. Martin Luther King Jr., prompting a backlash from a fellow panelist.

    "Think of President Trump as the Martin Luther King of healthcare," Lord, a pro-Trump surrogate, said during an appearance on CNN.

    "When I was a kid, President Kennedy did not want to introduce the civil rights bill because he said it wasn't popular, he didn't have the votes for it, etcetera. Dr. King kept putting people in the streets, in harms way, to put the pressure on so that the bill would be introduced. That's what finally worked," he continued.

    Lord was referring to Trump's suggestion that his administration could stop funding cost-sharing subsidies in the individual insurance marketplaces set up by the Affordable Care Act, also known as Obamacare. These subsidies currently go to insurance companies to allow them to offer lower out-of-pocket costs to low-income Americans.

    Estimates show that pulling funding would increase premiums by nearly 20% over the current projection for next year and could lead to an exodus of insurers form the exchanges.

    Health policy experts have said the move would be potentially devastating for low-income people and the more than 12 million people currently enrolled in health insurance through the Obamacare exchanges. Additionally, they argue the move would effectively fulfill Trump's claims that the market is "collapsing."

    Symone Sanders, the CNN guest opposite Lord and a Democratic activist, pushed back on Lord's claim, saying it was unfair to compare Trump making healthcare more expensive for millions of low-income Americans to the work of King to fight for racial justice in the US.

    "There is no similarity. What Donald Trump is doing is he is in over his head, he doesn't understand healthcare is a complicated issue," Sanders said. "He just arrived here — most of us have been here, thank you — and he doesn't understand that these are people's lives."

    Lord has repeatedly been a source of controversy during his appearances on CNN.

    SEE ALSO: There are a few simple ways Trump could cause Obamacare to 'explode'

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    CNN commentator and Trump surrogate Jeffrey Lord on Thursday compared President Donald Trump's moves to overhaul healthcare to Dr. Martin Luther King Jr., prompting a backlash from a fellow panelist.

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    The Centers for Medicare and Medicaid Services rolled out its final rule for the 2018 healthcare exchanges on Thursday.

    The final rule, an update of changes proposed February 15, included a variety of changes to the indiviudal health insurance marketplaces, including cutting down on the amount of time people have to enroll for plans on the exchanges and allowing insurers to collect unpaid premiums before allowing a patient to sign up the next year.

    "This proposal will take steps to stabilize the Marketplace, provide more flexibility to states and insurers, and give patients access to more coverage options," the CMS’ acting administrator, Patrick Conway, said in a statement. "They will help protect Americans enrolled in the individual and small-group health insurance markets while future reforms are being debated."

    Democrats quickly blasted the changes.

    Rep. Frank Pallone, of New Jersey, the ranking Democrat on the House Energy and Commerce Committee, said the new rule "will not produce any meaningful improvements for the stability of the ACA Marketplace" and said aspects of the rule would prove negative.

    "It's time for the threats and the sabotage to end, and for President Trump to undo the damage he's done to the Marketplaces," Pallone said in a statement. "It's time to work to improve the law."

    Here's a quick rundown of the changes in the CMS rule. It would:

    • Limit the 2018 open-enrollment period to six weeks, half the previous length: Notably, the rule said CMS and the Department of Health and Human Services will continue to spend money on outreach to encourage people to sign up. But the shorter enrollment period — November 1 to December 15 — will most likely result in lower enrollment.
    • Allow insurers to collect unpaid premiums before customers sign up with the same insurer the next year: The CMS release says the rule "will incentivize patients to avoid coverage lapses." It could also discourage those who have a lapse in coverage from signing up the next year, but it could help insurers recoup some of the money lost on the exchanges.
    • Force people to provide further identification to sign up outside the open-enrollment period: To limit the number of people who drop coverage and enroll only when they need it, the CMS rule will force people to give more identification to sign up for the exchanges outside open enrollment. This suggestion was also floated by the Obama administration.
    • Allow insurers to determine the level of their coverage: The actuarial value of a plan is the percent of medical costs a plan would cover. The rule will allow insurers to adjust their actuarial value while still qualifying for the exchanges. In the worst case, that could mean consumers will end up with plans that cost close to the plans offered on the exchanges currently but cover fewer procedures.

    Even with the changes, it is unclear whether the Trump administration will fund cost-sharing reduction payments, which most policy analysts say is key to keeping the market from collapsing.

    SEE ALSO: Report: Trump personally dictated a fiery rebuttal to a New York Times story for his health department

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    Jeff Flake

    Sen. Jeff Flake encountered a raucous audience at a town-hall meeting in Mesa, Arizona, on Thursday night.

    Constituents peppered the Republican lawmaker with questions about President Donald Trump's actions in office and his broader agenda on climate change, the president's taxes, the Supreme Court, and Planned Parenthood.

    Much as with other GOP town halls held since Trump assumed the Oval Office, attendees railed against Flake, many of them accusing him of being a rubber stamp for Trump. Flake, like Reps. Jason Chaffetz and Mike Coffman and Sen. Mitch McConnell before him, tried to answer the audience's concerns, though most explanations drew shouts and boos from the crowd.

    That was especially evident when an audience member asked Flake about Trump's nearly weekly trips to his Mar-a-Lago estate in Florida.

    "Does this concern you at all? Do you approve a budget for these weekly excursions," an unidentified woman asked. "If yes, how much is that? And if no, why do you have no desire to control President Trump's spending or his personal profit from that spending?"

    The audience erupted. Flake answered: "As I mentioned, I wasn't critical of the last president or the president before that for what they do on their time off."

    Jeff Flake town hall April 13 2017

    "That's something we'll deal with when we deal with the budget," Flake said, "but I'm not going to tell the president where he can and cannot spend his weekends."

    Flake often criticized Trump during the 2016 election and dramatically confronted the then-candidate at a closed-door meeting on Capitol Hill in July.

    Though Flake's town hall on Thursday did not appear to have a large presence of demonstrators, as was the case for some high-profile members of Congress in recent months, Flake at times struggled to contend with fits of chanting and jeering from the crowd at the Mesa Convention Center.

    Jeff Flake town hall April 13 2017

    • "Can you please take your job more seriously, senator? We would appreciate it," one woman asked, displeased with Flake's response to a question about holding Trump accountable.
    • "Three things always come out: the sun, the moon, and the truth — why don't you get in front of those," a man asked, concerning the congressional investigations into potential ties between the Trump campaign and Russia.
    • On a question about Republican leaders' refusal to hold confirmation hearings for Barack Obama's Supreme Court nominee, Merrick Garland, Flake said the move was not without precedent. A man in the audience shouted, "Bulls---!" as the crowd chanted "shame on you."
    • "When do you feel like you'll have the backbone or conviction to put country over party and impeach him," a man asked Flake of Trump. "I don't care for Mike Pence either, but he's not as dangerous as Trump," the man said.

    Not all of the questions were hostile, and some constituents applauded Flake for sharing his time. The senator extended the meeting by one hour to take more questions, but the mood frequently returned to a bitter note. "Can you just remind me when you're up for reelection," one woman asked. The audience erupted in cheers at the question.

    Flake replied: "I think everybody knows."

    You can watch the entire meeting below:

    SEE ALSO: Tensions between the US and North Korea are ramping up amid nuclear threats

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    WASHINGTON (AP) — "Obamacare" is proving more of a challenge than the Trump administration bargained for.

    With the "repeal and replace" effort at an impasse on Capitol Hill, the administration released on Thursday a set of fixes to stabilize the Affordable Care Act's shaky insurance markets for next year. But the insurance industry quickly said the changes don't go far enough.

    While calling the administration action a step in the right direction, the industry is looking for a guarantee that the government will also keep paying billions in "cost-sharing" subsidies that help consumers with high deductibles. President Donald Trump says he hasn't made up his mind on that.

    Republicans contend that the Affordable Care Act, or ACA, is beyond repair, but their "repeal and replace" slogan hasn't been easy to put into practice, or politically popular. So the administration is trying to keep the existing system going temporarily as it pursues a total remake.

    Many of the changes follow recommendations from insurers, who wanted the government to address shortcomings with HealthCare.gov markets, including complaints that some people are gaming the system by signing up only when they get sick, and then dropping out after being treated.

    But the White House remained mum on the biggest concern. Insurers, doctors, hospitals and the business community have asked Trump to preserve ACA cost-sharing subsidies that pare down high deductibles and copayments for consumers with modest incomes. They're separate from the better-known premium subsidies that most customers receive.

    "There is still too much instability and uncertainty in this market," Marilyn Tavenner, president of America's Health Insurance Plans and the industry's top lobbyist, said in a statement. "Health plans and the consumers they serve need to know that funding for cost-sharing reduction subsidies will continue uninterrupted."

    Estimated at $7 billion this year, the subsidies are under a legal cloud. Without the payments, experts say, the government marketplaces that provide private insurance for about 12 million people will be overwhelmed by premium increases and insurer departures.

    In a Wall Street Journal interview this week, Trump raised the possibility of shutting off the money if Democrats won't bargain on health care. But the president also said he hasn't made up his mind, and that he doesn't want people to get hurt.

    House Democratic leader Nancy Pelosi of California called that an "appalling threat." Democrats are now demanding that the issue be addressed in a must-pass spending bill due at the end of the month. The new administration has continued to make cost-sharing payments to insurers as it weighs options.

    nancy pelosi

    The changes announced Thursday include:

    —A shortened sign-up window of 45 days, starting with coverage for 2018. That's about half as long as the current open enrollment season.

    —Curbs on "special enrollment periods" that allow consumers to sign up outside the normal open enrollment window. Insurers say these have been too easily granted, allowing some people to sign up only when they need costly treatment.

    —Allowing an insurer to collect past debt for unpaid premiums from the prior 12 months before applying a consumer's payments to a new policy.

    —Giving insurers more flexibility to design low-premium plans that can be tailored to young adults.

    "The bottom line is that while the final rule addresses some of the challenges in the market, I think the reaction will be that it doesn't go far enough," said Cara Kelly, a vice president at the consulting firm Avalere Health.

    The changes come as insurers are figuring out their plans for 2018.

    Consumers likely won't know for certain what sort of choices they will have until late summer or early fall, a couple of months before open enrollment begins.

    This year saw premium increases averaging 25 percent for a standard plan in states served by HealthCare.gov. Some insurers say they've lost hundreds of millions of dollars, and many have pulled back or are considering it.

    Most communities will have competing insurers on the public marketplace next year, but a growing number will be down to one, and some areas may face having none.

    All eyes are now on Anthem, a big Blue Cross-Blue Shield insurer operating in several states that has yet to announce its intentions for 2018. CEO Joseph Swedish has said his company would not commit to participating next year. Swedish and other insurance officials have said the government has to stabilize the marketplaces.

    Dave Dillion of the Society of Actuaries says growth in underlying medical expenses could drive coverage prices up another 10 percent or more.

    Nonetheless, the nonpartisan Congressional Budget Office says the ACA markets will be stable next year in most areas.

    In Washington, Republicans are trying to resolve an impasse between hard-liners and moderates that has prevented them from getting their own health care bill through the House.

    Meanwhile, the legal issue over the cost-sharing subsidies remains in limbo. A U.S. District Court judge found that Congress did not specifically authorize the payments, making the expenditure unconstitutional. The case is on hold. Congress could approve the money, but that would be a politically difficult vote for Republicans.

    ___

    Murphy reported from Indianapolis.

    SEE ALSO: The Trump administration just rolled out big changes to Obamacare

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