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The latest news on Obamacare from Business Insider

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    The Affordable Care Act (ACA), also known as Obamacare, faces an uncertain future.

    Despite the failure of the American Health Care Act, the Republican bill which would have repealed and replaced the ACA, President Donald Trump has made moves regarding the administration of the ACA that could undermine the law.

    The ACA, however, also had issues before it fell into Trump's cross hairs. For one thing, the mix of people signing up for insurance on the ACA's individual insurance exchanges was leading to large losses for insurance companies, with more older and sicker patients and fewer younger and healthier enrollees than expected. These insurers, facing continued losses, began to pull their plans from the exchanges.

    Data from the Department of Health and Human Services laid this dilemma out clearly by showing the number of insurance companies that yanked their plans from each states' exchange between the 2016 and 2017 plan years.

    25 of the 38 states with exchanges run through the federal platform had a decrease in the number of insurers on their exchanges in 2017. 

    Large states like Ohio, Pennsylvania, Texas, and Arizona led the way in terms of insurer losses. Interestingly, Ohio, Arizona, and Pennsylvania were all swing states in the 2016 election that broke for Trump.

    By contrast only two states — Maine and Iowa — saw an increase in the number of insurers.

    While this isn't necessarily a death knell for these exchanges, it is a worrying trend that will only get exacerbated by the political uncertainty surrounding these marketplaces.

    obamacare change in number of insurers

    SEE ALSO: Trump is playing a dangerous game of chicken with Democrats that could cause healthcare costs to skyrocket

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    prescription, medication, pharmaceuticals, pills, medicine

    Non-adherence to prescription drugs poses a greater and more costly threat to our health than any of the most common diseases currently plaguing millions of Americans.

    The phenomenon currently takes around 125,000 lives and costs the medical community somewhere between $100-289 billion a year. The problem is rather pervasive, with over 50 percent of patients neglecting their prescription schedules and has the potential to get worse. Nearly half of all Americans over the age of 12 use some type of prescription drug, the Centers for Disease Control and Prevention reports.

    Patients have a variety of reasons for not strictly following their doctor’s orders, with the high-cost of many prescription medications being the chief complaint.

    Research estimates that up to 15 percent of non-adherence is due to the cost. A patients sees a high-stick price and decides they can forgo the medication. Consumers have a legitimate reason with the cost argument, as co-pays for some drugs can run as high as $100 a prescription, Kaiser Family Foundation reports.

    The marketplace is difficult to navigate and adds to why consumers shy away from taking their medications.

    Obamacare created a system of stratified health plans which, in turn, created drug tiers. These tiers pushed higher price drugs into groups with lower levels of coverage, and forced the majority of consumers into the least expensive drugs in each tier. In the majority of cases, the system also forces consumers to first prove that the generic medications are not effective before moving to more expensive, non-generic forms.

    Still, there are some other reasons patients stop taking their medications that are rather finicky. Some 34 percent of patients were likely to stop taking their pills if there was a sudden change in its color, according to a 2014 study out of the Annals of Internal Medicine. While 66 percent were more likely to stop taking their medication after a pill changed shape.

    A pharmacy employee looks for medication as she works to fill a prescription while working at a pharmacy in New York December 23, 2009. REUTERS/Lucas Jackson

    There is not much that President Donald Trump and lawmakers could do to change consumer preferences regarding the shape and size of a medication, but they could address the cost and access problems.

    Trump met with executives from the pharmaceutical industry in January at the White House to discuss ways to lower the exponentially increasing drug prices in the US Trump told the executives that "we have to lower drug prices," increase research and development spending, and massively deregulate the pharmaceutical industry to lower barriers for entry of new drugs to the market.

    Democrats are signaling their readiness to work with the president on combating rising drug prices.

    The president continued the conversation in early-March with Democratic Reps. Elijah Cummings of Maryland and Peter Welch of Vermont in a private White House meeting. The congressmen were enthusiastic following the meeting, saying Trump was "aware of the problem." The pair left the president with a bill proposal that would expand the federal government’s capacity to negotiate drug prices.

    Democratic Sen. Bernie Sanders of Vermont has also expressed his willingness to get behind Trump in fighting the pharmaceutical industry. "Let’s work together. Let’s end the absurdity of Americans paying by far the highest prices in the world for prescription drugs," Sanders told reporters.

    The president and congressional leadership attempted to address the problems with the Obamacare system in the American Health Care Act (AHCA), which was pulled just hours before it was slated to go up for a vote on the House floor in March. Trump promises that health care reform is his administration’s first priority, and that tax reform and his other pro-growth policies will take a backseat.

    Congress is on its first two-week recess and will not reconvene until April 25. Whatever Trump chooses to do with Obamacare reform likely have to wait until lawmakers return to Washington.

    SEE ALSO: The 10 most popular prescription drugs in the US

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    doctor smile happy

    UnitedHealth Group posted stronger-than-expected earnings Tuesday in the first quarter without the bulk of its Affordable Care Act-compatible individual health-insurance business.

    The insurance giant earned $2.37 a share, higher than the $2.17 expected by analysts. It also generated $48.7 billion in revenue, higher than the $48.3 billion that analysts were anticipating.

    UnitedHealth also raised its guidance for both profit and revenue for the year. The insurer now sees full-year EPS of $9.65 to $9.85 a share, higher than the expected $9.51 a share.

    This was the first quarter in which UnitedHealth rolled back most of its plans from the exchanges established by the ACA, the healthcare law better known as Obamacare. The company said the rollback slowed revenue growth and the number of lives covered.

    "UnitedHealthcare's withdrawal from ACA Individual markets, combined with the 2017 health insurance tax deferral, reduced consolidated first quarter 2017 revenues by approximately $1.6 billion and lowered the revenue growth rate by 4.1 percent," the release from UnitedHealth said.

    The company also said it dropped 765,000 people through the ACA market, partially offsetting the addition of 1.5 million customers through other lines of business.

    Following the release, UnitedHealth's stock was up 2.25% in premarket trading to $170.95 as of 6:35 a.m. ET.

    SEE ALSO: Here's how many insurers ditched each state's Obamacare exchanges in 2017

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    trump stephen hemsley

    Even the CEO of the US' largest health insurer by number of people covered has no more insight into the tumultuous healthcare fight than anyone else, he told analysts during the insurer's first-quarter earnings call

    "It's probably not often we say this but if you really have actually been following the media with respect to healthcare policy, I would say the media has been very accurate with respect to the narrative that is going on there," UnitedHealth Group CEO Stephen Hemsley said.

    Hemsley also said UnitedHealth executives previously "engaged" with lawmakers about the details of the plan, but the American Health Care Act went through constant upheaval during its short lifespan.

    The AHCA underwent rapid transitions over its month-long existence, as leaders added provisions to try and make it more popular with conservative Republicans. In fact, at one point during the White House's attempt to revive the AHCA after the initial vote's failure, it appeared that the moderate and conservative sides of the House GOP conference were told two different things by Vice President Mike Pence, and no one was sure what was actually being proposed.

    With Congress on a two week recess, it appears that little progress has been made toward reviving the AHCA, despite the sizable Republican majority in both chambers of Congress.

    "So, if you're following the media, generally speaking, you would be up to speed," Hemsley told analysts. "We couldn't probably offer any more insights than that."

    The UnitedHealth CEO said the insurers' executives are committed to working with lawmakers and had some details they wanted included, but did not have any real update on the progress of the AHCA.

    SEE ALSO: UnitedHealth crushes earnings in its first quarter since dumping most of its Obamacare business

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    UnitedHealthcare Group’s quarterly profit skyrocketed after the insurance provider drastically downsized its participation in the Obamacare exchanges.

    The company’s profit rose by 35 percent in the first-quarter of 2017, and expanded nearly every aspect of its operation, including its participation in Medicare Advantage and Medicaid plans, The Associated Press reports.

    In total, UnitedHealth brought in $2.17 billion in first-quarter earnings, with $48.72 billion in revenue. Shares of UnitedHealth are up 1.08 percent as of 2:12 p.m. Tuesday afternoon.

    UnitedHealth’s operating income also rose outside of its health insurance offerings. The company experienced a 16 percent bump in operating earnings from Optum, another facet of UnitedHealth. Optum provides it with pharmacy benefits management and technological capabilities, as well as a network of doctor and clinical offices.

    Following what amounted to a $475 million loss from participating in the exchanges in 2015, UnitedHealth announced in April 2016, that it would back out of all but a "handful" in 2017. The group expected to lose as much as $800 million in 2016.

    "The smaller overall market size and shorter term, higher-risk profile within this market segment continue to suggest we cannot broadly serve it on an effective and sustained basis," UnitedHealthcare Group CEO Stephen Hemsley told reporters in 2016. "Next year, we will remain in only a handful of states, and we will not carry financial exposure from exchanges into 2017."

    UnitedHealth is not alone. Insurance providers Aetna and Humana are also leaving the exchanges.

    Aetna announced in August 2016, that it would stop offering plans on 11 of the 15 Obamacare exchanges where it currently operates.  The company reports losing $430 billion through participating in exchanges since 2014.

    Humana became the first insurance provider to completely opt out altogether in February, announcing it would no longer offer health insurance plans on state exchanges in 2018.

    SEE ALSO: A startup CEO who watched his 84-year-old mother struggle after leaving the hospital is on a mission to change healthcare from the 'inside out'

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    Donald Trump Paul Ryan

    The White House is considering reviving the American Health Care Act — again — according to a CNN report Wednesday.

    Sources close to the process told CNN's Jim Acosta and Elizabeth Landers that the Trump administration has attempted to make progress on the plan to repeal and replace Obamacare before Trump's 100th day in office, which comes next week.

    An administration official told CNN that they "don't think it's impossible to think we'll have a vote" in the next week on the AHCA, but that differences in the House GOP conference could still derail the attempt.

    Additionally, during a question and answer session in London on Wednesday House Speaker Paul Ryan said the House GOP was putting the "finishing touches" on the bill according to CNN's Deirdre Walsh.

    The AHCA, which became colloquially known as "Trumpcare,"hit a wall just three weeks after its introduction, when conservative Republicans in the House said they would not vote for the bill because it did not go far enough in repealing Obamacare. On the other end, more moderate Republicans worried about projected coverage losses under the AHCA and its cuts to Medicaid funding.

    These disagreements led to a decision by Ryan and Trump to pull the bill from the House floor just minutes before a scheduled vote.

    Vice President Mike Pence and White House officials even tried to revive the bill after it was pulled, negotiating with the conservative House Freedom Caucus and moderate Tuesday Group to try and find common ground. That attempt at compromise also collapsed.

    Trump's team previously pushed for a show of progress just before the two week congressional recess. On April 6, the House Rules Committee approved an amendment to the AHCA that would add "invisible risk pools" to help offset insurers' costs for covering sicker Americans.

    Trump and administration officials have begun to discuss the healthcare bill in interviews over the past week, hinting that they may be ready to give the AHCA another try.

    Adding another element to the discussions is the looming threat of a government shutdown. If a funding bill is not passed by next Friday — just five days after lawmakers return to Capitol Hill — the federal government will partially shut down.

    SEE ALSO: Trump's team is considering a controversial plan that could make his promise to cut taxes harder to keep

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    Paul Ryan

    Republicans are closing in on a deal to try — again — to push their plan to repeal and replace Obamacare through the House.

    The compromise, first reported by Matt Fuller and Jonathan Cohn at The Huffington Post, would allow states to obtain a waiver from the federal government to do away with certain protections from the Affordable Care Act, aka Obamacare.

    According to The Huffington Post, the deal would initially keep two provisions — essential health benefits and community rating — favored by moderate GOP lawmakers but allow states to waive these protections. In order to waive the protections, states would have to fulfill two provisions: prove that the waiver would bring down costs and either join a federal high-risk pool or establish their own.

    The full text of the proposed amendment, obtained by Politico's Jake Sherman and Anna Palmer, states that the waiver would be granted by the federal government if the state can prove that it has an alternative to "reduce premium costs, increase the number of persons with healthcare coverage, or advance another benefit to the public interest in the state."

    Essential health benefits require insurers to cover a baseline of health procedures such as prenatal care and emergency room visits. Community rating means that insurers must charge people living in the same area the same price for insurance regardless of things such as age, gender, or preexisting conditions.

    "The gist of this is that federal protections for pre-existing conditions and required benefits remain...unless a state doesn't want them to,"tweeted Larry Levitt, senior vice president at health policy think thank The Kaiser Family Foundation on Thursday.

    Without the community rating, insurers could charge people with preexisting conditions higher premiums and some policy experts fear this could price sick people out of the market.

    However, this means that the Trump administration, most likely Secretary of Health and Human Services Tom Price, would have final say on whether or not a waiver is granted.

    While the deal was reportedly reached by conservative House Freedom Caucus chair Rep. Mark Meadows and moderate Tuesday Group chair Rep. Tom MacArthur, it also bears similarities to a previous deal that drew the ire of moderates for going too far in pulling back protections.

    Additionally, it does not address the concerns of moderates such as the defunding of Medicaid expansion or the estimates that the Affordable Health Care Act could leave up to 24 million fewer people without health coverage over the next 10 years.

    The Washington Post's Robert Costa reported after the amendment's outline was leaked that the GOP leadership is planning to release the exact language for the amendment later on Thursday and are targeting Wednesday for a vote on the revised bill, but that could change.

    According to CNBC, a Freedom Caucus source said the changes would bring 18 to 20 members of the group who were originally against the AHCA over to a "yes" vote on the bill. It is unclear how many moderate Republicans would shift to a "no."By most accounts the House GOP was as many as 33 votes short of the needed number when the AHCA went to the House floor on March 24.

    The amendment comes the day after reports that the White House was pushing for a deal to be completed by the end of next week in order to show progress during Trump's first 100 days as president. Additionally, House Speaker Paul Ryan said in London on Wednesday that the GOP was putting the "finishing touches" on an Obamacare deal.

    Passing the AHCA, even with the proposed changes, would be difficult in the short-term as Congress must also pass a bill to fund the federal government before parts of it shut down on April 28.

    Read the full summary of the amendment, via Politico (PDF) »

    SEE ALSO: The White House is reportedly considering another stab at 'Trumpcare'

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    Paul Ryan donald trump

    The developing plan from House Republicans to push forward their overhaul of the US healthcare system has one big problem: timing.

    According to reports, the White House is pushing to get a deal done on the American Health Care Act by April 28 to show progress on their pledge to repeal and replace Obamacare during President Donald Trump's first 100 days. 

    A new amendment leaked Wednesday night appears to be a compromise between the leaders of the conservative House Freedom Caucus and moderate Tuesday Group that could produce some movement on the bill in that timeframe.

    But Congress faces another looming deadline by April 28: funding the federal government. If no new funding bill is passed by next Friday, parts of the federal government will shut down.

    Washington is not known for multitasking, and it could be difficult to get a funding bill passed as the White House and lawmakers push to add policy proposals to the funding bill. Given the political ramifications of the issue, the shutdown fight could consume the calendar.

    According to Politico, the White House and Congress are considering passage of a one-week extension on funding in order to hash out a more considered funding bill and possibly give the House time to take up the AHCA, which became colloquially known as "Trumpcare."

    Barring such an extension, however, it would be highly unlikely that the American Health Care Act moves forward before Trump's 100th day in the Oval Office.

    SEE ALSO: Here's the plan for Trumpcare 3.0

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    Donald Trump Paul Ryan

    House Republicans' healthcare-reform plan has been revived as Congress prepares to return from a two-week break next week. But a divide has emerged between the White House and congressional Republican leaders about its chance of passing.

    The White House reportedly wants to get a revised version of the American Health Care Act through the House by April 28 to show progress on one of President Donald Trump's biggest campaign promises — repeal and replace the Affordable Care Act, better known as Obamacare — by his 100th day in office.

    The original bill was pulled from the House in late March before a vote.

    Senior White House officials have said they believe a vote could take place next week and are aiming for Wednesday.

    According to Politico's Adam Cancryn and Josh Dawsey, the White House believes it is close to having the votes needed to pass the bill through the House.

    House GOP leaders aren't singing the same tune.

    A senior GOP aide told Business Insider that congressional leaders were not sure whether the bill, even with the adjustments, had enough support to get through the House.

    "The question is whether it can get 216 votes in the House, and the answer isn't clear at this time," the aide said. "There is no legislative text and therefore no agreement to do a whip count on."

    The aide also told Business Insider that a strategy call scheduled for Saturday was a typical procedure coming back from a recess.

    A proposed amendment leaked Wednesday is an attempt to bridge the gap between moderate House Republicans in the Tuesday Group and conservative lawmakers in the House Freedom Caucus to generate enough votes to pass the bill.

    A Freedom Caucus source told Business Insider that 15 to 20 members who were against the original AHCA could back the bill if the proposed changes were added but said members were "cautious until we actually have text."

    However, the changes — mainly the ability for states to get a waiver to eliminate so-called essential health benefits and the community rating — may drive away moderates in the Republican conference who believe they would hurt people with preexisting conditions.

    Before the planned vote on the original bill, which was scrapped at the last minute, The New York Times estimated 33 Republicans had publicly come out against it. Republicans can afford only 22 defections in the House to pass the bill.

    SEE ALSO: Here's the plan that some Republican leaders think will get their Obamacare repeal bill to pass

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    donald trump

    A GOP lawmaker thinks the dreaded "swamp" may have stopped President Donald Trump from repealing Obamacare.

    Rep. David Brat of Virginia, a conservative member of the House Freedom Caucus, told CNN on Friday that "something in the swamp" was holding up Trump's promise to repeal Obamacare, formally the Affordable Care Act, as soon as he took office.

    Brat said the American Health Care Act, the bill to repeal and replace Obamacare, was close to completion but was sidetracked by "the swamp of special interests."

    "President Trump was very good in the negotiating process," Brat said. "He said yes, [the Freedom Caucus] said yes to him, and then somehow something in the swamp said no, so we waited another couple of weeks."

    Brat was referencing the president's promise during the campaign to "drain the swamp" of the so-called establishment and special interests.

    The AHCA was pulled from the House on March 24 after conservative Freedom Caucus members and moderate Republicans could not come to an agreement on the framework of the bill. Trump and House Speaker Paul Ryan reversed course minutes before a scheduled vote, after it became clear that not enough GOP representatives supported the bill.

    Since then, the White House has tried to bridge the gap to no avail. But a proposed amendment that circulated Thursday could bring Freedom Caucus members on board with the AHCA.

    White House sources indicated that they wanted a vote on the updated version of the AHCA as early as next week, a prospect Brat said he would favor. But GOP congressional leaders have been skeptical of that timeline.

    Brat had publicly said he would not vote for the original installment of the AHCA.

    Watch the full interview, via CNN:

    SEE ALSO: The White House and Congress seem to be on completely different pages on their healthcare revival

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    mick mulvaney

    As the possibility of a government shutdown looms, the horse trading over what to include in a funding bill has begun in earnest.

    Office of Management and Budget Director Mick Mulvaney said at a Bloomberg Live event on Friday that for every $1 in funding that goes toward a border wall in the funding bill, the Trump administration would put $1 of funding toward Obamacare.

    "We'd offer them $1 of CSR payments for $1 of wall payments. Right now that's the offer that we've given to our Democratic colleagues,"Mulvaney said.

    Mulvaney was referring to cost-sharing reduction payments, which are provided in the Affordable Care Act to insurers to help offset higher costs associated with covering lower-income Americans without prohibitively high deductibles. Without the payments, most health policy experts agree that the Obamacare individual insurance exchanges would see skyrocketing costs and fewer insurer offerings.

    Democrats strongly objected to Mulvaney's proposal, with Senate Minority Leader Chuck Schumer's office likening the idea to a hostage situation.

    "The White House gambit to hold hostage health care for millions of Americans, in order to force American taxpayers to foot the bill for a wall that the President said would be paid for by Mexico is a complete non-starter," a Schumer spokesman said in a statement.

    "The US government is supposed to take care of its citizens and, according to the President, Mexico is supposed to pay for the wall. If the administration would drop their 11th hour demand for a wall that Democrats, and a good number of Republicans oppose, Congressional leaders could quickly reach a deal."

    The federal government will partially shut down Friday if Congress does not pass a bill to keep the government funded.

    SEE ALSO: GOP congressman: 'Something in the swamp' stopped Trump from repealing Obamacare

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    donald trump

    During a meeting with conservative opponents of his healthcare-reform bill, President Donald Trump asked them to paint a rosier picture to the press about the bill, according to a Washington Post report published on Sunday.

    "I know you have already said it's a bad deal, but Kellyanne is going to walk you out to the microphones and I'd love it if you could say it's great," Trump said after the meeting, according to The Post. Kellyanne Conway is the counselor to the president.

    Although the people at the meeting did not ultimately endorse the American Health Care Act, the bill to repeal and replace Obamacare that Trump and Republican leadership had introduced, they "were polite and took pains not to criticize Trump himself," the report said.

    Despite not supporting the bill, they continued to praise the president for what they said was his openness to dialogue and healthy debate, according to the report.

    The AHCA was pulled from the floor of the House before a vote because Republicans were not able to drum up enough support for it amid disagreements between conservatives and moderates.

    Trump is a frequent consumer of cable news, often praising networks that broadcast favorable coverage of him, while blasting those that are more critical as "fake news."

    Check out the full report »

    SEE ALSO: Nearly 100 days into his presidency, Trump is still a voracious consumer of cable news

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    trump protest

    Despite a recent loss in a special House race in Kansas, liberal voters and operatives have become energized about their chances in a coming runoff in Georgia's 6th District, a May special election in Montana, and the party's overall chances at flipping multiple House seats in the 2018 midterms and reducing the GOP's 44-seat majority in the House.

    Rachel Paule, a grassroots organizer in Georgia, told Business Insider that the biggest indicator she had seen of local Democratic sentiments was the number of "secret liberals who have come out of the woodwork" since President Donald Trump's victory in the 2016 election.

    The district in which Paule volunteers has been held by a Republican for the past 40 years — most recently by Tom Price before he became secretary of health and human services. But the race to fill Price's seat has been dominated by the rise of former congressional staffer Jon Ossoff as a serious Democratic contender.

    A Republican congressman "was just sort of a given, and a lot of people were afraid to speak out because this is such a conservative area," Paule said of Georgia's 6th District.

    Ossoff's candidacy spurred Paule and her fellow organizers into action, in large part because many saw Ossoff as their "first chance" to "make a meaningful change by flipping the seat," Paul said, adding that the most recent Democratic candidate in the district didn't campaign, have a website, take donations, or make appearances.

    In a field crowded with Republicans, Ossoff failed to break the 50% threshold in a vote last week needed to avoid a runoff. A runoff for the special election is now set for June 20.

    Nonetheless, the Democratic Party is ecstatic about the results — Ossoff received about 48% of the vote, while his closest Republican challenger, Karen Handel, Georgia's former secretary of state, earned about 20%.

    "What people have to understand is that Republicans had almost no spin coming out of Georgia," a Democratic Congressional Campaign Committee staffer told Business Insider in an interview.

    "They said Ossoff would never make it above 40%. In a district that Republicans usually win by 20, 26%, Ossoff got 48.1," the source said. "It's incredible."

    Jon Ossoff

    Paule said she and other liberals in the community were "really excited" about the results and the campaign so far had been "really inspiring."

    Leading up to the runoff between Ossoff and Handel, Paule said, she and other volunteers were focusing primarily on canvassing.

    "What we really need are people hitting the pavement," Paule said. "We need people to knock on doors at every corner of the district, people to call voters, and more face-to-face contact to ensure they come out in droves this June."

    Democrats are also hopeful that Ossoff can exploit potential weaknesses they believe Handel possesses among suburban conservative voters. A spike in Democratic turnout and a decrease in GOP turnout could swing the district Ossoff's way come June.

    "She's known for waging ideological wars, and she was a big spender when she was [Georgia's] secretary of state," the DCCC source said. "That's the kind of stuff that turns off Republicans who are fiscally conservative."

    On to Montana

    Ossoff's campaign, especially if he's successful in the runoff, could become something of a model for Democrats over the next year and into the 2018 midterm elections, according to the DCCC staffer, who described Republicans as being "stuck between a rock and a hard place."

    Democrats are hopeful that voter enthusiasm against Trump and strong grassroots organizing could swing congressional races if discontent over the GOP's lack of effectiveness in Washington decreases Republican turnout.

    Democrats in Montana are similarly looking to capitalize on liberal anger and potential conservative apathy by running Rob Quist, a folk singer with a populist streak, for Montana's House seat in the May special election.

    While Quist's first rally in Montana in March drew about 70 people, recent rallies have seen hundreds of attendees, according to The Huffington Post.

    Washington Democrats initially paid little, if any, attention to the race, which is being held to fill the seat left vacant by Interior Secretary Ryan Zinke. When The Huffington Post asked Rep. Jim Clyburn, of South Carolina, the DCCC's national mobilization chair, if the committee was planning on getting more involved, Clyburn didn't seem to even know the race was happening.

    But after Democrats' surprisingly strong showings in Kansas and Georgia, the DCCC feels differently about Quist's chances in Montana.

    "We're actually watching it really closely," the DCCC source said. The committee announced that it would be injecting a six-figure amount into the Montana state party to boost Quist's campaign, DCCC spokeswoman Meredith Kelly told The Huffington Post on Thursday.

    After a close call in Georgia's special election, the NRCC also poured $1.2 million in ad buys ahead of Montana's special election.

    The energy gap

    Donald Trump

    While Democrats say the remaining 2017 special elections and the 2018 midterms will be a dogfight, Republicans have been wary of a shifting tide in the political sentiment in the country.

    A Republican operative familiar with the races said a major concern for the GOP was that the party's base could be complacent after Trump's victory.

    "The energy we've seen, there's been a slight downtick, which I think is natural coming off a very contentious election that we won,"the operative told Business Insider before the first round of the Georgia special election.

    The operative added that the liberal opposition to Trump was "energized from the get-go" and would be out in full force for the next few elections. Republicans will have to ensure their base is, as the operative said, "reengaged."

    Republicans have also seen the energy with which Democrats have raised money for special elections. Ossoff hauled in approximately $8.3 million in the first quarter of 2017.

    "You see $8.3 million, that's a significant chunk that somebody can run in their district," said a GOP operative who was familiar with the race. "Essentially, that's what somebody usually raises for a statewide campaign, not an off-year, early special election."

    The operative also said he hadn't seen previous fundraising efforts come close to Ossoff's war chest, saying Ossoff's donations came from liberals who were "fired up" about Trump.

    "That's very clear. The liberal base dislikes Donald Trump."

    The DCCC raised a record $13.6 million in online donations in the first quarter, compared with its Republican counterpart's $1.7 million in online donations. The NRCC still outpaced the DCCC in overall donations, however, raising $36 million compared with the DCCC's $31 million.

    Nevertheless, Democrats are focused on drawing out liberals who are angry with Trump and concentrating on what they characterize as the administration's missteps.

    'Business as usual'

    Donald Trump and Paul Ryan

    The first few months of Trump's presidency have been rocky for Trump and his party, whose progress has been hindered by White House infighting, failed attempts at implementing a travel ban, and a failure to repeal and replace President Barack Obama's signature healthcare law.

    Though Trump and Republican leadership were working hard to drum up support for the American Health Care Act, the new healthcare bill, in March, many conservatives in Congress faced angry constituents who demanded they vote against the AHCA and keep the Affordable Care Act in place while working to amend it.

    During a town hall held by Republican Sen. Chuck Grassley, constituents came out in force against the AHCA.

    "I'm on Obamacare. If it wasn't for Obamacare, we wouldn't be able to afford insurance," said Chris Peterson, a farmer from Grassley's state. "With all due respect, sir, you're the man that talked about the death panel. We're going to create one big death panel in this country if people can't afford insurance."

    Republican Rep. David Brat of Virginia faced similar outrage from his constituents for claiming the ACA had "collapsed."

    Some of Trump's core voters have become disaffected since Trump took office in January. His authorization of a military strike against forces of Syrian President Bashar Assad following a devastating chemical weapons attack infuriated some supporters who had voted for Trump because of the isolationist "America First" stance he had adopted throughout his campaign.

    "Trump campaigned on not getting involved in Mideast. Said it always helps our enemies & creates more refugees. Then he saw a picture on TV,"tweeted Ann Coulter, the conservative firebrand who has been an ardent Trump supporter.

    "Everything is going to s---," one former Trump supporter told Business Insider. "Looks like we're back to business as usual."

    And all that has Democrats cautiously optimistic.

    "The preconditions for a good election cycle are there," the DCCC source said. "But it's still early and things can change."

    Maxwell Tani and Allan Smith contributed to this report.

    SEE ALSO: The first test of Democrats' anti-Trump fervor comes today with a huge election in Kansas

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    paul ryan smile

    Republicans have a new plan to revive their overhaul of the healthcare system, and it may bring the party closer to passing their bill.

    An amendment to the American Health Care Act, offered by Rep. Tom MacArthur of New Jersey on Tuesday night, appears to satisfy many demands made by conservatives in the House GOP conference that originally sank the bill. Questions remain, however, over the ability to get moderates on board.

    The new plan is broadly similar to the rough outline leaked Thursday. It opens the possibility of allowing states to opt out of two of the biggest provisions of the Affordable Care Act, the healthcare law better known as Obamacare.

    Here's a quick rundown of the key provisions of the amendment:

    • Allows states to waive essential health benefits: Under Obamacare, health-insurance plans are required to cover a baseline of health benefits such as maternity care and emergency-room visits. Under the new amendment, states could define their own essential health benefits if they show that doing so would cause prices to decrease. This could allow states to eliminate some of the baseline benefits in the AHCA since covering fewer benefits would allow insurers to offer cheaper plans, but it could also result in slimmer plans and less care for people enrolled.
    • Allows states to waive aspects of the community rating: Under Obamacare, community-rating rules make it so insurers must charge the same price to consumers in a certain area regardless of gender, preexisting condition, and other factors. Under the AHCA's new amendment, states could get around this rule if they provided some funding for people with preexisting conditions to get coverage, participate in the "invisible high risk pools" established by the AHCA, or "provide incentives to appropriate entities" to "stabilize premiums." While the bill says the waiver cannot limit access to people with preexisting conditions, it is unclear what the baseline of funding would be to grant this waiver. Therefore, people with preexisting conditions could still end up having higher costs.
    • Default approval: States requesting a waiver would have to be denied within 60 days of notifying the Department of Health and Human Services. If the HHS does not explicitly deny the waiver request, it is approved. This would allow the Trump administration to decide how rigorous the process would be for states.

    Still not a slam dunk

    These new provisions have been key sticking points for the conservative members of Congress who originally prevented the plan from making it to a vote.

    After the text of the bill was released Tuesday, numerous conservatives came out in favor of the amended AHCA.

    "It’s pretty much everything I was looking for in terms of concessions," Rep. Scott DesJarlais, a member of the conservative House Freedom Caucus, told Bloomberg.

    Numerous other Freedom Caucus members came out in support of the amended bill, and the group's chair, Rep. Mark Meadows, told reporters after a meeting at the White House that he was "optimistic" about the plan.

    Rep. Gary Palmer also told the news website Axios"we're really close, if not there," on getting enough votes to pass the bill.

    But questions remain as to whether the AHCA has enough support from more moderate members of the party. Moderate GOP members were already concerned about concessions to conservatives regarding some of the essential health benefits and protections for preexisting conditions.

    Rep. Charlie Dent, a key moderate member of the House GOP, told the Washington Examiner that even with the MacArthur amendment he was against the AHCA.

    "Based on what I've read, it does not change my position," Dent said Tuesday. "I was a no, and I remain a no."

    SEE ALSO: Republicans could be the biggest obstacle to Trump's massive planned tax cut for businesses

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    paul ryan laughing

    House Speaker Paul Ryan told reporters Wednesday that the spending bill that would avoid a government shutdown would not include payments critical to keeping the Affordable Care Act’s health-insurance markets viable.

    Democrats had hoped to include cost-sharing reduction payments in the spending bill to ensure the stability of the individual insurance exchanges and therefore of the Affordable Care Act, the healthcare law better known as Obamacare.

    "CSRs, we're not doing that," Ryan told reporters a press conference with House GOP leadership. "That is not in an appropriation bill — that's something separate that the administration does."

    While Congress could fund the CSR payments via a new appropriation, the White House currently controls the CSR spending — though its authority to do so is under dispute in the court system.

    CSR payments go to insurers to help defray the cost of offering plans to low-income Americans. Without the roughly $8 billion in annual payments, many health-policy experts have said, the marketplaces would see a flood of insurer exits and steeper price increases for Americans getting insurance through the marketplaces.

    The payments are the subject of a lawsuit between the Republican-controlled House of Representatives and the Department of Health and Human Services that dates back to the Obama administration. The House argued the program was illegal since the funds were not appropriated by Congress. A judge ruled in Congress' favor in 2016, but an appeal from the Obama administration is still pending.

    President Donald Trump has discussed the possibility of dropping the payments if they are not appropriated by Congress, injecting massive uncertainty into the Obamacare exchanges and insurers' plans for 2018.

    Whether Democrats demand that CSR payments be included in any spending legislation could decide whether the bill passes and a government shutdown is avoided this week. Forty-two percent of people surveyed in a Politico/Morning Consult poll said the continuation CSR payments were important enough to prompt a government shutdown.

    SEE ALSO: Republicans have a new plan to repeal Obamacare — and it may bring them closer to passing 'Trumpcare'

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    Mark Meadows

    The conservative House Freedom Caucus on Wednesday reversed course and said it was on board with the latest iteration of a Republican plan to repeal and replace Obamacare.

    The caucus said the recently added, so-called MacArthur amendment to the American Health Care Act satisfied the group's conditions for supporting the bill.

    "Over the past couple of months, House conservatives have worked tirelessly to improve the American Health Care Act to make it better for the American people," the statement said. "Due to improvements to the AHCA and the addition of Rep. Tom MacArthur's proposed amendment, the House Freedom Caucus has taken an official position in support of the current proposal."

    The Freedom Caucus, a block of roughly 35 House Republicans, did not support the original AHCA. Its lack of support contributed heavily to the bill's being pulled from the House floor.

    The MacArthur amendment, released Tuesday, would allow states to receive waivers to avoid certain regulations established by Obamacare, the healthcare law officially known as the Affordable Care Act. Critics have expressed concern that through the waivers states would allow insurers to charge more for people with preexisting conditions and offer lower standards of care in their plans.

    These waivers have also drawn criticism of moderate GOP members, whose support for the new version of the AHCA, also known as "Trumpcare," remains unclear.

    In addition to the Freedom Caucus, the new amendment has also won over conservative advocacy groups, like the Club for Growth and Heritage Action, that originally opposed the AHCA.

    SEE ALSO: Republicans have a new plan to repeal Obamacare — and it may bring them closer to passing 'Trumpcare'

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    Paul Ryan

    The immediate politics of the latest iteration of the Republican healthcare bill make sense for some Republicans, particularly for members of the House Freedom Caucus who would like to not be blamed anymore for the bill's demise.

    But this new proposal is ugly for moderates, both substantively and politically, and they are likely to pay a political price if they support it.

    There is nothing in this revision for those Republicans who opposed the American Health Care Act. It would throw too many people off health insurance, disrupt healthcare markets too much, and expose people to too much risk if they got sick. In fact, this bill would be worse on the dimensions those members worried about before.

    The latest proposal would allow states to opt out of Obamacare rules that require health insurance to cover core benefits like prescription drugs and hospitalization, and out of rules that prohibit insurers from charging you more if you have a preexisting condition.

    That is, under this plan, insurers could sell plans that don't cover pregnancy or even doctor visits. It would ensure that everyone has "access to coverage" only in the sense that insurers would have to offer to sell a plan to anyone. They could set the premium at $10 million for people with preexisting conditions, and that offer of insurance at $10 million would constitute "access to coverage."

    Last month, many members on the moderate end of the Republican House conference made on-the-record statements about why they opposed the AHCA that would seem to box them into opposing this version, too.

    Rep. Ileana Ros-Lehtinen of Florida said that if the AHCA were passed, "too many of my constituents will lose insurance and there will be less funds to help the poor and elderly with their healthcare." This amendment does nothing to address those concerns.

    Rep. Rodney Frelinghuysen of New Jersey objected because of the bill's "denial of essential health benefits in the individual market," as well as its cuts to Medicaid. Those issues remain substantially the same in the new bill.

    Rep. Barbara Comstock of Virginia said she opposed the bill because of "uncertainties" it would create, but she said at least it required insurance to cover preexisting conditions— a proviso that would no longer hold with the new version.

    And Rep. David Young of Iowa said he didn't"think people should be discriminated on" because of preexisting conditions. This bill would allow insurers to do so.

    If they voted for this new version, these members and many others would be subject to attacks based on their past statements — they said the healthcare bill was unacceptable, and then they voted for it after it was made even more unacceptable.

    That's not to say they can't change their minds. But I wouldn't assume they will.

    Many of these "moderate" defections were unexpected the first time around and came from members who aren't even that moderate — including Frelinghuysen, who chairs the House Appropriations Committee and is close to leadership.

    Frelinghuysen represents an affluent, highly educated suburban district, centered on Morris County, New Jersey, which has been Republican for approximately forever but has trended Democratic in recent years. His choice to oppose the prior iteration of the AHCA was a signal that he, like many members, viewed a vote for the bill as a threat to his political survival.

    There's little reason to expect this new version, which could eviscerate protections for people with preexisting conditions, would be less of a threat.

    They should be afraid. The story will be that the bill was changed to placate extremists who want to hang sick people out to dry — and that these members went along with it.

    SEE ALSO: The group of conservatives who killed the original version of 'Trumpcare' is now on board

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    Donald Trump and Barack Obama

    With a little less than 48 hours to go until the bill funding the federal government expires, lawmakers are scrambling to come up with a plan to prevent a partial shutdown of the federal government.

    The spending bill, however, will likely be a source of horse-trading as Democrats and Republicans attempt to fit their own political goals in the package.

    One of the biggest desires of Democrats was to include funding for a key part of Obamacare, called cost-sharing reduction (CSR) payments, into the new continuing resolution.

    Republicans would rather leave these payments out, as they would likely take a toll on Obamacare's individual insurance market and are an added expenditure.

    CSR payments go to insurers to help defray the cost of offering plans to low-income Americans. Without the roughly $8 billion in annual payments, many health-policy experts have said the marketplaces would see a flood of insurer exits and steeper price increases for Americans getting insurance through the marketplaces.

    Currently, these payments are being made by the White House instead of Congressional appropriation. Politico reported on Wednesday that the White House agreed to continue to fund the CSR payments as it has been doing, apparently clearing the way for a deal on the shutdown.

    Democratic sources told Politico, however, that the White House had not committed to funding the CSR payments past next month, which may hang up the preliminary agreement between the White House and Democratic leaders.

    Additionally, a Democratic aide told Business Insider later on Wednesday that Democrats "still hope to secure language in the omnibus to continue the payments" but was not able to predict the outcome of the debate.

    On Thursday, Trump stoked the flames that the CSR debate may not be over, tweeting, "The Democrats want to shut government if we don't bail out Puerto Rico and give billions to their insurance companies for OCare failure. NO!"

    This echoed a nearly identical tweet on Wednesday night.

    House Speaker Paul Ryan also pushed back on the inclusion of CSRs at a press conference on Wednesday, saying that the bill would not include these payments. "CSRs, we're not doing that," Ryan said. 

    Technically, due to Republicans' solid majority in the House, they do not need Democratic votes to pass the bill through the lower chamber, but Democrats could filibuster any legislation in the Senate. Thus, Democrats have some leverage to try and get the CSR payments included.

    The trouble with a short-term commitment from the White House is that CSR payments are the subject of a lawsuit between the Republican-controlled House of Representatives and the Department of Health and Human Services that dates back to the Obama administration.

    The House argued the program was illegal since the funds were not appropriated by Congress. A judge ruled in Congress' favor in 2016, but an appeal started by the Obama administration is still pending.

    What is not clear, however, is whether the Trump administration will continue with the lawsuit. If the lawsuit is dropped by the administration, the lower court ruling would stand and this would effectively end the CSR payments.

    Getting the CSR payments in the spending bill would be one way around the legal concerns of the lawsuit since they would be officially appropriated.

    SEE ALSO: Trump is playing a dangerous game of chicken with Democrats that could cause healthcare costs to skyrocket

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    Donald Trump rally

    President Donald Trump on Thursday moved the negotiations over a spending bill to prevent a government shutdown to Twitter.

    In a series of tweets on Thursday, Trump attacked Democrats' requests for inclusions in the bill.

    "I promise to rebuild our military and secure our border," Trump tweeted. "Democrats want to shut down the government. Politics!"

    The current funding bill for the federal government expires Friday, and if a spending bill is not passed by then, parts of the federal government will shut down.

    Trump highlighted one part that would be affected.

    "As families prepare for summer vacations in our National Parks - Democrats threaten to close them and shut down the government. Terrible!" Trump said.

    While Republicans hold a majority in both chambers of Congress, Democrats could filibuster a spending bill in the Senate. One of the biggest hang-ups in the negotiations has come over Obamacare, the law formally known as the Affordable Care Act.

    Democrats have expressed a desire to include funding for Obamacare's cost-sharing-reduction payments in the spending bill. The payments help to offset the cost for insurers that are required to offer lower-cost insurance plans to poorer Americans and help stabilize the insurance market.

    Currently, funding for the payments comes from the White House, and Trump has threatened to end them. Most health-policy experts agree that if these payments were halted, insurers would abandon Obamacare's insurance exchanges and many Americans would either lose health insurance or see their costs skyrocket.

    Amid the uncertainty from the White House over the payments, Democrats have attempted to lock them in as a congressional appropriation.

    Trump in his tweetstorm called funding the payments "bailing out insurance companies," echoing tweets on Wednesday and earlier Thursday.

    House Republicans on Thursday introduced legislation that would extend government funding through next week to provide more time for negotiations.

    Here's Trump's full tweetstorm:

    SEE ALSO: Trump says he won't 'give billions' to Democrats in Obamacare funding to avoid a government shutdown

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    House Minority Leader Nancy Pelosi took colorful aim at the Republican effort to revive their healthcare overhaul during a press conference on Thursday.

    After introducing an amendment to sway conservative GOP lawmakers in the House, Republican leadership has reintroduced the American Health Care Act— which would repeal and replace Obamacare — onto the legislative agenda.

    Pelosi said that puts Republicans in a "lose-lose-lose" situation.

    "The president is making them walk the plank on a bill," Pelosi said. "When they brought it up before, it had 17% support among the American people. Which means even Republicans were not supporting their bill."

    Pelosi was referring to a poll from Quinnipiac that showed only 17% of American were in favor of the AHCA. Subsequent surveys have shown new ideas that have been floated on the legislation have not improved its popularity.

    Pelosi said that a vote on the bill would likely stain Republicans' reputations going forward.

    "So if they vote on it — just bringing it up is not good — if they vote on it, the minute they cast that vote they put doo-doo on their shoe. A tattoo on their forehead," Pelosi said. "And they have to explain it to their children, at some point they have to explain to their children what they did to make America sick again."

    The Congressional Budget Office estimated that the original version of the AHCA would leave 24 million more people without insurance over the next 10 years than the current projection. Independent health policy analysts have said new amendments to the bill could drive up costs for Americans with preexisting conditions.

    "And then, say they pass it," Pelosi said. "Even worse, they really have to be accountable for it. And it's largely unpassable in the Senate, so they walk the plank for nothing. Thank you, Mr. President."

    SEE ALSO: Trump just scored a big win with the conservatives who killed his healthcare bill

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