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Here's what doctors think about the updated Obamacare replacement plan

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doctors

It looks like House Republicans' Obamacare replacement plan is getting another shot. 

On Wednesday, the conservative House Freedom Caucus came on board with the latest version of the American Health Care Act, the bill that aims to repeal and replace the Affordable Care Act. The group originally did not support the bill. 

The bill now includes a new addition, called the MacArthur amendment. The amendment would allow states to receive waivers to avoid some of the regulations set up under the ACA.

When the original AHCA debuted, more than half a dozen doctors' organizations, hospital groups, and patient advocacy groups expressed their concerns with the bill. Now, with the new amendment, some organizations are speaking out again. 

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

DON'T MISS: Republicans have a new plan to repeal Obamacare — and it may bring them closer to passing 'Trumpcare'

American Medical Association — "Nothing in the MacArthur amendment remedies the shortcomings of the underlying bill."

The biggest group of doctors in the US doubled down on its opposition to the AHCA

"We are deeply concerned that the AHCA would result in millions of Americans losing their current health insurance coverage. Nothing in the MacArthur amendment remedies the shortcomings of the underlying bill," the AMA said in a letter to Congress on Thursday.

The organization previously said it wouldn't support the bill's plans to roll back Medicaid expansion or the repeal of the Prevention and Public Health Fund, which helps fund the Centers for Disease Control and Prevention. 

Regarding the new amendment, the AMA's concerns centered around individuals who have preexisting conditions, who might find their healthcare coverage unaffordable. 

Here's the full letter.



American Nurses Association — "The new bill is an even further departure from our principles."

The American Nurses Association originally opposed the bill, in part because of the rollback on Medicaid expansion and the defunding of the Prevention and Public Health Fund. 

"In its current form, the bill changes Medicaid to a per capita cap funding model, eliminates the Prevention and Public Health Fund, restricts millions of women from access to critical health services, and repeals income based subsidies that millions of people rely on. These changes in no way will improve care for the American people,"the organization wrote in a letter March letter.

The group's president tweeted on Thursday, calling the bill "worse than before." 



American College of Physicians — "We continue to urge that Congress move away from the fundamentally flawed and harmful policies that would result from the American Health Care Act."

The organization, which represents 148,000 internal-medicine physicians and medical students, sent another letter in opposition to the bill.

The College strongly believes in the first, do no harm principle," the organization wrote in a letter Monday. "Therefore, we continue to urge that Congress move away from the fundamentally flawed and harmful policies that would result from the American Health Care Act and from the changes under consideration—including the proposed 'Limited Waiver' amendment—that would make the bill even worse for patients."

When the AHCA was originally released, the ACP had worried that those with preexisting conditions, while still technically covered, may not be able to afford coverage under the AHCA.

"We urge you to oppose the American Health Care Act because it would weaken key gains in coverage and consumer protections and lead to fewer people having access to affordable coverage," Dr. Nitin Damle, the ACP president, wrote in a letter to Congress at the time.

 



See the rest of the story at Business Insider

Trump isn't going to get the health care victory he wants

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Donald Trump Mauricio Macri

WASHINGTON (AP) — President Donald Trump seems destined to serve his 100th day in office without House passage of a major Republican health care bill or enactment of a budget financing the government for the rest of this year. But at least the government probably won't be shut down — for at least another week.

The House won't vote on a reworked health care overhaul until at least next week, Majority Leader Kevin McCarthy, R-Calif., told reporters late Thursday. Party leaders made that decision after spending all day pressuring moderate GOP lawmakers to back that bill, but fell short of the votes they'd need to prevail.

"As soon as we have the votes, we'll vote on it," McCarthy said after leaving a nearly two-hour meeting of the House GOP leadership.

He ruled out votes on Friday or Saturday — which is Trump's 100th day in the White House. That was a disappointment for the administration, whose officials had pressured House leaders all week to try completing the health measure by Saturday.

McCarthy also said Republicans would push through the House Friday a short-term spending bill keeping the government open for at least another week. They plan to pass it with only GOP votes, if necessary. Minority Democrats are threatening to withhold support unless there is a bipartisan deal on a massive $1 trillion measure funding agencies through Sept. 30, when the current fiscal year ends, and no final agreement has been reached.

"We're working on the funding of government. We're getting that through" on Friday, McCarthy said of the temporary spending measure.

Asked by reporters whether Republicans would have to pass the short-term bill without Democratic votes, McCarthy said, "Yeah."

The struggle over both bills was embarrassing to the GOP, which has Trump in the White House and majorities in Congress. Republicans would have preferred to not be laboring to keep agencies functioning or approve a health care overhaul, the gold standard of GOP campaign promises for the past seven years.

Senate Majority Leader Mitch McConnell, R-Ky., said bargainers were "very close" to completing the $1 trillion budget package. But underscoring lingering battles over environmental and financial regulations, Senate Minority Leader Chuck Schumer, D-N.Y., blocked the Senate late Thursday from approving the short-term measure.

"No poison pill riders," he said.

Paul Ryan

The bipartisan budget talks had progressed smoothly after the White House dropped a threat to withhold payments that help lower-income Americans pay their medical bills and Trump abandoned a demand for money for a border wall with Mexico.

With neither party savoring a federal shutdown, it seemed likely Congress would approve the week-long stopgap measure in time to keep agencies open.

On the separate health care bill, House Republican leaders are still scrounging for votes from their own rank-and-file to rescue it.

Republicans have recast it to let states escape a requirement under President Barack Obama's 2010 law that insurers charge healthy and seriously ill customers the same rates. They could also be exempted from Obama's mandate that insurers cover a list of services like hospitalization and substance abuse treatment and from its prohibition against charging older customers more than triple their rates for younger ones.

The overall legislation would cut the Medicaid program for the poor, eliminate Obama's fines for people who don't buy insurance and provide generally skimpier subsidies.

Centrist Republicans were the primary target of lobbying by the White House and GOP leaders seeking the 216 votes they would need to clinch passage of the health measure.

More than a dozen Republicans, mostly moderates, said they were opposing the legislation. Many others remained publicly uncommitted, putting party elders in a tough spot. If 22 Republicans defect, the bill would fail, assuming all Democrats opposed it.

House Speaker Paul Ryan, R-Wis., wants to avoid an encore of last month's embarrassment. He abruptly canceled a vote on a health care overhaul at that time because of opposition from moderates and conservatives alike.

On Wednesday, conservatives in the House Freedom Caucus announced their support for the revised health legislation. That reversed the conservatives' opposition to the earlier edition of the legislation.

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AP reporters Erica Werner, Andrew Taylor and Kevin Freking contributed to this report.

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Insurance companies are freaking out about Trump's Obamacare threats

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Insurance companies are getting nervous about President Donald Trump's saber rattling on healthcare.

Trump, in interviews and tweets in recent days, has raised doubts about whether the White House will continue to fund the Affordable Care Act's so-called cost-sharing reduction (CSR) payments.

CSR payments are provided to insurers to defray the cost of offering low-income Americans cheaper out-of-pocket costs on the ACA's individual insurance exchanges. The money is funneled through the plans to providers to make up the difference in copays or deductibles paid by Americans making 200% of the federal poverty line or less. Any money not used to lower the costs is returned to the federal government.

Currently, the roughly $8 billion in payments comes from the White House rather than a congressional appropriation. The payments have been the subject of a lawsuit between the Republican-controlled House and the executive branch dating back to the Obama administration.

Trump's recent threats to cease the payments have caused insurers and industry groups to grow increasingly worried about potential losses and their participation in the individual insurance markets.

Anthem, one of the big five public insurance companies, said Wednesday that if CSR payments are not funded, they could either raise premiums in the individual market by as much as 20% or leave them altogether.

Anthem CEO Joe Swedish said on the company's earnings call that it was making the assumption that CSR payments would be funded. He said the company's outlook would change if the payments are pulled.

"However, we are notifying to our states that, if we do not have certainty that CSRs will be funded for 2018 by early June, we will need to evaluate appropriate adjustments to our filing," Swedish said. "Such adjustments could include reducing service area participation, requesting additional rate increases, eliminating certain product offerings or exiting certain individual ACA-compliant markets altogether."

Other major insurers such as Aetna and Cigna also warned earlier in the year that their participation in the exchanges would be based on the payments. Aetna already announced it would pull out of Iowa's marketplace.

Mario Molina, the CEO of Medicaid-focused insurer Molina Healthcare, wrote a letter to congressional leaders on Thursday about the CSR payments. He urged House Speaker Paul Ryan, House Minority Leader Nancy Pelosi, Senate Majority Leader Mitch McConnell, and Senate Minority Leader Chuck Schumer to fund the CSR payments for the next two years.

"If the CSR is not funded, we will have no choice but to send a notice of default informing the government that we are dropping our contracts for their failure to pay premiums and seek to withdraw from the Marketplace immediately," Molina wrote.  

In the letter, Molina — whose company has turned a profit from the exchanges — said without the payments, the company would have to immediately drop up to 700,000 marketplace enrollees if the payments were ceased and 1 million people would lose their coverage in 2018.

Major lobbying groups have also pleaded with the administration and congressional leaders to continue the payments.

Groups including America's Health Insurance Plans, American Medical Association, American Hospital Association, Blue Cross Blue Shield Association, and the US Chamber of Commerce sent a letter to lawmakers to urge them to continue CSR funding.

"As medical professionals, insurers providing health care services and coverage to hundreds of millions of Americans, and business leaders concerned with maintaining a stable health insurance marketplace for consumers, we believe it is imperative that the Administration and Congress fund the cost-sharing reduction program," the letter read.

The Trump administration told congressional leaders on Wednesday that it would continue to fund the payments for now, but did not make a longer-term commitment that many insurers feel they need to plan for 2018.

Insurers have to submit their plans for 2018 plan year coverage on the exchanges by late June or drop out of the markets.

SEE ALSO: Trump goes on raging tweetstorm against Democrats over negotiations to avoid a government shutdown

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NOW WATCH: Watch Trump walk out of an executive-order signing ceremony without signing any orders

Obama trolls Trump, says Obamacare is more popular than the current president

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Former President Barack Obama took a swipe at his successor during a private even Thursday, noting that polls have shown the Affordable Care Act to be more popular than President Donald Trump.

A person who attended the event paraphrased Obama's comments to CNN, saying Obama told the audience in Manhattan that the Affordable Care Act, also known as Obamacare, is more popular than the current president.

Recent polling has shown that Obamacare has hit its highest popularity ever, drawing the support of 55% of Americans in a Gallup survey on April 4.

In comparison, the most recent reading on Trump's approval rating from Gallup on Thursday sat at 43%, with 52% disapproving of the president's handling of his job.

Trump is on track to be the most unpopular president through his first 100 days in modern history.

Meanwhile, the GOP's bill to replace Obamacare, the American Health Care Act, has been shown to be much more unpopular in contrast, drawing as little as 17% support in a recent Quinnipiac poll.

Republicans updated their new plan this week with an amendment whose provisions also appear to be unpopular. The AHCA was pulled from a House floor vote in March, and the revised version has not yet received a vote.

SEE ALSO: Republicans deny Trump one last chance at a 100-day victory and punt on healthcare again

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NOW WATCH: Watch Trump walk out of an executive-order signing ceremony without signing any orders

Trump splits from the GOP and says Trumpcare 2.0 will guarantee pre-existing protections nationwide

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Donald Trump

President Trump appeared to suggest on Sunday that the GOP's new iteration of its healthcare bill to repeal and replace the Affordable Care Act would cover pre-existing conditions for all Americans. 

Trump, seeming to break from House Republicans' latest proposal that states could opt out of an Affordable Care Act requirement on covering pre-existing conditions, told CBS' John Dickerson on "Face the Nation" that congressional leaders were making changes to the newest bill to provide for nationwide pre-existing conditions coverage.

"Pre-existing conditions are in the bill. And I mandate it. I said, 'Has to be,'" Trump said.

Trump's first replacement bill included that provision, but it was pulled from the floor of the House before it could come to a vote after it became clear the bill did not have enough support to pass, largely because the ultraconservative House Freedom Caucus said it did not go far enough to repeal Obamacare in its entirety.

In order to bring members of the Freedom Caucus on board, leader of the Tuesday Group, NJ Rep. Tom MacArthur, introduced an amendment on Tuesday that would allow states to opt out of the two largest Obamacare provisions.

In addition to allowing states to waive coverage for essential health benefits — like maternity care and emergency-room visits — the amendment also allows states to waive parts of the community rating. Community-rating rules under the Affordable Care Act prohibit insurance companies from charging higher premiums to those with pre-existing conditions.

Under MacArthur's proposal, states would have the option of waiving that requirement, meaning insurance companies could ostensibly charge higher premiums to sicker people. States would be eligible to apply for a waiver if they provide 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."

But in Sunday's interview, Trump seemed to suggest that the amendment will be altered to ensure pre-existing conditions coverage for people regardless of where they live. 

"In one of the fixes that was discussed, pre-existing [coverage] was optional for the states," Dickerson said. 

"Sure, in one of the fixes," Trump replied. "And they're changing it."

"So it'll be permanent?" Dickerson asked. 

"Of course," Trump said. 

trump john dickerson face the nation

When Dickerson sought to get a clearer answer from Trump, however, the president seemed to hedge. "So what I hear you saying is pre-existing is going to be in there for everybody, it's not going to be up to the states?" Dickerson asked. 

"Pre-existing is going to be in there and we're also going to create pools," Trump said, referring to the high-risk pools Republicans have proposed in order to cover the cost of healthcare for those who are sicker. "And pools are going to take care of the pre-existing."

Vice President Mike Pence also echoed Trump's point on high-risk pools when he was asked to address the issue of rising premiums for sicker people on Sunday's "Meet the Press" with Chuck Todd. 

"We're basically borrowing an idea from the state of Maine that has seen a significant drop in premiums for people on their health insurance, because you take people that have pre-existing and costly conditions and put them into a high risk pool," Pence told Todd. "And you subsidize that so that it is affordable to those individuals."

Although Republicans have championed the idea of state high-risk pools, critics say that an inevitable effect of isolating the sickest people into separate groups is skyrocketing premiums. 

The effectiveness of state high-risk pools has been contested, because the program's success depends on whether the federal government decides to adequately subsidize them — likely through raising taxes. Some notable high-risk pools have also failed in the past.

Dickerson continued to press Trump, asking, "But on that crucial question, it's not going to be left up to the states? Everybody gets pre-existing, no matter where they live?"

Trump then spent some time talking about how he ultimately wanted healthcare to be managed by the states, saying he'd "rather have the federal government focused on North Korea." 

When Dickerson repeatedly asked Trump whether he could guarantee that the new Republican healthcare proposal would not lead to unaffordable costs for those with pre-existing conditions, Trump said, "Well, forget about unaffordable. What's unaffordable is Obamacare, John."

"So I'm not hearing you, Mr. President, say there's a guarantee of pre-existing conditions," Dickerson said. 

"We actually have — we actually have a clause that guarantees. We have a specific clause that guarantees," Trump said. 


If the president and congressional Republicans are working on making changes to the healthcare bill to ensure pre-existing conditions coverage, it will likely pick up more support among moderate Republicans who have expressed concerns about the legislation as it currently stands.

"It could affect people with preexisting conditions and it’ll make different insurance probably much more expensive for them, and in some cases perhaps inaccessible," said Pennsylvania Rep. Charlie Dent.  

SEE ALSO: Trump's approval rating at the 100-day mark is the lowest in modern history

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NOW WATCH: Watch Hasan Minhaj roast Trump at the White House correspondents' dinner

The GOP sounds confident the House is going to pass 'Trumpcare' this week

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paul ryan mike pence Donald Trump

Republican leaders sound more and more convinced that their plan to overhaul the American healthcare system will clear a huge hurdle this week.

Officials from Congress and the White House suggested over the weekend that the American Health Care Act — the GOP plan to repeal and replace Obamacare — would make it past the House of Representatives this week.

On CBS' "Face the Nation," President Donald Trump said he believed the House could have voted on the bill on Friday, but he told House leaders to wait.

"I think they could have voted on Friday," Trump said. "I said, 'Just relax. Don't worry about this phony 100-day thing. Just relax. Take it easy. Take your time. Get the good vote and make it perfect.'"

Vice President Mike Pence, when asked about Trump's accomplishments during his first 100 days on "Meet the Press," predicted that while the healthcare overhaul didn't happen before the milestone, it would soon.

"But he's signed 30 different executive orders on virtually every one of those topics that you just referred to," Pence said. "And we’re working with the Congress. I think healthcare reform, repealing and replacing Obamacare is just around the corner."

And House Majority Leader Kevin McCarthy, who schedules votes for the House floor, told attendees at a Republican event in Texas to "watch next week, and you will see the repeal and replace of Obamacare,"according to Politico.

Gary Cohn, the National Economic Council director and Trump's top economic adviser, also told CBS' "This Morning" that the AHCA should be voted on in the House this week. He said he expects it to pass.

"Do we have the votes for healthcare? I think we do," Cohn told CBS. "This is going to be a great week. We're going to get healthcare down to the floor of the House, we're convinced we've got the votes, and we're going to keep moving on with our agenda."

The AHCA hit snags the first time it was brought to the floor in March due to differences within the GOP conference.

Conservatives felt the bill did not go far enough in repealing Obamacare, while moderates were concerned over the Congressional Budget Office's estimate that 24 million more people that would go without insurance than the current system over the next decade.

Since the failure in late March, the bill has undergone changes to make it more palatable for conservatives like the House Freedom Caucus, which officially supports the new version. But recent amendments have raised concerns among moderates, and some withdrew their support of the bill.

The White House pushed for a vote on Friday or Saturday to get the plan passed during Trump's first 100 days, but House GOP leaders were unable to get enough members on board to make that happen.

As of Monday morning, the AHCA is not on McCarthy's official schedule.

SEE ALSO: A key part of Trump's tax plan just hit a roadblock with Republicans

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NOW WATCH: 'OJ had me shook': A Georgetown professor reveals what it was like to talk to OJ Simpson after bashing him on national television

Trump is making a big promise about his healthcare plan — but it's not in the GOP bill

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President Donald Trump has made some huge promises for healthcare overhaul, but his new guarantee for people with preexisting conditions may not reflect the reality of the GOP's current legislation.

Trump has promised that the plan to repeal and replace the Affordable Care Act, the law also known as Obamacare, will bring down premiums, deductibles, and the cost to the government, and will eventually cover "everybody."

Most health-policy experts agree that hitting all four of these marks is next to impossible.

Now, with the White House and congressional leaders apparently readying an effort to bring the American Health Care Act to the House floor, Trump is making another promise that is contradicted by the actual legislation.

In an interview with CBS's "Face the Nation" on Sunday, Trump guaranteed protections for patients with preexisting conditions, something he has done since the campaign.

"Preexisting conditions are in the bill," Trump said. "And I just watched another network than yours, and they were saying, 'Preexisting is not covered.' Preexisting conditions are in the bill. And I mandate it. I said, 'Has to be.'"

Trump reiterated those comments during an interview with Bloomberg on Monday, saying the AHCA has to cover preexisting conditions just as well as or better than Obamacare.

"I want it to be good for sick people. It's not in its final form right now," Trump said. "It will be every bit as good on preexisting conditions as Obamacare."

But those guarantees run in opposition to recent adjustments to the AHCA.

An amendment to the bill written by moderate Republican Rep. Tom MacArthur would allow states to waive certain protections of Obamacare, including aspects of its community-rating provisions that mandated all people who are the same age be charged the same price by insurers.

If a state were given a waiver for those protections, experts agree that insurers could price plans for people with illnesses above those for healthy people and, in the worst case, make it unaffordable for people with preexisting conditions to access insurance.

Speaking with CBS, Trump said the addition of "pools" could offset the issue.

The new version of the AHCA would allow for the implementation of an "invisible high-risk pool," which would function as a way to subsidize insurers covering people with preexisting conditions to keep costs down for others.

That could reduce costs for people without preexisting conditions, but unless the government adequately funded the plan, it would likely leave people with preexisting conditions with higher costs or unable to enroll. According to experts at the Kaiser Family Foundation, a nonpartisan health-policy think tank, the current iteration of the AHCA's pools would not provide enough funds to keep costs down.

In response to Trump's comments to Bloomberg, AshLee Strong, a spokeswoman for House Speaker Paul Ryan, told NBC that the AHCA would take care of people with preexisting conditions.

"The Republican plan protects people with preexisting conditions," Strong said. "States can't opt out without a high-risk pool to take care of them. And waivers never apply to someone who has been continuously covered. We believe there is more than one way to address this problem."

House Republicans are attempting to wrangle enough votes to pass the AHCA at some point this week. Both administration and congressional officials have pushed for a vote in the coming days, and reports suggest it could be as soon as Wednesday.

SEE ALSO: The GOP sounds confident the House is going to pass 'Trumpcare' this week

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NOW WATCH: Yale history professor: Here’s why it's useful to compare Trump's actions to Hitler's

No, the Republican healthcare bill does not protect preexisting conditions

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obama trumpPresident Donald Trump told Bloomberg News on Monday that the healthcare bill he wants Congress to pass is "not in its final form right now.

"It will be every bit as good on pre-existing conditions as Obamacare," he said.

But currently, the bill isn't as good on preexisting conditions as Obamacare— because of changes Trump's own White House sought to the bill. To secure the votes of members of the far-right House Freedom Caucus, the White House brokered an amendment that would allow states to waive Obamacare rules that protect people with preexisting conditions.

Republican trepidation about undermining these protections is a major reason there are not the votes to pass the bill in the House. For example, Rep. Billy Long of Missouri — not a moderate by any measure — told The Hill he can't vote for the latest version of the American Health Care Act because it "strips away any guarantee that preexisting conditions would be covered and affordable."

But some Republicans are claiming that the Republican bill is good enough on preexisting conditions, already meeting Trump's promise to be "every bit as good" as Obamacare on this measure.

"The Republican plan protects people with pre-existing conditions," a spokesperson for Speaker Paul Ryan told NBC News. "States can't opt out without a high risk pool to take care of them. And waivers never apply to anyone who has been continuously covered. We believe there is more than one way to address this problem."

This argument is similar to the one Ramesh Ponnuru has made in National Review. The idea is, while the Republican bill would allow insurers to charge sick people more for insurance, it would still protect people because insurers wouldn't be able to raise prices on you due to your health as long as you never let your coverage lapse. And if you did let your coverage lapse, you'd be able to go buy a plan through a high-risk pool.

This argument is highly misleading, for two reasons.

The first is that coverage gaps are common. Often, people lose health insurance coverage because they lose a job. Many people cannot afford to buy their own health insurance when they've lost the income from their job. 

Ponnuru argues that the insurance subsidies in the AHCA would help people avoid coverage gaps. In some cases, they would. But the subsidies (of $2,000 to $4,000 per person) would not be sufficient to buy a comprehensive insurance policy. Many people would still find it unaffordable to maintain coverage when they face a financial shock — especially if they are older or live in high-cost markets.

A possible exception would be if the abolition of Obamacare's "essential health benefits" rules allows insurers to design limited insurance policies that are scoped to be priced equal to the credit amounts — for example, you might be able to get a health plan for $2,000, just using your tax credit and making no payment out of pocket, but the plan wouldn't cover doctor's visits or hospitalization.

In this scenario, people would find it easy to maintain some form of continuous coverage, but health insurance markets would become highly dysfunctional on other dimensions, as I wrote in March. (Also, people would have health insurance that doesn't cover important benefits, such as doctor's visits.)

If everything else fails, Ponnuru and Ryan's spokesperson both argue that uninsured sick people could fall back on a high-risk pool. And indeed, under the Republican healthcare law, states waiving the preexisting condition protections would have to provide some form of subsidized risk-pool or reinsurance program to help insurers cover high-cost patients.

But the law would impose no adequacy test on these programs.

Before Obamacare, many states offered high-risk pools, which were intended to provide subsidized insurance to high-cost patients who insurers would otherwise be unwilling to cover at an affordable price. The problem was, covering these patients is very expensive, and public funding to subsidize the pools routinely proved to be insufficient to cover the number of people who needed such coverage.

As a result, pools often featured very high pricing (unaffordable to many would-be participants) and waiting lists to participate. The Republican plan would likely lead to the return of this dysfunction.

Protecting people with preexisting conditions, to ensure they can buy affordable insurance, is one of the most popular parts of Obamacare. The current Republican proposal does not maintain such protections, despite what its supporters claim.

SEE ALSO: This is why Barack Obama shouldn't take Wall Street speaking fees

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Jimmy Kimmel opens up about son's open-heart surgery and advocates for progress in the US healthcare system

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Jimmy Kimmel got personal tonight on “Jimmy Kimmel Live!,” opening up about complications following the birth of his son 10 days ago.

Kimmel broke down, tearing up through his nearly 15-minute long monologue. He recounted the “terrifying” few hours after Billy was born, how he started to turn purple about three hours after he was born, and a nurse at Cedars-Sinai Medical Center noticed and rushed him into emergency care.

Kimmel thanked the long list of doctors and nurses at Cedars-Sinai where Billy was born and Children’s Hospital Los Angeles where he was rushed for emergency heart surgery.

He also made a plea for politicians on both sides of the aisle to make sure Americans have access to health care especially for those with pre-existing conditions, as his son has after being born with a heart defect.

“If your baby is going to die it shouldn’t matter how much money you make,” he said.

He flashed a slate for Children’s Hospital Los Angeles on the screen urging viewers to donate.

“I hope you never have to go there but if you do you’ll see so many kids from so many financial backgrounds being cared for so well with so much compassion.”

Kimmel said the surgeon “did some kind of magic I can’t even begin to explain. It was the longest three hours of my life.”

Kimmel also broke down while thanking his family, friends, production crew and ABC executives for supporting his family during the frightening experience. He showed a picture of Billy covered in tubes and medical equipment, and then another picture of a smiling infant. (“Poor kid, not only did he get a bad heart, he got my face,” joked Kimmel.)

“We had atheists praying for us,” said Kimmel. “Even that son of a bitch Matt Damon sent flowers.”

Watch Kimmel tell his story below:

He urged Congress not to make cuts to the National Institutes of Health.

“Don’t let their partisan political squabbles divide us. This is not football. This is not about picking teams. We are the team — it’s the United States of America.”

Kimmel and his wife, co-head writer Molly McNearney, also have a 2-year-old daughter, Jane.

The host will now be on paternity leave for the rest of the week while his friends guest-host the show in his absence (assuming there isn’t a writers strike, in which case the show will go dark). The lineup will be:

Tuesday: Host Will Arnett, with guests Maya Rudolph and Ben McKenzie and musical guest Incubus

Wednesday: Host Anthony Anderson, with guest George Lopez and musical guest Future

Thursday: Host Kristen Bell, with guests Charlie Hunnam and Adam Scott and musical guest Alison Krauss

Friday: Host David Spade, with guest Guy Ritchie and musical guest alt-J

In addition, Kimmel will skip his usual standup performance at ABC’s May 16 upfront presentation in New York in order to stay close to his family.

SEE ALSO: No, the Republican healthcare bill does not protect preexisting conditions

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Republicans are scrambling to win votes in what looks like a razor-thin vote on 'Trumpcare'

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The House vote on the GOP's plan to overhaul the healthcare system looks like it could come down to the wire.

According to aggregate "whip counts" conducted by various outlets, somewhere between 20 and 22 Republican members of the House have said they will vote "no" on the American Health Care Act, which would repeal and replace Obamacare.

That's right on the edge of the 22 members Republicans can afford to lose for the bill to pass.

"We've been making important progress," House Majority Whip Steve Scalise told reporters Tuesday.

Most of the "no" votes come from moderate Republicans who fear that recent changes to the bill would undermine protections for people with preexisting conditions.

An amendment proposed last week by moderate Rep. Tom MacArthur would allow states to waive certain protections of Obamacare, including aspects of its community-rating provisions that mandated all people who are the same age be charged the same price by insurers.

If a state were given a waiver for those protections, experts agree that insurers could price plans for people with illnesses above plans for healthy people and, in a worst-case scenario, make it unaffordable for people with preexisting conditions to access insurance.

While the MacArthur amendment was able to bring the conservative House Freedom Caucus on board, flipping roughly 20 votes of members who had been against the original version of the AHCA, it has also left some moderates fearing that costs for Americans with preexisting conditions may rise.

Based on the public statements of members, nearly every single undecided vote would need to break in favor of the AHCA for Republicans to obtain the votes needed to pass the bill.

The bill was already pulled from the House floor once, in late March, due to a lack of support. A second failed attempt would reflect poorly on the future of Trump's agenda and on congressional leaders' ability to deliver a successful vote.

Given the precarious position of the legislation, the White House has been pressuring members to deliver on the healthcare vote. Vice President Mike Pence, chief of staff Reince Priebus, and other Trump administration officials have reportedly been working the phones to flip votes.

According to Axios, GOP lawmakers have said they are targeting Wednesday for a new vote.

SEE ALSO: Trump is making a big promise about his healthcare plan — but it's not in the GOP bill

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NOW WATCH: Watch a Trump surrogate get shut down after calling Trump the 'Martin Luther King of healthcare'

Jimmy Kimmel's emotional monologue shows why Republicans are having trouble repealing Obamacare

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Late-night host Jimmy Kimmel delivered an impassioned monologue on Monday night detailing his newborn son's recent open-heart surgery.

The heartstring-pulling speech, during which Kimmel teared up, detailed the harrowing experience for Kimmel and his family. It also presented a compelling, personal case for why it has been so difficult for Republicans to repeal the Affordable Care Act, the law better known as Obamacare.

Kimmel, in the monologue, said his son's story also had a lot to do with recent changes to the US healthcare system enacted by the Affordable Care Act.

Prior to the ACA, people could be denied insurance by insurers due to a litany of preexisting conditions. This included everything from heart conditions (like in the case of Kimmel's son), to asthma, to working in a mine.

"Before 2014, if you were born with a congenital heart condition like my son was, there was a good chance you would never be able to get health insurance because you had a preexisting condition, you were born with a preexisting condition," Kimmel said. "If your parents didn't have health insurance, you may not even live long enough to get denied insurance due to a preexisting condition."

According to Kaiser Family Foundation, a nonpartisan health policy think tank, 27% of Americans — just over 52 million people — have a preexisting condition that could have denied them health insurance prior to Obamacare's implementation. And while the new GOP bill to repeal and replace the ACA, called the American Health Care Act, has nominal protections for people with preexisting conditions, recent changes have undermined those protections.

An amendment added to the AHCA last week would allow states to apply for a waiver for an exemption from some of the ACA's protections if they show they can bring down costs. Among those protections is a provision that insurers cannot charge sick people more than healthier people in a given area.

Republicans have argued that Obamacare is already unaffordable for people with preexisting conditions. But experts say those costs would likely only rise if states were able to attain such waivers. Insurers could increase costs for those with preexisting conditions. In the worst-case scenario these people could be priced out of the market, according to health policy experts.

People with preexisting conditions could see their premiums skyrocket while healthy people would no longer have to subsidize sicker Americans. Overall costs could decline, but sicker people would likely get the short end of the stick.

And the problem for Republicans is that these protections are incredibly popular, as Kimmel suggested.

"If your baby is going to die, it shouldn't matter how much money you make," Kimmel said. "I think that's something that whether you're a Republican, or a Democrat, or something else, we can all agree on."

Roughly 70% of Americans support the preexisting-conditions provision. A recent ABC News/ Washington Post poll found that only 26% of people want the issue left up to states.

In addition to the preexisting-conditions clause, Kimmel also hinted at other benefits of the ACA, specifically the end of lifetime limits. Prior to the ACA, insurance companies could place a cap on the amount of benefits that a person received over their lifetime. Once the cap was overrun, the financial burden shifted heavily onto the patient and his or her family.

"No parent should have to decide if they can afford to save their child's life. It just shouldn't happen. Not here," Kimmel said.

As Sarah Kliff at Vox has written, for many infant patients born with health problems, lifetime limits could mean the end of benefits at an incredibly young age, causing serious financial strain early in life. The Affordable Care Act removed those caps. The new GOP bill preserves them, but it also makes it harder to say that they are repealing Obamacare when they are also keeping this provision in place.

Overall, the Affordable Care Act has hit its highest level of popularity since the passage of the law. A recent Gallup survey showed 55% approval for Obamacare, the first time the bill had garnered a majority of Americans' support in the Gallup poll.

To sum up: Republicans have to convince their base that they are delivering on their seven-year promise to repeal Obamacare, while protecting some of its more popular elements, while also getting enough lawmakers on board to pass a replacement law.

Kimmel finished his emotional appeal by asking congressional lawmakers to protect these clauses of the ACA instead of altering them in the American Health Care Act.

"We need to make sure that the people that are supposed to represent us, the people meeting about this right now in Washington, understand that very clearly," Kimmel said. "Let's stop with the nonsense, this isn't football there are no teams. We are the team, it's the United States. Don't let their partisan squabbles divide us on something every decent person wants." 

Watch Kimmel's monologue below:

 

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'That's exactly why we fought so hard for the ACA': Obama responds to Jimmy Kimmel's emotional healthcare plea

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Former President Barack Obama responded to late-night television host Jimmy Kimmel's monologue about his son's open heart surgery, saying stories like his are why his administration fought so hard to pass the Affordable Care Act.

Monday night on "Jimmy Kimmel Live," Kimmel broke down a number of times while detailing his family's struggles with his son Billy's open heart surgery.

"Before 2014, if you were born with a congenital heart condition like my son was, there was a good chance you would never be able to get health insurance because you had a preexisting condition, you were born with a preexisting condition," Kimmel said. "If your parents didn't have health insurance, you may not even live long enough to get denied insurance due to a preexisting condition."

Kimmel also delivered a heartfelt plea to President Donald Trump and congressional leaders to preserve protections for those with pre-existing conditions in their new healthcare proposal.

"Well said, Jimmy," Obama tweeted on Tuesday. "That's exactly why we fought so hard for the ACA, and why we need to protect it for kids like Billy. And congratulations!"

Congressional Republicans are currently embroiled in a debate over an amendment to the American Healthcare Act (AHCA). The amendment would allow states to waive certain parts of the Affordable Care Act's community-rating rules, which prohibit insurance companies from charging more to those who have preexisting conditions.

States would be eligible to apply for a waiver if they provide 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 amendment garnered the support of the ultraconservative House Freedom Caucus, it has driven away more moderate Republicans who have said they cannot support a bill that doesn't guarantee protections for those with preexisting conditions.

During an interview with CBS' John Dickerson for "Face the Nation" on Sunday, Trump said that the bill would include a clause that guarantees protections for those with preexisting conditions.

"Preexisting conditions are in the bill," Trump said. "And I just watched another network than yours, and they were saying, 'Preexisting is not covered.' Preexisting conditions are in the bill. And I mandate it. I said, 'Has to be.'"

He later added: ""We actually have — we actually have a clause that guarantees. We have a specific clause that guarantees."

He also repeated his comments during an interview with Bloomberg on Monday.

"I want it to be good for sick people," Trump said. "It's not in its final form right now. It will be every bit as good on preexisting conditions as Obamacare."

But the the AHCA, as it currently stands, does not include that guarantee.

SEE ALSO: Trump splits from the GOP and says Trumpcare 2.0 will guarantee pre-existing protections nationwide

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Republicans are throwing 'every sink in every kitchen they can find' to save their plan to repeal and replace Obamacare

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Fresh optimism displayed by White House and some House GOP officials at the beginning of the week has turned into a familiar mad dash to secure votes needed to pass the Republican healthcare-overhaul plan in the House.

The growing number of GOP lawmakers coming out publicly against the new version of the American Health Care Act — the bill to repeal and replace Obamacare — has already put the plan on a razor's edge of support. Leadership is attempting to shore up the centrist wing of the party by introducing new funding to protect sick Americans.

House Speaker Paul Ryan told conservative radio host Hugh Hewitt on Wednesday that Republicans were "extremely close" to securing enough votes to pass the legislation, but he did not say whether the bill would come to a vote this week.

The main sticking point is an amendment added by Rep. Tom MacArthur, a centrist member from New Jersey who has long supported the AHCA. The amendment to the legislation that has also become known as "Trumpcare" was designed to win over conservatives.

It would allow states to apply for waivers to repeal parts of Obamacare's protections if they can prove it would lower costs. Conservatives members support the addition because they say it gives more flexibility to the states and gets closer to an full repeal of the Affordable Care Act.

On the other hand, some House GOP members, especially moderates, have expressed concerns about the latest version of the bill, because many health-policy analysts say the addition could undermine protections for people with preexisting conditions.

To counter their concerns, Rep. Fred Upton, who came out against the current version of the AHCA with the MacArthur amendment, is expected to introduce his own addition on Wednesday.

It's not yet clear what the final version of the legislation would look like. Axios reported Wednesday that Upton's addition would help soften the blow of the penalty incurred by people who allow their insurance to lapse, in an effort to protect people with preexisting conditions.

The Independent Journal Review, however, reported Tuesday night that the amendment would instead call for additional $8 billion in funding for the AHCA's state stability funds. The legislation already proposes for $150 billion to be allocated over 10 years for the funds, which would go toward supporting things like high-risk pools and offsetting high costs for poorer Americans.

The changes appear to have won over Upton, who said the bill is "likely now to pass in the House," and fellow hold out Rep. Billy Long. 

But concerns have mounted that any addition to the bill could cause conservatives like those in the House Freedom Caucus to drop their tenuous support of the bill.

The last-ditch efforts come after White House and House GOP leaders pledged to get the healthcare bill through the House this week, setting another artificial deadline that has ramped up pressure to deliver the votes.

President Donald Trump said during a speech on Tuesday that "now is the time" to pass the healthcare bill and leaders from Vice President Mike Pence to House Majority Leader Kevin McCarthy told the press that the bill would pass this week during appearances over the weekend.

There is also a growing sense that Republicans just want to get the bill through, no matter what the circumstances.

Rep. Tom Cole told Politico that the leadership would "throw every sink in every kitchen they can find" to get the bill passed.

Republican senators have been similarly exasperated at the false starts and unsuccessful attempts to get the AHCA through the lower chamber. One Republican senator told Politico that House GOP leadership needs to focus on just getting the bill to the Senate.

"Getting that bill out of there no matter what it says or what’s in it should probably be the No. 1 priority of the House leadership," the senator said.

SEE ALSO: Jimmy Kimmel's emotional monologue shows why Republicans are having trouble repealing Obamacare

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Republicans just moved closer than ever to passing their Obamacare overhaul

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In an abrupt turn of events, House Republicans came within inches of the finish line Wednesday on their repeal and replacement of Obamacare.

After the American Health Care Act looked close to dead at the start of the day, a flip by two key centrist holdouts on the bill appears to have its passage closer than ever.

Centrists had pushed back on an addition to the legislation that allowed states to apply for a waiver to repeal some Obamacare regulations, which some members worried would undermine protections for people with preexisting conditions.

To combat this concern, Rep. Fred Upton on Tuesday began circulating an amendment to provide an additional $8 billion in funds to protect those sick Americans in the event that such a waiver is triggered.

The amendment and a trip to meet with President Donald Trump at the White House was apparently enough to win over Upton and fellow hold out Rep. Billy Long. Their movement, along with the potential cover it could provide other more moderate members, means the legislation is closer to passage than ever before.

Importantly, the additional funding also has not turned away members of the conservative House Freedom Caucus, which only supported the AHCA after the original provision providing for state waivers was added.

A source close to the Freedom Caucus told Business Insider that some members of the Caucus had seen legislative text of the Upton amendment.

"The Freedom Caucus will continue to support as long as there are no substantive policy changes," the source said.

So if the changes are limited to funding, the source said, the Freedom Caucus will remain on board.

The movement appears to have set the stage for GOP House leadership to bring the bill to a floor for a vote as soon as Thursday. The Freedom Caucus source told Business Insider that members expect the bill to be brought to the floor on Thursday afternoon.

Earlier Wednesday, House Speaker Paul Ryan told conservative radio hose Hugh Hewitt that the the House GOP was "extremely close" to obtaining the necessary votes.

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Obamacare just suffered 2 big blows from insurance companies as repeal looms

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As Republicans ready a new bid to repeal and replace Obamacare, two companies announced moves that could serve as significant blows to some of the law's individual health insurance exchanges.

Aetna on Wednesday announced that it plans to exit the Virginia individual insurance market both for Affordable Care Act exchanges and off-exchange plans.

That will leave Aetna with just two states in which it is offering plans through the ACA exchanges.

"Despite significantly reducing our exchange footprint, our individual Commercial products could potentially lose more than $200 million in 2017," the company said in a statement. "Based on that financial risk, and growing uncertainty in the marketplace, we will not offer on- or off-exchange individual plans in Virginia for 2018."

Meanwhile, Medica — a smaller Minnesota-based insurer — said it is heavily considering abandoning the ACA exchanges in Iowa, which would leave all but five counties in the state without an insurer in the marketplace. Aetna and Wellmark, a Blue Cross Blue Shield system company, left Iowa's exchanges in April.

Medica cited political uncertainty as a major factor for its considerations to leave Iowa's exchanges.

"Without swift action by the state or Congress to provide stability to Iowa’s individual insurance market, Medica will not be able to serve the citizens of Iowa in the manner and breadth that we do today," Medica said in a statement. "We are examining the potential of limited offerings, but our ability to stay in the Iowa insurance market in any capacity is in question at this point."

In addition to the battle over the American Health Care Act, the GOP's bill to overhaul the US healthcare system, the Trump administration has not committed to funding cost-sharing reduction (CSR) payments beyond May. Those payments help offset the cost of providing low-cost plans on the exchanges to poorer Americans. Without CSR payments, many insurers said they would be forced to leave the exchanges.

Aetna's situation is a bit more complicated, with the termination of a planned merger with rival Humana and shifts in its business likely contributing to its decision in Virginia along with political uncertainty.

The company did not give a firm commitment to stay in its last two Obamacare markets — Delaware and Nebraska.

"We will communicate decisions on our remaining states as appropriate," Aetna said.

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The Republican healthcare bill still has a massive problem

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On Thursday, the House will vote on the American Health Care Act— the Republican plan to repeal and replace Obamacare. 

While the vote is expected to be close, Republicans leaders have expressed confidence that the bill will pass.

Even if the bill does go through, however, it still has a glaring weakness.

Republicans have relied heavily on a key new provision of their healthcare overhaul to sell the bill, but it has a potential problem: They may have not allocated enough money to it.

The GOP has touted high-risk pools as a way to section off people with preexisting conditions from the rest of the market, lowering costs for healthy people.

Such pools are, in theory, supposed to be subsidized by states and the federal government in order to keep costs down for the sick people in them.

Republicans have used that idea to combat criticism of another AHCA amendment from Rep. Tom MacArthur, which would allow states to apply for waivers to repeal parts of Obamacare's protections if they can prove it would lower costs. Centrist GOP members have expressed concerns about McArthur's offering, however, because many health-policy analysts say it could undermine protections for people with preexisting conditions.

House Speaker Paul Ryan, President Donald Trump, and White House press secretary Sean Spicer have all cited the high-risk pools as a way to ensure protections for Americans with preexisting conditions in recent days.

But the problem, according to analysts and experts, is that the AHCA doesn't provide enough money to run a functional high-risk pool.

The original AHCA set aside $130 billion over 10 years for a state stability fund. That fund wasn't explicitly earmarked for high-risk pools, but they were among the functions for which the states could use the funding. Also, a new amendment from Rep. Fred Upton would add another $8 billion to this funding over five years.

Ryan and others have cited state iterations of high-risk pools as a model for the AHCA. According to the Kaiser Family Foundation, a nonpartisan health policy think tank, however, these high-risk pools were woefully underfunded, prohibitively expensive, and few people signed up for them.

Larry Levitt, a senior vice president at Kaiser, said based on old experiences and the number of people with preexisting conditions, high-risk pools need a lot of money put toward them to be effective.

"Even under pretty conservative estimates, a minimally adequate high-risk pool could cost $25 billion per year nationwide," Levitt tweeted Wednesday.

Even an estimated from conservative analysts James C. Capretta and Tom Miller said that in order to operate functional high-risk pools in all 50 states, the federal government would need to provide $15 billion to $20 billion annually, leaving the AHCA short even with the proposed money from Upton's amendment.

A separate analysis from Emily Gee and Topher Spiro at the liberal Center for American Progress found that high-risk pools would need $327 billion over 10 years, leaving the AHCA well short under the current plan.

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The House will vote on the Republican Obamacare replacement bill on Thursday

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The House of Representatives will vote on the American Health Care Act on Thursday.

Republican House Majority Leader Kevin McCarthy told reporters he plans to bring the American Health Care Act to the floor of the House and is confident that the bill will pass.

"Do we have the votes? Yes. Will we pass it? Yes," McCarthy said.

The vote will take place just over a month after House Republicans were forced to pull the AHCA from the floor just minutes before a vote after they were unable to wrangle enough of their members to vote for the bill.

Most projections for the outcome of the vote are close. The New York Times aggregate of unofficial whip counts collected by various media outlets has between 19 and 21 GOP lawmakers publicly against the bill. Due to the universal opposition by Democrats, only 23 Republican members can vote against the AHCA for it to fail.

The move comes after a last-minute effort by the House GOP leadership and the White House to win moderates over on the AHCA.

Centrists had pushed back on an addition to the legislation that allowed states to apply for a waiver to repeal some Obamacare regulations, which some members worried would undermine protections for people with preexisting conditions.

To combat this concern, Rep. Fred Upton on Tuesday release an amendment to provide an additional $8 billion in funds to protect those sick Americans in the event that such a waiver is triggered. Importantly, three of the co-sponsors of the amendment — Reps. Steve Knight, David Valado, and Jeff Denham all from California — were either uncommitted or publicly against the AHCA.

The amendment and a trip to meet with President Donald Trump at the White House was apparently enough to win over Upton and fellow hold-out Rep. Billy Long. Their movement, along with the potential cover it could provide other more moderate members, helped get passage within reach.

Importantly, Upton's extra funding did not lose the support of the conservative House Freedom Caucus which did not support the AHCA when it was first brought to the floor in March.

A source close to the Freedom Caucus told Business Insider that some members of the Caucus had seen legislative text of the Upton amendment.

"The Freedom Caucus will continue to support as long as there are no substantive policy changes," the source said.

The House Rules Committee approved the bill and the amendments in a meeting on Wednesday night, officially opening the way for a full House vote.

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It looks like 'Trumpcare' could clear its first major hurdle today

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Thursday's the day.

The House is finally set to vote on the American Health Care Act, the GOP plan to repeal and replace Obamacare, after nearly two months of stalled attempts at passage.

The vote is expected around 2 p.m ET.

The House Rules Committee cleared the AHCA late Wednesday after House Majority Leader Kevin McCarthy told reporters the bill would be brought to the floor, setting up a vote early Thursday afternoon.

The vote is expected to be close, with several Republicans still expressing concerns about the bill's potential effects on people with preexisting conditions.

Despite the narrow count, McCarthy appeared confident on Wednesday that the bill would pass.

"Do we have the votes? Yes," McCarthy said. "Will we pass it? Yes."

The White House appears similarly confident in the bill's passage. A White House aide told attendees at a dinner with religious leaders that Republicans felt confident they had 218 votes in the House and could have as many as 220, according to Billy House and Anna Edgerton at Bloomberg. The bill needs 216 votes to pass.

Some representatives have gone to extreme lengths in the blitz to secure the votes. Republican Rep. Jason Chaffetz, who underwent foot surgery last week in Utah, flew back to Washington, DC, on Wednesday for the vote.

Conservatives are highly anticipating the vote, as the bill's passage would be a major hurdle in delivering on their seven-year promise to gut Obamacare, the healthcare law officially called the Affordable Care Act.

"I'll take around 2,000 votes this Congress. Most of them will be forgotten," Rep. Ted Budd told Politico on Wednesday. "This is not one of those votes. This vote marks the beginning of the end of Obamacare as we know it."

The AHCA, also known as "Trumpcare," was first called to the House floor on March 24 only to be pulled at the last minute when House GOP leaders could not persuade enough members of their party to vote for the bill.

Since that failure, two amendments have been added to win over recalcitrant members of the party — one aimed at conservatives and another at the party's more centrist members. Here's a quick rundown of the two additions:

  • The MacArthur amendment: Introduced by centrist Rep. Tom MacArthur, the amendment would allow states to apply for waivers from the federal government to rescind some Obamacare regulations if they can prove it would reduce the costs for residents.

    The amendment, which was seen as a step toward a fuller repeal of Obamacare, was enough to win over the conservative House Freedom Caucus and flip as many as 20 votes to support the AHCA.

    The removal of one of the two regulations, community ratings, could result in some people with preexisting conditions being charged more for insurance and priced out of the market, experts say. That possibility drove some moderates away from the AHCA, leaving the bill seemingly short of the needed votes to pass it.
  • The Upton amendment: Introduced by Rep. Fred Upton, the amendment would allocate an additional $8 billion over five years to states that receive waivers for additional funding for their programs.

    While Upton said it was designed to help bring down costs for people with preexisting conditions, the amendment does not specify that the money must be used for them. Instead, it says the funds are to be used to "reduce premiums or other out-of-pocket costs of individuals who are subject to an increase in the monthly premium rate for health insurance coverage as a result of such waiver."

    Many health-policy analysts agree that the funding proposed by the amendment, in addition to the funds allocated in the original AHCA, likely wouldn't be enough to run a sustainable high-risk pool for Americans with preexisting conditions.

    Reps. Billy Long, Steve Knight, David Valadao, and Jeff Denham cosponsored the amendment. With those additions, it appears the GOP has a more comfortable path to passing the bill.

The current iteration of the AHCA does not have a score from the Congressional Budget Office, so it is unclear how the two major changes to the bill could affect the federal budget, Americans' insurance coverage, or long-term insurance premiums. Upton told reporters he wished he had the CBO score, but since it would take a few weeks to get, Republicans would forge on without it.

The lack of clarity has drawn extensive criticism from Democrats, including House Minority Leader Nancy Pelosi.

"Forcing a vote without a CBO score shows that Republicans are terrified of the public learning the full consequences of their plan to push Americans with preexisting conditions into the cold," Pelosi said.

Even with the additions, the legislation has also drawn the ire of a large swath of the major medical groups in the country, including the American Medical Association, the American Hospital Association, Blue Shield of California, AARP, and more.

Passage in the House would not guarantee smooth sailing for the AHCA in the Senate. The upper chamber is expected to make significant changes to the bill, as many GOP senators have expressed concern about various aspects of it. Some arcane chamber rules, such as the Byrd rule, may make passage difficult as well.

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Here are the major changes to the GOP healthcare bill

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The House of Representatives voted Thursday to pass the American Health Care Act, the GOP plan to repeal and replace Obamacare.

The first version of the AHCA was released in early March. But it has since undergone significant changes that could affect people with preexisting conditions as well as the millions with employer-based insurance.

The changes have seemingly brought together a large enough coalition of conservative and moderate holdouts from the original AHCA to push the bill over the finish line in the House.

While the Congressional Budget Office has not issued an analysis of the bill with the changes, healthy-policy experts have attempted to analyze some of its potential effects.

Here's what's different this time:

  • Invisible high-risk pools: These pools would operate similarly to the reinsurance policies established by Obamacare — officially the Affordable Care Act — which gave money to insurers to help lower premiums for the sickest people. In theory, this would help stabilize the individual insurance market for people without coverage through an employer or government program like Medicare.

    The bill would allocate $15 billion for the program over nine years, less than the $20 billion the Affordable Care Act did for a similar program.
  • The MacArthur amendment: Introduced by centrist Rep. Tom MacArthur, the amendment would allow states to apply for waivers from the federal government to rescind some Obamacare regulations if they can prove it would reduce the costs for residents. States could lower costs through things like high-risk pools or larger reinsurance programs.

    The amendment, which was seen as a step toward a fuller repeal of Obamacare, was enough to win over the conservative House Freedom Caucus and flip as many as 20 votes to support the AHCA.

    The removal one of the two regulations, community ratings, could result in some people with preexisting conditions being charged more for insurance and priced out of the market, experts say. That possibility drove some moderates away from the AHCA, leaving the bill seemingly short of the needed votes to pass it.

    There are concerns, however, that the waivers could have other unintended effects, such as gutting protections for employer-based coverage and ending funding for special-education programs at schools.
  • The Upton amendment: Introduced by Rep. Fred Upton, the amendment would allocate an additional $8 billion over five years to states that receive waivers for additional funding for their programs.

    While Upton said it was designed to help bring down costs for people with preexisting conditions, the amendment does not specify that the money must be used for them. Instead, it says the funds are to be used to "reduce premiums or other out-of-pocket costs of individuals who are subject to an increase in the monthly premium rate for health insurance coverage as a result of such waiver."

    Many health-policy analysts agree that the funding proposed by the amendment, in addition to the funds allocated in the original AHCA, likely wouldn't be enough to run a sustainable high-risk pool for Americans with preexisting conditions.

    Reps. Billy Long, Steve Knight, David Valadao, and Jeff Denham cosponsored the amendment. With those additions, it appears the GOP has a more comfortable path to passing the bill.

Here's a reminder of some of the key provisions of the AHCA:

  • Allow people with preexisting conditions to access coverage, but penalize lapses in coverage. Under the new law, insurers still could not deny coverage based on a preexisting condition, but anyone who did not have coverage for 63 days or more in the previous year would be subject to a 30% increase in premiums as a penalty. The idea is to discourage people from waiting until they are sick to access coverage.
  • Introduce block tax credits for people to access health insurance. Instead of the ACA's tax credits, which adjusted the amount based on a person's income and residence, the AHCA would give lump tax credits to Americans based on age. A person making over $75,000 or a household making over $150,000 a year would see a decrease in the credit depending on the amount made over that.

    Here's how much each age group would get:
    • Under 30: $2,000 a year
    • 30 to 39: $2,500 a year
    • 40 to 49: $3,000 a year
    • 50 to 59: $3,500 a year
    • 60 and above: $4,000 a year
  • Provide grants to establish high-risk pools and encourage enrollment. The AHCA would include a fund for states to institute programs to stabilize the insurance market, most notably "the provision of financial assistance to high-risk individuals who do not have access to health insurance coverage offered through an employer." This would allow states to establish high-risk pools for people with preexisting conditions.

    The plan would give states $15 billion in both 2018 and 2019 and $10 billion every year after that through 2026.

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Here's what doctors and patient advocates think about the Republican healthcare bill

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The Obamacare replacement plan is headed for a vote in the House on Thursday afternoon.

That's after some changes have been made to the American Health Care Act, the bill that aims to repeal and replace the Affordable Care Act.

The bill now includes a new addition called the MacArthur amendment. The amendment would allow states to receive waivers to avoid some of the regulations set up under the ACA.

And on Wednesday, Rep. Fred Upton introduced an amendment that allowed for $8 billion in funding to protect people who are sick in the case that those waivers are triggered.

The two amendments have led to dozens of patient-advocacy groups and physician groups to speak out.

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10 patient-advocacy groups —"There is no substitute for fundamental, unequivocal protections for people with pre-existing conditions."

On Wednesday, in response to Upton's amendment to the bill, 10 patient groups sent a release stating their opposition to the new amendment and the bill as a whole:

"Despite the Upton amendment, we remain strongly opposed to the American Health Care Act and urge Congress to consider the people at the heart of this decision," the groups said in a statement. "The various patchwork solutions offered by lawmakers would still leave the millions of patients we represent, who have serious and chronic health conditions, at risk of not being able to access life-saving treatments and care."

"There is no substitute for fundamental, unequivocal protections for people with pre-existing conditions."

The groups included the American Cancer Society Cancer Action Network, the American Heart Association, the American Lung Association, the American Diabetes Association, the Cystic Fibrosis Foundation, March of Dimes, the National Organization for Rare Disorders, the National MS Society, and WomenHeart: The National Coalition for Women with Heart Disease.



American Academy of Pediatrics — "The current version makes an already bad bill even worse for children and families."

The organization, which represents 66,000 pediatricians, originally cited changes to the Medicaid program as the reason why it couldn't support the bill.

"As Congress began considering changes to the ACA and Medicaid, the message from America’s pediatricians was clear: any changes to the ACA cannot erode the progress we have made in reducing child uninsurance. Unfortunately, the AHCA does not meet this test and the AAP opposes it as currently drafted,"the AAP wrote in a letter in March.

On May 1, the organization reiterated its position.

"Pediatricians have been voicing our opposition to the AHCA since it was initially introduced, and the current version makes an already bad bill even worse for children and families,"the AAP said in a statement.

The AAP was also one of six physician groups that sent a letter to Congress in April opposing the bill, along with the American Academy of Family Physicians, the American College of Physicians, the American Congress of Obstetricians and Gynecologists, the American Osteopathic Association, and the American Psychiatric Association.



American Medical Association — "Nothing in the MacArthur amendment remedies the shortcomings of the underlying bill."

The biggest group of doctors in the US doubled down on its opposition to the AHCA.

"We are deeply concerned that the AHCA would result in millions of Americans losing their current health insurance coverage. Nothing in the MacArthur amendment remedies the shortcomings of the underlying bill," the AMA said in a letter to Congress on Thursday.

The organization previously said it wouldn't support the bill's plans to roll back Medicaid expansion or the repeal of the Prevention and Public Health Fund, which helps fund the Centers for Disease Control and Prevention.

Regarding the new amendment, the AMA's concerns centered around individuals who have preexisting conditions, who might find their healthcare coverage unaffordable.

Here's the full letter.



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